The 2020 annual meeting of the American Society of Hematology (ASH) provided us with several contributions to the field of hematopoietic stem cell transplantation (HSCT). Post-transplant cyclophosphamide (PTCy) occupied a prominent place on the stage. This modality of graft-versus-host disease (GvHD) prophylaxis, which was initially developed in the haploidentical HSCT setting, was associated with major benefits so that its use tended to spread across other donor types. PTCy appears to be particularly invested with the benefit of improving outcomes in HSCT from mismatched unrelated donors (MMUD). This appears to be of great usefulness for patients from underserved ethnicities that lack a matched donor. Likewise, management of chronic graft-versus-host disease (cGvHD) had its share of improvement with the result presentation of the REACH3 study. Notably, in this study, ruxolitinib was compared to the best available therapy. The approach of reduced intensity conditioning (RIC) for myeloid malignancies similarly received some attention with a boost to supporting its use for higher-risk myelodysplastic syndrome (MDS), including the elderly. Finally, we present a Phase 1 study, which was designed to improve its efficacy in high-risk myeloid malignancies by adding venetoclax .
Jelena Hubrechts, Madeline Barbier, Coralie De Bruyne, Sylvie Lommaert, Mieke Roggen, Laetitia Vanhoutte, Christophe Vô, Stéphane MoniottePublished in the journal : February 2021Category : Cardiologie pédiatrique
Despite the worldwide health crisis, different advances were made in pediatric cardiology in 2020. This paper discusses six different topics, the first being related to the ongoing pandemic and the last one being a review of the last two decades’ advances made in this field.
During the SARS-CoV-2 pandemic, an unexpected high number of children were admitted, presenting with Kawasaki disease and coronary dilatation. Moreover, in 2021, a new clinical entity arose, which is referred to as multisystem inflammatory syndrome, which was temporarily associated to COVID-19 (MIS-C).This new clinical condition shared similarities with atypical Kawasaki disease, even though the patients’ median age tended to be higher, while a significant left ventricular dysfunction was mostly the prominent cardiac feature at the time of diagnosis. Treatment guidelines of Kawasaki disease were reviewed in the light of this recent outbreak of patients presenting with MIS-C.
Other topics that have been addressed in this paper are the routine use of angiotensin-converting enzyme inhibitors (ACEI) in patients with single ventricle, as well as that of pulmonary artery banding in infants and children with end-stage dilated cardiomyopathy, in addition to cardiac resynchronization therapy. Lastly, the use of physical exercise in Fontan patients has been discussed before ending with an historical overview of the major advances made in congenital heart disease.
These new European Society of Cardiology guidelines concern the management of patients with acute coronary syndrome presenting without persistent ST-segment elevation. The central role of performing an electrocardiogram and troponin assessment in the initial diagnosis is highlighted. A rapid use of high-sensitive troponin schema for ruling out acute myocardial infarction enables us to safely discharge patients without any acute syndrome. Performing fast troponin assessments within 2 hours or 24 hours of admission allows to screen patients for coronary angiography and percutaneous revascularization. Following coronary artery stent placement, anti-platelet or anticoagulant regimens should be carefully chosen so as to balance the bleeding risk against the ischemic or thrombotic risk. The different protocols are reviewed herein according to the patients’ clinical situation. Lastly, the comprehensive treatment of patients is presented.
Barbara Gauchet (1), Véronique Gerard (2), Hadrien Fourneau (3)Published in the journal : January 2021Category : Emergency
We present the case report of a 28-year-old man admitted to the emergency department for acute hepatitis due to nasal cocaine use. Cocaine abuse is associated with a variety of acute medical complications. Acute hepatitis without other systemic disorders is a rare condition that may occur following cocaine use.
Based on a systematic review of the literature, this report seeks to discuss the clinical, biological, and histopathological features of this disease and its evolution, too. The clinical practice guidelines for managing acute hepatitis due to cocaine use will be discussed, as well.
This case provides us the opportunity to remember and explore the differential diagnosis of acute hepatitis and the usefulness of a precise anamnesis.
Marie Cuvelier (1*), Josette André (2), Didier Bessis (3), Pierre-Paul Roquet-Gravy (1), Audrey Bulinckx (1)Published in the journal : January 2021Category : Dermatology
PENS hamartoma or “papular epidermal nevus with "skyline" basal cell layer” is a congenital epidermal hamartoma, which is characterized by specific histopathological features. We report a diagnosis of PENS hamartoma that was made in an 18-month-old girl.
Initially described by Torrelo et al. in 2011 (1), PENS hamartoma exhibits particular clinical features consisting of coalescent, verrucous, and light brown polygonal papules (2). The diagnosis is confirmed by histological examination, which, in the majority of cases, shows an alignment of epidermal basal cells and palissadic disposition of nuclei evoking a "skyline". In 2012, the term PENS Syndrome was retained, owing to new clinical descriptions associating light neurological abnormalities with these cutaneous lesions (2). PENS syndrome is a rare neuro-cutaneous syndrome, which involves one or more congenital epidermal hamartomas of PENS type, as well as non-specific neurological abnormalities (1-3). Neurological manifestations begin to occur during the first two years of life (1). A review of the literature identified 27 reported cases of PENS hamartomas (1-12), including some familial cases and other cases associated with neurological abnormalities (PENS syndrome). The physiopathology of PENS hamartoma and PENS syndrome remains unclear, whereas several hypotheses have been advanced (7).
Moïra Poncelet (1), Catherine Lambert (2), Pierre Bernard (1)Published in the journal : January 2021Category : Obstétrique
Autoimmune hemolytic anemia, specifically during pregnancy, is an uncommon hematological disorder, which causes premature destruction of red blood cells. While it may be idiopathic, this disorder may also be secondary to an underlying condition. Whatever its etiology, this disease is associated with high maternal, fetal, and neonatal morbidity, which is due to the transplacental passage of immunoglobulins G (IgG). This highlights the usefulness of diagnosing and managing this pathology, which is a real challenge, given the lack of codified recommendations published in the literature.
Hélène Legrand (1), Nathalie Godefroid (2), Axel Feyaerts (3), Stéphane Thiry (3), David Tuerlinckx (4)Published in the journal : January 2021Category : Pediatrics
Antenatal hydronephrosis is the most common congenital abnormality. The post-natal management is, however, still controversial, specifically concerning further testing, as well as and benefit of antibiotic prophylaxis. The systematic indication of performing a voiding cystourethrogram for vesicoureteral reflux screening and of prescribing antibiotic prophylaxis for preventing urinary tract infections has been increasingly questioned by recent study data. A less aggressive approach is discussed here, which is essentially based on post-natal ultrasound findings.
We herein propose an algorithm that is based on these study data.
Isabelle Aujoulat (1), Bénédicte Scheen (1), Kirsten Vanderplanken (2), Stephan Van den Broucke (3), Joris van Loenhout (2)Published in the journal : January 2021Category : Santé publique
Since the first case of COVID-19 was detected in December 2019, the world has experienced a pandemic of unprecedented proportions. While the development of vaccines against the disease became high priority, many countries were trying to reduce the impact and the burden on healthcare systems by implementing infection prevention and control measures. These measures are flexible, and can be adapted based on the severity of the outbreak that a country is experiencing at a given moment in time. However, the effectiveness of such measures is for a large part determined by the ability and willingness of the population to adhere to them. For Belgium, which has experienced a high infection rate over the year, there was no clear insight in overall adherence to the measures, reasons for (non)adherence, and subgroups of the population that are less likely to adhere.
This article presents the results of a panel-based internet survey, that addressed a sample of respondents (n=2.008), representative for the adult Belgian population in terms of age, sex, region and socio-economic status. The questionnaire was developed by researchers with backgrounds in social sciences, epidemiology, health promotion and psychology. It was guided by the Protection Motivation Theory. Data were collected in September 2020. The detailed methodological design and results may be consulted through the following link: https://dial.uclouvain.be/pr/boreal/object/boreal:241832.
Martin Buysschaert, Vanessa Preumont, Dominique MaiterPublished in the journal : January 2021Category : Diabétologie
The aim of this paper is to propose a current state of the art in the field of insulin treatment. We describe human insulin and analogs available in Belgium, as well as the current recommendations in terms of insulin strategies in type 1 and type 2 diabetes.
Nathalie Lannoy, Cédric HermansPublished in the journal : November 2020Category : Prix Nobel
The 2020 Nobel Prize in chemistry was jointly awarded to two geneticists Emmanuelle Charpentier and Jennifer Doudna for their having developed the "Crispr-Cas9 molecular scissors". This real innovation pertaining to the molecular biology field is principally able to easily, quickly, and inexpensively edit the genome of any cell. Its use in all fields of life allows for scientific, medical, agronomic, and industrial applications both for better and worse.