Myocarditis after COVID-19 vaccination

Antoine Lété (1), Stella Marchetta (2), Julien Djekic (3), Thierry Couvreur (3), Philippe Evrard (2), Bruno Raskinet (2), Olivier Gach (2) Published in the journal : April 2023 Category : Clinical Report

Myocarditis reactive to the COVID-19 vaccine has progressively been observed during the massive vaccination campaign among the population. It usually follows the second dose, occurs within 5 days of vaccine administration, and affects more often young men. The incidence is rare, clinical presentation usually benign, and the evolution is generally uncomplicated, without long term sequelae. Moreover, mortality is rate extremely low. Although the physio-pathological mechanisms implicated are not fully elucidated to date, several hypotheses have been put forward. Finally, the low risk of post-vaccination myocarditis must be weighed against the undeniable public health benefits of the vaccine compared to the risks of severe complications inherent to COVID-19 infection itself.

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Withdrawal of nutrition and hydration at the end of life

Thibaud De Blauwe (1), Michèle Pieterbourg (2) Published in the journal : April 2023 Category : Geriatry

Discontinuing nutrition and hydration at the end of life can be a difficult decision for both caregivers and families. It is a process with an enormous symbolic significance value, involving high emotional and affective charge. There is a lack of knowledge among healthcare teams about the pathophysiology of stopping nutrition and hydration, creating a fear of “starving or dehydrating” the patient. The understanding of the pathophysiological mechanisms and symptoms related to prolonged fasting were acquired thanks to the American and British experiences during the Second World War. Therefore, we are able to explain this process to families or teams in pain to try to alleviate their apprehension regarding the situation. The present work attempts to summarize these issues in order to provide caregivers with avenues to anticipate their questions and those of the patients’ families regarding nutrition and hydration withdrawal in the advanced palliative situation.


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Reducing the carbon footprint of hospitals: anesthesia services and operating rooms as examples

Pierre Lepoivre (1), Natalia Magasich-Airola (2) Published in the journal : April 2023 Category : Médecine et société

Human-induced climate change is threatening basic needs, living conditions and development of future generations. The health system itself is a substantial contributor to global warming, either directly through greenhouse anesthetic gas emissions or indirectly by high consumption of energy and single-use medical devices, and the generation of large quantities of waste. The present narrative literature review briefly synthesizes updated major data on the negative environmental impact of energy-intensive operating room activities. More positively, the review recapitulates some of the most recent initiatives, successfully implemented to reduce the carbon footprint and pollution associated with anesthesia and surgery departments, following the 5Rs rule: reduce, recycle, reuse, rethink and research.

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Radiation-Induced Breast Angiosarcoma

Charlotte Charlier (1), Stanislas Laurent (2) Published in the journal : April 2023 Category : Clinical Report

Breast angiosarcoma is a rare primary or secondary endothelial tumour. Optimal management differs according to the etiology.

The authors illustrate the diagnostic and therapeutic complexity of this type of cancer, based on two clinical cases. A recent review article sheds light on the management of this pathology.

The two types of angiosarcomas have different macroscopic appearances. An anatomopathological analysis enables a real diagnosis of this tumour, as do the immunohistological markers such as c-Myc and FLT4, which allow to differentiate between a primary or secondary angiosarcoma. (1)

Imaging tests such as ultrasound, mammography and (magnetic resonance imaging) MRI are not specific but can detect distant metastases and make the differential diagnosis with breast cancer recurrence. (2)

The specificity of post-radiation angiosarcoma surgical treatment lies in the width of the procedure. It is imperative to resect the entire irradiated skin area. Primary angiosarcoma, on the other hand, should be resected with a margin of 1cm to 2cm for tumours which are ≤ 5cm in diameter. (3) Indeed, the irradiated bed is the breeding ground for subsequent recurrence.

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Male Perpetrators of Domestic Violence. Qualitative Study on the Experience of Belgian General Practitioners in their Care

Antoine Chaumont (1), Yasmin Abid (2), Ségolène de Rouffignac (2) Published in the journal : April 2023 Category : Médecine Générale

Despite the prevalence of domestic violence (DV) in Belgium, few studies have examined the role of general medicine practice in the management of perpetrators of DV. What is the experience of Belgian general practitioners in the management of male perpetrators of domestic violence?
A qualitative study examined the history of Belgian general practitioners in the supervision of men who commit domestic violence. Through a snowball sampling and individual semi-directed interviews, we were able to collect information from five general practitioners. The heterogeneity of profiles in terms of gender, age, years of experience, type, and location of practice was preferred to obtain a rich and diversified sample. These five interviews were marked out by an interview guide and then strictly transcribed.
Three main themes related to the physicians' experience were identified: [1] by what means do the physicians identify male perpetrators of violence against women (VAW) and how can they be considered as patients? Their identification is mostly made by the female victims. There is little self-identification by the perpetrators of VAW. This is a victim-centered approach. The importance of the therapeutic relationship with the male perpetrators of violence is emphasized. [2] The second theme highlights a generalized taboo among respondents towards male perpetrators of sexual violence, which has an impact on their treatment. It proposes communication and verbalization in order to include [3] general medicine in a network- centered system on the male perpetrators of violence. This system is necessary to provide support and adequate multidisciplinary management of male perpetrators of domestic abuse.
There is a general taboo around male perpetrators of DV. General medicine practice contributes to this taboo. There is a lack of responsibility on the part of general practitioners, leading to a poor care for male perpetrators of domestic abuse. A network system is essential for their appropriate management. Further studies are needed to evaluate the role of the front liners in preventing domestic violence.

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A 360-degree overview of the effects of alcohol consumption

Pauline Gérard, Thomas Calozet, Léo Moreau, Audrey Bonnelance, Thomas Orban Published in the journal : March 2023 Category : Médecine Générale

Report of the RESUMES symposium of 21/01/2023

This article summarizes the most relevant messages shared during the annual RESUMES asbl (Multidisciplinary Network for Scientific Exchange) symposium on alcohol consumption. This theme was addressed through 12 disciplines, such as gastroenterology, gynecology, internal medicine, general medicine, etc.

Considering that at least 25% of the population consumes alcohol in a risky or even excessive way, each health professional is regularly confronted with the consequences of alcohol consumption, which this article attempts to review in its multiple dimensions and in a practical way.

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Finerenone: Towards better cardio- vascular and renal protection in chronic kidney disease associated with type 2 diabetes

Johann Morelle, Nathalie Demoulin, Michel Jadoul Published in the journal : March 2023 Category : Actualité thérapeutique

The kidney is undoubtedly a major target for microvascular damage in diabetes, and approximately half of patients with type 2 diabetes develop chronic kidney disease. The presence of chronic kidney disease increases the risk of death, cardiovascular events, and progression to kidney failure, which may require dialysis or transplantation. For diabetic patients, these complications obviously have a major impact, both on their outcomes and quality of life.

Reimbursed in Belgium since February 1, 2023, finerenone (Kerendia®, Bayer) is a novel non-steroidal mineralocorticoid receptor antagonist that has recently been shown to be effective in preventing cardiovascular events and the progression of chronic kidney disease in type 2 diabetes patients.

This review summarizes the current state of knowledge and provides clinicians with the necessary tools to prescribe finerenone to patients at high cardiovascular and renal risk, who require holistic and multidisciplinary management.

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Some novelties in the 2021 recommendations for the management of dyslipidemia in cardiovascular prevention

Olivier S. Descamps (1), Fabian Demeure (2), Ann Mertens (3), Ann Verhaegen (4), Michel Langlois (5), Caroline Wallemacq (6), Ernst Rietzschel (7) au nom du Belgian Atherosclerosis Society/Belgian Lipid Club Published in the journal : March 2023 Category : Actualité thérapeutique

In terms of treatment decision-making for dyslipidemia, the new 2021 European recommendations for the prevention of atherosclerotic cardiovascular diseases provide some nuances compared to the previous 2019 recommendations. These nuances notably concern the use of a new primary prevention risk assessment based on more recent epidemiological data and some changes in risk classification: the SCORE2. Changes include the use of non-HDL cholesterol rather than total cholesterol to estimate the risk, as well as a risk expressed as morbi-mortality rather than mortality alone as previously. Changes in risk thresholds to categorize patients as being at “very high”, “high”, or “low-to-moderate” risk also better identify younger patients who may benefit from cardiovascular prevention early enough to avoid cardiovascular problems that may occur in their 50s or 60s. Conversely, in elderly patients, the cardiovascular risk classification has been revised upwards so as not to treat these more drug-sensitive patients aggressively. The recommendations are also timely to better define the use of new molecules that have been introduced in Belgium during the year 2022.

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Gonarthrosis in obese patients: practical recommendations

Barbora Bocankova, Stéphanie Meirlaen, Emmanuel Thienpont Published in the journal : March 2023 Category : Orthopédie et Traumatologie

Obesity prevalence is rapidly growing and becoming a critical health issue, especially in developed countries. Obesity and life expectancy increase are the main reasons for the rising incidence of osteoarthritis (OA). Obese patients greatly benefit from surgical OA treatment and should therefore not be denied any intervention, including knee arthroplasty, regardless of their body mass index.

Conservative measures, such as lifestyle modification, exercise, and pharmacological treatment with systematic slow-acting drugs for OA (SYSADOA) like glucosamine sulphate, chondroitine sulphate or curcumine, topical or oral non-steroidal anti-inflammatory drugs, and intra-articular steroids or hyaluronic acid injections should be tried before resorting to knee surgery. Minimally invasive knee prosthesis, respecting soft tissue as much as possible, might be particularly beneficial for obese patients, reducing complication rates and improving outcome. However, further studies are needed to confirm this trend.

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Hallux valgus: What to tell the patient in the first line?

Maxime Fasseaux, Olivier Cornu, Dan Putineanu, Karim Tribak Published in the journal : March 2023 Category : Orthopédie et Traumatologie

Hallux valgus is the most common disease of the forefoot. Its etiology remains unclear, but is influenced by genetics. This condition can cause incapacitating and even disabling problems. It can have several presentations, the clinical and radiological severity of which will guide the treatment.

The level of evidence regarding first-line management remains poor. This article aims to explore the conservative treatment possibilities and their limits, and attempts to provide answers to the questions most frequently asked by patients.

Patients with mild to moderate hallux valgus, or severe hallux valgus, can have their pain relieved without surgical management. It is not yet established that conservative treatment can actually slow down disease progression, but future studies could explore this possibility.

Conservative treatment is based on adapting the footwear, wearing insoles or orthoses, physiotherapy, level I analgesics, as well as lifestyle and dietary adaptations.

In patients who do not respond to conservative treatment and have significant deformity, surgical treatment can be proposed. This treatment yields a satisfaction rate of approximately 80%

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