Mohammad F Pirbuccus, Elliott Van Regemorter, Michel Jadoul, Nathalie DemoulinPublished in the journal : October 2024Category : Nephrology
Despite being a major public health problem, chronic kidney disease is often underdiagnosed. Measurement of glomerular filtration rate and albuminuria should be offered regularly to patients with comorbidities such as diabetes, hypertension, and/or cardiovascular disease. Early diagnosis of chronic kidney disease is essential for optimal management, especially given the availability of new therapies aimed at reducing the risk of progression and the occurrence of cardiovascular complications.
Véronique Deneys (1,3), Christine Pirlet (1), Jean Stoefs (2), Youssra Khaouch (1), Edith Rubin Winkler (3), Corentin Streel (1)Published in the journal : October 2024Category : Banque de sang
Patient identification is an essential step in hospital risk management and a key factor in transfusion safety. When taking a blood sample, the probability of mistaking a person’s identity is estimated at around 1/2,000. This can lead to diagnostic errors and/or inappropriate therapeutic patient management. In addition, the impact in terms of transfusion safety is major because mistaken identity can lead to ABO incompatibility, which can be fatal, as will be explained below. The causes of identitovigilance errors are diverse, but human factors are predominant. As part of the risk management process, various measures can be implemented to reduce the risk of WBIT (Wrong Blood in Tube): determining a patient’s blood group using two samples taken at different times plays a very important role. Staff training, adherence to procedures, and incident analysis are also essential and valuable tools. Finally, patient involvement in the safety of their care must become a “standard of care”.
Florence Fares (1), Nancy Laval (1), Jana Assy (2), André Mulder (3)Published in the journal : October 2024Category : Neonatology
Congenital nephrotic syndrome (CNS) is a rare and severe disorder that manifests in utero or during the first 3 months of life and is amenable to prenatal diagnosis. We report a case of CNS of the Finnish-type, the most common form of the disease, in a Lebanese newborn admitted to the neonatal intensive care unit for generalized edema. The diagnosis was confirmed by the presence of two compound heterozygous mutations in the NPHS1 gene. Despite optimal conservative treatment, the course of the disease was characterized by numerous complications resulting from massive protein loss. This case report illustrates the complexity of managing severe forms of CNS, especially in the neonatal period. We discuss its diagnostic, evolutionary, and therapeutic aspects, as well as the importance of genetic testing.
Emmanuelle Henry (1), Pierre-Michel François (2)Published in the journal : October 2024Category : Anesthesiology
Airway management is a top priority for the anesthesiologist and, more broadly, for all medical personnel involved in acute care. The anesthesiologist is accustomed to airway management on a day-to-day basis, with all the resources at his or her disposal. However, the use of cricotomy is the last option in the airway management algorithm, and when necessary, cricotomy is often delayed or not performed due to a certain denial or even stupefaction of the operator.
This study sought to demystify cricotomy and demonstrate the benefits of simulation.
In this prospective study, we compared two heterogeneous groups in terms of medical training (anesthesia assistants and military paramedics) in order to highlight the simplicity of the gesture. Two simulation sessions were conducted in each group, and the results showed that simulation allows rapid learning of this technique and produces good results, with good retention of skills in the medium term.
A survey of anesthesia trainees also revealed significant benefits after a single simulation session such as this one.
The author explains what the deaths in his geriatric ward have taught him. It is about mental hygiene and the means to accompany these patients at the end of life. Listening, talking, being there for them in order to better care for the living.
Julie Wénin (1), Frédéric Evrard (2), Jean-Marc Raymackers (2)Published in the journal : October 2024Category : Neurology
Ischemic stroke is the first, second, and third most common cause of disability, dementia, and death, respectively. The introduction of intravenous thrombolytic treatment (IVT) and endovascular treatment (EVT) led to substantial functional prognosis improvements in patients. These treatments have radically modified the initial management of stroke. Even though the faster the better, later IVT may improve outcomes in selected patients by extending the treatment window to 9 hours after onset. These patients are selected by means of brain perfusion imaging. According to perfusion parameters, patients can be eligible for EVT until 24 hours after symptoms onset. At the same time, indications for IVT have been expanded and contraindications reduced. More patients can see their prognosis improved.
In this article, we report on the “PEAU’se dermatologique” meeting held at the Cliniques universitaires Saint-Luc, dedicated to allergic contact dermatitis (ACD). Professor Anne Herman reminded us of the main contact allergens involved, depending on skin location.
ACD, which affects approximately 25% of the general population, is an acquired immunological disorder resulting from exposure to sensitizing substances (contact allergens) in previously exposed and sensitized individuals. The article describes the various allergological tests available, in particular patch tests, repeated open application test (ROAT), and glove repeated application test (GRAT), specifying their indications and procedures.
The article reviews different clinical topographies frequently encountered in consultations (eczema of the hands, feet, eyelids, and lips) and identifies the most frequently implicated allergens for each. The specificities of ACD in children are also discussed, as well as the emergence of new allergens.
Julie Godefroi (1), Patricia Steenhaut (2), Matthieu Ortegat (3)Published in the journal : October 2024Category : Obstétrique
Maternal thrombocytopenia (<150,000 platelets/µL) occurs in 5 to 10% of pregnancies. Differential diagnosis can be difficult, but it is essential to offer appropriate antenatal monitoring and treatment. Indeed, thrombocytopenia during pregnancy can lead to maternal, fetal, and neonatal complications.
After ruling out pseudothrombocytopenia, a distinction is made between isolated thrombocytopenia (gestational thrombocytopenia and immune thrombocytopenic purpura) and thrombocytopenia associated with hemolytic anemia (pre-eclampsia, HELLP syndrome and microangiopathies). In this article, we will describe these different pathologies in detail and offer diagnostic keys, before outlining current knowledge regarding treatment, antenatal monitoring, delivery, as well as neonatal period and post-partum periods.
An algorithm to facilitate the differential diagnosis of thrombocytopenia in pregnant women is proposed at the end of this article.
Olivier S. Descamps1*, Fabian Demeure (2), Ann Mertens (3), Ann Verhaegen (4), Michel Langlois (5), Caroline Wallemacq (6), Ernst Rietzschel (7). On behalf of the Belgian Society of Atherosclerosis.Published in the journal : September 2024Category : Internal Medicine
In this article, we propose an update of the recommendations concerning lipid-lowering treatment in cardiovascular prevention. Since the 2021 publication, new risk estimation and medication selection tools have been developed. Notable advances in risk assessment include the development of a specific score for Type 2 diabetic patients, and the promotion of lipoprotein(a) measurement, which brings a significant nuance to cardiovascular risk. Regarding new drugs, we have benefited from the arrival of bempedoic acid since 2022 in Belgium, which belongs to a new therapeutic class, and inclisiran, which has been added to the therapeutic class of treatments targeting PCSK9, as well as the extension of reimbursement conditions for evolocumab. We felt that this update was necessary, given the importance of these new developments in our daily cardiovascular prevention practice.
As one of the objectives of the Belgian Plan for Rare Diseases and aimed at quality management in the officially designated Belgian Centers for Medical Genetics (CMGs), the Belgian Genetic Testing Database (BGTD) is intended to be a single entry point for the centralized registration of genetic tests, providing relevant, uniform, detailed, and quality-related information, while ensuring traceability. Its implementation should enable healthcare providers to better guide patients to appropriate genetic testing, optimize data exchange with external resources such as Orphanet, promote uniform reporting to government healthcare organizations, and increase the visibility of Belgian clinical genetics expertise.
The BGTD is a web application based on open source software (https://gentest.healthdata.be/) and currently comprises 854 molecular genetic tests linked to general and supplementary information.
The data is validated at least annually by the CMGs and continuously by Sciensano, which hosts and maintains the database.
