Spontaneous pneumothorax in a pregnant woman : difficulty of diagnosis and treatment

Natacha De Decker (1), Pol Vincent (1), Thierry Castelain (2), Paula Blaj (2), Pascale Grandjean (3), Sophie Gilles (3), Tudor Azoicai (1) Published in the journal : December 2022 Category : Clinical Report

Spontaneous pneumothorax is a frequent cause of admission to emergency departments. Its etiology and lethal potential if not diagnosed are well known. However, there are less common etiologies of this condition. The diagnosis can then be tricky, especially since the symptoms may be equivocal. This is the case of spontaneous pneumothorax in pregnant women with no risk factors, in whom the symptoms may mimic those observed during the last trimester of pregnancy.

In this context, we wish to report a case of spontaneous pneumothorax in a 32-week pregnant wo-man, without any known risk factor. We also propose a literature review on this subject.

Our analysis highlights that spontaneous pneumothorax in pregnant women is a rare condition whose diagnosis may be overlooked, given the clinical manifestations that may be confused with physiological phenomena of the last trimester of pregnancy.

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Recognizing, understanding, and treating angioedema in the emergency room

Cédric Hermans (1), Emilie Delloye (2), Françoise Pirson (3,4,5) Published in the journal : December 2022 Category : Urgence/Allergologie - Immunologie/Hématologie

Angioedema, whether related to histamine release or excessive bradykinin, is a common reason for admission to the emergency department. This condition is a potentially serious and even fatal condition. Its diagnostic and therapeutic management can be difficult. This article details the practical management of angioedema in the emergency room, particularly its bradykinic form, as well as the modalities and objectives of the specialized allergology assessment, which is frequently indicated. Finally, this article gives a special look at hereditary angioedema, a rare disease justifying a specialized therapeutic management, which has recently been revolutionized by the advent of new and very promising molecules.

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Primary care medicine in the management of the SARS-CoV-2 pandemic: international perspectives

Published in the journal : December 2022 Category : Médecine Générale

Why such a symposium?

In the winter of 2021, when the beginnings of a possible way out of the Covid-19 crisis were appearing, many of us made the same observation: primary care medicine, that is medicine that goes from individual or group medical practices to large urban policlinics and nursing homes, has certainly played an important role in the management of the pandemic, but its potential has been insufficiently exploited, particularly by the authorities in charge of public decisions. This observation has been confirmed by international bodies such as the WHO and the OECD. We therefore felt that it would be interesting to take our heads off the wheel, to distance ourselves from all of our activities deployed during the pandemic (care, screening, vaccination, etc.) and to organize an exchange of experiences in order to build a body of knowledge and propose recommendations in four countries: Belgium, Canada, France and Switzerland. The commonalities shared by these four countries, whether at the historical (thank you Napoleon!), linguistic, cultural, societal, academic and of course health system levels (universal coverage, private and/or public insurers, among others), facilitate such an exchange dynamic.

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COVID-19, cardiovascular manifestations, and competitive sport in the pediatric population

Jelena Hubrechts¹, Stéphane Moniotte¹ Published in the journal : December 2022 Category : Pediatrics

Since 2019, the SARS-CoV-2 has been associated with the occurrence of myocarditis. Moreover, specifically in the pediatric population, this virus can cause an exaggerated inflammatory response several weeks after the acute infection. This new entity is called “multisystem inflammatory syndrome in children” (MIS-C). Cardiovascular involvement is very common in this syndrome, particularly in the form of ventricular dysfunction with increased cardiac enzymes. As myocardial damage is one of the causes of sudden cardiac death in young athletes, resumption of sporting activities must be undertaken with caution. Depending on initial symptoms, a focused history taking and meticulous physical examination may be sufficient to permit resumption of sports after the legal duration of quarantine in case of simple COVID-19 infection. In other cases, the patient should be referred to a pediatric cardiologist for a more comprehensive workup. For patients with MIS-C, sport remains contraindicated for a period of 3 to 6 months. Sport should in any case be resumed gradually, with the patient, his parents, and trainers being made aware of the possible appearance of cardiorespiratory symptoms.

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Fulminant hepatitis complicated by a reactive hemophagocytic syndrome in an immunocompetent patient: two rare manifestations of Herpes simplex virus 1 infection.

Sarah Brilot (1), Esther Calvo Lasso De La Vega (2), Christian Michaux (2), Leïla Belkhir (1), Lucie Pothen (1) Published in the journal : December 2022 Category : Clinical Report

Fulminant hepatitis is a rare and fatal complication of Herpes simplex virus 1 (HSV1) infection, which can affect both immunocompetent and immunodeficient adults. The diagnosis is often delayed due to the rapid evolution of the infection, hence the importance of initiating rapid treatment with aciclovir. We report the case of a 36-year-old patient with no medical history who consulted for sudden asthenia after two days of fever and myalgia. The initial laboratory workup revealed hepatic cytolysis and bicytopenia (thrombocytopenia and leukopenia). The evolution was rapidly unfavorable, with the development of acute hepatic failure and a reactive hemophagocytic syndrome. The etiological workup then revealed an HSV1 infection. Treatment with aciclovir resulted in clinical and biological improvement, and the patient fully recovered.

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SCORE 2: a new model to estimate total cardiovascular risk

Guy De Backer (1), Fabian Demeure (2), Olivier Descamps (3), Dirk De Bacquer (1) Published in the journal : October 2022 Category : Cardiology

Primary prevention of cardiovascular disease (CVD) is actually needed, though poorly implemented as yet. The choice of the most optimal preventive strategy depends on the total cardiovascular (CV) risk of a given person. Several models have been developed to estimate total CV risk. Until recently, the SCORE model, calibrated for Belgium (SCORE-Belgium), has been recommended for that purpose.

A new model has now been developed and validated (SCORE 2), with certain advantages. Four systems have been advocated, and the ‘SCORE 2 low-risk’ system has been recommended for implementation in Belgium. This easy-to-use model allows for the stratification of the apparently healthy adult population into subgroups at low-to-moderate, high, and very-high total CV risk, so that preventive strategies can then be adapted accordingly. A recalibration of this ‘SCORE 2 low-risk’ model for Belgium seems unnecessary. The international model likely underestimates slightly the total CV risk in the population, which is in accordance with the position of Belgium as one of the countries with the highest CV mortality rates among the 10 countries considered being at ‘low CV risk’. Indeed, this only marginal difference does not justify a recalibration of the international model.

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Bariatric surgery, from dream to reality: How do patients experience obesity management based on bariatric surgery?

Charline Bronchain (1), Thérèse Leroy (2), Ségolène de Rouffignac (3) Published in the journal : October 2022 Category : Médecine Générale

Due to the increasing prevalence of obesity, bariatric surgery has become an effective treatment option, resulting in a significant weight loss and reduction in associated comorbidities. Nevertheless, this procedure is an invasive therapeutic act, inducing rapid physical and psychological changes and requiring serious post-operative discipline. Seven patients who had undergone bariatric surgery were interviewed via individual semi-structured interviews. These were aimed to better understand their experiences and clarify the role that the general practitioner could play in managing obesity through bariatric surgery. The qualitative analysis of the testimonies reveals different emotional phases that patients may go through once the surgical process has been performed. The general practitioner (GP), present on the front line, exerts a crucial role in accompanying the patients through the associated changes and identifying the early signs of psychological suffering, provided that the GP is continuously attentive to the patient’s emotional evolution. In addition, the GP could be a relay contact concerning the help that is available by informing the patient about it.

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Thrombosis and haemostasis in women

Cédric Hermans, Catherine Lambert Published in the journal : October 2022 Category : Résumés des webinaires

Coagulation disorders, both thrombotic and haemorrhagic, affect many women throughout their lives. We provide a summary of a Webinar on the risks of thrombosis favoured by hormonal treatments, the relevance of thrombophilic assessments and finally the diagnosis and management of haemorrhagic diseases, the presence of which should be suspected in any woman presenting unusual haemorrhages, particularly from haematological reasons.

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Antiphospholipid syndrome, an unrecognized cause of multiple and varied thrombotic events

Camille Desender (1), Pascal Fajardo (2), Nicolas Eppe (3), Fleur André-Mathieu (4), Ludivine Hougardy (5) Published in the journal : October 2022 Category : Clinical Report

The antiphospholipid syndrome is an acquired autoimmune thrombotic disorder that has been known since 1906, with an incidence of 40 to 50/100,000 people. Its complex pathophysiology remains poorly understood at present, with all organs potentially affected. Symptoms are very variable and most commonly associated with multiple thrombotic or thromboembolic events. If such manifestations including obstetric events occur in young patients, we should consider the diagnosis of antiphospholipid syndrome. Owing to its morbidity and mortality, this syndrome constitutes a diagnostic and therapeutic emergency.

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Medium-term survival rate of dual mobility Polarcup® cup in primary hip arthroplasty

Juan Toussaint (1), Julien Vanderplasschen (1), Didier Postlethwaite (2) Published in the journal : October 2022 Category : Orthopédie et Traumatologie

The purpose of this study was to evaluate the medium-term survival of a dual mobility (D.M.) new generation cup: Polarcup® (Smith&Nephew, Fort Worth, Texas) in primary hip arthroplasty, in a population over the age of 70 (mean in our study: 80 years old). In comparison with other studies, our results are similar in terms of medium-term implant survival (100% after 9 years of follow-up, with the occurrence of nine periprosthetic femur fractures long after the operation). This type of cup is indicated for patients with a high risk of dislocation, aged between 70 and 75 years old, with neurological pathologies, alcoholism, low muscle trophicity and prosthesis revision, as well as tumor pathology requiring cementing of the cup in a Kerboull cross-type reconstruction ring. Wear problems occurred at the beginning of the first-generation DM cups use because the surface condition and the geometry of the prosthetic neck are involved in these wear phenomena. This led to the current preference for stems with smooth necks without extraction notches and highly cross-linked polyethylene. Currently, despite a wear and survival rate comparable to that of fixed polyethylene, the risk of intra-prosthetic dislocation (2%) specific to this type of implant should make their use cautious, especially in young and active patients (1). A more widespread use in patients over 70 years of age, supported by the significant reduction in the dislocation risk, as well as the very favorable medium-term survival results of new generation D.M. implants demonstrated by the Australian 2021 registry, could lead to a significant economic advantage (2).

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