New indications of SGLT2-inhibitors

Michel Jadoul Published in the journal : September 2022 Category : Diabétologie

Inhibitors of the sodium-glucose cotransporter 2 (SGLT2) are dramatically changing the management of heart failure and, especially, chronic kidney disease. Indeed, this class of drugs, which was initially developed to improve glycemia control in Type 2 diabetics, is now widely recommended by global/international guidelines as part of the standard care for both diabetics and non-diabetics presenting with heart failure and/or albuminuric chronic kidney disease. Indeed, large outcome trials have conclusively demonstrated their efficacy and safety, with some undesirable effects that are easily manageable in clinical practice, such as mycotic genital infection. The key challenge for the coming years is to ensure that the broad population of patients susceptible to benefit from SGLT2-i is actually treated by these drugs. In the near future, additional trials may further enlarge the population targeted by this drug class.

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Pitfalls of pituitary biology

Damien Gruson Published in the journal : September 2022 Category : Endocrinology

The biological work-up of the pituitary gland is primarily aimed to detect an excess or deficit of hormone production. The assay methods for the different tests of this workup have significantly evolved over recent years, both through the automation of immunoassays and development of liquid chromatography-mass spectrometry methods. The clinico-biological relationship plays a fundamental role in the evaluation and optimization of these assays, and in the interpretation of their results, as well.

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Pitfalls of pituitary imaging (present and future...)

Thierry Duprez Published in the journal : September 2022 Category : Endocrinology

Following a brief review of pituitary diagnostic imaging and basic magnetic resonance imaging (MRI) semiology, the pitfalls of daily pituitary imaging are further discussed and illustrated. The risk of false positives due to the desire to be highly efficient in detecting micro-lesions, along with the risk of ignoring the complexity of the differential diagnosis of macro-lesions, are the two major pitfalls that should be avoided. Technological progress has generated two recent avenues of improvement, including whole-body MRI at 7 Tesla (7T) and, above all, deep-learning (DL), the promises of which are further discussed on the basis of initial data reported in the literature.

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Monkeypox virus (MPXV)

Liselot Vandenbergen¹*, Geoffroy Vandercam¹*, Ellen Hoornaert¹*, Alice Sluijters¹, Jean Cyr Yombi¹ Published in the journal : July 2022 Category : Médecine interne et maladies infectieuses

Belgium is facing an outbreak of Monkeypox virus. This illness was until now only endemic in West and Central Africa. Since May 2022, an exponential growth of new cases has been recorded in Europe. The clinical presentation is an influenza-like illness followed by a varioliform rash. Most patients will have mild to moderate symptoms but immunocompromised people, children and pregnant women can develop a severe illness. Mortality is low (3-10%) depending on the viral strain. The virus is transmitted mainly by prolonged skin contact and to a lesser extent by air (droplets). It is essential to implement preventive measures now (rapid screening, isolation of confirmed cases and high-risk contacts, public awareness) in order to contain this outbreak. A live attenuated vaccine (Imvanex®), currently not very available, could be used for post-exposure prophylaxis of contact cases and to a greater extent, for pre-exposure prevention. Antiviral treatments (Brincidofovir and Tecorivimat) will also be available in the near future.

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Adult IgA vascularitis : a case report and review of the literature

Ramanandafy Herveat 1, Ramily Samison Leophonte 2, Raharinoro Raïssa Haingotiana1, Ratovonjanahary Volatantely 2, Rakotoarisaona Fifaliana Mendrika 2, Sendrasoa Fandresena Arilala 2, Rahantamalala Marie Ida 1, Ramarozatovo Lala Soavina 2, Vololontiana Han Published in the journal : July 2022 Category : Clinical Report

Adult IgA vasculitis or Henoch-Schonlein rheumatoid purpura is a rare clinical entity, which is characterized by tissue deposits of immune complexes containing type A immunoglobulins. A 24-year-old man without any particular history, especially concerning past infections, displayed purpuric petechial and ecchymotic skin lesions, which were infiltrated and vascular in nature, as well as associated with polyarthralgia of the elbows and knees, in addition to spasmodic abdominal pain. The blood analysis revealed a discrete inflammatory syndrome with a C-reactive protein (CRP) level at 37 mg/L, the rest of the workup including hemostasis being unremarkable. The renal assessment showed significant proteinuria at 0.73g/24 hours without renal failure. Skin histology exhibited a lymphocytic vasculitis lesion and perivascular infiltrates consisting of mononuclear cells, without fibrinoid necrosis. The diagnosis of subacute IgA vasculitis was established based on the criteria of the American College of Rheumatology and EULAR/PRINTO/PRES (European League Against Rheumatism/Paediatric Rheumatology INternational Trials Organisation/Paediatric Rheumatology European Society). A cortico-resistance of the skin lesions was noted following 21 days of treatment, which eventually resolved at 1 month.

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Spontaneous coronary artery dissection (SCAD): a case report and literature review

Merveil Ndongala1, Christophe Laruelle2 Published in the journal : July 2022 Category : Clinical Report

Myocardial infarction results from obstruction of the coronary arteries, which is most often secondary to the progression of atherosclerotic disease with rupture of the atheromatous plaques formed. In some cases, myocardial infarction is not secondary to the progression of atherosclerotic disease, but it is rather due to coronary artery stenosis following dissection of the artery wall and this, in a population without significant cardiovascular risk factors.

This article illustrates, based on three cases managed in our institution, the presentation and current state of knowledge pertaining to an atypical cause of myocardial infarction, namely the spontaneous coronary artery dissection (SCAD).

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Medico-scientific immigration to the United States during the 20th century

Jean-Louis Michaux1, Émilie. Michaux2 Published in the journal : July 2022 Category : Médecine et société

The collection of authors at the origin of classic disease description in the medical dictionary compiled the biography of American authors whose origins proved to be multiple: emigrants, descendants of immigrants, or native Americans. These emigrants and descendants of immigrants were mainly of European origin and of Jewish faith; their immigration, a consequence of anti-Semitism in Europe, significantly favored the medico-scientific development in the United States.

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Impact of visual impairment on the occurrence of posttraumatic and psychotic symptoms following aggression

Valentin Coutant1, Sylvain Dal2 Published in the journal : July 2022 Category : Psychiatrie adulte

Based on a clinical case description and associated literature review, this article sought to investigate the multidirectional interactions between trauma, psychosis, and visual impairment.

Trauma and psychosis have been mostly described separately, though they share mutually-reinforcing interactions. Visual impairment alters the perception of the world. As a result, visual deficiency modifies the expression of psychiatric symptoms and promotes the risk of developing psychotic symptoms. In some cases of severe traumatisation, psychotic symptoms like hallucinations and delusions have been reported to occur outside of the schizophrenia spectrum. This is referred to as Post-Traumatic Stress Disorder with Secondary Psychosis (PTSD-SP).

The diagnosis of this condition is paramount in view of the treatment that must be administered to the patient. Emphasis should first and foremost be placed on treating trauma rather than on exclusively reducing psychotic symptoms.

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Rhizarthrosis: What should be proposed to patients suffering from pain at the base of the thumb?

Ghady El Khoury1, Olivier Barbier1, Antoine Vanderlinden1, Xavier Libouton1 Published in the journal : July 2022 Category : Orthopédie et Traumatologie

Rhizarthrosis, which is also called trapeziometacarpal osteoarthritis, is one of the most common sites affected by osteoarthritis. The initial symptoms of pain progressively evolve to result in thumb deformity with functional deficits. Standard radiography is the examination of choice to establish the diagnosis. The initial treatment is conservative and consists of immobilization by orthosis, analgesics, physiotherapy, or infiltrations. When this treatment fails, surgical interventions may be proposed, sush as trapeziectomy or trapeziometacarpal prosthesis.

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Innovations and Perspectives for Rare Diseases

Marie-Cécile Nassogne, Marie-Françoise Vincent, Olivier Devuyst, Joseph P. Dewulf, Nicolas Garcelon, Arnaud Devresse, Valentine Gillion, Cédric Hermans, Sophie Gohy, Silvia Berardis, Christophe Goubau, Jean-Baptiste Demoulin Published in the journal : July 2022 Category : Rare Diseases

Approximately 7,000 rare diseases, defined by their prevalence of less than 5 per 10,000 in the community, have been identified. These diseases, most often of genetic origin, collectively affect 5-8% of the European population, or 25-30 million people. In Belgium, it is estimated that around 700,000 people have a rare disease, with often severe clinical, social and economic consequences. The diagnosis and management of rare diseases requires a concentration of expertise in highly specialised centres, working in concert with hospital networks and health professionals. Within Cliniques universitaires Saint-Luc (CUSL), the Institute of Rare Diseases (IMR) coordinates some thirty centres of reference for rare diseases, involving more than 15,000 patients and 300 health professionals. Fifteen of the CUSL centres are part of the European Reference Networks (ERNs), officially validated and supported by the European Community. Patients and their treating physicians often find themselves at a loss when faced with rare diseases and the difficulties they entail. The setting up of multidisciplinary networks bringing together a critical mass of medical, biological and technical expertise and the recruitment of a sufficient number of patients are essential to optimise the management of these diseases. One of the key missions of the CUSL Rare Disease Institute is to establish an information and support programme for patients, their families and health professionals. It is within this framework that the RMI organised a symposium on Friday 3 June 2002 on the theme of innovation in the field of rare diseases. Speakers from Belgian and foreign centres covered a wide interdisciplinary field, from basic research to clinical practice, genetics, therapeutic innovation, drug repositioning, the use of artificial intelligence and medical data, as well as ethical and economic aspects and, of course, the views and expectations of patients. As you will read in the following pages, the presentations of this symposium have shown a tremendous momentum in the holistic management of rare diseases. This momentum is irreversible and is part of the global awareness of the medical and societal importance of these diseases.

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