Comorbidities of atopic dermatitis

Marie Baeck, Axel De Greef Published in the journal : May 2023 Category : Dermatology

Atopic dermatitis (AD) is a chronic, itchy inflammatory dermatosis with a potentially significant impact on the quality of life of patients and their families. In addition to skin signs and symptoms, increasing evidence suggests that AD is systemic in nature. Moreover, the higher frequency of cardiovascular, metabolic, neuropsychiatric, and autoimmune disorders that are observed in AD patients deserve to be further investigated. While several diseases may coexist with AD on account of coincident exposure to similar environmental factors, it has also been suggested that AD exerts a synergistic effect with inflammation occurring within other organs and systems, as is the case in other immune-mediated inflammatory diseases. Alternatively, these comorbidities may directly be related to the AD pathophysiology through shared genetic and immunologic mechanisms. These comorbidities are commonly unrecognized or underestimated, and clinicians must thus be informed about their existence. Treatment and management of AD are thus likely to impact not only skin lesions, but also to prevent the development of various comorbidities. In some patients, a multidisciplinary approach must be encouraged, upon which the overall burden of AD and its comorbidities, both atopic and non-atopic, are properly assessed and managed.

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Right and duty of the doctor and the patient" - Hospital mediation: reality or utopia?

María Jesùs Alvarez Baranga Published in the journal : May 2023 Category : Ethique en soins de santé

What is the current state of the law regarding patients' rights after 20 years? What are the upcoming changes in a world with an underfunded health care system? How to support caregivers in pain facing increasingly demanding patients in a complex society that has been battered during the pandemic years? Does the control and sanction commission for caregivers make sense in the current health care context? How can we preserve the human element in hospitals when resources are lacking?

How can we value and encourage the communication between patients and caregivers? The author attempts to provide answers and avenues of reflection regarding all of these questions in the context of a narrative review, based on her extensive field experience as a mediator.

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Combined juvenile polyposis/hereditary hemorrhagic telangiectasia syndrome

Sophie Mercier (1), Nicolas Janin (2) Published in the journal : May 2023 Category : Chirurgie orthopédique et traumatologie

Combined juvenile polyposis/hereditary hemorrhagic telangectasia (JP/HHT) syndrome is a rare genetic disorder associating both the development of hamartomatous polyps in the gastrointestinal tract and the Rendu-Osler-Weber disease. Patients affected by these two pathologies are exposed to an increased risk of digestive tract cancers and vascular malformations.

In this article, we present the case of a 73-year-old patient diagnosed with juvenile polyposis at the age of 67, following a bifocal left colon cancer. During his lifetime, this patient presented numerous epistaxis episodes without a clearly identified cause. Because his eldest daughter also suffered from repeated episodes of epistaxis, a genetic origin was then suggested.

In order to properly organize the follow-up of their patients, it is important that practitioners likely to see a person suffering from JP/HHT in consultation take into account the possibility that this person might suffer from the JP/HHT syndrome.

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Myositis ossificans circumscripta: from diagnosis to treatment

Pauline Despontin, Nanni Allington (1) Published in the journal : May 2023 Category : Chirurgie orthopédique

Non-tumoral heterotopic bone proliferation within soft tissues, and more specifically in striated skeletal muscles, is known as myositis ossificans.

The most frequently encountered form is the acquired form which is benign and often trauma-related, but can also appear without any trigger. It develops through three stages (acute, subacute, and mature). Diagnosis can be difficult, especially during the acute phase where the clinical presentation can mimic other pathologies, such as muscle abscess or sarcoma. It is important to identify the disease at this stage, as it avoids unnecessary recourse to biopsy. When mature, myositis ossificans has a well-defined appearance, hence the name myositis ossificans circumscripta. In all cases, the diagnosis will require imaging exams. The pathophysiological mechanism of myositis ossificans has not yet been fully elucidated, but there are several theories.

This article illustrates the diagnosis and management of acquired and circumscribed myositis ossificans on the basis of a clinical case.

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Neonatal myocardial infarction: a rare and complex entity

Nancy Laval (1,2), David Bienjonetti-Boudreau (3), Joaquim Miro (3), Sophie Tremblay (1), Christophe Vô (3,4) Published in the journal : May 2023 Category : Neonatology

Although myocardial infarction is a major cause of death worldwide, this pathology is uncommon in pediatrics and mainly occurs during the neonatal period. There are very few cases described in the literature. While multiple recommendations exist in the field of adult cardiology, there is no real worldwide consensus on myocardial infarction management in young children, although some etiologies are well established. This article describes a case of complex neonatal resuscitation in a newborn with a confirmed diagnosis of myocardial infarction during the first day of life. This case report will provide a recent literature review on this topic and establish optimized therapeutic management.

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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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