New-onset polyarthritis: usefulness of early remission

Emilie Sapart1*, Stéphanie Dierckx2*, Tatiana Sokolova1, Aleksandra Avramovska1, Laurent Meric de Bellefon3, Adrien Nzeusseu1, Bernard Lauwerys1, Patrick Durez1 Published in the journal : November 2020 Category : Rheumatology

Polyarthritis is a chronic inflammatory disease of immune origin that is characterized by a synovitis that progressively destroys the joints, which is at times associated with extra-articular manifestations.

This heterogenic rheumatic disease group can cause both structural and functional impairments, in addition to a decrease in patients' quality of life.

A better understanding of the disease's pathophysiology has led to the development of new encouraging therapeutic strategies for managing this disease.

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COVID-19: clinical presentation and mortality of the first 50 geriatric patients hospitalized at the Cliniques universitaires Saint-Luc in spring 2020

Cédric Mahiat, Séverine Henrard, Isabelle Gilard, Nicolas Lanthier, Peter Stärkel, Isabelle De Brauwer, Pascale Cornette, Benoit Boland Published in the journal : November 2020 Category : Geriatry

Objectives. Although the majority of COVID-19-related in-hospital deaths were reported in patients over 75 years of age, this population has been scarcely described so far. This study was aimed at describing the clinical presentation and in-hospital mortality rate of these geriatric patients.

Methods. This retrospective cohort studied the first 50 patients that were affected with COVID-19 and admitted to geriatric wards at Cliniques universitaires Saint-Luc.

Results. Before admission, the patients (median age: 88 years) were vulnerable (16%), mildly/moderately frail (32%), and severely/very severely frail (52%) according to the clinical frailty scale, whilst presenting with geriatric syndromes (cognitive impairment in 54%, recurrent falls in 44%, and malnutrition in 40%). In 36% of patients, the initial COVID-19 presentation was atypical, consisting of delirium-related or digestive symptoms. The in-hospital mortality rate was high (52%), while being not associated with the degree of frailty; the patients’ mortality rate was associated upon diagnosis with older age, lower systolic blood pressure, higher serum lactate dehydrogenase levels, and marked lung infiltrates.

Conclusions. Concerning the first geriatric COVID-19-affected patients, the initial symptom was often misleading, and the in-hospital mortality rate was high (52%),whereas the prognosis factors still need to be better defined, particularly as for the impact of clinical frailty.

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Rivaroxaban (Xarelto®): Update on new clinical data and therapeutic perspectives

Cédric Hermans Published in the journal : October 2020 Category : Actualité thérapeutique

Direct oral anticoagulants (AODs), which target coagulation Factors Xa or IIa, represent a major therapeutic innovation. Even if classical anticoagulants, such as vitamin K antagonists (AVK) and low molecular weight heparins, still play a crucial role in preventive or curative treatment, AODs have revolutionized the medical management of thrombotic diseases, concerning both arterial and venous conditions.

In addition to being able to replace conventional anticoagulants in common indications like atrial fibrillation and venous thromboembolic disease, there is a plethora of Xarelto data from recent and original studies, as well as from registries and Phase III sub-analyses, which are currently revolutionizing the modalities and benefits of oral anticoagulation at all stages of life and in a wide spectrum of indications.

This article provides a synthetic and practical review of these data and their therapeutic implications.

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Vogt-Koyanagi-Harada disease in a young man, which was complicated by tuberculosis reactivation and occlusive retinal vasculitis

Zineb Bouterfa, Halil Yildiz, Jean Cyr Yombi, Alexandra Kozyreff Published in the journal : October 2020 Category : Clinical Report

We report the case of a 17-year-old man presenting with bilateral visual loss, panuveitis, exudative retinal detachments, and diffuse choroidal infiltration. The patient also complained of headaches and ear pain. Based on the fundus image analysis, fluoangiography, indocyanine green angiography, and optical coherence tomography, Vogt-Koyagani-Harada disease was diagnosed. The patient received high-dose methylprednisolone along with azathioprine. He responded well to treatment with progressive visual improvement and subretinal fluid disappearance. One month later, his right eye exhibited a sectorial retinal vasculitis with infero-temporal vein branch occlusion and massive sub-retinal hemorrhages. Coagulation screening as well as HIV and syphilis serology were all negative; whereas QuantiFERON was positive. An 18F-FDG PET/CT revealed hypermetabolic mediastinal lymph nodes, and a biopsy confirmed active tuberculosis (TB) infection. Anti-TB quadritherapy was initiated, resulting in cytochrome P450 enzyme induction and lowered steroid treatment efficacy, with consecutive recurrence of choroidal inflammation.

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Esophageal perforation as a consequence of the Heimlich maneuvre

Marie de Broux, Anne Druez Published in the journal : October 2020 Category : Clinical Report

The Heimlich maneuver is a technique designed to clear the airways obstructed by a foreign body, which is able to save life. In rare cases, however, this maneuver can lead to life-threatening complications. Among these undesirable effects figure a few exceptional cases of esophageal rupture. Esophageal perforation is an extremely rare complication of the Heimlich maneuver. Due to this pathology’s high mortality rate and its requirement of rapid multidisciplinary management, it is essential that this clinical entity be known by physicians and be incorporated into their differential diagnosis.

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Incidence and causes of diagnostic errors in emergency medicine

Emilie Jacques, Jean-Marie Jacques Published in the journal : October 2020 Category : Médecine d’urgence

Diagnosis is an incredibly dynamic and complex process, which is prone to errors. We all make many diagnostic errors and this, in every healthcare setting, but particularly so in the emergency department. However, these errors are preventable. It is thus essential to better understand how and why these errors occur; then, some simple steps must be taken to avoid their repetition. Many of these errors pertain to the clinical reasoning process and are due to cognitive errors, although other system-related factors are likely present in most cases.

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Maintaining the cold chain in general medicine

Aurore Girard Published in the journal : October 2020 Category : Médecine Générale

Keeping vaccines requires maintaining the cold chain, which commonly exhibits weaknesses, even in more developed countries. However, the exposure of most vaccines to high temperatures results in some degree of degradation. Moreover, the freezing itself can cause an immediate vaccine degradation. In this context, the conservation of vaccines in the refrigerator at a constant temperature between 2 and 8 °C is a required framework for the general practitioner, which is designed to preserve the vaccines’ properties. The main characteristics of suitable refrigerators must combine the maintenance of temperature (between 2 and 8 °C), an equal temperature distribution, the availability of an evaporator that prevents freezing, a very rapid temperature recovery device, as well as forced air circulation. Domestic refrigerators may suffice for storing small volumes of vaccines. They must display the minimum characteristics required for good storage conditions and undergo the adaptations necessary to their proper use. Additionally, regular temperature monitoring and reporting must be performed using an outdoor thermometer with a probe. These easily manageable elements enable vaccines to be stored in good conditions, with the eventual outcome of optimizing vaccine coverage of the population.

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Reflection on the contribution of artificial intelligence to medical practice

Théophile Godfraind Published in the journal : September 2020 Category : Médecine et IA

Artificial intelligence (AI) refers to the simulation of human intelligence by machines with integrated computer programs. AI analyzes data and contributes to decision making. The computer performs human-like tasks based on algorithms. Moore's law says that computer performance increases exponentially and doubles every 18 months. On this basis, AI would surpass human intelligence by 2050. Machine learning mimics the human brain. It is fed by big data, which is a mass of heterogeneous data that are processed at a rate far beyond human capacity and in which exploitable data can be gathered. In addition to this virtual branch of AI, there is also the physical branch of robots. It has been shown that physicians surpass current diagnostic programs with respect to medical diagnosis. However, in the case of mammography, while no single AI algorithm outperformed radiologists, overall diagnostic accuracy was improved when using a set of AI algorithms combined with radiologist assessment in a single-reader screening. Only the physicians who have empathy, unlike the machines that lack this skill, may diagnose the disease. Patients’ confidence must come at the top of researchers’ priority list. Nat Med 26, 301 (2020).

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Management of diabetic foot infections: practical recommendations and recommended use of antibiotics

Laura Orioli, Bernard Vandeleene, Dan Putineanu, Caroline Briquet, Hector Rodriguez-Villalobos, Jean-Cyr Yombi Published in the journal : September 2020 Category : Endocrinologie et Nutrition

Infections are a common complication of the diabetic foot ulcer. They are recognized as a factor of poor prognosis for both the foot and the patient. Their management is complex, requiring multidisciplinary collaboration. Our article summarizes the general principles of the management of diabetic foot infections, mainly based on the new recommendations of the International Working Group for the Diabetic Foot (IWGDF). It also presents the recommendations on the use of antibiotics, based on the PEDIS classification, as applied in the Saint-Luc University Hospital.

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Pharmacological treatment of motor symptoms of Parkinson's disease

Eric Mormont Published in the journal : September 2020 Category : Neurology

This article presents the different pharmacological classes and therapeutic strategies employed at the different stages of Parkinson's disease. To date, only symptomatic treatments exist. Levodopa remains the most effective treatment with the best benefit-risk ratio. It is the initial treatment of choice for most patients. In order to delay the onset of motor complications, such as dyskinesia or end-of-dose akinesia, dopamine agonists or monoamine oxidase B inhibitors may be proposed as first-line treatment to young patients with mild disability. Motor fluctuations can be improved by adjusting the levodopa dosing frequency or by adding a dopamine agonist, monoamine oxidase inhibitor, or catechol-O-methyltransferase inhibitor. Disabling dyskinesias can be improved by reducing the levodopa dose or using amantadine. Patients with severe motor complications may benefit from a treatment with Duodopa® or subcutaneous apomorphine.

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