Recommendations of the European Society of Cardiology on management of patients with non-STEMI acute coronary syndrome

Agnès Pasquet, Frédéric Maes Published in the journal : February 2021 Category : Cardiology

These new European Society of Cardiology guidelines concern the management of patients with acute coronary syndrome presenting without persistent ST-segment elevation. The central role of performing an electrocardiogram and troponin assessment in the initial diagnosis is highlighted. A rapid use of high-sensitive troponin schema for ruling out acute myocardial infarction enables us to safely discharge patients without any acute syndrome. Performing fast troponin assessments within 2 hours or 24 hours of admission allows to screen patients for coronary angiography and percutaneous revascularization. Following coronary artery stent placement, anti-platelet or anticoagulant regimens should be carefully chosen so as to balance the bleeding risk against the ischemic or thrombotic risk. The different protocols are reviewed herein according to the patients’ clinical situation. Lastly, the comprehensive treatment of patients is presented.

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Acute hepatitis due to nasal cocaine use: clinical case report and literature review

Barbara Gauchet (1), Véronique Gerard (2), Hadrien Fourneau (3) Published in the journal : January 2021 Category : Emergency

We present the case report of a 28-year-old man admitted to the emergency department for acute hepatitis due to nasal cocaine use. Cocaine abuse is associated with a variety of acute medical complications. Acute hepatitis without other systemic disorders is a rare condition that may occur following cocaine use.

Based on a systematic review of the literature, this report seeks to discuss the clinical, biological, and histopathological features of this disease and its evolution, too. The clinical practice guidelines for managing acute hepatitis due to cocaine use will be discussed, as well.

This case provides us the opportunity to remember and explore the differential diagnosis of acute hepatitis and the usefulness of a precise anamnesis.

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Epidermal hamartoma type PENS («papular epidermal nevus with « skyline » basal cell layer»)

Marie Cuvelier (1*), Josette André (2), Didier Bessis (3), Pierre-Paul Roquet-Gravy (1), Audrey Bulinckx (1) Published in the journal : January 2021 Category : Dermatology

PENS hamartoma or “papular epidermal nevus with "skyline" basal cell layer” is a congenital epidermal hamartoma, which is characterized by specific histopathological features. We report a diagnosis of PENS hamartoma that was made in an 18-month-old girl.

Initially described by Torrelo et al. in 2011 (1), PENS hamartoma exhibits particular clinical features consisting of coalescent, verrucous, and light brown polygonal papules (2). The diagnosis is confirmed by histological examination, which, in the majority of cases, shows an alignment of epidermal basal cells and palissadic disposition of nuclei evoking a "skyline". In 2012, the term PENS Syndrome was retained, owing to new clinical descriptions associating light neurological abnormalities with these cutaneous lesions (2). PENS syndrome is a rare neuro-cutaneous syndrome, which involves one or more congenital epidermal hamartomas of PENS type, as well as non-specific neurological abnormalities (1-3). Neurological manifestations begin to occur during the first two years of life (1). A review of the literature identified 27 reported cases of PENS hamartomas (1-12), including some familial cases and other cases associated with neurological abnormalities (PENS syndrome). The physiopathology of PENS hamartoma and PENS syndrome remains unclear, whereas several hypotheses have been advanced (7).

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Autoimmune hemolytic anemia warm antibody type associated with seroconversion for cytomegalovirus infection during pregnancy

Moïra Poncelet (1), Catherine Lambert (2), Pierre Bernard (1) Published in the journal : January 2021 Category : Obstétrique

Autoimmune hemolytic anemia, specifically during pregnancy, is an uncommon hematological disorder, which causes premature destruction of red blood cells. While it may be idiopathic, this disorder may also be secondary to an underlying condition. Whatever its etiology, this disease is associated with high maternal, fetal, and neonatal morbidity, which is due to the transplacental passage of immunoglobulins G (IgG). This highlights the usefulness of diagnosing and managing this pathology, which is a real challenge, given the lack of codified recommendations published in the literature.

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Reflections on the management of antenatal hydronephrosis

Hélène Legrand (1), Nathalie Godefroid (2), Axel Feyaerts (3), Stéphane Thiry (3), David Tuerlinckx (4) Published in the journal : January 2021 Category : Pediatrics

Antenatal hydronephrosis is the most common congenital abnormality. The post-natal management is, however, still controversial, specifically concerning further testing, as well as and benefit of antibiotic prophylaxis. The systematic indication of performing a voiding cystourethrogram for vesicoureteral reflux screening and of prescribing antibiotic prophylaxis for preventing urinary tract infections has been increasingly questioned by recent study data. A less aggressive approach is discussed here, which is essentially based on post-natal ultrasound findings.

We herein propose an algorithm that is based on these study data.

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COVID-19 - Measures seen as useful are better adhered to

Isabelle Aujoulat (1), Bénédicte Scheen (1), Kirsten Vanderplanken (2), Stephan Van den Broucke (3), Joris van Loenhout (2) Published in the journal : January 2021 Category : Santé publique

Since the first case of COVID-19 was detected in December 2019, the world has experienced a pandemic of unprecedented proportions. While the development of vaccines against the disease became high priority, many countries were trying to reduce the impact and the burden on healthcare systems by implementing infection prevention and control measures. These measures are flexible, and can be adapted based on the severity of the outbreak that a country is experiencing at a given moment in time. However, the effectiveness of such measures is for a large part determined by the ability and willingness of the population to adhere to them. For Belgium, which has experienced a high infection rate over the year, there was no clear insight in overall adherence to the measures, reasons for (non)adherence, and subgroups of the population that are less likely to adhere.

This article presents the results of a panel-based internet survey, that addressed a sample of respondents (n=2.008), representative for the adult Belgian population in terms of age, sex, region and socio-economic status. The questionnaire was developed by researchers with backgrounds in social sciences, epidemiology, health promotion and psychology. It was guided by the Protection Motivation Theory. Data were collected in September 2020. The detailed methodological design and results may be consulted through the following link:

The results which are summarised hereafter were presented on Decembre 17th, 2020 in a webinar organised by Fondation Louvain, who supported study:

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Insulinotherapy in 2021

Martin Buysschaert, Vanessa Preumont, Dominique Maiter Published in the journal : January 2021 Category : Diabétologie

The aim of this paper is to propose a current state of the art in the field of insulin treatment. We describe human insulin and analogs available in Belgium, as well as the current recommendations in terms of insulin strategies in type 1 and type 2 diabetes.

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The therapeutic potential of molecular scissors: perspectives of the 2020 Nobel Prize in chemistry

Nathalie Lannoy, Cédric Hermans Published in the journal : November 2020 Category : Prix Nobel

The 2020 Nobel Prize in chemistry was jointly awarded to two geneticists Emmanuelle Charpentier and Jennifer Doudna for their having developed the "Crispr-Cas9 molecular scissors". This real innovation pertaining to the molecular biology field is principally able to easily, quickly, and inexpensively edit the genome of any cell. Its use in all fields of life allows for scientific, medical, agronomic, and industrial applications both for better and worse.

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Anesthesia without opioids: May this be useful in Sub-Saharan countries?

Published in the journal : November 2020 Category : Clinical Report

The systematic use of opioids has made us lose sight of their significant adverse effects, including respiratory distress, hyperalgesia, as well as postoperative nausea and vomiting. Sub-Saharan African countries are currently facing the issue of post-interventional surveillance, with post-operative respiratory problems being rather common. Similarly, these countries experience difficulties in managing pain, nausea, and vomiting. At times, opioid ruptures may occur, which may lead to postponing surgical procedures, in a context where access to surgery is already a obstacle. The opioid-free anesthesia could be an interesting alternative for these countries, especially when using accessible drugs with simple protocols. Therefore, anesthesiologists from these countries should focus their interest on such anesthesia techniques, in the aim to better define their place in their daily practice and share their potential benefits in a limited-resource setting.

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Use and abuse of tissue fillers in the field of urology

Walther Brochier, Greet Swinnen, Peter De Wil, Sam Ward Published in the journal : November 2020 Category : Clinical Report

The injection of tissue fillers for esthetic purposes is considered a decade-old practice. In our urological practice, we are now seeing an increasing number of patients that have purposefully injected such fillers in order to increase penile girth. Nevertheless, particularly when done in non-professional settings or using low-quality products, this may lead to severe complications. These complications are mostly caused by the injections of silicone, which is a non-resorbable filler, unlike hyaluronic acid or autologous fat.

We present herein the case report of a 37-year-old man treated in our department for preputial pain and swelling following silicone self-injections. We then continue with a literature review on the topic.

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