Vasculitis: from clinical and pathological descriptions to successful treatments

Loïc Guillevin Published in the journal : October 2023 Category : Docteur Honoris Causa

Systemic vasculitis is a group of inflammatory diseases of vessels of various sizes, with variable pathogenic mechanisms. Their causes are often unknown. This disease group is historically dominated by polyarteritis nodosa but also includes granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis, and giant cell arteritis. Immunologically, anti-neutrophil cytoplasmic antibodies (ANCA) are present in a group of small-sized vessel necrotizing vasculitis. The extremely severe prognosis of vasculitis has been modified by corticosteroids and immunosuppressive treatments. More recently, biotherapies, including rituximab in ANCA-associated vasculitis, mepolizumab in eosinophilic granulomatosis with polyangiitis, and tocilizumab in giant cell arteritis, have achieved remissions in more than 90% of patients and prevented relapses. They have also made possible to considerably reduce corticosteroid treatment and, consequently, its side effects. Vasculitis is now curable with a favorable prognosis.

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New recommendations for the management of acute otitis media in primary care

Jan-Harm Keijzer (1), Saphia Mokrane (1,2), Paul Van Royen (3), Nicole Dekker (1), Martine Goossens (1), Olivier Vanderveken (4), An De Sutter (5), Rupal Mehta (6), Cécile Ducène (7), Alexandra Sousa (8), Monique Boulad (9) Published in the journal : October 2023 Category : Médecine Générale

This article is a summary of the recent update of the clinical practice guideline (CPG) on the management of acute otitis media (AOM) in general practice.

The CPG was developed with the participation of all relevant disciplines and according to an internationally recognized methodology for guideline development (Adapte procedure).

The elements of the medical history and clinical examination have limited diagnostic value and symptoms alone are not enough to make a diagnosis of AOM. The diagnostic hypothesis is based on the combination of these elements.

The doctor pays attention to the patient's experience and provides the necessary information to enable the patient to manage his/her disease properly (e.g., pain management, etc.). Shared decision making is a key point.

Antibiotics are justified in case of an unfavorable disease course and in the presence of major risk factors for complications. However, certain subgroups may benefit from antibiotic treatment.

Effective treatment (paracetamol or ibuprofen) of pain or fever has become the cornerstone of AOM management. More targeted antibiotic treatment is reserved for specific indications.

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High-flow priapism after pelvic fracture

Romain Carlat (1), Renaud Destraix (4), Nicolas Jacquemart (2), François Melebeck (3), Michaël Twahirwa (4), Michaël De Foy (3) Published in the journal : October 2023 Category : Chirurgie orthopédique

Priapism is an erectile dysfunction characterized by partial or complete penile erection lasting more than four hours without any sexual stimulation. Its incidence is estimated at 0.5-0.9 cases per 100,000 people per year. Ischemic priapism, which is more frequent and painful, is induced by the paralysis of the cavernous smooth muscle, which can no longer contract, allowing hypoxic blood to stagnate within the sinusoidal spaces. Arterial priapism, rare (5% of priapism) and typically painless, generally results from direct perineal trauma responsible for an arterio-cavernous fistula. In this case report, we discuss the multidisciplinary management of a 31-year-old patient, polytraumatized after a high-velocity motorcycle accident. He presented with a pelvic fracture osteosynthesized with a plate and screws. Following surgery, the patient developed post-traumatic high-flow priapism, which was managed by interventional radiology.

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Sexual assaults on very young children (0-6 years)

Jean-Yves Hayez (1), Hélène Romano (2) Published in the journal : October 2023 Category : Pédopsychiatrie

Although sexual violence against children seems to be better recognized and managed nowadays, one age category of victims is totally forgotten: babies and very young children. It is extreme abuse, given the vulnerability of the victims.

Nevertheless, it is a real problem and the lack of publications on this subject can only make us worry, as it probably leaves many situations unaddressed.

The main objective of this article is to describe the specificity of sexual assaults on young children and to better identify signs likely to alert healthcare professionals.

This article is based on our clinical experience and qualitative data collected throughout our years of experience.

Our fieldwork has enabled us to propose a summary table of the basic identification elements present in very young children who have been assaulted.

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Cervical cysts in adults: caution!

Daniel Moens (1), Sébastien Van der Vorst (2) Published in the journal : September 2023 Category : Clinical Report

Any cervical cystic lesion detected after the age of 40 should lead to thorough investigations in the ear-nose-throat (ENT) sphere and in particular in the homolateral palatine tonsil and tongue base.

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Pyroglutamic acidemia in an elderly patient

Maxime Cuylits (1), Christophe Dumont (2), Blaise Anthonissen (3), Denis Glorieux (4), Ioana Almas (5) Published in the journal : September 2023 Category : Clinical Report

Pyroglutamic acidemia, initially described in the pediatric population due to inborn enzymatic deficiencies, is a relatively unknown cause of high anion gap metabolic acidosis (1). Acquired pyroglutamic acidemia is mostly diagnosed in malnourished women suffering from a chronic illness and with a history of chronic acetaminophen use (2). During the past decade, several cases of flucloxacillin- and paracetamol-induced pyroglutamic acidosis have been reported (3,4). We herein report a case of a patient diagnosed with pyroglutamic acidosis in the context of concomitant paracetamol and flucloxacillin treatment. This case report highlights the need to consider pyroglutamic acidosis in the differential diagnosis of high anion gap metabolic acidosis, given its reversibility under appropriate management.

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Study of the benefits of cryotherapy in postoperative anterior total hip arthroplasty

Antoine Ledoux, Stéphanie Meirlaen, Julie Manon, André Claude Mbaga Ntjam, Jean-Emile Dubuc, Maité Van Cauter, Olivier Cornu Published in the journal : September 2023 Category : Orthopedics

The aim of this prospective study was to evaluate the influence of a cryotherapy device compared to conventional cold packs in postoperative anterior total hip arthroplasty to assess the benefits in terms of rehabilitation, analgesia, and blood loss.

Existing literature suggests that cryotherapy may be beneficial in reducing postoperative pain (1) and blood loss in joint replacement surgery (2,3). However, no study has comprehensively evaluated these effects on patient rehabilitation and mobilization.

Firstly, our cohort comprised 158 patients, 14 of whom were excluded during hospitalization. The control group, consisting of 72 patients, received cold packs twice a day and, if necessary, on demand. The interventional group, also comprising 72 patients, received the cryotherapy machine three times a day during the first two postoperative days.

Secondly, our results showed a significant improvement in the revalidation score on the third postoperative day in the cryotherapy group. We could not confirm the significant impact on the clinical outcome. Moreover, no difference was noted in pain medication intake or blood loss. Finally, we can consider cryothera- py as a simple, non-invasive approach that does not increase the risk of adverse effects when used in immediate postoperative total hip arthroplasty (2).

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Focus on suspected hemorrhagic diathesis

Michael Iarossi, MD, Cédric Hermans, MD, PhD, FRCP (Lon, Edin) Published in the journal : September 2023 Category : Hematology/Oncology

Clinical bleeding manifestations are commonly encountered reasons for medical consultations in both general and specialized fields. A comprehensive medical history, encompassing personal and familial contexts, plays a pivotal role in predicting a bleeding disorder. Employing a bleeding clinical score constitutes the primary approach. While routine coagulation tests are useful, they are inadequate for definitively ruling out a potential hemostatic abnormality. If a strong suspicion of hemostasis dysfunction exists, a comprehensive array of biological assessments must be requested. This evaluation should encompass primary hemostasis, coagulation factors, and fibrinolysis. This combined clinical and biological strategy is instrumental in recognizing whether a coagulation disorder is acquired or hereditary, in elucidating its underlying cause, and in gauging its severity. The commonly encountered congenital causes comprise platelet functional disorders, von Willebrand disease, hemophilia A/B, and deficiencies in coagulation factors like Factor VII and Factor XI, as well as hyperfibrinolysis. Nonetheless, a notable subset of patients is unlikely to benefit from this diagnostic approach. This prompts us to an undetermined source of the bleeding tendency, necessitating cautious attention to its potential implications. For hemostatic interventions, it is crucial to exercise vigilance. Indeed, the aim of such procedures is to attain effective management or bleeding prevention, while sidestepping unnecessary treatments with inherent risks, such as allergies, immunization, infections, and even thrombotic complications.


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Mobile pediatric psychiatry intervention and care network: Clinical case study of a mother- infant attachment disorder

Karim Odr (1), Caroline Grégoire (2), Julia Plat (2), Jessy Poels (2) Published in the journal : September 2023 Category : Psychiatrie infanto-juvénile

This article presents the advantages of mobile intervention in perinatal child psychiatry and the collaboration among healthcare professionals to provide individualized care to infants and families facing mental health challenges. After describing the framework of mobile intervention in perinatal child psychiatry, a clinical case is presented, outlining the analysis of the request, the initial observations, the establishment of a network around the family, and the clinical evolution. Guidelines for networked care and the benefits of this approach are also detailed. This article emphasizes the importance of a flexible and collaborative approach to ensure tailored care for infants and their families.

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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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