SARS-CoV-2 vaccination of kidney transplant recipients

Hélène Georgery (1*), Arnaud Devresse (1*), Jean Cyr Yombi (2), Eric Goffin (1), Nada Kanaan (1) Published in the journal : September 2021 Category : Nephrology

Kidney transplant recipients (KTRs) are at increased risk of developing severe and lethal COVID-19 compared to the general population. Current therapies against severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infections are still limited. Nevertheless, growing evidence has revealed that KTRs exhibit a poor response to standard vaccine regimens, with humoral immune responses of roughly 50% at one month following two mRNA anti-SARS-CoV-2 vaccine doses. Moreover, most responders were shown to exhibit low antibody titers. Our experience at Cliniques universitaires Saint-Luc is perfectly in line with such data.

Considering these disappointing results, it is apparent that other strategies are required for KTRs and immunosuppressed patients, including a third vaccine dose along with monoclonal antibody therapy. This work’s aim is to provide a review on this topic and report on our experience at Cliniques universitaires Saint-Luc.

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Periprosthetic joint infection: general principles for primary care physicians

Quentin Muller (1), Randy Buzisa Mbuku (1), Hervé Poilvache (1), Maïté Van Cauter (1), Jean-Cyr Yombi (2), Olivier Cornu (1) Published in the journal : October 2021 Category : Orthopedics

Prosthetic joint infection (PJI) is a dramatic complication, with devastating and costly consequences for both the patient and healthcare system. Despite the progress made in the past decades, its incidence remains stable at around 0.5 to 2%. With the ageing population, the number of prostheses steadily increases, with consequently an increased number of infections. PJI management is complex and requires a multidisciplinary approach, including surgical treatment and antibiotic administration. A delayed diagnosis likely displays serious consequences for the patient. This article summarizes the general management principles of prosthetic joint infections, mainly designed for primary care physicians.

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Perforated jejunal diverticulum with abscess: a literature review

Miroslava Kuzmova, Mikhael Salame, Philippe Colonval (1) Published in the journal : October 2021 Category : Clinical Report

Acquired diverticula of the small intestine are formed via a mucosa and submucosa herniation through the muscular layer of the intestinal wall.

These diverticula remain asymptomatic in 60 to 70% of cases. Symptoms, when present, are non-specific, as they likely imitate other acute intra-abdominal conditions. The etiological diagnosis proves often difficult following initial assessment. In most cases, an exploratory laparoscopy is necessary in view of an accurate diagnosis.

This article consists of an exhaustive review of the literature in regard to this pathology.

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Covid-19 related suffering: patients and geriatricians on an equal footing

Dominique Piette, Catherine Magnette Published in the journal : October 2021 Category : Geriatry

This article describes the case of two elderly patients suffering from COVID-19 and admitted to a geriatric ward. It refers to the physical but, above all, psychological suffering that affects both the patients and their geriatricians at their bedside. Based on international literature, we analyze the severity of COVID-19 consequences on mental health. Moreover, we also add recommendations to be implemented so as to limit the impact of this long-term suffering.

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Antenatal management of disorders of sex development

Cécile Habran (1), Marie Laterre (2), Julie Fudvoye (3), Michelle Nisolle (4) Published in the journal : October 2021 Category : Clinical Report

Disorders of sex development (DSD) represent a diagnostic challenge. The complexity and variability of DSD and their psychosocial consequences require multidisciplinary care, including obstetricians, endocrino-pediatricians, clinical geneticists, pediatric urologists, neonatologists, psychologists, as well as child psychiatrists. The clinical case described herein is a genotypic-phenotypic discordance. Indeed, the non-invasive prenatal test argued in favor of a male chromosomal sex, whereas the fetal ultrasound was rather in favor of a female phenotype. The antenatal biological explorations will likely enable us to review both the mechanisms and genes involved in sex determination and sexual differentiation. Currently, a molecular diagnosis is found in only 30-50% of cases pertaining to 46, XY. In the event of an unusual external genitalia appearance, 75% of the reported cases are related to 46, XY, the most commonly encountered being hypospadias. The etiology retained in this foetal case is idiopathic DSD, with normal testicular function and severe intrauterine growth restriction (IUGR). Despite the improved etiological and genetic knowledge of sexual differentiation, the understanding of the underlying physiopathology is still incomplete, and some clinical situations remain unresolved.

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Understanding, recognizing, and preventing Necrotizing enterocolitis of the newborn

Stéphanie Jasienski (1), Bénédicte Van Grambezen (1) , Renaud Menten (2), Olivier Danhaive (1) Published in the journal : September 2021 Category : Clinical Report

Necrotizing enterocolitis remains the leading intestinal cause of morbidity and mortality in preterm infants. Given that this clinical condition can be unpredictable and fulminant, it is paramount to recognize this disease quickly and initiate appropriate treatment promptly so as to achieve better clinical outcomes. The condition’s management is multidisciplinary. Therefore, transferring the patient to a tertiary hospital with pediatric surgery must be considered in advanced cases. The condition’s physiopathology is still incompletely understood, with several factors considered to be involved, including the intestinal mucosa’s immaturity with innate immunity dysregulation, vascular immaturity, as well as microbiota imbalance that may be of iatrogenic origin. Complications may arise early or later in the disease course. Human milk and probiotics are the most established preventive measures.

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Surgical treatment of posttraumatic pseudo-aneurysm of right subclavian artery

Justine Malvaux (1), Asmae Belhaj (2), Philippe Eucher (3) Published in the journal : September 2021 Category : Clinical Report

Right proximal subclavian artery traumatism is rare, but it may be associated with pseudo-aneurysm formation. Currently, its treatment consists of an endovascular procedure using covered stenting. Indeed, open surgery can be quite challenging due to the subclavian artery’s anatomical; therefore, such an intervention is associated with a high morbidity and mortality rate. We report the case of a 71-year-old man presenting with a right proximal subclavian artery pseudo-aneurysm following a car injury having occurred 11 years prior. Several endovascular procedures were performed, but they all failed to exclude the aneurysm. This report sought to demonstrate that an open surgical approach is still possible following failure of less invasive interventions. A right aorto-carotido-subclavian bypass was carried out using an approach combining a median sternotomy and right cervicotomy. The patient’s postoperative course was uneventful. The first follow-up at 6 weeks post-intervention confirmed both the exclusion of the pseudo-aneurysm and vascular permeability. Yet, the 1-year-follow-up is mandatory to confirm this favorable outcome.

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Psychological health following pregnancy termination

Xavier De Muylder (1), Wallys Willaert (2) Published in the journal : September 2021 Category : Gynecology and Obstetrics

The presence of psychological sequelae among women that have undergone induced abortion is still a controversial issue in the scientific literature. In order to clarify this further, we first constructed a questionnaire and then analyzed the answers from 100 women, at more than one year following the abortion. The results revealed that a quarter of these women still presented signs of major distress. However, it must also be stressed that another quarter declared they went serenely through this interruption, without any adverse outcome. These observations could be of interest to all those who take care of women experiencing unwanted pregnancy.

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First experiences with rehabilitation of serious burn victims

Mathilde Delrue, Nele Beeckmans, Tri-t- Vo, Claire Vanderhofstadt, Jean-Marie Vanmarsenille Published in the journal : September 2021 Category : Médecine Physique et Réadaptation

"Burn victims" represent a specific population that requires complex care. A brief description of the burns and their healing process is given herein.

Clinical burn symptoms are patient-dependent, given that they may be associated with numerous and various skin lesions, including burns, hypertrophic scars, keloids, as well as skin retractions; joint lesions consisting of mobility reductions and heterotopic ossifications, in addition to various associated pathologies, such as nerve compressions, amputations, as well as perineal lesions.

The care of these patients requires a multidisciplinary approach, enabling the management of various purely medical problems, along with a bio-psycho-social approach allowing for the various difficulties the patient is inevitably confronted with to be addressed.

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Doctorats Honoris Causa 2021 - Institut de Recherche Expérimentale et Clinique (IREC/UCLouvain)

Published in the journal : July 2021 Category : Doctorats Honoris Causa 2021

On 19 May, the Health Sciences Sector of UCLouvain awarded its highest distinction to 3 personalities of the medical community for their major contribution, Professor Bruno Crestani (University of Paris and Hôpital Bichat, France); Professor Amit Nathwani (University College London and Royal Free Hospital, UK) and Professor Marc Pfeffer (Harvard University and Brigham and Women's Hospital, USA). At this virtual ceremony, the contributions of these renowned researchers in understanding the pathophysiology of pulmonary fibrosis, the development of gene therapy for the treatment of haemophilia and the role of enzyme conversion inhibition in myocardial infarction were presented and honoured. This is a summary of these scientific achievements by exceptional doctors written by the sponsors from the pneumology and haematology division and the cardiovascular department of the Cliniques universitaires Saint-Luc.

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