Ankle sprains represent a frequent reason for general or emergency medicine consultations. The most common complications are ligament lesions, bone avulsions, and hemarthroses. The pseudoaneurysm of the pedal artery is an often overlooked and rare complication. The case presented in this article is that of a 32-year-old man treated for a sprained ankle 3 weeks before. He received conservative treatment because no fractures were detected during the X-ray examination. Two weeks later, he presented with a pulsatile mass in front of the anterior talofibular ligament, associated with a small wound.
Ekaterina Melnik, Denis Daspremont, Tatiana Roy, Valérie Verbelen, Gatien RousselPublished in the journal : January 2023Category : Microbiology
The development of molecular biology led to a new diagnostic tactic for gastrointestinal infections: a syndromic approach, which led to the development of numerous multipathogen molecular polymerase chain reaction (PCR) panels. We evaluated the BD MAX™ (BD Diagnostics, USA) system and compared the results with conventional methods used in our microbiology laboratory to determine if this approach could be implemented as a routine analysis. We also highlighted the practical advantages of a multipathogen molecular panel: reduction of the number of needed technologists needed per day to perform microbiological stool analyzes, easier stock management, and complete traceability for each clinical sample of reagents, expiry date, and user. Moreover, the the BD MAX™ system is easy to use, requires minimal training, and the bidirectional connection with the Laboratory Information System enables a more reliable encoding of the results. In some laboratories, molecular panels already replace conventional methods. Some of these panels’ performances are very satisfactory and their cost are gradually becoming more affordable. Each microbiology laboratory can therefore consider the integration of a multipathogen molecular PCR panel in their routine work.
The first traces of opium use date back to the time of the Sumerians, around four thousand years before our era. The Egyptians employed it to soothe crying children. After briefly reviewing the pharmacology of opium derivatives and opioids, we will discuss their still poorly understood endocrine side effects. The steadily increasing use of opioids in medical practice and their misuse have uncovered a whole series of side effects on several hypothamic-pituitary endocrine axes. These side effects can have a significant impact on the general health and quality of life of patients who use them chronically. It is therefore crucial for clinicians to recognize them. In the present article, we will review the main symptoms to look for, the additional examinations which should be carried out, and the appropriate management of these patients.
Platelet factor 4 (PF4) is a positively charged molecule stored in the alpha granules of blood platelets and secreted during platelet activation, endothelial breach, or in the presence of microorganisms. PF4 binds to glycosaminoglycans on the endothelial surface and neutralizes their anticoagulant properties. Moreover, PF4 can combine with heparin, mainly unfractionated, in heparin-induced thrombocytopenia (HIT), with cartilage components or other negatively charged polyanions (so-called spontaneous HIT), and with some constituents of the SARS-CoV-2 adenovirus vaccine, resulting in post-vaccination thrombocytopenia. The common feature of these molecules is their negative charges which induce their binding to PF4 and a conformational change of the latter. This complex is recognized by anti-PF4 antibodies, which activate platelets and inflammatory cells via the Fc receptor, induce a pro-thrombotic state, and venous, arterial, or microcirculation thrombosis. The diagnosis of HIT is based on the detection of anti-PF4-heparin antibodies by immunoassay in cases of clinical suspicion and intermediate or high pre-test probability, estimated by different scores, the 4T score being the most common. Functional tests may also be performed. HIT management consists in stopping heparin and starting non-heparin anticoagulant therapy.
Natacha De Decker (1), Pol Vincent (1), Thierry Castelain (2), Paula Blaj (2), Pascale Grandjean (3), Sophie Gilles (3), Tudor Azoicai (1)Published in the journal : December 2022Category : Clinical Report
Spontaneous pneumothorax is a frequent cause of admission to emergency departments. Its etiology and lethal potential if not diagnosed are well known. However, there are less common etiologies of this condition. The diagnosis can then be tricky, especially since the symptoms may be equivocal. This is the case of spontaneous pneumothorax in pregnant women with no risk factors, in whom the symptoms may mimic those observed during the last trimester of pregnancy.
In this context, we wish to report a case of spontaneous pneumothorax in a 32-week pregnant wo-man, without any known risk factor. We also propose a literature review on this subject.
Our analysis highlights that spontaneous pneumothorax in pregnant women is a rare condition whose diagnosis may be overlooked, given the clinical manifestations that may be confused with physiological phenomena of the last trimester of pregnancy.
Angioedema, whether related to histamine release or excessive bradykinin, is a common reason for admission to the emergency department. This condition is a potentially serious and even fatal condition. Its diagnostic and therapeutic management can be difficult. This article details the practical management of angioedema in the emergency room, particularly its bradykinic form, as well as the modalities and objectives of the specialized allergology assessment, which is frequently indicated. Finally, this article gives a special look at hereditary angioedema, a rare disease justifying a specialized therapeutic management, which has recently been revolutionized by the advent of new and very promising molecules.
In the winter of 2021, when the beginnings of a possible way out of the Covid-19 crisis were appearing, many of us made the same observation: primary care medicine, that is medicine that goes from individual or group medical practices to large urban policlinics and nursing homes, has certainly played an important role in the management of the pandemic, but its potential has been insufficiently exploited, particularly by the authorities in charge of public decisions. This observation has been confirmed by international bodies such as the WHO and the OECD. We therefore felt that it would be interesting to take our heads off the wheel, to distance ourselves from all of our activities deployed during the pandemic (care, screening, vaccination, etc.) and to organize an exchange of experiences in order to build a body of knowledge and propose recommendations in four countries: Belgium, Canada, France and Switzerland. The commonalities shared by these four countries, whether at the historical (thank you Napoleon!), linguistic, cultural, societal, academic and of course health system levels (universal coverage, private and/or public insurers, among others), facilitate such an exchange dynamic.
Jelena Hubrechts¹, Stéphane Moniotte¹Published in the journal : December 2022Category : Pediatrics
Since 2019, the SARS-CoV-2 has been associated with the occurrence of myocarditis. Moreover, specifically in the pediatric population, this virus can cause an exaggerated inflammatory response several weeks after the acute infection. This new entity is called “multisystem inflammatory syndrome in children” (MIS-C). Cardiovascular involvement is very common in this syndrome, particularly in the form of ventricular dysfunction with increased cardiac enzymes. As myocardial damage is one of the causes of sudden cardiac death in young athletes, resumption of sporting activities must be undertaken with caution. Depending on initial symptoms, a focused history taking and meticulous physical examination may be sufficient to permit resumption of sports after the legal duration of quarantine in case of simple COVID-19 infection. In other cases, the patient should be referred to a pediatric cardiologist for a more comprehensive workup. For patients with MIS-C, sport remains contraindicated for a period of 3 to 6 months. Sport should in any case be resumed gradually, with the patient, his parents, and trainers being made aware of the possible appearance of cardiorespiratory symptoms.
Sarah Brilot (1), Esther Calvo Lasso De La Vega (2), Christian Michaux (2), Leïla Belkhir (1), Lucie Pothen (1)Published in the journal : December 2022Category : Clinical Report
Fulminant hepatitis is a rare and fatal complication of Herpes simplex virus 1 (HSV1) infection, which can affect both immunocompetent and immunodeficient adults. The diagnosis is often delayed due to the rapid evolution of the infection, hence the importance of initiating rapid treatment with aciclovir. We report the case of a 36-year-old patient with no medical history who consulted for sudden asthenia after two days of fever and myalgia. The initial laboratory workup revealed hepatic cytolysis and bicytopenia (thrombocytopenia and leukopenia). The evolution was rapidly unfavorable, with the development of acute hepatic failure and a reactive hemophagocytic syndrome. The etiological workup then revealed an HSV1 infection. Treatment with aciclovir resulted in clinical and biological improvement, and the patient fully recovered.
Guy De Backer (1), Fabian Demeure (2), Olivier Descamps (3), Dirk De Bacquer (1)Published in the journal : October 2022Category : Cardiology
Primary prevention of cardiovascular disease (CVD) is actually needed, though poorly implemented as yet. The choice of the most optimal preventive strategy depends on the total cardiovascular (CV) risk of a given person. Several models have been developed to estimate total CV risk. Until recently, the SCORE model, calibrated for Belgium (SCORE-Belgium), has been recommended for that purpose.
A new model has now been developed and validated (SCORE 2), with certain advantages. Four systems have been advocated, and the ‘SCORE 2 low-risk’ system has been recommended for implementation in Belgium. This easy-to-use model allows for the stratification of the apparently healthy adult population into subgroups at low-to-moderate, high, and very-high total CV risk, so that preventive strategies can then be adapted accordingly. A recalibration of this ‘SCORE 2 low-risk’ model for Belgium seems unnecessary. The international model likely underestimates slightly the total CV risk in the population, which is in accordance with the position of Belgium as one of the countries with the highest CV mortality rates among the 10 countries considered being at ‘low CV risk’. Indeed, this only marginal difference does not justify a recalibration of the international model.