COVID-19 in primary care medicine

Cassian Minguet Published in the journal : May 2020 Category : Médecine Générale

The COVID-19 pandemic has had and still has a remarkable impact on general medicine in Belgium. From the day the first Belgian case was diagnosed on February 4, 2020 until the beginning of de-containment- three full months have passed during which general medicine needed to re- structure itself more effectively to be able to speak up with one voice, adapted itself by switching to telemedicine during the population’s confinement period, and constantly developed updated management procedures. In the first month, general practitioners (GPs) did not expect a pandemic of this magnitude to occur. In the second month, things accelerated and GPs’ offices closed their doors, with GPs applying themselves the procedures they helped convey to their patients over the phone. By the third month, while suspicious cases sharply dropped, procedures needed to be strengthened. The situation is more difficult in nursing homes. Within 3 months, relations with patients, colleagues, paramedics, and institutions were, there, entirely altered. In other countries as well, there has been a profound change that is likely to profoundly impact medical practices in the long term. On the eve of a new phase consisting of progressive de-containment, general medicine is now properly prepared to assume its role of an essential player in the fight against coronavirus in the wider community.

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A geriatric care unit dedicated to COVID-19 elderly patients

Isabelle Gilard, Isabelle De Brauwer, Pascale Cornette Published in the journal : May 2020 Category : Geriatry

This article describes the transformation of a geriatric care unit into a COVID-19 geriatric care unit. Besides ensuring proper treatment, the multidisciplinary team adapted its care practice and procedures with the objective of preserving the patients’ functional capacities. Each dimension of health is taken into account and the adaptations are described in the light of this challenge. Along with the severity of our patients' medical and functional situations, infectious isolation is the parameter that most influences the adaptations and generates the most complexity.

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Ethical issues relevant to a pandemic crisis: A local planning strategy to manage the intensive care unit admissions to hospitals

Olivier Descamps, Pierre Henin, Pierre Hanotier, Francois-Xavier Lens, Jean-Paul Meurant, Michèle Pieterbourg, Sébastien Loix, Vanessa Wauters, Isabelle Reusen . Published in the journal : May 2020 Category : Ethics

The region of Mons-Borinage and Center in the Province of Hainaut was one of the most affected by the COVID-19 epidemic in both the Walloon region and Belgium. While facing the constant flow of patients and threat of intensive care unit saturation in this part of the Hainaut Province, the various medical teams that were particularly involved in the care of these patients (intensive care, emergency care, department of general internal medicine and geriatrics) had to implement admission management strategies in collaboration with general practitioners, medical directors, and the ethics committees.

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COVID-19 and diabetes

Laura Orioli, Michel P. Hermans, Vanessa Preumont, Audrey Loumaye, Jean-Paul Thissen, Orsalia Alexopoulou, Raluca Furnica, Maria-Cristina Burlacu, Dominique Maiter, Jean-Cyr Yombi, Bernard Vandeleene Published in the journal : May 2020 Category : Diabétologie

Diabetes is one of the most commonly reported comorbidities in COVID-19-infected patients. According to current data, diabetic patients do not appear to be at increased risk of contracting SARS-CoV-2 compared to the general population. However, diabetes is a risk factor for developing severe and critical COVID-19 forms, which often require intensive care unit admission and, eventually, invasive mechanical ventilation, which are associated with high mortality rates. The characteristics of COVID-19 diabetic patients and prognostic impact of diabetes on SARS-CoV-2 infection are currently under investigation. Obesity, the main risk factor for incident Type 2 diabetes, appears to be more common in patients with critical COVID-19 forms that require mechanical invasive ventilation. In diabetic patients, COVID-19 is associated with poor glycemic control and acute metabolic complications like ketoacidosis. At present, there are no recommendations in favor of discontinuing antihypertensive medications that interact with the renin-angiotensin-aldosterone system. Owing to the risks of lactic acidosis and ketoacidosis, metformin and SGLT2 inhibitors should be discontinued in patients with severe COVID-19 forms. Finally, we advise a systematic screening for (pre)diabetes in patients with proven SARS-CoV-2 infection.

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Cutaneous manifestations associated with COVID-19

Marie Baeck, Caroline Peeters, Marie Cuvelier, Laetitia Fameree, Evelyne Harkemanne, Fanny Ickx, Margaux Mairlot, Marine Matthews, Nina Nielens, Laura Nobile, Romane Thirion, Anne Herman Published in the journal : May 2020 Category : Dermatology

Skin manifestations are considered uncommon presentations of COVID-19. Despite reported cases in the literature, no causal link has been formally demonstrated to date. Skin lesions associated with COVID-19 are: 1) rashes that are classically viral or paraviral in nature like exanthemas, urticaria, and erythema multiforme; 2) eruptions that are secondary to the systemic consequences of COVID-19 like vasculitis or thrombotic vasculopathy; 3) rashes induced by drugs prescribed as part of COVID-19; 4) skin lesions like chilblains that are likely to be an indirect consequences of COVID-19 and containment measures.

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Cardiological aspects of COVID-19 infection

Christophe Scavée, Agnès Pasquet, Christophe Beauloye Published in the journal : May 2020 Category : Cardiology

From the beginning of the COVID-19 crisis, physicians alerted the scientific community to the emergence of severe acute respiratory problems related to viral lung infections. The vast majority of these patients require oxygen therapy and 5 to 10% need assisted ventilation or even extracorporeal membrane oxygenation in the event of an uncontrolled situation. Poor prognosis factors mainly include age, as well as the presence of comorbidities such as hypertension, diabetes, obesity, but also cardiovascular diseases. Coronaviruses are known to attack the cardiovascular system, and it also appears that the virus might attack the heart muscle directly. Data relayed namely by Chinese and Italian physicians show that besides the lungs, certain patients develop sometimes severe cardiac problems, such as acute myocarditis, acute coronary syndrome (ACS), or arrhythmias that in turn lead to heart failure, shock, or cardiac arrest in those most affected. Cardiac damage is therefore a factor contributing to the poor prognosis of COVID-19 and it must be detected. Patients who have an ACS but whose pulmonary picture prevails may have their cardiac management dangerously delayed. Conversely, patients who present with an exclusively "cardiological" picture may not be properly diagnosed as COVID-19. Finally, the focus on COVID-19 and the patients' fear of the contagiousness of this virus may delay their presentation at the hospital. These data directly impact the way physicians and hospitals should consider COVID-19 cardiac patients, especially at the first signs of the disease. It is therefore essential to have recommendations for the management of all patients with preexisting heart problems and those with demonstrated myocardial damage caused by the virus.

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Diagnostic testing for COVID-19

Jean-Luc Gala, Omar Nyabi, Jean-François Durant, Nawfal Chibani, Mostafa Bentahir Published in the journal : May 2020 Category : Méthodes diagnostiques du COVID-19

Diagnosing COVID-19, which has recently been renamed COVID, in a quick and accurate manner constitutes the cornerstone of pandemic control. However, this evidence shared by almost everyone is being challenged by the truly-multifaceted nature of the SARS-CoV2 infection, which is the well-identified viral cause of COVID. In addition to the completely asymptomatic forms, there are indeed mild or pauci-symptomatic forms, moderate-to-severe forms, the latter requiring hospital care, as well as very severe forms requiring intensive care admission and assisted ventilation. All of these viral infection manifestations are likely to contribute to virus transmission within communities. Among the diagnostic tests to confirm COVID, we have used the reverse transcription reaction followed by a real-time quantitative chain polymerization reaction (RT-qPCR) rapid diagnostic testing based on specific SARS-CoV-2 antigen detection in the early phase of infectious manifestations. In addition, we have applied serum antibody testing, such as ELISA and lateral flow assay, in both the later phase and following recovery. Owing to the lack of an optimal "reference test", the respective sensitivities and specificities reported in the different published studies must all be considered with great caution. For this reason, we shall only briefly comment on them.

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COVID-19 patients and anesthesia

Chloé Damman, Guillaume Lemaire, Fabienne Roelants Published in the journal : May 2020 Category : Anesthésie

In March 2020, the COVID-19 outbreak enforced the initiation of the Hospital Emergency Plan in Belgian hospitals. The anesthesiology department of the Cliniques universitaires Saint-Luc (CUSL) was invited to develop strategies designed to adapt the workflow at an ever increasing pace and ensure an optimal provision of care. Among these strategies was the reorganization of the operating room and maternity department, along with their respective staff, introduction of personal protective equipment, formulation of guidelines for anesthetic management, as well as simulation exercises in order to train and prepare staff.

These measures were deemed necessary in order to assure the quality of care and reduce the risk of transmission to other patients or healthcare workers.

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Hyperglycemia in type 2 diabetes: a synthesis of the new therapeutic recommendations

Martin Buysschaert Published in the journal : April 2020 Category : Diabétologie

This paper sought to describe and discuss the new guidelines for the treatment of hyperglycemia in patients with Type 2 diabetes, published in 2020 by the American Diabetes Association (ADA) and European Association for the Study of Diabetes (EASD). Besides lifestyle measures, metformin remains the first-line treatment. Additional antihyperglycemic agents are now selected depending of a past history of cardiovascular or renal diseases. Antidiabetic agents with proven cardiac and renal protection should be privileged, particularly in secondary prevention. These recommendations define a structured strategy, which must be implemented in each country, according to internal rules.

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A pediatric case of locked-in-syndrome

Laura Wulleman, Magali De Roy, Sybille Andries, Christine Bonnier, Leslie Danvoye Published in the journal : April 2020 Category : Pediatrics

The locked-in syndrome (LIS) is a rare neurologic disorder, especially in the pediatric population. It is defined by five clinical criteria: (1) persistence of eye opening and presence of vertical eye movements; (2) preserved superior cortical functions; (3) aphonia or severe hypophonia; (4) quadriplegia or quadriparesis; (5) initial communication mode with vertical eye movements or blinking. The LIS should be considered as part of the differential diagnoses appertaining to vegetative states and comas. The most common etiology is a pontine stroke, caused by vertebrobasilar artery thrombosis. We herein describe a pediatric clinical case of this pathology, which represents a challenge in terms of both diagnosis and management.

In this article, we present the etiological factors of ischemic pediatric stroke, a problem with multiple risk factors, with particular attention paid to post-varicella vasculopathy and its therapeutic management.

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