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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Pitfall of diagnostic medicine: an uncommon cause of legs ulcers

Eva Larrañaga, Jean-Baptiste Nicolas, Julian Muguerza Published in the journal : April 2020 Category : General Internal Medicine

Calciphylaxis is an uncommon and complex syndrome characterized by the occlusion of micro-vessels within the subcutaneous tissue, resulting in painful ischemic skin ulcers. Its prognosis is poor, and the disease is associated with a high mortality rate. This rare condition usually affects patients with chronic kidney disease, but it may also occur in patients with normal kidney function. The pathogenesis of calciphylaxis is unlikely to be linked to vascular calcifications, which are frequently seen in the general population. Therapeutic guidelines are still lacking, whereas recent studies have improved the understanding of the condition’s physiopathology, enabling us to expect encouraging therapeutic approaches. Through a clinical case, this paper highlights the condition’s diagnostic difficulties and discusses its physiopathology, as well as treatment procedures.

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Systemic IgG4 disease, a rare cause of severe acute pancreatitis

Rhita Bennis, Tatiana Roy, Yves Nang Atto, Michel Ides Colin Published in the journal : April 2020 Category : Gastroenterology

Autoimmune pancreatitis (AIP) remains little known. It is part of the differential diagnosis of acute non-alcoholic, non-biliary pancreatitis. The clusters of arguments in favor of type 1 AIP diagnosis are the clinical profile (male aged 50-70), the imaging (diffusely enlarged, “sausage-like”, pancreas), the elevation of serum IgG4 beyond the threshold of 135 mg/dl, the histological criteria and the disease corticosensitivity. Type 1 AIP is a component of the systemic IgG4 disease. Lymphadenopathies, pancreatitis and tubulointerstitial nephritis are the most frequent pathologies occurring in IgG4 disease. The evolution is often favorable following treatment with corticosteroids. Given the risk of relapse, a follow-up is necessary. The purpose of this article is to highlight the major elements leading to the diagnosis and treatment of type 1 AIP.

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Post-stroke sexual dysfunction: an update

Morgane Chalon, Irina Tacu, Agnieszka Gierasimowicz-Fontana, Marie-Dominique Gazagnes, Eric Durand Published in the journal : April 2020 Category : Médecine Physique et Réadaptation

Sexuality and intimacy are essential aspects of an individual's quality of life. Sexual dysfunction is an underestimated and underevaluated complication of stroke. The issue is often fudged by patients and sparsely discussed by health professionals. The cause of post-stroke sexual dysfunction is multifactorial, including neuro-anatomical, physical, psychological, and cultural factors. The resumption of sexual life is part of the post-stroke recovery goals. The diagnosis and treatment of sexual dysfunction should undeniably be part of the rehabilitation process. In this narrative review, we explored the literature pertaining to sexuality in stroke patients and discussed the health professional’s behavior towards sexual rehabilitation. The articles were selected based on a PubMed research using the keywords “stroke”, “sexuality”, “stroke rehabilitation”, “sexuality after stroke” as well as combinations of these keywords. The results of this review are presented herein.

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Type 1 Gaucher disease: diagnostic and therapeutic challenges

Déborah Costard, Cédric Hermans Published in the journal : April 2020 Category : Rare Diseases

Gaucher disease is the result of a deficiency of a lysosomal enzyme, glucocerebrosidase, which causes the accumulation of its substrate, glucosylceramide, in macrophages. Bone involvement, (hepato)splenomegaly, bleeding diathesis, thrombocytopenia, increased ferritin levels, and immunoglobulin abnormalities, such as monoclonal gammopathy or hypergammaglobulinemia, are all clinical or biological signs that should prompt a diagnosis of Gaucher disease. Type 1, the most common form, is responsible for visceral damage, while Types 2 and 3 are responsible for neurological disorders. The diagnosis, which is facilitated by using algorithms, is based on the confirmation of the enzyme deficiency and search for the causal mutation. Treatment involves the intravenous administration of the deficient enzyme, such as miglucerase, velaglucerase, or taliglucerase) or the use of oral molecules that inhibit the biosynthesis of glycosylceramide like miglustat or eliglustat.

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A new health care system is needed!

Philippe A. Coucke Published in the journal : April 2020 Category : Médecine et société

Our health care system is not sustainable anymore. A new ecosystem is absolutely mandatory. The key elements of this new system are as follows: Internet of Things (IoT), big data, artificial intelligence, as well cloud and blockchain. In such a system, patients become connected “objects” within the IoT and, hence, produce a real continuous tsunami of data. To transform this enormous amount of data in useful information, we need artificial intelligence. This will allow for the evolution towards refined and personalized diagnostics and treatment decisions.

Worldwide demographics are at the origin of the shift towards connected health care and “offshoring”, both for primary and specialized care. The connection of patient results within a continuous data flux characterized by big volumes, variability and velocity. In order not to bias artificial intelligence, we must ensure data veracity. Automation becomes mandatory in all sectors of human activity, inclusive health care. This will likely be a perfect opportunity to come back to the real values in health care: communication, teamwork, and human empathy.

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