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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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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Unusual cause of back pain in a previously healthy teenager

Lara Lunelli, Camelia Rossi, Nathalie Demeulenaere, Marc Léon, Xavier Collard Published in the journal : July 2021 Category : Clinical Report

Infectious spondylodiscitis is a rare disease in children, generally of hematogenic origin. In the reported case, the clinical presentation was non-specific, whereas the usual symptom consisting of severe low back pain was present.

The responsible agent, which is not always found, is usually detected using blood cultures. The most commonly implicated germs are Staphylococcus aureus, Streptococcus α-hemolytic, Streptococcus pneumoniae bacteria, and gram-negative bacilli

Evidence of Streptococcus pyogenes is anecdotical.

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Anti-SAE ½ antibody-associated dermatomyositis on adalimumab treatment: a case report

Léa Frisson, Cédric Mahiat, Pauline Richez, Liliane Marot, Henri Colin, Philippe D’Abadie, Julie Lelotte, Jean Cyr Yombi, Halil Yildiz Published in the journal : July 2021 Category : Clinical Report

Dermatomyositis (DM) is an autoimmune inflammatory disorder affecting the skin and muscles, whose etiology is often unknown. While DM induced by biological agents like anti-tumor necrosis factor-alpha agents is uncommon, this disorder is mainly seen in patients with autoimmune disorders or underlying neoplasms. We report the case of a 57-year-old female patient who developed DM with anti-small ubiquitin-like modifier-1 activating enzyme (anti-SAE 1/2) antibodies following an adalimumab treatment on account of refractory hidradenitis suppurativa. Our patient presented typical cutaneous findings consisting of heliotrope rash, Gottron papule, arthralgia, joint swelling, proximal muscle weakness, and dysphagia. Laboratory studies showed mild inflammatory syndrome, polyclonal hypergammaglobulinemia, hypoalbuminemia, high LDH levels, yet normal CK, AST, and ALT levels. Myositis-specific antibody assay was found to be positive for anti-SAE 1/2 antibodies. The electromyogram (EMG) and muscle biopsy revealed inflammatory myopathy. Systemic corticosteroid therapy was initiated. As a result, the patient’s joint pain and muscle strength both improved following 7 days of treatment. A clinical recurrence of the pathology occurred during the gradual regression of corticosteroid therapy, requiring the initiation of azathioprine with both good clinical and biological responses.

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Cold urticaria

Nathalie Bilem, Marie-Noelle Vogeleer, Julien Mergen, Samuel Balbeur Published in the journal : July 2021 Category : Clinical Report

Cold urticaria is a physical urticaria induced by contact with cold environments like water or air, but also by contact with cold objects, food, or beverages. The severity of the reaction can vary widely, ranging from a simple urticaria up to an anaphylaxis with cardiovascular collapse. The cardiovascular and respiratory systems are mostly involved in severe anaphylaxis cases. Severe anaphylaxis occurs most often following aquatic activities in cold water. The diagnosis is based on the clinical history together with an ice cube challenge test. The treatment is based on antihistamines, as well as on using an epinephrine auto-injector in anaphylaxis cases. Awareness on how to avoid risk factors is also crucial, particularly including a warning against immersion in water colder than 25°C and against the ingestion of very cold food. Differential diagnosis includes the different forms of chronic physical urticaria.

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Ketamine in emergency situations: a molecule with a bright future!

Vanessa Bellemans, Caroline Declerfayt, Jean-Marie Jacques Published in the journal : July 2021 Category : Emergency

Ketamine is an old drug that was first used in the 1960s in anesthesia, displaying quite special properties. This agent is simultaneously hypnotic, amnesic, bronchodilator, antidepressant, and analgesic, while offering a safe profile of use. It preserves airway protection reflexes and respiratory drive, provides hemodynamic stability, and exerts enhanced sympathetic activity. These properties render it ideal for managing critically ill patients. In the emergency room, ketamine plays already a role in intubation support, sedation, and analgesia. Recently, its indications have been extended to the domains of psychiatry and neurology.

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