Acta Clinica Belgica最新文献

Introduction: The wide-reaching consequences of a restrictive diet are often underestimated or poorly recognized both by the public and many physicians. Deficiency symptoms may go unnoticed leading to unnecessary investigations and ineffective treatments, and a delay in a simple and directed treatment: suppletion of the missing nutrients.

Case presentation: This case-report describes a 68-year-old man in a high-income country who presented with a 3-week history of painful, indurated edema of the lower legs, immobility due to pain, and dyspnea. Treatment with antibiotics and LMWH was ineffective. Laboratory tests showed anemia (Hb 7.7 g/dL), elevated C-reactive protein (48 mg/L) and elevated D-dimers. He was hospitalized for further investigation. Folate and iron deficiencies were found. Pulmonary embolism and deep venous thrombosis were ruled out, as were systemic inflammatory diseases and infectious causes. PET-CT revealed lung changes suggestive of pulmonary hemorrhage and findings suspicious for bilateral lower leg fasciitis. Detailed dietary history revealed a severely restricted intake (limited to bread, white rice, butter, honey and coffee) for over 20 years. Skin biopsy and exclusion of differential diagnoses confirmed the clinical suspicion of scurvy due to vitamin C deficiency. Nutritional supplementation and dietary expansion led to rapid clinical improvement.

Conclusions: Although scurvy is more common in low- and middle-income countries, it still occurs in high-income settings. It should be considered in at-risk patients presenting with suggestive symptoms.

POEMS syndrome is a rare paraneoplastic disorder caused by an underlying plasma cell dyscrasia, characterized by a constellation of clinical features including polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and sclerotic bone lesions. Due to its rarity and variable presentation, diagnosis is often delayed. We present a case of POEMS syndrome in which the patient was initially ineligible for autologous stem cell transplantation (ASCT) due to poor performance status. Front-line treatment with daratumumab, lenalidomide, and dexamethasone (DRd) resulted in a rapid and durable clinical and biochemical response, including normalization of vascular endothelial growth factor levels. This improvement ultimately enabled the patient to successfully undergo ASCT.This case highlights the potential role of DRd as an effective induction strategy in functionally impaired patients with POEMS syndrome.

Objectives: Synchronous bilateral renal cell carcinoma (RCC) is a rare condition that presents significant clinical challenges in balancing oncologic control and renal function preservation. Due to the lack of standardized treatment guidelines, understanding prognostic factors and developing predictive models is crucial for optimizing clinical decision-making.

Methods: This study utilized the Surveillance, Epidemiology, and End Results (SEER) database (2000-2019) to retrospectively analyze independent risk factors associated with 2-year mortality in synchronous bilateral RCC patients. A predictive model was developed using multivariate Cox regression analysis and validated with receiver operating characteristic (ROC) curves and calibration plots. Patients were categorized based on surgical approach, and clinicopathological characteristics were compared.

Results: Among 1,291 eligible patients, 362 (28.03%) died within 2 years. Age, household income, and surgical approach were identified as independent mortality risk factors (p < 0.05). The predictive model demonstrated good discriminatory ability (AUC = 0.70 in the training cohort and 0.67 in the validation cohort). Surgical decisions were significantly correlated with tumor size, stage, and grade, with radical nephrectomy preferred for more aggressive tumors, whereas nephron-sparing procedures were more common in smaller, early-stage tumors.

Conclusion: This study provides a validated 2-year mortality prediction model that may assist in identifying high-risk patients and guiding personalized treatment strategies. The findings emphasize the impact of socioeconomic factors on prognosis and the need for optimized healthcare resource allocation.

Introduction: Bone disease after kidney transplantation is complex, converging features of senile, postmenopausal, glucocorticoid-induced, and chronic kidney disease (CKD)-associated osteoporosis.

Case presentation: We present a case of a 60-year-old female kidney transplant recipient with osteoporosis, who failed to show an improvement in areal bone mineral density (aBMD) after 5 years of annual intravenous therapy with 5 mg zoledronate. After thorough examination, persistent hyperparathyroidism and subsequent hypophosphatemia were pointed to as the most likely explanation.

Discussion: Persistent hyperparathyroidism is a common finding in kidney transplant patients. Therapy with antiresorptive agents may mask the bone phenotype of persistent hyperparathyroidism, delaying the initiation of parathyroid hormone (PTH) suppressive therapy. Meanwhile, PTH driven hypophosphatemia may be a cause of antiresorptive treatment failure.

Conclusion: Present case emphasizes the importance of controlling CKD-mineral and bone disorders prior to initiating bone targeting drugs, as also has been recommended by recent consensus manuscripts. In an era in which bone turnover markers gain importance in guiding PTH suppressive and osteoporosis therapy, antiresorptive agents may complicate the diagnosis of hyperparathyroidism by masking the bone phenotype.

Objectives: Data about the clinical management of patients with ovarian cancer (OC) in real-world settings are scarce. This study documents baseline characteristics, treatments, and clinical outcomes in a real-world population of women with newly diagnosed advanced-stage OC in Belgium.

Methods: This observational study, conducted at four hospitals in Belgium, retrospectively enrolled 120 women with FIGO (International Federation of Gynecology and Obstetrics classification) stage III or IV high-grade serous or endometrioid OC diagnosed between 2007 and 2018. Treatment outcomes, response to therapy, and patient survival were followed up until 20 months after diagnosis.

Results: Of 113 patients with a clinical response assessment, 49.6% were diagnosed with a stage IV disease, 53.1% underwent interval debulking surgery, 98.2% received any type of chemotherapy, and 35.4% received bevacizumab. Deleterious mutations in breast cancer susceptibility genes (BRCA1/BRCA2) were detected in 12/84 (14.3%) patients. After primary or interval debulking surgery, 50.0% and 60.0% of stage III, and 66.7% and 80.0% of stage IV patients had no visible residual disease, respectively. Following chemotherapy, 59.3% of patients had complete clinical response and/or no visible residual disease. Until month 20 of follow-up, 37.2% of patients were disease-free.

Conclusion: Until 2018, surgical resection followed by first-line chemotherapy and bevacizumab use comprised the cornerstone therapy for newly diagnosed FIGO stage IV OC in Belgium. Clinical response and progression-free survival rates were relatively high. The patients' BRCA1/BRCA2 status was insufficiently characterized, likely reflecting the lack of perceived relevance of BRCA1/BRCA2 mutations for OC treatment before adoption of targeted therapies in clinical practice.

Presbyopia is a very common condition, which can easily be treated with reading glasses. Although a number of contact lenses and surgical solutions have been introduced, also a number of pharmacological treatments have been proposed in recent years for treating presbyopia. As presbyopia is a multifactorial condition, a number of pharmacological approaches have been explored so far. Most eye drops contain miotic/parasympathomimetic agents (e.g. pilocarpine, carbachol, aceclidine), which create a pinhole effect. Pilocarpine and aceclidine already have been approved. Brimochol (carbachol + brimonidine, an α-agonist that helps further reduce pupil size have been submitted for approval, Tenpoint Therapeutics) and MR-14/Nyxol (phentolamine) will be submitted in the near future. Some newer formulations combine a miotic agent (to create the pinhole effect) with a non-miotic agent (to improve comfort or reduce ciliary spasm).On the other hand, chemical modification of the lens proteins has been explored as potential therapeutic options in presbyopia. These products target specific chemical modification (destruction of disulfide bridges, deglycation). Use of deglycating enzymes (e.g. fructosyl amino oxidase, FAOD) may rejuvenate the lens by removing the advance glycation end products which have been attached to the lens crystallins over the years.As these drugs are relatively new in the treatment of presbyopia, further studies will be needed to study the long-term effects, the effects of the products which are still in the pipeline and to establish the role of drug treatment in presbyopia.

Objective: In primary care, urinary tract infections (UTIs) are typically treated empirically, based on the likelihood of specific pathogens and their susceptibility profiles. The goal of this study was to reassess empirical treatment guidelines by comparing he current distribution and susceptibility of uropathogens.

Method: Distribution and susceptibility were analyzed and compared with data from three previous surveys conducted in Belgium over the past 25 years. Between August 2020 and February 2022, 137 general practitioners (GPs) collected midstream urine samples from adult female patients with specific cystitis symptoms. The dipslide was inoculated and sent for microbiological analysis.

Results: Of the 237 enrolled patients, 201 (85%) had positive cultures. Escherichia coli (74,6%) was the most frequently isolated uropathogen, followed by Staphylococcus saprophyticus (8%), Enterococcus faecalis (6,6%), and Klebsiella pneumoniae (3,3%), confirming the results of the 1995, 2005, and 2015 surveys. The susceptibility of E. coli in 2020 remained 100% for nitrofurantoin and fosfomycin. For ampicillin, there was gradual increase of resistance with a susceptibility in 2020 of 53,5%. The susceptibility rates were 97,5% for levofloxacin and 83,6% for trimethoprim-sulfamethoxazole. Contrary to previous surveys, pivmecillinam was included in the 2020 survey with a susceptibility of 94,8%.

Conclusion: Over a 25-year period, the distribution and antimicrobial susceptibility of uropathogens associated with uncomplicated UTIs remained stable. For the first time in Belgium, we assessed E. coli susceptibility to pivmecillinam and found excellent outcomes, suggesting that pivmecillinam could be considered equivalent to standard treatments for uncomplicated UTIs.

Background: Uncontrolled haemorrhage remains a leading cause of mortality, particularly in trauma care and intraoperative settings. Existing haemostatic agents such as kaolin and chitosan have limitations including thermal tissue injury, infection risk, restricted internal applicability and delayed clot formation.

Objective: This paper proposes a theoretical haemostatic innovation, Nano Clot-SAFE, designed to achieve rapid haemostasis (≤3 seconds) with enhanced biocompatibility, antimicrobial properties and usability in both external and internal bleeding scenarios.

Methods: A conceptual formulation was developed based on an extensive review of 30 peer-reviewed studies. The proposed composition includes silica-alginate nanocomposites, microporous starch, tannin-functionalised cellulose and silver-doped zinc oxide nanoparticles. The formulation is designed for delivery via air-jet or aerosol mechanisms. Safety and usability considerations were informed by systems-based frameworks including the Swiss cheese model, human factors engineering and systems thinking.

Results: Nano Clot-SAFE is theoretically designed to provide ultra-rapid clot formation, moisture resistance, antimicrobial action and surface adaptability, including compatibility with internal organs. The multi-component nano-powder formulation integrates multiple safety barriers aimed at reducing user error and enhancing clinical performance across trauma and surgical environments.

Conclusion: Nano Clot-SAFE represents a conceptual haemostatic framework rather than a finalised product. It offers potential applicability in emergency trauma care and surgical bleeding control. Further experimental validation and clinical testing are required. The proposed innovation highlights future directions in surgical technology development and trauma preparedness policy.

Objectives: To validate the Turkish versions of the Mini Sarcopenia Risk Assessment (MSRA-5 and MSRA-7) questionnaires among older adults.

Methods: In this cross-sectional study of 267 participants (aged 65-89 years), MSRA-5 and MSRA-7 were translated and culturally adapted. Reliability was evaluated by Cronbach's α and intraclass correlation coefficient (ICC). Diagnostic accuracy was assessed against national and international sarcopenia criteria using ROC analysis.

Results: Cronbach's α was 0.65; ICC for MSRA-5 and MSRA-7 were 0.86 and 0.73, respectively. AUC values were 0.78 (MSRA-5) and 0.74 (MSRA-7) with optimal cut-offs ≤45 and ≤30 (p < 0.001). Sensitivity and NPV for Turkish BMI criterion were 79.7% and 98.8%.

Conclusion: The Turkish MSRA-5 and MSRA-7 demonstrated acceptable reliability and validity as preliminary screening tools for sarcopenia among community-dwelling older adults.

Background: Nocardia farcinica is an uncommon cause of brain abscess, most often in immunocompromised hosts. Increasingly, cases in immunocompetent individuals are reported, but diagnosis remains challenging and mortality is high.

Case presentation: We report a 63-year-old diabetic male with sudden altered mental state and right temporal hemianopsia. Initial CT and FDG-PET/CT suggested a tumour, delaying suspicion of infection. MRI later revealed a cerebral abscess, and stereotactic aspiration yielded purulent material. Direct microscopy showed branching Gram-positive rods; culture identified Nocardia spp. within 1 week. MALDI-TOF confirmed N. farcinica, resistant to meropenem. Empirical ceftriaxone/metronidazole was switched to high-dose trimethoprim-sulfamethoxazole (TMP-SMX) and amoxicillin-clavulanate. The patient developed severe hyperkalaemia (7.7 mEq/L) necessitating TMP-SMX dose reduction and discontinuation of spironolactone. Follow-up MRI at 13 weeks showed complete resolution, with full recovery of visual function. Total therapy duration was 6 months.

Discussion: Although high-dose TMP-SMX remains the standard for CNS nocardiosis, toxicity is common. A recent multicenter cohort by Yetmar et al. found that in non-disseminated pulmonary nocardiosis, lower TMP-SMX doses achieved similar outcomes with significantly fewer adverse events, questioning whether universally high doses are necessary. While CNS involvement generally warrants aggressive therapy, our case highlights the need for individualized dosing and close monitoring. Early stereotactic drainage, rapid microbiological work-up, and timely therapy adjustments likely contributed to the excellent outcome in this high-risk patient.

Conclusions: This case underscores diagnostic challenges, therapeutic dilemmas, and potential for full recovery in N. farcinica brain abscess. It also emphasizes the importance of balancing efficacy and safety when determining TMP-SMX dosing.