Acta Clinica Belgica最新文献

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.

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: 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.

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.

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.

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.

Background: Obinutuzumab has increasingly been used in patients with PLA2R-associated membranous nephropathy (MN). However, reported outcomes vary substantially across studies due to heterogeneity in patient selection, response definitions, and follow-up duration. This study aimed to synthesize case-level extraction analysis to better characterize response patterns and factors influencing remission rates.

Methods: MEDLINE, Web of Science, SCOPUS, and grey literature were systematically searched. Case-level extraction analysis from eligible case reports and case series were synthesized to evaluate clinical and immunological remission.

Results: Eighty-nine patients from 19 publications were included. Most patients (64%) were reported from China. During a median follow-up of 12 months, overall clinical and immunological remission rates were 83% and 88.7%, respectively. Complete remission was numerically less frequent in patients refractory to prior immunosuppressive therapy compared with those who had previously responded (23.5% vs. 61.5%; nominal p = 0.012). Clinical remission appeared more common among patients followed for at least 12 months (92.6% vs. 75%; nominal p = 0.026). Geographic variation in reported outcomes was noted and appeared to be influenced by differences in follow-up duration and publication type. Adverse events were inconsistently reported; when reported, they were predominantly mild to moderate.

Conclusion: This descriptive case-level extraction analysis is consistent with previous small series reporting relatively high clinical remission rates for obinutuzumab in PLA2R-associated MN. The observed remission rates may be influenced by prior treatment responsiveness and duration of follow-up.

Objectives: To assess the prevalence of anti-aminoacyl tRNA synthetase antibodies (anti-ARS) in a large cohort of untreated early rheumatoid arthritis (RA) patients compared to healthy controls.

Methods: The baseline serum samples of patients with early RA (n = 332) included in the multicentre CareRA trial, a completed interventional trial in untreated early RA, and healthy controls (n = 72) were screened for anti-ARS antibodies with a commercial dot immunoassay (DIA). Radiolabelled protein immunoprecipitation (IP) was performed to confirm the presence of suspected anti-ARS antibodies, in addition to HEp-2 indirect immunofluorescence and a commercial line immunoassay (LIA).

Results: Anti-ARS antibodies (anti-PL12 n = 2, anti-OJ n = 1) were detected in 0.9% of early RA patients using a DIA, of which one anti-PL12-positive sample was also positive on LIA. Presence of these anti-ARS antibodies could, however, not be confirmed by protein immunoprecipitation. No anti-ARS antibodies were detected in the healthy control group.

Conclusion: We report that the presence of anti-ARS antibodies cannot be confirmed by IP in a multicentre cohort of untreated early RA patients. Anti-ARS autoantibodies should not routinely be evaluated in patients with early RA. Sensitivity and specificity issues with DIA and LIA for anti-ARS should be considered in the interpretation of anti-ARS testing.

Objectives: Medication reviews (MRs) in nursing homes (NHs) are valuable but time-consuming. Electronic screening tools can assist community pharmacists by detecting potential drug-related problems (pDRPs). This study aimed to evaluate the implementation of electronic tools (GheOP³S-tool and EBMeDS®CMR) to facilitate MR in NH residents and to explore the overall clinical and economic impact of this MR process.

Methods: A pilot study was conducted in one NH (January-July 2024). For each included resident (life expectancy of ≥3 months, excluding short-stays and general practitioner (GP) refusals), a 3-step MR was performed: 1) medication record analysis by a pharmacist using GheOP³S-tool and EBMeDS®CMR, and additional implicit screening, 2) interdisciplinary meeting (with pharmacist, GP, nurse) to discuss pDRPs and interventions, and 3) 3-month follow-up. Primary outcomes included the number, type, and resolution rate of pDRPs per screening method. Secondary outcomes were changes in medication use (number, fall risk-increasing drugs (FRIDs), Drug Burden Index (DBI)), and medication costs.

Results: Fifty-four residents were included (mean age 84.7 ± 8.9 years, 66.7% female). The electronic tools detected 508 pDRPs: 41.7% only by GheOP³S-tool, 29.5% only by EBMeDS®CMR, and 28.7% by both. The pharmacist appended 252 pDRPs. Of the 603 recommendations formulated, 48.4% were accepted and 37.5% implemented. The overall resolution rate was 40.1%. At follow-up, significant reductions were observed in number of medications, FRIDs, DBI, and medication costs.

Conclusion: GheOP³S-tool and EBMeDS®CMR detected a considerable proportion of complementary pDRPs. A substantial part of pDRPs was appended by the pharmacist, highlighting the importance of combining explicit and implicit screening.

Objectives: Familial hypercholesterolemia (FH) markedly increases the risk of premature atherosclerotic cardiovascular disease (ASCVD). Despite available therapies, FH remains underdiagnosed and undertreated. The aim of this study is to characterize FH patients and to evaluate treatment response specifically in those with a confirmed pathogenic mutation.

Methods: We retrospectively analysed 189 adults with clinical suspicion of FH seen at a cardiology department of a Belgian hospital between 2018 and 2024. Clinical, biochemical, and treatment data were retrieved from electronic records, and the Dutch Lipid Clinic Network (DLCN) score was calculated. Genetic testing was performed in 181 patients. Patients were stratified into primary and secondary prevention groups.

Results: The cohort comprised 116 patients (61%) in primary prevention and 73 (39%) in secondary prevention; the latter were older, predominantly male, and had more comorbidities. Genetic mutations were identified in 91 patients, most frequently in the LDL receptor gene (74%), followed by the ApoB gene (19%). Twenty-one patients had a DLCN score > 8, of whom four had no detectable pathogenic mutation. In genetically confirmed FH, mean LDL-cholesterol decreased from 267 ± 82 mg/dL at baseline to 100 ± 57 mg/dL at last follow-up, with greater reductions in secondary prevention. PCSK9 inhibitor use increased significantly during follow-up. Nevertheless, only 43% of secondary prevention patients achieved LDL-C < 55 mg/dL, and 24% of primary prevention patients reached < 70 mg/dL.

Conclusion: FH lipid management in this real-world cohort achieved substantial LDL-C reductions, but target attainment remained suboptimal.