Acta Clinica Belgica最新文献

Background: Chronic kidney disease (CKD) is becoming a global health concern due to its rising prevalence owing to the complex interplay of environmental, genetic, and epigenetic factors. Leukocyte telomere length (LTL) is a potential indicator of biological age in age-related diseases. Our objective is to investigate the association between LTL and CKD in Pakistani population to systematically synthesize existing evidence by investigating previously reported studies.

Material and methods: We conducted a case-control study (n = 166), aged 18-60 years. Relative LTL was measured using quantitative real-time PCR and expressed as telomere-to-single copy gene (T/S) ratios. Biochemical parameters and estimated glomerular filtration rate (eGFR) were assessed using standard methods. Multivariable linear regression adjusted for demographic and cardiometabolic factors was performed. A meta-analysis (11 studies, n = 24,089) were conducted.

Results: Our results revealed significant LTL attrition in CKD patients compared to controls with a moderate effect size. Correlational analysis revealed that LTL positively correlated with eGFR (p-value = 0.038) and negatively correlated with urea and creatinine (p < 0.05). After adjustment for age, sex, body mass index, diabetes, smoking, hypertension, and LDL cholesterol, CKD status remained independently associated with shorter LTL. Meta-analysis demonstrated an overall trend toward shorter telomeres in CKD, although substantial heterogeneity and evidence of small study effects were observed. Subgroup analysis in Asian populations showed a consistent but less robust association.

Conclusion: LTL is associated with CKD, which may reflect systemic biological aging and disease burden rather than serving as a standalone clinical biomarker. Longitudinal studies are required to clarify causality and population-specific effects.

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: Sarcopenic obesity (SO) is a syndrome increasingly recognized in older adults. We aimed to conduct a systematic review and a meta-analysis to reveal the global prevalence of SO in olders, and the effects of non-pharmacological interventions on the different components of SO.

Methods: A comprehensive search of 3270 studies was conducted between 2009 and 2021 from PubMed, Scopus, and Cochrane databases. After screening we included 57 studies. Statistical analysis was performed in R software. The standardized mean difference was used as the effect size and heterogeneity was evaluated with I² statistic. Low muscle mass(MM) or low MM plus low muscle strength(MS) were used for the diagnosis of sarcopenia, body fat percentage (BF%), waist circumference (WC) or body mass index (BMI) parameters were used for the diagnosis of obesity. Intervention studies included exercise-based interventions, nutritional-based interventions,combined interventions, and electrical acupuncture.

Results: The global SO prevalence was 7%. The prevalence of SO, depending on the sarcopenia definition, was 8% and 5% due to MM and MM plus MS, respectively. The prevalence of SO, depending on the definition of obesity, was 8%, 5%, and 7% according to BF%, BMI, and WC, respectively. In the overall intervention groups, BF% was reduced, MS and MM was increased. Exercise appears to have a more pronounced effect on sarcopenia.

Conclusion: The global prevalence of SO in the older population was 7%. MS and MM improved, and BF% decreased significantly in the overall intervention groups, with a more pronounced effect in exercise intervention studies.

Objective Acute upper gastrointestinal bleeding (AUGIB) is one of the most common critical conditions in clinical practice and is characterized by rapid progression and a high incidence of secondary acute kidney injury (AKI). This study aimed to analyze the clinical characteristics of patients with AUGIB, identify related risk factors for secondary AKI, and develop a predictive model for AKI risk in this patient population. Methods A retrospective analysis was conducted on 300 patients with AUGIB admitted to our department. Patients were categorized based on the occurrence of AKI within 7 days. Univariate analysis and Least Absolute Shrinkage and Selection Operator (LASSO) regression were used for feature selection, followed by multivariable logistic regression to construct a predictive model. The model's performance was rigorously evaluated through bootstrap internal validation, calibration curves, and decision curve analysis (DCA). Results Seven independent risk factors were identified and incorporated into the SCORE-AKI: a history of renal insufficiency, hypertension, shock index > 1, Glasgow Coma Scale score ≤14, hemoglobin < 60 g/L, platelet count < 50 × 109/L, and serum creatinine > 103 μmol/L. The model showed strong discrimination with a bootstrap-corrected area under the curve (AUC) of 0.808, which was significantly superior to the Glasgow Blatchford score (AUC: 0.722, p < 0.001). The model also demonstrated excellent calibration and a positive net benefit across clinical decision thresholds. Conclusion The SCORE-AKI model is a accurate, well-calibrated, and clinically useful tool that outperforms the GBS for predicting secondary AKI risk in patients with AUGIB, potentially aiding in early risk stratification and preventive intervention.

Background: Systemic inflammation contributes to arrhythmogenesis in acute coronary syndromes, but its role in NSTEMI-related ventricular arrhythmias remains poorly defined. The pan-immune-inflammation value (PIV) is a novel composite biomarker reflecting immune and thrombotic activity derived from routine blood counts. This study aimed to assess the association between PIV and the risk of sustained VT/VF in NSTEMI.

Methods: In this retrospective cohort study, 1,788 NSTEMI patients who underwent percutaneous coronary intervention were analyzed. The primary endpoint was the occurrence of sustained VT or VF during hospitalization. PIV was calculated as (neutrophil × platelet × monocyte)/lymphocyte. Logistic regression, ROC analysis, Kaplan - Meier curves, reclassification indices (NRI, IDI), and restricted cubic spline modeling were used.

Results: VT/VF occurred in 34 patients (1.9%). Those with VT/VF had significantly higher PIV values (median 1132 vs. 329, p < 0.001). In multivariable analysis, PIV remained an independent predictor (OR: 1.356 per 1000 unit increase; 95% CI: 1.028-1.787; p = 0.031). The risk of VT/VF rose progressively across PIV quartiles (Q4 vs. Q1 OR: 4.0, p for trend < 0.001). Adding PIV to conventional predictors improved risk classification (NRI: +0.089; IDI: 0.007). Kaplan - Meier analysis showed significantly reduced arrhythmia-free survival in high-PIV tertiles (log-rank p < 0.001), and cubic spline modeling revealed a non-linear association with increased arrhythmic risk at higher PIV levels.

Conclusions: Elevated PIV is independently associated with malignant ventricular arrhythmias in NSTEMI. As an accessible biomarker, PIV may aid early arrhythmic risk stratification and guide clinical surveillance strategies.

Background: Listeria monocytogenes Meningoencephalitis is a rare but potentially severe and lethal infectious disease caused by Listeria monocytogenes invading the central nervous system. The infection mainly affects the immunocompromised, neonates and older adults.

Case report: A 71-year-old woman without relevant medical history was referred to the emergency department with febrile gastroenteritis. Upon admission, neurological examination was normal. Ten hours after admission, an acute neurological deterioration was observed, with the patient exhibiting incoherent speech and ocular motility abnormalities. She appeared lethargic, not oriented in time or place, and with nuchal rigidity. Cranial nerve testing revealed a left-sided internuclear ophthalmoplegia and a left-sided nervus abducens palsy. A tentative diagnosis of meningoencephalitis was made. Empirical treatment was initiated with high-dose amoxicillin, high-dose ceftriaxone, and high-dose aciclovir. Lumbar puncture was performed, and both culture and polymerase chain reaction were positive for Listeria monocytogenes. Antibiotic therapy was narrowed to high-dose amoxicillin. Magnetic resonance imaging showed edema within the brainstem and signs of a small abscess. The patient developed an acute kidney injury and therapy was switched to high-dose meropenem. Her neurological symptoms improved but the left internuclear ophthalmoplegia and nervus abducens palsy remained present.

Conclusions: Listeria monocytogenes Meningoencephalitis is a severe infectious disease with marked morbidity that can occur in previously immunocompetent hosts, regardless of age.

Objectives: To review the current evidence on intermittent fasting (IF) and ketogenic diet (KD) as dietary interventions for the management of metabolic syndrome (MetS) and type 2 diabetes mellitus (T2D), including their mechanisms of action, clinical benefits, and potential when used in combination.

Methods: A narrative review of recent scientific literature examining the physiological mechanisms, clinical outcomes, and practical implementation of IF and KD in patients with MetS and T2D. The focus is on studies evaluating glycemic control, body weight, lipid profiles, and inflammation, as well as the proposed shared biochemical pathways involving AMPK activation and mTOR inhibition.

Results: Both IF and KD independently show clinically significant benefits in improving metabolic parameters in MetS and T2D, including reductions in HbA1c, fasting glucose, body weight, and triglycerides. Mechanistically, both approaches enhance insulin sensitivity, promote autophagy, reduce inflammation, and activate energy-regulating pathways (AMPK) while inhibiting mTOR. Emerging evidence suggests that combining IF and KD may offer synergistic metabolic effects, although data on long-term safety, adherence, and patient-specific suitability remain limited.

Conclusions: IF and KD represent promising, non-pharmacologic strategies for improving metabolic health in patients with MetS and T2D.