Acta Clinica Belgica最新文献

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.

Objectives: Recently, eosinophilic Chronic Obstructive Pulmonary Disease (COPD) has been identified as a clinically relevant phenotype, as patients with elevated blood eosinophil counts (BEC) demonstrate a better response to maintenance inhaled corticosteroids (ICS). This real-world study in Belgian primary care describes the distribution of BECs and the ICS use in stable COPD patients.

Methods: This study retrospectively analysed data from two primary care practices using the most recent values retrievable from the electronic health record. Patients were dichotomized based on BEC GOLD thresholds of 100 and 300 cells/µL.

Results: Eighty stable COPD patients (60% male, mean (SD) age of 70.7 (9.7)years, mean FEV1 (SD) of 65.4 (17.5) % Predicted) were included. Amongst them, 46% used ICS maintenance therapy. BEC values ranged from 0 to 667 cells/µL with a median (IQR) of 182 (80-291) cells/µL. 71% and 23% of patients presented BEC > 100 and ≥ 300 cells/µL, respectively. The mean age in the BEC^≥300 group was significantly higher than in the BEC^<300 group (MD = 7.2 y; p = 0.005). No other significant differences in demographic characteristics, dyspnea, FEV1 % Predicted, ≥1 moderate/severe exacerbations in the previous year, current maintenance ICS use, number of comorbidities or Charlson Comorbidity Index were detected between groups.

Conclusion: In this primary care population in Belgium, elevated BECs and maintenance ICS use are prevalent. Besides age, clinical characteristics were comparable between eosinophil-based groups whether the 100 or 300 cells/µL threshold was used.

Trial registration: Not applicable given the retrospective nature of the study.

Objectives: Liver cirrhosis is a leading cause of morbidity and mortality worldwide, with complications such as ascites, spontaneous bacterial peritonitis (SBP), and hepatorenal syndrome (HRS) significantly worsening prognosis. This paper aims to review the pathophysiology, diagnostic approaches, and management strategies for ascites and the complication of it, emphasizing the role of portal hypertension.

Methods: We conducted a comprehensive review of the literature on liver cirrhosis, portal hypertension, ascites formation, and related complications. Existing evidence was evaluated and ranked using the GRADE system: A (high) to D (verly low). Recommendation strength was graded 1 (strong) or 2 (weak).

Results: Portal hypertension is the key factor in ascites development. Non-invasive tools such as liver stiffness measurement (LSM) have proven to be effective in identifying patients at risk for clinically significant portal hypertension (CSPH), thus guiding treatment decisions. Carvedilol, recommended over propranolol, offers superior efficacy in reducing portal pressure. Diuretics, in combination with a moderate sodium-restricted diet, are the first-line treatment for ascites. However, refractory ascites requires advanced interventions. Spontaneous bacterial peritonitis (SBP) remains a major complication in patients with ascites, while hepatorenal syndrome - acute kidney injury (HRS-AKI) demands early recognition and timely vasoconstrictor therapy.

Conclusions: Liver cirrhosis and the complication of it significantly impact patient quality of life and survival. Portal hypertension is a critical driver of ascites and other complications, making early identification through non-invasive diagnostic methods essential for appropriate management. Medical treatments, including non-selective beta-blockers (NSBBs), diuretics, and advanced procedures, offer substantial benefits in controlling ascites and preventing further decompensation.

Objectives: Bone metastases in breast cancer are typically osteolytic but can rarely be osteoblastic. While malignancy-related hypercalcemia is well-known, malignancy-related hypocalcemia is rare and often multifactorial.

Case presentation: We present a case of a 48-year-old woman with metastatic breast cancer who developed severe hypocalcemia due to a combination of expanding osteoblastic bone metastases and hypoparathyroidism after total thyroidectomy. Despite oral and intravenous calcium supplementation, adequate calcium levels were not achieved until the patient responded to systemic therapy with Trastuzumab Deruxtecan (T-DXd), a HER2-directed antibody-drug conjugate.

Conclusion: This case underscores the challenges in finding the cause of and managing hypocalcemia in patients with complex oncological histories and emphasizes the need for close calcium monitoring in patients with bone metastases, particularly those with additional risk factors such as hypoparathyroidism or treatment with anti-resorptive drugs.

Objectives: To illustrate the diagnostic challenges, as well as the importance of early recognition of rare immunotherapy-induced complications, presenting a case and literature of sarcoid-like granulomatous reaction.

Methods: This report presents a case of asymptomatic hypercalcemia, revealing a sarcoid-like granulomatosis in a patient with metastatic melanoma, treated with an immune checkpoint inhibitor (ICI). In the discussion, an overview of the existing literature is provided through a PubMed search.

Results: Thorough investigations are essential to rule out disease progression and other possible explanations. Ultimately, biopsy with extensive staining led to the diagnosis of sarcoid-like granulomatosis. As there is no consensus in treatment, we suggest a case-by-case assessment, if possible by discussion within the multidisciplinary treatment team, to decide discontinuation of the causal ICI-therapy or the use of systemic steroids as supportive therapy.

Conclusion: This case demonstrates the importance of a broad differential diagnosis when identifying an asymptomatic hypercalcemia as well as new CT-graphic lesions, since the diagnosis of sarcoid-like granulomatosis can avoid not only unnecessary changes in treatment plans, avoiding toxicity, but also be a sign of good prognosis.

Patients with liver disease experience complex haemostatic changes leading to a state of 'rebalanced haemostasis' that may shift towards bleeding or thrombosis due to complications like kidney dysfunction, bacterial infection, or acute-on-chronic liver failure. Traditional coagulation tests inadequately capture haemostasis in cirrhosis, whereas advanced assays like thrombin generation assay and viscoelastic testing offer better insights but remain limited in clinical outcome prediction or guiding pre-procedural prophylaxis.Contrary to the traditional view of cirrhosis as a bleeding disorder, recent evidence highlights a paradox of higher venous thromboembolism incidence in hospitalised cirrhotic patients. Misconceptions about 'auto-anticoagulation' and concerns about anticoagulation safety hinder consistent thromboprophylaxis. Emerging data suggest that low molecular weight heparin is safe and effective in cirrhotic patients, supporting more evidence-based thromboprophylaxis. For thrombotic events or conditions like atrial fibrillation, therapeutic anticoagulation is recommended, and may offer additional benefits, such as attenuating liver fibrosis and portal hypertension. However, anticoagulation is not established as a core therapy in cirrhosis, given safety concerns in advanced disease.Bleeding remains a significant challenge in cirrhosis, with management focusing on specific aetiologies, including portal hypertension or procedural injuries. In pre-procedural planning, there is a trend of unnecessary blood product use, often based on an assumed bleeding risk. Rational pre-procedural planning should minimize unnecessary transfusions, optimise modifiable risks, and include a plan for managing potential bleeding.This review aims to clarify the 'coagulation paradox' in cirrhosis, promoting a nuanced, individualized approach to managing bleeding and thrombosis in chronic liver disease.