Acta Clinica Belgica最新文献

Objectives: Pregnancy is a period of heightened vulnerability to mental health problems. This pilot study aims to investigate the association between psychosocial and obstetric risk factors and the onset of depressive and anxious symptoms during pregnancy, with a focus on cumulative risks.

Method: Conducted at Ghent University Hospital in Belgium, this prospective observational study involved 378 pregnant women. Participants received a semi-standardized psychosocial assessment at 16 weeks to evaluate potential risk factors, followed by stepped screening protocol for depressive and anxious symptoms at 20 weeks. Due to significant overlap, the analysis focused solely on depressive symptoms.

Results: Depressive symptoms were identified in 5.5% of participants with a score ≥ 13 on the Edinburgh Depression Scale. Key psychosocial risk factors that increase the risk of antepartum depression include a history of mental health issues, especially depression (Fisher's exact test (FET), p = .018), experiences of physical (FET, p = .007) or emotional (FET, p = .008) violence, lack of social support (FET, p = .014), and unplanned pregnancy (FET, p = .008). No significant association was found between obstetric factors and depressive symptoms. The study highlights that the accumulation of psychosocial risk factors significantly elevates the risk of depression (Kendall's τ = 0.22, p < .001).

Conclusion: These findings underscore the necessity of comprehensive psychosocial assessments in pregnant women, offering deeper insights than mere screenings for depression and anxiety. Recognizing and quantifying these risk factors facilitates targeted interventions. Employing a cumulative risk index effectively identifies women at heightened risk of mental health problems.

Introduction: Behçet's disease (BD) is a vasculitis affecting multiple systems within the body and poses challenges due to its diverse organ involvement. This study investigates the relationship between systemic and pulmonary arterial parameters and the involvement of the disease, utilizing non-invasive measures to assess pulmonary and aortic stiffness in BD patients.

Methods: Transthoracic echocardiography and a blood pressure holter monitor were utilized to evaluate a total of 96 patients with BD and 51 healthy controls. Various parameters, including pulmonary pulse wave transit time (pPTT), pulmonary arterial stiffness (PAS), and aortic stiffness, were measured to investigate their association with BD and potential predictive value in disease progression.

Results: The PAS (kHz/sec) increased in BD patients (20.8 ± 5.8 vs 15.0 ± 2.7, p < 0.001), and this condition was associated with disease duration and C-Reactive protein (CRP) values (r = 0.361 p < 0.001, r = 0.377 p < 0.001, respectively). pPTT (sec) exhibited a significant decrease compared to the control group (0.16 ± 0.04 vs. 0.23 ± 0.05, p < 0.001), while no notable difference was detected in aortic stiffness parameters. In linear regression analysis CRP and disease duration were independent predictors of PAS, albeit age, left ventricle ejection fraction, aortic stiffness (pulse wave velocity) and activity score were not.

Conclusion: Increased PAS in BD is independent of aortic arterial stiffness. It is affected by inflammation and disease duration.

Metabolic dysfunction-associated steatohepatitis (MASH) represents a critical stage in the progression of metabolic dysfunction-associated steatotic liver disease (MASLD), significantly increasing the risk of cirrhosis, hepatocellular carcinoma (HCC), and liver-related mortality. Despite the rising global prevalence of MASLD, gaps in understanding the pathophysiological mechanisms driving MASH to cirrhosis persist, leading to challenges in early diagnosis, prevention, and treatment. This review explores the current knowledge on MASH, focusing on its pathophysiology, clinical management, and treatment strategies in the advanced stages. The role of metabolic dysfunction, portal hypertension, decompensation, and HCC occurrence is highlighted, alongside an evaluation of therapeutic options including lifestyle intervention, bariatric surgery, pharmacological therapies and liver transplantation. Furthermore, we emphasize the need for a multidisciplinary care approach to improve patient outcomes and address the complex metabolic and hepatic interplay in MASLD. Bridging these gaps will require an integrated effort combining advanced diagnostic tools, novel treatments, and comprehensive care strategies.

Introduction: Hereditary transthyretin amyloidosis (hATTRv) is a rare, genetic, adult-onset, multisystemic disorder which can affect diverse organs, including peripheral nerves, heart, kidneys, gastrointestinal tract, liver, skin and eyes. Currently, several disease-modifying treatments for hATTRv are available in Belgium including the TTR stabilizer tafamidis and TTR mRNA silencers patisiran and vutrisiran. Patisiran contains a small interfering RNA encapsulated into a lipid nanoparticle to deliver to hepatocytes, the main source of TTR protein production, thereby reducing TTR production.

Methods: We report and discuss five cases of hATTRv in different clinical scenarios that were successfully managed with patisiran, highlighting our real-world clinical practice.

Results: These cases illustrate that patisiran is effective to improve mild symptoms and stabilize the moderate ones. The cases also highlight the importance of red flags recognition to allow early diagnosis and treatment to prevent further disease progression.

Conclusion: Due to the multisystemic nature of the disease and its heterogeneous clinical presentation, close collaboration between neurologists and cardiologists is highly recommended, ideally within a multidisciplinary amyloidosis team, to provide holistic care in hATTRv patients.

Objectives: Proliferative glomerulonephritis with monoclonal immunoglobulin deposits (PGNMID) is a subtype of monoclonal gammopathy of renal significance (MGRS). PGNMID can present with insidious, slowly progressing kidney damage to overt nephrotic syndrome or rapidly progressive glomerulonephritis. It is a renal-limited disease that often lacks a detectable plasma or B-cell clone and requires kidney biopsy for diagnosis.

Methods: We present the case of a 77-year-old woman who developed nephrotic range proteinuria and progressive chronic kidney disease, despite a normal hematological work-up that showed no evidence of monoclonality.

Results: This case highlights the potential risk for severe renal damage caused by monoclonal proteins, even in the absence of a detectable pathological hematologic clone.

Conclusion: PGNMID requires further research to gain knowledge regarding pathophysiology and potential serum biomarkers for diagnosis as well as therapy response.

Belgium has a vibrant health eco-system, with world-class universities and hospitals, and a strong presence of pharmaceutical companies, resulting in a substantial contribution to drug development and a high number of clinical trials. Talent development is pivotal for further growth of this eco-system and to attract future professionals. Although physicians play an important role in this complex eco-system, with an estimated 400-450 Belgian physicians presently active in the field of the drug life cycle, Pharmaceutical Medicine and Clinical Pharmacology were not recognized as a speciality in Belgium until recently.It took a group of engaged people almost 20 years to create this new title, based on the European Directive 2005/36/EG appendix V, mentioning the medical specialties accepted in Europe and requiring a minimum training of 4 years. Although in this directive only 'pharmacology' is mentioned, a title of physician-specialist in Clinical Pharmacology/Pharmaceutical Medicine was proposed by the High Council for Physician-Specialists and General Practitioners to the Minister of Social Affairs. The Ministerial Decree was finally published in October 2023. The current paper describes the process of unwavering perseverance, clarity on the added value offered to stakeholders and the continued support of advocates in reaching the goal.

Hepatopulmonary syndrome (HPS) and portopulmonary hypertension (POPH) are two distinct pulmonary vascular complications seen in patients with liver disease and/or portal hypertension. HPS is characterized by disturbed gas exchange and hypoxemia because of intrapulmonary vascular dilatations. POPH is defined by pulmonary arterial hypertension, which might lead to right heart failure. HPS affects up to 30% of patients with end-stage liver disease requiring liver transplantation. POPH is rarer and affects 1-5% of this patient population. If not recognized and left untreated, these disorders result in significant mortality. This review provides an update on HPS and POPH and discusses their clinical characteristics, screening and diagnostic modalities, and management, including the place of liver transplantation.

Objectives: Implementation of outpatient parenteral antimicrobial therapy (OPAT), also known as intravenous (IV) antimicrobial treatment at home, has increased in recent years. Ensuring OPAT quality is crucial to achieve positive patient outcomes. However, data on the Belgian quality of OPAT organisation is lacking. We aimed to monitor the organisational quality of OPAT in Belgian hospitals and identify roles of hospital pharmacists involved in OPAT.

Methods: A cross-sectional study applying a web-based survey on OPAT quality was conducted from 2 to 29 April 2024. The survey assessed the presence of six core and five non-core structure indicators, and OPAT-related tasks of hospital pharmacists.

Results: Almost two-thirds (64%; 65/101) of Belgian hospitals answered the survey, with 77% of these hospitals providing OPAT, with an increase since 2023. All 11 structure indicators were present in 6% of hospitals, while 18% had all six core structure indicators.Three of the six core structure indicators were formally present in the majority of the hospitals: a policy on patient selection criteria (76%), a structured OPAT programme (70%), and a dedicated team (64%). In contrast, a system for fast communication between the patient and OPAT team members (50%), a mechanism for urgent clinical discussions (42%), and monitoring of quality indicators (28%) were not formally present in the majority of the hospitals. The primary tasks for hospital pharmacists included overseeing OPAT prescriptions and supplying antimicrobials and related materials.

Conclusion: While the adoption of OPAT is increasing among Belgian hospitals, significant opportunities remain for improving the quality of the OPAT organisation and expanding the OPAT-related tasks of Belgian hospital pharmacists.

Background: Urinary tract infections (UTIs) are one of the most commonly reported infections in Belgian nursing home residents. In older adults, UTI diagnosis and management is complex, often leading to over-diagnosis and irrational antimicrobial use, stressing the need for a guideline approach.

Objectives and methods: A consensus statement on the prevention, diagnosis and treatment of UTIs in older adults residing in nursing homes was developed in a collaborative effort between the Flemish Hospital Outbreak Support Teams, the Flemish Agency for Care and Health, the Association of the Flemish Coordinating and Advising General Practitioners, the Belgian Association of Urology, the Belgian Society for Gerontology and Geriatrics and PhD researchers based on a combination of clinical expertise, (inter)national guidelines and peer-reviewed studies.

Results: Optimizing fluid intake, appropriate toilet behaviour and posture, mobilization and local estrogen therapy in women are of proven value in UTI prevention, whereas the use of cranberry and probiotics is not to be advocated. The importance of avoiding bladder catheterization is stressed. In older nursing home residents, the diagnosis of UTIs remains challenging, mostly due to atypical systemic symptoms. A consensus diagnostic algorithm for UTI among residents with and without a urinary catheter was developed, including the presence of suggestive clinical symptoms and a positive urine culture. Urine dipsticks have a high negative but a low positive predictive value. C-reactive protein point-of-care testing is not recommended. Asymptomatic bacteriuria should not be screened for, in order to avoid unnecessary triggers for treatment. In cystitis, nitrofurantoin is the primary choice for treatment, with fosfomycin as an alternative; in prostatitis and uncomplicated pyelonephritis a fluoroquinolone is the advocated empirical antimicrobial.