Acta Clinica Belgica最新文献

Introduction: Long-term use of benzodiazepines and Z-drugs (BZRA) remains widespread, despite guidelines recommending short-term use and highlighting the harms. On 1 February 2023, a tapering pilot program was launched in Belgium to facilitate deprescribing BZRA by enabling community pharmacists (CPs) to compound capsules with stepwise gradual dose reductions.

Aim: This study aims to explore the CPs' role in this program and the barriers and facilitators they encounter within the program.

Methodology: A cross-sectional survey study evaluating barriers and facilitators was conducted. Participants were randomly selected from the National Database of Community Pharmacies. Results were analyzed descriptively using the Theoretical Domains Framework to identify influences on behaviour change.

Results: Out of 2000 CPs contacted, 328 participants (16.4%) completed the survey. CPs rated their overall satisfaction with the program with a mean score of 7.4/10. Key facilitators identified included the relationship of trust between the patient, CP and general practitioner (GP), the patient's confidence in the CP's role in the program and the specific program elements. The most significant barriers were the CPs' perceived lack of interest from GPs and patients.

Conclusion: The Belgian pilot program has been positively received by CPs. Success factors are the interdisciplinary collaboration (social influences) and the specific elements of the program itself (environmental context and resources). To better understand the factors influencing participation, a qualitative in-depth exploration of CPs, GPs and patients perspectives of the tapering program is recommended. Furthermore, implementation outcomes, the sustainability of BZRA cessation and the benefits patients experience from discontinuation need to be investigated.

Background: In this work, an innovative two-tier feature-optimized deep learning model is proposed for kidney stone detection in CT images. The framework uses a new modified ConvNeXt learning model to capture complex image patterns from CT images, along with the use of a LightGBM classifier.

Methods: A two-tier optimization strategy is implemented to refine the detection process. Initially, Dynamic Channel Pruning is used within the ConvNeXt architecture to identify and retain the most informative channels during feature extraction. By dynamically evaluating the importance of each channel, this step processes the most relevant channels, reducing computational complexity and highlighting critical features. Then, the Pufferfish Optimization Algorithm (POA) is applied for optimal feature selection. This optimization helps isolate the most discriminative features for kidney stone detection. Additionally, POA is applied to adjust the hyperparameters of the LightGBM classifier to increase classification accuracy and efficiency.

Results: The proposed model achieves the highest accuracy of 97.8%, compared with other models.

Conclusion: The proposed model achieves enhanced detection accuracy and efficiency through the use of Dynamic Channel Pruning and Pufferfish Optimization. This model offers a promising solution for kidney stone detection in CT images.

Background: This study sought to investigate the effects of polycystic kidney disease and tolvaptan administration on mucociliary clearance.

Methods: The cross-sectional study enrolled 30 patients with autosomal dominant polycystic kidney disease undergoing tolvaptan therapy, 30 patients with autosomal dominant polycystic kidney disease not on tolvaptan, and 30 healthy volunteers. Nasal mucociliary clearance time was determined using the saccharin transit time test, with a 1 mm diameter saccharin particle carefully placed on the anteromedial surface of the inferior nasal concha. Comparisons of mucociliary clearance time were then performed between the groups.

Results: In our study, the average mucociliary clearance time for patients with polycystic kidney disease was determined to be 9, in contrast to an average of 11 in the control group. A comparative analysis of patients receiving tolvaptan and those not receiving tolvaptan revealed an identical average mucociliary clearance time of 9 for both cohorts (p = 0.706). Furthermore, patients treated with tolvaptan demonstrated an average urine specific gravity of 1004, significantly lower than the 1011 observed in the non-tolvaptan group (p = 0.001).

Conclusion: This study indicates that the administration of tolvaptan yielded a beneficial impact on hydration status; however, this improved hydration did not translate into a significant effect on mucociliary clearance. Furthermore, the mucociliary clearance times recorded in the patient group were found to be in alignment with those typically associated with chronic kidney disease cohorts.

Aim: First Responder [FR] systems are associated with improved outcomes. However, this evidence has very low certainty. We aimed to explore - using real-life data - the reality of out-of-hospital cardiac arrest [OHCA] in a Belgian municipal region where there currently is no such system.

Methods: We explored the hypothetical potential for an FR in all cases of OHCA attended by the physician-staffed emergency medical services [EMS] team of Ghent University Hospital [07/2020-06/2021].

Results: Of the 200 attended cases, 76% were residential; 54% were unwitnessed. Bystander CPR occurred in 36.5%, a public-access AED was used in only three cases. Eleven patients survived beyond hospital discharge, all but one with good neurological outcomes. In 60%, we considered an FR obsolete from start (due to irreversible death, existing advance directive, resourceful setting, early EMS arrival, OHCA not recognized, or EMS witnessed). Another 10% were traumatic OHCA, a category universally excluded. Although impossible to identify those cases from the remaining 30% (n = 60) that would truly benefit, the actual number is likely far lower due to a.o. the likelihood of prolonged no-flow in unwitnessed residential OHCA (one-third or complicating contexts, victim accessibility, or FR availability).

Conclusion: There might be added value for an FR system in selected populations, but the associated cost-effectiveness ratios and the potential for harm should not be ignored. Better identification of victims potentially benefitting at the system point of entry is crucial.

Purpose: To unmask the alarming prevalence, intricate antimicrobial resistance patterns, and consequential clinical outcomes of World Health Organization (WHO) priority pathogens causing device-associated infections in critical care settings - a frontier analysis of silent pandemic threatening modern healthcare.

Methods: This groundbreaking retrospective study analysed data from 5,398 patients at risk for central line-associated bloodstream infections (CLABSI) and 15,416 patients for catheter-associated urinary tract infections (CAUTI) spanning 2021-2024. Microbial isolates were categorized according to WHO's priority pathogen classifications. Antimicrobial susceptibility profiles were comprehensively analysed using Clinical and Laboratory Standards Institute guidelines, with statistical analyses elucidating pathogen distribution dynamics, resistance mechanisms, and mortality correlations.

Results: Striking findings revealed WHO priority pathogens dominated the microbial landscape, constituting 76.47% of CLABSI and 82.14% of CAUTI isolates - with critical priority organisms overwhelmingly predominant (83.34% and 91.3%, respectively). Carbapenem-resistant Enterobacterales (CRE) emerged as the formidable leading threat (39.5% of CLABSI, 72.7% of CAUTI), while Carbapenem-resistant Acinetobacter baumannii (CRAB) demonstrated exceptional virulence with devastating mortality (93.33%). The study unveiled unprecedented levels of multidrug resistance, with most therapeutic options rendered ineffective; only colistin maintained universal efficacy against gram-negative isolates despite its concerning toxicity profile. Dramatic disparities in infection outcomes revealed CLABSI-associated mortality rates (71.79%) significantly eclipsed CAUTI (39.13%), establishing infection type as a critical independent predictor of survival.

Conclusions: This landmark investigation exposes the crossroad between WHO priority pathogens and healthcare-associated infections, sounding an urgent alarm for global healthcare systems. Our findings provide crucial evidence-based guidance for recalibrating therapeutic approaches, optimizing antimicrobial selection, and prioritizing infection control measures in intensive care settings worldwide.

Objective: This study aimed to assess changes in muscle mass and strength in patients hospitalized due to a diabetic foot ulcer, and to evaluate the impact of malnutrition at admission on these parameters.

Methods: This prospective observational cohort study included patients from February 2021 to July 2024. Anthropometric measurements, handgrip strength tests, and impedance analyses were conducted. Diagnosis of malnutrition was based on the Global Leadership Initiative on Malnutrition criteria. All patients received nutritional support during their hospital stay.

Results: Seventy-eight DFU patients (74% men, median age 72 years, median BMI 27.6 kg/m²) were recruited. Half of them was malnourished. Median hospital stay was 28 days. Overall, muscle mass and handgrip strength at admission and discharge did not differ significantly (18.31 ± 2.05 versus 18.08 ± 2.11 kg/m² and 26.02 ± 10.27 versus 26.45 ± 11.45 kg respectively). At admission, muscle mass was 17.25 ± 1.66 kg/m² in malnourished patients versus 19.37 ± 1.85 kg/m² in non-malnourished patients (p < 0.001), muscle strength was 24.82 ± 9.39 kg versus 27.23 ± 11.07 kg respectively (non-significant). Muscle mass change in malnourished patients was -0.039 ± 1.35 versus -0.562 ± 1.21 kg/m² for non-malnourished. Muscle strength change for malnourished patients was 0.4 (-8.3 to 15) and 0 (-2.90 to 2.70) kg for non-malnourished. Both changes were not significantly different.

Conclusion: DFU Patients exhibited no significant changes in muscle mass or strength during hospitalization, regardless of nutritional status at admission. Malnutrition did not significantly affect changes in muscle mass or strength during hospitalization. These findings indicate that the current clinical approach including nutritional counselling and support, appears to stabilize muscle health in this relatively immobile and fragile population.

Objective: Continuous glucose monitoring (CGM) benefits type 2 diabetes (T2D) patients on multiple daily insulin injections (MDI), but its role in non-intensive insulin therapy remains underexplored. This study evaluates whether a short-term CGM non-blinded can postpone the escalation to multiple daily insulin injections in people with poorly controlled T2D.

Methods: This retrospective real-world study analyzed data from 309 adults with T2D in primary care who used a 10 or 14-day CGM (2020-2024). The primary objective was to assess CGM's impact on therapy escalation, particularly to MDI. The secondary objective was to identify factors predicting the intensification of glucose-lowering therapy (GLT).

Results: Among the 309 participants (median age: 65 [56-73] years, diabetes duration: 16 [11-23] years, baseline HbA1c: 8.6% [70 mmol/mol]), 91.3% were deemed unsuitable for MDI based on CGM results (non-MDI GLT group, n = 282). In this group, 76% achieved an HbA1c-GMI differential > 0.5%, and 54% >1.0% after 14 day-CGM. Basal insulin use decreased slightly (70% to 64%, p = 0.13), while twice-daily insulin increased (12% to 18%, p = 0.02). GLTs remained largely unchanged.

Conclusion: A short-term CGM prevented MDI escalation in 91.3% of poorly controlled T2D adults, reinforcing its role as a cost-effective strategy. CGM likely improved self-management behaviors, as evidenced by frequent HbA1c-GMI differentials, reflecting better management of hyperglycemia. These findings highlight CGM as a practical behavioral and therapeutic tool in diabetes care.

Objective: Cervical cancer, primarily caused by persistent infections with high-risk human papillomaviruses (hrHPV), remains a significant global health issue. Effective screening methods are essential for early detection and prevention. This study evaluates a novel 'heat protocol' (HP) for pre-treatment of cervical samples in SurePath medium in the detection of hrHPV using the Seegene Allplex HPV HR Assay on the fully automated Seegene STARlet platform.

Methods: 50 cervical samples from women aged 21-69 were collected between March 2024 and June 2025 during routine screening at Sint-Trudo Hospital. Samples were pre-treated using either the HP (95 °C for 55 minutes on the Seegene STARlet) or the validated LB method. All were tested using the Allplex HPV HR Assay. The Alinity m assay served as reference. Precision, accuracy, and method comparison were assessed using clinical and external quality control samples. Statistical analyses included kappa agreement, non-inferiority testing, and Bland-Altman analysis of Ct values. .

Results: Our findings demonstrate that the HP shows higher sensitivity (96%) than both the LB pre-treatment (93%) and the external reference method (Alinity m). The HP also identified additional HPV genotypes not detected by the other methods, suggesting improved detection of low viral loads. Ct values were on average lower with HP, which supports this increased sensitivity. A non-inferiority analysis confirmed that HP is not inferior to LB.

Conclusion: The study confirms that the new HP offers excellent precision, accuracy, and sensitivity. While the LB pre-treatment remains a viable alternative, the HP's efficiency, reduced hands-on time and improved sensitivity make it the preferred method for our routine clinical practice.

Objectives: To evaluate the analytical performance of the automated AIX1000 RPR assay compared to the manual Macro-Vue RPR Card Test for syphilis monitoring in a high-prevalence, reverse screening setting.

Methods: Serum samples were tested using both AIX1000 and manual RPR in retrospective (n = 75) and prospective (n = 279) cohorts. Qualitative and quantitative concordance were assessed, along with AIX1000's accuracy, precision, specificity, carry-over, and freeze-thaw stability.

Results: In the retrospective cohort, overall qualitative agreement was 90.7% (κ = 0.80), with 77.3% of samples showing titers within one dilution. In the prospective cohort, qualitative agreement was 86.0% (κ = 0.72), with 90.7% of samples within one dilution. AIX1000 results were often 1-2 dilutions lower than manual RPR, especially in high-titer samples (≥1:16), where titer concordance (±1 dilution step) dropped to 38.7% (prospective) and 35.3% (retrospective). Accuracy analysis using external quality controls revealed a consistent one dilution-step bias for both assays: manual RPR read higher and AIX1000 lower, explaining the observed discrepancies. Analytical performance met predefined criteria: within and between runs were consistent, specificity showed no cross-reactivity, and no carry-over contamination was observed. Freeze-thaw testing had minimal effect on results.

Conclusion: The AIX1000 showed good concordance with manual RPR, particularly at lower titers, with reliable analytical performance and operational advantages. However, systematic titer underestimation compared to manual RPR, particularly in high-titer samples, may affect clinical interpretation if tests are transitioned. Clinicians should be informed of this discrepancy when transitioning platforms.

Background: Sleep apnea is a common disorder characterized by recurrent episodes of upper airway obstruction or impaired respiratory drive, leading to disrupted sleep and significant cardiopulmonary consequences. While anatomical and neuromuscular factors are well-established contributors to obstructive sleep apnea (OSA), and central sleep apnea (CSA) is often linked to cardiac or neurological conditions, the impact of endocrine disorders, particularly hypothyroidism, is frequently overlooked.

Clinical presentation: We describe a case of severe sleep apnea that exhibited persistent sleep apnea (including obstructive, but also central and mixed events) under continuous positive airway pressure (CPAP) therapy. Clinical and biochemical findings confirmed profound hypothyroidism with myxedema. Thyroid hormone replacement therapy led to substantial clinical improvement, including weight loss, normalization of thyroid function, and a marked reduction in residual AHI after eight months.

Conclusion: This case highlights the need for increased awareness of hypothyroidism as a potential and reversible cause of treatment-resistant sleep apnea (TRSA). Thyroid hormone replacement therapy can lead to significant improvement, emphasizing the need for routine thyroid function screening in patients with sleep apnea.