Acta Clinica Belgica最新文献

Objectives: Keratinocyte carcinoma (KC) represents 90% of all skin cancers and despite its relatively low mortality, may affect patients' health-related quality of life (HRQoL). This Belgian/Dutch cross-sectional study measured the impact of KC on HRQoL using generic instruments and a disease-specific questionnaire.

Methods: HRQoL was measured using the disease-specific Basal and Squamous Cell Carcinoma Quality of Life (BaSQoL) questionnaire, consisting of five domains. Sub-scores range from 0 to 3, with a higher score meaning higher impact on HRQoL. Additionally, the generic instruments EuroQol 5-Dimension 5-level (EQ-5D-5 L), visual analog scale (VAS), 15-dimensions (15D) and the time trade-off (TTO) technique were employed. Scores range from 0 to 1, with 0 meaning death and 1 meaning perfect health. HRQoL scores were stratified by patients with single and multiple KC. Generalized linear models assessed differences in mean HRQoL scores across KC groups, adjusting for relevant covariates.

Results: The study included 715 patients; 332 with single KC and 383 with multiple KC. The BaSQoL subscores for single and multiple KC patients ranged from 0.44 to 0.52 for the 'appearance' subdomain to 1.16 and 1.27 for the 'other people' subdomain, indicating a low-to-moderate impact on HRQoL. Patients with multiple KC showed significantly higher impact on BaSQoL 'worries' subdomain (p = 0.002) and worse perceived health on the EQ-5D-5 L (p = 0.004) compared to patients with single KC. No significant differences were observed in VAS, 15D or TTO between single and multiple KC.

Conclusion: Findings suggest, both with disease-specific and generic instruments, a moderate to low impact of KC on HRQoL.

Background: Pulmonary embolism (PE) presents significant challenges due to its wide clinical spectrum, associated right ventricular failure, and high mortality rates. Despite guideline recommendations for systemic thrombolysis in high-risk PE, its implementation remains suboptimal due to safety concerns. This study investigates barriers to guideline implementation in treating intermediate- and high-risk PE and assesses catheter-based thrombectomy (CBT) as an alternative treatment.

Methods: A single centre retrospective cohort study analyzed medical records of all PE-diagnoses between January 2022 and June 2023 . Patients with central, lobar, or segmental PE and Pulmonary Embolism Severity Index scores of III - V were included. A subgroup of patients received CBT. Data on patient characteristics, treatment, outcomes, and eligibility for CBT were collected.

Results: Of the 124 intermediate- and high-risk patients, thrombolysis was administered to only 17% of high-risk patients. Within the conventional treatment group, barriers to thrombolysis included contra-indications in 72% of intermediate-risk and 80% of high-risk patients, leaving a significant number eligible for CBT. Additionally, 20% of high-risk PE patients who did not received thrombolysis had no contra-indications and should have been treated with thrombolysis. In-hospital mortality was 50% among high-risk patients. Eleven patients received CBT, with no mortality at 30 days.

Conclusions: Guideline-recommended thrombolysis is underutilized in high-risk PE, due to safety concerns and contra-indications. CBT demonstrates a promising alternative with a favourable safety profile and low mortality rates, highlighting the need for prospective studies. Multidisciplinary approaches, such as Pulmonary Embolism Response Teams, may help to standardize care and to improve outcomes.

Introduction: The diagnosis of cyst infection in autosomal dominant polycystic kidney disease (ADPKD) is difficult. [18F]FDG PET/CT imaging is helpful, but early diagnosis remains challenging. Procalcitonin (PCT), a serum biomarker for bacterial infections, has not been evaluated in ADPKD-related cyst infections.

Methods: A retrospective review (between 2009 and 2023) identified all ADPKD patients who were (i) hospitalized (ii) with serum PCT measurements. Cyst infection was conventionally defined. Univariate and multivariate logistic regressions assessed the association between PCT and cyst infection risk.

Results: The cohort included 104 patients (mean age of 65.5 ± 14.9 years; 49% post-kidney transplantation; 16.3% on chronic dialysis). Cyst infections occurred in 24 cases. [18F]FDG PET/CT was performed in 47 patients, detecting cyst infection in 17 cases and non-cystic inflammation in 11. In the whole cohort, CRP levels at admission reached 97.3 [42.8; 164] mg/L. Serum PCT level was measured within 72-h post admission in 83/104 (79%) cases, and the median value reached 0.47 [0.18-2.04] µg/L. A significant correlation was observed between serums levels of PCT and creatinine at admission (r = 0.37, p < 0.05). PCT > 0.59 µg/L significantly predicted cyst infection (OR = 6.30, p = 0.0047). Antibiotics were administered ≥48 h before PCT measurement in 9/24 cases of cyst infection. PCT levels did not significantly differ between patients exposed to antibiotics (0.98 [0.43-2.19] µg/L) or not (1.42 [0.94-3.81] µg/L; p = 0.39). Higher PCT was associated with cyst [18F]FDG uptake above the pathological threshold (OR = 2.01, p = 0.0028).

Conclusion: PCT >0.59 µg/L within 72-h post admission is a significant biomarker for cyst infection in ADPKD patients.

Background: Intra-aortic thrombi with systemic embolization are rare but potentially life-threatening conditions. Known risk factors include hypercoagulability (e.g. due to inflammation) and atherosclerosis.

Case summary: We present a 46-year-old female patient presenting with highly elevated inflammatory parameters due to an atypical community-acquired pneumonia. Stabbing chest pain at admission, negative anterolateral and inferior T-waves on the electrocardiogram and a rise in high-sensitivity troponin T level indicated a diagnostic coronarography which showed no significant coronary stenosis, prompting the diagnosis of an infectious perimyocarditis. Four days after the angiography, the patient experienced multiple systemic thromboembolic events within a timeframe of 24 hours due to a large intra-aortic thrombus.

Discussion: The co-occurrence of aortic thrombi following a coronary angiography in a highly inflammatory patient raises the suspicion of inflammation-induced arterial thrombosis subsequent to endothelial cell injury. An overwhelming inflammatory response will increase the levels of coagulation factor VIII - produced by the endothelium and acting as an acute phase protein - and thus the tendency to form blood clots, especially after local damage to the endothelial cells by guidewire or catheter manipulation. Within this case report, we underscore the importance of adopting a cautious strategy when contemplating invasive arterial procedures, or even postpone when not urgently needed, in patients with strongly elevated levels of inflammation. Here, factor VIII levels can act as a guidance even before C-reactive protein levels rise. These interventions carry the risk of causing endothelial cell injury, consequently amplifying the probability of arterial thrombus formation, with a challenging management and treatment.

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.

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.

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.

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.