Acta Clinica Belgica最新文献

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.

Objectives: We investigated lupus anticoagulant (LA) testing in Belgium and verified these findings against the 2020 International Society on Thrombosis and Haemostasis Scientific and Standardization Committee (ISTH-SSC) Guidelines.

Methods: A survey, interrogating pre- and post-analytical aspects of antiphospholipid antibodies, including LA analysis, was distributed to all Belgian laboratories (n = 111).

Results: About 66% of the laboratories responding to the entire survey (58%) performed LA analysis. About 78% used thrombocyte-free citrated plasma. Most (90%) used the combination of dilute Russell's viper venom time (dRVVT) and activated partial thromboplastin time (aPTT), performing dRVVT (82%) and aPTT (78%) if the screening test was prolonged. A variety of instrument/reagent combinations were used. Normal pooled plasma (PNP) for mixing tests was used by 83%, either commercially lyophilized (56%) or frozen (44%), mostly (98%) in a 1:1 PNP: patient plasma ratio. Interpretation was based on normalized clotting time ratio, using manufacturers' or own study data as cutoff values. About 61% gave a final conclusion. About 88% added comments, mainly (94%) with a positive result. All laboratories programmed a barring period after an initial positive result. About 66% performed LA detection in patients receiving direct oral anticoagulants, 74% after using sample pretreatment with active charcoal absorption. LA testing for vitamin K antagonists and heparin-treated patients was done by 54%, regardless of international normalized ratio (64%) or anti-FXa results (82%).

Conclusions: The survey shows adherence to ISTH-SSC guidelines, especially for sample preparation and test methodologies. Additional efforts are required to harmonize LA detection in anticoagulated patients and result interpretation.

We describe the case of a 50-year old woman presenting with hypertension-associated thrombotic microangiopathy (TMA) and nephrotic syndrome as an unusual initial presentation of a cryoglobulinemic glomerulonephritis secondary to primary Sjögren's disease. This case first highlights the importance of a thorough and systemic work-up in patients with TMA, given the broad differential diagnosis and diagnostic complexity. When initial evaluation does not reveal an underlying cause and TMA parameters improve with blood pressure control, a diagnosis of hypertension-associated TMA may be considered. However, hypertension-associated TMA is often secondary to an underlying auto-immune or primary renal disease, warranting further investigation. In this case, kidney biopsy revealed a membranoproliferative glomerulonephritis with hyaline thrombi. Electron microscopy showed subendothelial electron dense deposits, and serum analysis confirmed the presence of mixed cryoglobulins, establishing the diagnosis of cryoglobulinemic glomerulonephritis. Primary Sjögren's disease was suspected based on positive anti-Ro60 and anti-Ro52 antibodies and supported by the presence of sicca symptoms, and was finally confirmed by a positive Schirmer's test. This case illustrates the diagnostic value of a kidney biopsy in identifying the underlying etiology of TMA and it also highlights the importance of considering cryoglobulinemia in the differential diagnosis of membranoproliferative glomerulonephritis.

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.