Acta Clinica Belgica最新文献

Background: Diabetes mellitus is a major global public health problem. Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) is a key laboratory index in the assessment of insulin resistance. The calculation of HOMA-IR and its updated version HOMA2-IR are partly based on plasma glucose determinations, which are prone to important pre-analytical errors. As glycated hemoglobin (Hb) fractions strongly correlate with fasting glucose levels and are more stable analytes, we explored the possibilities of using glycated Hb fractions for calculating HOMA-IR.

Methods: Labile Hb and HbA_1c fractions were simultaneously assayed on a Tosoh G8 analyzer and expressed as %. Fasting glucose was measured in fluoride plasma using a hexokinase method. A Lumipulse G1200 luminescence immunoassay was used to measure serum insulin. The HOMA-IR and HOMA2-IR values were compared to corresponding indices calculated using glucose and glycated Hb fractions.

Results: Labile Hb could be measured with between-run CVs of 2.2-2.3%. Labile Hb correlated with both glycemia (r = 0.80) and HbA_1c results (r = 0.73). HbA1c-derived estimated average glucose (eAG)-based HOMA calculation correlated very well with HOMA-IR (r² = 0.9972). Based on eAG calculations, HOMA2-IR (%B, %S, and IR) gave comparable results, as compared to labile Hb-based calculations, in particular for fasting plasma glucose values between 4.44 and 6.67 mmol/L.

Conclusions: HbA1c and eAG are practical alternatives for glucose for estimating HOMA-IR. The use of glycated Hb enables home sampling for HOMA-IR and HOMA2-IR calculation.

Case report: We report the case of a 59 year-old woman with persistent nausea, hyporexia, fatigue and mild abdominal discomfort. The patient was hospitalized upon suspicion of malignancy due to multiple hepatic and splenic nodules found on an abdominal ultrasound. Hypercalcemia emerged at initial diagnostic workup, which was considered secondary to iatrogenic vitamin D intoxication. After an adequate management of hypercalcemia and normalization of serum calcium level, all symptoms presented by the patient completely regressed. In order to characterize splanchnic lesions, several biochemistry, microbiology and radiological tests were performed, including two bioptic specimens of a focal hepatic lesion. Eventually, a diagnosis of leishmanial infection was made. The patient started a specific anti-leishmanial treatment, and the focal hepatic and splenic lesions progressively disappeared.

Conclusion: To our knowledge, this is the first reported case of asymptomatic leishmanial infection with a widespread focal splanchnic involvement. The anti-inflammatory effect of vitamin D could be related to this atypical presentation of visceral leishmaniasis without systemic symptoms.

Objective: Fatigue is a prominent and disabling manifestation that impairs the quality of life of Systemic Lupus Erythematosus (SLE) patients both physically and mentally. The majority of SLE patients reports fatigue as an unmet need. Physical exercise could help SLE patients to reduce fatigue and improve quality of life.

Methods: A systematic review was conducted to analyse the effectiveness of physical exercise interventions to reduce fatigue in SLE patients. PubMed, EMBASE, Web of Science: Core Collection, the Cochrane Library, CINAHL via EBSCO, and PEDro were searched (March 2021 to October 2021). Studies were included if they fulfilled prespecified criteria and were assessed for quality using the PEDro risk of bias tool.

Results: A total of 17 studies (11 RCTs, 3 non-RCTs, 2 one-group pretest-posttest designs, and 1 cross-sectional study) were included in this review. They compared exercise treatment with standard care, alternative treatment, or a different type of exercise. Most of the included studies reported significant improvement in fatigue after exercise therapy. However, study heterogeneity is an important methodological limitation. Exercise interventions did not cause disease flare-ups in patients with low to moderate disease activity.

Conclusion: Studies are heterogeneous, precluding firm conclusions. In general, 10 out of 17 studies showed statistically significant but rarely clinically relevant improvement in fatigue after exercise treatment. However, results were not always consistent across different instruments used to assess fatigue. More multi-centred randomised controlled trials are needed to find the best type of physical activity that is both safe and effective for SLE patients.

Case presentation: A 34-year-old woman presented to the emergency department for arterial hypertension. Blood analysis requested by the endocrinologist showed very high level of aldosterone (1805 ng/L, normal values: <264 ng/L) and high level of renin activity (2.8 ng/mL/h, normal values: 0.1-2.0 ng/mL/h). The patient reported the use of Yasmin® (ethinylestradiol 30 µg/drospirenone 3 mg) continuously (without hormone-free week between cycles) as oral contraception. Medical imaging examinations revealed no anomaly in the kidneys and the adrenal glands. On the endocrinologist advice, patient stopped the intake of Yasmin®. Aldosterone and renin levels were measured several times after the discontinuation of the oral contraception and a diminution of these levels was observed with a complete normalization of both levels 26 days after the synthetic hormones discontinuation.

Discussion: The literature shows that ethynilestradiol/drospirenone association can interfere with the renin-angiotensin-aldosterone system and increase the levels of aldosterone and/or renin. We reported here a clinical case illustrating the significant impact of this medication on the renin-angiotensin-aldosterone axis of a young woman. However, this association is not listed among the drugs interfering with the aldosterone and renin-level measurements.

Conclusion: Considering the data in the literature and our clinical case, we suggest adding drospirenone and the ethinylestradiol/drospirenone association in the list of drugs interfering with aldosterone and renin level determination.

Introduction: Invasive meningococcal disease (IMD) caused by Neisseria meningitidis is a disease with a high mortality and morbidity rate. Serogroup W meningococci (MenW) used to be associated with sporadic disease worldwide. In recent years, a surge in MenW incidence is being observed.

Report: An older adult presenting with acute onset shortness of breath, chest pain and fever, was diagnosed with pericarditis with meningococcemia due to MenW:ST11 strain. MenW infections are reported to have a higher case fatality rate and atypical clinical presentations: MenW has been identified in patients presenting with pneumonia, gastro-intestinal symptoms, arthritis, and pericarditis.

Discussion: In Belgium, the National Reference Laboratory is also noticing an increase in serogroup Wmeningococcal disease. Recent epidemiological data for Belgium is reported in the article. MenW infections are reported to have a higher case fatality rate and atypical clinical presentations: MenW has been identified in patients presenting with pneumonia, gastro-intestinal symptoms, arthritis, and pericarditis.

Conclusion: When factors for poor prognosis are present in patients with pericarditi clinicians should be vigilant and search for the underlying aetiology .

Objectives: To explore the quality of in-hospital end-of-life care in adult patients with special attention to those 75 years and older and to make a comparison with the situation 10 years ago.

Methods: Data were retrospectively collected on adult patients who deceased at Ghent University Hospital between September 2018 and December 2019. The main outcome measures were 'ICU use' and 'presence of DNR forms on non-ICU units' in the final hospitalization. In order to identify possible risk factors for ICU use, logistic regression was performed.

Results: In total, 762 people died, of whom 35% were 75 or older. Just as 10 years ago, one-third (31%) died in the ICU versus 49% of those younger than 75 years (p < 0.001). Of people ≥75 years, 38%, compared to 42% 10 years ago, received an ICU treatment during their final hospitalization. The median length of an ICU stay was 4 versus 3 days 10 years ago. After adjusting for gender, comorbidities and the Charlson Comorbidity Index, factors associated with less ICU use were higher age, active malignancy and dementia (OR 0.838, 0.116 and 0.098 respectively). Seventy-nine percent of older patients on non-ICU wards died with a DNR form (versus 87% 10 years ago).

Conclusion: Although there was an increase in the presence of DNR forms in the final hospitalization, no significant differences were seen in actual ICU use compared to 10 years ago. Factors associated with less ICU use were higher age, active malignancy and dementia.

Background: Direct oral anticoagulants (DOACs), such as apixaban, edoxaban, rivaroxaban, or dabigatran, are an effective treatment for atrial fibrillation (AF) and deep venous thromboembolism. We hope to evaluate the safety of DOACs versus warfarin/low molecular weight heparin (LMWH) in improving bleeding events in patients with different severity of the liver disease.

Methods: We systematically searched the Cochrane Library, PubMed, and Embase databases for studies reporting the effects of DOACs in patients with liver cirrhosis. A random-effects model or fixed-effects model was selected to pool risk ratios (RR) and 95% confidence intervals (CI).

Results: A total of 18 studies involving 41,447 participants was included in this meta-analysis. Compare with warfarin/ LMWH, the use of DOACs significantly reduced the incidence of all bleeding (RR: 0.76; 95%CI: 0.66 to 0.87), major bleeding (RR: 0.51; 95%CI: 0.28 to 0.91), intracranial hemorrhage (RR: 0.50; 95%CI: 0.31 to 0.81), and gastrointestinal bleeding (RR: 0.76, 95% CI: 0.60 to 0.97), and all-cause death in patients with liver disease (RR: 0.77; 95%CI: 0.62 to 0.95). Similar results were observed in atrial fibrillation patients with liver disease and cirrhosis subgroups. Furthermore, the pooled estimates of the Child-Turcotte-Pugh (CTP) class indicated that DOACs reduced the incidence of all bleeding (RR: 0.61; 95%CI: 0.45 to 0.82), gastrointestinal bleeding (RR 0.55; 95%CI: 0.37 to 0.83), and all-cause death (RR: 0.62; 95%CI: 0.49 to 0.79) in patients with mild to moderate cirrhosis.

Conclusions: Our study demonstrates that DOACs significantly reduce the risk of bleeding in patients with liver disease compared with warfarin/LMWH.

Background: Membranoproliferative glomerulonephritis is a histological pattern of glomerular injury due to the deposition of immune complexes and complement factors. It is associated with bacterial and viral infections, auto-immune diseases such as systemic lupus erythematosus and Sjögren's syndrome, monoclonal gammopathy, and complement disorders (dense deposit disease and C3 glomerulopathy).  Case presentation: This is the report of a 25-year-old male with membranoproliferative glomerulonephritis who was initially treated for systemic lupus erythematosus, but who was later diagnosed with nephritis due to a chronic infection of a central nervous system shunt, last revised at the age of 3 years old.

Discussion: We highlight the challenges in making an early diagnosis of shunt nephritis, and succinctly discuss the clinical, biochemical, histopathological findings, and differential diagnosis of this type of infection-related glomerulonephritis.

We present the first documented isolation of Wohlfahrtiimonas chitiniclastica from a patient in Belgium. The isolate was identified as W. chitiniclastica using matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) and 16S rRNA gene sequencing. Our methodology corresponds with the previous conclusions on the superior performance of MALDI-TOF MS for bacterial identification. The patient was treated with amoxicillin/clavulanate and was discharged home after wound management. Although the clinical relevance of the isolate in our case is inconclusive, the pathogenicity of such isolate has been described and therefore must be considered as a potential pathogen in chronic and ulcerating wound cultures.

Objective: Sleep disorders including excessive daytime sleepiness (EDS), insomnia and anemia are both common. The aim of this study is to investigate associations between anemia and insomnia/EDS in the elderly.

Methods: A total of 744 older outpatients were included in this cross-sectional study. Anemia was defined as a hemoglobin concentration below 12 g/dL in females and <13 g/dl in males. Patients were divided into two groups as anemic and non-anemic. The Epworth Sleepiness Scale score of ≥11 points indicates EDS. Insomnia Severity Index with scores of ≥8 indicates insomnia.

Results: The mean age was 79.8±7.7 years. The prevalence of insomnia, EDS and anemia was 62.1%, 23.8%, and 47.2%, respectively. Insomnia (66.3% vs 58.5%) and EDS (29.6% vs 18.6%) were more common in patients with anemia compared to those without anemia (p<0.05). In univariate analysis, there were significant associations between anemia and insomnia [odds ratio (OR):1.4, 95% confidence interval (CI):1.0-1.9], and EDS (OR:1.8,95% CI:1.3-2.6). In multivariate analysis, the relationship between insomnia and nocturia, chronic obstructive pulmonary disease (COPD), and number of drugs used persisted, whereas being male, of an older age, coronary arterial disease, COPD, Parkinson's disease, dementia, and urinary incontinence were associated with EDS (p<0.05), but there was no significant relationships between anemia and insomnia/EDS (p>0.05).

Conclusion: The present data suggests that an elderly who has anemia is 1.4 times more likely to experience insomnia and 1.8 times more likely to experience EDS than those without anemia.