Revue medicale de Liege最新文献

Dilated cardiomyopathy (DCM) is a common cause of heart failure and may progress to acute decompensation requiring intensive care management. Genetic forms, particularly those associated with truncating mutations in the titin (TTN) gene, account for a significant proportion of DCM cases. The clinical case presented involves a young patient admitted to the intensive care unit for cardiogenic shock, revealing severe DCM. Etiological diagnosis was confirmed by genetic analysis, which identified a truncating mutation in the TTN gene. Initiation of optimal medical therapy led to partial recovery of cardiac function. This case highlights the importance of comprehensive etiological assessment in critical settings and underscores the specific management considerations of genetically determined DCM. A review of the literature is provided, focusing on the pathophysiological, clinical, and therapeutic aspects of this condition.

Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity reaction to Aspergillus fumigatus, commonly found in patients with cystic fibrosis and severe asthma. It leads to bronchial inflammation, excessive mucus secretion, and progressive lung function decline. The diagnosis is challenging and is based on clinical, biological, and radiological criteria. Treatments include systemic corticosteroids, antifungals, and monoclonal antibodies such as omalizumab and mepolizumab. The triple combination of elexacaftor, tezacaftor, and ivacaftor indirectly improves ABPA by reducing inflammation and enhancing bronchial drainage. After presenting a complex clinical case, this article provides a synthesis of the diagnostic criteria for ABPA, and the different treatments.

The management of type 2 diabetes has considerably evolved during the last decades. It remains a major challenge for the clinician because of the multiplicity of factors that should be taken into account and because of the emergence of an increasing number of new medications. The present clinical vignette summarizes and practically discusses three key steps for an optimal management of type 2 diabetes : why and how control hyperglycaemia, why and how correct associated risk factors and why and how protect two target organs, heart and kidneys.

Following an increase in the incidence of invasive Group A Streptococcal infections (iGASi) in the paediatric department of our institution, concomitant with a World Health Organization alert at the end of December 2022, we conducted a retrospective study at the Citadelle hospital in Liège until the end of 2023. As described in the literature, the patients most affected are healthy children under the age of 5. On admission, the clinical picture was non specific. The diagnosis of iGASi was mostly made by identifying the germ on a pleural fluid sample or on a blood culture (predominance of purulent pneumonia and pleurisy as well as toxic shock syndrome). In half the cases, a virus was also identified by PCR on a nasopharyngeal swab. These patients required prolonged hospitalisation, including a stay in intensive care for 68 % of them.

Spontaneous incomplete hemorrhagic abortions in the first trimester of pregnancy are a common clinical situation. This condition may usually be managed by urgent electric vacuum aspiration as the standard surgical treatment in the operating room. The use of a single-use handheld device that allows effective and rapid uterine evacuation at the patient's bedside, without requiring the surgical team, represents an attractive alternative. This device can also be used after a delayed miscarriage or if management of the miscarriage using medication to empty the uterus has not been successful. It provides safety and efficacy results equivalent to those of traditional electric aspiration. Moreover, this technique facilitates organizational logistics (absence of hospitalization, no need for operating room staff) and results in high patient satisfaction. In light of these considerations, its use in daily practice should be encouraged.

The growing aging population is increasing the demand for nursing home placements, while these institutions face persistent difficulties in recruiting and retaining nursing and paramedical staff. This study explored whether the organizational and managerial context (OMC) influences staff attitudes, such as job satisfaction, commitment, and intention to leave, and compared these perceptions across for-profit, non-profit, and public ownership models. An online survey using the validated COMEt© questionnaire was distributed to nursing and paramedical staff in Walloon nursing homes. Among 386 responses, 11 of 18 OMC dimensions were rated as underdeveloped, particularly leadership, communication, recognition, and role clarity. Participants expressed a need for greater autonomy, clearer task distribution, and more training opportunities. Directors were consistently evaluated less favorably than head nurses, revealing a leadership gap. Non-profit institutions received the most positive ratings, especially regarding hierarchical support, satisfaction, and retention intentions. Improving the OMC appears crucial to strengthening staff satisfaction, retention, and ultimately the quality of care for the elderly.

Peripheral arterial disease (PAD) affects approximately 200 million people worldwide. It is a common condition with variable symptomatology that negatively impacts morbidity, mortality, and patients' quality of life. In contrast to coronary artery disease, it remains largely underdiagnosed if not overlooked and undertreated. Early diagnosis and management allow the best prognosis. The 2024 European Society of Cardiology (ESC) guidelines introduce several significant changes, particularly including medical management and revascularization strategies. Greater emphasis is placed on endovascular techniques and personalized patient management. These changes aim to improve patient outcomes while reducing the risk of amputation.

Vaginal breech delivery is a specific obstetric situation in which informed consent is of major importance. This prospective study evaluates the impact of an educational video designed to inform patients about the methods, risks, and benefits of different delivery options. Fourteen pregnant women with a fetus in a breech presentation watched an explanatory video and then completed a questionnaire assessing their understanding, anxiety level, and delivery preference. The results suggest an overall improvement in understanding, a partial reduction in anxiety, and a change in initial opinion among one-third of participants. The video promoted self-reflection, supported decision-making autonomy, and alleviated the emotional burden associated with this complex decision. Patients from the medical field were more favorable towards cesarean section, suggesting an influence of professional representations. This educational video has proven effective in improving the transmission of information, supporting autonomous decision-making, and reducing, at least partially, the anxiety associated with breech delivery. Its integration into clinical practice could promote informed consent and support patients in an interactive care pathway that respects their needs.

The occupational deafness is one the most frequent diseases recognized in occupational medicine. This paper recalls how noxious the noise in working places can be; it describes how to measure it by the definition of the notion of decibel and the evaluation rules within the scope of labour laws. It draws attention to the principle of «globalization», which implies that the expert in charge of the evaluation takes into account the distinction between occupational deafness and other disorders such as age-related hearing loss or transmission defects in the hearing apparatus.

Transthyretin amyloid cardiomyopathy (ATTR-CM), a rare infiltrative disease associated with the accumulation of transthyretin-derived amyloid deposits, exists in an age-related wild-type form (ATTRwt) and a hereditary form (ATTRv). Myocardial infiltration leads to ventricular stiffness, diastolic heart failure, and a poor prognosis in the absence of disease-specific treatment. After tafamidis, acoramidis, a high-affinity tetrameric stabilizer, represents a major advance. In the ATTRibute-CM trial, it demonstrated a significant reduction in mortality, cardiovascular hospitalizations, and functional decline, with a rapid and sustained increase in serum TTR concentrations, which is closely correlated with survival. Well tolerated, it has few drug interactions. Indicated in patients with NYHA functional class I-II, it represents a major therapeutic advance and reinforces the importance of early treatment.