Revue medicale de Liege最新文献

Chronic kidney disease (CKD) is a common and severe complication in patients with type 2 diabetes (T2D). While inhibitors of the renin-angiotensin system remained for a long time the only medications that had proven nephroprotective effects, several other pharmacological classes also recently showed such a benefit : sodium-glucose cotransporter type 2 (SGLT2) inhibitors (gliflozins), glucagon-like peptide-1 receptor agonists (semaglutide), and mineralocorticoid receptor antagonists (MRA, finerenone). This clinical vignette aims at explaining the pharmacotherapy strategy for a patient with T2D who presents a progressive CKD. The interest of prescribing a combination of several medications with complementary actions that had proven a nephroprotection is emphasized.

Asthma is a common respiratory disease, accounting for 3 to 10 % of severe cases. Among these, bronchiectasis is more frequent (prevalence between 15.5 % and 67.5 % depending on the studies), but the causal relationship between the two diseases remains unclear. The aim of this literature review is to define the characteristics associated with the presence of bronchiectasis in patients with severe asthma. Patients presenting both severe asthma and bronchiectasis are generally older. The duration of their asthmatic disease is longer. They also have more impaired respiratory function, more difficult-to-control asthma, and decreased quality of life. The inflammatory profile varies. The efficacy of mepolizumab, a biological treatment targeting interleukin 5, has been demonstrated in patients with allergic bronchopulmonary aspergillosis, particularly in terms of reducing exacerbations. However, optimal management for patients presenting with both diseases remains to be defined, and additional studies are needed to clarify the relationship between them and thus implement preventive measures.

Out-of-hospital cardiac arrests represent impactful events. Despite the evolution of care, they are still associated with high morbidity and mortality. We present the analysis of our activity included in the 2023 CHC - Bcar registry in Liege area (Belgium). A cardiac massage is initiated by bystander in more than 50 % of cases. However, we must remember the crucial aspect of early resuscitation and defibrillation to improve outcome, just like the training of the general public in life-saving actions.

Introduction: Empathy refers to the ability to understand the emotions of others and to show this understanding. It plays a crucial role in the healthcare professions and should be developed during training. The aim of this study was to compare the empathy levels of students from different sections of health sciences enrolled in their final year at the University of Liège.

Materials and methods: Students in their final year of Medicine, Psychology and Physiotherapy at ULiège were asked to complete the Jefferson Scale of Empathy (HPS version), two numerical scales (0-10) relating to empathy (importance and self-assessment, respectively) and some demographic questions.

Results: In total, 292 subjects (103 students in Physiotherapy, 99 in Medicine and 90 in Psychology) took part in the study. Empathy scores were significantly higher for Psychology students (118.7 ± 9.60) than for Medicine (109.9 ± 13.4) and Physiotherapy (109.5 ± 12.6) students. The importance of empathy in the practice of the profession was estimated at 8.96 ± 1.18 and the average level of self-perceived empathy was 7.85 ± 1.12.

Conclusion: This study suggests that Psychology students are more empathetic than Medicine and Physiotherapy students. Students generally consider themselves to be empathetic and believe that this concept is important in professional practice.

Type 2 diabetes is a public health problem in which general practitioners are in the front line, acting on all fronts, from screening to management.

Methods: Single-centre, quantitative, retrospective and descriptive study aimed at characterising the profile of patients referred to hospital by general practitioners in an internal medicine department in Strasbourg for rebalancing of their type 2 diabetes during the period from 1 January 2020 to 31 December 2022.

Results: 167 files were analysed, resulting in the inclusion of 72 patients with an average age of 61.1 years, M/F sex ratio 1.25. 51% were of foreign origin. 34.7% were covered by universal health insurance (CMU) and 7% by state medical aid (AME). Alcohol and tobacco intoxication were significant, as were associated comorbidities and vascular complications linked to diabetes. The average age of diabetes was 16 years. The mean length of hospitalisation was 5.9 days (± 1.9). The mean HbA1c was 10.2% (± 2.4). Prior to hospitalization, 44% of patients were being treated with insulin and 39% with oral antidiabetics only. Insulin treatment was started/modified/stopped in 58% of cases.

Conclusions: Patients admitted to hospital had long-standing diabetes with significant imbalance, occurring in a difficult social context and requiring insulin therapy adjustment in most cases.

Objectives: Chronic pelvic pain (CPP) accounts for 15 to 40 % of exploratory laparoscopies. An exploratory laparoscopy was performed to exclude the presence of peritoneal endometriosis in patients experiencing significant impairment of their quality of life.

Methods: This retrospective observational study was carried out in a tertiary referral center for endometriosis. Forty-six patients with CPP, including a non contributive clinical examination and additional investigations, underwent exploratory laparoscopy. They were divided into three subgroups : patients with a history of endometriosis (group 1), those with another non-gynecological concomitant etiology of CPP (group 2) and those without any primary etiological diagnosis (group 3). We report the observed endometriosis lesions, surgical techniques applied and histopathological results.

Results: Exploratory laparoscopy revealed endometriosis lesions in 93.5 % of cases. Endometriosis lesions were found in 85 % of cases in group 1 (n = 20), 100 % in group 2 (n = 6) and 80 % in group 3 (n = 20).

Conclusion: Exploratory laparoscopy maintains a fundamental role in the diagnosis of patients with CPP, enabling simultaneous visualization and surgical treatment of endometriosis lesions.

We report the clinical case and the infrequent image of a patient developing a ventricular aneurysm following a myocardial infarction. We take advantage of this clinical case to recall some differences between aneurysm and pseudo-aneurysm with a very different prognosis.

Introduction: Transthyretin cardiac amyloidosis is a pathology increasingly encountered in all hospital departments, including internal medicine. The aim of our study is to describe the characteristics and care pathway of patients with transthyretin cardiac amyloidosis in internal medicine and to show that the number of patients diagnosed is increasing.

Methods: Descriptive, retrospective, non-interventional, single-center study at Strasbourg University Hospitals (HUS). Study period over 10 years from January 2013 to December 2023. Inclusion of adult patients diagnosed with transthyretin amyloidosis following hospitalization in internal medicine. Exclusion of patients with a type of amyloidosis other than transthyretin amyloidosis after medical record review.

Results: We were able to include 44 patients, 66 % of whom were men, with a mean age of 83.7 years at diagnosis. The mean time to diagnosis was 37 months. The most common comorbidities, besides heart failure (67 %), were atrial fibrillation (91 %), hypertension (80 %) and anemia (64 %). The mean time from diagnosis to first rehospitalization was 9 months, with an average of four recurrent hospitalizations until death, which took an average of 22 months. There was twice more cases diagnosed after versus before 2018.

Conclusion: Our study was able to profile the typical internal medicine inpatient with transthyretin cardiac amyloidosis and find significantly more patients diagnosed over the last 5 years. In order to better assess the impact of this disease, a prospective study would enable us to be more precise and limit biases.

In the context of Acute Pulmonary Edema (APE), the old school moto was LMNOP, for "Lasix-Morphine-Nitrates-Oxygen-Positive Pressure". However, this mnemonic, while not entirely inaccurate, deserves revision or at least a slight reinterpretation. APE remains a well-known condition in emergency departments, with a high mortality rate. Despite its prevalence, management recommendations have seen minimal evolution over the past four decades, with references dating back to a 1974 article in the New England Journal of Medicine that already advocated for the triplet of Lasix-Oxygen-Nitrates, a recommendation still present in the 2021 ESC guidelines. In this article, we will discuss the management and potential updates in the treatment of this common pathology.

Shingles, also termed herpes zoster (HZ), is due to the reactivation of the varicella zoster virus (VZV) in a dorsal root nerve ganglion with an intra-axonal passage of the virus to a predetermined dermatome. The risk of HZ increases with age, as well as the morbidity risks. The most feared complication is post-herpetic neuralgia, defined as persisting pain sensations three months after the resolution of the skin lesions. Those risks are even more important in the immunocompromised patient. Currently a recombinant vaccine against HZ reactivation is available with an excellent safety profile. It has demonstrated a very high vaccine protection achieving 97 % for preventing HZ and its complications. A patient presented severe facial HZ with a large number of HZ satellite lesions disseminated over the entire tegumentum. These satellite lesions are a reliable clinical marker for HZ with a high risk for complications. This case underlines the risk of morbidity in the elderly immunocompromised patient as well the fact that HZ is a vaccine preventable disease, currently reimbursed, but not well-known.