Revue medicale de Liege最新文献

Background: the efficacy of helicopter medical transport in terms of prehospital time savings, compared to ground transport, remains a topic of debate in the management of extrahospital emergencies. This study aims to assess the temporal impact of using the air emergency service in Belgian rural context.

Methods: We retrospectively analyzed the interventions of the Bra-sur-Lienne emergency medical helicopter service from 2015 to 2023. The study included five target conditions: acute myocardial infarction, traumatic brain injury, coma, cardiopulmonary arrest, and severe polytrauma. Prehospital intervention times, actual for helicopter and simulated for ground transport, were compared using the Wilcoxon rank-sum test.

Results: The study encompassed 255 myocardial infarction cases, 404 traumatic brain injuries, 129 comas, 297 cardiopulmonary arrests, and 680 severe polytraumas. The results demonstrate a significant prehospital time saving with helicopter transport (p < 0.0001), highlighting its effectiveness in reducing intervention delay.

Conclusion: Helicopter transport emerges as a preferred option to optimize prehospital intervention times in Belgian rural areas, particularly for critical pathologies over long distances. Its deployment should be considered an essential link in the chain of survival in extrahospital emergencies.

This article explores two anesthetic strategies for carotid endarterectomy: cervical plexus block and general anesthesia. Regional anesthesia is increasingly favoured for its ability to enable continuous neurological monitoring and maintain hemodynamic stability. General anesthesia remains essential for certain patients, offering comfort, optimal control of physiological conditions, and extended cerebral protection. We also discuss pathophysiological considerations, crucial elements for understanding patient responses to these techniques. The development of ultrasound-guided cervical plexus block emerges as a promising alternative to general anesthesia, enhancing the options available for safer and more effective anesthetic management. However, an individualized approach remains crucial to optimize clinical outcomes. This approach is part of the concept of «personalized medicine», in which contemporary anesthesia must necessarily be adapted to the specific needs of each individual.

Sudden death (SD) in young, apparently healthy athletes under 35 is an underestimated public health problem in Belgium. This is dramatically illustrated by the case of a 28-year old ultra-trail runner who suffered cardiac arrest during training, revealing an unrecognized cardiomyopathy. This highlights the importance of pre-participation cardiovascular screening in identifying such hidden conditions. The variety of causes of SD, mainly of cardiac origin, underlines the complexity of screening and the need to tailor it to the specific risks of each individual. The central issue in screening is the relevance of the resting 12-lead electrocardiogram (ECG). While some countries have adopted it with positive results, others continue to debate its systematic inclusion. Sudden death affects not only professional athletes, but also amateurs, who are often less medically monitored. The aim of cardiovascular screening is twofold: to identify young people at risk, while not unnecessarily limiting access to sport for those with no cardiac pathology. The effectiveness of the ECG is well recognized, but the implementation of such systematic screening in Belgium must take into account certain practical aspects.

Although the principle of recording and transmitting patient data is not new, the computerized medical record used in today's practice of care still does not meet the needs. We can easily - and often rightly - cast shame on the designers of those medical records and on administrators of our care institutions, but we as caregivers do need to share responsibility. If we really intend to use multiple sources of data wisely, in order to increase global health status at the individual level or for a population, we need to understand clearly the multiple dimensions of data and therefore acquire a real data culture. The revival of the medical record, for too long a source of disillusionment and burnout, is within reach especially as technical solutions appear to automate and facilitate our work of recording data in the field.

As a result of excessive salt loss, cystic fibrosis patients are at risk of dehydration, especially in hot weather. The urinary sodium/creatinine ratio is an easy and noninvasive tool for assessing whether dietary salt intake is adequate, whatever the patient's age. Recently, new reference values have been established, adapted to the patient's age. The objectives of this study are to investigate the impact of these new standards on the diagnosis of inadequate sodium intake and the variation in this ratio as a function of body mass index (BMI), outdoor temperature and the use of modulator therapy of CFTR protein. The present study included 40 patients and 335 urine samples. Adapting the urinary sodium/creatinine ratio with the new reference values reduced the number of patients with sodium deficiency by 11.8%. However, there were no significant differences in BMI, lung function or outdoor temperature between the sodium deficient and non-deficient groups. The CFTR modulator-treated group had a better mean urinary sodium/creatinine ratio compared with the group without modulators (p = 0.01), However, larger-scale studies are needed to provide a definitive answer to this question.

We present the pathognomonic image of the «bear paw sign» of xanthogranulomatous pyelonephritis, a rare form of chronic pyelonephritis typically occurring in association with obstructive uropathy (especially with staghorn calculi) and recurrent urinary tract infections.

Given the lack of hope for a cure of dementia, healthcare professionals provide end-of-life patients and their families with close support. The strain they place on their medical, technical, relational and emotional skills is not without consequences for their quality of life and psycho-emotional adjustment. The aim of this study is to evaluate the consequences of the work of practitioners in a gerontological psychiatric service in Belgium. The study was carried out on 20 professionals working on a regular basis in this hospital department. The practitioners completed several questionnaires (quality of life, stress, emotional work, anxiety-depressive symptoms). The results showed that a state of emotional consonance (or congruence) underpins their quality of life and psycho-emotional adjustment. In contrast, a state of dissonance seems to contribute to the onset of symptoms such as anxiety or depression among healthcare professionals. The study highlights the importance of developing national prevention strategies and plans to detect psychological distress in healthcare professionals working in the field of psychiatric gerontology.

Incretin gut hormones, especially glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP), raise a huge interest in diabetology. GLP-1 receptor agonists have gained a privileged role in the management of type 2 diabetes (T2D). They improve glucose control without inducing hypoglycaemia, while promoting weight loss. Furthermore, they protect people with T2D against atherosclerotic cardiovascular disease and contribute to reduce the risk of heart failure and chronic kidney disease, two other common complications of T2D. A recent innovation consists in the development of co-agonists that target both GIP and GLP-1 receptors. Whereas the co-infusion of GIP and GLP-1 failed to further reduce hyperglycaemia of T2D compared to GLP-1 single infusion, tirzepatide, an original dual unimolecular biaised GIP/GLP-1 agonist, showed a remarkable improvement of glucose control in the SURPASS programme in patients with T2D. Consequently, it is now commercialized in many countries for the management of T2D. GLP-1/glucagon (GCG) co-agonists and GIP/GLP-1/GCG poly-agonists are currently in development, aiming to benefit from the favourable effects of GCG on energy expenditure and liver lipid metabolism, while mitigating the hyperglycaemic effects of this hormone thanks to balanced effects of GLP-1 and/or GIP. They might occupy in the future an interesting place in the management of obesity and its metabolic complications among which T2D and liver steatosis.

Membranous nephropathy (MN) is a frequent cause of nephrotic syndrome in adults. In recent years, many progresses have been made, both in terms of diagnosis and treatment. For diagnosis, the discovery of new antigens and diseases that may be associated with MN led to the establishment of a new classification of MNs. In terms of treatment, many progresses have also been made with increasingly effective management, particularly with the help of immunosuppressive drugs. However, there are still cases of MN refractory to conventional treatments. Numerous molecules are being developed to manage these refractory MNs. Among them, Obinutuzumab, a type II anti-CD20, allows a more profound depletion of B cells compared to Rituximab classically used in clinical routine. To illustrate this point, we present the case of a patient suffering from MN with anti-THSD7A antibodies in whom a clinical and biological improvement was observed with obinutuzumab, after failure of conventional therapies.

Selective progesterone receptor modulators (SPRMs) are synthetic steroid compounds that interact with the progesterone receptor, inducing various agonist, antagonist or mixed responses. First identified with mifepristone, they are now represented by ulipristal acetate (UPA), used for emergency contraception and uterine fibroids. Despite a few rare cases of severe hepatic insufficiency, SPRMs offer advantages in the treatment of uterine fibroids, reducing their volume without the hypoestrogenic side-effects of GnRH agonists, thus preserving patients' bone capital and quality of life. Despite temporary suspension of UPA administrated on a daily basis, research is exploring the potential of SPRMs in the management of endometriosis, adenomyosis and breast cancer. Despite certain concerns, SPRMs offer promising prospects in gynecological pathologies, opening up new therapeutic avenues to improve women's health and quality of life. This article describes the case of a patient with peritoneal leiomyomatosis for whom UPA significantly alleviated symptoms, reduced disease progression and improved quality of life, even allowing a pregnancy.