Revue medicale de Liege最新文献

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.

Bipolar disorders (BD) bring together different forms of mood disorders, characterized by the occurrence of depressive, manic, hypomanic and/or mixed episodes. They are recognized as the seventh cause of disability per year of life among 15 to 44 year old people by the World Health Organization (WHO). It is therefore a frequently encountered pathology. On the etiological level, the avenues currently accepted concerning BD are multiple, yet they still remain at the hypothesis stage. Each of these avenues therefore has therapeutic potential. It therefore seems interesting to address the different major hypotheses existing to date on the etiological level. We will first describe BD from historical, nosological and epidemiological points of view. We will then develop the genetic etiological aspects and the neural aspects through brain imaging research. Finally, we will propose a reflection on the specific relational etiology and the avenues of research that result from it.

Pulmonary embolism is a manifestation of venous thromboembolic disease, characterized by thrombus formation within the pulmonary arteries. Symptoms and clinical signs are numerous and nonspecific. Diagnosis relies on medical imaging (thoracic CT angiography or ventilation/perfusion scintigraphy). This disease requires prompt management to reduce morbidity and mortality. Treatment strategies include anticoagulation, systemic or catheter-guided thrombolysis, mechanical thrombectomy or surgery. In our institution, we have a multidisciplinary team, called PERT (Pulmonary Embolism Response Team), responsible for guiding the management of pulmonary embolism and for facilitating the access to those emerging endovascular techniques.

Heart failure (HF) is a major public health problem in our country and in most developed countries. Despite advances in the diagnosis and management of this condition and numerous therapeutic innovations, many patients with chronic HF progress inexorably to advanced HF, characterized by persistent symptoms despite maximal treatment. The prognosis for this condition is poor. However, mechanical circulatory support and heart transplantation, when considered in suitable candidates, are likely to improve the quality of life and life expectancy of these patients. In this context, timely referral to referral centers for the management of advanced HF is crucial. This article reminds the definition of advanced HF, details its specific management and specifies the criteria and timing for appropriate referral.

We report a rare diagnosis of ring-enhanced brain lesions. We describe a case of a 4-year-old immunocompetent girl presenting with a subacute alteration of her general condition and a walking disorder a few weeks after her return from a trip to Bangladesh. The etiological work-up revealed ring-enhanced brain lesions on magnetic resonance imaging (MRI). A wide range of etiologies, including infectious, tumoral and inflammatory causes, were considered. Given the clinical and radiological suspicion of neurocysticerosis, the patient was initially treated with corticosteroids and various infectious serologies were carried out, with negative results. Following a rapidly favourable clinical course on corticosteroids alone, further biological investigations revealed the presence of anti-MOG antibodies in both serum and cerebrospinal fluid, suggesting MOGAD (myelin oligodendrocyte glycoprotein antibody-associated disease). This case report highlights the complexity of diagnosing ring-enhanced brain lesions. It also draws attention to MOGAD in immunocompetent patients as a rare but possible etiology, to be systematically investigated in the presence of this type of lesion. Indeed, consideration of inflammatory and autoimmune causes is crucial for accurate diagnosis, enabling earlier targeted treatment.

Gastric outlet obstruction (GOO) is a mechanical obstruction of the distal stomach or proximal duodenum. Surgical gastro-jejunostomy and self-expanding metal duodenal stents were the conventional treatments for GOO. In recent years, a new treatment option emerged using echo-guided endoscopic gastroenterostomy (EUS-GE). It appears to be a safe and effective technique with a clinical success rate of 85-90 % and a side effect rate of less than 18 %. Compared to metal duodenal prostheses, the risk of recurrence of GOO and of re-intervention is lower with EUS-GE. The rate of side effects also appears to be lower than with the surgical technique, with a shorter length of hospital stay. Randomised studies comparing these different techniques are still needed to determine a new treatment algorithm for GOO. We report a case of successful EUS-GE performed at our institution.

Fat embolism syndrome mainly occurs following trauma to the long bones or pelvis. Non-traumatic causes are rarer. Its incidence varies greatly and depends on the number of fractures involved. Two physiopathological theories, one mechanical and the other biochemical, attempt to explain this still poorly understood phenomenon. The complete form of the syndrome results in a combination of pulmonary involvement, neurological disorders and a petechial rash. Given the polymorphism of signs and symptoms, Fat embolism syndrome remains a diagnosis of exclusion. Regarding treatment, the therapeutic strategy combines treatment of the causative process with conservative measures.