Revue medicale de Liege最新文献

Asthma is a chronic inflammatory disease of the respiratory tract. The etiology is multifactorial. Despite its high prevalence, asthma is often underdiagnosed or over diagnosed, based solely on medical history without diagnostic tests. This article discusses the new guidelines for paediatric asthma diagnosis, according to the age in children and adolescents, as well as the new concepts in asthma care, including some adaptations according reimbursement criteria in the Belgian context.

The management of type 2 diabetes relies on an integrated approach that goes beyond metabolic control, also targeting the prevention of cardiovascular and renal complications. Recent guidelines emphasize the importance of a personalized therapeutic strategy, tailored to the individual characteristics of patients, their comorbidities, and based on shared decision-making. SGLT2 inhibitors and GLP-1 receptor agonists have emerged as cornerstone treatments due to their effectiveness in glycaemic control and their demonstrated protective effects on the heart and kidneys. Moreover, weight management is now considered a key therapeutic lever, offering significant metabolic and cardiovascular benefits. Beyond pharmacological choices, therapeutic education, multidisciplinary support, and addressing social determinants of health play a crucial role in optimizing treatment adherence and improving patients' quality of life. A proactive and evolving management approach, adapted to disease progression and individual patient needs, is now at the heart of type 2 diabetes recommendations.

Concussions represent a major public health concern due to their high prevalence and the risk of long-term consequences. In some patients, they can lead to persistent post-concussion symptoms lasting for several months or even years, significantly impacting their quality of life. To date, no curative treatment exists for this syndrome, but early and appropriate management plays a key role in preventing long-term complications. However, concussions often remain underdiagnosed, both by healthcare professionals and the patients themselves. Various assessment tools have been developed to facilitate the identification of concussions and to guide the gradual return to daily activities, whether sports-related, educational, or professional. This article synthesizes these tools and highlights their relevance at different stages of care : acute, subacute, and chronic. Clinicians will be better informed to improve the diagnosis and management of concussions in their respective fields. Furthermore, raising awareness among the medical and sports communities, as well as the general population, about the benefits of proper concussion management remains essential in order to optimize recovery and limit long-term negative consequences.

This article outlines the 2024 KDIGO («Kidney Disease: Improving Global Outcomes») guidelines to slow the progression of chronic kidney disease in adults. Non-pharmacological measures include a healthy diet (Mediterranean or vegetarian), regular physical activity (150 minutes per week), smoking cessation, and weight loss. A low-salt diet (less than 5 g of salt per day) is also recommended. The latest KDIGOs advise a protein intake of 0.8 g/kg/day, with a potential reduction for some non-diabetic patients. Concerning drug-based therapies, renin-angiotensin system inhibitors remain crucial, particularly for patients with pathological albuminuria. Sodium-glucose cotransporter 2 inhibitors are becoming a key pillar of nephroprotection, even in non-diabetic patients. Mineralocorticoid receptor antagonists like finerenone and glucagon-like peptide-1 receptor agonists further enhance therapeutic options, especially in diabetic nephropathy. Finally, contrary to previous assumptions, reducing uric acid and systematically correcting acidosis are not considered as nephroprotective measures.

Since its first description 50 years ago, much progress has been made in the diagnosis and management of ARDS (Acute Respiratory Distress Syndrome). In this context, we regularly benefit from updates of best guidelines. Here we present a summary of the most recent guidelines based on the latest publications from the European and American intensive care societies.

The article compares recommendations based on Evidence-Based Medicine (EBM) and expert consensus. EBM utilizes scientific evidence from clinical trials to formulate objective recommendations, while expert consensus relies on the experience of recognized practitioners in the field of clinical trials, often, but not always, in the absence of sufficient data. EBM follows a systematic and rigorous methodology and provides a clear-cut classification, whereas consensus approaches are more subjective and less rigorous, even if also based on the results already available. While EBM recommendations (also called guidelines) are viewed as more transparent and verifiable, consensus report can provide useful insights where data are still scarce. Both approaches are complementary and essential for improving the quality of medical care.

Obsessive-compulsive disorders (OCD) are characterized by obsessions (recurrent, inappropriate thoughts or images) and/or compulsions (repetitive behaviours or mental acts) that cause marked impairment in functioning. This article summarizes the principles and recommendations of care for OCD. A "stepped care" approach is recommended, with increasing intensity of treatment according to severity and clinical complexity. The pillars of care articulate different components, starting with building a therapeutic alliance and psychoeducation, followed by psychotherapeutic and/or pharmacological approaches and, in cases of resistance, neuromodulation. The article integrates the need for an individualized strategy centered on an integrated brain health approach.

The incidence of kidney cancer is rising. It is the 7th most common cancer in men and the 10th most common in women. Diagnosis is based on imaging (thoraco-abdominopelvic computed tomography scan +/- abdominal magnetic resonance) and histopathology. Clear cell carcinoma is the most frequently observed histological subtype. Management of localized kidney cancer involves surgery or ablative treatments. Active surveillance is indicated in the indolent oligometastatic setting with local treatment in case of localized progression. Apart from this specific situation, two first-line therapeutic strategies are recommended in the metastatic setting : a dual immunotherapy regimen or the combination of immunotherapy with an antiangiogenic tyrosine kinase inhibitor. Both combinations have demonstrated superior survival outcomes compared to sunitinib, the previous standard of care until 2019. Treatment selection should be individualized, considering the characteristics of the disease (histology, tumour burden, location of metastases and if they are threatening, speed of progression), potential side effects of the treatments, the patient's general health, comorbidities and preferences.

The anatomical pathology laboratory receives human tissue samples, which are examined for the diagnosis of disease. At every stage of this process, from sending the sample to the laboratory to communicating the final diagnosis, there is a risk of error and nonconformity. This can affect the quality of the analyses that are performed. Standards and procedures exist, at the national and international levels. Applying these procedures and adhering to the current standards help to reduce risk of errors, to improve diagnostic accuracy and speed and ultimately to provide optimal patient care.

After the joint publication of hypertension management guidelines in 2003, 2007, 2013, and 2018, the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC) decided to issue their recommendations separately - ESH in 2023 and ESC in 2024. Notable differences include the ESC's new blood pressure classification, which significantly impacts patient management. Other variations exist in diagnosis and treatment algorithms, yet both approaches remain complementary. Rather than a hurdle, this duality offers valuable flexibility, allowing treatment to be tailored to the patient and the clinician's judgment. The key priority remains: combating therapeutic inertia in this common condition with serious consequences.