Revue medicale de Liege最新文献

Disseminated histoplasmosis is a condition with nonspecific clinical signs. In case of fever in a patient receiving anti-TNF alpha therapy, a thorough history that includes travel to areas of high endemicity can raise suspicion of infection. When suspected, diagnosis is made by detecting antigens in urine and blood (if this analysis is available), conducting serology, and obtaining a specimen for culture, direct microscopy, and histopathological analysis. PCR for Histoplasma can also be performed. When treatment is initiated early, the outcome is favourable in the vast majority of cases. Treatment requires intravenous administration of amphotericin B followed by oral itraconazole.

We report on a 46-year-old female patient with a recent history of kidney transplantation who presented with acute sinusitis. Further investigation revealed rhino-sinusal mucormycosis. Surgical debridement and a five-month antifungal treatment along with the cessation of the immunosuppressive therapy were needed. This approach led to clinical improvement but unfortunately resulted in the loss of the allograft. More than two years after this infection, the clinical and endoscopic outcomes remain favourable. Mucormycosis is a rare opportunistic infection caused by fungi of the Mucorales order, characterized by angio-invasive properties that lead to thrombosis, necrosis and infarction of the affected tissues. Diagnosis primarily relies on imaging, microbiological studies and histopathological examination. Early detection and prompt management are crucial given the poor prognosis of mucormycosis. Treatment involves a combination of surgical debridement, antifungal therapy and management of risk factors such as immunosuppression. Despite an appropriate treatment, mucormycosis remains a serious and potentially life-threatening condition.

The application of clinical practice guidelines faces specific challenges in complex or multi-morbid situations. In these cases, the proposal is to shift the focus from disease-oriented care to patient's goal-oriented care, in which disease management becomes a means of supporting the achievement of the person's life goals. The GOC approach ("Goal Oriented Care") offers a method and tools for implementing this approach. The approach also implies a series of conditions for implementation. The GOC involves shared decision-making, with healthcare professionals translating the patient's personal goals into realistic professional objectives. It promotes better coordination of care, improves patient compliance and responds to various challenges in the current healthcare system. It complements other approaches that already exist in the practices. Concrete examples and current initiatives illustrate the application of this method.

The treatment of moderate to severe psoriasis relies currently on the use of IL17 and IL23 antagonists. These biological treatments are highly efficacious with an excellent long-term safety profile. Despite the targeted actions of these agents, they are associated with a mild degree of immunosuppression, potentially leading to the reactivation of preexisting infectious diseases, or to an increased susceptibility to infectious diseases or an increased severity and duration of an infectious disease. Hence psoriasis patients receiving biologics must be counseled on recommended vaccinations before initiating a biological therapy or during a biological treatment. In general, for living attenuated vaccinations biologic treatment must be interrupted but for inactivated vaccinations it may be continued. Currently there is no proof that psoriasis patients treated with IL17 or IL23 antagonists present an increased risk for the infections covered by the conventional vaccines and hence the vaccination guidelines should follow the recommendations for the general population.

Asthma is a common disease the diagnostic of which remains challenging in real life with a substantial proportion of misdiagnosis. The European Respiratory Society has recently published practical recommendations for asthma diagnosis in adults distinguishing what can be done in both primary and secondary care in order to improve diagnostic accuracy. Here we review the algorithm which has been proposed and discuss the strengths and the weaknesses of these recommendations.

With the increasing use and quality of imaging techniques, pancreatic cystic lesions are being diagnosed more frequently, and their prevalence increases with age. Some of these lesions are precancerous and therefore require appropriate follow-up. However, the precise diagnosis of these lesions is complex, and there is considerable variability in the recommendations for monitoring them. This heterogeneity can lead to high costs for society and increased anxiety for patients. The aim of this article is to review the recommendations for the management and monitoring of pancreatic cystic lesions, and to propose a clinical practice algorithm for the assessment of these lesions.

Obesity is a chronic, multifactorial and relapsing disease, with its prevalence continuously increasing in Belgium as well as in Europe. It is associated with numerous metabolic, cardiovascular, functional, and psychological complications. Its assessment and management require a holistic and personalized approach, incorporating the latest guidelines from scientific societies such as BASO (Belgian Association for the Study of Obesity) and EASO (European Association for the Study of Obesity). This article provides a summary of current data on the definition, assessment, and various therapeutic modalities of obesity, with an emphasis on the importance of individualized, multidisciplinary care that is free of stigma and based on an integrated care model.

Immune checkpoint inhibitors (ICI) have revolutionized the treatment of solid tumors. However, they can induce immune-related adverse effects (irAEs) that can affect any organ. These irAEs are different from the side effects of traditional oncological treatments and require specific management. Given the increasing use of ICI, first-line care will increasingly need to manage these irAEs. This article aims to assist in the implementation of the guidelines for managing irAEs, with a particular focus on aspects related to first-line care.

The interpretation of laboratory results traditionally relies on comparison with reference values or clinical recommendations. Reference values are established from a population considered «healthy», while clinical recommendations come from epidemiological studies or expert consensus. Recommendations represent a more personalized approach compared to reference values, as they take into account various criteria such as the patient's pathophysiological condition, risk factors, etc. It is important to understand the process of developing recommendations and reference values and to be aware of their potential limitations to ensure appropriate clinical application. The aim of this work is to illustrate, through concrete examples, the use of clinical recommendations or reference values and their limitations.

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.