2021 - volume 76 (4)
|Crossed eyes on arterial blood pressure in sitting position|
Scheen AJ , Marchand M , Philips JC
Rev Med Liege 2021, 76(4),221-223
Summary : Prolonged standing or even sitting position can induce a fall in arterial blood pressure because of gravity that provokes a blood volume sequestration in lower limbs. Such a phenomenon may be associated with orthostatic dizziness or sometimes syncope. We present the image of a continuous monitoring using a Finometer® of systolic blood pressure and heart rate. Crossing legs while in sitting position allows immediate increase of arterial blood pressure. This pathophysiological mechanism explains why numerous people cross legs in sitting position, for instance during a prolonged meeting, in an auditorium or in a movie theater. This common phenomenon has potential diagnostic, therapeutic and prognostic implications.
|Management of mycosis fungoide : focus on brentuximab vedotin|
Lebas E , Collins P , Bonnet C , Libon F , Dezfoulian B , Nikkels AF
Rev Med Liege 2021, 76(4),224-231
Summary : Recently, brentuximab vedotin (BV) (Adcetris®) obtained the reimbursement in Belgium for the treatment of the primary cutaneous NKT-cell lymphomas mycosis fungoides (MF), large cell anaplastic lymphoma and lymphomatoid papulosis type A. BV is a monoclonal antibody directed against the CD30 expressed on tumoral T cells. The inhibition of this pathway releases the process of apoptosis leading to the cell death of the tumoral cells. BV is reimbursed after the use of another systemic treatment without success and if the number of CD30 positive atypical T-cells is larger than 10 %. BV is administered intravenously every 3 weeks with a dosing of 1,8 mg/kg with a maximum of 16 courses. The response rates exceed 75 %. In some instances, interesting treatment responses have been observed with BV in CD30 negative patients. The principal adverse effects are neutropenia and peripheral neuropathy. Two patients are presented with longstanding multi-resistant MF that were successfully treated with BV.
|Multiple myeloma in an elderly patient with history of breast cancer : the value of multidisciplinary oncogeriatric collaboration|
Legros M , Bouillon AS , Janin N , Moonen M , Louviaux I , Salmon JP , Berg N , Servais P
Rev Med Liege 2021, 76(4),232-238
Summary : As the prevalence of cancers increases with age, some elderly patients are confronted with multiple tumoural pathologies. The clinical case of a 70-year-old patient with adenocarcinoma of the breast and multiple myeloma complicated by severe renal failure illustrates the complexity of oncogeriatric management. The geriatric assessment makes it possible to detect frailty and provides assistance in the development of a personalized care plan while respecting the quality of life.
|Preoxygenation by high-flow nasal cannula in a patient with difficult ventilation and intubation criteria|
Sylvestre JB , Javillier B
Rev Med Liege 2021, 76(4),239-244
Summary : The different protocols and algorithms for difficult intubation highlight the need for early detection of patients at risk of ventilation and difficult intubation. These protocols allow an adaptation of the management and all conclude that an emergency trans-tracheal approach is necessary in case of impossible intubation. In this context, the prevention of hypoxemia must be a major concern of any anaesthetic management. Indeed, in case of an impossible orotracheal intubation, the occurrence of hypoxemia is directly correlated to the duration of apnea. Classically, preoxygenation maneuvers can significantly increase the duration of apnea without hypoxemia. Furthermore, apneic oxygenation maneuvers may be added in case of impossible ventilation but permeable laryngeal passage. This article reports on a patient with difficult intubation and ventilation criteria who benefitted from preoxygenation associated with apneic oxygenation via high flow nasal cannula.
|COVID-19 : a challenge for democracies|
Rev Med Liege 2021, 76(4),245-247
Summary : Previous studies have established a positive correlation between democracy and health. The COVID pandemic seems to be putting democracies in trouble. One option to face this challenge could be to strengthen health promotion, as defined in Ottawa Charter.
|SGLT2 inhibitors, new option to prevent or treat heart failure|
Scheen AJ , Lancellotti P
Rev Med Liege 2021, 76(4),248-255
Summary : Gliflozins (sodium-glucose cotransporter type 2 inhibitors or SGLT2is) are the only glucose-lowering agents that have proven their ability to reduce major cardiovascular events, hospitalisations for heart failure and the progression to end-stage kidney disease in at risk patients with type 2 diabetes (T2D). One of the most marked and reproducible effects is the reduction in hospitalisations for heart failure. This protective effect was observed in all large prospective cardiovascular outcome trials, independently of the presence of heart failure at inclusion, and was confirmed in two dedicated trials that specifically targeted patients with heart failure and reduced left ventricular ejection fraction, with or without diabetes : DAPA-HF with dapagliflozin and EMPEROR-reduced with empagliflozin. The reduction in hospitalisations for heart failure appeared more marked when baseline renal function was impaired, including when estimated glomerular filtration rate (eGFR) was < 45 ml/min/1.73 m². These favourable results contribute to give a privileged position to SGLT2is in more recent international guidelines produced by diabetologists, cardiologists and nephrologists. According to these guidelines, the prescription of SGLT2is should be extended to patients with an eGFR between 30 and 60 ml/min/1.73 m² as well to non-diabetic patients with heart failure and reduced ejection fraction. For other patients with preserved ejection fraction, one has to wait for further results from ongoing large prospective trials.
|Advocacy for an improved training in clinical nutrition during the medical cursus|
Thissen JP , Boucquiau A , Paquot N , Preiser JC
Rev Med Liege 2021, 76(4),256-261
Summary : The knowledge of physicians regarding nutrition is often far below the expectations of patients, and does not comply with official recommendations. However, poor-quality nutrition and diet represent the first cause of mortality worldwide. As a result of an insufficient training and awareness, many physicians cannot meet patients’ expectations. Moreover, nutrition is sometimes felt as a field of low scientific level, thereby opening the area to pseudo-scientific drifts. We advocate an improvement in the training in nutrition during the medical cursus, namely by the transversal integration of nutritional insights into medical courses, and the recognition of post-university training validated by the academic authorities. A clarification of the roles and the recognition of the competency are urgently required to promote the professionalism of nutritional counselling.
|Rotationplasty as an alternative to amputation|
Deloge C , Allington N , Rondia J
Rev Med Liege 2021, 76(4),262-267
Summary : Rotationplasty can be used as an alternative to amputation when conservative treatment is not possible, for example in malignant tumours of the knee. The principle of the operation is to rotate the lower leg through 180 ° after resection of the distal femur and in this way the ankle joint replaces the knee joint. This surgical technique, although complex, allows satisfactory carcinological resection with a functional outcome superior to amputation above the knee as well as a better quality-of-life. Patients do not develop phantom pain, neuroma or stump discomfort because it is not an amputation. In addition, they can actively control their knee and having proprioception and normal contact with the ground. This results in a coordinated, harmonious and elegant gait pattern similar to the normal population. Patients are more efficient in their activities of everyday life and sports. The major disadvantage is the particular aesthetic aspect and the psychological acceptance.
|The concept of paedophilia. Part 2: Etiologies, forensic aspects and therapeutic options|
Leistedt S , Thibaut F
Rev Med Liege 2021, 76(4),268-272
Summary : Paedophilia is a paraphilia characterised by behaviour, drives or sexual fantasies that are intense and recurring and that generally involve children. This sexual deviation is often linked to personal distress, to a significant alteration of personal, family, professional and social life, in a general sense. In our modern Western societies, paedophilia and the perversions associated with it are punishable by law. Paedophilia is a concept that is very ancient, complex and particularly diverse in its many clinical presentations. Its societal impact is very important and contrasts with the real knowledge of this issue among non-specialists, or even among specialists. In this second part of the article, the authors will develop the aetiologies of paedophilia, the therapeutic options and the forensic aspects.
|Epidemiology of patients presenting to the emergency room for dyspnea in Belgium|
Pfendler M , Ghuysen A , Vranckx M , Laribi S , Verschuren F
Rev Med Liege 2021, 76(4),273-279
Summary : Studies about patients’ profile presenting to the emergency department for dyspnea are scarce in Europe, and even more in Belgium. We analyze here a cohort of patients with acute dyspnea in three Belgian centers, as to the epidemiology of this dyspnea, the tests carried out, the diagnoses retained, the treatments administered, the hospitalization and survival rates. The secondary objective is to compare this Belgian cohort with a European population resulting from a large multicenter study. The analysis of 131 patients showed that acute dyspnea in the emergency department corresponds to four main diagnoses (exacerbation of chronic obstructive pulmonary disease, infections of the lower respiratory tract, acute cardiac decompensation and asthma). The age of patients is over 80 years in a quarter of them, the hospitalization rate is 57 % and the mortality is 5 %. Our analysis also reveals that the check of vital parameters may be insufficiently realized, as may the use of non-invasive ventilation. Etiological diagnoses made in the emergency department are confirmed at the end of hospitalization in 75 % of cases. The Belgian population is younger than the European population (62 against 69 years), presents fewer infection of the lower respiratory tract (20 % against 31 %), and is comparable to the European population for the other parameters studied. The article ends with 10 key messages that will enlighten clinicians about the reality of acute dyspnea in emergency rooms in Belgium.
|Benefits and limitations of geriatric dysphagia screening tools|
Denuit C , Delcourt S , Poncelet M , Dardenne N , Lagier A , Gillain S
Rev Med Liege 2021, 76(4),280-286
Summary : This prospective study aims to evaluate both benefits and limitations of dysphagia screening tools (DePippo, EAT10, V-VST, the IOPI tongue-strength assessment) used in a geriatric unit. Among the 102 patients under study, 47 showed a dysphagia diagnosed by full logopedic examination. The sensitivity and the specificity of the screening tools were, respectively, 31,9 % and 83,6 % for EAT10, 86,9 % and 52,7 % for the V-VST and 76,6 % and 65,0 % for the DePippo test. Regarding the posterior tongue strength assessment, the threshold value of 31kPA showed an 77,3 % sensitivity and a 52,7 % specificity. Given the results obtained from the above-mentioned screening tools and their practical application limitations, the DePippo test appears to be the most convenient for a day-to-day geriatric utilization. Finally, this study outlines the necessity of confirming, in a larger sample, the reproducibility of the DePippo test as well as the interest of measuring the tongue strength among frail older people.
|Motivational interviewing : a useful technique for both smoking cessation and periodontal interventions|
Gondel O , Jungo S , Aubin HJ
Rev Med Liege 2021, 76(4),287-291
Summary : Tobacco is a risk factor for many chronic diseases and is the leading cause of preventable death. In the same way, periodontal diseases are one of the main chronic inflammatory diseases. The significant positive association between smoking and a higher risk of periodontitis is not any more to show and it appears that if smoking would be eliminated in this population, the risk of periodontitis would be reduced by approximately 14 %. Thus, the management of smoking cessation as well as periodontal treatment have become a public health issue. Motivational interviewing is a method of communication to support the change of health behaviour. The periodontist is then in the first position to set up a motivational interview in conjunction with smoking cessation and periodontal therapy. The taking into account of the risk factors among which tobacco is a stake for the restoration and the maintenance of periodontal health. Published evidence suggests that smoking cessation interventions are effective, highlighting the need for behavioural support in periodontal care. Motivational interviewing becomes an important part of both periodontal and smoking treatment.
|Pharma industry reinvents itself in the turmoil. Part 2. Opportunities|
Rev Med Liege 2021, 76(4),292-296
Summary : In the first article we described how pharmaceutical industry is facing major challenges in general. In this second part, we intend to focus on new concepts and developments, which might sound «futuristic» for most of us. However, this seems definitely «work in rapid progress», especially concerning, for example, the use of the pharmacogenome (prerequisite for treatment personalization), «clever» medication, 3D printing and labelling with QR code. The future is bright but we cannot omit to quote the ever growing role of incumbent actors, both in the fields of medication production as well as distribution.