2022 - volume 77 (4)
|Céline Grégoire, Lauréate du Prix Désiré et Maurice Jaumain 2021. Pour son projet sur les rejets hyperaigus de cellules CAR T allogéniques TCR et CD52 éditées|
|Post-traumatic ileal branch pseudoaneurysm|
Grandjean F, Brisbois D
Rev Med Liege 2022, 77(4),199-201
Summary : Arterial aneurysms of visceral branches are rare, even more if they occur on the superior mesenteric artery and its branches (among which ileal branches). Rupture is its major complication, thus rapid treatment is mandatory. CT angiography is the gold standard for diagnosis and therapeutic planification. Usual treatment is surgical, even though percutaneous embolization can be safely and precisely performed. Use of coils with sandwich technique is preferred
|Uterine rupture in a patient with a cesarean scar pregnancy|
Salsac N, Brichant G, Petit P, Chantraine F, Nisolle M
Rev Med Liege 2022, 77(4),202-205
Summary : Caesarean scar pregnancy is a rare form of ectopic pregnancy, but it is increasingly common due to the increasing number of caesarean sections and advances in medical imaging. There are two types of cesarean scar pregnancy depending on the depth of the implantation : endogenous type I and exogenous type II. In the case of a pregnancy resulting from a type II caesarean scar, the main complication is uterine rupture, which could be life-threatening for the patient. Early diagnosis and treatment are therefore essential for the woman. We report the case of a patient in early pregnancy with a history of cesarean section who presented with severe pelvic pain due to uterine rupture.
|Cellular immunotherapy at the University Hospital of Liege : advances, challenges and prospects|
Grégoire C, Servais S, Willems E (1), Baudoux E, Lechanteur C, Briquet A, Bettonville V, Detry O, Erpicum P, Jouret F, Louis E, Baron F, Beguin Y
Rev Med Liege 2022, 77(4),206-211
Summary : Cellular immunotherapy consists in using the cells of the immune system as a therapeutic weapon. In this constantly evolving field, the therapeutic strategies developed at the University Hospital of Liege are hematopoietic stem cell transplantation, mesenchymal stromal cells and targeted therapy with CAR-T cells (Chimeric Antigen Receptor T cells). The first two modalities represent a form of non-targeted cell therapy that has been developed over the past decades. While hematopoietic stem cell transplantation is established as the reference treatment for many hematological diseases, mesenchymal stromal cells are still under investigation in various pathologies (notably Crohn’s disease, organ transplantation, COVID-19 and pulmonary fibrosis). By contrast, CAR-T cells represent a recently developed and extremely promising targeted immunotherapy. This therapeutic approach has already revolutionized the treatment of B-cell lymphopathies, and has the potential to do the same for many other diseases in the near future.
|Learnings from the use of CEdRIC strategy in the context of COVID-19 pandemic|
Pétré B, Paridans M, Guillaume M
Rev Med Liege 2022, 77(4),212-217
Summary : This article relates the experience of mobilisation of the CEdRIC strategy by health promotion staff of the Province of Liège, Belgium between June and September 2020. The perception of the beneficiaries is also approached. Four key messages are discussed in the article: the adjustment of a brief educational intervention strategy to the context of the pandemic and integration into primary care; the need for the citizen to be heard and accompanied in times of crisis; the need to go beyond information to health education embedded in a health promotion approach; the role that a structure such as the Province of Liège can play in the health promotion landscape. This article relates the experience of mobilisation of the CEdRIC strategy by health promotion staff of the Province of Liège, through the eyes of the beneficiaries (citizen) contacted by telephone in the days following the intervention. The results indicate an over-information concerning the rules to be respected and a good knowledge of preventive measures. The participants consider these measures useful, easy to apply and declare that they have a role to play in the fight against the pandemic. Nevertheless, not all of the recommendations made by the government are implemented by all participants. Future research should focus on adherence to preventive measures and the factors that can influence this adherence so that future and sustainable actions can be put in place.
|About the safety profile of SGLT2 inhibitors|
Rev Med Liege 2022, 77(4),218-223
Summary : Since their launch, sodium-glucose cotransporter type 2 inhibitors (SGLT2is) were suspected to be associated with various adverse events. They contributed to delay, as in France, or to restrict the use of this new pharmacological class in clinical practice, despite remarkable results reported in large cardiovascular or renal clinical trials. This article is devoted to three major adverse events that were imputed to SGLT2is : lower-limb extremity amputations, euglycaemic ketoacidosis and acute kidney injuries. In contrast to pharmacovigilance reports that raised suspicion, analysis of all data from the literature, either placebo-controlled trials or retrospective observational cohort studies, led to rather reassuring conclusions. The incidence of amputations does not appear to be increased while cases of acute kidney injury are reduced instead of increased as suspected earlier. Ketoacidosis events are almost doubled with SGLT2is versus comparators, yet their incidence remains extremely low among patients with type 2 diabetes. Of note, this potentially severe complication contributes to the denial of marketing authorization and reimbursement of SGLT2is in the population with type 1 diabetes.
|Comparative analysis of the brain distribution of [18F]FDG in populations of patients with Alzheimer’s disease with or without family history of dementia|
Lamaye C, Bastin C, Bernard C, Withofs N, Hustinx R, Salmon E
Rev Med Liege 2022, 77(4),224-230
Summary : Hereditary forms of Alzheimer’s disease (AD) and early-onset forms have more brain damage than sporadic or late-onset forms at the time of diagnosis (1, 2). Data in the literature are contradictory concerning familial forms without known heredity or mutation. The aim of this study was to compare the brain distribution of FDG between two populations of patients with a clinical diagnosis of sporadic AD according to the presence or not of a first degree family history of dementia. We retrospectively included 243 patients with clinical diagnosis of AD who underwent brain FDG PET imaging between 2012 and 2017. SPM12 was used to compare the FDG brain distribution in 199 patients with AD and no familial history of dementia and 43 patients with AD and first degree familial history of dementia. Compared to a database of 22 healthy control subjects, both groups of AD patients showed a significant decrease of FDG distribution in temporo-parietal, posterior cingulate and posterior left frontal cortex with respect to the controls (p < 0.05 corrected for the family-wise error, pFWE-corr). There were no significant differences between the two AD groups (pFWE-corr > 0.05 and p > 0.001 uncorrected for multiple comparisons) that present the same brain metabolic pathology.
|Neuromusculoskeletal disorders related to musical playing - a review of the literature|
Collard X, Kaux JF, Forthomme B
Rev Med Liege 2022, 77(4),231-235
Summary : The prevalence of pathologies associated with musical playing are high among professional musicians. While hearing injuries appear to be the most commonly disorder, instrumentalists are also prone to numerous neurological and musculoskeletal problems. Despite the increasing number of recent clinical studies, an appropriate identification of these problems by health practitioners remains difficult and the implementation of an adequate treatment is almost inexistent in a population of musicians with several disorders affecting the ability to play their instrument.
|Somatic care in psychiatry : barriers perceived by patients and health professionals|
Kohn L, Christiaens W, Detraux J, De Lepeleire J, De Hert M, Gillain B, Delaunoit B, Savoye I, Mistiaen P, Jespers V
Rev Med Liege 2022, 77(4),236-243
Summary : Disparities in access to, use of and delivery of somatic health care contribute to widening gaps in morbidity and mortality between psychiatric patients and the general population. We conducted a qualitative semi-structured interview study with psychiatric patients and health professionals from different psychiatric care settings to understand these poor physical health outcomes. Optimal somatic follow-up of patients with severe mental illness seems to be hampered by (1) provider-related elements (attitude, training, experiences); (2) organisational aspects (equipment, infrastructure, staff, pharmacy, communication networks); (3) psychiatric patient-related elements and (4) financial barriers.There is an urgent need for integrated somatic and psychiatric health care systems and for cultural change. Psychiatrists and somatic health care providers continue to view the mental and physical health of their patients as mutually exclusive responsibilities. A range of system changes will improve the quality of somatic health care for these vulnerable patients.
|Fixed combination of budesonide, formoterol, glycopyrronium for the treatment of severe COPD : Trixeo Aerosphere®|
Louis R, Bonhomme O, Heinen V, Nguyen D, Van Cauwenberge H, Corhay JL
Rev Med Liege 2022, 77(4),244-248
Summary : Here we present pharmacological and clinical properties of a new fixed triple inhaled combination including an inhaled corticoid, a long acting ?2 agonist and a long acting anticholinergic for the treatment of severe chronic obstructive pulmonary disease (COPD). Trixeo Aerosphere® is the name of this triple combination which contains 160 µg budesonide, 4,8 µg formoterol and 9 µg glycopyrronium delivered by a pMDI. As compared to a budesonide/formoterol combination, Trixeo Aerosphere® improves forced expiratory volume in the first second (FEV1). As compared to glycopyrronium/formoterol combination, Trixeo Aerosphere® reduces exacerbation rate, improved quality of life and most importantly reduces mortality with a benefit increasing with blood eosinophil count. Trixeo Aerosphere® 320/18/9.6 is delivered twice daily 2 inhalations and is indicated in moderate to severe COPD insufficiently controlled by LABA/LAMA (long-acting ?2-adrenergic receptor agonist/ long-acting ?2-muscarinic receptor agonist) or ICS/LABA (inhaled corticosteroid/long-acting ?2-adrenergic receptor agonist).
|Diagnostic approach to chronic kidney disease|
Delanaye P, Dubois B, Cavalier E, Jouret F
Rev Med Liege 2022, 77(4),249-252
Summary : Chronic kidney disease (CKD) affects ~7 % of the general population and is burdened with significant morbidity and mortality, especially cardiovascular disease. At the terminal stage, CKD requires demanding and costly treatments for the patient and the society, such as dialysis or kidney transplantation. The symptomatology of CKD is poor and unspecific, which complicates the identification and early management of patients with CKD. Diagnostic criteria for CKD include (1) renal morphological abnormality; and/or (2) proteinuria >150 mg/g creatinine; and/or (3) glomerular filtration rate (GFR) < 60 ml/min/ 1.73 m². The persistence of these abnormalities for more than 3 months indicates the chronicity of the renal damage. Starting from an exemplary clinical case, we detail the diagnostic steps when faced with a suspicion of CKD.