Acta Clinica Belgica最新文献

{"title":"Human urea production, an ignored factor in the nitrogen debate.","authors":"Joris Delanghe","doi":"10.1080/17843286.2023.2290412","DOIUrl":"10.1080/17843286.2023.2290412","url":null,"abstract":"<p><p>A public debate idealing with nitrogen (N) emissions is ongoing. Government reports use models in which the major N producers are agriculture and industry. Flemish NOx emission amounted to 26.4 kt N accompanied by an ammonia emission of 34.0 kt N. Major sources of Flemish N emission are agriculture (59% of total emission) and transport (21%); 95 percent of the ammonia emission is reported to come from agriculture. In this government's view, it looks like Flanders is unpopulated. In Flanders, 6,800,000 inhabitants show an average urea production of 20 g/day, or 3.65 kg N/year. This urea production eventually ends up in wastewaters as ammonia. Human urea production represents the grand total of 24.8 kl N/year. However, this contribution is made invisible in the statistics. Flemish reports mention a grand total of 33 kt/year, so Flemish numbers appear to be incomplete. Human production has not been taken into account. When calculating human N excretion in Flanders, 24.8 kt N/12.322 km2 is obtained, corresponding to an additional N load of ± 20 kg/ha. Implementing human N excretion into the calculation thoroughly changes the situation: adding human N production results in peak loads of 40 kg N/ha. The human nitrogen input is comparable with the heavily criticized contribution by agriculture. Policy should take into account the real size of the problem and not selectively focus on partial problems.</p>","PeriodicalId":48865,"journal":{"name":"Acta Clinica Belgica","volume":" ","pages":"75-76"},"PeriodicalIF":1.6,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138478938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Flemish network on rare connective tissue diseases (CTD): patient pathways in systemic sclerosis. First steps taken.","authors":"Y Piette, F Van den Bossche, J Aerts, N Aerts, S Ajeganova, V Badot, N Berghen, D Blockmans, G Brusselle, N Caeyers, M De Decker, P De Haes, C De Cock, F De Keyser, E De Langhe, M Delcroix, H De Nutte, M De Pauw, A Depicker, A De Sutter, J De Sutter, T Du Four, C Frank, J Goubau, J Guiot, J Gutermuth, L Heeman, F Houssiau, I Hennes, J Lenaerts, A Lintermans, B Loeys, H Luyten, B Maeyaert, F Malfait, A Moeyersoons, Y Mostmans, J Nijs, B Poppe, K Polfliet, D Ruttens, V Sabato, E Schoeters, H Slabbynck, A Stuer, F Tamirou, Kristof Thevissen, G Van Kersschaever, B Vanneuville, J Van Offel, M Vanthuyne, J Van Wabeke, C Verbist, I Vos, R Westhovens, W Wuyts, J Yserbyt, V Smith","doi":"10.1080/17843286.2023.2280737","DOIUrl":"10.1080/17843286.2023.2280737","url":null,"abstract":"<p><p>Despite the low prevalence of each rare disease, the total burden is high. Patients with rare diseases encounter numerous barriers, including delayed diagnosis and limited access to high-quality treatments. In order to tackle these challenges, the European Commission launched the European Reference Networks (ERNs), cross-border networks of healthcare providers and patients representatives. In parallel, the aims and structure of these ERNs were translated at the federal and regional levels, resulting in the creation of the Flemish Network of Rare Diseases. In line with the mission of the ERNs and to ensure equal access to care, we describe as first patient pathways for systemic sclerosis (SSc), as a pilot model for other rare connective and musculoskeletal diseases. Consensus was reached on following key messages: 1. Patients with SSc should have multidisciplinary clinical and investigational evaluations in a tertiary reference expert centre at baseline, and subsequently every three to 5 years. Intermediately, a yearly clinical evaluation should be provided in the reference centre, whilst SSc technical evaluations are permissionably executed in a centre that follows SSc-specific clinical practice guidelines. In between, monitoring can take place in secondary care units, under the condition that qualitative examinations and care including interactive multidisciplinary consultations can be provided. 2. Patients with early diffuse cutaneous SSc, (progressive) interstitial lung disease and/or pulmonary arterial hypertension should undergo regular evaluations in specialised tertiary care reference institutions. 3. Monitoring of patients with progressive interstitial lung disease and/or pulmonary (arterial) hypertension will be done in agreement with experts of ERN LUNG.</p>","PeriodicalId":48865,"journal":{"name":"Acta Clinica Belgica","volume":" ","pages":"26-33"},"PeriodicalIF":1.6,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138805898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acquired factor X deficiency in a multiple myeloma without amyloidosis: a case report.","authors":"Amber Coussee,&nbsp;Gudrun Alliet,&nbsp;Anne-Sophie Hervent,&nbsp;Liesbeth Vynckier,&nbsp;Jan Emmerechts,&nbsp;Sam Van Hecke,&nbsp;Lies Persijn","doi":"10.1080/17843286.2023.2265650","DOIUrl":"10.1080/17843286.2023.2265650","url":null,"abstract":"<p><strong>Background: </strong>Multiple myeloma is one of the most common hematologic malignancies. Acquired factor X deficiencies are often observed in primary (AL) amyloidosis and rarely in multiple myeloma.</p><p><strong>Objective: </strong>We report a case of an acquired factor X deficiency in a patient with a newly diagnosed IgA lambda multiple myeloma, without any evidence of concomitant amyloidosis.</p><p><strong>Methods: </strong>We present the patient's medical history, clinical and physical examinations, laboratory analysis, and outcome.</p><p><strong>Results: </strong>A 76-year-old male presented at the emergency department with ongoing gingival bleeding. Several analytical problems with blood sample analysis arose, which eventually led to the diagnosis of a multiple myeloma. Further exploration revealed an acquired factor X deficiency, explaining the ongoing bleeding. There was no evidence of concomitant amyloidosis. The multiple myeloma was treated, leading to complete remission of the malignancy and bleeding tendency.</p><p><strong>Conclusion: </strong>While coagulopathy is rarely observed in patients diagnosed with multiple myeloma, considering an acquired factor X deficiency becomes relevant when such patient present with bleeding diathesis.</p>","PeriodicalId":48865,"journal":{"name":"Acta Clinica Belgica","volume":" ","pages":"524-528"},"PeriodicalIF":1.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41148842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute stroke in patients taking an oral anticoagulant: impact of clinical pharmacist's intervention on pharmacovigilance reporting.","authors":"Eve-Marie Thillard,&nbsp;Chloé Rousselière,&nbsp;Johana Béné,&nbsp;François Caparros,&nbsp;Marie Bodenant,&nbsp;Pascal Odou,&nbsp;Sophie Gautier,&nbsp;Bertrand Décaudin","doi":"10.1080/17843286.2023.2261716","DOIUrl":"10.1080/17843286.2023.2261716","url":null,"abstract":"<p><strong>Introduction: </strong>Ischemic or hemorrhagic stroke can occur to patients treated with oral anticoagulants (OAC), through lack of effectiveness or overdosing.</p><p><strong>Objective: </strong>To evaluate the impact of clinical pharmacist's intervention on pharmacovigilance (PV) reporting for OAC-treated patients hospitalized for stroke.</p><p><strong>Methods: </strong>Monocentric prospective study in which a clinical pharmacist's intervention was performed in a stroke unit, with a focus on patients treated by OAC prior admission. A PV report was made with all data collected for cases of stroke suspected to be related to OAC therapy. Data provided by pharmacist were compared with data initially available in the patient's electronic medical records. PV reports with pharmacist intervention were compared to those without.</p><p><strong>Results: </strong>During the study period, 48 patients were included in the study: 43 (89.6%) ischemic strokes with an embolic or unknown etiology, four hemorrhage strokes (8.33%), and one medication error (2.08%). A clinical pharmacist intervention was performed for 19 patients (39.6%) and provided significant additional data in all of them (100%). The information was related to adherence to treatment for 17 cases (89.5%), OAC's initial prescription date for 11 cases (57.9%) and identifying event(s) that could have interfered with the efficacy of the OAC in five cases (26.3%). For patients with pharmacist intervention, PV reports were significantly more informative in terms of date's introduction of anticoagulant, adherence to treatment, reference to weight change or concomitant event.</p><p><strong>Conclusions: </strong>clinical pharmacist's intervention with patients taking oral anticoagulants and hospitalized for acute stroke contributes to collect high-quality data for pharmacovigilance reporting.</p>","PeriodicalId":48865,"journal":{"name":"Acta Clinica Belgica","volume":" ","pages":"478-485"},"PeriodicalIF":1.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41152859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Simvastatin-induced erythromelalgia: less is more.","authors":"Yuran Vanwonterghem,&nbsp;Samyah Shadid","doi":"10.1080/17843286.2019.1640929","DOIUrl":"https://doi.org/10.1080/17843286.2019.1640929","url":null,"abstract":"<p><p>We describe a case of a woman with uncomplicated Type 2 diabetes mellitus, presenting with severe burning pains and intense redness of the legs, for which only cooling could provide relief. Although the description was classic of erythromelalgia, the lack of familiarity of the disorder caused considerable doctor's delay as well as the erroneous advice to start pain killers and amitriptyline. However, empirical discontinuation of simvastatin made all symptoms disappear. Erthyromelalgia is a rare but debilitating disease which is diagnosed by exclusion only. It usually occurs as a secondary feature to (hematologic) malignant disorders, autoimmune diseases or, infections or, most notoriously, to pharmacological agents. One of the latter might be simvastatin, and possibly all HMG CoA Reductase inhibitors.</p>","PeriodicalId":48865,"journal":{"name":"Acta Clinica Belgica","volume":"76 1","pages":"58-59"},"PeriodicalIF":1.6,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17843286.2019.1640929","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37406213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perceptions of physicians, medical and nursing students concerning shared decision-making: a cross-sectional study.","authors":"Gabriël Rafaël Cantaert,&nbsp;Ann Van Hecke,&nbsp;Kim Smolderen","doi":"10.1080/17843286.2019.1637487","DOIUrl":"https://doi.org/10.1080/17843286.2019.1637487","url":null,"abstract":"<p><p><b>Objective</b>: The purpose of this study was to evaluate the attitudes of Flemish physicians and medical/nursing trainees regarding shared decision-making (SDM) and to determine possible differences based on sex, age, rank, occupation and specialty. <b>Methods</b>: A cross-sectional study was conducted between June and September 2017 in which the Patient-Practitioner Orientation Scale (PPOS) was translated and administered. Higher scores on the six-point scale indicate a patient-centered respondent. Independent t-tests, One and Two-way ANOVA and multivariate regression analysis with the variables sex, age, occupation and specialty were performed. <b>Results</b>: 266 responses from 93 physicians, 147 medical and 26 nursing students were analyzed. Mean sharing scores were 4,24 ± 0,64; 4,30 ± 0,61; and 4,30 ± 0,67, respectively. In the regression model, female sex (p < 0,10) and employment (p < 0,05) in general practice or internal medicine is predictive for higher sharing among physicians. Bivariate analysis revealed significant differences between specialisms (p < 0,05): pediatricians (4,79 ± 0,69), psychiatrists (4,74 ± 0,47), obstetricians/gynecologists (4,40 ± 0,38) and general practitioners (4,31 ± 0,59) scored higher on the PPOS than surgeons (3,84 ± 0,58). <b>Conclusion</b>: Flemish providers and trainees are disease-centered. Physicians' attitudes vary depending on their specialism, presumably due to prolonged exposure to the specific clinical context. Additionally, academic-trained nurses share the belief that the physician should decide and the patient should rely on his knowledge rather than his own. There is an urgent need for health policy and educational institutions to facilitate an environment in which SDM is supported.</p>","PeriodicalId":48865,"journal":{"name":"Acta Clinica Belgica","volume":"76 1","pages":"1-9"},"PeriodicalIF":1.6,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17843286.2019.1637487","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37116875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Echtyma gangrenosum caused by coinfection with <i>group A Streptococcus</i> and <i>Staphylococcus aureus</i>: an emerging etiology? Case reports and literature review.","authors":"Antonio Ulpiano Trillig,&nbsp;Véronique Y Miendje Deyi,&nbsp;Pierre Youatou,&nbsp;Deborah Konopnicki","doi":"10.1080/17843286.2019.1630570","DOIUrl":"https://doi.org/10.1080/17843286.2019.1630570","url":null,"abstract":"<p><p>Ecthyma gangrenosum (EG) is a potentially lethal skin infection, most commonly due to <i>Pseudomonas aeruginosa</i> with bacteremic dissemination and affecting mostly immunocompromised patients. We present two cases of EG in two men in Belgium recently admitted to our hospital, caused by a suspected coinfection by group A <i>Streptococcus</i> and <i>Staphylococcus aureus</i>, with a cutaneous dissemination, in which multiple impetigo lesions were the portal of entry. The first patient had no risk factors nor immunodeficiency, but the second was a homeless man with drug and alcohol abuse and advanced HIV infection. Early management of the condition is crucial, with initial broad spectrum antibiotherapy, rapidly narrowed down to the germs identified and skin lesion debridement if necessary. Any immunocompromising condition must be ruled out in any patient suffering from EG.</p>","PeriodicalId":48865,"journal":{"name":"Acta Clinica Belgica","volume":"76 1","pages":"53-57"},"PeriodicalIF":1.6,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17843286.2019.1630570","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37065104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<i>Mycobacterium abscessus</i> felon complicated with osteomyelitis: not an ordinary nail salon visit.","authors":"Jose Armando Gonzales Zamora,&nbsp;Abelardo Villar Astete","doi":"10.1080/17843286.2019.1637390","DOIUrl":"https://doi.org/10.1080/17843286.2019.1637390","url":null,"abstract":"<p><p><i>Mycobacterium abscessus</i> is an environmental organism that has been implicated in pulmonary and extrapulmonary infections. Cases of furunculosis have been described in patients who underwent footbaths in nail salons; however, no cases of severe soft tissue infections or osteomyelitis have been reported following manicures. Here, we present the case of a 50-year-old woman who developed a felon in right index finger one week after having a manicure. She underwent incision and drainage of affected area. Cultures from purulence grew <i>Mycobacterium abscessus</i>. Imaging revealed osteomyelitis of distal phalanx. She was successfully treated with a prolonged course of antibiotics that included imipenem, linezolid, tigecycline, and clarithromycin. We highlight the importance of recognizing this uncommon complication and advocate the use of combined antibiotic regimens for an adequate treatment of this infection.</p>","PeriodicalId":48865,"journal":{"name":"Acta Clinica Belgica","volume":"75 6","pages":"429-433"},"PeriodicalIF":1.6,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17843286.2019.1637390","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37380686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When clozapine appears at a dance event….","authors":"Lisbeth Patteet,&nbsp;Kristof Maudens,&nbsp;Sarah Wille,&nbsp;Peter Blanckaert,&nbsp;Hugo Neels,&nbsp;Paul Calle","doi":"10.1080/17843286.2019.1630068","DOIUrl":"https://doi.org/10.1080/17843286.2019.1630068","url":null,"abstract":"<p><p><b>Objectives</b>: The content of substances sold and consumed as party drugs is often unknown. They may contain inactive, contaminated or unexpected ingredients, and the dosage of the active components may vary considerably. Obviously, these phenomena increase the chances of a wrong or delayed therapy. To illustrate this point, we report 3 cases of clozapine intoxication at a dance event where most likely clozapine tablets were sold as party drugs.<b>Methods</b>: The three cases were part of a prospective toxicology study at a nocturnal indoor dance event.<b>Results</b>: One patient had to be intubated after obstructive breathing with desaturation and bradycardia, while the 2 other patients presented with syncope and altered mental status. All patients recovered after 20 minutes to 8 hours. Systematic toxicological analysis of the blood samples revealed the presence of clozapine (73-244 ng/ml) and its metabolite norclozapine (9-59 ng/ml). A pill, found in a pocket of one patient, was identified as Leponex® 100 mg (clozapine). This neuroleptic drug is mainly prescribed for treatment-resistant schizophrenia. In clozapine-naive subjects, orthostatic hypotension, bradycardia and syncope have been reported with a single 25 mg oral dose. Serum clozapine concentrations of the 3 cases were below the defined therapeutic range (350-600ng/ml) and the clozapine:norclozapine ratios were suggestive for recent drug intake.<b>Conclusion</b>: Routine drug screening may be unable to detect the toxic agent(s) involved. Whenever unusual symptoms are observed in an intoxicated patient, blood and urine samples should be sent to a reference toxicology laboratory.</p>","PeriodicalId":48865,"journal":{"name":"Acta Clinica Belgica","volume":"75 6","pages":"416-420"},"PeriodicalIF":1.6,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17843286.2019.1630068","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37055522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case report of successful eradication of new isolates of <i>Burkholderia cenocepacia</i> in a child with cystic fibrosis.","authors":"V Sputael,&nbsp;G Van Schandevyl,&nbsp;L Hanssens","doi":"10.1080/17843286.2019.1630585","DOIUrl":"https://doi.org/10.1080/17843286.2019.1630585","url":null,"abstract":"<p><p>Chronic respiratory infection with <i>Burkholderia cenocepacia (Bc)</i> in patients with cystic fibrosis (CF) is associated with accelerated decline in lung function and increased mortality. It is therefore important to attempt to eradicate new isolates, especially in children. However, there are no standardized guidelines to eradicate Bc. We report a case of successful eradication of new isolates of Bc in a 2-year-old child with CF using a combination of IV, nebulized antibiotics and sinus surgery.</p>","PeriodicalId":48865,"journal":{"name":"Acta Clinica Belgica","volume":"75 6","pages":"421-423"},"PeriodicalIF":1.6,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17843286.2019.1630585","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37333896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}