Acta Clinica Belgica最新文献

{"title":"Implementation of a multidisciplinary infectious diseases team in a tertiary hospital within an Antimicrobial Stewardship Program.","authors":"F M Buyle,&nbsp;M Wallaert,&nbsp;N Beck,&nbsp;J Boelens,&nbsp;S Callens,&nbsp;G Claeys,&nbsp;S Deryckere,&nbsp;E Haegeman,&nbsp;I Leroux-Roels,&nbsp;E Sermijn,&nbsp;E Steel,&nbsp;H Robays,&nbsp;L Vandekerckhove,&nbsp;K Vermis,&nbsp;D Vogelaers","doi":"10.1179/2295333714Y.0000000045","DOIUrl":"https://doi.org/10.1179/2295333714Y.0000000045","url":null,"abstract":"<p><strong>Background: </strong>In January 2011, as part of an antimicrobial stewardship program the Antimicrobial Management Team (AMT) at the Ghent University Hospital initiated a multidisciplinary Infectious Diseases Team (MIT) consisting of infectious diseases physicians, clinical microbiologists, and clinical pharmacists. The aim of this study is to describe the type and acceptance rate of recommendations provided by the MIT.</p><p><strong>Method: </strong>Prospective, observational study in a tertiary care, university teaching hospital with 1062 beds in non-consecutive hospitalized adult patients, excluding intensive care units and paediatrics.</p><p><strong>Results: </strong>The MIT communicated 432 recommendations in 87 days observed. Of the 293 patients for whom a recommendation was made, the median age was 57 years (range: 16-91 years) and 169 (57·7%) were male. Skin or soft tissue infections (14%), respiratory tract infections (13%), infections without known focus (11%), abdominal infections (11%), and bone infections (8%) were most common. Recommendations were made to perform additional clinical investigation(s) [N = 137 (27%)], to adjust the dose of an antimicrobial drug [N = 42 (8%)], to stop an antimicrobial drug [N = 104 (21%)], to switch from a parenteral to an oral drug [N = 39 (8%)] or to initiate an antimicrobial drug [N = 178 (36%)], with an acceptance rate of 73·0%, 83·3%, 81·7%, 76·9%, and 84·0%, respectively.</p><p><strong>Conclusions: </strong>The MIT formulated about five recommendations a day primarily focusing on pharmacotherapy, but also on clinical investigations. In both fields, a high acceptance rate was observed.</p>","PeriodicalId":48865,"journal":{"name":"Acta Clinica Belgica","volume":"69 5","pages":"320-6"},"PeriodicalIF":1.6,"publicationDate":"2014-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/2295333714Y.0000000045","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32506764","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":"Tuberculous mastitis presenting as a lump: a mimicking disease in a pregnant woman case report and review of literature.","authors":"A Brouwer,&nbsp;N Degrieck,&nbsp;M Rasschaert,&nbsp;F Lockefeer,&nbsp;M Huizing,&nbsp;W Tjalma","doi":"10.1179/2295333714Y.0000000048","DOIUrl":"https://doi.org/10.1179/2295333714Y.0000000048","url":null,"abstract":"<p><p>Tuberculosis (TB) of the breast is a rare entity, and can be confused with many other breast disorders, like mamma carcinoma or inflammatory breast cancer. When finding granulomatous mastitis (GM) on histology, it is important to make a differential diagnosis and seek actively for clues on the presence of tuberculosis, sarcoidosis, Wegener's granulomatosis, or idiopathic granulomatous mastitis, since treatment strategies differ and maltreatment has major implications on morbidity and mortality. An extensive clinical evaluation, laboratory work up, and imaging will lead in most cases to the right diagnosis. Anti-tuberculous therapy is the core treatment for breast TB, and surgery is indicated for extensive or persistent residual disease. Here we present a case of tuberculous mastitis and a review of literature on GM. </p>","PeriodicalId":48865,"journal":{"name":"Acta Clinica Belgica","volume":"69 5","pages":"389-94"},"PeriodicalIF":1.6,"publicationDate":"2014-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/2295333714Y.0000000048","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32532629","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":"ANCA-negative associated vasculitis initially presenting with pulmonary embolism.","authors":"O Filleul,&nbsp;P Madhoun,&nbsp;M Vanhaeverbeek","doi":"10.1179/2295333714Y.0000000041","DOIUrl":"https://doi.org/10.1179/2295333714Y.0000000041","url":null,"abstract":"<p><p>Antineutrophil-cytoplasm antibodies (ANCA)-associated vasculitis are severe inflammatory pathologies that, although rare, may induce significant morbidity or death. Their impact on multiple organ systems implies an important variability in their clinical presentation, which might delay the diagnosis. In this setting we report on a case of ANCA-negative-associated vasculitis, initially presenting as pulmonary embolism with severe pulmonary infarction and digestive involvement. Literature is then discussed on these complications and their implications for therapy. </p>","PeriodicalId":48865,"journal":{"name":"Acta Clinica Belgica","volume":"69 5","pages":"382-5"},"PeriodicalIF":1.6,"publicationDate":"2014-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/2295333714Y.0000000041","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32498325","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":"Intramural haematoma of the esophagus: multimodality imaging findings and clinical triad.","authors":"Q Wang,&nbsp;Y-H Juan,&nbsp;X Zhong","doi":"10.1179/2295333714Y.0000000044","DOIUrl":"https://doi.org/10.1179/2295333714Y.0000000044","url":null,"abstract":"<p><p>Intramural haematoma of the esophagus (IHE) is an uncommon clinical condition, which can mimic other cardiothoracic emergencies in both clinical and imaging perspectives. We presented the case of a 54-year-old female who presented to the emergency department with a clinical triad of retrosternal chest pain, odynophagia, and haematemesis for 3 days. Multi-detector computed tomography (MDCT) revealed long-segmental, well-defined, isodense mass in postero-lateral wall of esophagus with smooth arc-shaped indentation into the lumen and no obvious enhancement after IV contrast administration. The preserved fat plane between the thickened esophagus and the aorta allows exclusion of aortic dissection. Subsequent esophagogram and endoscopy confirmed the finding of IHE and thus, patient was successfully treated with conservative treatment and discharged uneventfully. Owing to the presence of clinical and image mimickers of IHE, the recognition of clinical triad of retrosternal pain, odynophagia, and haematemesis, and the typical MDCT and esophagographic presentation of submucosal haematoma are important in avoiding misdiagnosis with inappropriate treatment. </p>","PeriodicalId":48865,"journal":{"name":"Acta Clinica Belgica","volume":"69 5","pages":"395-6"},"PeriodicalIF":1.6,"publicationDate":"2014-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/2295333714Y.0000000044","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32498327","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":"Retrospective analysis of a suburban out-of-hours clinic in Belgium.","authors":"J L Belche,&nbsp;M A Berrewaerts,&nbsp;P Burette,&nbsp;A L Lenoir,&nbsp;C Duchesnes,&nbsp;D Giet","doi":"10.1179/2295333714Y.0000000052","DOIUrl":"https://doi.org/10.1179/2295333714Y.0000000052","url":null,"abstract":"<p><strong>Introduction: </strong>In many countries, out-of-hours medical care is under scrutiny. The aim of this article is to study the activities recorded by the first out-of-hours clinic that has been opened, as a pilot study, in two Walloon communes.</p><p><strong>Material and method: </strong>A retrospective analysis of anonymized data was conducted for 2009. Coding of diagnoses was conducted using the International Classification of Primary Care (ICPC-2).</p><p><strong>Results: </strong>A total of 3949 contacts were recorded in 2009 with the out-of-hours clinic, 3294 related to inhabitants of the two communes covered, which was equivalent to 13% of the total population in question. Compared to 7·2% of contacts between midnight and 8 a.m., 82·9% of contacts took place between 8 a.m. and 9 p.m., and 91·6% of contacts were handled locally, with only 8·4% resulting in hospitalization. In addition, 52% of contacts were with patients aged between 25 and 65; 29·9% of contacts were with paediatric patients (<15 years). Patients over the age of 65 made up 18% of contacts. The most common pathologies were respiratory (R). Analysis of flu diagnoses identified two epidemic peaks.</p><p><strong>Discussion: </strong>The suburban out-of-hours clinic studied fulfilled an important role in managing the demand for health care. The large majority of health problems were resolved locally, and the inhabitants did not need to go to hospital. Appointments between midnight and 8 a.m. were in the minority, which points towards adjusting the organization of the out-of-hours service during the night. The geriatric population is not highly over-represented contrary to what might be expected considering its largest number of pathologies. The on-call doctor's skills profile should take account of the populations and morbidities encountered. Out-of-hours clinics could possibly play a sentinel role in terms of flu epidemics.</p><p><strong>Conclusion: </strong>This study describes a pilot suburban out-of-hours clinic which met three of recommendations set by the KCE in its report on out-of-hours care in general medicine: the organization of an out-of-hours clinic with logistical support, the use of a single telephone number and merging out-of-hours areas. While debate exists on the management of out-of-hours care, this study provides evidence on the role of the physician during these hours.</p>","PeriodicalId":48865,"journal":{"name":"Acta Clinica Belgica","volume":"69 5","pages":"341-7"},"PeriodicalIF":1.6,"publicationDate":"2014-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/2295333714Y.0000000052","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32529993","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":"Massive pericardial effusion and rhabdomyolysis secondary to untreated severe hypothyroidism: the first report.","authors":"M R Zare-Khormizi,&nbsp;M Rahmanian,&nbsp;F Pourrajab,&nbsp;S Akbarnia","doi":"10.1179/2295333714Y.0000000049","DOIUrl":"https://doi.org/10.1179/2295333714Y.0000000049","url":null,"abstract":"<p><p>Hypothyroidism is an endocrine disease with various clinical manifestations. It is a rare cause for rhabdomyolysis and massive pericardial effusion. We describe a case of severe hypothyroidism secondary to autoimmune hashimoto thyroiditis with massive pericardial effusion and rhabdomyolysis. Improvement of mentioned complications after hypothyroidism treatment and rule out of other possible causes are supportive clues that hypothyroidism is the main cause of patient's rare presentation. With the best of our knowledge, it is the first report of rhabdomyolysis and massive pericardial effusion coincidence in a patient of adult population with primary uncontrolled hypothyroidism for years. </p>","PeriodicalId":48865,"journal":{"name":"Acta Clinica Belgica","volume":"69 5","pages":"375-8"},"PeriodicalIF":1.6,"publicationDate":"2014-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/2295333714Y.0000000049","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32532630","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":"Views of general practitioners on the use of STOPP&START in primary care: a qualitative study.","authors":"O Dalleur,&nbsp;J-M Feron,&nbsp;A Spinewine","doi":"10.1179/2295333714Y.0000000036","DOIUrl":"https://doi.org/10.1179/2295333714Y.0000000036","url":null,"abstract":"<p><strong>Background and objective: </strong>STOPP (Screening Tool of Older Person's Prescriptions) and START (Screening Tool to Alert Doctors to Right Treatment) criteria aim at detecting potentially inappropriate prescribing in older people. The objective was to explore general practitioners' (GPs) perceptions regarding the use of the STOPP&START tool in their practice.</p><p><strong>Design: </strong>We conducted three focus groups which were conveniently sampled. Vignettes with clinical cases were provided for discussion as well as a full version of the STOPP&START tool. Knowledge, strengths and weaknesses of the tool and its implementation were discussed. Two researchers independently performed content analysis, classifying quotes and creating new categories for emerging themes.</p><p><strong>Results: </strong>Discussions highlighted incentives (e.g. systematic procedure for medication review) and barriers (e.g. time-consuming application) influencing the use of STOPP&START in primary care. Usefulness, comprehensiveness, and relevance of the tool were also questioned. Another important category emerging from the content analysis was the projected use of the tool. The GPs imagined key elements for the implementation in daily practice: computerized clinical decision support system, education, and multidisciplinary collaborations, especially at care transitions and in nursing homes.</p><p><strong>Conclusion: </strong>Despite variables views on the usefulness, comprehensiveness, and relevance of STOPP&START, GPs suggest the implementation of this tool in primary care within computerized clinical decision support systems, through education, and used as part of multidisciplinary collaborations.</p>","PeriodicalId":48865,"journal":{"name":"Acta Clinica Belgica","volume":"69 4","pages":"251-61"},"PeriodicalIF":1.6,"publicationDate":"2014-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/2295333714Y.0000000036","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32374747","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":"Stressful life events and type 2 diabetes.","authors":"J M Maksimovic,&nbsp;H D Vlajinac,&nbsp;B D Pejovic,&nbsp;N M Lalic,&nbsp;I S Vujicic,&nbsp;M Z Maksimovic,&nbsp;N D Vasiljevic,&nbsp;S B Sipetic","doi":"10.1179/2295333714Y.0000000042","DOIUrl":"https://doi.org/10.1179/2295333714Y.0000000042","url":null,"abstract":"<p><strong>Objectives: </strong>The purpose of this study is to compare cases with type 2 diabetes and their controls for the frequency of stressful life events and social support before the occurrence of the disease.</p><p><strong>Methods: </strong>The study of cases and their controls was undertaken in Belgrade. A case group comprised 179 subjects in whom type 2 diabetes was for the first time diagnosed in the 'Savski Venac' Medical Center during the period 2005-2007 year. The diagnosis was made by a specialist of internal medicine according to criteria of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. For each case two controls were chosen among patients with trauma (fracture, reposition, internal/external fixation) who were treated at the 'Banjica' Institute for Orthopedic-Surgical Diseases during the same period. Cases and controls were matched by sex, age (±2 years) and place of residence (Belgrade). Data were collected on demographic characteristics, habits, personal history, stressful life events, social support and family medical history.</p><p><strong>Results: </strong>According to multivariate analysis low social support in personal history, such as relatives/friends help and financial assistance in solving problems, and bad management of monthly income were significantly positively related to type 2 diabetes. However, significantly more controls than cases had no financial insurance in case of urgent need</p><p><strong>Conclusion: </strong>Examine psychosocial factors play a role in the development of type 2 diabetes.</p>","PeriodicalId":48865,"journal":{"name":"Acta Clinica Belgica","volume":"69 4","pages":"273-6"},"PeriodicalIF":1.6,"publicationDate":"2014-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/2295333714Y.0000000042","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32496096","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":"Systemic capillary leak syndrome revealing a diffuse large B-cell lymphoma.","authors":"L Pothen,&nbsp;H Rouvière,&nbsp;R Poncin,&nbsp;L Michaux,&nbsp;P Damoiseau,&nbsp;M Lambert","doi":"10.1179/0001551214Z.00000000076","DOIUrl":"https://doi.org/10.1179/0001551214Z.00000000076","url":null,"abstract":"<p><p>We report on a 75-year-old woman who presented with recurrent episodes of hypotension, anasarca, renal failure, hypoalbuminaemia without proteinuria, suggestive of systemic capillary leak syndrome (SCLS). Further investigations led to a diagnosis of diffuse large B-cell lymphoma. Secondary SCLS associated with non-Hodgkin lymphoma is reviewed. </p>","PeriodicalId":48865,"journal":{"name":"Acta Clinica Belgica","volume":"69 4","pages":"305-8"},"PeriodicalIF":1.6,"publicationDate":"2014-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/0001551214Z.00000000076","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32437130","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":"Performance of qualitative urinary hCG assays.","authors":"S Nickmans,&nbsp;P Vermeersch,&nbsp;J Van Eldere,&nbsp;J Billen","doi":"10.1179/0001551214Z.00000000069","DOIUrl":"https://doi.org/10.1179/0001551214Z.00000000069","url":null,"abstract":"<p><p>Significant differences in the sensitivity of eight frequently used qualitative urine human chorionic gonadotropin (hCG) tests in Belgium were observed in this study. Although most manufacturers claimed to detect hCG levels as low as 25 mIU/ml, only two out of six tests for home use and one out of two tests for professional use only, achieved the claimed detection limit. According to a survey, we performed among 20 acute care hospitals, 80% of the surveyed hospitals claimed to use these types of hCG analysis in a diagnostic setting. Unsatisfactory performance of these point-of-care testing (POC) assays for urinary hCG could have major consequences in a hospital setting, exposing the early pregnant woman to harmful diagnostic and therapeutic procedures. Although qualitative urine hCG tests are rapid and convenient, determination of hCG in blood remains the gold standard for the diagnosis of pregnancy. </p>","PeriodicalId":48865,"journal":{"name":"Acta Clinica Belgica","volume":"69 4","pages":"277-9"},"PeriodicalIF":1.6,"publicationDate":"2014-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/0001551214Z.00000000069","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32355111","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}