Acta Clinica Belgica最新文献

{"title":"The human microbiome in health and disease: hype or hope.","authors":"Gwen Falony,&nbsp;Doris Vandeputte,&nbsp;Clara Caenepeel,&nbsp;Sara Vieira-Silva,&nbsp;Tanine Daryoush,&nbsp;Séverine Vermeire,&nbsp;Jeroen Raes","doi":"10.1080/17843286.2019.1583782","DOIUrl":"https://doi.org/10.1080/17843286.2019.1583782","url":null,"abstract":"<p><strong>Objectives: </strong>The prognostic, diagnostic, and therapeutic potential of the human gut microbiota is widely recognised. However, translation of microbiome findings to clinical practice is challenging. Here, we discuss current knowledge and applications in the field.</p><p><strong>Methods: </strong>We revisit some recent advances in the field of faecal microbiome analyses with a focus on covariate analyses and ecological interpretation.</p><p><strong>Results: </strong>Population-level characterization of gut microbiota variation among healthy volunteers has allowed identifying microbiome covariates required for clinical studies. Currently, microbiome research is moving from relative to quantitative approaches that will shed a new light on microbiota-host interactions in health and disease.</p><p><strong>Conclusions: </strong>Covariate characterization and technical advances increase reproducibility of microbiome research. Targeted in vitro/in vivo intervention studies will accelerate clinical implementation of microbiota findings.</p>","PeriodicalId":48865,"journal":{"name":"Acta Clinica Belgica","volume":"74 2","pages":"53-64"},"PeriodicalIF":1.6,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17843286.2019.1583782","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37178637","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":"Complicated pneumothorax and congenital lung cystic malformation.","authors":"Rachid Attou,&nbsp;Pascal Reper","doi":"10.1179/2295333714Y.0000000023","DOIUrl":"https://doi.org/10.1179/2295333714Y.0000000023","url":null,"abstract":"<p><p>Congenital cystic adenomatoid malformation, also named congenital pulmonary airway malformation (CPAM), is a congenital lung abnormality which is uncommon in adults. The usual radiological appearance of CPAM is a cystic space-occupying lesion. We present one case of CPAM with unusual clinical and radiological findings, a complicated spontaneous pneumothorax with intracystic haemorrhage with successful conservative initial treatment, despite acute haemodynamic instability.</p>","PeriodicalId":48865,"journal":{"name":"Acta Clinica Belgica","volume":"71 5","pages":"313-315"},"PeriodicalIF":1.6,"publicationDate":"2016-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/2295333714Y.0000000023","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32229761","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":"Tuberculin skin test versus interferon-gamma release assays for the diagnosis of tuberculosis infection.","authors":"E De Keyser,&nbsp;F De Keyser,&nbsp;F De Baets","doi":"10.1179/2295333714Y.0000000043","DOIUrl":"https://doi.org/10.1179/2295333714Y.0000000043","url":null,"abstract":"<p><strong>Objective: </strong>Accurate detection of latent tuberculosis infection (LTBI) is becoming increasingly important due to the increasing use of immunosuppressive medications and the human immunodeficiency epidemic, which have increased the risk for reactivation to active tuberculosis (TB) infection. LTBI is detected by tuberculin skin test (TST) and interferon-gamma release assays (IGRAs). The latter include T-SPOT(®).TB (Oxford Immunotec) and QuantiFERON(®)-TB Gold In-Tube (QFT-GIT; Cellestis). We examined the value of TST versus IGRAs in the diagnosis of TB infection by meta-analysis based on data derived from a systematic literature review.</p><p><strong>Methods: </strong>PubMed was searched for articles in English published between January 2010 and July 2012 in which TST and IGRA were performed simultaneously in individuals with and without active TB infection. A random effect model meta-analysis was performed to determine pooled sensitivity and specificity values for TST, T-SPOT.TB, and QFT-GIT. Owing to the absence of a gold standard for the diagnosis of LTBI, active TB infection was used as a surrogate for LTBI.</p><p><strong>Results: </strong>Nineteen studies were included. T-SPOT.TB was significantly more sensitive [90% (95% confidence interval: 85-95) versus 64% (46-81)] than TST. The specificity of T-SPOT.TB was higher than the specificity of TST, but there was overlap between confidence intervals [77% (68-85) versus 57% (41-72)]. QFT-GIT seemed to be more sensitive than TST [75% (61-86) versus 64% (48-78)] but similarly specific [71% (62-86) versus 70% (57-81)].</p><p><strong>Conclusions: </strong>IGRAs, especially T-SPOT.TB, are more effective at detecting TB infection than TST. Despite their higher cost, they have added value and can be requested in addition to TST.</p>","PeriodicalId":48865,"journal":{"name":"Acta Clinica Belgica","volume":"69 5","pages":"358-66"},"PeriodicalIF":1.6,"publicationDate":"2014-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/2295333714Y.0000000043","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32498326","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":"Management of the neonate at risk for early-onset Group B streptococcal disease (GBS EOD): new paediatric guidelines in Belgium.","authors":"L Mahieu,&nbsp;J-P Langhendries,&nbsp;V Cossey,&nbsp;C De Praeter,&nbsp;P Lepage,&nbsp;P Melin","doi":"10.1179/2295333714Y.0000000054","DOIUrl":"https://doi.org/10.1179/2295333714Y.0000000054","url":null,"abstract":"<p><p>Despite group B streptococcal (GBS) screening in late pregnancy and intrapartum antimicrobial prophylaxis, early-onset sepsis in neonates remains a common source of neonatal morbidity and mortality especially in preterm neonates. The identification of neonates with early-onset sepsis is usually based on perinatal risk factors. Clinical signs are aspecific and laboratory tests are not sensitive. Therefore, many clinicians will overtreat at-risk infants. Inappropriate treatment with antibiotics increases the risk for late-onset sepsis, necrotizing enterocolitis, mortality, and prolongs hospitalisation and costs. In 2003, the Belgian Health Council published guidelines for the prevention of perinatal GBS infections. This report presents the Belgian paediatric management guidelines, which have been endorsed by the Belgian and Flemish societies of neonatology and paediatrics. The most imported changes in the 2014 guidelines are the following: recommendations for a lumbar puncture; clarification of normal spinal fluid parameters and blood neutrophil indices corrected for gestation age; specific timing for diagnostic testing after birth; no indication for diagnostic testing in asymptomatic newborns unless additional risk factors; a revised algorithm for management of neonates according to maternal and neonatal risk factors; and premature infants described as those below 35 weeks instead of 37 weeks. The guidelines were made on the basis of the best evidence and on expert opinion when inadequate evidence exists. </p>","PeriodicalId":48865,"journal":{"name":"Acta Clinica Belgica","volume":"69 5","pages":"313-9"},"PeriodicalIF":1.6,"publicationDate":"2014-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/2295333714Y.0000000054","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32529994","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":"Prospective non-interventional multicentre observational trial of first-line anti-cancer treatment in patients with metastatic renal cell cancer in Belgium.","authors":"N Cornelis,&nbsp;T Vermassen,&nbsp;D Schallier,&nbsp;J-P Machiels,&nbsp;T Gil,&nbsp;P R Debruyne,&nbsp;R D'hondt,&nbsp;A Bols,&nbsp;D Schrijvers,&nbsp;J Mebis,&nbsp;N Lumen,&nbsp;S Rottey","doi":"10.1179/2295333714Y.0000000051","DOIUrl":"https://doi.org/10.1179/2295333714Y.0000000051","url":null,"abstract":"<p><strong>Objectives: </strong>Renal cell carcinoma (RCC) accounts for 2·4% of all new cancers in Belgium. Over the past decade, the armamentarium for systemic therapy of metastatic RCC (mRCC) has undergone important changes with implementation of targeted therapies directed against pathways involved in the pathogenesis of RCC. We describe first-line treatment choice of a group of patients in 9 Belgian oncology centres between October 2009 and November 2012.</p><p><strong>Methods: </strong>A clinical report form was established to assess patient characteristics, Karnofsky performance score, Memorial Sloan-Kettering Cancer Center risk criteria (MSKCC) and first-line therapy of mRCC patients. Choice of therapy and starting dose was analyzed before and after reimbursement of pazopanib in Belgium.</p><p><strong>Results: </strong>Ninety-six patients were eligible for the study. Non-smokers accounted for 53% of the patients. Seventy-three per cent of the patients had 0 or 1 MSKCC criteria in the group of patients that started treatment more than 1 year after initial diagnosis. In the group of patients that started therapy less than 1 year after diagnosis, 85% had 2 or more MSKCC criteria. This difference was statistically significant (P<0·0001). Overall distribution of the first-line therapies consisted of 43% sunitinib, 33% pazopanib, 14% temsirolimus, 7% everolimus and 3% sorafenib. Seventeen (18%) out of 96 patients started at a reduced dose level.</p><p><strong>Conclusion: </strong>This report shows that the guidelines for the start of first-line treatment in mRCC in 9 centres in Belgium were applied most of the time: a tyrosine kinase inhibitor was the first treatment choice for most patients while temsirolimus was an option for poor prognosis patients. In the majority of patients standard dose levels were initiated, although in some patients adaptation of dosage/treatment schedule was recorded.</p>","PeriodicalId":48865,"journal":{"name":"Acta Clinica Belgica","volume":"69 5","pages":"335-40"},"PeriodicalIF":1.6,"publicationDate":"2014-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/2295333714Y.0000000051","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32529992","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 multidisciplinary network for the care of abnormal fatigue and chronic fatigue syndrome in the provinces of East and West Flanders in Belgium.","authors":"E Tobback,&nbsp;A Mariman,&nbsp;S Heytens,&nbsp;T Declercq,&nbsp;A Bouwen,&nbsp;D Spooren,&nbsp;P Snoeck,&nbsp;K Van Dessel,&nbsp;S D'Hooghe,&nbsp;S Rimbaut,&nbsp;D Vogelaers","doi":"10.1179/2295333714Y.0000000056","DOIUrl":"https://doi.org/10.1179/2295333714Y.0000000056","url":null,"abstract":"<p><p>The organization of care for patients with the chronic fatigue syndrome (CFS) in tertiary care referral centres from 2002 onwards, was negatively evaluated by the Belgian Health Care Knowledge Centre on the endpoint of socio-professional reintegration. Subsequently, the federal health authorities asked for the elaboration of a new and innovative model of stepped care, aiming at improved integration of diagnosis and treatment into primary care and between levels of health care for patients with CFS. The reference centre of the University Hospital Ghent took the initiative of recruiting partners in the Belgian provinces of East and West Flanders to guarantee the care for patients with medically unexplained symptoms, in particular abnormal fatigue and CFS. A new and innovative care model, in which general practitioners play a central role, emphasizes the importance of early recognition of the patient 'at risk', correct diagnosis and timely referral. Early detection and intervention is essential in order to avoid or minimize illness progression towards chronicity, to safeguard opportunities for significant health improvement as well as to enhance successful socio-professional reintegration. This approach covers both the large sample of patients developing somatic complaints without obvious disease in an early phase as well as the more limited group of patients with chronic illness, including CFS. Cognitive behavioural therapy and graded exposure/exercise therapy are the evidence based main components of therapy in the latter. A biopsychosocial model underlies the proposed path of care. </p>","PeriodicalId":48865,"journal":{"name":"Acta Clinica Belgica","volume":"69 5","pages":"327-34"},"PeriodicalIF":1.6,"publicationDate":"2014-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/2295333714Y.0000000056","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32532628","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":"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}