Hereditary angioedema (HAE) in Belgium: results from a national survey.

Background: Hereditary angioedema (HAE) is a rare heritable disorder that is characterized by recurrent, circumscribed, nonpitting, nonpruritic, often painful subepithelial swellings of sudden unpredictable onset that generally fade during 48-72 h. Epidemiological data of hereditary angioedema patients in Belgium is lacking. Methods: We set up a nation-wide, multicentric study involving the 8 Belgian hospitals known to follow-up patients with Type I and II HAE. All Belgium HAE patients were asked to fill out questionnaires that mainly covered demographic data, family history, and detailed information about diagnosis, treatment and burden of their Type I and II HAE. Results: 112 patients with type I or type II HAE could be included. Median delay between first symptoms and diagnosis was 7 years. 51% of patients had experienced pharyngeal or tongue swelling and 78% had experienced abdominal symptoms, both known to cause an important reduction in quality of life. 60% of symptomatic patients reported to receive long term prophylactic treatment. Human plasma-derived C1-esterase inhibitor concentrate was used by 56.3% of patients. 16.7% and 27.1% of patients used a 17-α-alkylated androgen and tranexamic acid as long term prophylactic therapy. Conclusions: We present the first nation-wide epidemiological study regarding HAE in Belgium. Our data show that the morbidity of HAE is not to be underestimated. Knowledge and dissemination of this data is critical in raising awareness, encouraging development of therapies and optimising nationwide management.

Clinical practice of hereditary angioedema in Belgium: opportunities for optimized care.

INTRODUCTION: Hereditary angioedema (HAE) is a rare disorder characterized by unpredictable painful and potentially life-threatening swelling episodes. The international WAO/EAACI guideline on the diagnosis and management of HAE was recently updated and provides up-to-date guidance for the management of. In this paper, we assessed to what extent the Belgian clinical practice was aligned with the revised guideline, and whether there were opportunities to optimise Belgian clinical practice in HAE. METHODS: We compared the updated international guideline for HAE with information we acquired on Belgian clinical practice, a Belgian patient registry and expert opinion analysis. The Belgian patient registry was developed with the involvement of eight Belgian reference centers for HAE patients. Eight Belgian experts, physicians in the participating centers, included patients in the patient registry and participated in the expert opinion analysis. RESULTS: The main action points to further optimise the Belgian clinical practice of HAE are Work towards total disease control and normalize patients' life by considering the use of new and innovative long-term prophylactic treatment options; (2) inform C1-INH-HAE patients about new long-term prophylactic therapies; (3) assure the availability of on-demand therapy for all C1-INH-HAE patients; (4) implement a more universally used assessment including multiple aspects of the disease (e.g. quality of life assessment) in daily clinical practice; and (5) continue and expand an existing patient registry to assure continued data availability on C1-INH-HAE in Belgium. CONCLUSIONS: In light of the updated WAO/EAACI guideline, five action points were identified and several other suggestions were made to optimise the Belgian clinical practice in C1-INH-HAE.

Contribution of the FilmArray Respiratory Panel in the management of adult and pediatric patients attending the emergency room during 2015-2016 influenza epidemics: An interventional study.

AIM: To evaluate the contribution of a multiplex PCR for respiratory viruses on antibiotic and antiviral prescription, ancillary test prescription, admission and length of stay of patients. METHODS: Two hundred ninety-one adult and pediatric patients visiting the emergency department during the 2015-2016 influenza epidemic were prospectively included and immediately tested 24/7 using the FilmArray Respiratory Panel. The results were communicated to the practitioner in charge as soon as they became available. Clinical and biological data were gathered and analyzed. FINDINGS: Results from the FilmArray Respiratory Panel do not appear to impact admission or antibiotic prescription, with the exception of a lower admission rate for children who tested positive for influenza B. Parameters that account for the clinical decisions evaluated are CRP level, white blood cell count, suspected or proven bacterial infection and, for adult patients only, signs of respiratory distress. Length of stay is also not significantly different between patients with a positive and a negative result. A rapid influenza test result permits a more appropriate prescription of oseltamivir.

Does endotracheal intubation increases chest compression fraction in out of hospital cardiac arrest: A substudy of the CAAM trial.

BACKGROUND: Optimal out of hospital cardiac arrest (OHCA) airway management strategies remain unclear. We compared chest compression fraction (CCF) between patients receiving endotracheal intubation (ETI) versus bag mask ventilation (BMV). METHODS: We studied adult OHCA enrolled from our center in the CAAM trial. Primary exposures were ETI or BMV. Primary outcome was whole intervention CCF, adjusted for Utstein confounders. Secondary outcomes were per cycle CCF, no flow time associated (NFT) with ventilation, rhythms checks and mechanical chest compression device placement. RESULTS: Of 2040 OHCA enrolled in the CAAM trial we analyzed 112 cases recruited by our center. Unadjusted CCF was 0.89 for ETI and 0.88 for BMV (p = 0.19). Compared with BMV, ETI achieved lower NFT associated with ventilations (32 vs 127 s; p < 0.001). ETI cases experienced higher NFT associated with rhythm checks (69.5 vs 42.5 s p = 0.02) and with mechanical chest compression placement (29 vs 20 s; p = 0.04). CCF was higher during the first cycle in BMV than in ETI patients (0.81 vs 0.74; p = 0.02). After correction for confounders we observed no difference in global intervention CCF between the ETI and BMV (ΔCCF [ETI-BMV] 0.301; [95%CI: -1.9 to 2.51]; p = 0.79). CONCLUSION: In our substudy whole intervention CCF among OHCA was not modified by ETI compared to BMV. In the ETI group we observed lower NFT associated with ventilations and higher NFT associated with mechanical chest compression devices placement. CCF was lower in the ETI group during the first cycle.

Prospective evaluation of diagnostic tools for respiratory viruses in children and adults.

AIM: To compare the performances of molecular and non-molecular tests to diagnose respiratory viral infections and to evaluate the pros and contras of each technique. METHODS: Two hundred ninety-nine respiratory samples were prospectively explored using multiplex molecular techniques (FilmArray Respiratory Panel, Clart Pneumovir), immunological techniques (direct fluorescent assay, lateral flow chromatography) and cell cultures. FINDINGS: Molecular techniques permitted the recovery of up to 50% more respiratory pathogens in comparison to non-molecular methods. FilmArray detected at least 30% more pathogens than Clart Pneumovir which could be explained by the differences in their technical designs. The turnaround time under 2 hours for the FilmArray permitted delivery of results when patients were still in the emergency room.

[Eye's traumatic enucleation : need for a multidisciplinary management]. / Enucléation traumatique bilatérale des yeux : une prise en charge multidisciplinaire s'impose.

We report a rare case of a 33 year-old man victim of a public assault resulting in bilateral enucleation of the orbits. The optic nerves were ripped or even pulled out with subsequent subarachnoïdal hemorrhage as well as chiasm lesions. Meaning castration, such an act may express a psychiatric or a neurologic disorder. The management must be multidisciplinary by a team that includes emergency doctors, radiologist, ophthalmologist, neurosurgeon as well as psychiatrist and neurologist.

Nous rapportons le cas rare d'un patient de 33 ans victime d'une énucléation des deux yeux par agression sur la voie publique. Les nerfs optiques ont été sectionnés voire avulsés, causant une hémorragie méningée et des lésions du chiasma optique. Symbole de castration, un tel acte peut exprimer une pathologie psychiatrique ou neurologique. La prise en charge doit être pluridisciplinaire par une équipe comportant urgentiste, radiologue, neurochirurgien, ophtalmologue, mais aussi psychiatre et neurologue.

[Evaluations by hospital-ward physicians of patient care management quality for patients hospitalized after an emergency department admission]. / Evaluation par le médecin de salle de la qualité de la prise en charge médicale des patients hospitalisés via le Service des Urgences.

BACKGROUND: patient management in the acute and sub-acute setting of an Emergency Department is challenging. An assessment of the quality of provided care enables an evaluation of failings. It contributes to the identification of areas for improvement. OBJECTIVES: to obtain an analysis, by hospital-ward physicians, of adult patient care management quality, as well as of the correctness of diagnosis made during emergency admissions. To evaluate the consequences of inadequate patient care management on morbidity, mortality and cost and duration of hospitalization. METHODS: prospective data analysis obtained between the 1/12/2009 and the 21/12/2009 from physicians using a questionnaire on adult-patient emergency admissions and subsequent hospitalization. RESULTS: questionnaires were completed for 332 patients. Inadequate management of patient care were reported for 73/332 (22 %) cases. Incorrect diagnoses were reported for 20/332 (6 %) cases. 35 cases of inadequate care management (10.5 % overall) were associated with morbidity (34 cases) or mortality (1 case), including 4 cases (1.2 % ) that required emergency intensive-care or surgical interventions. CONCLUSION: this quality study analyzed the percentage of patient management cases and incorrect diagnoses in the emergency department. The data for serious outcome and wrong diagnosis are comparable with current literature. To improve performance, we consider the process for establishing a diagnosis and therapeutic care.

OBJECTIFS: analyser la qualité de la prise en charge médicale et l'adéquation des diagnostics des patients admis en urgence par les spécialistes des unités de soins. En évaluer les conséquences sur la morbidité, la mortalité, le coût et la durée d'hospitalisation. MATERIEL ET METHODES: sur une période s'échelonnant du 1/12/2009 au 21/12/2009, nous avons prospectivement analysé, sur base d'un questionnaire, les constatations émises par les spécialistes des salles sur 332 patients adultes admis à l'hôpital via le Service des Urgences. Les critiques sur la qualité de la prise en charge se fondent, subjectivement, sur l'avis des spécialistes des salles. RESULTATS: les pourcentages de prises en charge inadéquates et d'erreurs diagnostiques sont respectivement de 22 % et de 6 %. Parmi les 22 % des prises en charge inadéquates, 10,5 % présentent des conséquences en termes de morbidité, coût et durée d'hospitalisation, 1,2 % ont été repris in extremis par les intensivistes et les chirurgiens, on note 1 décès. CONCLUSION: cette étude qualité analyse le pourcentage de prises en charge et de diagnostics adéquats au sein du Service des Urgences. Les erreurs diagnostiques et leurs conséquences sont comparables à celles retrouvées dans la littérature. Une réflexion sur les processus cognitifs d'élaboration du diagnostic et les prises en charge thérapeutiques est entreprise pour améliorer nos performances.

[Rational approach and management of the dyspnoeic patient in general medical practice]. / Approche rationnelle et prise en charge du patient dyspnéique en médecine génerale.

Dyspnea represents 3-4 % of consultations at primary care medicine (general medicine, emergency medicine) and is found in 14 % of the interviewed general population. It is defined as an abnormal and uncomfortable breathing and can be classified according to the mode of appearance, the breathing pattern or the rhythm. Different classifications are used to specify the severity of the situation: visual analog scale, functional classification of the New York Heart Association, dyspnea modified scale from the Medical Research Council, ... Rare among young people, dyspnea often hides asthma; more prevalent among seniors, it is often secondary to chronic lung or heart disease. The rational approach is the same in general medicine and in the emergency room. The management starts with an assessment of the severity of the patient's clinical situation, via the early warning score. The critical patient requires to be managed according to the progressive and cyclical ABCDE approach. For non-critical patients, a traditional approach and a reasoned method are needed. In patients suffering from chronic obstructive pulmonary disease (COPD), the use of the Anthonissen criteria allows to orient toward a pulmonary superinfection or another cause of worsening dyspnea (cardiac, ...). In case of suspected pulmonary embolism, the Geneva score and the modified Wells score help to separate low, intermediate or high probability cases of pulmonary embolism. D-dimers have a very good negative predictive value in the low and middle risk group and pulmonary CT angiography applies only to a smaller group of dyspnoeic patients with a high probability of pulmonary embolism. Echocardiography has a prominent role to assess the LV systolic function, the search for pulmonary artery hypertension, the vascular filling state, etc. We speak of psychogenic dyspnea after having excluded the potentially serious pathologies.

[Prospective study of waiting time delays in a university hospital emergency department with a physician triage model]. / Evaluation prospective des délais d'attente dans un service d'urgence d'un hôpital universitaire avec un accueil médicalisé de première ligne.

To measure waiting time delays of patients and to evaluate if the waiting time before the first physician contact is inversely correlated to the illness severity. During the period of 26/02/2007 through 3/03/2007, we prospectively studied the waiting times before the first contact with a physician (WTP) and the length of stay (LS) in 473 patients (0.8% of the annual patient volume) evaluated in our emergency department, which has a physician triage model. The WTP was correlated to a severity score "Clinical Classification of Patients in Emergency (CCPE)". The median WTP was: 48 (22-79) min. (minutes) (median, P25, P75). This time was 33 (14-47), 16 (3-28) and 3 (0-3) min. for patients having a CCPE score of 3, 4 and 5. The median LS was 119 (76-186) min. In conclusion, the waiting times are comparable to those measured in similar studies. The waiting time evaluated according to CCPE is adequate.