Introduction and background: Pulmonary fibrosis (PF) is the most common pulmonary manifestation of rheumatoid arthritis (RA) but is currently largely under-diagnosed. This leads to a late onset of management, resulting in significant morbidity and mortality. Aims and objectives: The aim of our study is to describe the prevalence and incidence of pulmonary manifestations and especially PF among all RA patients referred to our center. We seek to compare their epidemiological characteristics, pulmonary comorbidities and survival rates. Methods: We conducted a retrospective study based on data extracted from our center's computerized files and completed by a file review. Results: Among 1512 patients with RA, we found out that 197 had a pulmonary manifestation (based on CT scans and pulmonary function testing). In those 197 patients, 29,9% were presenting non-specific interstitial pneumonia (NSIP) pattern and 14,2% were presenting usual interstitial pneumonia (UIP) pattern. In this subgroup, 57 had progressive fibrosing interstitial lung disease (PF-ILD) (45,6% NSIP and 26,3% UIP). The overall ratio of patients suffering from the PF-ILD phenotype in the total RA population was 3,8 % whereas 28,9 % of patients suffering from RA associated lung diseases were presenting the PF-ILD phenotype. Conclusions: RA associated lung disease is associated with a high morbid-mortality rate and is today the major cause of death in those patients. Since anti-fibrotic therapies have shown to be effective in patients with a PF-ILD phenotype there is a clear specific need of identifying those patients at risk of progressive lung decline.
Introduction: Small bowel obstruction (SBO) is a common presentation to emergency abdominal surgery. The most frequent causes of SBO are congenital, postoperative adhesions, abdominal wall hernia, internal hernia and malignancy.Patients: A 27-year-old woman was hospitalized because of acute abdominal pain, blockage of gases and stools associated with vomiting. Abdominal computed tomography showed an acute small bowel obstruction without any obvious etiology. In view of important abdominal pain and the lack of clear diagnosis, an explorative laparoscopy was performed. Diagnostic of pelvic inflammatory disease was established and was comforted by positive PCR for Chlamydia Trachomatis.Results: Acute small bowel obstruction resulting from acute pelvic inflammatory disease, emerging early after infection, without any clinical or X-ray obvious signs was not described in the literature yet. This infrequent acute SBO etiology but must be searched especially when there is no other evident cause of obstruction in female patients. Early laparoscopy is mostly advised when there are some worrying clinical or CT scan signs.
Deep remission including clinical remission and tissue healing has been advocated as the therapeutic target in Crohn's disease. Yet, the definition of deep remission remains unclear. The aim of this study was to assess the persisting lesions at magnetic resonance enterocolonography (MREC) in clinically quiescent Crohn's disease as well as their relapse predictive value.we performed a prospective monocentre cohort study. We included patients with clinical remission. At baseline, these patients had blood tests, the measurement of fecal calprotectin and underwent a MREC. They were then followed up clinically for a minimum of 1 year. A relapse was defined by a HBI > 4 with an increase of at least 3 points. Correlations between clinical, demographic, biological parameters and MREC signs were assessed as well as the time-to-relapse predictive value of the studied variables.Twenty seven patients were recruited. Fourteen out of 27 had persisting disease activity at MREC. MREC signs only partly correlated with biomarkers. Ten out of 27 patients relapsed over a median follow up of 25 months. In univariate analysis, relative contrast enhancement of the most affected segment (HR: 2.56; P = 0.046), ulcers (HR: 12.5; P = 0.039), fistulas (HR: 14.1; P = 0.009) and target sign (HR: 3.63; P = 0.049) were associated with relapse. In multivariate analysis, fistula was the only one.Half of the patients with clinically quiescent Crohn's disease had persisting signs of disease activity at MREC. These signs predicted time-to-relapse.
Background: Interstitial lung diseases (ILDs) are an heterogeneous group of infiltrating lung pathologies, for which prompt diagnosis and continuous assessment are of paramount importance. While chest CT is an established diagnostic tool for ILDs, there are no formal guidelines on the follow-up regimen, leaving the frequency and modality of follow-up largely at the clinician’s discretion. Methods: The study retrospectively evaluated the indication of chest CT in a cohort of 129 ILD patients selected from the ambulatory care polyclinic at University Hospital of Liège. The aim was to determine whether the imagining acquisition had a true impact on clinical course and follow-up. We accepted three different situations for justifying the indication of the CTs: clinical deterioration, a decrease in pulmonary function tests (at least a 10% drop in a parameter), and monitoring for oncological purposes. The other indications, mainly routine follow-up, were classified as “non-justified”. Radiation dose output was evaluated with Computed Tomography Dose Index (CTDI) and Dose Length Product (DLP). Results: The mean number of CT scans per patient per year was 1.7 ± 0.4, determining irradiation in CTDI (mGy)/year of 34.9 ± 64.9 and DLP in (mGy*cm)/year of 1095 ± 1971. The percentage of justified CT scans was 57 ± 32%, while the scans justified a posteriori were 60 ± 34%. Around 40% of the prescribed monitoring CT scans had no impact on the management of ILD and direct patient care. Conclusions: Our study identifies a trend of overuse in chest CT scans at follow-up (up to 40%), outside those performed for clinical exacerbation or oncological investigation. In the particular case of ILD exacerbation, CT scan value remains high, underlying the benefit of this strategy.
Despite many calls, functional brain magnetic resonance imaging (fMRI) studies are relatively rare in the domain of entrepreneurship research. This methodological brief presents the brain-imaging method of resting-state fMRI (rs-fMRI) and illustrates its application in neuroentrepreneurship for the first time. In contrast to the traditional task-based fMRI approach, rs-fMRI observes the brain in the absence of cognitive tasks or presentation of stimuli, which offers benefits for improving our understanding of the entrepreneurial mind. Here, we describe the method and provide methodological motivations for performing brain resting-state functional neuroimaging studies on entrepreneurs. In addition, we illustrate the use of seed-based correlation analysis, one of the most common analytical approaches for analyzing rs-fMRI data. In this illustration, we show that habitual entrepreneurs have increased functional connectivity between the insula (a region associated with cognitive flexibility) and the anterior prefrontal cortex (a key region for explorative choice) as compared to managers. This increased connectivity could help promote flexible behavior. Thus in brief, we provide an exemplar of a novel way to expand our understanding of the brain in the domain of entrepreneurship. We discuss possible directions for future research and challenges to be addressed to facilitate the inclusion of re-fMRI studies into neuroentrepreneurship.
Various symptoms and considerable organ dysfunction persist following infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Uncertainty remains about the potential mid- and long-term health sequelae. This prospective study of patients hospitalized with coronavirus disease 2019 (COVID-19) in Liège University Hospital, Belgium aimed to determine the persistent consequences of COVID-19.Patients admitted to the University Hospital of Liège with moderate-to-severe confirmed COVID-19, discharged between 2 March and 1 October 2020, were recruited prospectively. Follow-up at 3 and 6 months after hospital discharge included demographic and clinical data, biological data, pulmonary function tests (PFTs) and high-resolution computed tomography (CT) scans of the chest.In total, 199 individuals were included in the analysis. Most patients received oxygen supplementation (80.4%). Six months after discharge, 47% and 32% of patients still had exertional dyspnoea and fatigue. PFTs at 3-month follow-up revealed a reduced diffusion capacity of carbon monoxide (mean 71.6 ± 18.6%), and this increased significantly at 6-month follow-up (P<0.0001). Chest CT scans showed a high prevalence (68.9% of the cohort) of persistent abnormalities, mainly ground glass opacities. Duration of hospitalization, intensive care unit admission and mechanical ventilation were not associated with the persistence of symptoms 3 months after discharge.The prevalence of persistent symptoms following hospitalization with COVID-19 is high and stable for up to 6 months after discharge. However, biological, functional and iconographic abnormalities improved significantly over time.
Epiploic appendagitis is the term used to describe the inflammation of an epiploic appendage. These small masses of fat distributed along the colon, from the caecum to the recto-sigmoid junction can inflammate by torsion, spontaneously or secondarily with the inflammation of an anatomical structure in the neighbourhood. Symptomatology may mimic retro-caecal appendicitis or diverticulitis and the diagnosis by CT avoids unnecessary surgery or hospitalization. Indeed, under conservative treatment by AINS and analgesics, symptomatology regresses in about five days. In this article, we relate the case of a patient with a typical clinical presentation, to remind the elements of this pathological entity.
