RESUMO
Osteochondrosis dissecans is a particularly common developmental orthopaedic disorder in equines. Among its causes, the hereditary component is no longer a matter of debate, and, for several decades, the various studbooks for sport horses have been selecting stallions in order to limit the prevalence of this condition in the population. However, to our knowledge, no study has evaluated changes in the prevalence of osteochondrosis dissecans over time through longitudinal monitoring of a population of sport horses. The study presented here is part of a large screening programme for developmental orthopaedic pathologies in Wallonia (Belgium) and assessed the presence of these lesions over a period of 19 years in the Walloon sport horse population according to constant and standardised sampling and diagnostic criteria. The effects of breeding conditions and infection in foals were also assessed by means of questionnaires. The results showed no significant change in the prevalence of osteochondrosis dissecans in a population of 1099 individuals born between 2004 and 2022. Furthermore, individuals who had suffered from sepsis during their growing period were very significantly predisposed (p < 0.001) to the development of osteochondrosis dissecans compared to a control group, with respectively 14/21 (67%) and 103/364 (28%) of individuals affected. This study suggests that the selection programmes applied to the population studied are not sufficiently strong or adapted to reduce the prevalence of osteochondrosis dissecans in the population over a period of 19 years. Moreover, this study confirms that foals with sepsis and concurrent osteochondrosis dissecans lesions should not necessarily be excluded from breeding programmes on this basis.
Assuntos
Doenças dos Cavalos , Sepse , Cavalos , Animais , Doenças dos Cavalos/epidemiologia , Prevalência , Masculino , Sepse/epidemiologia , Sepse/veterinária , Feminino , Osteocondrite Dissecante/epidemiologia , Osteocondrite Dissecante/veterinária , Osteocondrite Dissecante/diagnóstico por imagem , Radiografia , Bélgica/epidemiologiaRESUMO
BACKGROUND: Ticks carry a variety of microorganisms, some of which are pathogenic to humans. The human risk of tick-borne diseases depends on, among others, the prevalence of pathogens in ticks biting humans. To follow-up on this prevalence over time, a Belgian study from 2017 was repeated in 2021. METHODS: During the tick season 2021, citizens were invited to have ticks removed from their skin, send them and fill in a short questionnaire on an existing citizen science platform for the notification of tick bites (TekenNet). Ticks were morphologically identified to species and life stage level and screened using multiplex qPCR targeting, among others, Borrelia burgdorferi (sensu lato), Anaplasma phagocytophilum, Borrelia miyamotoi, Neoehrlichia mikurensis, Babesia spp., Rickettsia helvetica and tick-borne encephalitis virus (TBEV). The same methodology as in 2017 was used. RESULTS: In 2021, the same tick species as in 2017 were identified in similar proportions; of 1094 ticks, 98.7% were Ixodes ricinus, 0.8% Ixodes hexagonus and 0.5% Dermacentor reticulatus. A total of 928 nymphs and adults could be screened for the presence of pathogens. Borrelia burgdorferi (s.l.) was detected in 9.9% (95% CI 8.2-12.0%), which is significantly lower than the prevalence of 13.9% (95% CI 12.2-15.7%) in 2017 (P = 0.004). The prevalences of A. phagocytophilum (4.7%; 95% CI 3.5-6.3%) and R. helvetica (13.3%; 95% CI 11.2-15.6%) in 2021 were significantly higher compared to 2017 (1.8%; 95% CI 1.3-2.7% and 6.8%; 95% CI 5.6-8.2% respectively) (P < 0.001 for both). For the other pathogens tested, no statistical differences compared to 2017 were found, with prevalences ranging between 1.5 and 2.9% in 2021. Rickettsia raoultii was again found in D. reticulatus ticks (n = 3/5 in 2021). Similar to 2017, no TBEV was detected in the ticks. Co-infections were found in 5.1% of ticks. When combining co-infection occurrence in 2017 and 2021, a positive correlation was observed between B. burgdorferi (s.l.) and N. mikurensis and B. burgdorferi (s.l.) and B. miyamotoi (P < 0.001 for both). CONCLUSIONS: Although the 2021 prevalences fell within expectations, differences were found compared to 2017. Further research to understand the explanations behind these differences is needed.
Assuntos
Anaplasma phagocytophilum , Borrelia burgdorferi , Borrelia , Vírus da Encefalite Transmitidos por Carrapatos , Ixodes , Animais , Bélgica/epidemiologia , Humanos , Prevalência , Vírus da Encefalite Transmitidos por Carrapatos/isolamento & purificação , Vírus da Encefalite Transmitidos por Carrapatos/genética , Borrelia/isolamento & purificação , Borrelia/genética , Borrelia/classificação , Ixodes/microbiologia , Ixodes/virologia , Borrelia burgdorferi/isolamento & purificação , Borrelia burgdorferi/genética , Anaplasma phagocytophilum/isolamento & purificação , Anaplasma phagocytophilum/genética , Babesia/isolamento & purificação , Babesia/genética , Rickettsia/isolamento & purificação , Rickettsia/genética , Rickettsia/classificação , Feminino , Doenças Transmitidas por Carrapatos/epidemiologia , Doenças Transmitidas por Carrapatos/microbiologia , Doenças Transmitidas por Carrapatos/virologia , Masculino , Dermacentor/microbiologia , Dermacentor/virologia , Ninfa/microbiologia , Ninfa/virologia , Carrapatos/microbiologia , Carrapatos/virologia , Picadas de Carrapatos/epidemiologiaRESUMO
(1) Background: early in the COVID-19 pandemic, reverse transcription polymerase chain reaction (RT-PCR) testing was limited. Assessing seroprevalence helps understand prevalence and reinfection risk. However, such data are lacking for the first epidemic wave in Belgian nursing homes. Therefore, we assessed SARS-CoV-2 seroprevalence and cumulative RT-PCR positivity in Belgian nursing homes and evaluated reinfection risk. (2) Methods: we performed a cross-sectional study in nine nursing homes in April and May 2020. Odds ratios (ORs) were calculated to compare the odds of (re)infection between seropositive and seronegative participants. (3) Results: seroprevalence was 21% (95% CI: 18-23): 22% (95% CI: 18-25) in residents and 20% (95% CI: 17-24) in staff. By 20 May 2020, cumulative RT-PCR positivity was 16% (95% CI: 13-21) in residents and 8% (95% CI: 6-12) in staff. ORs for (re)infection in seropositive (compared to seronegative) residents and staff were 0.22 (95% CI: 0.06-0.72) and 3.15 (95% CI: 1.56-6.63), respectively. (4) Conclusion: during the first wave, RT-PCR test programmes underestimated the number of COVID-19 cases. The reinfection rate in residents was 3%, indicating protection, while it was 21% in staff, potentially due to less cautious health behaviour. Future outbreaks should use both RT-PCR and serological testing for complementary insights into transmission dynamics.
Assuntos
COVID-19 , Casas de Saúde , SARS-CoV-2 , Humanos , Bélgica/epidemiologia , COVID-19/epidemiologia , COVID-19/transmissão , COVID-19/virologia , Casas de Saúde/estatística & dados numéricos , Estudos Soroepidemiológicos , SARS-CoV-2/imunologia , SARS-CoV-2/genética , SARS-CoV-2/isolamento & purificação , Feminino , Masculino , Estudos Transversais , Idoso , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Anticorpos Antivirais/sangue , Adulto , Reinfecção/epidemiologia , Reinfecção/virologia , Pessoal de Saúde/estatística & dados numéricos , Teste Sorológico para COVID-19 , PrevalênciaRESUMO
INTRODUCTION: The sex ratio at birth (male/total births, M/T) is expected to approximate 0.515. M/T is influenced by many factors including stress. Both World Wars have been implicated as influencing birth rates and M/T. This study was carried out to analyse the effects of two World Wars on Belgium vis-à-vis missing births as well as M/T changes. METHODS: Belgian male and female births were available for 1830-2019 and annual population was available from Statista. ARIMA models were used to estimate and project birth losses. The effect of wars was assumed to begin in the years following the commencement of each war and extend to the year after cessation of hostilities i.e., 1915-1919 and 1940-1946 for the First and Second World Wars respectively. RESULTS: This study included 27,346,178 live births for 1830-2019, M/T 0.5124. There was a decreasing trend in births for 1830-2019, significant for 1950-2019. There were dips in births in association with both Wars resulting in over 440,000 missing births, 3.80% of the Belgian population for the First World War and 1.91% for the Second World War. M/T rose non-significantly for the First World War and significantly for the Second World War. DISCUSSION: The declining birth rate and M/T in developed countries is a recognised phenomenon. The missing births in relation to wars are of demographic importance but are often overlooked with emphasis usually on casualties and deaths. M/T may rise in wars, possibly due to increased coital activity as well as other factors.
Assuntos
Coeficiente de Natalidade , Razão de Masculinidade , II Guerra Mundial , I Guerra Mundial , Bélgica/epidemiologia , Humanos , Feminino , Masculino , História do Século XX , Coeficiente de Natalidade/tendências , Recém-Nascido , História do Século XIXRESUMO
OBJECTIVES: The study was undertaken to assess the association between certification and volume of breast centres on the one hand and survival on the other in patients with invasive breast cancer (IBC). METHODS: The study comprises a cohort of 46,035 patients diagnosed with IBC between 2014 and 2018, selected from the nation-wide Belgian Cancer Registry (BCR) database, which was linked with health insurance, hospital discharge and vital status data. Overall and relative survival probabilities were obtained with Kaplan-Meier method and an actuarial approach based on Ederer II, respectively. The associations between centre certification/volume and relative survival were assessed using Poisson models, adjusted for potential confounders. RESULTS: Five years after the diagnosis of IBC, the observed and relative survival probabilities for the cohort were 83.4 % (95 %CI: [83.1, 83.8]) and 93.3 % (95 %CI: [92.9, 93.7]), respectively. After adjustment for age and combined tumour stage, the risk to die from BC was 44 % higher (EHR: 1.44, 95 %CI: [1.24, 1.66]) for patients treated in a low-volume centre and 30 % higher (EHR: 1.30, 95 %CI: [1.14, 1.48]) for patients treated in a medium-volume centre, compared to high-volume centres. Likewise, the risk to die from BC was 30 % higher (EHR: 1.30, 95 %CI: [1.15, 1.48], p < 0.001) for patients treated in a non-certified centre (representing 23.8 % of the cohort), compared to patients treated in a coordinating breast clinic. CONCLUSION: This population-based study reveals that BC survival is higher when patients are treated in certified and high-volume breast clinics.
Assuntos
Neoplasias da Mama , Humanos , Feminino , Bélgica/epidemiologia , Neoplasias da Mama/mortalidade , Neoplasias da Mama/terapia , Pessoa de Meia-Idade , Idoso , Adulto , Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos , Sistema de Registros/estatística & dados numéricos , Institutos de Câncer/estatística & dados numéricos , Certificação/estatística & dados numéricos , Taxa de Sobrevida , Idoso de 80 Anos ou maisRESUMO
BACKGROUND: Nephron number variability may hold significance in the Developmental Origins of Health and Disease hypothesis. We explore the impact of gestational particulate pollution exposure on cord blood cystatin C, a marker for glomerular function, as an indicator for glomerular health at birth. METHODS: From February 2010 onwards, the ENVIRONAGE cohort includes over 2200 mothers giving birth at the East-Limburg hospital in Genk, Belgium. Mothers without planned caesarean section who are able to fill out a Dutch questionnaire are eligible. Here, we evaluated cord blood cystatin C levels from 1484 mother-child pairs participating in the ENVIRONAGE cohort. We employed multiple linear regression models and distributed lag models to assess the association between cord blood cystatin C and gestational particulate air pollution exposure. FINDINGS: Average ± SD levels of cord blood cystatin C levels amounted to 2.16 ± 0.35 mg/L. Adjusting for covariates, every 0.5 µg/m³ and 5 µg/m³ increment in gestational exposure to black carbon (BC) and fine particulate matter (PM2.5) corresponded to increases of 0.04 mg/L (95% CI 0.01-0.07) and 0.07 mg/L (95% CI 0.03-0.11) in cord blood cystatin C levels (p < 0.01), respectively. Third-trimester exposure showed similar associations, with a 0.04 mg/L (95% CI 0.00-0.08) and 0.06 mg/L (95% CI 0.04-0.09) increase for BC and PM2.5 (p < 0.02). No significant associations were observed when considering only the first and second trimester exposure. INTERPRETATION: Our findings indicate that particulate air pollution during the entire pregnancy, with the strongest effect sizes from week 27 onwards, may affect newborn kidney function, with potential long-term implications for later health. FUNDING: Special Research Fund (Bijzonder Onderzoeksfonds, BOF), Flemish Scientific Research Fund (Fonds Wetenschappelijk Onderzoek, FWO), and Methusalem.
Assuntos
Poluição do Ar , Cistatina C , Sangue Fetal , Material Particulado , Humanos , Feminino , Gravidez , Material Particulado/efeitos adversos , Material Particulado/análise , Cistatina C/sangue , Recém-Nascido , Adulto , Poluição do Ar/efeitos adversos , Poluição do Ar/análise , Exposição Materna/efeitos adversos , Glomérulos Renais , Masculino , Bélgica/epidemiologia , Biomarcadores , Taxa de Filtração GlomerularRESUMO
BACKGROUND: Dyslipidemia remains the major cause of atherosclerotic cardiovascular disease (ASCVD). Lipid management in patients with increased cardiovascular (CV) risk needs improvement across Europe, and data gaps are noticeable at the country level. HYPOTHESIS: We described the current treatment landscape in Belgium, hypothesizing that lipid management in patients with ASCVD remains inadequate and aiming to understand the reasons. METHODS: Using data from an anonymized primary care database in Belgium derived from 494 750 individuals, we identified those with any CV risk factor between November 2019 and October 2022 and described the clinical features of patients with ASCVD. The main outcomes were the proportion of patients (i) receiving lipid-lowering therapies (LLTs), (ii) per low-density lipoprotein cholesterol (LDL-C) threshold, stratified per LLT, (iii) reaching the 2021 ESC recommended LDL-C goals, and (iv) LDL-C reduction per type of LLT was also determined. RESULTS: Among 40 888 patients with very high CV risk, 24 859 had established ASCVD. Most patients with ASCVD were either receiving monotherapy (59.6%) or had no documented LLT (25.1%). Further, 64.2% of those with no documented LLT exhibited LDL-C levels ≥ 100 mg/dL. Among common treatment options, one of the greatest improvements in LDL-C levels was achieved with combination therapy of statin and ezetimibe, reducing LDL-C levels by 41.5% (p < 0.0001). Yet, in this group, 24.8% of patients had still LDL-C levels ≥ 100 mg/dL and only 20.7% were at goal. CONCLUSION: Our study emphasizes the importance of developing strategies to help patients achieve their LDL-C goals, with a focus on supporting the implementation of combination LLT in routine clinical practice.
Assuntos
Aterosclerose , LDL-Colesterol , Humanos , Bélgica/epidemiologia , Masculino , LDL-Colesterol/sangue , Feminino , Pessoa de Meia-Idade , Aterosclerose/sangue , Aterosclerose/epidemiologia , Aterosclerose/tratamento farmacológico , Idoso , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Biomarcadores/sangue , Estudos Retrospectivos , Dislipidemias/tratamento farmacológico , Dislipidemias/sangue , Dislipidemias/epidemiologia , Fatores de Risco , Hipolipemiantes/uso terapêutico , Padrões de Prática Médica , Resultado do TratamentoRESUMO
OBJECTIVES: Standard of care treatment for glioblastoma (GBM) involves surgical resection followed by chemoradiotherapy. However, variations in treatment decisions and outcomes exist across hospitals and physicians. In Belgium, where oncological care is dispersed, the impact of hospital volume on GBM outcomes remains unexplored. This nationwide study aims to analyse interhospital variability in 30-day postoperative mortality and 1-/2-year survival for GBM patients. METHODS: Data collected from the Belgian Cancer Registry, identified GBM patients diagnosed between 2016 and 2019. Surgical resection and biopsy cases were identified, and hospital case load was determined. Associations between hospital volume and mortality and survival probabilities were analysed, considering patient characteristics. Statistical analysis included logistic regression for mortality and Cox proportional hazard models for survival. RESULTS: A total of 2269 GBM patients were identified (1665 underwent resection, 662 underwent only biopsy). Thirty-day mortality rates post-resection/post-biopsy were 5.1%/11.9% (target < 3%/<5%). Rates were higher in elderly patients and those with worse WHO-performance scores. No significant difference was found based on hospital case load. Survival probabilities at 1/2 years were 48.6% and 21.3% post-resection; 22.4% and 8.3% post-biopsy. Hazard ratio for all-cause death for low vs. high volume centres was 1.618 in first 0.7 year post-resection (p < 0.0001) and 1.411 in first 0.8 year post-biopsy (p = 0.0046). CONCLUSION: While 30-day postoperative mortality rates were above predefined targets, no association between hospital volume and mortality was found. However, survival probabilities demonstrated benefits from treatment in higher volume centres, particularly in the initial months post-surgery. These variations highlight the need for continuous improvement in neuro-oncological practice and should stimulate reflection on the neuro-oncological care organisation in Belgium.
Assuntos
Neoplasias Encefálicas , Glioblastoma , Humanos , Masculino , Bélgica/epidemiologia , Glioblastoma/mortalidade , Glioblastoma/cirurgia , Glioblastoma/terapia , Feminino , Pessoa de Meia-Idade , Idoso , Neoplasias Encefálicas/mortalidade , Neoplasias Encefálicas/cirurgia , Neoplasias Encefálicas/terapia , Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos , Sistema de Registros/estatística & dados numéricos , Taxa de Sobrevida , Adulto , Hospitais com Baixo Volume de Atendimentos/estatística & dados numéricos , Prognóstico , Seguimentos , Procedimentos Neurocirúrgicos/mortalidadeRESUMO
BACKGROUND: People who use illicit drugs cumulate medical and psychosocial vulnerabilities, justifying a rounded health approach. Both caregivers and patients can form barriers to accessing care, leading to inadequate care. This study aimed to identify the needs and expectations of such patients in general practice. METHODS: Qualitative research was conducted using semi-structured interviews with 23 people with illicit substance use disorder in Brussels in 2020. Multicentric recruitment was conducted to obtain a heterogeneous mix of sociodemographic profiles and care trajectories. Thematic analysis was performed using RQDA package software. RESULTS: Participants highlighted several vulnerabilities. These include the presence of significant self-stigmatization and guilt, sometimes to the extent of self-dehumanization, even after years of care, and overdoses masking suicide attempts and early memory disorders. Multiple substance use, smoking in almost all participants, and misuse of benzodiazepines were also noted. The majority of participants expressed the need for an open-minded, non-stigmatizing and empathic GP with a holistic approach that could guide them throughout their life course. The competencies of the GPs in the field of addiction seemed secondary to the participants. Knowledge and good collaboration with the mental health network were assets. CONCLUSION: Participants expressed the need for GPs with good interpersonal skills, including a non-stigmatizing attitude. The care coordinator role of the GP was highlighted as a key element, as it was a holistic approach focusing on global health (including the social determinants of health) and not only on substance use disorders.
Assuntos
Medicina Geral , Pesquisa Qualitativa , Transtornos Relacionados ao Uso de Substâncias , Humanos , Feminino , Masculino , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adulto , Bélgica/epidemiologia , Pessoa de Meia-Idade , Estigma Social , Adulto Jovem , Entrevistas como Assunto , Drogas IlícitasRESUMO
BACKGROUND: Since June 2017, oral pre-exposure prophylaxis (PrEP) has been reimbursed in Belgium for people at substantial risk of HIV. To inform the national PrEP programme, we described sociodemographic characteristics of PrEP users, PrEP dispensing practices, testing for HIV and sexually transmitted infections (STIs; gonorrhoea, chlamydia and syphilis), and incidence of HIV and STIs. METHODS: Analysis of routinely collected social health insurance claims data from all individuals who were dispensed at least one PrEP prescription between June 2017 and December 2019. Using logistic regression adjusted for age, we examined associations between sociodemographic characteristics and having been dispensed PrEP only once in the first six months of PrEP use. RESULTS: Overall, 4559 individuals were dispensed PrEP. Almost all PrEP users were male (99.2%, 4522/4559), with a median age of 37 years (IQR 30-45). A minority were entitled to an increased healthcare allowance (11.4%, 514/4559). 18% (657/3636) were dispensed PrEP only once in the first six months of PrEP use. PrEP users younger than 25 years, unemployed, entitled to an increased healthcare allowance, and who initiated PrEP between January 2019 and June 2019 were more likely to have had no PrEP dispensing after initiation compared to their counterparts. The testing rates for bacterial STIs and HIV were 4.2 tests per person-year (95% CI 4.1-4.2) and 3.6 tests per person-year (95% CI 3.5-3.6), respectively. Twelve individuals were identified to have seroconverted during the study period, resulting in an HIV incidence rate of 0.21/100 person-years (95% CI 0.12-0.36). The incidence of bacterial STIs was 81.2/100 person-years (95% CI 78.7-83.8). CONCLUSIONS: The study highlights challenges in PrEP persistence and a high incidence of bacterial STIs among individuals receiving PrEP. Tailored prevention support is crucial for individuals with ongoing HIV risk to optimise PrEP effectiveness. Integrated STI testing and prevention interventions within PrEP care are necessary to mitigate STI acquisition and transmission among PrEP users.
Assuntos
Infecções por HIV , Profilaxia Pré-Exposição , Infecções Sexualmente Transmissíveis , Humanos , Profilaxia Pré-Exposição/estatística & dados numéricos , Bélgica/epidemiologia , Masculino , Adulto , Feminino , Incidência , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Pessoa de Meia-Idade , Infecções Sexualmente Transmissíveis/epidemiologia , Infecções Sexualmente Transmissíveis/prevenção & controle , Revisão da Utilização de Seguros , Estudos de Coortes , Adulto Jovem , AdolescenteRESUMO
Open surveys complementing surveillance programs often yield opportunistically sampled data characterised by spatio-temporal imbalance. We set up our study to understand to what extent spatio-temporal statistical models using such data achieve in describing epidemiological trends. We used self-reported symptomatic COVID-19 data from two Belgian regions, Flanders and the Brussels-Capital Region. These data were collected in a large-scale open survey with spatio-temporally imbalanced participation rates. We compared incidence estimates of both self-reported symptoms and test-confirmed COVID-19 cases obtained through generalised linear mixed models correcting for spatio-temporal correlation. We additionally simulated symptom incidences under different sampling strategies to explore the impact of sample imbalance, sample size and disease incidence, on trend detection. Our study shows that spatio-temporal sample imbalance generally does not lead to bad model performances in spatio-temporal trend estimation and high-risk area detection. Except for low-incidence diseases, collecting large samples will often be more essential than ensuring spatio-temporally sample balance.
Assuntos
COVID-19 , SARS-CoV-2 , Autorrelato , Análise Espaço-Temporal , Humanos , COVID-19/epidemiologia , Bélgica/epidemiologia , Incidência , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Monitoramento Epidemiológico , Vigilância da População/métodosRESUMO
BACKGROUND: commensal Neisseria species are part of the oropharyngeal microbiome and play an important role in nitrate reduction and protecting against colonization by pathogenic bacteria. They do, however, also serve as a reservoir of antimicrobial resistance. Little is known about the prevalence of these species in the general population, how this varies by age and how antimicrobial susceptibility varies between species. METHODS: we assessed the prevalence and antimicrobial susceptibility of commensal Neisseria species in the parents (n = 38) and children (n = 50) of 35 families in Belgium. RESULTS: various commensal Neisseria (n = 5) could be isolated from the participants. Most abundant were N. subflava and N. mucosa. Neisseria subflava was detected in 77 of 88 (87.5%) individuals and N. mucosa in 64 of 88 (72.7%). Neisseria mucosa was more prevalent in children [41/50 (82%)] than parents [23/38 (60.5%); P < .05], while N. bacilliformis was more prevalent in parents [7/36 (19.4%)] than children [2/50 (4%); P < .05]. Neisseria bacilliformis had high ceftriaxone minimum inhibitory concentrations (MICs; median MIC 0.5 mg/l; IQR 0.38-0.75). The ceftriaxone MICs of all Neisseria isolates were higher in the parents than in the children. This could be explained by a higher prevalence of N. bacilliformis in the parents. INTERPRETATION: the N. bacilliformis isolates had uniformly high ceftriaxone MICs which warrant further investigation.
Assuntos
Antibacterianos , Testes de Sensibilidade Microbiana , Neisseria , Pais , Humanos , Bélgica/epidemiologia , Neisseria/efeitos dos fármacos , Neisseria/isolamento & purificação , Neisseria/genética , Estudos Transversais , Criança , Antibacterianos/farmacologia , Feminino , Pré-Escolar , Masculino , Adulto , Pessoa de Meia-Idade , Adolescente , Farmacorresistência Bacteriana , Lactente , Orofaringe/microbiologia , Prevalência , Adulto JovemRESUMO
Candidemia, predominantly caused by C. albicans, poses a significant threat in hospitals. Yet, non-albicans candidemia (NAC) and antifungal resistance are increasing concerns. This retrospective study at CHU UCL Namur Mont-Godinne, a Belgian university hospital, from January 2013 to February 2023, analyzed 148 candidemia cases. The mean annual incidence was 0.94 per 1000 admissions, with a notable surge in C. albicans cases in 2020, possibly due to COVID-19. Candidemia was most prevalent in the ICU (48 %), with C. albicans (57.1 %) and C. glabrata (18.4 %) being the predominant species and a 30-day mortality rate of 38 %. NAC was significantly higher in the hematology unit (81 %). Notably, no echinocandin resistance was observed, while fluconazoleresistance remained stable at 10 %. NAC was associated with azole resistance. This study provides a decade-long overview of candidemia at CHU UCL Namur Mont-Godinne, offering valuable insights into its epidemiology and clinical characteristics in Belgian hospital settings.
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Antifúngicos , COVID-19 , Candidemia , Farmacorresistência Fúngica , Centros de Atenção Terciária , Candidemia/epidemiologia , Candidemia/mortalidade , Candidemia/microbiologia , Candidemia/tratamento farmacológico , Humanos , Bélgica/epidemiologia , Centros de Atenção Terciária/estatística & dados numéricos , Estudos Retrospectivos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Fatores de Risco , Antifúngicos/uso terapêutico , Adulto , Prognóstico , COVID-19/epidemiologia , COVID-19/mortalidade , Candida/classificação , Candida/efeitos dos fármacos , Candida/isolamento & purificação , Idoso de 80 Anos ou mais , Incidência , Adulto Jovem , Adolescente , CriançaRESUMO
Introduction: Hepatitis C (HCV) is one of the major worldwide infections with 58 million infected persons in the world. HCV can lead to chronic liver disease, cirrhosis, and cancer. These past few years, clinical progress allowed a curative rate of 95% of the patients. There are still populations in which, treating the disease is more difficult, especially psychiatric patients, when substance abuse, psychiatric disorders are important risks factors for getting HCV. With the WHO organization establishing goals for clinical management and treatment of HCV, it is important to target where the difficulties lie in getting a better treatment program for those populations. Aim: Try to highlight the challenges of treating a certain group of patients compare to the general population. Method: This is a cross sectional monocentric study. 79 patients from a mental facility were included between 2012 and 2022. Inclusion criteria were: >18 years old, an active viral HCV infection. Results: 34.7% of patients with a positive PCR were treated with a significant difference between the closed psychiatric unit and the open one (66.5 vs 22.6%, p<.05). There was an 82.4% eradication rate (Sustained Viral Response at 3 months). There were significantly more schizophrenic disorders in the closed unit and significantly more alcohol abuse in the open one. Conclusion: Treatment of HCV in a psychiatric population is feasible with eradication rate equivalent at those in the general population. Patients with more severe mental illness are better treated in the configuration of a closed psychiatric unit.
Assuntos
Antivirais , Transtornos Mentais , Humanos , Masculino , Estudos Transversais , Feminino , Antivirais/uso terapêutico , Pessoa de Meia-Idade , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Adulto , Bélgica/epidemiologia , Hepatite C Crônica/complicações , Hepatite C Crônica/epidemiologia , Hepatite C Crônica/tratamento farmacológico , Hepatite C Crônica/psicologia , Resultado do Tratamento , Hepatite C/epidemiologia , Hepatite C/complicações , Hospitais Psiquiátricos , Resposta Viral SustentadaRESUMO
INTRODUCTION: H. influenzae carriage may evolve into respiratory or systemic infections. However, no surveillancesystem is in place in Belgium to monitor carriage strains. MATERIAL AND METHODS: This study provides a detailed description of H. influenzae strains isolated from both carriage and lower respiratory infections, collected during a six-month national surveillance. Subsequently, a comparison is conducted with invasive isolates collected during the same period at the National Reference Centre (NRC). RESULTS AND DISCUSSION: From November 2021 to April 2022, 39 clinical laboratories collected 142 and 210 strains of H. influenzae from carriage and infection, respectively, and 56 strains of blood were submitted to the NRC. In each group, the biotype II comprised more than 40%, followed by biotypes III and I. The majority of strains were non-typeable H. influenzae, with a notable increase in the number of encapsulated strains in the invasive group (14.3% vs. 1-2%). A beta-lactamase was identified in 18.5% and 12.5% of surveillance and invasive strains, respectively. Resistance to the amoxicillin-clavulanic acid combination accounted for 7% in the surveillance strains and 10.7% in invasive strains. The overall resistance to third-generation cephalosporins at 1.2% is consistent with rates observed in other European countries. Of particular significance is the identification of mutations in the ftsI gene in both carriage and infected strains, which are associated with high-level beta-lactam resistance. CONCLUSION: NRC must engage in regular and systematic monitoring of beta-lactam susceptibility of H. influenzae to guarantee safe empiric therapy in severe cases and identify potential transitions from low-level to high-level resistance in the future.
Assuntos
Antibacterianos , Portador Sadio , Infecções por Haemophilus , Haemophilus influenzae , Testes de Sensibilidade Microbiana , Infecções Respiratórias , Humanos , Bélgica/epidemiologia , Haemophilus influenzae/genética , Haemophilus influenzae/isolamento & purificação , Haemophilus influenzae/efeitos dos fármacos , Haemophilus influenzae/classificação , Infecções por Haemophilus/microbiologia , Infecções por Haemophilus/epidemiologia , Infecções Respiratórias/microbiologia , Infecções Respiratórias/epidemiologia , Portador Sadio/microbiologia , Portador Sadio/epidemiologia , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Pré-Escolar , Criança , Adolescente , Idoso , Adulto Jovem , Lactente , Idoso de 80 Anos ou maisRESUMO
OBJECTIVE: Sotrovimab, a dual-action, engineered human monoclonal antibody, has been demonstrated to significantly reduce the risk of hospitalisation and death in high-risk patients with COVID-19. Here, we describe the real-world use of, and outcomes from, sotrovimab treatment in Belgium during the Delta and Omicron waves among patients with COVID-19 at high risk of developing severe disease. METHODS: This was a multicentric, single-arm observational cohort study of non-hospitalised patients receiving outpatient sotrovimab treatment between 1 November 2021 and 2 August 2022 at nine hospitals in Belgium. The primary outcomes were all-cause and COVID-19-related hospitalisations and all-cause deaths during the 29-day acute follow-up period from first administration of sotrovimab. RESULTS: A total of 634 patients were included (63.4% aged < 65 years; 50.3% male). A high proportion (67.7%; n = 429/634) of patients were immunocompromised, with 36.9% (n = 234/634) actively treated for malignancy. During the 29-day acute period, 12.5% (n = 79/634) of sotrovimab-treated patients were hospitalised due to any cause (median duration 4 days; median time to hospitalisation 14 days) and 1.1% (n = 7/634) died due to any cause. The proportion of sotrovimab-treated patients experiencing COVID-19-related hospitalisation was highest during the Delta predominance and Delta/BA.1 codominance (both 6.3%) periods. During the BA.1 predominance, BA.1/BA.2 codominance and BA.2/BA.5 codominance periods, COVID-19-related hospitalisations were consistently low (all ≤2.7%). CONCLUSION: This study indicated low rates of COVID-19-related hospitalisations and all-cause deaths in sotrovimab-treated patients in Belgium, including during Omicron subvariant periods, despite over two-thirds of the study population being immunocompromised.
Assuntos
Anticorpos Monoclonais Humanizados , Tratamento Farmacológico da COVID-19 , COVID-19 , Hospitalização , Humanos , Masculino , Bélgica/epidemiologia , Feminino , Pessoa de Meia-Idade , Anticorpos Monoclonais Humanizados/uso terapêutico , Idoso , COVID-19/mortalidade , COVID-19/epidemiologia , Hospitalização/estatística & dados numéricos , SARS-CoV-2 , Progressão da Doença , Adulto , Estudos de Coortes , Resultado do Tratamento , Índice de Gravidade de Doença , Anticorpos NeutralizantesRESUMO
BACKGROUND: Screening for gestational diabetes mellitus (GDM) is important to improve pregnancy outcomes and to prevent type 2 diabetes after pregnancy. Due to a lack of evidence, the 2019 Flemish consensus did not recommend screening for GDM in early pregnancy. Recently, a large randomized controlled trial (TOBOGM) demonstrated that screening for GDM before 20 weeks reduces the risk of neonatal complications in women with risk factors when using higher cut-offs to define GDM compared to the criteria used later in pregnancy. METHODS: Based on this new evidence, members of the Diabetes Liga, the Flemish associations of general physicians (Domus Medica), obstetricians (VVOG), midwives (VBOV), diabetes nurse educators (BVVDV), dieticians (VBVD) and clinical chemists (RBSLM) have adapted the Flemish consensus on screening for GDM. BACKGROUND: Recommendations: As in 2019, this new consensus recommends universal screening for overt diabetes in early pregnancy preferably by measuring fasting plasma glucose by using the same diagnostic criteria as in the non-pregnant state. Based on the new evidence, women with fasting plasma glucose 95-125 mg/dL (5.3-6.9 mmol/L) before 20 weeks gestation should be diagnosed as early GDM. In addition, in women with obesity and/or a history of GDM, it is advised to perform already a 75 g oral glucose tolerance test (OGTT) between 6 and 20 weeks gestation using higher cut-offs to diagnose early GDM [fasting ≥95 mg/dL (5.3 mmol/L), 1 hour ≥ 19 mg/dL (10.6 mmol/L) and/or 2 hour ≥ 162 mg/dL (9.0 mmol/L))]. The recommendation concerning screening for GDM between 24 and 28 weeks remains unchanged with a diagnosis of GDM based on the 75 g OGTT and IADPSG criteria [fasting ≥ 92 mg/dL (5.1 mmol/L), 1 hour ≥ 180 mg/dL (10.0 mmol/L) and/or 2 hour ≥ 153 mg/dL (8.5 mmol/L)].
Assuntos
Diabetes Gestacional , Humanos , Diabetes Gestacional/diagnóstico , Gravidez , Feminino , Programas de Rastreamento/métodos , Programas de Rastreamento/normas , Bélgica/epidemiologia , Teste de Tolerância a Glucose , Consenso , Glicemia/análiseRESUMO
The COVID-19 pandemic led to unprecedented changes in behaviour. To estimate if these persisted, a final round of the CoMix social contact survey was conducted in four countries at a time when all societal restrictions had been lifted for several months. We conducted a survey on a nationally representative sample in the UK, Netherlands (NL), Belgium (BE), and Switzerland (CH). Participants were asked about their contacts and behaviours on the previous day. We calculated contact matrices and compared the contact levels to a pre-pandemic baseline to estimate R0. Data collection occurred from 17 November to 7 December 2022. 7477 participants were recruited. Some were asked to undertake the survey on behalf of their children. Only 14.4â¯% of all participants reported wearing a facemask on the previous day. Self-reported vaccination rates in adults were similar for each country at around 86â¯%. Trimmed mean recorded contacts were highest in NL with 9.9 (95â¯% confidence interval [CI] 9.0-10.8) contacts per person per day and lowest in CH at 6.0 (95â¯% CI 5.4-6.6). Contacts at work were lowest in the UK (1.4 contacts per person per day) and highest in NL at 2.8 contacts per person per day. Other contacts were also lower in the UK at 1.6 per person per day (95â¯% CI 1.4-1.9) and highest in NL at 3.4 recorded per person per day (95â¯% CI 43.0-4.0). The next-generation approach suggests that R0 for a close-contact disease would be roughly half pre-pandemic levels in the UK, 80â¯% in NL and intermediate in the other two countries. The pandemic appears to have resulted in lasting changes in contact patterns expected to have an impact on the epidemiology of many different pathogens. Further post-pandemic surveys are necessary to confirm this finding.
Assuntos
COVID-19 , Busca de Comunicante , Humanos , COVID-19/epidemiologia , COVID-19/prevenção & controle , COVID-19/transmissão , Adulto , Masculino , Feminino , Bélgica/epidemiologia , Pessoa de Meia-Idade , Reino Unido/epidemiologia , Países Baixos/epidemiologia , Adolescente , SARS-CoV-2 , Suíça/epidemiologia , Criança , Adulto Jovem , Idoso , Pandemias , Inquéritos e Questionários , Pré-EscolarRESUMO
BACKGROUND: Congenital myasthenic syndromes (CMS) are a group of genetic disorders characterized by impaired neuromuscular transmission. CMS typically present at a young age with fatigable muscle weakness, often with an abnormal response after repetitive nerve stimulation (RNS). Pharmacologic treatment can improve symptoms, depending on the underlying defect. Prevalence is likely underestimated. This study reports on patients with CMS followed in Belgium in 2022. METHODS: Data were gathered retrospectively from the medical charts. Only likely pathogenic and pathogenic variants were included in the analysis. RESULTS: We identified 37 patients, resulting in an estimated prevalence of 3.19 per 1,000,000. The patients harbored pathogenic variants in CHRNE, RAPSN, DOK7, PREPL, CHRNB1, CHRNG, COLQ, MUSK, CHRND, GFPT1, and GMPPB. CHRNE was the most commonly affected gene. Most patients showed disease onset at birth, during infancy, or during childhood. Symptom onset was at adult age in seven patients, caused by variants in CHRNE, DOK7, MUSK, CHRND, and GMPPB. Severity and distribution of weakness varied, as did the presence of respiratory involvement, feeding problems, and extraneuromuscular manifestations. RNS was performed in 23 patients of whom 18 demonstrated a pathologic decrement. Most treatment responses were predictable based on the genotype. CONCLUSIONS: This is the first pooled characterization of patients with CMS in Belgium. We broaden the phenotypical spectrum of pathogenic variants in CHRNE with adult-onset CMS. Systematically documenting larger cohorts of patients with CMS can aid in better clinical characterization and earlier recognition of this rare disease. We emphasize the importance of establishing a molecular genetic diagnosis to tailor treatment choices.