Whereas intranasal (IN) drug delivery has been used for many years, this administration route has not gained much interest in Belgium. IN drug delivery is painless, easy, and quick, thus proving attractive in emergency settings, especially in pediatric patients. While achieving an efficacy comparable to that of intravenous administration, the IN route is an interesting new alternative for emergency doctors, who can use it to induce opioid analgesia, reach optimal procedural sedation with midazolam, stop epileptic seizures with benzodiazepines, or antagonize morphine overdosage with naloxone.
We report the case of a successful delivery following exposure to ustekinumab during pregnancy. Though psoriasis is not uncommon in pregnant women, its treatment may prove challenging during pregnancy, especially in severe psoriasis cases. While the disease usually improves during pregnancy, its treatment must often be continued. Besides local treatment, UVB phototherapy remains the treatment of choice in moderate-to-severe psoriasis. In patients requiring a systemic treatment, biologics can be considered. Whereas limited safety results are available from studies, various follow-up registers provide reassuring data. Unexpected exposure to biologics during the first trimester of pregnancy proves unproblematic.
While granuloma annulare is a benign disease, little is known about its pathophysiology, etiology, and comorbidities. Furthermore, its treatment remains poorly standardized. In this case report, we have reviewed and discussed the literature dealing with granuloma annulare, with a special focus on the advisable evaluations and therapies.
In June 2015, we reported the case of a 29-year-old woman with loin pain hematuria syndrome treated by right renal autotransplantation(1). This was the second renal autotransplantation performed in our hospital. Surgery led to complete remission, with total resolution of pain. Seven months later, the patient reported severe left flank pain, requiring high doses of analgesics, such as gabapentin, tramadol, and oxycodone. Owing to the good results of the first autotransplantation, we performed a left renal autotransplantation in December 2015. The patient was discharged on the 4th postoperative day with normal renal function but persistent microscopic hematuria. She no longer needed analgesics and resumed normal daily activities. This second experience seems to confirm our first observation: the first renal autotransplantation allowed for a complete resolution of pain over a 28-year follow-up. This case further supports the role of renal autotransplantation in the treatment of loin pain hematuria syndrome.
The electronic medical dictionary of the French National Academy of Medicine is available in open access on the internet, comprising approximately 60,000 definitions. An established editorial board meets twice a month in order to standardize and approve the modifications to the entries. The dictionary is accessed by at least 65,000 visits per month by people from over 120 countries.
The role of sugars, in particular in the form of soft drinks, in the development of obesity and its metabolic and cardiovascular comorbidities is increasingly recognized. The mechanisms involved are probably multiple, but the energy content, the glycemic load and the liquid consistence play probably a more important role than the fructose content. The present recommendations encourage to limit the amount of added or free sugars to 10% maybe 5% of the daily energy intake. The replacement of sugars with sweeteners may be helpful. On a broader scale, education to a less intensely sweet taste is paramount.
In diabetic patients, lipid-lowering drug therapy is almost always necessary, even when the lipid profile is seemingly unremarkable. This treatment is primarily aimed at reaching the target LDL cholesterol level (<70 mg/dL or <100 mg/dL, depending on prior cardiac or renal diseases, age, or concomitant risk factors) by prescribing a statin, with or without ezetimibe. Thereafter, adding a fibrate or including omega-3 fatty acid supplementation should be considered in patients whose triglyceride levels remain high, so as to target non-HDL cholesterol (<100 mg/dL or <130 mg/dL, depending on age or concomitant risk factors).
The assessment of the "diabetic health" of an individual includes: (i) contemporary and secular values of HbA1c; (ii) occurrence of hypoglycemia; (iii) time spent in the glucose target range; (iv) history of ketoacidosis; (v) history of severe hypoglycemia; (vi) presence or risk of incident micro/macrovascular complications; (vii) associated cardiometabolic comorbidities; (viii) psychological issues (anxiety/depression); and (ix) occupational issues.
Obesity and Type 2 diabetes are both associated with low-grade inflammation. Among the possible pathomechanisms, their link to intestinal bacteria is becoming increasingly convincing. Evidence suggests that gut microbiota plays a key role in triggering inflammation and insulin resistance through various mechanisms, such as the translocation of bacteria or bacterial components that induces metabolic endotoxemia. Certain intestinal bacteria may also be either deleterious or beneficial to glucose homeostasis. Among these, the specific role of Akkermansia muciniphila is currently being investigated.
This article aims to discuss the diagnostic approach to increased serum parathyroid hormone (PTH) levels in normocalcemic, normophosphatemic patients. This biological disorder is commonly detected in routine practice, especially given that the established PTH reference values used by clinical laboratories refer to subjects with adequate vitamin D levels and a normal renal function. The first diagnostic step consists in ruling out a cause of secondary hyperparathyroidism (SHPT). Among these, the most frequent include vitamin D deficiency, very low calcium intake, impaired renal function, malabsorption, drugs interfering with calcium/bone metabolism (e.g., lithium salts and antiresorptive therapies for osteoporosis), and renal leak hypercalciuria. If no cause of SHPT is found, the diagnosis of normocalcemic primary hyperparathyroidism (PHPT) should be considered. A calcium load test is a very useful tool for diagnosing this condition, which is characterized by a serum PTH being not sufficiently decreased while calcemia rises frankly above the upper normal limit. In normocalcemic patients with hypercalciuria and high serum PTH levels, a thiazide challenge test may help differentiate SHPT due to a renal calcium leak from normocalcemic PHPT. In addition to these diagnostic considerations, the article also discusses the advantages and difficulties of measuring and interpreting ionized calcemia and 24-hour calciuria.