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.
The new published guidelines on the management of the thyroid nodule have greatly improved the management of the disorder. Despite current guidelines, thyroid nodule management remains controversial and varies in different continents and countries. A difference between USA and Europe is in the iodine status and explains why the thyroid scintigraphy is more often prescribed in Europe than in USA. New recommendations are often applied in function of the easy access to complementary exams, the performance of other physicians, their personal experience and their medical habits. It is the reason why the guidelines are not always strictly followed.
Ultrasound plays a key role in the management of thyroid nodules, from diagnosis to follow-up. The Thyroid Imaging Reporting And Data System (TI-RADS) classification is a standardized system for analyzing and reporting thyroid ultrasound data in order to improve nodule management. This 6-grades score is based on ultrasound criteria (shape, contour, aspect, and structure) and aimed at categorizing and depicting carcinomas in a simple and reproducible way. Based on operator-dependent ultrasound examination, the TI-RADS classification has both strengths and limitations.
Cytology plays a key role in the management of thyroid nodules. This technique may prove to be a valuable diagnostic tool for differentiating benign lesions from malignant ones, enabling us to better select those nodules that warrant surgery. The middle cytology liquid allows us to complete this process by adding immunocytochemical or molecular biology tests, as necessary. In the event of nodules presenting atypia of undetermined significance, recent studies have revealed that genome sequencing for detecting BRAF or RAS mutations may permit to assess the risk for malignancy of these thyroid nodules. It should yet be mentioned that only a close collaboration with the clinicians in charge of the patient, in addition to a sound correlation with clinical-radiological data, allows the cytological thyroid examination to prove well-performing.
GLP-1 analogs are nowadays a validated treatment in type 2 diabetes, due to both their glycemic and extraglycemic effects. Dulaglutide (Truliciy®) is a new long-acting analog. Treatment pattern is characterized by once-weekly injection of 1.5 (or 0.75) mg. The aim of this article is to review recent results of the AWARD program and to discuss the position of this new agent in a modern therapeutic approach of type 2 diabetes.
Primary hyperparathyroidism is a common endocrine disorder, primarily caused by parathyroid adenomas localized in the cervical region. We report the case of a patient with recurrent primary hyperparathyroidism due to a parathyroid adenoma located in the mediastinum, close to the thymus. Both localization and management of the adenoma proved laborious. At the light of this complex case report, we reviewed the diagnostic criteria and therapeutic guidelines for primary hyperparathyroidism. After multiple surgical procedures leading to the resection of the four parathyroid glands located in the cervical region and of the ectopic parathyroid adenoma located in the mediastinum, the patient developed postoperative hypocalcemia, which was quite difficult to manage.
Ch. Beauloye, A. Persu, A.-C. Pouleur, A. PasquetPublished in the journal : February 2016Category : Cardiology
What are the lessons learned from 2015 in cardiology? In 2015, the European Society of Cardiology published new guidelines. This article sought to review the guidelines' key points as regards bacterial endocarditis and management of non-STEMI acute coronary syndrome. Like each year, numerous pharmacological studies were published. Among these, the Sprint Study certainly represents a milestone in the treatment of hypertension. Moreover, new therapeutic agents are emerging in the field of heart failure, as evidenced by the Paradigm and Socrates studies.
C. Hermans, C. Lambert, L. Knoops, M.-C. Vekemans, X. Poire, V. Havelange, L. Michaux, E. Van Den NestePublished in the journal : February 2016Category : Hematology/Oncology
In keeping with previous years, 2015 was rich in developments and innovations in the field of blood diseases. As regards blood coagulation, the development of an antidote to Pradaxa® represents a major advance. Furthermore, recent studies demonstrated that FXI could be a target of choice for new anticoagulants and that bridging with lowmolecular- weight heparin is no longer required in all patients with atrial fibrillation on vitamin K antagonist therapy prior to invasive procedures. Innovations in hemophilia are dominated by the development of new FVIII and FIX concentrates with prolonged half-lives, in addition to the validation of a bispecific antibody mimicking the function of FVIII within the coagulation cascade. With respect to hematological malignancies, several new therapies are expected to revolutionize the treatment of leukemia and lymphomas in the near future, including potent specific inhibitors and immunotherapies, especially chimeric receptor-expressing T cells. The molecular basis of myelodysplastic syndromes are now better understood. Plenty of new molecules have been developed for the treatment of multiple myeloma, in addition to new staging strategies displaying major therapeutic implications.
J.-Fr. Baurain, F. Cornélis, F. Duhoux, Y. Humblet, F. Mazzeo, M. van den Eynde, J.-P. MachielsPublished in the journal : February 2016Category : Oncologie
Cancer management has become multidisciplinary, and major advances have been achieved in medical oncology field over the last years. The year 2015 was marked by a change in the treatment strategies for metastatic prostate cancer, with docetaxel-based chemotherapy being now initiated concurrently with castration. This allows for a 10-month increase in median overall survival in these patients, thereby representing a major breakthrough. Last year, a new kind of targeted agent, olaparib, was also granted reimbursement for the treatment of platinumsensitive ovarian cancer. This inhibitor of PARP, a major protein involved in DNA repair, was shown to significantly increase recurrence-free survival in BRCA-mutated ovarian cancer patients. BRCA is a key protein involved in the second DNA repair mechanism. Lastly, the most impressive oncological advance achieved last year pertained to the introduction in daily practice of the anti-PD1 or PDL1 antibodies. Several studies, conducted mostly in melanoma patients, have shown this immunotherapy to be highly effective, with possible cancer cure for some patients. Administering these antibodies is, however, associated with very specific toxicity features, namely autoimmune toxicity that may be severe or even fatal if not recognized and treated early. All these treatments are available at the King Albert II Cancer Institute.