Hélène Reul(1), Bernard Vandercam(2), Pascale Grandjean(3), Julien De Greef(4)Published in the journal : June 2018Category : Internal Medicine
Travels and pregnancy are not incompatible. This article sought to provide an overview of the current recommendations on this topic and intends to be a tool for all practitioners, namely general practitioners, gynecologists-obstetricians, as well as midwives. To this end, we have chosen to investigate the following three topics: vaccination, malaria, and Zika virus. Vaccinating a pregnant woman is often possible and at times even recommended. Several vaccines, however, must be avoided, as they are live vaccines. Malaria during pregnancy may be severe, and appropriate prophylactic treatment should therefore be prescribed. Zika virus infection is associated with high risks for pregnant women. Appropriate precautions designed for pregnant women, women who plan to have a child, and partners of pregnant women have been summarized in this article. These guidelines based on national and international recommendations likely evolve over time and should therefore be updated on a regular basis.
Richter’s syndrome is a rare syndrome characterized by the development of aggressive lymphomas in patients with concomitant chronic lymphocytic leukemia. Known for several years, this syndrome is still very heterogeneous and represents a real clinical challenge, given its aggressive nature and very limited prognosis. In the era of targeted therapies and due to the increasingly-thorough characterization of the genetic abnormalities of this condition, there is an unmet need for new molecules in order to better manage patients suffering from this syndrome. This article is a brief literature review as regards diagnosis and management of Richter's syndrome in 2017.
Schizophrenia is a mental disease characterized by a personality dislocation. Gender dysphoria refers to the intimate, constant, and irreversible conviction of belonging to the opposite sex versus the origi-nal one. For these two diseases, studies have reported a thalamic damage in two neighboring areas. We may wonder if these two areas of joint damage could be linked and thus explain this sexual identity disor-der in schizophrenic patients, thereby guiding us towards appropriate medical management. In this article, we illustrate the medical care of schizophrenic patients affected by gender dysphoria by considering the representative case of a schizophrenic male patient who is searching for his sexual identity with the feeling of an “atrophic clitoris”, along with an increase in adrenal androgens in labor-atory tests. The medical care for these patients proves complex, as it requires us to come up with the right ques-tions.
This article describes the basic principles of electrocardiogram (ECG). It is aimed at people who are curious to know a little more about this basic and essential cardiological examination that allows detecting many heart diseases.
New guidelines for the treatment of type 2 diabetes have recently been published by the American Diabetes Association. This article was aimed at analyzing these recommendations in light of recent scientific data, including cardiovascular results.
Nephrolithiasis is a common condition affecting nearly 10% of the adult population, with a risk of recurrence exceeding 50%. In rare cases, nephrolithiasis can lead to end-stage renal disease. The increasing prevalence of nephrolithiasis is attributable to inherited metabolic factors in conjunction with environmental factors, such as dietary habits. The causes and mechanisms of stone formation can be determined by means of stone analysis (morphological analysis and infrared spectrophotometry) and crystalluria analysis. Calcium lithiasis is the most common form of nephrolithiasis (85%), and its medical treatment includes increased fluid intake along with some dietary modifications, such as normalization of calcium intake, restriction of animal protein and salt intake, and avoidance of food with high oxalate content. When medical treatment is well conducted, it significantly reduces the risk of recurrence.
Non-alcoholic fatty liver disease (NAFLD) refers to all liver disease severity stages, characterized by a build-up of hepatic fat. In most patients, it is associated with the presence of a metabolic syndrome. The prevalence of NAFLD is increasing, along with that of the inflammatory condition called non-alcoholic steatohepatitis (NASH), which is characterized not only by steatosis but also by lobular inflammation and hepatocyte injury. NASH is associated with an increased liver-related (for advanced fibrosis stages) and non-liver-related morbidity and mortality (mainly due to cardiovascular events). While NASH diagnosis relies on histology, both steatosis and fibrosis can be evaluated by non-invasive methods allowing adequate treatment and follow-up.
Celiac disease is a chronic enteropathy induced by dietary gluten in genetically predisposed patients (HLA-DQ2/DQ8). The diagnosis is based on positive anti-transglutaminase and anti-deamidated gliadin antibodies, followed by duodenal histology showing the intraepithelial lymphocytic infiltration and villous atrophy. The treatment consists in a lifelong adherence to a strict gluten-free diet, without wheat, rye, and barley. The gluten-free diet allows the intestinal villi to heal, which leads to symptom resolution. While gluten-free diet is of paramount importance in celiac disease and wheat allergy, its role in gluten hypersensitivity remains controversial. Indeed, several studies have shown that a fructan-free diet (part of the so-called FODMAPs) would be preferable in these non-celiac patients.
Over the past decade, the therapeutic strategy of inflammatory bowel diseases (IBD) has evolved owing to treatments’ ability to heal lesions. IBD therapy currently aims at treating more than just symptoms in order to achieve a deep remission. Early initiation of effective drugs, such as immunosuppressive agents and biologics, further prevents irreversible damages. This strategy of treating until reaching this predefined objective impacts the disease course by reducing complications, hospitalizations, and the need for surgery. Strict monitoring using objective parameters is essential to assess treatment adequacy and make the necessary adjustments to achieve this deep remission.