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.
Hidradenitis suppurativa/acne inversa is a multifactorial chronic inflammatory skin desease. This affection is characterized by reccurent nodules that rupture and lead to sinus tracts. To date, no evidence-based treatement guidelines has been proposed. However a multidiscipinary approach is recommanded.
Whereas surgical repair of severe bone or tendon traumas must be undertaken as soon as possible so as to prevent significant functional deficit, hip surgery is only performed in symptomatic patients, after considering its potential benefit in preventing osteoarthritis and the need for joint replacement. Prosthetic joint replacement provides good results, but it should not be performed too early in order not to disappoint the patient and expose him to subsequent surgical revision.
Greater trochanteric pain syndrome is a degenerative disorder of the tendons surrounding the greater trochanter, trochanteric bursitis may or may not be present. Sometimes referred to as the "false sciatica", pain may radiate to the knee, but has a mechanic clinical presentation. History taking and clinical examination are key to the diagnosis, revealing painful palpation of the peritrochanteric region. Paraclinical exams should be reserved to unusual clinical presentations.
Hip examination traditionally includes history taking, as well as an assessment of the patient’s gait pattern and joint mobility. If the patient is unable to stand following a trauma or a fall, a deformity (shortening, rotation of the lower limb) must be searched for, as it may indicate a fracture. Common tendinopathies must also be searched for through palpation, especially at the greater trochanter that is a common painful site in older overweight female patients.
Infection with the human immunodeficiency virus (HIV) remains a public health concern worldwide. Young adults are the most affected by the pandemic, with 40% of new cases concerning people from the 15-24 year age group, which also is the most sexually active. There are four prevention strategies of HIV infection. One of them is post-exposure prophylaxis (PEP) by the administration of antiretroviral therapy, which can be used in post-coital situation for exposed patients. The probability of HIV transmission depends on the type of exposure, infectivity level of the source, and susceptibility of the exposed person. The risk of acquiring HIV after an exposure incident can be calculated by multiplying the risk that the source person is HIV-positive by the risk of exposure. Prophylaxis is recommended when the risk of transmission is greater than 1/1,000 and must be considered when the risk is between 1/1,000 and 1/10,000. When this risk is below 1/10,000, prophylaxis is not recommended. All cases need to be evaluated on an individual basis. Most recent guidelines recommend two nucleoside reverse transcriptase inhibitors (NRTI) associated with either an integrase inhibitor (INI) or a boosted protease inhibitor (PI/r). The treatment should be initiated as soon as possible after exposure, preferably within 24 h or, at the latest, within 72 h. The treatment duration is 28 days. HIV serology is performed at Day 0, Week 8 and Week 12 using a 4th generation blood test. Counselling on HIV prevention should be provided during the follow-up.