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We report a case of an 81-year-old man with end stage renal disease (ESRD) in chronic hemodialysis with severe hypocalcaemia secondary to the intake of a parapharmaceutical containing sodium and potassium citrate and in association with poor dialysis efficiency, due to malfunction of the vascular access, which promptly resolved after discontinuation of the supplement. The patient never showed signs or symptoms of hypocalcaemia. This case highlightens the importance of a correct pharmacological reconciliation in dialysis patients in order to avoid the onset of adverse events due to the uncontrolled intake of drugs or parapharmaceuticals., We report a case of an 81-year-old man with end stage renal disease (ESRD) in chronic hemodialysis with severe hypocalcaemia secondary to the intake of a parapharmaceutical containing sodium and potassium citrate and in association with poor dialysis efficiency, due to malfunction of the vascular access, which promptly resolved after discontinuation of the supplement. The patient never showed signs or symptoms of hypocalcaemia. This case highlightens the importance of a correct pharmacological reconciliation in dialysis patients in order to avoid the onset of adverse events due to the uncontrolled intake of drugs or parapharmaceuticals.

Climate changes have never been as dramatically apparent in our everyday life as now. It is urgent to reduce greenhouse gas emissions and mitigate the consequences of climate changes both on the planet and on human health. The indiscriminate exploitation of natural  resources and the lack of shared  rules are among the major causes. Recently, some economists have called for a radical change in the present economic model towards a ‘social solidarity economy’ model. G.Giraud, a French economist, called for an ecological and social transition in order to reduce the ecological footprint and deal concretely with the problem of global warming. The good news is that the solutions are there and do not have to be punitive. Health consequences of climate changes have already caused serious draw backs on public health. Doctors and scientific institutions can and must contribute to help mitigate the effects of climate change through increasing commitment and support to goodenvironmental policies.  Climate emergency requires the extension of ethics and medical practice beyond their traditional mission to involve the relationship between patients, doctors and society. We propose that medical scientific institutions quickly promote the birth of task forces dedicated to addressing this problem. (GCND_planet), Climate changes have never been as dramatically apparent in our everyday life as now. It is urgent to reduce greenhouse gas emissions and mitigate the consequences of climate changes both on the planet and on human health. The indiscriminate exploitation of natural  resources and the lack of shared  rules are among the major causes. Recently, some economists have called for a radical change in the present economic model towards a ‘social solidarity economy’ model. G.Giraud, a French economist, called for an ecological and social transition in order to reduce the ecological footprint and deal concretely with the problem of global warming. The good news is that the solutions are there and do not have to be punitive. Health consequences of climate changes have already caused serious draw backs on public health. Doctors and scientific institutions can and must contribute to help mitigate the effects of climate change through increasing commitment and support to goodenvironmental policies.  Climate emergency requires the extension of ethics and medical practice beyond their traditional mission to involve the relationship between patients, doctors and society. We propose that medical scientific institutions quickly promote the birth of task forces dedicated to addressing this problem. (GCND_planet)

The diagnosis of amyloidosis has been difficult and troublesome until the introduction of periombelical fat tissue aspirate as the method of choice for tissue biopsy. Nowadays the diagnostic path includes three main steps: suspicion of the disease, periombelical fat tissue aspirate or biopsy of the involved organ(s), and identification of the amyloidogenic protein. Several clinical and biohumoral conditions are highly suggestive of the disease, such as MGUS or multiple myeloma for AL, chronic inflammatory diseases for AA, and a family history of cardiac or peripheral neuropathy for the hereditary forms. However, in case of a tissue sample positive for Congo red staining, these conditions are not sufficient to identify the type of amyloid fibrils. Indeed misdiagnosis, especially in the presence of MGUS, is very likely and deserves particular attention. In most cases traditional immunohistochemistry is no longer adequate and there is a need for further investigations such as immunoelectron microscopy (immunogold) or proteomics with laser dissection and mass spectroscopy. Chemotherapy cannot be started until a definite diagnosis of the type of amyloidosis has been made., non disponibile

The diagnosis of amyloidosis has been difficult and troublesome until the introduction of periombelical fat tissue aspirate as the method of choice for tissue biopsy. Nowadays the diagnostic path includes three main steps: suspicion of the disease, periombelical fat tissue aspirate or biopsy of the involved organ(s), and identification of the amyloidogenic protein. Several clinical and biohumoral conditions are highly suggestive of the disease, such as MGUS or multiple myeloma for AL, chronic inflammatory diseases for AA, and a family history of cardiac or peripheral neuropathy for the hereditary forms. However, in case of a tissue sample positive for Congo red staining, these conditions are not sufficient to identify the type of amyloid fibrils. Indeed misdiagnosis, especially in the presence of MGUS, is very likely and deserves particular attention. In most cases traditional immunohistochemistry is no longer adequate and there is a need for further investigations such as immunoelectron microscopy (immunogold) or proteomics with laser dissection and mass spectroscopy. Chemotherapy cannot be started until a definite diagnosis of the type of amyloidosis has been made., non disponibile