Search

Fat-soluble vitamins, including vitamins A, D, E and K, are molecules with no energy value that are essential for the body to function and for life. Their intake is almost exclusively exogenous, i.e. dietary. The ubiquitous and vital nature of the functions performed by these vitamins explains the wide variety of clinical manifestations and their potential seriousness, particularly in cases of deficiency, but also in cases of excess or hypervitaminosis. We present here the main symptoms of hypervitaminosis. [ABSTRACT FROM AUTHOR]

Fat-soluble vitamins, including vitamins A, D, E and K, are molecules with no energy value that are essential for the body to function and for life. Their intake is almost exclusively exogenous, i.e. dietary. As a result, deficiencies in fat-soluble vitamins are rarer in industrialised countries than in countries with limited resources. However, even in the latter, certain groups of individuals are affected, such as newborns or growing children, pregnant or breast-feeding women and elderly or isolated subjects. Vitamin A, D, E and K deficiencies are also relatively common in people with digestive tract disorders, in patients suffering from chronic pathologies or in intensive care patients. Deficiencies or excesses of fat-soluble vitamins are responsible for a variety of more or less specific clinical symptoms. Treatment of deficiencies requires vitamin supplementation, a well-balanced diet and treatment of the cause. [ABSTRACT FROM AUTHOR]

Fat-soluble vitamins, including vitamins A, D, E and K, are molecules with no energy value that are essential to the body's functioning and to life. Their intake is almost exclusively exogenous, i.e. dietary. Deficiency or excess of fat-soluble vitamins is responsible for a variety of more or less specific clinical symptoms. The fact that the functions performed by these vitamins are both ubiquitous and vital explains the wide variety of clinical manifestations and their potential seriousness. Some syndromes are typical of a deficiency in fat-soluble vitamins, such as: the combination of ophthalmological and immunity impairment in the case of vitamin A; a haemorrhagic syndrome and osteopenia in the case of vitamin E; and osteomalacia, muscular weakness, even falls, and rickets in the case of vitamin D. Diagnosis of a deficiency in one of the fat-soluble vitamins is based on blood tests, which are not always essential for routine use. In this case, a therapeutic test may be suggested. [ABSTRACT FROM AUTHOR]

Résumé: Objectif : L'objectif de la présente étude est de déterminer si la mise en place d'un suivi régulier et structuré des patients présentant une insuffisance cardiaque (IC) chronique, associé à une éducation thérapeutique, aboutissait à une meilleure prise en charge de ces patients. Patients et méthode : Il s'agissait d'une étude monocentrique, rétrospective, sur une cohorte de patients présentant une IC chronique avérée, suivis sur la région de Mulhouse (France), entre janvier 2016 et décembre 2017, par l'Unité de suivi des patients insuffisants cardiaques (USICAR). Ces patients bénéficiaient d'un suivi régulier protocolisé et d'un programme d'éducation thérapeutique pendant une période de 2 ans. Le critère principal de cette étude était : le nombre de jours d'hospitalisation pour IC par an et par patient. Les critères secondaires étaient : le nombre de jours d'hospitalisation pour autre cause cardiaque que l'IC et le nombre de séjours hospitaliers pour IC par patient. Ces critères étaient recueillis sur la période d'un an avant inclusion, après un an de suivi, puis à deux ans de suivi. Résultats : 159 patients, d'âge moyen de 72,9 ans, ont été inclus dans la présente étude. Ils présentaient tous une IC, essentiellement de stade I-II de la NYHA (88,7 %), d'origine préférentiellement ischémique (50,9 %), à fraction d'éjection ventriculaire gauche altérée dans 69,2 % des cas. En ce qui concerne le critère principal, celui-ci était en moyenne de 8,33 jours (6,84-10,13) durant l'année précédant l'inclusion, de 2,6 jours (1,51-4,47) durant la première année de suivi, et de 2,82 jours (1,30-6,11) (p < 0,01 pour les 2 comparaisons). Le nombre moyen de jours d'hospitalisation pour autre cause cardiaque que l'IC ramené au nombre de patients était : de 1,73 jours (1,16-2,6), de 1,81 jours (1,04-3,16) et de 1,32 jours (0,57-3,08) (p = ns). Le pourcentage d'hospitalisation pour IC pour chaque patient était : de 69,5 % (60,2-77,4) avant inclusion, de 16,2 % (10-25,2) durant la première année de suivi et de 19,3 % (11-31,8) durant la seconde (p < 0,001 pour les 2 comparaisons). Conclusion : La présente étude démontre l'intérêt d'un suivi protocolisé associée à un programme d'éducation thérapeutique pour améliorer la prise en charge des patients IC en ambulatoire, notamment pour les IC modérées. Objective: The objective of this study is to determine whether the implementation of regular and structured follow-up of patients with chronic heart failure (CHF), combined with therapeutic education, led to better management of these patients. Patients and Method: This was a monocentric, retrospective study on a cohort of patients with a proven CHF, followed in the Mulhouse region (France), between January 2016 and December 2017, by the Unit for Monitoring Heart Failure Patients (USICAR). These patients benefited from a regular protocolized follow-up and a therapeutic education program for a period of 2 years. The main criterion of this study was: the number of days of hospitalization for HF per year and per patient. The secondary endpoints were: the number of days of hospitalization for cardiac causes other than HF and the number of hospital stays for HF per patient. These criteria were collected over the one-year period before inclusion, at one-year-follow-up, and at two-years-follow-up. Results: 159 patients with a mean age of 72.9 years were included in this study. They all had a CHF, mainly stage I-II NYHA (88.7%), of predominantly ischemic origin (50.9%), with altered left ventricular ejection fraction in 69.2% of cases. The primary endpoint averaged 8.33 days (6.84-10.13) in the year prior to inclusion, 2.6 days (1.51-4.47) in the first year of follow-up, and 2.82 days (1.30-6.11) (p <0.01 for both comparisons). The mean number of days of hospitalization for other cardiac causes other than HF to patient numbers was: 1.73 days (1.16-2.6), 1.81 days (1.04-3.16), and 1.32 days (0.57-3.08) (p = ns). The percentage of hospitalization for HF for each patient was: 69.5% (60.2-77.4) before inclusion, 16.2% (10-25.2) during the first year of follow-up and 19.3% (11-31.8) during the second (p < 0.001 for both comparisons). Conclusion: This study demonstrates the value of a protocolized follow-up associated with a therapeutic education program to improve the management of ambulatory CHF patients, particularly for moderate CHF. [ABSTRACT FROM AUTHOR]

Copyright of Medicina (Buenos Aires) is the property of Medicina (Buenos Aires) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article presents a report on Sars-Cov-2. Topics discussed here include the Sars-Cov-2 potion, severe clinical infection like hypoxemic lung disease, and the diseases that negatively impact food and nutritional homeostasis of the human body. It also states that Sars-Cov-2 mainly attacks patients in intensive care and resuscitation.

We reported a case of measles-induced acute disseminated encephalomyelitis (ADEM) in a 40-year-old immunocompetent adult. The patient presented a week after the development of respiratory symptoms and a cutaneous rash, and was admitted to hospital for altered mental status. Blood tests showed hyperleukocytosis, thrombopenia and cytolysis. A lumbar puncture was consistent with acute meningitis and the patient was initially treated with antiviral and wide broad-spectrum antibiotics. Serology and PCR for measles came back positive., Learning Points: Acute disseminated encephalomyelitis (ADEM) associated with measles infection is not uncommon.Clinical suspicion must be based on the presence of measles infection or recent vaccination.A normal CT scan does not rule out the disease but magnetic resonance imaging (MRI) is not required to confirm the diagnosis., Competing Interests: Conflicts of Interests: The Authors declare that there are no competing interests., (© EFIM 2020.)

Introduction: Heart failure (HF) is a health problem in Spain where the prevalence rate for this disease is correlated with aging. Heart failure-related mortality and hospital readmissions are high. The purpose of this study was to evaluate the clinical features of patients with HF hospitalized in the Department of Internal Medicine as well as factors associated with readmission and intra-hospital mortality., Methods: We conducted a cross-sectional, descriptive, and retrospective study based on the review of the clinical records of patients with primary diagnosis of HF in the Basic Minimum Set of Data (BMSD, Conjunto Mínimo Básico de Datos),who were discharged from the Department of Internal Medicine of the San Carlos Clinical Hospital (HCSC) in 2014., Results: The study involved 199 patients, with an average age of 82.7 years (61.8% were females); 85% of them had left ventricular ejection fraction (LVEF) > 40%, with an average pro-BNP of 9.101,3 pg/ml and 64.3% had ongoing atrial fibrillation. Thirty point two percent of patients were readmitted within 30 days, with an average rate of readmission/year of 1.45 (±0.86). Twenty five percent of patients died during the follow-up period in hospital. Among factors associated with intra-hospital mortality, older age was an associated variable (OR 1,050)(1,002-1,101) (p = 0.04). The most important factors associated with early readmission were polypharmacy (p = 0.024) as well as pluripathology based on Ollero criteria 4,974 (1,396-17,730) (p = 0.024). Patients hospitalized for HF in our Department are elderly patients treated with polymedication., Conclusion: Patients hospitalized for cardiac insufficiency are older and are characterized by pluripathology and polypharmacy. Short-term prognosis is associated with high rates of readmission and mortality in hospitalmainly for patients suffering from kidney disease and/or neurological disorders., Competing Interests: Les auteurs ne déclarent aucun conflit d'intérêts., (© Noel Lorenzo Villalba et al.)

Boerhaave syndrome or spontaneous rupture of the oesophagus is a severe condition commonly misdiagnosed or unrecognized. Prognosis is poor even if the diagnosis is made promptly. We describe a case of Boerhaave syndrome diagnosed after the development of pneumomediastinum and cardiac arrest. Unfortunately, the patient died 48 hours after admission to the Intensive Care Unit. This entity requires a multidisciplinary management approach which may include conservative, surgical or endoscopic procedures., Learning Points: Boerhaave syndrome is a diagnostic and therapeutic challenge, and rapid diagnosis and management are crucial.A thoraco-abdominal CT scan with oesophageal opacification is the gold standard investigation.A multidisciplinary and individualized approach is needed in the management of this condition., Competing Interests: Conflicts of Interests: The Authors declare that there are no competing interest, (© EFIM 2019.)

Introduction: Idiosyncratic drug-induced neutropenia and agranulocytosis is seldom discussed in the literature, especially for new drugs such as biotherapies outside the context of oncology. In the present paper, we report and discuss the clinical data and management of this relatively rare disorder, with a focus on biotherapies used in autoimmune and auto-inflammatory diseases., Materials and Methods: A review of the literature was carried out using the PubMed database of the US National Library of Medicine. We searched for articles published between January 2010 and May 2019 using the following key words or associations: "drug-induced neutropenia", "drug-induced agranulocytosis", and "idiosyncratic agranulocytosis". We included specific searches on several biotherapies used outside the context of oncology, including: tumor necrosis factor (TNF)-alpha inhibitors, anti-CD20 agents, anti-C52 agents, interleukin (IL) 6 inhibitors, IL 1 inhibitors, and B-cell activating factor inhibitor., Results: Idiosyncratic neutropenia remains a potentially serious adverse event due to the frequency of severe sepsis with severe deep tissue infections (e.g., pneumonia), septicemia, and septic shock in approximately two-thirds of all hospitalized patients with grade 3 or 4 neutropenia (neutrophil count (NC) ≤ 0.5 × 109/L and ≤ 0.1 × 109/L, respectively). Over the last 20 years, several drugs have been strongly associated with the occurrence of idiosyncratic neutropenia, including antithyroid drugs, ticlopidine, clozapine, sulfasalazine, antibiotics such as trimethoprim-sulfamethoxazole, and deferiprone. Transient grade 1-2 neutropenia (absolute blood NC between 1.5 and 0.5 × 109/L) related to biotherapy is relatively common with these drugs. An approximate 10% prevalence of such neutropenia has been reported with several of these biotherapies (e.g., TNF-alpha inhibitors, IL6 inhibitors, and anti-CD52 agents). Grade 3-4 neutropenia or agranulocytosis and clinical manifestations related to sepsis are less common, with only a few case reports to date for most biotherapies. Special mention should be made of late onset and potentially severe neutropenia, especially following anti-CD52 agent therapy. During drug therapy, several prognostic factors have been identified that may be helpful when identifying 'susceptible' patients. Older age (>65 years), septicemia or shock, renal failure, and a neutrophil count ≤0.1 × 109/L have been identified as poor prognostic factors. Idiosyncratic neutropenia should be managed depending on clinical severity, with permanent/transient discontinuation or a lower dose of the drug, switching from one drug to another of the same or another class, broad-spectrum antibiotics in cases of sepsis, and hematopoietic growth factors (particularly G-CSF)., Conclusion: Significant progress has been made in recent years in the field of idiosyncratic drug-induced neutropenia, leading to an improvement in their prognosis (currently, mortality rate between 5 and 10%). Clinicians must continue their efforts to improve their knowledge of these adverse events with new drugs as biotherapies., Competing Interests: The authors have no conflict of interest that are directly relevant of the content of this manuscript. E.A. is the recipient of several grants from different laboratories: Novartis, BMS, Pfizer, Léo Pharma, Boehringer, Ferring, Chugai, Amgen, and Roche, but these sponsors have no part in the research or writing of the present manuscript. Cremmer Consulting Company has edited the text of the present manuscript.

We report a rare case of acute disseminated encephalomyelitis (ADEM) secondary to a primary Epstein-Barr (EBV) infection, in a 22-year-old male. Symptomatic infectious mononucleosis and ADEM are both quite uncommon conditions in this age group., Learning Points: ADEM is a very rare CNS disorder; it is more common in childhood but can also be described in adults.The clinical evaluation must focus on the presence of recent signs of infection or vaccination.A normal cerebral scan does not rule out the disease and MRI must be performed to confirm the diagnoses., Competing Interests: Conflicts of Interests: The Authors declare that there are no competing interests.

We report a case of brainstem infarction following a C5-C6 cervical transforaminal injection, a rare and serious neurological complication of this procedure. Cervical transforaminal steroid injection is a common therapy for patients with persistent cervical radiculopathy not relieved by conservative treatment, and is effective in 65-70% of cases. Unfortunately, this procedure may lead to serious complications such as neurological damage. These complications are rare but potentially fatal, as reported in our case. Complications could be due to three mechanisms: the technique itself, the cervical vascular anatomy and the properties of the product (corticoids). The neurological complications can be diagnosed through brain MRI. This case report focuses on the importance of a risk/benefit evaluation when performing this medical procedure., Learning Points: Physicians should be better informed about severe complications following cervical transforaminal epidural steroid injections and their strict indications.Severe adverse events are rare but they can be disastrous.Non-particulate corticosteroid should be used., Competing Interests: Conflicts of Interests: The Authors declare that there are no competing interests.

We here report the case of a 47-year old female patient with acute coronary syndrome associated with possible arterial embolism of the right lower limb. During examination we detected G201210A Mutation of the Prothrombin Gene associated with lupus anticoagulant factor., Competing Interests: Les auteurs ne déclarent aucun conflit d'intérêts.

We report a case of a 64-year-old man who, 44 days after starting treatment with prasugrel, presented with severe thrombocytopenia, anaemia, renal failure, and severe ADAMTS13 activity deficiency, along with a high titer of autoantibodies to this protease., Learning Points: Drug-induced TTP is a rare condition and difficult to diagnose.Decreased activity of ADAMTS13, unusual in drug-induced TTP, was present in this case., Competing Interests: Conflicts of Interests: The Authors declare that there are no competing interests.

We present the case of a 48-year-old man admitted to the critical care unit with atrial fibrillation, and acute heart and kidney failure accompanied by coagulopathy and an abnormal liver test. Initially diagnosed as a non-ST elevation myocardial infarction, re-evaluation of the case led to the consideration of severe sepsis. Q fever and leptospirosis were the most probable causes and empiric treatment was initiated. A complete recovery was achieved following treatment., Learning Points: Epidemiological antecedents of interest must always be collected in the clinical record.Acute Q fever infection may be mild or present with multiple organ damage.Empiric treatment with doxycycline must be started when Q fever is suspected., Competing Interests: Conflicts of Interests: The Authors declare that there are no competing interests.