Johnsenthuesen6940

Promising new pharmacotherapy for obesity is under development.In this article the dilemma of prescribing antidepressants during pregnancy is elucidated. Based on a case of a pregnant woman with a history of depressive disorder we discuss how to weigh the benefits and risks of prescribing antidepressant medication. On the one hand the possible effects of antidepressants on both the pregnancy as well as on the fetus are pointed out, while on the other hand the possible effects of an (untreated) depressive disorder on the course of the pregnancy and the development of the offspring are also explained. We conclude how the benefits and risks have to be discussed with the patient and preferably also her partner, in view of shared decision making.

Primary cardiac tumors are rare. Myxomas are the most prevalent benign primary cardiac tumors, followed by papillary fibroelastomas. These tumors can cause local cardiac complications, but also thromboembolic events. This case report describes an aortic valve tumor, causing embolic complications at two rare locations.

A 43-year-old female patient came to the emergency department with abdominal pain and shortly after chest pain with associated ECG abnormalities. CT angiography and transesophageal echocardiography revealed a tumor located at the aortic valve. The tumor caused thromboembolic complications in the left coronary artery and the right kidney. Valve-sparing excision of the tumor was performed. Histology revealed sclerosed material with myxoid degeneration.

Unexplained thromboembolic events, particularly with multiplicity in time and location, are suspicious for a cardiac source of embolism. Cardiac tumors should be part of the differential diagnosis of cardiac sources of embolism. After diagnosis, tumor resection is the preferred treatment.

Unexplained thromboembolic events, particularly with multiplicity in time and location, are suspicious for a cardiac source of embolism. Cardiac tumors should be part of the differential diagnosis of cardiac sources of embolism. After diagnosis, tumor resection is the preferred treatment.A 37-year-old male presented with acute lower right abdominal pain. A CT-scan showed a cecal mass. During laparoscopic right colectomy, multiple liver lesions and peritoneal deposits were seen. Histology confirmed pT4aN0 cecum carcinoma, but the liver lesions were consistent with sarcoidosis, and the peritoneal deposits were suggestive of benign mesothelioma.

To study school lifestyle interventions for elementary school children (The Healthy Primary School of the Future).

What are the effects of the introduction of increased physical activity with or without healthy nutrition on health behaviour and BMI of young children and what are the costs of this program?

Prospective controlled non-randomized study with nearly 1700 children in Parkstad (South-East Netherlands).

Preliminary results after two years show that the combination of increased physical activity and healthy nutrition result in a decreased BMIz-score (-0.036), increased physical activity alone in hardly any change (-0.10) while in the control group the BMIz-score increased (0.052). The net societal costs of the combination of physical activity and health nutrition costs were 1 euro per child per day.

The study contributes to the increasing amount of evidence proving that lifestyle interventions are effective in reducing the obesity epidemic. Future studies will show whether a weight reduction in children will result in the prevention of chronic disease later on in life and what the cost reduction related to this result will be.

The study contributes to the increasing amount of evidence proving that lifestyle interventions are effective in reducing the obesity epidemic. Future studies will show whether a weight reduction in children will result in the prevention of chronic disease later on in life and what the cost reduction related to this result will be.Peristomal dermatitis is a frequent problem in stoma patients. This causes problems with the adhesion of stoma material. Not being able to rely on a leak-free stoma plaque has major social consequences for stoma patients. In this article we discuss the differential diagnosis, pathophysiology and therapy based on a patients case. If the dermatitis is based on an irritating contact dermatitis due to the stoma adhesive, the dermatitis should be treated with a local corticosteroid, preferably in the form of a nasal spray.For decades beta-blockers have been used in the treatment of patients after a myocardial infarction (MI). Current guidelines on the use of beta-blockers after myocardial infarction are based on studies that date back to 3 decades ago. Since then advances in the treatment of myocardial infarction have been made, thanks to the implementation of percutaneous coronary intervention, statins and ACE-inhibitors. This has resulted in increased survival and lower rates of post-MI heart failure. Long-term beta-blocker treatment is a cornerstone for treatment in patients with decreased left ventricular systolic function. However, the efficacy of the long-term treatment in post-MI patients with preserved ventricular function is unknown. Side-effects of beta-blockers can considerably impact patient's quality-of-life. This contribution reviews available data on the efficacy and possibilities for discontinuation of treatment with beta-blockers.After a cessation of almost 40 years, there is renewed interest into therapeutic applicationsof the serotonergic psychedelic psilocybin for the treatment of patients with various psychiatric disorders. PubMed was searched for clinical trials into "psilocybin" between 2000 and 2020, complemented by handsearching. Articles were also screened for explanatory models and working mechanisms. Psilocybin has been studied in 9 clinical trials for the treatment of substance use disorders, depression, end-of-life anxiety, demoralization, and obsessive-compulsive disorder. Results show that psilocybin is well tolerated, with only limited side-effects, while even patients with treatment-resistant disorders sometimes show marked, long-term improvements after one or a few sessions. Initial results are encouraging, but there are several limitations. More research is needed to determine which patient populations can benefit, what role setting and the placebo response play, and how these novel treatments can be optimized.SARS-CoV-2 has rapidly spread worldwide since December 2019. Obviously, pregnant and lactating women will also be infected with SARS-CoV-2. Pregnant women, however, are a risk population for developing severe respiratory infections. Currently, the knowledge on potential risks and consequences of COVID-19 during pregnancy and lactation is limited. Available data show that pregnant women suffer from similar symptoms compared to non-pregnant patients. There is no evidence as yet that COVID-19 has a more serious course during pregnancy. Although pregnant women might suffer from a wide variety of symptoms, most of them are asymptomatic. Maternal SARS-CoV-2 infection might lead to adverse neonatal outcomes, such as prematurity or respiratory symptoms. There is currently no conclusive evidence of absence of intrauterine transmission of the virus; the virus has not been detected in breastmilk in most studies, although passage into breastmilk cannot be completely excluded.Transient visual phenomena in later life due to a visual aura in migraine are not uncommon and can also occur without headache. This migraine with aura is not always recognized as such. Since visual phenomena can also have a variety of other causes, they can present a diagnostic dilemma in both primary and secondary care. Visual aura phenomena have various and often complex manifestations and are usually observed binocularly. In case of transient visual phenomena, the patient's history is of utmost importance to determine whether there is a mono- or binocular cause of the complaints. Timely recognition of visual phenomena in the context of migraine can prevent unnecessary diagnostics and treatments.The buried bumper syndrome (BBS) is a rare complication of percutaneous endoscopic gastrostomy (PEG). Hereby the internal PEG bumper is overgrown by hypertrophic gastric mucosa and embedded into the gastric wall. Most often an endoscopic approach to remove the bumper is successful. If not, an operative removal of the plate is necessary. In this paper, we present a case of a patient in whom a BBS was diagnosed. Besides the therapeutic options to treat a BBS, in this paper we want to focus on the prevention of this complication. Consideration needs to be given as to how long after the procedure should it be loosened to prevent BBS. The distance a PEG tube is advanced and whether it should be rotated is crucial in order to prevent BBS.Many healthcare providers agree that reduction or stopping of medication, so-called deprescribing, would be good in vulnerable people with polypharmacy. However, deprescribing is not yet widely conducted. Physicians and pharmacists experience barriers, such as lack of evidence and guidance to support this process. There is also a tendency to maintain the status quo when there are no acute problems. Patients do want fewer pills but the proposal to stop certain medication can lead to resistance or confusion. The needs and concerns from a patient's perspective are a good starting point for desprescribing. It is important to set new goals and to prioritize together which medication can be stopped. selleckchem It is not only relevant to react to existing problems but also to act proactively when the potential benefits no longer outweigh the medication burden or risks. Recently, more guidance and tools to support deprescribing became available in the Netherlands.Introduction of new genetic test technologies in the last decade have accelerated genetic diagnosis in many medical specialties and have increased diagnostic yield considerably. SNP-arrays have been established as first tier diagnostic tools, more and more being replaced by next generation sequencing strategies, like targeted genomic panels and whole exome sequencing. We present the diagnostic work-up of a clinical case, a girl with congenital vertebral and rib anomalies. This case illustrates the complexity of genetic tests and the need for knowledge and experience to interpret the results. Intensive collaboration between pediatrician, clinical geneticist and laboratory specialist is mandatory, as is long-term commitment to involve parents in the diagnostic journey .

Rare studies focused on the tandem mass spectrometry (MS/MS) findings for the primary carnitine deficiency (PCD) in the neonates in China mainland. In this study, we aim to analyze the gene mutation spectrum of PCD in Fujian Province in China mainland.

Primary carnitine deficiency (PCD) samples used in this study were selected from 95,453 cases underwent neonatal screening between May 2015 and February 2020. SLC22A5 gene sequencing was performed on the neonates and their parents with C0 level of less than 8.8μmol/L.

Ten patients (male 7; female 3) were finally included in this study. Among these patients, nine were neonates, and one was maternal decline of C0 of less than 8.8μmol/L. The maternal case showed two types of mutations of SLC22A5 including c.760C>T(p.R254*) and c.1400C>G(p.S467C). The other nine neonates showed compound mutations involving nine types in 18 sites, among which two mutations [i.e., c.37G>T(p.E13*) and c.694A>G(p.T232A)] were novel that had never been reported before.