An uncommon cause of progressive visual loss in a heavy smoker

Loss of vision due to eye metastasis is generally uncommon, representing an ophthalmological diagnostic and therapeutic challenge. We here report a case of a smoker patient finally diagnosed with lung cancer, whose  initial symptom was visual loss due to choroidal metastasis. Given that the majority of subjects presenting with uveal metastasis have already developed other distant metastases as well, a complete diagnostic  work-up of these patients is always required. Despite being rare, eye metastasis from a lung malignancy  should always be suspected in smokers presenting with progressive vision deterioration.Key words: Lung cancer, metastasis, choroi

The “Who?” Question in the Hate Speech Debate: Part 1: Consistency, Practical, and Formal Approaches

This two-part article addresses the “Who?” question in the hate speech debate: namely, which characteristics, social identities or statuses should or should not be treated as protected characteristics within a body of hate speech laws? Using United Kingdom incitement to hatred laws as a focal point, the article outlines and critically appraises five broad approaches to specification. Part 1 deals with consistency specification, which highlights norms of consistency both within incitement to hatred law itself and in relation to other laws, practical specification, which focuses on the ostensible goals or apparent aims of incitement to hatred laws, and formal specification, which looks at the formal qualities of the characteristics themselves and to the different forms of people’s relationships with those characteristics. And Part 2 considers functional specification, which concentrates on the underlying or real functions, purposes or objectives of incitement to hatred laws, and democratic specification, which appeals to democratic procedures as well as to democratic values, norms and principles that speak to the proper scope of incitement to hatred laws. Along the way I shall also critically assess a range of substantive arguments about which particular characteristics should or should not be covered by incitement to hatred laws given the aforementioned approaches. My main conclusion shall be that each of the approaches has its strengths and weakness and that, partly because of this, no single approach is adequate by itself as a tool for specifying the proper scope of incitement to hatred laws, but also, by the same token, no approach should be ruled out entirely. Instead, the best strategy is one that combines together all five approaches in reasonable ways given the law, the characteristic and the context

Looking in the mirror: Situs inversus totalis

No Abstract

The “phantom” rash of Still’s disease

An 18-year-old, female patient presented with fever, sore throat and joint pain. Laboratory tests revealed elevated inflammation markers. During her hospitalization she presented a non-pruritic, salmoncolored rash, which was appearing with the fever in the evening hours and was vanishing during apyrexia. The rash could be seen in various parts of the body, such as the limbs, the face and the neck. The diagnosis of Adult-onset Still disease (AOSD) was established, since the patient was fulfilling the relevant criteria. AOSD is a rare, systemic inflammatory disorder of unknown etiology that typically presents as a high spiking fever accompanied by systemic symptoms. Various skin lesions have been described in patients with AOSD, both typical and atypical ones. Our patient presented significant clinical improvement after initiation of corticosteroid treatment.Pan African Medical Journal 2015; 2

Erythema nodosum leads to the diagnosis of pulmonary tuberculosis

Erythema nodosum is a panniculitis which may have various causes, such as drugs, infections, sarcoidosis, inflammatory bowel disease, tuberculosis or can be idiopathic. We here report a case of a woman diagnosed  with pulmonary tuberculosis whose first symptom was erythema nodosum. A thorough clinical and laboratory investigation of the patient presenting with erythema nodosum is always required, in order to assess a possible systemic, underlying condition.Key words: Erythema nodosum, Tuberculosis, Hilar lymphadenopath

Fordyce angiokeratoma

A 55 year-old Caucasian man, with Diabetes Melitus type 2 history, presented to our department with complaints of multiple, dark red papules located on the scrotum. The diagnosis of Fordyce angiokeratoma was clinically established. No special treatment was recommended, apart from patient's reassurance for the benign nature of this clinical entity. Fordyce angiokeratoma or angiokeratoma of the scrotum was first described in 1896 by John Addison Fordyce. Its etiology remains unclear, while its incidence is believed to increase with age. Genetic background of the disease has not been documented. Complications are generally uncommon, however bleeding of the papules can occur. Differential diagnosis mainly includes angiokeratoma corporis diffusum, malignant melanoma and nevomelanocytic nevus. In cases of diagnostic dilemma, dermoscopy can be useful, but biopsy of the lesion is the gold standard method for the establishment of the diagnosis. Specific treatment is unnecessary, still, excision, electrodessication and laser therapy have been described in complicated cases or for aesthetic reasons

Quetiapine-Induced Syndrome of Inappropriate Secretion of Antidiuretic Hormone

The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) can be induced by various conditions, including malignant neoplasms, infections, central nervous system disorders, and numerous drugs. We here report a case of a 65-year-old female patient, treated with quetiapine for schizophrenia, who presented with generalized tonic-clonic seizures and was finally diagnosed with quetiapine-induced SIADH. Quetiapine-associated hyponatremia is extremely uncommon and only a few, relevant reports can be found in the literature. This case underlines the fact that patients on antipsychotic medication and more specifically on quetiapine should be closely monitored and routinely tested for electrolyte disorders

Therapeutic Advances in Obesity: How Real-World Evidence Impacts Affordability Beyond Standard of Care

Obesity is currently considered a global epidemic, with rising prevalence worldwide and rather pessimistic projections. Based on its close interconnection with various co-morbidities, such as diabetes mellitus and cardiovascular disease, obesity is associated with significant increases in morbidity and mortality, while it also poses a substantial economic burden for national healthcare systems. Apparently, the majority of individuals classified as obese do not achieve adequate weight loss with the adoption of a healthy lifestyle intervention, including dietary modification and physical activity. Fortunately, during the last decade, a significant progress in pharmacotherapy of obesity has been observed, with the introduction of agents that have gained approval from regulatory authorities, namely semaglutide, liraglutide and tirzepatide, due to their impressive results in body weight reduction, alongside their beneficial, pleiotropic effects. The aim of the present review article is to discuss on evidence retrieved from real-world studies regarding the efficacy of those agents in obesity treatment, with emphasis on cost-effectiveness data, towards an effort to tackle efficiently the progression of obesity epidemic

The Effect of Sodium–Glucose Cotransporter Inhibitors on Renal Function as Adjunctive to Insulin in Adults with Type 1 Diabetes: An Updated Multilevel Meta-analysis of Randomized Controlled Trials

Introduction: This systematic review aimed to summarize the existing evidence from published randomized controlled trials (RCTs) on the impact of sodium–glucose cotransporter (SGLT) inhibitors on albuminuria levels and renal function in patients with type 1 diabetes mellitus (T1D). Methods: The literature search was performed through Medline (via PubMed), Cochrane Library, and Scopus until November 11, 2023. Double-independent study selection, data extraction, and quality assessment were performed. Evidence was pooled with three-level mixed-effects meta-analysis. Results: In total, 5221 participants with T1D among 11 RCTs were analyzed. All RCTs had low risk of bias according to the Cochrane Collaboration tool (RoB 2). SGLT inhibitors were associated with a significantly greater reduction in urine albumin-to-creatinine ratio (UACR) compared to controls (MD = − 23.13%; 95% CI = [− 33.69, − 12.57]; P < 0.001; level of evidence high). On the basis of subgroup analysis, this effect was consistent across all available SGLT inhibitors, irrespective of the dosage. Finally, a neutral class effect was observed on the estimated glomerular filtration rate (eGFR, MD = − 1.03 mL/min/1.73 m2; 95% CI = [− 2.26, 0.19]; P = 0.1; level of evidence moderate). Only empagliflozin was associated with a significant reduction in eGFR compared to placebo (MD = − 2.23 mL/min/1.73 m2; 95% CI = [− 3.62, − 0.84]; P = 0.002). Conclusion: Our findings suggest that adjunctive therapy with SGLT inhibitors results in a significant reduction in albuminuria, while their use is associated with a neutral effect on creatinine clearance, as a measure of renal function. Future renal outcome trials are needed to assess SGLT inhibitors’ role in the pharmacological armamentarium against diabetic nephropathy in T1D