Clinical medicine (London, England)
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Atopic eczema (eczema; also known as atopic dermatitis) is a chronic inflammatory skin condition. The burden of eczema can be very substantial with significant itch, skin pain, secondary infection, sleep disturbance and psychological distress. ⋯ When eczema cannot be adequately managed with skin-directed approaches such as topical preparations and/or phototherapy, systemic therapy may be required to achieve disease control and requires early input from dermatology specialists. The aim of this short review is to summarise this approach.
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Pregnancy leads to significant changes in renal physiology, which result in increases in glomerular filtration rate (GFR) and enhanced protein excretion. These changes may continue in the postnatal period and might be observed for 5-6 months after birth. Once confirmed, proteinuria warrants investigation and close surveillance. ⋯ New onset of proteinuria before 20 weeks' gestation (with or without kidney impairment) suggests known or previously undetected kidney disease. As pregnancy evolves, hyperfiltration may lead to increasing proteinuria, posing a diagnostic challenge in the diagnosis and recognition of pre-eclampsia. This article was written as a guide for the evaluation and management of proteinuria in pregnancy, as well as appreciating diagnostic dilemmas.
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Case Reports
Lessons of the month: Cerebrospinal Fluid Leak-associated Ventriculitis - a case report.
We present a case of a 74-year-old woman with headaches, pyrexia and intermittent right-sided otorrhoea and rhinorrhoea. Her nasal discharge tested positive for beta-2-transferrin, confirming a cerebrospinal fluid (CSF) leak. High-resolution CT (HRCT) mastoids showed a defect in the right tegmen, and CSF within the middle ear and mastoid air cells. ⋯ The patient had surgical repair of bony defects to prevent recurrence. This highlights a rare case of ventriculitis associated with a spontaneous CSF leak, with no existing set diagnostic criteria, and high mortality. High clinical suspicion aided by appropriate imaging, and a multidisciplinary approach to management are imperative.
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Asthma is the most common chronic disease to affect pregnant women and can have a significant effect on pregnancy outcomes, with increased rates of preterm birth, premature delivery and caesarean section observed if poorly controlled. Pregnancy can also influence asthma control. ⋯ The majority of asthma treatment can be continued as normal in pregnancy and there is emerging evidence of the safety of biologic medications also. This article aims to summarise the current evidence about asthma in pregnancy and guide the appropriate management of this population.
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With a rising worldwide incidence of obesity, particularly in the young, bariatric surgery offers an effective method of meaningful and sustained weight loss. At present, most bariatric procedures are carried out in women and increasingly in younger age groups. In line with the fertility benefits associated with weight loss, pregnancy after bariatric surgery is now a very common scenario. ⋯ However, rates of stillbirth and small-for-gestational-age (SGA) babies are increased, suggesting that screening and supplementation of micronutrients is likely to be very important in this cohort. The risks and benefits that bariatric surgery may pose to pregnancy outcomes, both maternal and fetal, are largely dependent upon the degree of weight loss, weight stability upon entering pregnancy, surgical complications and the time interval between bariatric surgery and pregnancy. Ideally, preconception care would be more widely available, helping to assess and address micronutrient deficiencies and support preparation for pregnancy.