Healing of Graves' Disease Thorough Lifestyle Changes: A Case Report.

BACKGROUND: Graves' disease is known as a chronic and incurable disease. The typical treatment is symptom-based and consists of medications, radioiodine, or surgery. These last two treatments are routinely offered to the 50% of patients that do not respond to drug therapy. Here we report the case of a patient who was able to normalize her thyroid hormones as well as her autoimmune markers in 6 months with the exclusive implementation of lifestyle interventions. SUMMARY: A 34-year-old Dutch, Caucasian female diagnosed with Graves' disease since 2014 implemented lifestyle modifications, which included dietary change to an ancestral type of diet, oral health interventions, practice of kundalini yoga, avoidance of environmental toxicants (by only eating organic food, drinking filtered water, and using natural products to clean her house or for her personal hygiene) and supportive supplements when necessary. The patient did not take any antithyroid drugs or beta-blockers during this period nor any other type of medication that could have had immunosuppressant effects. After 6 months of engaging in these lifestyle interventions, her thyroid analysis normalized and no anti-thyrotropin receptor antibodies were negative. CONCLUSION: This case report demonstrates that Graves' disease can effectively be put into lasting remission without conventional medical interventions. It also emphasizes the importance of a healthy lifestyle as a first line intervention for all patients but especially in the particular case of patients suffering from Graves' disease.

A 60-Year-Old Swiss Woman Presenting with Migratory Radicular Pain Diagnosed with Lyme Disease by Western Blot.

BACKGROUND Many diagnostic guidelines have been established to support the diagnosis of Lyme disease, but a recent meta-analysis did not find that 2-tier tests were better than individual tests. Here, we present the case of a patient who was diagnosed by immunoblot only, a second-line test that is usually not performed if the first-line test is negative. CASE REPORT A 60-year-old Swiss woman, without relevant comorbidities, presented to our clinic with 1-week symptoms of migratory radiculitis in the L1, L2, and L5-S1 right dermatomes. Blood analysis and lumbar and brain MRI did not show any significant abnormalities. However, unexpected results were obtained after testing Lyme serologies. They were performed first with LIAISON® test (Diasorin, Italy) then with Borrelia VIRAstripe® immunoblot (Viramed, Germany) and a positive IgM result was only obtained with the latter. Consequently, doxycycline 100 mg 2×/day was initiated and the symptoms completely resolved after 6 weeks of treatment. Ever since, and more than 1 year after the initial presentation, the patient remains symptom-free. CONCLUSIONS As shown, it was possible to diagnose this patient and treat her successfully by testing all the available serologies. Furthermore, we were surprised to find out after a review of the literature that the IgM sensitivity in neuroborreliosis with the LIAISON® test is only 43.9-46% versus 90-100% with VIRAstripe®. Hence, clinicians need to understand the pitfalls of these tests before excluding Lyme disease.

Increased body fat is independently and negatively related with cardiorespiratory fitness levels in children and adolescents with normal weight.

BACKGROUND: Body mass index (BMI) is related with cardiorespiratory fitness (CRF), but less is known regarding the combined relationships between BMI and body fat (BF) on CRF. DESIGN: Cross-sectional study included 2361 girls and 2328 boys aged 10­18 years living in the area of Lisbon, Portugal. BMI was calculated by measuring height and weight, and obesity was assessed by international criteria. BF was assessed by bioimpedance. CRF was assessed by the 20-m shuttle run and the participants were classified as normal-to-high or low-CRF level according to Fitness gram criterion-referenced standards. RESULTS: The prevalence of low CRF was 47 and 39% in girls and boys, respectively. The corresponding values for the prevalence of obesity were 4.8 and 5.6% (not significant) and of excess BF of 12.1 and 25.1% (P <0.001), respectively. In both sexes, BMI and BF were inversely related with CRF: r = ­ 0.53 and ­ 0.45 for BMI and % BF, respectively, in boys and the corresponding values in girls were ­ 0.50 and ­ 0.33 (all P <0.01). When compared with a participant with normal BMI and BF, the odds ratios (95% confidence interval) for low CRF were 1.94 (1.46­2.58) for a participant with normal BMI and high BF, and 6.19 (5.02­7.63) for a participant with high BMI and high BF. CONCLUSION: The prevalence of low-CRF levels is high in Portuguese youths. BF negatively influences CRF levels among children/adolescents with normal BMI.

Acute Renal Failure in a Patient with Rivaroxaban-Induced Hypersensitivity Syndrome: A Case Report with a Review of the Literature and of Pharmacovigilance Registries.

Direct oral anticoagulants (DOACs) are among the most commonly prescribed medications, and DOAC-associated kidney dysfunction may be a problem that is underrecognized by clinicians. We report on the case of an 82-year-old patient who, two weeks after the prescription of rivaroxaban for atrial fibrillation, was hospitalized for a drug-induced hypersensitivity syndrome whose main clinical manifestations were low-grade fever with a petechial rash in the legs and acute renal failure (ARF). Within one week after rivaroxaban withdrawal, the patient's clinical condition improved and the renal function normalized. In a review of the literature, we only found five case reports of rivaroxaban-related ARF: two patients had tubulo-interstitial nephritis (TIN), two had anticoagulant-related nephropathy (ARN), and the last one had IgA nephropathy. As some recent publications suggest that kidney injury due to anticoagulation drugs may be largely underdiagnosed, we also analyzed the data from the VigiAccess database, the World Health Organization pharmacovigilance program that collects drug-related adverse events from 134 national registries worldwide. Among all the rivaroxaban-associated adverse events reported in VigiAccess since 2006, 4,323 (3.5%) were renal side effects, of which 2,351 (54.3%) were due to unspecified ARF, 363 (8.4%) were due to renal hemorrhage (characteristically associated with ARN), and 24 (0.6%) were due to TIN. We also compared these results with those reported in VigiAccess for other DOACs and vitamin K antagonists. This analysis suggests that the frequency of renal adverse events associated with rivaroxaban and other DOACs may be appreciably higher than what one might currently consider based only on the small number of fully published cases.

Burnout levels among Portuguese family doctors: a nationwide survey.

AIM: To characterise the prevalence of burnout syndrome in a sample of family doctors (FDs) working in the Portuguese National Health System. DESIGN: Cross-sectional survey. SETTING: Primary healthcare centres from the 18 continental districts and two archipelagos of Portugal. METHOD: The Portuguese version of the Maslach Burnout Inventory-Human Services Survey was sent to 40 randomly selected healthcare centres and distributed to the FDs employed. Socio-demographic and work-related data were also collected. Participants were classified as having high, average or low levels of emotional exhaustion (EE), depersonalisation (DP) and personal accomplishment (PA) dimensions of burnout. RESULTS: 371 questionnaires were sent, of which 153 (83 women, age range 29-64 years; response rate 41%) returned. One-quarter (25.3%, 95% CI 18.6% to 33.1%) of FDs scored high for EE, 16.2% (10.7% to 23.2%) for DP and 16.7% (11.1% to 23.6%) for lack of PA. On multivariate analysis, being married, of older age, having many years of practice or working in a personalised healthcare unit tended to be associated with increased burnout components. Men tended to present higher EE and DP but lower lack of PA than women. Finally, the prevalence (95% CI) of burnout ranged between 4.1% (1.5% to 8.6%) and 32.4% (25.0% to 40.6%), depending on the definition used. CONCLUSIONS: High burnout is relatively common among Portuguese FDs. Burnout relief measures should be developed in order to prevent a further increase of burnout syndrome among Portuguese FDs.