• Question on Allergic Asthma Treatment

    Dear colleagues,

    I have been treating a 28-year-old patient, male, with severe allergic asthma for a while. The patient has many food allergies, plus allergic reaction to dust mites, mold and almost all types of pollen. It is almost impossible for him to avoid allergens. Even with long-acting beta-adrenoceptor agonist (LABA) or glucocorticoid therapy, severe asthma attacks are common, and day-to-day life is severely disrupted.

    I am studying the possibility of prescribing Omalizumab, a monoclonal antibody targeted at immunoglobulin E. However, I have no experience with this treatment and am at the moment somewhat reserved. I read that this treatment poses a risk of developing malignant tumors and that the drug could cause anaphylactic adverse reactions. Treatment costs are also of concern.

    Are you in favor of prescribing this medicine?

    Thanks for your help.

  • Cortisol and empathy

    In February 2014, the journal "Neuropsychopharmacology" published results from a research conducted at the Charité University Hospital in Berlin about cortisol’s capacity to influence feelings of compassion.

    We know that cortisol activates the mineralocorticoid and glucocorticoid receptors in the brain. For the study, the participants' mineralocorticoid receptors were stimulated with fludrocortisone. Stimulated participants reacted with significantly more empathy than the control group. 

    The pharmacological effect of feeling more compassion could be used for the treatment of psychiatric disorders. My questions to colleagues is, which pathologies do you believe may be relevant from a therapeutic perspective for the application of cortisol treatment given this finding?+

    Could people in non-pathological or asymptomatic mental health also benefit from this potential?

    Thanks for any opinions. Here's the link to the article in question

    https://www.nature.com/articles/npp201436

  • Aortic disease

    Hi am looking for a scientific article that addresses the topic of aortic disease, in particular references for thoracic/thoracic abdominal aneurysms are greatly appreciated. Especially articles that address these subjects with in-depth focus on its development and studies based on ultrasound methods.

    Thank you for your help.

  • Morbid obesity patient

    Hi, I’m a general practitioner and need an opinion on one of my patients.

    She is a 55-year-old morbidly obese female, with a BMI of 42 in need of bariatric care. The patient has already undergone LAGB with a therapeutic failure event 10 years ago. Her dietary history includes multiple regimes and the patient has had several cycles of weight loss and gain. Comorbidities include hypertension and type 2 diabetes (insulin independent), both treated and evolving within normal values.

    My question to colleagues is if this patient would benefit from a new bariatric surgery intervention despite the previous incidence of LAGB failure? If so, what type could she have as the best option? Or would any of you recommend a trial of psychological treatment associated with dietary management before a surgical intervention?

    Thank you in advance for your comments!

    Yours sincerely, AP

  • Tramadol side effect management

    Dear Colleagues, 

    Could any of you provide feedback on your experience with Tramadol ODs? In particular, instances of management with naloxone, and without association to alcohol intake. 

    best regards, 

    B

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