La Revue du praticien
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Mitochondrial and metabolic myopathies constitute a group of disorders characterised by abnormal muscular metabolism of energy. Most of these disorders are genetically transmitted. Recent progress in the field has led to spectacular advances in their classification and the understanding of the mechanisms involved, particularly in mitochondrail myopathies. ⋯ Acute episodes of rhabdomyolysis on effort can occur, with an attendant risk of renal failure. Mitochondrial myopathies have multi-organ manifestations and muscular involvement is not always at the forefront. Although diagnosis may be suggested by clinical factors, it should be confirmed by teams and laboratories that specialize in muscular disorders.
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Disturbances in the endocrine system induce a myopathy by acting on protein synthesis or on energetic metabolic pathways. Thus, a proximal myopathy is seen in hypercorticism, hyper- or hypothyroidism and acromegaly. ⋯ Moreover, the steroid myopathy induced by iatrogenic glucocorticoid excess may lead to confusion in patients treated for an inflammatory myopathy. The treatment of endocrine myopathies is based on the correction of the hormonal disorder.
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As the term of "dry eye" is very common among people and physicians, the presumed definition of this entity is rather wrong. The simplistic triple equation: "dry eye = Sjögren's syndrome = artificial tears" belongs definitively to the past. This review is an attempt to demonstrate the complexity of the tear film regulation, the difficulties of an accurate diagnosis and finally the numerous therapeutic attitudes we can held for each sicca syndrome.
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General diseases-associated nail disorders may be classified into 5 types according to their clinical impact. Type I refers to nail disorders considered as peculiar features among the various symptoms of general disease such as peri-ungueal vascular dilatation, onycholysis, Beau lines, opaque nails or melanonychia. ⋯ Type III refers to nails disorders presenting as significant syndromes of several diseases such as yellow-nail syndrome of subungueal splinter haemorrhages, and type IV to specific disorders considered as true keys for diagnosis such as digital hippocratism, Bazex's acrokeratosis, Koenen's tumor, or nail hypoplasia. In type V are included drug-induced nails disorders especially after chemiotherapy or antiretroviral therapy.
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Delirium is a neurologic emergency representative of 10% of the hospitalized patients. It is characterized by an acute and fluctuating change of consciousness and cognition. ⋯ An associated agitation need a quick specific treatment. The treatment should prevent the risk factors, notably iatrogenic, especially in the elderly patients or with previous altered cognitive functions.