Hypothesis: could Meniere's disease be a channelopathy?

Meniere's disease is a clinical syndrome of uncertain aetiology but it is a widespread belief that it is related to endolymphatic hydrops. Clinically, it is a paroxysmal disorder with vertigo and subsequent deafness. It is responsive to acetazolamide and sensitive to the sodium content in the diet, many of the features of the channelopathies. The present paper explores the possibility that it may be related to a channelopathy.     

When a liver transplant recipient goes back to alcohol abuse: Should we be more selective?

Alcoholic liver disease (ALD) is one of the most common indications for liver transplantation (LT). However, it has always remained as a complicated topic from both medical and ethical grounds, as it is seen for many a “self-inflicted disease”. Over the years, the survival rate of transplanted patients has significantly improved. The allocation system and the inclusion criteria for LT has also undergone some modifications. Early LT for acute alcoholic hepatitis has been subject to recent clinical studies with encouraging results in highly selected patients. We have learned from studies the importance of a multidisciplinary evaluation of candidates for LT. Complete abstinence should be attempted to overcome addiction issues and to allow spontaneous liver recovery. Risk factors for relapse include the presence of anxiety or depressive disorder, short duration of sobriety pre-LT and lack of social support. The identification of risk factors and the strengthen of social support system may decrease relapse among these patients. Family counseling of candidates is highly encouraged to prevent relapse to alcohol. Relapse has been associated with different histopathological changes, graft damage, graft loss and even decrease in survival among some studies. Therefore, each patient should be carefully selected and priority is to continue to lean on patients with high probability of success. The ethical issue remains as to the patient returning to drinking after the LT, hindering the way for other patients who could have received the same organ.     

Brief alcohol intervention—where to from here? Challenges remain for research and practice

Brief intervention (BI) is intended as an early intervention for non‐treatment‐seeking, non‐alcohol‐dependent, hazardous and harmful drinkers. This text provides a brief summary of key BI research findings from the last three decades and discusses a number of knowledge gaps that need to be addressed. Five areas are described: patient intervention efficacy and effectiveness; barriers to BI implementation by health professionals; individual‐level factors that impact on BI implementation; organization‐level factors that impact on BI implementation; and society‐level factors that impact on BI implementation. BI research has focused largely upon the individual patient and health professional levels, with the main focus upon primary health care research, and studies are lacking in other settings. However, research must, to a larger degree, take into account the organizational and wider context in which BI occurs, as well as interaction between factors at different levels, in order to advance the understanding of how wider implementation of BI can be achieved in various settings and how different population groups can be reached. It is also important to expand BI research beyond its current parameters to investigate more ambitious long‐term educational programmes and new organizational models. More widespread implementation of BI will require many different interventions (efforts, actions, initiatives, etc.) at different interlinked levels, from implementation interventions targeting individual health professionals' knowledge, skills, attitudes and behaviours concerning alcohol issues, BI and behaviour change counselling to efforts at the organizational and societal levels that influence the conditions for delivering BI as part of routine health care.     

Acute disabling low-back pain during intravenous administration of amiodarone: could intravenous to oral switch therapy be a safe strategy?

We report for the first time a case of an acute disabling low-back pain episode during intravenous administration of amiodarone in a patient with atrial fibrillation. The symptoms completely resolved after terminating the infusion, and switching amiodarone from intravenous to oral administration was well tolerated.     

Halitosis: could it be more than mere bad breath?

Halitosis is a generic term used to describe unpleasant odor emanating from the mouth air and breath, independent of the source where the odor substances originate. It affects between 50 and 65% of the population, but despite its frequency, this problem is often unaccepted and declared as taboo. Ninety percent of patients suffering from halitosis have oral causes: a small, but important percentage, of oral malodor cases have an extra-oral etiology, very often falling into the category of “blood-borne halitosis”. Several systemic diseases have been found to provoke malodor or to be a cofactor; bad breath may be an early sign of a serious local or systemic condition. A psychogenic halitosis also exists including the variant “pseudo-halitosis”, when the oral malodor does not exist, but the patient believes he or she is suffering severely from it, and the halitophobia, when, instead, there is an exaggerated fear of having halitosis. The aims of this paper are to review both oral and extra-oral causes of halitosis, especially those related to underlying systemic diseases, and to provide the primary care clinician a helpful means for its diagnosis and management. In fact, it is important to determine quickly whether the odor comes from an oral cause or not: if so, it requires referral to a dentist; if not (extra-oral origin alone or combined), its management requires the treatment of the underlying causes. Extra-oral disorders can be the cause in up to 15% of cases.