アジソン病

Trauma and social disadvantage are strongly associated with higher rates of chronic disease, partly driven by modifiable risk factors such as physical inactivity and poor diet. Despite strong evidence supporting exercise and dietary interventions for both physical and mental health, access to allied health professionals-particularly exercise physiologists, physiotherapists and dietitians-remains profoundly inequitable. Current prevention efforts predominantly reach individuals with stable living conditions and sufficient resources, ultimately privileging the privileged and entrenching health disparities. To close these gaps, these workforces must be reoriented: embedded within trusted community settings and delivered earlier in the care pathway, in ways that are trauma-informed and responsive to social context.

BACKGROUND: Spinal cord stimulation (SCS) is an established therapy for the management of chronic neuropathic low back pain (LBP) that is refractory to conventional measures. Although considered minimally invasive, SCS constitutes a surgical intervention that may induce significant physiological stress, placing patients with primary adrenal insufficiency (PAI) at an elevated risk of adrenal crises during perioperative periods. CASE REPORT: The authors present a woman with chronic LBP and PAI who successfully underwent SCS trial and permanent implantation with stress-dose glucocorticoid supplementation perioperatively, which resulted in 90% pain reduction, improved functional capacity, decreased analgesic reliance, and no adrenal crisis. To the authors' knowledge, there are no published clinical guidelines that address perioperative glucocorticoid management in PAI patients undergoing SCS implantation. CONCLUSIONS: Our case highlights a safe and effective perioperative protocol for SCS in PAI patients and underscores the importance of endocrine comorbidities when undergoing interventional procedures.

Evidence from clinical trials indicates that dietary protein plays an important and often underappreciated role in lipoprotein lipid metabolism. For this narrative review, literature searches were conducted in the PubMed and Cochrane Central Register of Controlled Trials databases for articles describing randomized controlled trials (RCTs) and systematic reviews and meta-analyses of RCTs, as well as dietary guidelines and dyslipidemia management recommendations, using search terms for protein quantity, source (e.g., animal- and plant-based), and type (e.g., dairy, meat, soy, and nuts) and effects on lipids and lipoproteins in humans. Findings indicated that dietary intakes of both animal-based and plant-based proteins, when replacing refined carbohydrates or saturated fatty acids, lower circulating concentrations of atherogenic lipoproteins. Protein from plant sources appears to produce a somewhat larger effect on lipoprotein lipid concentrations than protein from animal sources. Individual amino acids (e.g., branched-chain amino acids), protein food fractions (e.g., whey), and food-derived peptides may independently impact lipoprotein lipid metabolism. Beyond the effect of replacing one macronutrient for another, the biochemical pathways responsible for the effects of dietary protein on lipoprotein lipid metabolism in humans have not been fully defined. The importance of dietary protein in a healthy diet is emphasized in recent dietary recommendations for the general population and for individuals with dyslipidemias. Additional research is warranted to determine the amount of dietary protein and the best balance of food source(s) to optimize its benefits on lipoprotein lipid concentrations, as well as the mechanisms for these effects.

CASE PRESENTATION: A 3-year-old pregnant Golden Retriever bitch was presented 52 days after ovulation for nausea, hyporexia, regurgitation, polyuria, and polydipsia. Reproductive ultrasound demonstrated several viable foetuses, and the bitch was treated conservatively. Two days later, the bitch was hospitalized due to continued hyporexia, vomiting, abdominal distention, and an acute onset of haematochezia. Blood work showed regenerative mild anaemia and neutrophilia with a left shift, metabolic acidosis, hypocalcaemia, hyponatremia, hypochloraemia, hyperkalaemia, and Na:K ratio of 24:1, raising the suspicion of an Addisonian crisis. Baseline serum cortisol on the following day was slightly above the reference interval. Due to the patient's clinical decline, dexamethasone was given, and 48 h later, on day 57 post-ovulation, a caesarean section was performed. Eleven puppies were delivered alive with Apgar scores of 8-9/10. OUTCOME: The bitch decompensated immediately after surgery and was hospitalized for 4 additional days with aggressive supportive care. An ACTH stimulation test 2 days after the surgery did not support Addison's disease. Despite high initial Apgar scores, only one puppy survived, and the remaining 10 puppies progressively faded. Necropsy of eight puppies confirmed pulmonary immaturity with lung development at the canalicular stage. CONCLUSION: Clinical symptoms and laboratory derangements mimicking an Addisonian crisis should be a differential in pregnant bitches requiring intensive management. The long-term survival of newborn puppies depends on final lung maturation, which cannot be reliably induced by preterm maternal glucocorticoid administration.