Fewer than half of patients with celiac disease have characteristic GI symptoms. The diagnosis is often complicated by atypical symptoms such as constipation. How can clinicians improve their diagnostic abilities? This review and summary provides practical tips for identifying, diagnosing, and treating patients.

This 23-year-old woman is being seen for a chronic cough. She had repeat episodes of chronic bronchitis as a child and has a persistent, productive cough with thick, purulent sputum. She also has chronic nasal congestion and chronic diarrhea. What’s your suspicion?

The results of these trials show that vitamin D reduced the risk of diabetes progression by 3% to 18% after three years, with serum 25-hydroxy D levels of at least 125 nmol/L showing the greatest benefit. Vitamin D was also associated with a 30% increase in the likelihood of returning to normal glucose regulation.

In the US, chronic pain is widespread and continues to be a burden for people, families, and society as a whole. Extreme caution should be exercised when choosing to take an opioid to treat pain. The organizations do not advocate the regular use of opiate analgesics to treat chronic pain, as the hazards to the patient outweigh the minimal benefits that opioids may offer. Buprenorphine should be taken into consideration if it is decided to employ long-term opioid therapy for a patient due to its lower risk profile. By checking for underlying mental problems and a history of traumatic brain injury, clinicians can further lower the risk. Although risk mitigation strategies have been used to reduce risk in opioid patients, the guideline development group was surprised to find little evidence in this area.

Per Svenningsson, MD, PhD, a neurologist with expertise in Parkinson’s disease, will serve as the multicenter trial’s principal investigator. He previously oversaw a clinical study using montelukast (Singulair) tablets to treat PD. The multicenter trial is anticipated to begin between July and September. During the 18-month trial, participants will be randomized to receive either montelukast VersaFilm or a placebo film. IntelGenx plans to use the results to enhance the clinical development of its montelukast VersaFilm for Parkinson’s.

In statistical models, neurofilament light chain (Nlf) levels exhibited weaker connections with progression independent of relapse activity (PIRA)—”silent progression”—risk, while glial fibrillary acidic protein (GFAP) levels indicated very significant associations. Further models revealed that, whereas high NfL levels were linked to an approximately doubled risk of disability worsening, high levels of GFAP were associated with a nearly threefold higher risk of disability worsening. In contrast to low levels of both proteins, high levels of GFAP and NfL were linked to a more than fourfold probability of disease deterioration. Overall, the data, according to the researchers, support NfL as a biomarker of relapse activity and GFAP as a useful biomarker for predicting the likelihood of PIRA. The analysis of both markers provides “complete coverage of biological mechanisms contributing to disability worsening” as a result.