A 69-year-old man with a history of relapsing polychondritis developed a widespread cutaneous eruption that was clinically and histologically typical of erythema elevatum diutinum. This eruption was accompanied by a recurrence of arthralgias. The significance of this association between relapsing polychondritis and erythema elevatum diutinum, which has not been previously reported, is discussed.

Erythema elevatum diutinum in a patient with relapsing polychondritis.

Journal of the American Academy of Dermatology

Latent tuberculosis infection (LTBI) is a critical stage of tuberculosis infection in which Mycobacterium tuberculosis (MTB) is dormant and does not cause active disease. Traditionally, the most commonly used clinical methods for diagnosing LTBI have been the tuberculin skin test (TST) and the interferon-gamma release assay (IGRA). Recently, however, novel skin tests, molecular biology techniques, and cytokine biomarkers have been developed. This review summarizes the latest research on the diagnosis of LTBI, highlighting new tools and methods to improve detection and differentiation from active tuberculosis(ATB).

Advances in the Diagnosis of Latent Tuberculosis Infection.

Infection and Drug Resistance

Marathon training and running have many beneficial effects on human health and physical fitness; however, they also pose risks. To date, no comprehensive review regarding both the benefits and risks of marathon running on different organ systems has been published.

The aim of this review was to provide a comprehensive review of the benefits and risks of marathon training and racing on different organ systems. A predefined search strategy including keywords (e.g., marathon, cardiovascular system, etc.) and free text search was used. Articles covering running regardless of sex, age, performance level, and event type (e.g., road races, mountain marathons) were considered, whereas articles examining only cycling, triathlon, stress-tests or other sports were excluded. In total, we found 1021 articles in PubMed, Scopus, and Google Scholar, of which 329 studies were included in this review. Overall, marathon training offers several benefits for different organ systems and reduces all-cause mortality. As such, it improves cardiovascular risk factors, leads to favorable cardiac adaptations, enhances lung function, and improves quality of life in chronic kidney disease patients. It also enhances gastrointestinal mobility and reduces the risk of specific tumors such as colorectal cancer and hepatocellular carcinoma. Marathon training enhances bone health and skeletal muscle metabolism. It further positively affects hematopoiesis and cytotoxic abilities of natural killer cells, and may act neuroprotective on a long-term basis. After a marathon, changes in biomarkers suggesting pathological events in certain organ systems such as cardiovascular, renal, gastrointestinal, liver, hematological, immune, musculoskeletal, central nervous, and endocrine systems can often be observed. Mostly, these changes are limited to 1-3 days post-race and usually normalize within a week. Moreover, marathon running poses the risk of serious adverse events such as sudden cardiac death or acute liver failure. Concerning lung function, a decrease after a marathon race was observed. Acute kidney injury, as well as electrolyte imbalances, are relatively common amongst marathon finishers. Many runners complain of gastrointestinal symptoms during or after long-distance running. Many runners suffer from running-related musculoskeletal injuries often impairing performance. A marathon is often accompanied by an acute inflammatory response with transient immunosuppression, making runners susceptible to infections. Also, hormonal alterations such as increased cortisol levels or decreased testosterone levels immediately after a race are observed. Disturbances in sleep patterns are commonly found in marathon runners leading up to or directly after the race.

All in all, marathon training is generally safe for human health and individual organ systems. Considering the high popularity of marathon running, these findings supply athletes, coaches, sports scientists, and sports medicine practitioners with practical applications. Further large-scale studies examining long-term effects on the cardiovascular, renal, and other system are needed.

Physiology and Pathophysiology of Marathon Running: A narrative Review.

Sports Medicine - Open

Over the past few decades, heart failure with preserved ejection fraction has established itself as an individual clinical entity.&#xa0;Although it is associated with a better prognosis,&#xa0;it offers high resistance to classic treatment techniques, and the frequency of hospitalizations and mortality rates&#xa0;are comparable to cases of heart failure with reduced ejection fraction.&#xa0;Heart failure often leads to death and morbidity, and there has recently been a growing interest in studying the relationship between cardiac and renal function due to epidemiological evidence indicating that even a modest deterioration in renal function is a considerable risk factor in patients with heart failure, myocardial infarction or in the context of cardiovascular surgery. In fact, studies have proven that patients with chronic kidney disease have a cardiovascular risk about 10 times higher than a population of the same age, sex, and race without&#xa0;it. Before writing this review, research literature on heart failure with preserved ejection fraction and chronic kidney disease&#xa0;was reviewed. Studies have shown that in patients with chronic kidney disease, heart failure is mostly caused by the presence of left ventricular diastolic dysfunction,&#xa0;with aggravating comorbidities such as high blood pressure and coronary heart disease.&#xa0;A possible underlying mechanism may be the excessive activation of the renin-angiotensin-aldosterone system, which is known to be a determinant in the onset of profibrotic factors. In fact, it is known that, in patients with chronic heart failure, the renin-angiotensin-aldosterone system is activated, and it has even been shown that the activity of increased plasma renin levels directly contributes to mortality. Angiotensin II promotes cardiac remodeling, and aldosterone may increase myocardial fibrosis, which is a marker of diastolic dysfunction&#xa0;and cardiac necrosis, acting as an endogenous bioactive factor involved in the process of vascular calcification. On the other hand, the development of diastolic dysfunction in patients with chronic kidney disease may result from disorders of metabolism. Besides, evidence indicates that individuals with 25-hydroxyvitamin D deficiency have an increased risk of developing various cardiovascular conditions, such as hypertension, peripheral vascular disease, myocardial infarction, diabetes mellitus, heart failure, and even death.&#xa0;In recent studies, it has been described that the direct effect of vitamin D on cardiomyocytes consists essentially in the acceleration of myocardial relaxation, leading to the hypothesis that it causes a determining effect on diastolic function. Currently, both heart failure with preserved ejection fraction and chronic kidney disease are very prevalent and are closely linked to several other factors, including disturbances in phospho-calcium metabolism and variations in serum vitamin D levels.&#xa0;Although the concept of heart failure began to be explored a few decades ago,&#xa0;further studies are required in order to explain the factors that created the controversy behind the concept of diastolic dysfunction. This review aims precisely to identify the areas that lack further investigation, which can be essential to the development of more effective treatments and subsequently obtain better outcomes.

Diastolic Dysfunction and Renal Disease: Analysis, Mechanisms, and Different Perspectives.

Curēus

Hemorrhagic complications associated with regional anesthesia are extremely rare. The fifth edition of the American Society of Regional Anesthesia and Pain Medicine's Evidence-Based Guidelines on regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy reviews the published evidence since 2018 and provides guidance to help avoid this potentially catastrophic complication.The fifth edition of the American Society of Regional Anesthesia and Pain Medicine's Evidence-Based Guidelines on regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy uses similar methodology as previous editions but is reorganized and significantly condensed. Therefore, the clinicians are encouraged to review the earlier texts for more detailed descriptions of methods, clinical trials, case series and pharmacology. It is impossible to perform large, randomized controlled trials evaluating a complication this rare; therefore, where the evidence is limited, the authors continue to maintain an 'antihemorrhagic' approach focused on patient safety and have proposed conservative times for the interruption of therapy prior to neural blockade. In previous versions, the anticoagulant doses were described as prophylactic and therapeutic. In this version, we will be using 'low dose' and 'high dose,' which will allow us to be consistent with other published guidelines and more accurately describe the dose in the setting of specific patient characteristics and indications. For example, the same 'high' dose may be used in one patient as a treatment for deep venous thrombosis (DVT) and in another patient as prophylaxis for recurrent DVT. Due to the increasing ability to obtain drug-specific assays, we have included suggestions for when ordering these tests may be helpful and guide practice. Like previous editions, at the end of each recommendation the authors have clearly noted how the recommendation has changed from previous editions.

Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (fifth edition).

Regional Anesthesia and Pain Medicine

To update the 2017 European Alliance of Associations for Rheumatology (EULAR) recommendations for treatment of systemic sclerosis (SSc), incorporating new evidence and therapies.

An international task force was convened in line with EULAR standard operating procedures. A nominal group technique exercise was performed in two rounds to define questions underpinning a subsequent systematic literature review. The evidence derived was discussed and overarching principles, recommendations and future research agenda were iteratively developed with voting rounds.

The task force agreed on 22 recommendations covering 8 clinical/organ domains including Raynaud's phenomenon, digital ulcers, pulmonary arterial hypertension, scleroderma renal crisis, skin fibrosis, interstitial lung disease (ILD), gastrointestinal manifestations and arthritis. Most new recommendations are related to skin fibrosis and ILD. These included novel recommendations for the use of mycophenolate mofetil, nintedanib, rituximab and tocilizumab for the treatment of these crucial disease manifestations. The recommendations also included first-line and second-line interventions, providing increased utility for rheumatology practitioners. Important additions to the future research agenda included consideration of novel interventions for the management of vascular, musculoskeletal and gastrointestinal manifestations and calcinosis, as well as for the local management of digital ulcers.

These updated recommendations include the first set of synthetic and biological targeted therapies recommended for key fibrotic manifestations of SSc as well as first-line combination treatment for newly diagnosed pulmonary artery hypertension and prioritise a new research agenda for the coming years.

Erythema elevatum diutinum in a patient with relapsing polychondritis.

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