Jason S Knight, D Ware Branch, Thomas L Ortel
Antiphospholipid syndrome (APS) is a thrombo-inflammatory disease propelled by circulating autoantibodies that recognize cell surface phospholipids and phospholipid binding proteins. The result is an increased risk of thrombotic events, pregnancy morbidity, and various other autoimmune and inflammatory complications. Although antiphospholipid syndrome was first recognized in patients with lupus, the stand alone presentation of antiphospholipid syndrome is at least equally common. Overall, the diagnosis appears to affect at least one in 2000 people...
February 27, 2023: BMJ: British Medical Journal
Deepa J Arachchillage, Charis Pericleous
Antiphospholipid syndrome (APS) is an autoimmune prothrombotic disease characterized by thrombosis and/or pregnancy complications caused by antiphospholipid antibodies (aPL). The history of APS can be traced back to observations made during screening programs for syphilis conducted in the mid-20th century, with identification of patients with the so-called biological false-positive serological reactions for syphilis. Initial observation linking aPL with recurrent miscarriages was first reported more than 40 years ago...
January 16, 2023: Seminars in Thrombosis and Hemostasis
Fabiana Radu, Claudia-Gabriela Potcovaru, Teodor Salmen, Petruța Violeta Filip, Corina Pop, Carmen Fierbințeanu-Braticievici
Metabolic syndrome (MetS) is characterized by an association of cardiovascular and diabetes mellitus type 2 risk factors. Although the definition of MetS slightly differs depending on the society that described it, its central diagnostic criteria include impaired fasting glucose, low HDL-cholesterol, elevated triglycerides levels and high blood pressure. Insulin resistance (IR) is believed to be the main cause of MetS and is connected to the level of visceral or intra-abdominal adipose tissue, which could be assessed either by calculating body mass index or by measuring waist circumference...
February 7, 2023: Diagnostics
Hiroyuki Seki, Satoshi Ideno, Toshiya Shiga, Hidenobu Watanabe, Motoaki Ono, Akira Motoyasu, Hikari Noguchi, Kazuya Kondo, Takahiro Yoshikawa, Hiroshi Hoshijima, Shunsuke Hyuga, Miho Shishii, Ai Nagai, Midoriko Higashi, Takashi Ouchi, Kazuki Yasuda, Norifumi Kuratani
Although the recommended preoperative cessation period for sodium-glucose cotransporter 2 inhibitors (SGLT2is) changed in 2020 (from 24 h to 3-4 days preoperatively) to reduce the risk of SGLT2i-associated perioperative ketoacidosis (SAPKA), the validity of the new recommendation has not been verified. Using case reports, we assessed the new recommendation effectiveness and extrapolated precipitating factors for SAPKA. We searched electronic databases up to June 1, 2022 to assess SAPKA (blood pH < 7...
February 27, 2023: Journal of Anesthesia
Manuel Alfredo Podestà, Gianmarco Sabiu, Andrea Galassi, Paola Ciceri, Mario Cozzolino
Results from recent randomized controlled trials on inhibitors of the sodium-glucose cotransporter 2 (SGLT2) have determined a paradigm shift in the treatment of patients with type 2 diabetes mellitus. These agents have been shown not only to ameliorate metabolic control, but also to independently protect from cardiovascular events and to reduce the progression of chronic kidney disease (CKD) in these patients. The magnitude of the nephroprotective effect observed in these studies is likely to make SGLT2 inhibitors the most impactful drug class for the treatment of diabetic patients with CKD since the discovery of renin-angiotensin system inhibitors...
January 19, 2023: Biomedicines
Saeed Alshahrani
Chronic kidney disease presents a health challenge that has a complex underlying pathophysiology, both acquired and inherited. The pharmacotherapeutic treatment options available today lower the progression of the disease and improve the quality of life but cannot completely cure it. This poses a challenge to the healthcare provider to choose, from the available options, the best way to manage the disease as per the presentation of the patient. As of now, the recommended first line of treatment to control the blood pressure in chronic kidney disease is the administration of renin-angiotensin-aldosterone system modulators...
2023: Frontiers in Pharmacology
David G Sweet, Virgilio P Carnielli, Gorm Greisen, Mikko Hallman, Katrin Klebermass-Schrehof, Eren Ozek, Arjan Te Pas, Richard Plavka, Charles C Roehr, Ola D Saugstad, Umberto Simeoni, Christian P Speer, Maximo Vento, Gerry H A Visser, Henry L Halliday
Respiratory distress syndrome (RDS) care pathways evolve slowly as new evidence emerges. We report the sixth version of "European Guidelines for the Management of RDS" by a panel of experienced European neonatologists and an expert perinatal obstetrician based on available literature up to end of 2022. Optimising outcome for babies with RDS includes prediction of risk of preterm delivery, appropriate maternal transfer to a perinatal centre, and appropriate and timely use of antenatal steroids. Evidence-based lung-protective management includes initiation of non-invasive respiratory support from birth, judicious use of oxygen, early surfactant administration, caffeine therapy, and avoidance of intubation and mechanical ventilation where possible...
2023: Neonatology
Jasodhara Chaudhuri, Angshuman Mukherjee, Ambar Chakravarty
PURPOSE OF REVIEW: To describe the clinical manifestations of Hashimoto's encephalopathy (HE) and discuss its pathogenesis in light of recent research. RECENT FINDINGS: The pathogenesis of HE is uncertain. Available evidences point towards an autoimmune etiology due to vasculitis or other inflammatory process. Detection of thyroid antibodies - antithyroid peroxidase and anti-thyroglobulin are essential for diagnosis. Autoimmune encephalitis including Anti-IgLON5 disease needs to be excluded in suspected cases with appropriate tests for neuronal surface antibodies...
February 28, 2023: Current Neurology and Neuroscience Reports
Ayman Elbehiry, Eman Marzouk, Musaad Aldubaib, Adil Abalkhail, Sulaiman Anagreyyah, Nuha Anajirih, Abdulaziz M Almuzaini, Mohammed Rawway, Abdulmajeed Alfadhel, Abdelmaged Draz, Akram Abu-Okail
Helicobacter pylori ( H. pylori ) infection, which affects approximately half of the world's population, remains a serious public health problem. As H. pylori infection leads to a number of gastric pathologies, including inflammation, gastroduodenal ulcers, and malignancies, early detection and treatment are crucial to preventing the spread of the infection. Multiple extragastric complications, such as iron deficiency anaemia, immune thrombocytopenic purpura, vitamin B12 deficiency, diabetes mellitus, cardiovascular diseases, and certain neurological disorders, have also been linked to H...
January 17, 2023: Antibiotics
Diana L Alsbrook, Mario Di Napoli, Kunal Bhatia, Masoom Desai, Archana Hinduja, Clio A Rubinos, Gelsomina Mansueto, Puneetpal Singh, Gustavo G Domeniconi, Asad Ikram, Sara Y Sabbagh, Afshin A Divani
Background: Delayed cerebral ischemia (DCI) is a common and serious complication of aneurysmal subarachnoid hemorrhage (aSAH). Though many clinical trials have looked at therapies for DCI and vasospasm in aSAH, along with reducing rebleeding risks, none have led to improving outcomes in this patient population. We present an up-to-date review of the pathophysiology of DCI and its association with early brain injury (EBI). Recent Findings : Recent studies have demonstrated that EBI, as opposed to delayed brain injury, is the main contributor to downstream pathophysiological mechanisms that play a role in the development of DCI...
January 28, 2023: Journal of Clinical Medicine
Merica Aralica, Vesna Šupak-Smolčić, Lorena Honović, Lucija Franin, Pavica Šonjić, Maja Šimac, Mihovil Horvat, Nina Poropat
In the initial diagnostics of arterial hypertension (AH) laboratory medicine is a cornerstone, along with a blood pressure (BP) measurement and an electrocardiogram. It mainly refers to routine blood and urine tests for diagnosis and monitoring primary hypertension and its associated conditions such as asymptomatic hypertension-mediated organ damage, chronic kidney disease and hypertensive disorders of pregnancy. In addition, long term non-fatal and fatal risks for cardiovascular (CV) events in hypertension are assessed based on clinical and laboratory data...
February 15, 2023: Biochemia Medica: časopis Hrvatskoga Društva Medicinskih Biokemičara
Cynthia Levy, Michael Manns, Gideon Hirschfield
Primary biliary cholangitis (PBC) is an archetypal autoimmune disease. Chronic lymphocytic cholangitis is associated with interface hepatitis, ductopenia, cholestasis and a progressive biliary fibrosis. People living with PBC are frequently symptomatic, experiencing a quality-of-life burden dominated by fatigue, itch, abdominal pain, and sicca complex. Whilst the female predominance, specific serum autoantibodies, immune mediated cellular injury, as well as genetic (HLA and non-HLA) risk factors, identify PBC as autoimmune, to date treatment has focused on cholestatic consequences...
February 19, 2023: Clinical Gastroenterology and Hepatology
Lauren M Westafer, Brit Long, Michael Gottlieb
No abstract text is available yet for this article.
February 17, 2023: Annals of Emergency Medicine
Rosaria Vincenza Giglio, Angelo Maria Patti, Ali Abbas Rizvi, Anca Panta Stoian, Marcello Ciaccio, Nikolaos Papanas, Andrej Janez, Alper Sonmez, Maciej Banach, Amirhossein Sahebkar, Manfredi Rizzo
Diabetic nephropathy (DN) is the leading cause of end-stage renal disease (ESRD) worldwide. Its pathogenesis encompasses functional alterations involving elevated intraglomerular and systemic pressure, increased activity of the renin-angiotensin system (RAS) and oxidative stress, and the eventual development of renal fibrosis. The management of DN involves the optimization of blood pressure (BP) and blood glucose targets. However, treatment of these risk factors slows down but does not stop the progression of DN...
January 20, 2023: Biomedicines
Swarna Rajagopalan, Aarti Sarwal
OBJECTIVES: Critically ill patients are at high risk of acute brain injury. Bedside multimodality neuromonitoring techniques can provide a direct assessment of physiologic interactions between systemic derangements and intracranial processes and offer the potential for early detection of neurologic deterioration before clinically manifest signs occur. Neuromonitoring provides measurable parameters of new or evolving brain injury that can be used as a target for investigating various therapeutic interventions, monitoring treatment responses, and testing clinical paradigms that could reduce secondary brain injury and improve clinical outcomes...
February 16, 2023: Critical Care Medicine
Sandra Huber, Torsten Haferlach, Heiko Müller, Manja Meggendorfer, Stephan Hutter, Gregor Hoermann, Constance Baer, Wolfgang Kern, Claudia Haferlach
No abstract text is available yet for this article.
February 22, 2023: Leukemia
Stuart M White, Tiffany Tedore, Clifford L Shelton
A meta-analysis influenced by two recent large randomised controlled trials (REGAIN and RAGA) concluded that little, if any, difference in commonly measured outcomes exists between patients administered spinal or general anaesthesia for their hip fracture surgery. We explore whether there is genuinely no difference, or what the methodological problems in research might be that prevent any real difference from being observed. We also discuss the need for greater nuance in future research to determine how anaesthetists might deliver perioperative care towards improving postoperative recovery trajectories in patients following hip fracture...
February 16, 2023: British Journal of Anaesthesia
Gregorio Romero-González, Joaquin Manrique, María F Slon-Roblero, Faeq Husain-Syed, Rafael De la Espriella, Fiorenza Ferrari, Jordi Bover, Alberto Ortiz, Claudio Ronco
Point-of-Care Ultrasonography (PoCUS) aims to include a fifth pillar (insonation) in the classical physical examination in order to obtain images to answer specific questions by the clinician at the patient's bedside, allowing rapid identification of structural or functional abnormalities, enabling more accurate volume assessment and supporting diagnosis, as well as guiding procedures. In recent years, PoCUS has started becoming a valuable tool in day-to-day clinical practice, adopted by healthcare professionals from various medical specialties, never replacing physical examination but improving patient and medical care and experience...
February 2023: Clinical Kidney Journal
Carole-Anne Potvin, James Green, Bo Pan, Yazid N Al Hamarneh, Derek Dillane
BACKGROUND: Early severe postoperative pain is frequently resistant to management with opioid analgesia alone. Perioperative low-dose ketamine as an analgesia adjunct has been studied extensively. Its efficacy as a rescue analgesic in the postanesthesia care unit (PACU) has not been determined. The objective of this study was to evaluate the analgesic efficacy of low-dose bolus ketamine for opioid-resistant pain in the PACU by measuring its effect on numerical rating scale (NRS) pain scores and opioid requirement...
February 27, 2023: Canadian Journal of Anaesthesia
Alexander Zarbock, Mitra K Nadim, Peter Pickkers, Hernando Gomez, Samira Bell, Michael Joannidis, Kianoush Kashani, Jay L Koyner, Neesh Pannu, Melanie Meersch, Thiago Reis, Thomas Rimmelé, Sean M Bagshaw, Rinaldo Bellomo, Vicenzo Cantaluppi, Akash Deep, Silvia De Rosa, Xose Perez-Fernandez, Faeq Husain-Syed, Sandra L Kane-Gill, Yvelynne Kelly, Ravindra L Mehta, Patrick T Murray, Marlies Ostermann, John Prowle, Zaccaria Ricci, Emily J See, Antoine Schneider, Danielle E Soranno, Ashita Tolwani, Gianluca Villa, Claudio Ronco, Lui G Forni
Sepsis-associated acute kidney injury (SA-AKI) is common in critically ill patients and is strongly associated with adverse outcomes, including an increased risk of chronic kidney disease, cardiovascular events and death. The pathophysiology of SA-AKI remains elusive, although microcirculatory dysfunction, cellular metabolic reprogramming and dysregulated inflammatory responses have been implicated in preclinical studies. SA-AKI is best defined as the occurrence of AKI within 7 days of sepsis onset (diagnosed according to Kidney Disease Improving Global Outcome criteria and Sepsis 3 criteria, respectively)...
February 23, 2023: Nature Reviews. Nephrology
2023-03-07 00:24:57
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