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Sirota Articles

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18 papers 0 to 25 followers
Ahmed Hassaan Qavi, Rida Kamal, Robert W Schrier
Diuretics play significant role in pharmacology and treatment options in medicine. This paper aims to review and evaluate the clinical use of diuretics in conditions that lead to fluid overload in the body such as cardiac failure, cirrhosis, and nephrotic syndrome. To know the principles of treatment it is essential to understand the underlying pathophysiological mechanisms that cause the need of diuresis in the human body. Various classes of diuretics exist, each having a unique mode of action. A systemic approach for management is recommended based on the current guidelines, starting from thiazides and proceeding to loop diuretics...
2015: International Journal of Nephrology
Gulen Hatemi, Melike Melikoglu, Recep Tunc, Cengiz Korkmaz, Banu Turgut Ozturk, Cem Mat, Peter A Merkel, Kenneth T Calamia, Ziqi Liu, Lilia Pineda, Randall M Stevens, Hasan Yazici, Yusuf Yazici
BACKGROUND: Oral ulcers, the hallmark of Behçet's syndrome, can be resistant to conventional treatment; therefore, alternative agents are needed. Apremilast is an oral phosphodiesterase-4 inhibitor that modulates several inflammatory pathways. METHODS: We conducted a phase 2, multicenter, placebo-controlled study in which 111 patients with Behçet's syndrome who had two or more oral ulcers were randomly assigned to receive 30 mg of apremilast twice daily or placebo for 12 weeks...
April 16, 2015: New England Journal of Medicine
Peter H R Green, Benjamin Lebwohl, Ruby Greywoode
This review will focus on the pathogenesis, clinical manifestations, diagnosis, and management of celiac disease (CD). Given an increasing awareness of gluten-related disorders, medical professionals of all varieties are encountering patients with a diagnosis of CD or who are thought to have food intolerance to gluten. The prevalence of CD among the general population is estimated to be 1% in Western nations, and there is growing evidence for underdiagnosis of the disease, especially in non-Western nations that were traditionally believed to be unaffected...
May 2015: Journal of Allergy and Clinical Immunology
Letiția Adela Maria Streba, Cristin Constantin Vere, Costin Teodor Streba, Marius Eugen Ciurea
Abusive alcohol intake currently ranks as a major cause of liver disease, and is associated with significant mortality worldwide. Alcoholic liver disease (ALD) generically defines liver abnormalities ranging from liver steatosis to the end-stages of disease such as liver cirrhosis. Information regarding the precise incidence and prevalence of ALD is still limited by a lack of large population-based studies and by the absence of large systematic reviews of all epidemiological data available. However, existing collected data show an overall increase in the number of alcohol abusers and alcohol-related liver disease...
July 7, 2014: World Journal of Gastroenterology: WJG
Elizabeth J Carey, Ahmad H Ali, Keith D Lindor
Primary biliary cirrhosis is a chronic cholestatic liver disease characterised by destruction of small intrahepatic bile ducts, leading to fibrosis and potential cirrhosis through resulting complications. The serological hallmark of primary biliary cirrhosis is the antimitochondrial antibody, a highly disease-specific antibody identified in about 95% of patients with primary biliary cirrhosis. These patients usually have fatigue and pruritus, both of which occur independently of disease severity. The typical course of primary biliary cirrhosis has changed substantially with the introduöction of ursodeoxycholic acid (UDCA)...
October 17, 2015: Lancet
Isabel S Bazan, Wassim H Fares
Pulmonary hypertension (PH) is a hemodynamic and pathophysiologic state that can be found in multiple conditions with associated symptoms of dyspnea, decreased exercise tolerance, and progression to right heart failure. The World Health Organization has classified PH into five groups. The first group is pulmonary arterial hypertension (PAH), which can be idiopathic, heritable, due to drugs and toxins, or associated with conditions such as connective tissue diseases, congenital heart disease, portal hypertension, and others...
2015: Therapeutics and Clinical Risk Management
Thomas J Cahill, Bernard D Prendergast
Infective endocarditis occurs worldwide, and is defined by infection of a native or prosthetic heart valve, the endocardial surface, or an indwelling cardiac device. The causes and epidemiology of the disease have evolved in recent decades with a doubling of the average patient age and an increased prevalence in patients with indwelling cardiac devices. The microbiology of the disease has also changed, and staphylococci, most often associated with health-care contact and invasive procedures, have overtaken streptococci as the most common cause of the disease...
February 27, 2016: Lancet
Talal Moukabary, Mario D Gonzalez
Atrial fibrillation is a very common clinical problem with a high prevalence that is expected to rise over time because of increasing risk factors (eg, age, obesity, hypertension). This high prevalence is also associated with high cost, because atrial fibrillation represents about 1% of overall health care spending. The management of atrial fibrillation involves multiple facets: (1) management of underlying disease if present and the management of atrial fibrillation risk factors, (2) prevention of thromboembolism, (3) control of the ventricular rate during atrial fibrillation, and (4) restoration and maintenance of normal sinus rhythm...
July 2015: Medical Clinics of North America
Claudine Angela Blum, Nicole Nigro, Matthias Briel, Philipp Schuetz, Elke Ullmer, Isabelle Suter-Widmer, Bettina Winzeler, Roland Bingisser, Hanno Elsaesser, Daniel Drozdov, Birsen Arici, Sandrine Andrea Urwyler, Julie Refardt, Philip Tarr, Sebastian Wirz, Robert Thomann, Christine Baumgartner, Hervé Duplain, Dieter Burki, Werner Zimmerli, Nicolas Rodondi, Beat Mueller, Mirjam Christ-Crain
BACKGROUND: Clinical trials yielded conflicting data about the benefit of adding systemic corticosteroids for treatment of community-acquired pneumonia. We assessed whether short-term corticosteroid treatment reduces time to clinical stability in patients admitted to hospital for community-acquired pneumonia. METHODS: In this double-blind, multicentre, randomised, placebo-controlled trial, we recruited patients aged 18 years or older with community-acquired pneumonia from seven tertiary care hospitals in Switzerland within 24 h of presentation...
April 18, 2015: Lancet
Prescott G Woodruff, Alvar Agusti, Nicolas Roche, Dave Singh, Fernando J Martinez
Chronic obstructive pulmonary disease (COPD) is a common, complex, and heterogeneous disorder that is responsible for substantial and growing morbidity, mortality, and health-care expense worldwide. Of imperative importance to decipher the complexity of COPD is to identify groups of patients with similar clinical characteristics, prognosis, or therapeutic needs, the so-called clinical phenotypes. This strategy is logical for research but might be of little clinical value because clinical phenotypes can overlap in the same patient and the same clinical phenotype could result from different biological mechanisms...
May 2, 2015: Lancet
Clara Camaschella
New England Journal of Medicine, Volume 372, Issue 19, Page 1832-1843, May 2015.
May 7, 2015: New England Journal of Medicine
Stephen I Rennard, M Bradley Drummond
Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide. COPD, however, is a heterogeneous collection of diseases with differing causes, pathogenic mechanisms, and physiological effects. Therefore a comprehensive approach to COPD prevention will need to address the complexity of COPD. Advances in the understanding of the natural history of COPD and the development of strategies to assess COPD in its early stages make prevention a reasonable, if ambitious, goal.
May 2, 2015: Lancet
Neil R Poulter, Dorairaj Prabhakaran, Mark Caulfield
Raised blood pressure is the biggest single contributor to the global burden of disease and to global mortality. The numbers of people affected and the prevalence of high blood pressure worldwide are expected to increase over the next decade. Preventive strategies are therefore urgently needed, especially in less developed countries, and management of hypertension must be optimised. Genetic advances in some rare causes of hypertension have been made lately, but the aggregate effect on blood pressure of all the genetic loci identified to date is small...
August 22, 2015: Lancet
Daniel A Leffler, J Thomas Lamont
New England Journal of Medicine, Volume 372, Issue 16, Page 1539-1548, April 2015.
April 16, 2015: New England Journal of Medicine
Sabitha Rajan
Skin and soft-tissue infections (SSTIs) are a common presenting problem in both inpatients and outpatients. SSTIs have been broadly classified as complicated or uncomplicated, but specific disease processes and patient characteristics are important in guiding clinical management. Early recognition of the extent of infection, close follow-up, and familiarity with local antibiotic susceptibility data are critical to successful treatment.
January 2012: Cleveland Clinic Journal of Medicine
Brad Spellberg, Benjamin A Lipsky
The standard recommendation for treating chronic osteomyelitis is 6 weeks of parenteral antibiotic therapy. However, oral antibiotics are available that achieve adequate levels in bone, and there are now more published studies of oral than parenteral antibiotic therapy for patients with chronic osteomyelitis. Oral and parenteral therapies achieve similar cure rates; however, oral therapy avoids risks associated with intravenous catheters and is generally less expensive, making it a reasonable choice for osteomyelitis caused by susceptible organisms...
February 1, 2012: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Chana A Sacks, John A Jarcho, Gregory D Curfman
New England Journal of Medicine, Volume 0, Issue 0, Ahead of Print.
September 11, 2014: New England Journal of Medicine
Douwe F Postma, Cornelis H van Werkhoven, Leontine J R van Elden, Steven F T Thijsen, Andy I M Hoepelman, Jan A J W Kluytmans, Wim G Boersma, Clara J Compaijen, Eva van der Wall, Jan M Prins, Jan J Oosterheert, Marc J M Bonten
BACKGROUND: The choice of empirical antibiotic treatment for patients with clinically suspected community-acquired pneumonia (CAP) who are admitted to non-intensive care unit (ICU) hospital wards is complicated by the limited availability of evidence. We compared strategies of empirical treatment (allowing deviations for medical reasons) with beta-lactam monotherapy, beta-lactam-macrolide combination therapy, or fluoroquinolone monotherapy. METHODS: In a cluster-randomized, crossover trial with strategies rotated in 4-month periods, we tested the noninferiority of the beta-lactam strategy to the beta-lactam-macrolide and fluoroquinolone strategies with respect to 90-day mortality, in an intention-to-treat analysis, using a noninferiority margin of 3 percentage points and a two-sided 90% confidence interval...
April 2, 2015: New England Journal of Medicine
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