{"title":"Crohn Disease in Childhood and Adolescence","authors":"Lori A. Zimmerman","doi":"10.2310/im.5604","DOIUrl":"https://doi.org/10.2310/im.5604","url":null,"abstract":"Crohn disease (CD) is a chronic inflammatory condition that can occur throughout the gastrointestinal tract (the mouth to the anus). CD is classified by location within the gastrointestinal tract and behavior of the disease (inflammatory, penetrating, and/or stricturing). It can also affect the extraintestinal tissue and cause perianal disease. It occurs from a complex interplay of genetic predisposition, altered gut microbiota, immunologic dysregulation, and likely environmental triggers. Children with CD often present with signs and symptoms related to the inflammation within their gastrointestinal tract. Most children with CD will present with diarrhea and abdominal pain, whereas some will present with rectal bleeding, fevers, weight loss, perianal disease, or joint disease. There is no single test to confidently diagnose a patient with CD. Instead, clinicians rely on a combination of biomarkers in the serum and stool, imaging studies, and endoscopic evaluation to make the diagnosis. The general aims of treatment of children with CD are to induce and maintain clinical remission of disease, optimize nutrition and growth, minimize adverse effects of therapies, and ultimately target mucosal healing.\u0000This review contains 3 figures, 3 tables and 34 references.\u0000Key Words: biologics, child, chronic diarrhea, Crohn disease, hematochezia, inflammatory bowel disease, immunodeficiency, pediatric, weight loss","PeriodicalId":11220,"journal":{"name":"DeckerMed Medicine","volume":"52 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83150330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Liver Transplant Immunology 2: Application to Liver Allograft Immunity","authors":"M. Kriss, H. Rosen","doi":"10.2310/im.14075","DOIUrl":"https://doi.org/10.2310/im.14075","url":null,"abstract":"The liver is a multifunctional organ responsible for complex metabolic and immune functions. Although not a classic lymphoid organ, the liver is enriched with traditional immune cells as well as parenchymal and nonparenchymal cells that play a key role in immune homeostasis. Due to its location and unique anatomic structure, the liver must finely balance immunity and tolerance to avoid undue inflammation in the setting of constant antigenic exposure from portal blood flow while maintaining appropriate immunity against pathogens. Since the first successful liver transplantation in humans in 1967 at the University of Colorado, our knowledge of hepatic immunity and tolerance, in the context of both liver disease and liver transplantation, has evolved dramatically. With these advancements, therapeutic modalities have been developed that have revolutionized the care of liver transplant recipients. In Part 2: Application to Liver Allograft Immunity, we apply the basic principles of liver immunology and allorecognition to our current management of liver transplant recipients in the context of both immunosuppression and the holy grail of transplantation, operational tolerance.\u0000\u0000This review contains 4 figures, 3 tables, and 32 references\u0000Key Words: adaptive immunity; allograft rejection; allograft tolerance; allorecognition; antigen presenting cells; immunosuppression; innate immunity; liver transplantation; T lymphocytes","PeriodicalId":11220,"journal":{"name":"DeckerMed Medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85730126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Posttransplant Complications: Renal, Cardiovascular, Diabetes, and Obesity","authors":"Pranab M. Barman, J. Levitsky","doi":"10.2310/im.14056","DOIUrl":"https://doi.org/10.2310/im.14056","url":null,"abstract":"With improving surgical technique and perioperative care, liver transplant recipients will continue to survive longer and longer. After the first year of transplantation, the risk of mortality is largely based on the development of renal disease and metabolic syndrome, including hypertension, hyperlipidemia, diabetes, and obesity. Mechanistically, these complications can be a result of immunosuppressive medications as well as a return to poor dietary and exercise regimens posttransplant. Renal injury is almost exclusively a result of calcineurin toxicity over time, and new strategies are in place, utilizing mammalian target of rapamycin inhibitors to minimize this risk. Cardiovascular complications can also be spurred on by immunosuppressive medications, and close monitoring and treatment with standard agents are required in the recipient. Diabetes is perhaps the most feared medical complication posttransplant, as it carries a higher risk of mortality. It is also impacted by many of the different immunosuppressive regimens. Finally, novel strategies are being researched to appropriately treat the obese patient pre- and post liver transplant.\u0000\u0000This review contains 1 figure, 2 tables, and 52 references.\u0000Key Words: complications, diabetes, everolimus, immunosuppression, liver transplant, medical, metabolic syndrome, obesity, posttransplant, renal disease, tacrolimus.","PeriodicalId":11220,"journal":{"name":"DeckerMed Medicine","volume":"38 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74125944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Acute Pneumonia","authors":"J. I. Hogan, B. Davis","doi":"10.2310/im.1140","DOIUrl":"https://doi.org/10.2310/im.1140","url":null,"abstract":"Acute pneumonia continues to represent a major source of morbidity, mortality, and healthcare expenditure in the U.S. It is imperative that clinicians at all levels of training have a firm understanding of this potentially deadly infection and its numerous complications. The current state of our diagnostic capabilities often dictates that clinicians will need to make important therapeutic decisions in patients presenting with acute pneumonia before identifying a culprit pathogen. Only after understanding the pathogenesis of pneumonia under different clinical circumstances can one devise rational empiric therapeutic regimens. In this practical review we offer a succinct description of the epidemiology and pathogenesis of acute pneumonia. We then proceed to discuss the evaluation and management of patients presenting with acute pneumonia with emphasis on the most valuable clinical trials and major guidelines that we use to inform our clinical decisions. Despite significant advances in the field of infectious disease over the past century, clinicians continue to recognize pneumonia, the infection of the pulmonary parenchyma, as a major source of morbidity and mortality. In this article we attempt to provide the general practitioner with a practical review of acute pneumonia and its complications. Prioritizing the needs of the general practitioner, we most thoroughly address community acquired pneumonia (CAP). Though we do not intend for this review to be completely comprehensive, in this article we also briefly discuss healthcare associated pneumonia (HCAP), hospital associated pneumonia (HAP), and ventilator associated pneumonia (VAP). Focusing much of our attention on the most important clinical trials and guidelines underpinning the diagnosis and management of this common problem, we hope that this publication will serve as a useful review to aid in clinical decision making.\u0000This review contains 65 references, 1 figure and 6 tables.\u0000Key Words: Pneumonia, viral pneumonia, bacterial pneumonia, community-acquired pneumonia, ventilator-associated pneumonia, VAP, healthcare-associated pneumonia, hospital-acquired pneumonia\u0000 ","PeriodicalId":11220,"journal":{"name":"DeckerMed Medicine","volume":"40 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75152504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Evaluation and Treatment of Pediatric Obesity","authors":"N. Desai, S. Softic","doi":"10.2310/im.5605","DOIUrl":"https://doi.org/10.2310/im.5605","url":null,"abstract":"Obesity is one of the most significant health problems facing children and adolescents. The definition of overweight in children is a body mass index between the 85th and less than 95th percentile, whereas obesity is greater than or equal to the 95th percentile for age and sex. There are multiple comorbidities associated with obesity, including dyslipidemia, hypertension, type 2 diabetes, sleep apnea, and nonalcoholic fatty liver disease, as well as psychosocial issues. \u0000\u0000This review contains 3 figures, 4 tables and 63 references.\u0000Key Words bariatric surgery, metabolic syndrome, obesity treatment, pediatric obesity, weight loss surgery","PeriodicalId":11220,"journal":{"name":"DeckerMed Medicine","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84071778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Diet and Exercise in the Treatment of Obesity","authors":"Meghan Ariagno","doi":"10.2310/IM.9024","DOIUrl":"https://doi.org/10.2310/IM.9024","url":null,"abstract":"This review addresses the role of nutrition and physical activity in weight management. There is not one standardized approach toward weight loss, but research demonstrates the effectiveness of following a reduced-calorie plan, as well as emphasizing increases in physical activity. Other important elements of consideration include promoting contact with weight management clinicians to provide structure, encouragement, and support. Physical activity alone has not been proven to support weight loss but in combination with a lower caloric intake can be helpful toward achieving weight loss. Sustaining weight loss is difficult for most individuals, so the support of clinicians is valuable not only in the starting phase but in the long term as well. \u0000\u0000This review contains 1 figure, 4 tables and 37 references\u0000Key words: activity, calorie, carbohydrate, diet, dietitian, exercise, intervention, lifestyle, maintenance, obesity, portion, technology, weight","PeriodicalId":11220,"journal":{"name":"DeckerMed Medicine","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87157466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. M. Prado, Camila L. P. Oliveira, M. Gonzalez, Steven B Heymsfield
{"title":"Techniques For Assessment Of Body Composition In Health","authors":"C. M. Prado, Camila L. P. Oliveira, M. Gonzalez, Steven B Heymsfield","doi":"10.2310/im.9001","DOIUrl":"https://doi.org/10.2310/im.9001","url":null,"abstract":"Body composition assessment is an important tool in both clinical and research settings able to characterize the nutritional status of individuals in various physiologic and pathologic conditions. Health care professionals can use the information acquired by body composition analysis for the prevention and treatment of diseases, ultimately improving health status. Here we describe commonly used techniques to assess body composition in healthy individuals, including dual-energy x-ray absorptiometry, bioelectrical impedance analysis, air displacement plethysmography, and ultrasonography. Understanding the key underlying concept(s) of each assessment method, as well as its advantages and limitations, facilitates selection of the method of choice and the method of the compartment of interest.\u0000This review contains 5 figures, 3 tables and 52 references\u0000Key words: air displacement plethysmography, bioelectrical impedance analysis, body composition, disease, dual-energy x-ray absorptiometry, health, muscle mass, nutritional status, obesity, sarcopenia, ultrasound fat mass","PeriodicalId":11220,"journal":{"name":"DeckerMed Medicine","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82503965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Primary and Preventive Care of Women","authors":"J. Henrich","doi":"10.2310/TYWC.1068","DOIUrl":"https://doi.org/10.2310/TYWC.1068","url":null,"abstract":"Women’s health can be defined as diseases or conditions that are unique to women or that involve gender differences that are particularly important to women. This definition acknowledges the increasing scientific evidence supporting a focus on sex and gender and expands the concept of women’s health beyond the traditional focus on reproductive organs and their function. Over time, the definition has come to include an appreciation of wellness and prevention, the interdisciplinary and holistic nature of women’s health, the diversity of women and their health needs over the life span, and the central role of women as patients and as active participants in their health care. This broader interdisciplinary perspective has important implications for clinicians providing care to women. In addition to understanding basic female physiology and reproductive biology, clinicians need to appreciate the complex interaction between the environment and the biology and psychosocial development of women. When dealing with conditions that are not specific to women, clinicians need to be aware of those aspects of disease that are different in women or have important gender implications. The ability to apply this information requires that clinicians adopt attitudes and behavior that are culturally and gender sensitive. Figures visualize female life expectancy, age-adjusted death rates, female breast cancer incidence and death rates, trends in female cigarette smoking, and the U.S. Preventive Services Task Force guidelines for preventive primary care in women. \u0000This review contains 5 figures, 6 tables and 56 references.","PeriodicalId":11220,"journal":{"name":"DeckerMed Medicine","volume":"40 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88020297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
L. Hoyte, R. Bassaly, S. Hart, M. McCullough, E. Jackson
{"title":"Pelvic Organ Prolapse","authors":"L. Hoyte, R. Bassaly, S. Hart, M. McCullough, E. Jackson","doi":"10.2310/im.1308","DOIUrl":"https://doi.org/10.2310/im.1308","url":null,"abstract":"Pelvic organ prolapse (POP) is the descent of one of more aspects of the vagina and/or uterus. Evaluation of POP always begins with a thorough history and physical examination. Management choices include observation, conservative options, and surgical options. Surgical management is divided into two categories, which are restorative and obliterative. It is important to counsel patients that although POP may affect quality of life, it is not life-threatening. This chapter is designed to guide the healthcare provider with a review of epidemiology, anatomy, evaluation, and management of POP. The chapter contains 14 figures that illustrate examples of common examination findings, devices, and treatment options. Also, there are 5 tables that provide concise reference materials to help guide the healthcare provider.\u0000This review contains 91 references, 14 figures, and 6 tables.\u0000Key Words: constipation, mesh, pain, pelvic floor, pessary, POP-Q, risk factors, surgery, vaginal wall","PeriodicalId":11220,"journal":{"name":"DeckerMed Medicine","volume":"37 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81119110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Substance Use Disorders","authors":"F. Moeller","doi":"10.2310/im.1191","DOIUrl":"https://doi.org/10.2310/im.1191","url":null,"abstract":"There is a consistent body of evidence showing that substance abuse and dependence can worsen preexisting medical conditions, can temporarily mimic medical and psychiatric disorders, and can themselves cause medical problems, including life-threatening overdose. Substance use disorders are common in young and middle-aged persons: the lifetime prevalence of these syndromes, including alcoholism, is over 20% for men and about 15% for women. This chapter discusses dependence, abuse, substance use disorder, and substance-induced disorders involving depressants, stimulants, opioids, cannabinoids, hallucinogens, N-methyl-D-aspartate (NMDA) receptor channel blockers, and inhalants. Epidemiology, etiology, pathophysiology, diagnosis (including clinical assessment and laboratory tests), and treatment are reviewed. Treatment of intoxication, overdose, withdrawal, and rehabilitation is discussed. A figure illustrates the neurocircuitry of addiction. Tables describe the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) diagnostic criteria for abuse and dependence; frequently misused drugs; neural effects of commonly abused drugs; the natural history of drug dependence; conditions affecting the outcome of urinary drug tests; and pharmacologic options for treatment of drug overdose. This chapter contains 112 references.","PeriodicalId":11220,"journal":{"name":"DeckerMed Medicine","volume":"234 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73955534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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