Postgraduate Medicine最新文献

{"title":"Vasculitis issue - introduction.","authors":"Sophia Panaccione, David A Cohen","doi":"10.1080/00325481.2023.2190287","DOIUrl":"https://doi.org/10.1080/00325481.2023.2190287","url":null,"abstract":"The terminology ‘systemic vasculitis’ encompasses an array of conditions characterized by inflammation of blood vessels of varying size that without recognition and treatment can lead to end organ damage and failure with subsequent mortality. Vasculitis disease states are categorized by the size of vessel they involve along with recognition of affiliated age group. Data over the last 40 years estimate varying but overall increasing incidence of vasculitis in the United States (U.S.) [1,2]. Since establishment of more standardized diagnostic tools and the evolution of immunomodulating therapy, survival has increased and mortality has decreased; however, estimated death count in the U.S. remains high at 13,048 individuals with vasculitis contributing to their death from 1999 to 2019. During this same period in the U.S., ageadjusted mortality rate of vasculitis as underlying cause of death has averaged 1.888 per million (CI 1.855–1.921) [2]. Sequalae of systemic vasculitis can include damage to lungs, kidneys, liver, eyes, skin, joints, muscles, nerves, and intestines, whereas complications of the vasculitis itself or treatment can include cardiovascular, stroke, and pulmonary-related deaths. Given severity of progression and complications and prior limited consensual diagnostic criteria, guidelines have been established to assist in early diagnosis and then treatment and identify areas for additional research [3–5]. Treatment has shifted to a ‘triphasic approach’ focused on induction, maintenance of remission, and treatment of relapses while at the same time considering co-morbid conditions [6]. Currently, treatments include corticosteroids, rituximab, plasmapheresis, cytokinemodulating therapy such as inhibitors of TNF-alpha, IL-1, and IL-6 along with other immunosuppressant agents. Evolving data provide increasing evidence to support earlier targeted treatment and use of glucocorticoid sparing immunomodulators and biologic agents to allow for more disease-specific treatment with lessened drug toxicity [7]. The purpose of this issue will be to discuss updates on eight prevalent entities within vasculitis literature. Within the category of large vessel vasculitis, the following disease states are included: Takayasu’s arteritis and giant cell arteritis. Though both processes are granulomatous in nature, these are differentiated in their large vessel location and demographic distribution. Takayasu’s arteritis is seen to classically involve the aorta and its larger branches and affects younger females of Asian descent, whereas giant cell, though also may involve the aorta, is found mostly within the temporal artery, is seen in individuals greater than 50 years of age and has a predilection for those with polymyalgia rheumatica. Amongst the medium vessel vasculitis class are polyarteritis nodosa and Kawasaki’s disease. Given this issue will focus primarily on adult pathologies, the focus here will be on polyarteritis nodosa. Polyarteritis nodosa, which","PeriodicalId":20329,"journal":{"name":"Postgraduate Medicine","volume":"135 sup1","pages":"1-2"},"PeriodicalIF":4.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9361388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Polyarteritis nodosa: an evolving primary systemic vasculitis.","authors":"Jason M Springer,&nbsp;Kevin Byram","doi":"10.1080/00325481.2022.2088940","DOIUrl":"https://doi.org/10.1080/00325481.2022.2088940","url":null,"abstract":"<p><p>Polyarteritis nodosa (PAN) is a primary form of vasculitis characterized by inflammation of primarily medium-sized arteries. Several key events have shaped the current spectrum of the disease including the separation of a subgroup with microscopic polyangiitis, the discovery of the association of hepatitis B, and the discovery of adenosine deaminase 2 deficiency (DADA2). With the discovery of secondary causes of PAN and changing nomenclature, the incidence of PAN has declined over time. Common manifestations include constitutional symptoms, skin involvement, peripheral neuropathy, gastrointestinal disease, and renal involvement. DADA2 is a genetic cause of medium vessel vasculitis that is important to distinguish from primary PAN as treatment with TNF inhibitors can prevent morbidity and mortality in those with a vasculitis phenotype. Treatment of systemic primary PAN involves the use of systemic immunosuppressive therapy largely guided by the severity of disease. With current treatment regimens, the prognosis has changed from a once uniformly fatal disease to a 5-year survival rate above 80%.</p>","PeriodicalId":20329,"journal":{"name":"Postgraduate Medicine","volume":"135 sup1","pages":"61-68"},"PeriodicalIF":4.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9316276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to the letter regarding 'The effect of early oral feeding after esophagectomy on the incidence of anastomotic leakage: an updated review'.","authors":"Longbo Gong,&nbsp;Chu Zhang,&nbsp;Miao Zhang,&nbsp;Wenbin Wu","doi":"10.1080/00325481.2022.2133825","DOIUrl":"https://doi.org/10.1080/00325481.2022.2133825","url":null,"abstract":"Dear Editor in Chief, We really appreciate the letter from the readers and their interest in this review [1]. The readers found a serious mistake that the study by Weijs et al. cited in the text wasn’t a randomized controlled trial (RCT) because of the retrospective nature of the control group [2]. Therefore, the study design of this article should be considered as a retrospective case-control study, with an evidence level of 4 according to the Oxford Center for Evidence-Based Medicine 2011 Levels of Evidence [3]. Early oral feeding (EOF) within 3 days following esophagectomy demonstrates its safety and promising efficacy in a few RCTs. However, the current available data are obviously insufficient. A metaanalysis based on the limited sample is not appropriate, which might result in misleading information for inexperienced surgeons, considering the potential risk of anastomotic leakage. Further large-scale, well-designed trials are warranted before a formal consensus or guideline supporting EOF in esophagectomy could be drawn.","PeriodicalId":20329,"journal":{"name":"Postgraduate Medicine","volume":"135 1","pages":"1"},"PeriodicalIF":4.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9161730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Eosinophilic granulomatosis with polyangiitis.","authors":"Alexandra Villa-Forte","doi":"10.1080/00325481.2022.2134624","DOIUrl":"https://doi.org/10.1080/00325481.2022.2134624","url":null,"abstract":"<p><p>This review aims to describe the epidemiology, pathogenesis, clinical manifestations, diagnosis, treatment, and prognosis of eosinophilic granulomatosis with polyangiitis (EGPA). Eosinophilic granulomatosis with polyangiitis is a small to medium vessel necrotizing vasculitis, typically classified with granulomatosis with polyangiitis (GPA) and microscopic polyangitis (MPA) as antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). However, less than 50% of patients with EGPA have a positive ANCA test. Among all the vasculitides, asthma and eosinophilia are unique features of EGPA. Eosinophilic granulomatosis with polyangiitis is very rare and the diagnosis may be missed as the disease evolves over time. Polyneuropathies are common and may be severe, requiring aggressive immunosuppressive therapy. Heart involvement is the most common cause of death in EGPA. Biopsy of involved tissue supports a clinically suspected diagnosis but is not always feasible. Treatment of EGPA is primarily dictated by the severity of disease and prognostic factors. More severe disease frequently requires the use of aggressive therapy such as cyclophosphamide. Once treatment is initiated, patients can achieve good control of symptoms; unfortunately, disease relapses are common and prolonged treatment with corticosteroids is often necessary for asthma management. A better understanding of the disease heterogeneity is needed for the development of better therapies.</p>","PeriodicalId":20329,"journal":{"name":"Postgraduate Medicine","volume":"135 sup1","pages":"52-60"},"PeriodicalIF":4.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9312372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Behcet disease: an undifferentiating and complex vasculitis.","authors":"Daniel Pak,&nbsp;Hyon Ju Park","doi":"10.1080/00325481.2022.2159205","DOIUrl":"https://doi.org/10.1080/00325481.2022.2159205","url":null,"abstract":"<p><p>Behçet Disease is a relapsing and remitting variable vessel vasculitis characterized by recurrent mucocutaneous ulcers that can involve almost every organ system in the body. Indeed, the presence of recurrent oral or genital ulcers with other auto-inflammatory symptoms should raise suspicion for this elusive disease. It is unique among the vasculitides in that it can affect vessels of small, medium, and large size and tends to involve venous rather than arterial circulation, and its effects on the pulmonary venous circulation are particularly notable for their role in disease mortality. Classically seen in Mediterranean, Middle-Eastern, and eastern Asian countries, and relatively rare in the United States, prevalence has been increasing, prompting an increased need for internists to be aware of Behcet's clinical presentation and treatment. As early recognition and diagnosis of the disease is key to successful treatment and better prognosis, this review provides a brief summary of the current etiological theories, important clinical manifestations, and treatments including newer biologic alternatives.</p>","PeriodicalId":20329,"journal":{"name":"Postgraduate Medicine","volume":"135 sup1","pages":"33-43"},"PeriodicalIF":4.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9316839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cutaneous small vessel vasculitis.","authors":"Danielle M DeHoratius","doi":"10.1080/00325481.2022.2159207","DOIUrl":"https://doi.org/10.1080/00325481.2022.2159207","url":null,"abstract":"<p><p>This review discusses the clinical manifestations of cutaneous small vessel vasculitis. The etiologies and work up will be explored as well as the treatment considerations. This entity is multifactorial and usually involves multiple specialties. The presentation can range from self-limited to life threatening, multi-organ failure. It is essential to be able to diagnose vasculitis and proceed with the appropriate laboratory studies and work-up. Finally, investigation of associated etiologies such as infection and drugs will guide additional diagnostic studies.</p>","PeriodicalId":20329,"journal":{"name":"Postgraduate Medicine","volume":"135 sup1","pages":"44-51"},"PeriodicalIF":4.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9681213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical features and management of animal bites in an emergency department: a single-center experience.","authors":"Orkun Aydin,&nbsp;Elif Tugce Aydin Goker,&nbsp;Zeynep Aybuke Arslan,&nbsp;Halil Mustafa Sert,&nbsp;Ozlem Teksam","doi":"10.1080/00325481.2022.2124089","DOIUrl":"https://doi.org/10.1080/00325481.2022.2124089","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to evaluate the clinical features, management, and outcomes of patients with animal bites presented to the pediatric emergency department of a tertiary center.</p><p><strong>Methods: </strong>Patients with ICD-10 code W54 (contact with dog) and W55 (contact with other mammals) between March 1^st, 2017, and July 1^st, 2021, were included in the study. Demographic characteristics of the patients, type of contacted animal, wound characteristics (muscle involvement, soft tissue defect, vascular injury, type of nerve injury, and Lackmann's classification), wound care measurements, tetanus prophylaxis, administration of rabies immunoglobulin and antibiotics, location of the injury, existing fractures, suturing, splinting, surgical consultations and hospitalization status were recorded.</p><p><strong>Results: </strong>Four hundred and nineteen incidents of animal bites (240 males and 179 females) occurred over a four-year period. 51% was due to a dog bite; 47% was by a cat. The median age was nine years (IQR: 5-14 years). Most bites (91.6%) involved only a single anatomical site. The extremities were the commonly involved part (right upper limb [35.3%], left upper limb [21.2%], right lower limb [12.6%], left lower limb [16%]). Head-neck and face injury ratio was 17.6%. Torso (5.7%) and genitalia (5.2%) were uncommonly involved. A consultation was requested from at least one surgical department for 8% of the patients. 97.1% of patients received a rabies vaccine. Most attacks were trivial and did not require hospitalization.</p><p><strong>Conclusion: </strong>Animal bites often cause minor injuries. However, multiple dog attacks can be seen related to a high number of stray animals in our country. Therefore, these patients may present with major traumas. Surgical intervention and hospitalization may be required. Emergency physicians play an essential role in acute management and rabies prophylaxis in these patients.</p>","PeriodicalId":20329,"journal":{"name":"Postgraduate Medicine","volume":"135 1","pages":"31-37"},"PeriodicalIF":4.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10539910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Congenital malformations of the urinary system as visceral markers of undifferentiated connective tissue dysplasia.","authors":"Nataliia Lukianenko,&nbsp;Zhansulu Nurgaliyeva,&nbsp;Olha Astapieva,&nbsp;Viktor Starenkiy,&nbsp;Nataliia Pidchenko","doi":"10.1080/00325481.2022.2131439","DOIUrl":"https://doi.org/10.1080/00325481.2022.2131439","url":null,"abstract":"<p><strong>Objective: </strong>The relevance of this study is conditioned by the need for urgent search and implementation of effective methods of treatment of urinary system diseases in people of different ages, as well as addressing issues of quality treatment of connective tissue diseases in general and its dysplasia in particular. The aim of the article is to identify congenital defects as visceral markers of connective tissue dysplasia.</p><p><strong>Methods: </strong>The methodology of this study includes a survey of a group of children with considerable problems in the development and functioning of the urinary system at the age of 2 weeks to 3 years, in order to qualitatively select and determine the most effective methods of treatment. Children who took part in this study had a set of phenotypic and clinical properties of undifferentiated connective tissue dysplasia.</p><p><strong>Results: </strong>The considerable prevalence of undifferentiated connective tissue dysplasia in young children with congenital malformations of the urinary system, especially in children with abnormal development and functioning of kidney tissue, which substantially influences the course of the disease was determined. Also, treatment of undifferentiated connective tissue dysplasia was predicted.</p><p><strong>Conclusions: </strong>It was concluded that the presence of a malformation of the urinary system, which is acquired by a child from birth, can be considered as a visceral manifestation of undifferentiated connective tissue dysplasia.</p>","PeriodicalId":20329,"journal":{"name":"Postgraduate Medicine","volume":"135 1","pages":"67-71"},"PeriodicalIF":4.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10546950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of pediatric patients with idiopathic uveitis, and uveitis due to juvenile idiopathic arthritis and Behçet's disease.","authors":"Deniz Gezgin Yıldırım,&nbsp;Murat Hasanreisoğlu,&nbsp;Sevcan A Bakkaloğlu","doi":"10.1080/00325481.2022.2133853","DOIUrl":"https://doi.org/10.1080/00325481.2022.2133853","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of this study is to compare the demographic, clinical features, treatment results and outcomes in pediatric patients with idiopathic uveitis and uveitis due to juvenile idiopathic arthritis (JIA) and Behçet's disease (BD).</p><p><strong>Methods: </strong>97 pediatric uveitis patients were divided into three groups according to the etiology of uveitis: Group 1 comprised idiopathic uveitis patients, Group 2 uveitis patients who had JIA, and Group 3 uveitis patients with BD.</p><p><strong>Results: </strong>Symptomatic presentation and intermediate uveitis were more common in Group 1 (p < 0.005). Asymptomatic presentation and anterior uveitis in Group 2 (p < 0.005), whereas symptomatic presentation and posterior uveitis in Group 3 (p < 0.005). Erythrocyte sedimentation rate (ESR) was higher in patients with BD or JIA uveitis than those with idiopathic uveitis (p < 0.005). Biologic therapy was more commonly used in JIA group compared to other groups (p < 0.005). Patients who had a complication related with uveitis were more common in females, asymptomatic disease course, and needed use of biologic treatment than in those without any complication (p < 0.005).</p><p><strong>Conclusion: </strong>Uveitis accompanying rheumatologic diseases may have asymptomatic and insidious course but have higher ESR as an important notice.</p>","PeriodicalId":20329,"journal":{"name":"Postgraduate Medicine","volume":"135 1","pages":"79-85"},"PeriodicalIF":4.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10606146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognosis of systemic inflammation at an early stage of cirrhosis using the monocyte-to-lymphocyte ratio during malnutrition risk screening: a prospective cohort study.","authors":"Yuchao Wu,&nbsp;Mengmeng Zhang,&nbsp;Tianzhi Ni,&nbsp;Xiaoli Zhang,&nbsp;Ruojing Wang,&nbsp;Li Zhu,&nbsp;Juan Du,&nbsp;Yage Zhu,&nbsp;Yingren Zhao,&nbsp;Yuan Yang","doi":"10.1080/00325481.2022.2110600","DOIUrl":"https://doi.org/10.1080/00325481.2022.2110600","url":null,"abstract":"<p><strong>Objective: </strong>To determine whether the monocyte-to-lymphocyte ratio (MLR), as a systemic inflammation index, predicts malnutrition risk during the early stages of cirrhosis.</p><p><strong>Methods: </strong>We conducted a single-center prospective cohort study, enrolling patients from June 2016 to September 2020. The patients underwent malnutrition risk assessments upon admission. The patients were classified into five clinical stages according to portal hypertension. The malnutrition risk was scored using the Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT) and validated by the Nutritional Risk Screening 2002 (NRS-2002) or Liver Disease Undernutrition Screening Tool (LDUST). Routine clinical laboratory measurements were performed to calculate the MLR, Child-Turcotte-Pugh (CTP) class, and model for end-stage liver disease (MELD) score. The patients were followed up for 2 years.</p><p><strong>Results: </strong>Among the 154 patients with cirrhosis, 60 had compensated cirrhosis and 94 had decompensated cirrhosis. The optimal cutoff value of the MLR, >0.4, was effective in predicting malnutrition related to death or liver transplantation. Those with a high malnutrition risk defined by the NRS-2002 or RFH-NPT had a higher MLR than those with a low malnutrition risk. For patients with class A CTP cirrhosis or a MELD score of <10, an MLR cutoff of <0.4 significantly distinguished more patients with a low malnutrition risk than those with a high malnutrition risk. Both the RFH-NPT score and MLR increased significantly across the decompensated cirrhosis substages. Interestingly, the MLR exhibited a positive correlation with the RFH-NPT score until varices appeared, but the correlation was the highest at the substage of a history of variceal bleeding (r = 0.714, P = 0.009). Multivariable analysis demonstrated that an MLR of >0.4 was an independent factor for malnutrition risk by screening with the RFH-NPT, and this was confirmed using the LDUST and NRS-2002.</p><p><strong>Conclusion: </strong>Immune-related inflammatory dysfunction predicts malnutrition risk during the early stages of cirrhosis.</p>","PeriodicalId":20329,"journal":{"name":"Postgraduate Medicine","volume":"134 8","pages":"801-809"},"PeriodicalIF":4.2,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10793056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}