{"title":"Introduction to precision medicine","authors":"Stefanie Lip, Sandosh Padmanabhan","doi":"10.1016/j.mpmed.2025.04.018","DOIUrl":"10.1016/j.mpmed.2025.04.018","url":null,"abstract":"<div><div>Precision medicine is revolutionizing healthcare by transitioning from the traditional ‘one-size-fits-all’ approach to a more individualized strategy. This paradigm tailors diagnostics and treatments based on each patient's unique genetic, molecular and environmental profiles by leveraging advanced technologies such as omics profiling, imaging techniques and artificial intelligence artificial intelligence (AI)-driven data analytics. This reduces the reliance on trial-and-error prescribing, minimizes adverse effects and enhances overall treatment efficacy. As a consequence, disease taxonomy is evolving to more accurately reflect the underlying pathology of several diseases such as cancer, Alzheimer disease and various chronic illnesses, along with therapeutic insights accelerating the creation of targeted therapies. Despite its transformative potential, precision medicine faces significant challenges. While the initial costs of implementing precision medicine may be higher, the long-term benefits – including improved patient outcomes, cost-effectiveness and optimized resource utilization – underscore its potential to transform global healthcare systems. Unequal access to advanced diagnostics and therapies can worsen existing health disparities, limiting the benefits of precision medicine to more affluent and well-resourced populations. For medical trainees, understanding and applying evolving molecular insights and a commitment to inclusivity and innovation will ensure that the full advantages of precision medicine are realized for all patients.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 7","pages":"Pages 476-482"},"PeriodicalIF":0.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144491797","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":"Dermatological pharmacology: systemic drugs","authors":"Sarah H Wakelin","doi":"10.1016/j.mpmed.2025.04.020","DOIUrl":"10.1016/j.mpmed.2025.04.020","url":null,"abstract":"<div><div>Systemic treatment of skin disease continues to evolve with biological drugs (‘biologics’) and new small molecules. This has been made possible by a deepening understanding of the pathogenesis of inflammatory dermatoses and skin cancer at a molecular level. As well as a range of biologics for psoriasis, there are now licensed biologics for eczema, urticaria and hidradenitis suppurativa. Biologic therapy also offers the chance of improved survival for patients with advanced melanoma. Biologics and new drugs may be highly effective but their expense limits patient access to those with severe disease where other systemic treatments have failed or are inappropriate. Many patients with skin disease are therefore prescribed traditional immunosuppressive or anti-inflammatory medication. These drugs require careful patient selection, prescribing and monitoring for adverse effects to reduce the risk of harm. The prescriber also needs to be able to advise patients of the risks versus benefits of different treatment options so they can make an informed choice about their care.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 7","pages":"Pages 435-440"},"PeriodicalIF":0.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144491790","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":"Acne, hidradenitis suppurativa and hyperhidrosis","authors":"Natalie Rachel Attard","doi":"10.1016/j.mpmed.2025.04.010","DOIUrl":"10.1016/j.mpmed.2025.04.010","url":null,"abstract":"<div><div>Acne, hidradenitis suppurativa and hyperhidrosis are three distinct skin disorders. In this article, the key clinical features, medical associations and important aspects of management are highlighted.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 7","pages":"Pages 461-466"},"PeriodicalIF":0.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144491788","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":"Structure and function of skin, hair and nails","authors":"John A McGrath","doi":"10.1016/j.mpmed.2025.04.013","DOIUrl":"10.1016/j.mpmed.2025.04.013","url":null,"abstract":"<div><div>The skin is the largest organ of the human body. It is a complex epithelial and mesenchymal tissue comprising a multilayered stratified epidermis, adnexal structures such as hair follicles, sweat glands and sebaceous glands, a dermis containing collagen and elastic fibres, and underlying subcutaneous fat. More than 1000 disease entities involving the skin have been described, and up to 20% of all general practitioner consultations involve skin pathology. Infections, drug reactions and diseases such as psoriasis, eczema, urticaria and skin cancer impose a considerable burden on healthcare resources and significantly affect patients' quality of life. Knowledge of the structure and function of the skin and its appendages is paramount for understanding the biology of healthy skin and the pathophysiology of skin diseases.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 7","pages":"Pages 417-422"},"PeriodicalIF":0.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144491785","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":"Self-assessment/CPD answers","authors":"","doi":"10.1016/j.mpmed.2025.04.022","DOIUrl":"10.1016/j.mpmed.2025.04.022","url":null,"abstract":"","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 7","pages":"Pages 483-486"},"PeriodicalIF":0.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144491789","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":"Non-atopic dermatitis","authors":"David Orton","doi":"10.1016/j.mpmed.2025.04.012","DOIUrl":"10.1016/j.mpmed.2025.04.012","url":null,"abstract":"<div><div>The terms ‘eczema’ and ‘dermatitis’ are used interchangeably to describe an inflammatory skin disorder with different clinical and histological appearances according to duration (acute versus chronic) and cause. ‘Non-atopic dermatitis’ encompasses various kinds of dermatitis that are usually classified by appearance, such as discoid eczema, or body site, such as seborrhoeic dermatitis. Attempts at classification are often unsatisfactory and different kinds of dermatitis can coexist and overlap with atopic dermatitis. The role of irritant and allergic contact factors should be considered in all cases and patch tests undertaken where allergic contact dermatitis is suspected or cannot be excluded.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 7","pages":"Pages 454-456"},"PeriodicalIF":0.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144491793","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":"Urticaria and angioedema","authors":"Tabi Leslie","doi":"10.1016/j.mpmed.2025.04.011","DOIUrl":"10.1016/j.mpmed.2025.04.011","url":null,"abstract":"<div><div>Urticaria is characterized by transient itchy wheals, angioedema or both. It is a debilitating disease that places a substantial burden on patients and society. Urticaria is classified as acute (lasting <6 weeks) or chronic (persisting for >6 weeks). Chronic urticaria can be subdivided into chronic spontaneous urticaria, with no specific trigger, and chronic inducible urticaria, where there is an identifiable trigger. Chronic spontaneous urticaria can have an autoimmune basis. A detailed history and examination should be undertaken in order to make a diagnosis, with limited routine laboratory tests if indicated. H<sub>1</sub> antihistamines taken in standard dosage or ‘updosed’ up to 4-fold provide effective symptom control for most patients. The biological drug omalizumab is licensed for severe chronic urticaria not adequately controlled with antihistamines and is a safe and effective treatment. Ciclosporin is a fourth-line option for refractory chronic urticaria.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 7","pages":"Pages 457-460"},"PeriodicalIF":0.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144491794","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":"Myeloma and MGUS","authors":"Matthew J Streetly","doi":"10.1016/j.mpmed.2025.02.010","DOIUrl":"10.1016/j.mpmed.2025.02.010","url":null,"abstract":"<div><div>Plasma cell disorders result from a clonal proliferation of bone marrow plasma cells and range from benign monoclonal gammopathy of undetermined significance (MGUS) to malignant myeloma. Serum or urine monoclonal protein is usually detectable. MGUS is asymptomatic but can progress to myeloma or lymphoma. Myeloma is generally a disease of elderly individuals and presents with variable problems including anaemia, bone pain, fractures, spinal cord compression, renal failure, hypercalcaemia, recurrent infections and hyperviscosity. Diagnosis is based on bone marrow examination, and prognosis is influenced by specific acquired genetic abnormalities. Treatment is required after the development of, or to reduce the risk of developing, myeloma-related organ or tissue impairment. Myeloma is incurable, and treatment combines anti-myeloma chemoimmunotherapy with supportive therapies. Younger, medically fit patients are treated with intensive regimens combining chemotherapy with an autologous stem cell transplant, whereas older patients with co-morbidities and poorer performance status are generally offered less intensive treatment. It has a responding–relapsing disease course with eventual development of drug resistance. However, newer therapy options alone or in combination have improved outcomes in myeloma.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 5","pages":"Pages 325-330"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143924657","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":"CAR-T cells – the future for cancer therapy","authors":"Reuben Benjamin, Francesco Restuccia","doi":"10.1016/j.mpmed.2025.03.002","DOIUrl":"10.1016/j.mpmed.2025.03.002","url":null,"abstract":"<div><div>Chimeric antigen receptor T cells (CAR-T) are a novel form of immunotherapy in which T cells from individuals with cancer are genetically modified to express a chimeric receptor enabling them to target cancer cells, with profound anti-tumour effects. CAR-T cells have shown highly impressive results in the treatment of B cell haematological malignancies, with several CD19-targeted CAR-T cells products now approved for routine clinical use. The main adverse effects of CAR-T cells treatment include cytokine-release syndrome, neurotoxicity and cytopenias; these require prompt treatment in specialist centres. Future developments related to CAR-T cells are likely to see products with improved efficacy, newer indications such as solid tumours and autoimmune disease and more affordable and easier access to this promising therapy.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 5","pages":"Pages 340-342"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143924660","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":"Chronic lymphocytic leukaemia","authors":"Anita Sarma, Piers EM Patten","doi":"10.1016/j.mpmed.2025.03.003","DOIUrl":"10.1016/j.mpmed.2025.03.003","url":null,"abstract":"<div><div>Chronic lymphocytic leukaemia is a common subtype of non-Hodgkin lymphoma often diagnosed incidentally through the finding of a lymphocytosis on a routine blood count. Key diagnostic tests are peripheral blood morphology and immunophenotyping. At all stages of disease patients are vulnerable to infections and other malignancies. Treatment is only indicated in individuals who show progression by developing symptoms such as fatigue, lymphadenopathy or splenomegaly, or cytopenias. An increasing number of prognostic biomarkers are now available to assess likely disease outcome and response to different types of treatment. Use of newer agents such as Bruton tyrosine kinase inhibitors and BCL2 inhibitors have largely replaced more traditional chemo-immunotherapy and significantly improved outcomes.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 5","pages":"Pages 298-303"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143924652","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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