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https://www.readbyqxmd.com/read/29336434/acg-clinical-guideline-alcoholic-liver-disease
#1
Ashwani K Singal, Ramon Bataller, Joseph Ahn, Patrick S Kamath, Vijay H Shah
Alcoholic liver disease (ALD) comprises a clinical-histologic spectrum including fatty liver, alcoholic hepatitis (AH), and cirrhosis with its complications. Most patients are diagnosed at advanced stages and data on the prevalence and profile of patients with early disease are limited. Diagnosis of ALD requires documentation of chronic heavy alcohol use and exclusion of other causes of liver disease. Prolonged abstinence is the most effective strategy to prevent disease progression. AH presents with rapid onset or worsening of jaundice, and in severe cases may transition to acute on chronic liver failure when the risk for mortality, depending on the number of extra-hepatic organ failures, may be as high as 20-50% at 1 month...
January 16, 2018: American Journal of Gastroenterology
https://www.readbyqxmd.com/read/29321413/remission-of-refractory-ascites-and-discontinuation-of-hemodialysis-after-additional-rituximab-to-long-term-glucocorticoid-therapy-in-a-patient-with-tafro-syndrome
#2
Hanako Tsurumi, Yoshihide Fujigaki, Tadashi Yamamoto, Risa Iino, Kei Taniguchi, Michito Nagura, Shigeyuki Arai, Yoshifuru Tamura, Tatsuru Ota, Shigeru Shibata, Fukuo Kondo, Nozomu Kurose, Yasufumi Masaki, Shunya Uchida
Thrombocytopenia, ascites, myelofibrosis, renal dysfunction, and organomegaly (TAFRO) syndrome is a newly recognized but rare disease, and its treatment has not yet been established. We reported a 50-year-old woman with TAFRO syndrome diagnosed 2 years after the initial symptoms of a fever, fatigue, epigastric pain, edema, ascites, lymphadenopathy, thrombocytopenia and renal insufficiency. The patient showed refractory ascites and required hemodialysis under corticosteroid mono-therapy for suspected immune-mediated disease but was successfully treated with additive rituximab, resulting in improvement in her laboratory data, the withdrawal of hemodialysis and the disappearance of ascites...
January 11, 2018: Internal Medicine
https://www.readbyqxmd.com/read/29317810/inhaled-therapies-in-patients-with-moderate-copd-in-clinical-practice-current-thinking
#3
REVIEW
Amnon Ariel, Alan Altraja, Andrey Belevskiy, Piotr W Boros, Edvardas Danila, Matjaz Fležar, Vladimir Koblizek, Zvi G Fridlender, Kosta Kostov, Alvils Krams, Branislava Milenkovic, Attila Somfay, Ruzena Tkacova, Neven Tudoric, Ruxandra Ulmeanu, Arschang Valipour
COPD is a complex, heterogeneous condition. Even in the early clinical stages, COPD carries a significant burden, with breathlessness frequently leading to a reduction in exercise capacity and changes that correlate with long-term patient outcomes and mortality. Implementation of an effective management strategy is required to reduce symptoms, preserve lung function, quality of life, and exercise capacity, and prevent exacerbations. However, current clinical practice frequently differs from published guidelines on the management of COPD...
2018: International Journal of Chronic Obstructive Pulmonary Disease
https://www.readbyqxmd.com/read/29282040/case-report-atypical-presentation-of-vancomycin-induced-dress-syndrome-a-case-report-and-review-of-the-literature
#4
Olivia Wilcox, Mohamed Hassanein, John Armstrong, Nader Kassis
BACKGROUND: Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe hypersensitivity drug reaction involving the skin and multiple internal organ systems. The symptoms typically present with fever and skin rash, and rapidly progress to multiple organ failures. Vancomycin is a rare drug to cause DRESS syndrome with 23 cases reported to date. CASE PRESENTATION: We described a case of a 39 year-old man who was treated with vancomycin for osteomyelitis of the foot...
December 28, 2017: BMC Pulmonary Medicine
https://www.readbyqxmd.com/read/29227569/new-diagnosis-of-bullous-pemphigoid-after-withdrawal-of-immunosuppressive-therapy-in-a-failed-renal-transplant-recipient-on-hemodialysis
#5
Sohail Abdul Salim, Litty Thomas, Amanda Quorles, Seyed Mehrdad Hamrahian, Tibor Fülöp
The occurrence of the autoimmune blistering disease, bullous pemphigoid (BP), in patients with failed renal allograft is rare and the few reported cases suggest various provocative factors without reaching a consensus. Here we report the case of a patient presenting with bullous lesions soon after the complete discontinuation of immunosuppressant therapy following renal allograft failure. Skin biopsy confirmed the diagnosis of BP. Administration of systemic corticosteroid controlled the occurrence of BP lesions in our patient...
December 11, 2017: Hemodialysis International
https://www.readbyqxmd.com/read/29199808/how-to-identify-dress-drug-reaction-with-eosinophilia-and-systemic-symptoms
#6
Piia Sarajärvi, Minna Kubin, Kaisa Tasanen, Laura Huilaja
DRESS (drug reaction with eosinophilia and systemic symptoms) is a rare, severe multiorgan adverse drug reaction. Antiepileptic age's and antibiotics are the most frequently reported causative agents. Compared with other drug reactions, DRESS demonstrates a long latency period thus complicating recognition and diagnosis. DRESS is defined as presence of fever, skin eruption, hematologic abnormalities and systemic involvement, especially liver injury. Withdrawal of the culprit drug, commencement of systemic corticosteroid and supportive care are the mainstay of treatment...
2017: Duodecim; Lääketieteellinen Aikakauskirja
https://www.readbyqxmd.com/read/29199436/-considerations-on-the-treatment-of-iga-nephropathy-on-the-basis-of-the-results-of-the-latest-studies-stop-igan-testing-nefigan
#7
Judit Nagy, Balázs Sági, Judit Máté, Tibor Vas, Tibor Kovács
IgA nephropathy is an immune-mediated chronic glomerulonephritis with a great variability in clinical presentation and outcome. The disease can progress to end-stage renal failure in 25% of patients. For this reason we should identify patients with potential to progress. Most important risk factors for progression are persistent proteinuria, hypertension, decreased renal function and some histological lesions. The actually suggested treatment is summarized in KDIGO Clinical Practice Guideline from 2012. They suggest to give firstly non-specific supportive treatment (especially renin-angiotensin system blocking agents)...
December 2017: Orvosi Hetilap
https://www.readbyqxmd.com/read/29198698/successful-intravenous-immunoglobulin-treatment-in-pediatric-severe-dress-syndrome
#8
Nufar Marcus, Keren Smuel, Moran Almog, Dario Prais, Rachel Straussberg, Daniel Landau, Oded Scheuerman
BACKGROUND: Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare, potentially life-threatening delayed drug-induced hypersensitivity reaction. The most frequently reported drugs causing DRESS are aromatic antiepileptic agents. Prompt withdrawal of the offending drug and administering systemic corticosteroids is the most widely accepted and used treatment. The treatment of severe DRESS not responsive to systemic corticosteroids is uncertain. OBJECTIVE: The objective of this study was to describe a case series of pediatric patients with DRESS who were treated successfully with intravenous immunoglobulins (IVIGs)...
November 30, 2017: Journal of Allergy and Clinical Immunology in Practice
https://www.readbyqxmd.com/read/29190196/clinical-and-histologic-features-of-acute-onset-erythroderma-in-dogs-with-gastrointestinal-disease-18-cases-2005-2015
#9
Christine L Cain, Charles W Bradley, Elizabeth A Mauldin
OBJECTIVE To describe the clinical and histologic features of acute erythroderma in dogs with gastrointestinal disease. DESIGN Retrospective case series. ANIMALS 18 dogs with erythroderma and gastrointestinal disease. PROCEDURES Medical records and biopsy specimens were reviewed. Information collected from medical records included signalment, clinical signs, physical examination and diagnostic test results, treatment, and outcome. The Naranjo algorithm was used to estimate the probability of an adverse drug reaction for each dog...
December 15, 2017: Journal of the American Veterinary Medical Association
https://www.readbyqxmd.com/read/29190160/clinical-profile-ultra-wide-field-fluorescence-angiography-findings-and-long-term-prognosis-of-uveitis-in-tubulointerstitial-nephritis-and-uveitis-syndrome-at-one-tertiary-medical-institute-in-china
#10
Menglu Yang, Ying Chi, Chunying Guo, Junwen Huang, Li Yang, Liu Yang
PURPOSE: To analyze the clinical features and long-term prognosis of uveitis in tubulointerstitial nephritis and uveitis (TINU) syndrome in a cohort of Chinese patients. METHODS: A total of 32 patients with TINU syndrome between 2000 - 2016 were analyzed retrospectively. RESULTS: Mild anterior inflammation was observed in all cases. Ultra-wide-field fluorescence angiography (UWFA) was conducted on 13 patients, and peripheral vascular leakage was observed in 22/26 eyes (84...
November 30, 2017: Ocular Immunology and Inflammation
https://www.readbyqxmd.com/read/29188475/current-perspectives-on-stevens-johnson-syndrome-and-toxic-epidermal-necrolysis
#11
REVIEW
Marianne Lerch, Carlo Mainetti, Benedetta Terziroli Beretta-Piccoli, Thomas Harr
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are considered a delayed-type hypersensitivity reaction to drugs. They represent true medical emergencies and an early recognition and appropriate management is decisive for the survival. SJS/TEN manifest with an "influenza-like" prodromal phase (malaise, fever), followed by painful cutaneous and mucous membrane (ocular, oral, and genital) lesions, and other systemic symptoms. The difference between SJS, SJS/TEN overlap, and TEN is defined by the degree of skin detachment: SJS is defined as skin involvement of < 10%, TEN is defined as skin involvement of > 30%, and SJS/TEN overlap as 10-30% skin involvement...
November 29, 2017: Clinical Reviews in Allergy & Immunology
https://www.readbyqxmd.com/read/29183929/effectiveness-of-inhaled-corticosteroids-in-real-life-on-clinical-outcomes-sputum-cells-and-systemic-inflammation-in-asthmatics-a-retrospective-cohort-study-in-a-secondary-care-centre
#12
Sophie F Demarche, Florence N Schleich, Monique A Henket, Virginie A Paulus, Thierry J Van Hees, Renaud E Louis
OBJECTIVES: The impact of inhaled corticosteroids (ICS) on eosinophilic inflammation in asthma is well established, but their effect in a real-life setting has not been extensively studied. Our purpose was to investigate the effect of ICS on airway and systemic inflammation as well as on clinical outcomes in patients with asthma from clinical practice. DESIGN, SETTING AND PARTICIPANTS: We conducted a retrospective analysis on asthmatics from a secondary care centre in whom ICS were initiated/increased (n=101), stopped/decreased (n=60) or remained stable (n=63, used as a control group) between two visits with available sputum and blood cell counts...
November 28, 2017: BMJ Open
https://www.readbyqxmd.com/read/29183382/a-proposal-for-the-withdrawal-of-inhaled-corticosteroids-in-the-clinical-practice-of-chronic-obstructive-pulmonary-disease
#13
REVIEW
Marc Miravitlles, Borja G Cosío, Aurelio Arnedillo, Myriam Calle, Bernardino Alcázar-Navarrete, Cruz González, Cristóbal Esteban, Juan Antonio Trigueros, José Miguel Rodríguez González-Moro, José Antonio Quintano Jiménez, Adolfo Baloira
According to the current clinical practice guidelines for chronic obstructive pulmonary disease (COPD), the addition of inhaled corticosteroids (ICS) to long-acting β2 agonist therapy is recommended in patients with moderate-to-severe disease and an increased risk of exacerbations. However, ICS are largely overprescribed in clinical practice, and most patients are unlikely to benefit from long-term ICS therapy.Evidence from recent randomized-controlled trials supports the hypothesis that ICS can be safely and effectively discontinued in patients with stable COPD and in whom ICS therapy may not be indicated, without detrimental effects on lung function, health status, or risk of exacerbations...
November 28, 2017: Respiratory Research
https://www.readbyqxmd.com/read/29120273/triple-therapy-in-copd-what-we-know-and-what-we-don-t
#14
Peter M A Calverley, Helgo Magnussen, Marc Miravitlles, Jadwiga A Wedzicha
Triple inhaled therapy for chronic obstructive pulmonary disease (COPD) consists of an inhaled corticosteroid (ICS), a long-acting β2-agonist (LABA) and a long-acting muscarinic antagonist (LAMA) taken in combination. Triple therapy is recommended by the Global initiative for Chronic Obstructive Lung Disease (GOLD) for patients who experience recurrent exacerbations despite treatment with either a dual bronchodilator (preferred initial therapy) or LABA/ICS combination (alternative initial therapy). Although there is evidence for the greater efficacy of triple therapy compared with LABA/ICS and LAMA monotherapy with regards to improved lung function, health status, and exacerbation rate, the efficacy of triple therapy when compared with dual bronchodilation (LABA/LAMA) is as yet unknown...
December 2017: COPD
https://www.readbyqxmd.com/read/29113937/characterization-of-gastrointestinal-adverse-effects-reporting-in-clinical-studies-of-corticosteroid-therapy
#15
Tone Westergren, Sigrid Narum, Marianne Klemp
OBJECTIVE: To examine whether 159 studies included in a previous meta-analysis reported on gastrointestinal bleeding or perforation in accordance with the the CONSORT extension for reporting harms outcomes (CONSORT Harms recommendations checklist), whether differences were associated with funding source, journal or publication year, and whether the CONSORT Harms checklist is a suitable tool for evaluation of adverse effects reporting. STUDY DESIGN AND SETTING: Articles were assessed for fulfilment of the CONSORT Harms recommendations, funding source, publication type and year...
November 4, 2017: Journal of Clinical Epidemiology
https://www.readbyqxmd.com/read/29058249/a-2-year-step-down-withdrawal-from-inhaled-corticosteroids-in-asthmatic-children-receiving-immunotherapy
#16
Chun-Hui He, Xing Li, Jun-Hong Lin, Qiang Xiao, Jia-Lu Yu, Ying-Fen Liu, Wen-Hui Jiang, Chen Chen, Li Deng, Jie Zhou
BACKGROUND: Inhaled corticosteroids (ICSs) for treating asthma are controversial because of their negative effects on the growth of asthmatic children and without clearly defined withdrawal strategy. A 2-year ICS step-down and withdrawal strategy has been developed for asthmatic children receiving 3-year subcutaneous immunotherapy (SCIT). METHODS: Eleven children were included into the SCIT group and 13 children into the ICS group. ICSs were discontinued when children met the following criteria: requiring only 1 puffper day, with good control, for at least 6 months; having a forced expiratory volume in 1 second (FEV1)/forced vital capacity ≥80%; and SCIT discontinued for ≥24 months...
December 2017: World Journal of Pediatrics: WJP
https://www.readbyqxmd.com/read/29053578/treatment-with-synthetic-glucocorticoids-and-the-hypothalamus-pituitary-adrenal-axis
#17
REVIEW
Rosa Maria Paragliola, Giampaolo Papi, Alfredo Pontecorvi, Salvatore Maria Corsello
Chronic glucocorticoid (GC) treatment represents a widely-prescribed therapy for several diseases in consideration of both anti-inflammatory and immunosuppressive activity but, if used at high doses for prolonged periods, it can determine the systemic effects characteristic of Cushing's syndrome. In addition to signs and symptoms of hypercortisolism, patients on chronic GC therapy are at risk to develop tertiary adrenal insufficiency after the reduction or the withdrawal of corticosteroids or during acute stress...
October 20, 2017: International Journal of Molecular Sciences
https://www.readbyqxmd.com/read/29044640/a-step-down-protocol-for-omalizumab-treatment-in-oral-corticosteroid-dependent-allergic-asthma-patients
#18
Christian Domingo, Xavier Pomares, Albert Navarro, María José Amengual, Concepción Montón, Ana Sogo, Rosa M Mirapeix
AIMS: There are no specific criteria for a step-down or withdrawal dose of omalizumab (OMA). Our purpose was to evaluate the viability of a protocol for OMAlizumab DOse REduction (the OMADORE study) in severe allergic asthma (SAA). METHODS: The study population included 35 SAA patients treated during a minimum period of 1 year with oral corticosteroids (OC) equivalent to a mean daily dose of 4 mg of methyl-prednisolone. To qualify for the protocol, the patients had to have received treatment with OMA for at least one and a half years, OC dose had to have reached the lowest tolerated dose and spirometry had to be greater than or equal to that at entry...
October 18, 2017: British Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/29022964/nocardia-arthritidis-keratitis-case-report-and-review-of-the-literature
#19
Andrew Gieger, Stephen Waller, Joseph Pasternak
INTRODUCTION: Keratitis due to Nocardia infection is not commonly encountered in clinical practice and may therefore be mistaken for fungal or viral keratitis leading to delayed treatment and increased risk of permanent visual impairment. CASE: An otherwise healthy 27 years old Caucasian Active Duty military member presented to the clinic with three days of light sensitivity and irritation of his right eye. He carried a history of PRK in both eyes six years prior and admitted to recent contact lens overuse...
January 2017: Nepalese Journal of Ophthalmology
https://www.readbyqxmd.com/read/28994265/recognition-of-giant-cell-arteritis-in-patients-with-polymyalgia-rheumatica-who-have-a-stroke-a-cautionary-tale
#20
Donald H Gutteridge, Frank L Mastaglia
An 82-year-old woman with polymyalgia rheumatica (PMR) on prednisone 7 mg daily was admitted to an acute stroke unit with a right homonymous hemianopia, a left posterior cerebral artery occlusion and occipital lobe infarct. She had raised inflammatory markers, did not have a temporal artery biopsy, and was discharged on the same dose of prednisone. After 21 months, off prednisone, her ophthalmologist, concerned about giant cell arteritis (GCA), restarted prednisone 40 mg daily, with rapid, profound visual improvement...
October 2017: Internal Medicine Journal
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