bluuebunny/crossref_metadata_2025 huggingface dataset:
Essential Thrombocythemia and Myelofibrosis
Authors: Kantarjian Hagop M. , Verstovsek Srdan
Published: January 2021

This review details two major clonal stem cell disorders: essential thrombocythemia (ET) and myelofibrosis (MF). ET is distinguished by a sustained proliferation of megakaryocytes that results in peripheral blood thrombocytosis. Primary myelofibrosis (PMF) is associated with extramedullary hematopoiesis, splenomegaly, a leukoerythroblastic blood picture, and varying degrees of marrow fibrosis with marked megakaryocyte hyperplasia and atypia. The epidemiology, etiology/genetics, pathogenesis, diagnosis (including clinical manifestations and laboratory tests), differentials, management, and prognosis of each disorder are examined. Also included is the evaluation of treatment options for MF, including interferon alfa, JAK inhibitors, and allogeneic stem cell transplantation, the latter of which is still the only curative treatment for MF. Figures show treatment algorithms for ET and MF. Tables list the current criteria for the diagnosis of ET and PMF via the World Health Organization (WHO), the guidelines for diagnosis of post-ET MF via the International Working Group for Myelofibrosis Research and Treatment (IWG-MRT), prognostic factors in the International Prognostic Score for ET (IPSET) and IPSET-thrombosis, prognostic scoring systems for MF, and the clinical activity of JAK2 inhibitors.
This review contains ­2 highly rendered figures, 6 tables, and 60 references.
Imaging Of Lung Disease, Part II: ­Cavities, Cysts, Nodules, And Masses
Authors: Jr Gerald W. Staton , Berkowitz Eugene A , Bernheim Adam
Published: January 2021

Cavitary lesions may occur in the setting of pulmonary infection, neoplasm, or vasculitis.  Cystic lung disease must be differentiated from emphysema and is seen in lymphangioleiomyomatosis, Langerhans cell histiocytosis (LCH), and lymphoid interstitial pneumonia (LIP).  Pulmonary nodules are routinely encountered on chest imaging and may be due to benign or malignant etiologies.  There are follow-up algorithms that provide recommendations for solid and sub-solid nodules in certain clinical scenarios.  Nodules characteristics (such as size, morphology, and number [solitary versus multiple]) and patient characteristics (including age, oncology history, and cigarette smoking status) are important to consider in formulating a differential diagnosis and follow-up plan.  Lung cancer screening computed tomography (CT) is now a recommended screening test for high-risk patients who meet certain eligibility requirements, and should be reported according to the Lung Imaging Reporting and Data System (Lung-RADS).

This review contains 28 figures, 3 tables and 26 references
Keywords: Cavitary Lung Disease, Granulomatosis with Polyangiitis, Cystic Lung Disease, Lymphoid Interstitial Pneumonia, Pulmonary Emphysema, Pulmonary Nodules, Pulmonary Granulomatous Disease, Arteriovenous Malformation, Lung Cancer Screening, Pulmonary Fungal Infection
Infections Due to Candida, Cryptococcus, Other Yeasts, and Pneumocystis
Authors: Young Jo-Anne H. , Green Jaime S
Published: January 2021

Yeast-based fungal infections have become increasingly important over several decades, paradoxically because advances in medical practice have allowed patients with chronic medical conditions to live longer and have more productive lives. Many of these yeast infections are superficial in nature, such as thrush and candidal vaginitis among persons treated with antibiotics or with short courses of steroids. A minority of the yeast infections are associated with significant morbidity and mortality, generally among debilitated or otherwise immunosuppressed patients who have survived major surgeries or extensive chemotherapy regimens. These opportunistic yeast pathogens may originate as human commensals (e.g., Candida albicans) or have an environmental reservoir (e.g., Cryptococcus neoformans). Opportunistic Pneumocystis infections are inhaled. Knowledge of the host characteristics associated with specific infections will allow high suspicion for the type of yeast infection that may be occurring. Standard methods for making a diagnosis have included antigen testing, culture, and cytology. Newer methods for making the diagnosis include nucleic acid testing and nanotechnology. There are three general classes of antifungal agents. Treatment with antifungal agents for the most serious of these infections requires source control for cure. In addition, correction of predisposing conditions will also assist with prevention of recurrence. Immunocompromised patients require either prophylaxis or early empirical treatment during high-risk periods.
This review contains 1 figure, 4 tables, and 74 references.
Key words: Candida, Candidiasis, Cryptococcus, Malassezia, Trichosporon, Pneumocystis
Psychoactive Medications
Authors: Neavyn Mark J , Babu Kavita
Published: January 2021

Psychoactive medications are defined as medications that affect the central nervous system neurotransmitter pathways with the intention to modulate mood or consciousness. This broad category of medications includes sedative-hypnotic agents such as benzodiazepines and barbiturates, antidepressants, neuroleptics, and mood stabilizers. The principal source of exposure for these medications is through prescription drug use and misuse. This review discusses the principles of toxicity, immediate stabilization, diagnosis and definitive therapy, and disposition and outcomes related to sedative-hypnotics, antidepressants, neuroleptics, and lithium. Tables include common benzodiazepine and barbiturate compounds, dosing instructions for multidose activated charcoal, flumazenil dosing recommendations, commonly available tricyclic and atypical (noncyclic) antidepressants, dosing recommendations for sodium bicarbonate in serum alkalinization, benzodiazepine dosing recommendations in serotonin syndrome, dosing recommendations for cyproheptadine, signs and symptoms that differentiate  neuroleptic malignant syndrome from serotonin syndrome, and indications for renal replacement therapy based on lithium concentration and clinical setting. Figures show action potentials in the His-Purkinje syndrome, an electrocardiogram tracing demonstrating a terminal R wave, and a QT interval nomogram.
This review contains 2 highly rendered figures, 9 tables, and 101 references.
Dystonia
Authors: Ramírez Gómez Carolina Candelaria , Calandra Cristian , Micheli Federico
Published: January 2021

Diagnosing dystonia requires a solid understanding of the phenomenology of this movement disorder as well as successful classification and a systematic search for the etiology. We describe the current definition, classification, and methodology for reaching an accurate diagnosis. This review covers the most relevant clinical features of disorders where dystonia is present, emphasizing the affected genes most recently identified, as well as other pathophysiologic factors involved in the generation of this condition. Finally, advances in medical treatment and surgery for dystonia are discussed.

Key words: antipsychotics, botulinum toxin, combined, deep brain stimulation, dopa-responsive dystonia, dystonia, focal, isolated, neurodegenerative, phenomenology, specific task, triggers
Radiculopathies and Neuropathies
Authors: Chuang Kathy , David William S
Published: January 2021

“Radiculopathies” are disorders of nerve roots, whereas “neuropathies” are disorders of the peripheral nerve. These disorders may involve single roots or nerves, multiple roots or nerves, and even other aspects of the nervous system. This chapter reviews the anatomy and pathophysiology of the peripheral nervous system; the general approach to radiculopathies and neuropathies, including clinical manifestations and localization, diagnostic studies, and treatment; radiculopathies, including anatomy, cervical radiculopathy, lumbosacral radiculopathy, thoracic radiculopathy, and cauda equina syndrome; and neuropathies, including  mononeuropathies and polyneuropathies. Tables describe the innervation of select nerve roots and peripheral nerves, differences between root and nerve lesions, commonly used neuropathic pain medications, distinctive patterns of neuropathy with limited differential diagnoses, differential diagnosis of demyelinating polyneuropathy, drugs that may cause polyneuropathy, and neuropathies associated with diabetes mellitus. Figures show the anatomy of a spinal segment, nerve fascicles, ultrasound images of the median nerve, magnetic resonance imaging of the lumbosacral spine, the Spurling maneuver, and physical examination maneuvers for lumbosacral radiculopathies.
This review contains 6 highly rendered figures, 8 tables, and 77 references.
Nutrition For The Healthy Adolescent
Authors: Cullity Lauren
Published: January 2021

Adolescents need proper nutrition to continue to grow and develop. There are many aspects to consider when providing nutrition to adolescents. In this review, we discuss adolescent nutritional needs and provide ways to assess and guide adolescents as they transition to adulthood. We also discuss the latest research regarding bone health, obesity, and eating disorders.

This review contains 2 figures, 7 tables and 43 references
Key words: adolescent, bone health, eating disorders, energy needs, female athlete triad, growth, nutrition, obesity, polycystic ovarian syndrome, puberty
Diet and Exercise in the Treatment of Obesity
Authors: Ariagno Meghan
Published: January 2021

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. 

This review contains 1 figure, 4 tables and 37 references
Key words: activity, calorie, carbohydrate, diet, dietitian, exercise, intervention, lifestyle, maintenance, obesity, portion, technology, weight
Disorders of Water and Sodium Balance
Authors: Sterns Richard H
Published: January 2021

Water accounts for approximately half of an adult human’s body weight. Two thirds of body water is intracellular, and the remaining one third is contained in the extracellular fluid compartment, which includes intravascular (plasma) and interstitial fluid. Small amounts of water are also contained in bone, dense connective tissue, digestive secretions, and cerebrospinal fluid. To maintain the stability of the internal milieu, body fluids are processed by the kidney, guided by intricate physiologic control systems that regulate fluid volume and composition. This chapter reviews the regulation of body fluid volumes, cell volume regulation in hypotonicity and hypertonicity, disorders of water excess (hyponatremia), water deficiency (hypernatremia), water conservation (diabetes insipidus), saltwater excess (edematous states), and saltwater deficiency (volume depletion). Tables describe control of body fluid volumes, causes of nonhypotonic hyponatremia, causes and treatment of acute hyponatremia, causes of the syndrome of inappropriate release of antidiuretic hormone (SIADH), and causes of hypernatremia. Figures illustrate sodium reabsorption by the renal tubules, the relationship between plasma vasopressin levels, renal sodium handling, and dose-response curves for a loop diuretic in patients with normal and reduced renal function.
This chapter contains 4 highly rendered figures, 5 tables, 88 references, and 5 MCQs.
Respiratory Acidosis and Alkalosis
Authors: Adrogué Horacio J , Madias Nicolaos E
Published: January 2021

Respiratory acid-base disorders are those disturbances in acid-base equilibrium that are expressed by a primary change in CO2 tension (Pco2) and reflect primary changes in the body’s CO2 stores (i.e., carbonic acid). A primary increase in Pco2 (and a primary increase in the body’s CO2 stores) defines respiratory acidosis or primary hypercapnia and is characterized by acidification of the body fluids. By contrast, a primary decrease in Pco2 (and a primary decrease in the body’s CO2 stores) defines respiratory alkalosis or primary hypocapnia and is characterized by alkalinization of the body fluids. Primary changes in Pco2 elicit secondary physiologic changes in plasma [HCO3ˉ] that are directional and proportional to the primary changes and tend to minimize the impact on acidity. This review presents the pathophysiology, secondary physiologic response, causes, clinical manifestations, diagnosis, and therapeutic principles of respiratory acidosis and respiratory alkalosis. 
This review contains 4 figures, 3 tables, and 59 references.
Key words: Respiratory acidosis, respiratory alkalosis, primary hypercapnia, primary hypocapnia, hypoxemia, pseudorespiratory alkalosis
Viral Nephropathies
Authors: Lai Kar Neng , SH Lai Andrew , Tang Sydney CW
Published: January 2021

Viral infections are important causative agents in renal disease and are responsible for significant morbidity and mortality. The diagnostic criteria for virus-related nephropathy include detailed clinical and laboratory data and tissue molecular analysis. Possible pathogenetic mechanisms include kidney tropism of the virus, induction of abnormal immune complexes, direct cytopathogenic effects, and multiorgan failure. Hepatitis B virus is associated with membranous nephropathy and mesangiocapillary glomerulonephritis in endemic areas. Hepatitis C virus causes various forms of glomerulonephritis, including cryoglobulinemia-mediated glomerulonephritis. HIV infection is associated with a collapsing focal segmental glomerulosclerosis, a distinctive disease that mainly affects Africans and African Americans. In the course of HIV infection, other types of immune complex glomerulonephritis may occur. Recent reports indicate a role for parvovirus B19 in idiopathic collapsing focal segmental glomerulosclerosis. Acute kidney injury occurs in hantavirus and coronavirus-associated severe acute respiratory syndrome. Of particular interest are those viral infections with productive replication in the kidney, which often occur in immunocompromised hosts, such as renal allograft recipients. Epstein-Barr virus, cytomegalovirus, adenovirus, and BK polyomavirus are prominent members of this group causing specific diseases. Renal biopsy followed by appropriate serologic and molecular testing is essential for defining virus-related nephropathies and guiding prognostic and therapeutic evaluation.
This review contains 4 figures, 3 tables, and 90 references.
Key words: BK polyomavirus, cytomegalovirus, glomerulonephritis, hepatitis B, hepatitis C, HIV-associated nephropathy, viral infection
Hypertensive Disorders in Pregnancy
Authors: Vellanki Kavitha , Hou Susan
Published: January 2021

Hypertensive disorders are the second leading cause of maternal mortality in the United States. Hypertension in pregnancy is defined as blood pressure greater than or equal to 140 mm Hg systolic or greater than or equal to 90 mm Hg diastolic, measured on at least two separate occasions. Preeclampsia, as per the new guidelines, is characterized by the new onset of hypertension and either proteinuria or other end-organ dysfunction, more often after 20 weeks of gestation in a previously normotensive pregnant woman. New-onset proteinuria is not required for diagnosis of preeclampsia if there is evidence of other end-organ damage—a change from previous classifications. Although no screening test has yet proven accurate enough to predict preeclampsia, the use of a combination of the serologic factors seems promising. There are few data to support any specific blood pressure target in pregnancy. Although there is a general consensus on treating severe hypertension in pregnancy, there is a difference of opinion on treating mild to moderate hypertension in pregnancy. Avoiding uteroplacental ischemia and minimizing fetal exposure to adverse effects of medications are as important as avoiding maternal complications from high blood pressure during pregnancy.
This review contains 2 figures, 4 tables, and 73 references.
Plasmapheresis
Authors: Madore François
Published: January 2021

Plasmapheresis has been applied over the last several decades as primary or adjunctive treatment for a number of primary renal diseases and systemic conditions with renal involvement. The present review discusses renal conditions for which plasmapheresis may be attempted with recommendations based on evidence from the literature. Other indications of special interest for renal physicians (e.g., sepsis and multiple organ failure, drug overdose, and poisoning) are also discussed. In addition, the present text reviews general apheresis principles, technical considerations for optimal plasmapheresis prescription, and possible complications of plasmapheresis. Knowledge of disease mechanisms and plasmapheresis principles is invaluable in applying a plasmapheresis treatment regimen appropriately.
Surgical Aspects of Kidney Transplantation
Authors: Seshadri Anupamaa , Malek Sayeed
Published: January 2021

Kidney transplantation is the treatment of choice for patients with end-stage renal disease. This review discusses the surgical aspects of kidney transplantation in detail, beginning with the important features of the preoperative evaluation of a potential transplant recipient. We then explain in detail the technical aspects of living donor nephrectomy and kidney transplantation and provide guidance for managing variability in donor organ anatomy. Immediate postoperative management of the kidney transplant patient is briefly discussed. Finally, this review addresses the important postoperative complications to be aware of in the kidney transplant patient and management strategies, as well as outcomes of kidney transplantation.
Key words: chronic kidney disease, deceased donor transplantation, delayed graft function, kidney transplant, living donor nephrectomy, living donor transplantation, lymphocele, renal artery stenosis, transplant workup, urologic complications
Cutaneous Manifestations of Systemic Diseases
Authors: Lebwohl Mark
Published: January 2021

This chapter reviews key cutaneous manifestations of systemic diseases that should be recognized by most physicians and highlights recent developments in the diagnosis and management of those disorders. In many of the disorders presented, workup and therapy of the underlying systemic condition are essential to a favorable outcome. Cardiopulmonary, vascular, endocrinologic, gastrointestinal, hematologic, immunodeficiency, infectious, neurologic, renal, and rheumatologic diseases are discussed. Many of the syndromes characterized by physical symptoms are accompanied by photographs demonstrating the manifestations for the reader's reference.
This chapter contains 28 figures, 104 references, and 5 Board-styled MCQs.
Complications of Diabetes Mellitus
Authors: Dagogo-Jack Samuel
Published: January 2021

The long-term complications of diabetes mellitus include retinopathy, nephropathy, and neuropathy. Diabetic retinopathy can result in loss of vision; nephropathy may lead to end-stage kidney disease (ESKD); and neuropathy poses the risk of foot ulcers, amputation, Charcot joints, sexual dysfunction, and potentially disabling dysfunction of the stomach, bowel, and bladder. Hyperglycemia sufficient to cause pathologic and functional changes in target tissues may be present for some time before clinical symptoms lead to a diagnosis of diabetes, especially in patients with type 2 diabetes. Diabetic patients are also at increased risk for atherosclerotic cardiovascular, peripheral vascular, and cerebrovascular disease. These conditions may be related to hyperglycemia, as well as to the hypertension and abnormal lipoprotein profiles that are often found in diabetic patients. Prevention of these complications is a major goal of current therapeutic policy and recommendations for all but transient forms of diabetes. This chapter describes the pathogenesis, screening, prevention, and treatment of diabetic complications, as well as the management of hyperglycemia in the hospitalized patient. Figures illustrate the pathways that link high blood glucose levels to microvascular and macrovascular complications; fundus abnormalities in diabetic retinopathy; the natural history of nephropathy in type 1 diabetes; cumulative incidence of first cardiovascular events, stroke, or death from cardiovascular disease in patients with type 1 diabetes; the effect of intensive glycemic therapy on the risk of myocardial infarction, major cardiovascular event, or cardiovascular death in patients with type 2 diabetes; and risk of death in patients with type 2 diabetes who receive intensive therapy of multiple risk factors or conventional therapy. Tables describe screening schedules for diabetic complications in adults, foot care recommendations for patients with diabetes, and comparison of major trials of intensive glucose control. This chapter has 238 references.
Idiopathic Inflammatory Myopathies
Authors: Miller Frederick W
Published: January 2021

The idiopathic inflammatory myopathies (IIMs), also known as myositis syndromes, are a collection of heterogeneous disorders that share the common feature of chronic muscle inflammation of unknown cause. These disorders may occur in adults or children and are sometimes associated with other connective tissue disorders and a variety of cancers. A combined clinical, laboratory, and pathologic evaluation is needed to establish the diagnosis of these acquired systemic connective tissue diseases to rule out the many disorders that mimic IIMs. This module reviews the classification of IIMs, including polymyositis, dermatomyositis, inclusion body myositis, myositis associated with other connective tissue diseases and cancer, and antisynthetase syndrome. The epidemiology; etiology, genetics, and environmental factors; pathophysiology and pathogenesis; diagnosis; differential diagnosis; treatment; and prognosis of IIMs are discussed. Tables describe the criteria for polymyositis, dermatomyositis, and inclusion body myositis; well-characterized subgroups of the IIMs in adults and children; presentation of polymyositis; differential diagnosis of muscle weakness or pain; features that assist in discriminating IIMs from other myopathies; goals for managing IIMs; and key factors for achieving adequate corticosteroid response in IIMs. Figures demonstrate skin findings in IIMs, muscle pathology of IIMs, magnetic resonance imaging of three patients with different IIMs, and treatment approaches to the management of myositis patients.
This review contains 4 highly rendered figures, 8 tables, and 80 references.
Practice of Genetics in Clinical Medicine
Authors: Korf Bruce R , Gallego Carlos
Published: January 2021

This review provides a general overview of the genetic approach in medical practice, discusses the principles of genetic testing, including interpretation of genetic tests and direct-to-consumer genomic testing, and looks at genetic counseling and approaches to treatment. The internist should become familiar with genetic disorders such as those associated with mutations in single genes or changes in chromosome number or structure. This is the traditional area of focus for medical geneticists and is likely to remain so. The internist should be familiar with basic principles of care for individuals with the more common of these conditions and needs to recognize clues that suggest the presence of these disorders, especially in family history. The section on genetics of common disorders focuses on pharmacogenetics, risk assessment, and prevention. Figures illustrate commonly used standard pedigree symbols and examples of autosomal recessive, autosomal dominant, X-linked recessive, and maternal inheritance. Tables offer different forms of genetic testing and types of gene mutations at genome and DNA levels.
This review contains 2 figures, 2 tables, and 83 references.
Myoclonus
Authors: Shibasaki Hiroshi , Koning-Tijssen Marina A J
Published: January 2021

Myoclonus is defined as sudden, brief, jerky, shocklike, involuntary movements involving the extremities, face, and trunk, without loss of consciousness. Myoclonus is one of the most commonly encountered involuntary movements, and it can be seen in association with a variety of conditions. This review covers  the epidemiology, classification, and diagnosis of myoclonus, as well as a thorough discussion of cortical myoclonus, myoclonus of brainstem origin, myoclonus of spinal cord origin, and myoclonus of undetermined origin. Figures show the principle of jerk-locked back-averaging, example data of jerk-lock averaging, schematic diagrams of cortical reflex myoclonus and spontaneous cortical myoclonus, a polygraphic electromyogram (EMG) recorded from a patient with postanoxic, reticular reflex myoclonus, surface negative slow electroencephalographic (EEG) potentials recorded before psychogenic jerks and voluntary movements mimicking the jerks in a patient with a diagnosis of psychogenic truncal movements, and an EEG-EMG polygraph in a patient with Creutzfeldt-Jakob disease. Tables list the classification of myoclonus based on the estimated site of origin, causes of cortical myoclonus, and causes of progressive myoclonus epilepsy and gene abnormalities.
 
Key words: cortical myoclonus, EEG-EMG polygraph, epilepsy syndromes, involuntary movements, myoclonus
 
This review contains 6 highly rendered figures, 3 tables, and 63 references.
Prevention and Management of Obstetric Perineal Lacerations
Authors: Hesham Helai , Berkowitz Lori R
Published: January 2021

Vaginal deliveries vary widely in the trauma they may introduce to the pelvic floor as does the management of such trauma. Labor, operative deliveries, lacerations, and episiotomies all present unique risk factors for both acute and long-term pelvic floor complications. Of these risk factors, perineal lacerations are the most commonly encountered event that women experience during vaginal childbirth. This review attempts to analyze obstetric perineal lacerations, their management, and potential prevention strategies to enhance pelvic floor health. With standardized management based on evidence based strategies and care during both delivery and postpartum, clinicians can decrease higher order lacerations and their possible sequela.

This review contains 12 figures, 1 table and 36 references
Key Words: episiotomy, laceration, laceration repair, obstetric, operative delivery, perineal massage, prevention, pudendal block
Cardiovascular Disease in Pregnancy
Authors: Emerick Lindsay E , Foley Michael R
Published: January 2021

Cardiovascular disease in pregnancy is present in 0.1 to 4.0% of those in developed countries and 0.6% in developing countries. It accounts for 18% of ICU admissions in the United States. The incidence is increasing due to increases in obesity, hypertensive diseases, advanced maternal age, and repair of complex congenital heart diseases. The physiologic changes to the cardiovascular system lead to a state of high flow and low resistance in pregnancy. This causes physical exam findings that mimic cardiac disease in pregnancy, making the diagnosis, treatment, and management of cardiac disease even more difficult for clinicians. Each cardiac disease poses unique risks and potential complications during pregnancy, labor, delivery, and postpartum. Preconception counseling, complete understanding of physiologic changes to the cardiovascular system during pregnancy, multidisciplinary team approach, and delivery in a tertiary care center are the keys to the successful management of patients with cardiac disease in pregnancy.

This review contains 4 figures, 6 tables, and 45 references. 
Key Words: aortic stenosis, cardiac disease, cardiac risk assessment, congenital heart disease, endocarditis prophylaxis, Marfan syndrome, mechanical valve, mitral stenosis, pregnancy, pulmonary arterial hypertension
Neurologic Diseases in Pregnancy
Authors: Johnson Emily L , Kaplan Peter W
Published: January 2021

Neurologic conditions commonly affect women during pregnancy. The severity of some chronic conditions, such as headaches, epilepsy, and multiple sclerosis, may be affected by pregnancy. Due to teratogenicity, some medications used prior to pregnancy should be avoided or used at a lower dose during pregnancy. The physiologic changes of pregnancy put women at risk for new neurologic conditions, including posterior reversible encephalopathy syndrome, venous sinus thrombosis, and restless legs syndrome. Compression neuropathies may arise during pregnancy or delivery. Increased experience with neuroimaging has provided reassurance that magnetic resonance imaging may be used safely during pregnancy.

This review contains 7 figures, 7 tables, and 30 references
Key Words: epilepsy, headache, multiple sclerosis, myasthenia gravis, neurology, neuropathy, pregnancy, posterior reversible encephalopathy syndrome, stroke, venous sinus thrombosis
Cervical Insufficiency and Cervical Cerclage
Authors: Mhatre Mohak , House Michael
Published: January 2021

Preterm birth causes significant morbidity and mortality among newborns and is a financial burden on the healthcare system. One etiology for extreme prematurity is cervical insufficiency, a mechanical failure of normal cervical function, resulting in painless cervical dilation in the second trimester. The exact mechanism is unknown, but current research suggests that cervical insufficiency is caused by a combination of subclinical infection and inflammation, along with structural changes in the cervical stroma. Cervical changes associated with cervical insufficiency are gradual, beginning with changes occurring at the level of the internal os that lead to cervical shortening and subsequent cervical dilation. There are several risk factors that can be identified by clinical history and physical exam to stratify patients at risk. Cervical shortening is seen using transvaginal or transperineal ultrasonography, and evidence-based guidelines for screening high-risk patients for cervical shortening are available. The treatment for cervical insufficiency is cerclage placement. Deciding which patients benefit from cerclage can be complex and involves consideration of obstetric history, clinical presentation, and cervical length.
This review contains 10 figures, 1 table, and 72 references.
Key Words: abdominal cerclage, cervical funneling, cervical insufficiency, cervical length measurement, cervical shortening, dynamic cervix, preterm birth, transvaginal cerclage, TYVU progression
Post-term Pregnancy: Epidemiology, Outcomes, and Management
Authors: Caughey Aaron B
Published: January 2021

The term pregnancy ranges from 37 and 0/7 weeks’ gestation to 41 6/7 weeks’ gestation; a pregnancy that progresses to 42 weeks and beyond is deemed a postterm pregnancy. Such pregnancies are uncommon, in well dated pregnancies, likely less than 3-5 percent. However, because of induction of labor, in the United States it is less than 1%. Postterm pregnancy is associated with a number of complications including stillbirth, meconium, both fetal growth restriction and fetal macrosomia, birth injury, preeclampsia, cesarean delivery, operative vaginal delivery, chorioamnionitis, and postpartum hemorrhage. One of the primary reasons for induction of labor prior to 42 weeks is that it has been associated with a lower risk of many of these complications including cesarean delivery. In women who do not wish to undergo induction of labor, antenatal testing is indicated certainly by 41 weeks of gestation and is commonly used at earlier gestations. 
This review contains 1 table, 2 figures and 83 references
Key words: cesarean, induction, late term, acrosomia, meconium, postterm, stillbirth, term
Conventional Karyotype and Fluorescence in situ Hybridization (FISH) Technology
Authors: Cowan Janet M.
Published: January 2021

Karyotype analysis of cells has been in use for many years and has led to the causative genetic change in numerous clinical syndromes, including trisomy 21, Klinefelter, Turner, Prader-Willi and Angelman syndromes. The resolution of the test depends on the degree of condensation of the chromosomes in the karyotype, but even at high resolution (> 800 bands per haploid set) the changes identified are in the order of 5 Mb of DNA.  Fluorescence in situ hybridization (FISH) bridges the gap between the relatively low resolution of karyotype analysis and the very high resolution of DNA analysis. With FISH it is possible to identify smaller changes in individual cells. The size of the change identified correlates with the size of the probe, which vary from 120 kb to 600 kb in size. FISH is widely used to confirm deletions or duplications identified by newer methods, such as array analysis.  
This review contains 8 figures, 3 tables, and 25 references.
Keywords: Cytogenetics, chromosome, karyotype, chromosomal resolution, tissue culture, fluorescence, hybridization, probe
Inborn Errors of Metabolism
Authors: Dean S. Joy
Published: January 2021

Inborn errors of metabolism are a group of inherited disorders that are generally due to a block in an enzymatic pathway. In the past, individuals with inborn errors of metabolism were mainly isolated to the pediatric population. However, with the advent of newborn screening and improved treatment strategies, these patients are now reaching childbearing age. Many successful pregnancies in females with various inborn errors of metabolism have been reported. It is pertinent that obstetrician gynecologists are aware of these conditions and their management guidelines. This review will discuss three main categories of inborn errors of metabolism including protein metabolism disorders, carbohydrate metabolism disorders, and lipid metabolism disorders.
This review contains 5 tables, and 30 references.
Keywords: Inborn errors of metabolism, phenylketonuria, maternal PKU syndrome, ornithine transcarbamylase deficiency, galactosemia, fatty acid oxidation disorders
Pessary Management for the General Gynecologist
Authors: Dahl Molly , Zeno Aldene
Published: January 2021

Pessaries are vaginal support devices that come in a variety of shapes and sizes. The purpose of this book chapter is to describe the indications, management, outcomes, and complications associated with pessaries for the general practitioner. A review of the pessary is provided. Information is based on primary literature, systematic reviews, and current expert opinion. Pessaries are most commonly used for pelvic organ prolapse and stress urinary incontinence. They are easy to place and have minimal serious side effects. The majority of women can be successfully fitted with a pessary in the outpatient setting. Pessaries improve vaginal bulge symptoms, urinary complaints, body image, and quality of life for women with pelvic floor disorders. Therefore, pessaries are safe and effective options for the management of pelvic floor disorders and should be offered to patients with pelvic organ prolapse and stress urinary incontinence.
This review contains 5 tables, 6 figures and 30 references.
Key Words: conservative management, Gellhorn pessary, pelvic organ prolapse (POP), ring pessary, SUI, urinary urgency, vaginal exam
Nonsurgical Management Options for Pelvic Organ Prolapse: Review of the Current Evidence
Authors: Kow Nathan
Published: January 2021

Pelvic organ prolapse (POP) is a common disorder that impacts a woman’s quality of life and has been projected to increase in the near future. Although many different treatments are currently available, healthcare practioners should be familiar with the common nonsurgical options that are considered the first-line therapy. Advances in nonsurgical interventions have traditionally included pessaries and pelvic floor muscle therapy.  These optiosn have not changed much over time, however there have been recent trials providing more evidence with regards to their efficacy.  The objective of this article is to review the current evidence for nonsurgical treatment options for POP.

 This review contains 2 tables and 19 references
Key Words: pelvic floor muscle training, pelvic floor physical therapy, pelvic organ prolapse, pessary, kegel excercises, uterine prolapse, cystocele, rectocele
Baastrup Disease/Interspinous Bursitis
Authors: Cheng Jianguo , Xu Jijun
Published: January 2021

Baastrup disease (BD), an uncommon back pain syndrome, is characterized by pathologic approximation of adjacent spinous processes on a sagittal plane image. BD occurs most commonly at the lumbar L4-L5 level and tends to be more common in the elderly. The etiology is not precisely known, but BD may develop secondary to chronic active inflammatory facet arthropathy, leading to interspinous osteophytes and approximation of the adjacent spinous processes. Clinically, BD should be considered in the differential diagnosis of back pain if there is (1) midline back pain reproduced with palpation of the spinous process and exacerbated by extension of the lumbar spine and (2) direct contact of adjacent spinous processes on the lateral view of a plain x-ray image. Magnetic resonance imaging is more sensitive in detecting interspinous inflammation and the formation of bursa and new bone. Major differential diagnoses of BD include proliferative hyperostosis of the lumbar spinous processes, degenerative disease of the spine, sclerotic bone metastases to the spine, and ankylosing spondylosis. BD can be managed initially with nonsteroidal antiinflammatory drugs, a short-term steroid dose pack, and physical therapy. Injection of a local anesthetic to the inflamed spinous process and associated interspinous ligaments may be diagnostic, and injection of a local anesthetic/corticosteroid combination may be therapeutic. Surgery is reserved for patients with refractory BD. Surgical options include interspinous process decompression devices and excision of the affected spinous processes.
Patient with Chronic Abdominal Pain from Pancreatitis
Authors: Cheng Jianguo
Published: January 2021

Early diagnosis of chronic pancreatitis is possible by combining clinical information with pancreatic function testing, endoscopic ultrasonography, histology, and traditional imaging techniques such as magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography (ERCP). Such an approach helps improve the sensitivity and specificity of these complementary modalities. Pain management of chronic pancreatitis involves multidisciplinary and multimodal approaches. Behavioral modifications such as alcohol cessation, nutritional optimization, and cognitive-behavioral therapy play a significant role for better long-term outcomes. Pharmacologic management is directed at relieving both psychological and physical symptoms, and combination pharmacotherapies are often needed to address pancreatic deficiency, abdominal pain, and psychological disorders. Interventional approaches to celiac plexus and splanchnic nerve blocks and denervation (radiofrequency ablation, endoscopic or surgical denervation) may provide significant and prolonged pain relief. Neuromodulation in the form of spinal cord stimulation is a viable option for long-term pain relief. Managing complications of chronic pancreatitis, such as gastrointestinal complications (peptic ulcer, bile duct stenosis), pseudocysts, malnutrition, depression, diabetes, and painful diabetic neuropathy, is an integral part of comprehensive treatment and requires close collaboration between members of a multidisciplinary team.  
This review contains 1 figures, 2 tables and 64 references
Key words: behavioral modifications, celiac plexus, chronic abdominal pain, chronic pancreatitis, interventional therapy, pharmacologic modulation, splanchnic nerves, surgical intervention
Physicians' Role in Curbing the Worst Drug Crisis in America: Prescription Opioid Abuse
Authors: Atluri Sairam , Sudarshan Gururau
Published: January 2021

Opioids have an important role in the management of acute, cancer, and chronic pain. However, their indiscriminate use in chronic pain has led, in part, to the epidemic of prescription drug abuse, resulting in a dramatic increase in morbidity and mortality in America. Most of this abuse originates from legitimate prescriptions by physicians. Prescribing opioids to chronic pain patients while restricting them to those who abuse them is very challenging, and physicians seek appropriate and unbiased prescribing guidelines. Our review, based on analysis of the available literature, focuses on striking a balance between overprescribing and underprescribing. The core concept of this strategy relies in using screening tools to identify patients who are at high risk for opioid abuse along with diligent monitoring using prescription monitoring programs and urine drug screens, while also limiting opioid doses. Hopefully, using these principles, physicians can more confidently prescribe opioids to those who would benefit from these powerful drugs and at the same time keep opioids away from those who could potentially be harmed.
This review contains 3 figures, 4 tables, and 98 references.
Key Words: abuse, addiction, chronic pain, dose limitation, misuse, monitoring, opioids, overdose, screening
Patient with a History of Active Substance Abuse Requesting Opioids for Chronic Pain
Authors: Kaye Alan D. , Carney Martin J , Jones Mark R. , Campbell Harold J. , Beakley Burton R.
Published: January 2021

Health care providers face a considerable challenge when treating chronic pain patients with prescription opioid medications. Although indications exist for the use of these drugs, their addictive nature and street value render them high-risk targets for abuse, misuse, and diversion. All patients receiving opioids should, therefore, be screened for abuse potential before beginning opioid therapy, be required to sign an opioid agreement, and receive close monitoring throughout the course of their treatment. Patients who present with a history of active substance abuse are at higher risk for iatrogenic dependence and necessitate more frequent monitoring. Herein arise several ethical issues, such as the principle of justice, which mediates equitable treatment for all patients. This review discusses the disease underlying substance abuse and clinical manifestations thereof, as well as relevant pathophysiology, ethical issues, and guidelines for the safe treatment with opioids.
This review contains 3 tables and 43 references.
Key Words: addiction, ethics, opioids, safety, substance abuse
Pharmacologic and Technological Innovations in Pain Medicine
Authors: Gupta Anita , Abubakar Hawa
Published: January 2021

The experience of pain is subjective, and treatment modalities should aim at providing the greatest amount of pain relief while minimizing adverse effects. Pharmacologic and technological innovations are making this possible. By taking advantage of new manufacturing processes, the pharmaceutical industry is retooling old and effective drugs. SoluMatrix diclofenac uses nanotechnology to address the need for an effective nonsteroidal antiinflammatory drug at the lowest possible dose to minimize risks associated with cardiac, renal, and gastrointestinal side effects. Intravenous acetaminophen provides an additional alternative in multimodal analgesia in instances when the oral or rectal route of delivery is not desirable. Liposomal bupivacaine uses liposomal encapsulated, resulting in a local anesthetic with a prolonged duration of action that can be used effectively in the management of postoperative pain. With the recognition that opioid therapy still remains a mainstay in pain management, advances in science have allowed for the development of peripherally acting mu opioid receptor antagonists such as naloxegol, which minimize the bothersome side effect of opioid-induced constipation. In terms of interventional pain management, advances in radiofrequency ablation (RFA) technology have resulted in cooled RFA, which allows for the creation of larger spherical lesions, thereby alleviating pain by interfering with neurotransmission. Advances in stem cell research have led to the application of multipotent cells with the aim of treating the underlying disease process and thereby eliminating pain. Finally, pharmacogenetics testing and smart drugs provide an avenue via which issues surrounding how medication is consumed, determination of effectiveness, and ensuring compliance and adherence can be optimized.
Key words: Pain, Pharmacology, Medications, Technology, Innovation, Smart Pills, Personalized Medicine, Biotechnology, Device, Surgery, Multimodal
Ketamine Infusions for Complex Regional Pain Syndrome
Authors: Esaki Roy K.
Published: January 2021

Ketamine is an N-methyl-d-aspartate (NMDA) receptor antagonist that has been increasingly used in the management of treatment-resistant chronic pain conditions, particularly representing neuropathic involvement or central sensitization. Complex regional pain syndrome (CRPS) is a prototypical condition often treated with ketamine infusions. Although the analgesic benefits of ketamine as an opioid-sparing adjunct in the preoperative period have been well studied, the use of ketamine to mitigate chronic pain conditions remains largely anecdotal, composed largely of case reports and uncontrolled small studies. The limited evidence and published reports support the use of ketamine infusions as one aspect of a comprehensive, multimodal approach for CRPS. Although ketamine infusions are relatively safe when titrated appropriately, with minimal respiratory depression, side effects include sympathetic activation, unpleasant psychomimetic effects, lower urinary tract symptoms, and hepatic dysfunction.
Unusual Drugs of Abuse in Chronic Pain Patients
Authors: Kaye Alan D. , Cornett Elyse , Fox Charles , Patil Shilpadevi , Siddaiah Harish , Creel Justin , Novitch Matthew B.
Published: January 2021

Chronic pain occurs in one third of the American population. Management of chronic pain is a growing area in health care; however, there is a dilemma for health care providers to treat the chronic pain of individuals who have known current or suspected drug abuse or addiction. Even if the individual is not addicted to opiates or prescription pain medications, it is possible to become addicted to a new substance. The National Institutes of Health considers drug addiction a neurophysiologic disease, and as of 2014, 24.6 million people in the United States abuse drugs. As more patients are seeking treatment for chronic pain, health care providers are seeing an increase in patients who have a history of drug abuse or addiction, and it is imperative that health care providers are aware of how best to care for these patients. This review discusses chronic pain and the drugs that are typically used to treat chronic pain, as well as drugs that have been reported to be abused in chronic pain patients. There are limited or no data available on the more recent designer drugs, such as bath salts, K2 (spice), and even common drugs of abuse, such as methylenedioxymethamphetamine (MDMA). More research should be conducted on what drugs are abused in chronic pain patients, especially nonopioid drugs such as stimulants. This information would help educate health care providers and create better pain treatment regimens for patients who abuse drugs.
Key words: chronic pain, drug abuse, marijuana, methamphetamine, opioids