bluuebunny/crossref_metadata_2025 huggingface dataset:
ASYMPTOMATIC ANOMALOUS LEFT CORONARY ARTERY FROM THE PULMONARY ARTERY (ALCAPA) IN AN ADULT.
Authors: Dimitri Demetrio Sharp , Panakos Andrew , Alfonso Carlos , Orozco-Sevilla Vicente
Published: January 2021

We describe a patient in whom this anomaly was diagnosed during cardiac
catheterization for evaluation of progressive shortness of breath and
mild to moderate mitral regurgitation founded on a transthoracic
echocardiogram.A 58-year-old hypertensive female was evaluated for
progressive shortness of breath. Her physical examination showed a
regular heart rate and rhythm, with normal heart sounds with a
holosystolic systolic murmur on the 4th intercostal midclavicular line
on auscultation. Electrocardiography showed normal sinus rhythm and
criteria and possible left ventricular hypertrophy. Stress
Echocardiogram showed with no evidence of ischemia preserved left
ventricular function with an ejection fraction of 55-60%, with mild to
moderate mitral regurgitation. Patient underwent a coronary
catheterization for persistent shortness of breath which indicated no
evidence of obstructive coronary disease, normal left ventricular
function with mild to moderate mitral insufficiency. Angiography of the
right coronary artery showed a very large and tortuous artery that
collateralizes into the left main system and supplies the entire left
coronary artery system. The left main coronary origin was from the
pulmonary artery. CTA confirmed the same findings. The recommendations
between cardiology and cardiothoracic surgery were to maximize medical
therapy and follow up due to lack of myocardial ischemia or severe
valvular disease. Currently there are no guidelines or gold standard
management for patients with adult form of ALCAPA that present without
ischemic burden or for patients with the disease that present
asymptomatic with significant coronary collateralization.
Roles of host mitochondria in the development of COVID-19 pathology
Authors: Srinivasan Kavya , Pandey Ashutosh , Venkatesh Sundararajan
Published: January 2021

The recent emergence of Severe Acute Respiratory Syndrome-Corona Virus 2
(SARS-CoV-2) in late 2019 and its spread worldwide caused an acute
pandemic of Coronavirus disease 19 (COVID-19). COVID-19 pathologies are
currently under intense scrutiny as its outbreak led to immense and
urgent changes worldwide. Although many theories have been introduced on
how SARS-CoV-2 enters the host, the ACE-2 receptor is shown to be the
primary mechanism of SARS-CoV-2 entry. However, the mechanism behind the
establishment and pathology of infection is poorly understood. As recent
studies show that host mitochondria play an essential role in
virus-mediated innate immune response, in this review, we will discuss,
in detail, the entry and progression of SARS-CoV-2 and how mitochondria
play a role in the establishment of viral infection and the development
of an immune response, whether it is beneficial or not. We will also
review the possible treatments that could be used to prevent the
surgency of COVID-19 infection with respect to the role of mitochondria.
Understanding the mitochondria-mediated SARS-CoV-2 establishment may
provide a unique mechanism and conceptual advancement in finding a novel
treatment for COVID-19.
Efficiency of Niche Agriculture in Ukraine
Authors: Cherevko Heorhiy , Cherevko Iryna
Published: January 2021

The deepening of the dualization of Ukraine's agriculture into "large" and "small" producers force the latters to search opportunities for competitive opposition to the firsts by intensive development of niche agriculture. The purpose of the study is to present the efficiency of niche agriculture in Ukraine, describing the main features of this branch and anticipating prospects and barriers to stable development. There are few scientific publications on this topic so far, so their use in the study was quite limited. Materials of specialized scientific conferences and publications of materials of practitioners are more widely used. The research methodology includes general methods (monographic, induction and deduction, analysis and synthesis, scientific generalization and abstraction) as well as economic research methods (comparisons, indexes). The results show, that niche agriculture in Ukraine is especially relevant for small farms, which can increase profitability not because of the number of products, but because of its niche character. Niche agriculture has advantages and disadvantages, so there is no reason to absolutize it as a panacea for all the problems of the small producers. The barriers to develop niche agriculture in Ukraine: the lack of the culture of consumption, of technology and of knowledge of niche products marketing.
Genetically Modified Crops’ Technology and its Awareness among Smallholder Farmers in Nigeria
Authors: Obi-Egbedi Ogheneruemu , Ogungbite Omowunmi , Oluwatayo Isaac
Published: January 2021

Genetically Modified (GM) crops are crops modified through genetic engineering to improve their quality. Although safety concerns about genetically modified organisms (GMOs) are still being debated, the food security benefits have led to adoption by many counties. In Nigeria, where most farmers are uneducated and likely unaware of the agricultural technology, the government approved its first biotechnology crop for commercialization in 2018. Level of farmers’ awareness is crucial to acceptance of GM crops, although; this has not been fully explored in the literature. Therefore, this study aimed to assess farmers’ awareness for GM crops and the factors that determine their awareness in Oyo state, Nigeria, using primary data collected in 2018 with the aid of well-structured questionnaires from 242 smallholder farmers. Principal component analysis and Tobit regression model were used for data analysis. Results showed that farmers were aged 43 years with farm size of 3.57 ha, farming experience of 14 years and 11 years of education. Most farmers were male (71.90%), married (67.36%), not members of farmer groups (64.46%) and sourced their seeds from non-credible sources (85.12%). Most farmers (52.07%) had either not heard of or did not know of any benefits/costs of GM crops, hence; were not aware of GM crops. Factors that influenced awareness of GM crops were being a male farmer, years of education and source of seeds. The study concluded that increasing years of education and ensuring use of credible seed sources will increase awareness of the costs and benefits of GM crops among farmers.
The impact of agroecological factors on morphological traits of maize
Authors: Tabakovic Marijenka , Secanski Mile , Stanisavljevic Rade , Mladenovic-Drinic Snezana , Simic Milena , Knezevic Jasmina , Oro Violeta
Published: January 2021

Climate changes are one of the crucial issues of modern agriculture. These
changes imply the increase in average temperatures and the frequent
occurrence of temperature extremes. Such conditions are stressful to maize
concerning the expression of its traits. This paper presents the analysis
of the maize yield concerning the yield components, morphological and
chemical traits under various agroecological conditions. The objective of
the study was to evaluate variability of grain yield (GY) and yield
components (ear length, EL and number of kernel rows, NKR), morphological
traits (plant height, PH and ear height, EH), as well as chemical traits (the
whole plant dry matter, PDM and the ear dry matter, EDM), and the effect of
the environment on the intensity of expression of these traits. Fifteen
genotypes developed by crossing of six inbred lines were used as a material
in the study carried out during the two-year period in one location.
Obtained results indicate that traits were more pronounced in maize hybrids
than in the parental components including the lower variability of the
traits expression. NKR did not affect the yield unlike the EL, whose
coefficient of determination was R2 = 0.600 in both production years. The
environmental effect was high for all traits except NKR. PDM and EDM were
closely related to PH and EH, but they also depended on the EL and the NKR.
Variations in meteorological conditions have a significant impact on the
final goal of the production, the yield. Prevailing agro-ecological
conditions should be a major guideline in planning the crop production and
selecting the genetic material.
Genome profiling of differential salt stress responsive landraces and varieties of rice using ISSR markers
Authors: Kumari Rima , Kumar Pankaj , Sharma V.K. , Kumar Harsh
Published: January 2021

Using 14 ISSR primers for molecular profiling in relation to salinity
tolerance of 18 landraces and varieties of rice, altogether 483 allelic
variants including 236 shared and 247 unique alleles were generated with an
average of 34.50 alleles per primer, revealing ample genetic differentiation
and divergence amongst the entries under evaluation. Every primer generated
polymorphic amplified products, but only 12 out of 14 primers yielded unique
products. The primers having (AG)8YT, (CT)8A, (AG)8YA, (GA)8YT, (GA)8YC,
(CT)8G, (TC)8C, (GATA)4 and (GA)8YG repeat motifs recorded relatively higher
polymorphism per cent expressed in terms of the percentage of unique alleles
in descending order of magnitude. Polymorphism information content of the
primers varied from 0.612 to 0.992 for the primers (GACA)4 and (AG)8YA,
respectively, with an average of 0.919 across the primers. Comparatively
higher numerical values were obtained in respect of the primers (GA)8C,
(CT)8A, (CT)8G, (TC)8C, (TC)8G, (AG)8YT, (AG)8YA, (GA)8YT, (GA)8YC, (GA)8YG
and (GATA)4 amongst all the primers, reflecting their greater allelic
richness and diversity. Poly-GA containing anchored primers produced the
highest number (44.8) of allelic variants per primer followed by poly-CT,
poly-AG and poly-TC containing anchored primers. But, the highest mean
polymorphism per cent, highlighting the proportion of unique alleles, was
exhibited by poly-AG followed by poly-GA, poly-CT and poly-TC containing
anchored primers Clustering based on only poly-GA and poly-AG containing
anchored primers provided more efficient genotypic discrimination in
relation to salt stress responsiveness of the rice varieties. Moreover, a
panel of only three poly-AG containing anchored primers facilitated perfect
discrimination of rice varieties in accordance with their responsiveness to
salinity stress. These primers can be efficiently utilized as functional
instruments for connecting genotypic and phenotypic differences in relation
to salt stress responsiveness. Principal coordinate analysis completely
supported the results obtained from hierarchical classification of the
landraces and varieties.
Polymorphic status and phylogenetic analysis of myostatin gene in pak-thoroughbred
Authors: Raza Zeshan , Nadeem Asif , Javed Maryam , Hassan Faiz-Ul , Shehzad Wasim , Ahmad Arfan , Saadullah Muhammad , Ali Muhammad
Published: January 2021

Myostatin is a protein translated by the the MSTN gene (also known as GDF8),
is responsible for limiting muscle growth and strength. In thoroughbred
horse (Equus Caballus), limited studies have been designed to examine the
variants in the coding region of MSTN gene. However, no data is available
regarding the single nucleotide polymorphisms (SNPs) of the MSTN about
racing performance in thoroughbred horses of Pakistan. In this study blood
samples of fifteen Pakistani thoroughbred horses were collected from Race
Club Lahore and immediately transferred into the ice box. The DNA was
extracted by using phenol-chloroform method. Primers were designed for the
amplification of all exons of the MSTN gene. The amplified PCR products were
precipitated and sequenced for the identification of SNPs. SNPs were
identified by visualizing the peaks of sequenced data by using Chromas
Software. Phylogenetic analysis of MSTN gene in Pak-thoroughbred with racing
species and some breeds of horses like Marwari Indian breed, Sindhi breed,
Kathlawari breed, Italian breed and Chines breed was done separately by
using MEGA 6 software. The analysis of identified SNPs were carried out by
software SNPator. The sequenced data with altered protein was published in
GenBank with accession number MN604194. Results have shown a total of 3
single nucleotide polymorphisms through Blast with reference sequences. Two
SNPs were found in exon 2 at position of 2406 (C/T) and 2408 (C/T)
respectively. One SNP (T/C) was detected in exon 3 at the position of 4661.
In conclusion, Pak-thoroughbred horse population has 3 polymorphisms in
their coding region which can be used as a biological marker for athletic
abilities in Pak- thoroughbred.
Fruit maturity stage in relation to content of polyphenols, flavonoids and antioxidant activity of selected clones of Lonicera kamtschatica (Sevast.) Pojark
Authors: Juríková Tünde , Mlcek Jiří , Zitná Marcela , Hlavácová Irena , Dokoupil Libor , Sochor Jiří , Ercisli Sezai , Ozkan Gursel
Published: January 2021

The article is dealing with evaluation of four fruit maturity stages of 6
selected clones (LKL-3, LKL-14, LKL-19, LKL-33, LKL-96 and LKL-103) of
Lonicera kamtschatica (Sevast.) Pojark in relation to total polyphenols,
flavonoids content and antioxidant activity of berries. The experiment in 5
replications of each clones has been established in the conditions of
Botanical Garden in Nitra (Slovak republic)in 2016. The results of analyses
proved that in respect of the total polyphenols content (TPC), the content
of flavonoids (FC) and the antioxidant activity the most valuable clones at
the stage of full ripened fruit were following: LKL-14 (8.77; 2.57 g/kg FW;
9.07 g/kg), LKL-33 (6.77; 2.84 g/kg FW; 9.16 g/kg) and LKL -3 (8.19; 2.61
g/kg FW; 8.94 g/kg). The results of statistical analyses by one-way analysis
of variance proved significant differences among assayed clones in total
flavonoids and antioxidant activity of fruit but no differences among
content of total polyphenols and assayed stages of fruit maturity.
Simultaneous ipsilateral rhabdoid renal cell carcinoma and multifocal urothelial carcinoma of the ureter in a patient from the region of Balkan endemic nephropathy: Case report and literature review
Authors: Basic Dragoslav , Jankovic-Velickovic Ljubinka , Ignjatovic Ivan , Hadzi-Djokic Jovan , Veljkovic Andrej
Published: January 2021

Introduction. Simultaneous ipsilateral coexistence of renal cell carcinoma (RCC) and upper urinary tract urothelial carcinoma (UTUC) rarely occurs. Balkan endemic nephropathy (BEN) is a chronic degenerative tubulointerstitial renal disease, strongly associated with UTUC. Case outline. ? 60-year-old man from the region of BEN was referred to our clinic due to right flank pain, fever, and purulent discharge from the cutaneous fistulous opening in the right lumbar area. Multislice computed tomography urography scan showed right-side pyonephrosis and nephrocutaneous fistulous tract between the kidney and the skin in the right lumbar region. Cystoscopy detected a papillary tumor protruding from the right ureteric orifice. Right-side nephroureterectomy with bladder cuff excision was performed. Histopathological examination revealed rhabdoid RCC of the kidney and multifocal urothelial carcinoma of the ureter. Conclusion. Our case report and literature review indicate that due to rising incidence of multiple primary malignant neoplasms (MPMNs), when treating patients with RCC or UTUC, and especially those from the region of BEN, one should keep in mind the likelihood of synchronous or metachronous occurrence of these tumors.
Optimal control policy to production and inventory system with promotion effort dependent demand in segmented market
Authors: Mehta Sunita , Chaudhary Kuldeep
Published: January 2021

Increased competition in market leads to the interaction between marketing and production of a firm in segmented market. This paper considers the problem of finding an optimal promotion and production strategy, where the consumer demand rate depends on differentiated and mass promotion efforts. Differentiated promotions can reach each segment independently and mass promotion reaches it with a fixed segmentspectrum. Under reasonable conditions, two optimal control problems are formulated. The first one considers a single source inventory and multi-segmented demand problem. In the second, a multi-segmented inventory and demand problem is considered, where it is assumed that the firm chooses an inventory directed to each segment. The solution to both problems is obtained by using Pontryagin?s maximum principle. Numerical examples are provided to illustrate the applicability of proposed models. The discretized version of the problem is formulated and solved on some numeric data.
Rehabilitation of Geriatric Patients
Authors: Studenski Stephanie , Brown Cynthia R. , Hardy Susan E.
Published: January 2021

Primary care physicians play an important role in the rehabilitation of geriatric patients: they must be able to assess rehabilitation potential, determine specific patient needs, and then determine the appropriate setting to optimize patient care. Rehabilitation service planning is usually based on a different model of diagnosis and treatment than traditional medical care. This chapter describes the key aspects of rehabilitation planning for stroke, amputation and peripheral vascular disease, hip fracture, rheumatoid arthritis, and arthroplasty. The revised World Health Organization International Classification of Functioning, Disability and Health (ICIDH-2), included in a figure, can be used to assess the causes of disability, plan treatment approaches, and determine the outcomes of care. Tables describe selected results of the neurologic examination of a patient with stroke, assessment and management of complications of stroke and other disabling conditions, and pharmacologic therapy for poststroke depression. An algorithm shows the selection of the appropriate setting for rehabilitation after hospitalization for acute stroke. The Orpington Prognostic Scale for estimating stroke recovery is provided, as is a list of current Internet resources pertaining to geriatric care. This chapter contains 96 references.
Medical Complications in Pregnancy
Authors: Seely Ellen W. , Ecker Jeffrey L.
Published: January 2021

Medical complications and intercurrent disease have long presented challenges to obstetricians and other medical providers caring for pregnant women. Contemporary medical practice and treatments have only added to these challenges. Advances in disease management mean that patients with some conditions (e.g., cystic fibrosis) whose life expectancies in the past would have precluded pregnancy are now living to reproductive age. Furthermore, treatments to restore fertility allow the barrier of age, as well as anatomic and genetic barriers, to be surmounted. All of these advances emphasize the need for careful and considered collaboration between clinicians caring for women of reproductive age who are not pregnant and those who care for them during pregnancy. This review discusses pregnancy planning and counseling, principles of teratogenesis, physiologic changes in pregnancy, cardiovascular disease, diabetes mellitus, thyroid disease, thrombophilia, asthma, infectious diseases, renal disease, autoimmune diseases, cancer, neurologic diseases, substance use, intrahepatic cholestasis, and pregnancy-specific conditions. Tables list elements of preconception care and counseling, the Food and Drug Administration drug classification system for pregnancy, selected drugs with suspected or known teratogenic potential, and physiologic changes of pregnancy.
This review contains 15 tables and 83 references.
Key Words: Headache, maternal mortality, obstetric medicine, pregnancy, pulmonary embolism
Menopause
Authors: Reed Susan D. , Sutton Eliza L.
Published: January 2021

The female reproductive system matures in a continuous, natural process from menarche to menopause as the finite numbers of oocytes produced during fetal development are gradually lost to ovulation and senescence. Menopause is defined as the permanent cessation of menses; by convention, the diagnosis of menopause is not made until the individual has had 12 months of amenorrhea. Menopause is thus characterized by the menstrual changes that reflect oocyte depletion and subsequent changes in ovarian hormone production. However, hormonal changes, rather than the cessation of menstruation itself, cause the manifestations that occur around the time of menopause. Therefore, a woman who has undergone a hysterectomy but who retains her ovaries can experience normal menopausal symptoms as oocyte depletion leads to changes in estrogen levels, even though cessation of menstruation occurred with surgery. This review covers definitions, natural menopause, menopausal transition and postmenopausal symptom management, and premature ovarian insufficiency. Figures show stages of reproductive aging, serum concentrations of hormones during menopausal transition and postmenopause, hormonal changes associated with reproductive aging, symptoms of menopausal transition and menopause, treatment algorithm(s), and Women’s Health Initiative findings: risks and benefits of estrogen alone and estrogen plus progestin by age group: 50 to 59, 60 to 69, and 70 to 79 years. Tables list target tissues, physical manifestations, and menopausal symptoms; selective estrogen receptor modulators used in postmenopausal women; differential diagnosis and evaluation of common menopausal symptoms; estrogen doses; progestogen dosing for endometrial protection; nonhormonal pharmaceutical hot flash therapies; and pharmacologic therapy for genitourinary atrophy.
This review contains 6 figures, 8 tables, and 122 references.
Medical Evaluation of the Surgical Patient
Authors: Gerhard-Herman Marie , Gates Jonathan
Published: January 2021

Medical evaluation prior to surgery includes risk assessment and the institution of therapies to decrease perioperative morbidity and mortality to improve patient outcomes. The most effective medical consultation for surgical patients begins with an assessment of the individual patient and knowledge of the planned surgery and anesthesia followed by clear communication of a concise and specific recommended plan of perioperative care to the surgical team. This chapter describes anesthetic, cardiac, pulmonary, hepatic, nutritional, and endocrine risk assessment. Perioperative thrombotic management and postoperative care and complications, including fluid management; pulmonary, cardiac, renal complications; and delirium are discussed. Tables outline the American Society of Anesthesiologists class and perioperative mortality risk, a comparison of the Revised Cardiac Risk Index and National Surgery Quality Improvement Program, Duke Activity Status Index, high-risk stress test findings, markers for increased perioperative risk in pulmonary hypertension, aortic stenosis and nonemergent noncardiac surgery, risk factors for pulmonary complications in noncardiac surgery, the Model for End-Stage Liver Disease score to predict postoperative mortality, venous thromboembolism risk factors and options for pharmacologic prophylactic regimens, perioperative management of warfarin, and Brigham and Women’s Hospital guidelines for postoperative blood product replacement. Figures include a care algorithm for noncardiac surgery, an illustration of types of myocardial infarction, and an algorithm for the treatment of postoperative delirium.
This chapter contains 3 highly rendered figures, 12 tables, 68 references, and 5 MCQs.
Disorders of Hair
Authors: Del Rosso James Q
Published: January 2021

A basic knowledge of the hair growth cycle is needed to evaluate disorders of hair growth. This chapter presents a broad overview of the physiology and evaluation of hair growth, as well as discussions of specific types of alopecia. The epidemiology, pathogenesis, diagnosis, and treatment of androgenetic alopecia, the most common type of nonscarring hair loss, are covered. Diffuse hair shedding is generalized hair loss over the entire scalp. Diagnosis and treatment of telogen effluvium, anagen arrest (anagen effluvium), and other causes of diffuse hair shedding are covered in detail. Alopecia areata, typically characterized by patchy hair loss; cicatricial alopecia, which results from permanent scarring of the hair follicles; and miscellaneous causes of hair loss are also discussed. Tables list the causes of diffuse and cicatricial alopecia, telogen effluvium, and miscellaneous chemicals and categories of drugs that can cause alopecia, as well as miscellaneous causes of hair loss. Included is an algorithm outlining the approach to diagnosing nonscarring alopecia, as well as a variety of clinical photographs.
This review contains 9 highly rendered figures, 6 tables, and 42 references.
Disorders of Pigmentation
Authors: Grimes Pearl E.
Published: January 2021

The disorders of skin pigmentation discussed in this chapter fall into two categories: disorders of hyperpigmentation (melasma, postinflammatory hyperpigmentation, drug-induced hyperpigmentation, erythema dyschromicum perstans, lentigines, confluent and reticulated papillomatosis of Gougerot and Carteaud, and Dowling-Degos disease) and disorders of hypopigmentation (vitiligo, albinism, piebaldism, and idiopathic guttate hypomelanosis). The definition, epidemiology, etiology and pathogenesis, diagnosis, differential diagnosis, and treatment are discussed for each condition. Figures show examples of melasma, hyperpigmentation secondary to acne, vitiligo and its response to treatment with tacrolimus and with narrow-band ultraviolet B (UVB) light, Vogt-Koyanagi-Harada syndrome, and piebaldism. A table lists therapeutic approaches to vitiligo. This chapter contains 182 references.
Hypoglycemia
Authors: Service F John , Vella Adrian
Published: January 2021

Hypoglycemia is a clinical syndrome that has diverse causes and is characterized by episodes of low blood glucose and typically marked by autonomic and neuroglycopenic manifestations. This review discusses the classification, etiology, and diagnosis for hypoglycemia, including the Whipple triad, and the classic diagnostic test, the prolonged (72-hour) fast. Specific attention is given to the conditions that cause hypoglycemia, including insulinomas, factitious hypoglycemia, insulin autoimmune hypoglycemia, and post–gastric bypass hypoglycemia, as well as the diagnosis and management of these conditions. 
This review contains 2 figures, 6 figures, and 43 figures. 
Keywords: Blood glucose, hypoglycemia, neuroglycopenic manifestations, Whipple triad, 72-hour fast, insulinoma, post-gastric bypass, factitious hypoglycemia
Tuberculosis
Authors: Parr Jonathan B. , Leonard Jr Michael K , Blumberg Henry M
Published: January 2021

Tuberculosis (TB) is a bacterial disease caused by Mycobacterium tuberculosis, a relatively slow-growing, aerobic, acid-fast bacillus (AFB). Classically, TB is a pulmonary disease, but disseminated and extrapulmonary manifestations may also occur, especially in immunocompromised persons. TB is transmitted person to person and is usually contracted by inhalation of M. tuberculosis droplet nuclei generated by an infectious person. If infection occurs after M. tuberculosis enters the body, the host’s cell-mediated immunity may contain the organism but not eradicate all the bacilli, resulting in latent tuberculosis infection (LTBI). M. tuberculosis can remain dormant and persist (e.g., within macrophages); persons with LTBI are at risk for reactivation and development of active TB.

This review contains 5 figures, 7 tables, and 75 references.
Key Words: tuberculosis, pulmonary tuberculosis, extrapulmonary tuberculosis, tuberculosis in hiv-infected patients
HIV and AIDS
Authors: Kuritzkes Daniel R.
Published: January 2021

In the quarter-century since the first report of AIDS in the United States, HIV infection has spread throughout the population, disproportionately affecting black women, Hispanic women, and men who have sex with men. The prognosis for persons infected with HIV has improved dramatically with the introduction and evolution of highly active antiretroviral therapy (HAART). The underlying principle of HAART is that a combination of potent antiretrovirals, each of which requires different mutations in the HIV genome for resistance to develop, can suppress replication sufficiently to prevent mutation and the emergence of resistance. The prospect that currently available antiretroviral therapy (ART) regimens may suppress HIV replication indefinitely provides the hope that infected patients will have life expectancies similar to those of age-matched uninfected individuals. For these patients, HIV care has shifted from an emphasis on treatment and prevention of the complications of HIV disease itself to a focus on suppression of HIV replication and management of short- and long-term complications of HIV, ART toxicities, and aging. This chapter describes the epidemiology, pathophysiology and pathogenesis, prevention, diagnosis, and management of acute and chronic HIV infection and AIDS, with figures and tables illustrating each chapter section.
This review contains 9 figures, 32 tables, and 249 references
Vascular Diseases of the Kidney
Authors: Falk Ronald J. , McGregor Julieanne G , Derebail Vimal K , Kshirsagar Abhijit V.
Published: January 2021

A number of local and systemic disease processes affect the renal vascular tree. Although the underlying mechanisms may differ, vascular diseases of the kidney all characteristically cause varying degrees of vessel obstruction, eventually leading to an impairment of renal blood flow. Acute impairment in renal function occurs in most vascular diseases of the kidney. This chapter discusses the major vascular diseases of the kidney, categorized according to the size of the affected vessel. Large-vessel diseases described are renal artery stenosis from atherosclerosis and fibromuscular dysplasia, Takayasu arteritis, and renal vein thrombosis. Medium-size-vessel diseases described are polyarteritis nodosa and Kawasaki disease. Small-vessel diseases described are those traditionally associated with glomerulopathy, including rapidly progressive glomerulonephritis and Henoch-Schönlein purpura; thrombotic microangiopathy, including thrombotic thrombocytopenic purpura, hemolytic-uremic syndrome, preeclampsia, antiphospholipid syndrome, systemic sclerosis, and malignant hypertension; sickle cell disease; and atheroembolic disease. Tables describe the American College of Rheumatology classification criteria for Takayasu arteritis and induction therapy for rapidly progressive glomerulonephritis. Figures show an overview of vascular disease of the kidney; an arteriogram of renal artery stenosis demonstrating an ostial lesion; light microscopy showing typical crescentic glomerulonephritis; purpuric eruptions in small vessel vasculitides, Henoch-Schönlein purpura, hypersensitivity vasculitis, and antineutrophil cytoplasmic autoantibody–associated disease; light microscopy showing the characteristic onion-skin lesion in scleroderma renal crisis; electron microscopy showing a glomerular capillary with thrombotic thrombocytopenic purpura; injection microradioangiograms comparing the vasa recta of a normal kidney with that in a patient with sickle cell disease; and a light microscopy that reveals an atheroembolus lodged in a small renal artery and occlusion of the vascular lumen. This chapter contains 151 references.
Breast Cancer
Authors: Davidson Nancy E
Published: January 2021

Invasive breast cancer, the most common nonskin cancer in women in the United States, will be diagnosed in 266,120 In 2018, along with 63,960 new cases of non-invasive (in situ) breast cancer. Incidence and mortality reached a plateau and appear to be dropping in both the United States and parts of western Europe. This decline has been attributed to several factors, such as early detection through the use of screening mammography and appropriate use of systemic adjuvant therapy, as well as decreased use of hormone replacement therapy. However, the global burden of breast cancer remains great, and global breast cancer incidence increased from 641,000 in 1980 to 1,643,000 in 2010, an annual rate of increase of 3.1%. This chapter examines the etiology, epidemiology, prevention, screening, staging, and prognosis of breast cancer. The diagnoses and treatments of the four stages of breast cancer are also included. Figures include algorithms used for the systemic treatment of stage IV breast cancer and hormone therapy for women with stage IV breast cancer. Tables describe selected outcomes from the National Surgical Adjuvant Breast and Bowel Project (NSABP) P-1 and P-2 chemoprevention trials, tamoxifen chemoprevention trials for breast cancer, the TNM staging system and stage groupings for breast cancer, some commonly used adjuvant chemotherapy regimens, an algorithm for suggested treatment for patients with operable breast cancer from the 2011 St. Gallen consensus conference, guidelines for surveillance of asymptomatic early breast cancer survivors from the American Society of Clinical Oncology, and newer agents for metastatic breast cancer commercially available in the United States.
This review contains 2 highly rendered figures, 8 tables, and 108 references.
Gynecologic Cancer
Authors: Cannistra Stephen A , Herold Christina I
Published: January 2021

This chapter focuses on the three types of gynecologic cancer—epithelial cancer of the ovary, cancer of the uterine cervix, and cancer of the endometrium (uterine cancer)—and reviews their epidemiology, diagnosis, differential diagnosis, surgical features, and staging, as well as their risk factors and clinical features. Also discussed are methods of treatment and the management of relapse. Epithelial ovarian cancer occurs at a mean age of 60 years in the United States and is the most lethal of gynecologic tract tumors. However, a recent trial has demonstrated a survival advantage through the use of intraperitoneal chemotherapy for appropriate patients with optimally debulked ovarian cancer.
Invasive cervical cancer is uncommon in developed countries, partly because of the effectiveness of Pap smear screening. Nevertheless, cancer of the uterine cervix is the third most common gynecologic cancer diagnosis and cause of death among gynecologic cancers in the United States. However, for women with early-stage cervical cancer, data from several randomized trials indicate an improvement in response rate and survival through the use of combination platinum-based regimens for platinum-sensitive relapse. Also noted is an improvement in survival using combined-modality chemoradiation in appropriate patients with locally advanced cervical cancer.
Endometrial cancer is the most frequent tumor of the gynecologic tract; it is estimated that it occurred in over 46,000 women and caused more than 8,000 deaths in the United States in 2011. Recent data indicate improvement in survival using adjuvant platinum-based chemotherapy in appropriate patients with high-risk endometrial cancer.
Tables in this chapter review the common histologic types of epithelial ovarian cancer, selected signs and symptoms of ovarian cancer, the International Federation of Gynecology and Obstetrics (FIGO) staging system for epithelial ovarian cancer, differential diagnosis of a complex cyst detected by transvaginal sonography, selected adverse prognostic factors in epithelial ovarian cancer, common chemotherapy agents used in the treatment of epithelial ovarian cancer, the FIGO surgical staging of endometrial cancer, and postoperative management considerations for patients with uterine cancer. Figures illustrate the four histologic subtypes of epithelial ovarian cancer, the intraoperative appearance of stage III epithelial ovarian cancer, and FIGO staging of cervical cancer.
This review contains 6 highly rendered figures, 8 tables, and 150 references.
Management of Psychosocial Issues in Terminal Illness
Authors: Thomas Jane DeLima , Reitschuler-Cross Eva , Block Susan D
Published: January 2021

Patients facing serious or life-threatening illness experience challenges to their psychological, social, and spiritual lives as well as to their physical function and comfort. Physicians may be accustomed to focusing on the biomedical aspects of illness, but they have a critical role in assessing the patient's psychosocial issues to identify sources of distress and help implement a plan for mitigating them. An appropriate psychosocial assessment requires a methodical and rigorous approach and includes assessment of any psychosocial issue affected by or affecting a patient's experience of illness. This chapter outlines a structured approach to addressing psychosocial issues by discussing (1) the doctor-patient relationship; (2) coping with illness; (3) family dynamics and caregiving; (4) ethnic and cultural issues; (5) religious, spiritual, and existential issues; (6) mental health issues, including adjustment disorder, depression, anxiety, personality disorders, aberrant drug behaviors, and major mental health issues; and (7) grief and bereavement. Tables outline psychosocial assessment questions, factors predisposing patients with serious illness to depression, risk factors for suicide in patients with terminal illness, and classes of antidepressants, anxiolytics, and sedatives. The Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) questionnaire is provided, as well as a list of Web sites with further resources about psychosocial issues in serious illness.
This review contains 1 highly rendered figure, 6 tables, and 216 references.
Lymphomas
Authors: Dunleavy Kieron , Wilson Wyndham H
Published: January 2021

Lymphoma is the fifth most common type of cancer in the United States, with 74,490 new cases estimated in 2009. Approximately 15% of patients with lymphoma have Hodgkin lymphoma; the remainder have one of the non-Hodgkin lymphomas. The incidence of non-Hodgkin lymphoma has increased steadily over recent decades. This chapter reviews the epidemiology, classification, clinical features, pathology, diagnostic evaluation, staging and prognosis, and treatment of Hodgkin and non-Hodgkin lymphoma. Other topics discussed include the acute and chronic effects of therapy for Hodgkin disease, as well as the subtypes of non-Hodgkin lymphomas, including indolent B cell lymphoma, follicular lymphoma, small lymphocytic lymphoma, mantle cell lymphoma, marginal-zone lymphoma, diffuse large B cell lymphoma (DLBCL), primary central nervous system lymphoma (PCNSL), Burkitt lymphoma, and HIV-related non-Hodgkin lymphoma. Figures illustrate the cellular appearance of Hodgkin lymphoma subtypes and DLBCL, diagnosis of DLBCL subtypes by gene expression, computed tomography and plain chest film in primary mediastinal cell lymphoma, MRI of the brain in PCNSL, and gene expression and gene expression predictors of survival among patients with DLBCL treated with rituximab, cyclophosphamide, hydroxydaunorubicin, vincristine [Oncovin], and prednisone (R-CHOP). Tables describe the Ann Arbor classification and the Cotswold modification for staging of lymphoma; the International Prognostic Score for advanced Hodgkin lymphoma; the World Health Organization classification of hematopoietic neoplasms; chromosomal translocations in non-Hodgkin lymphoma; the Eastern Cooperative Oncology Group performance scale; the International Prognostic Index for aggressive non-Hodgkin lymphoma; and the Follicular Lymphoma International Prognostic Index. This chapter has 185 references.
Genomics Overview
Authors: Feero W Gregory
Published: January 2021

New genomic applications are affecting internal medicine subspecialties and will soon affect the practices of all physicians. This chapter discusses the fields of genetics versus genomics and details the fundamentals of a genomic approach to health care. It includes special considerations such as the intersection between genomics and evidence-based medicine, genetic discrimination, the regulation of genetic testing, and the marketing of genetic testing directly to consumers. The chapter looks at genome-wide association studies and clinical care, as well as sequencing technologies. Tables offer examples of patterns of inheritance, clinical recommendations and red flags raised by family history, and intended uses for genetic tests. One figure shows an example pedigree obtained by using the US surgeon general's My Family Health Portrait family history tool, while the other shows the chromosomal locations of genetic markers associated with disease risk discovered in genome-wide association studies between 2005 and 2009. This chapter contains 41 references.
Overview of Posttraumatic Stress Disorder
Authors: Downs Dana , North Carol
Published: January 2021

Posttraumatic stress disorder (PTSD) is a psychiatric disorder that may follow exposure to trauma. The experience of trauma has potential personal implications. Some individuals develop PTSD after trauma; others may be more resilient, experiencing distress but not succumbing to psychopathology; and yet others may emerge from the experience with new strength and direction.

This review contains 1 figure, 5 tables, and 46 references
Keyword: Posttraumatic stress disorder, transcranial magnetic stimulation (TMS), deep brain stimulation, vagal nerve stimulation, transcranial direct current stimulation, Diagnostic and Statistical Manual of Mental Disorders, hypothalamic-pituitary-adrenal (HPA) axis
Adjustment Disorder and Its Clinical Management
Authors: Giovanni Carta Mauro , Preti Antonio
Published: January 2021

Adjustment disorder is a condition of subjective emotional distress triggered as a consequence of a meaningful change in life. The diagnosis of adjustment disorder is hindered by the difficult operational definition of stress and of its related concept of “vulnerability,” by the problem of disentangling symptoms of adjustment disorder from those attributable to comorbid anxiety and mood disorders, and by the poor boundaries of the disorder with other stress-related conditions on the one hand and with common adaptation to life events on the other. Despite the high frequency of its diagnosis in clinical settings, there has been relatively little research on the adjustment disorder and, consequently, very few hints about its treatments. Several psychotherapies have been developed to deal with patients diagnosed with adjustment disorder, with inconclusive evidence on their effectiveness. Antidepressants may abate the symptoms and help patients reacquire occupational and social functioning. The medium-term outcome of adjustment disorder is good, with 70 to 80% of those diagnosed with it showing no evidence of psychopathology when reassessed 5 years from the episode. However, when comorbid with a personality disorder or a substance use disorder, the short-term risk of suicide may be increased. The long-term outcome of adjustment disorder seems to be worse in children and adolescents than in adults. In particular, adolescents diagnosed with adjustment disorder were more likely than adults to have received a diagnosis of a severe mental disorder at the 5-year follow-up, including schizophrenia, schizoaffective disorder, and bipolar disorder.
This review contains 1 figure, 6 tables, and 52 references.
Key words: adaptation, adjustment disorder, anxiety, depression, stress, trauma, treatment, vulnerability
Pelvic Organ Prolapse
Authors: Hoyte Lennox , Bassaly Renee , Hart Stuart , McCullough Mona , Jackson Elisha
Published: January 2021

Pelvic organ prolapse (POP) is the descent of one of more aspects of the vagina and/or uterus. Evaluation of POP always begins with a thorough history and physical examination. Management choices include observation, conservative options, and surgical options. Surgical management is divided into two categories, which are restorative and obliterative. It is important to counsel patients that although POP may affect quality of life, it is not life-threatening. This chapter is designed to guide the healthcare provider with a review of epidemiology, anatomy, evaluation, and management of POP. The chapter contains 14 figures that illustrate examples of common examination findings, devices, and treatment options. Also, there are 5 tables that provide concise reference materials to help guide the healthcare provider.
This review contains 91 references, 14 figures, and 6 tables.
Key Words: constipation, mesh, pain, pelvic floor, pessary, POP-Q, risk factors, surgery, vaginal wall
Pruritus
Authors: Tey Hong-Liang , Yosipovitch Gil , Bernhard Jeffrey D
Published: January 2021

Pruritus, or itch, can be defined as a sensation that elicits the desire to scratch. Normal physiologic "acute" itch occurs daily and can usually be abolished by scratching the affected area. On the other hand, chronic itch (defined as itch that persists for 6 weeks or more) is often made worse by scratching and is associated with significant morbidity. The focus of this chapter is on chronic pruritus. Discussion includes causes, clinical evaluation, investigation of, and treatment for chronic pruritus. Tables cover the etiologic classification of chronic pruritus, a morphologic approach to typically pruritic dermatoses and their classic distribution (with illustrative images), systemic diseases and associated clinical signs, localized pruritus and underlying neuropathy, screening tests for pruritus, further investigations following results of clinical findings and screening tests, general measures for patients managing pruritus, topical treatment, topical calcineurin inhibitors, systemic therapies, recommended stepwise treatment options, and phototherapy. Also included are a patient history checklist, an algorithm outlining the approach to chronic pruritus, and images depicting various forms of pruritus.
This review contains 16 highly rendered figures (including table images), 13 tables, and 41 references.
Septic Arthritis, Septic Bursitis, and Osteomyelitis
Authors: Ashbaugh Cameron
Published: January 2021

Infections of joints and bones are important causes of morbidity due to the potential for permanent injury to structures necessary for mechanical support and useful motion. The spectrum of disease is broad, with host factors, pathogen, site of infection, and comorbidities all influencing outcome. In some cases of bone infection, cure may not be possible, and the therapeutic goal becomes control. This review details the epidemiology, pathogenesis, diagnosis, differential diagnosis, treatment, and prognosis of septic arthritis, septic bursitis, vertebral body osteomyelitis, pedal osteomyelitis in association with diabetes, and chronic posttraumatic osteomyelitis with union or malunion.
This review contains 13 highly rendered figures, 16 tables, and 192 references.