bluuebunny/crossref_metadata_2025 huggingface dataset:
Lower Gastrointestinal Bleeding
Authors: Croft Chasen A , Moore Frederick
Published: January 2021

Lower gastrointestinal (GI) hemorrhage is a common clinical condition often encountered by the acute care surgeon. Lower GI bleeding, defined as bleeding distal to the ligament of Treitz, may present with diverse manifestations, from occult bleeding as evidenced only by anemia to massive hemorrhage and exsanguination. Severe, life-threatening hemorrhage may present precipitously with few initial symptoms. As such, the astute surgeon must be able to expeditiously identify patients with acute, massive lower GI bleeding and initiate the appropriate therapeutic algorithm to reduce the high morbidity and mortality associated with this condition. After initial resuscitation, the cause of the hemorrhage must be identified. Identification of the bleeding site often includes a multidisciplinary approach, including practitioners from critical care, gastroenterology, radiology, and surgery. In general, the primary methods to locate the site of hemorrhage include CT and endoscopy. Advances in endoscopic localization have increased both the diagnostic and therapeutic yields of such therapy. Surgical intervention is generally reserved for those patients in whom hemodynamic instability precludes further diagnostic workup or those in whom the source of bleeding cannot be controlled with other modalities. In this review, we discuss the diagnostic workup and therapeutic management of life-threatening lower GI hemorrhage.

This review contains 10 figures, 3 tables and 93 references
Key words: BLEED criteria, colonic ischemia, colonoscopy, CT angiography, diverticular disease, lower gastrointestinal bleeding, mesenteric arteriography, nuclear scintigraphy, push enteroscopy, video capsule endoscopy
Direct Oral Anticoagulants
Authors: Codner Panna A. , Mount Michael G
Published: January 2021

Non–vitamin K antagonist oral anticoagulants, also known as direct oral anticoagulants, are a relatively recent class of medications introduced into clinical practice. Due to their safety profiles, fixed dosing, and lack of need for frequent laboratory monitoring, they are becoming preferred to traditional anticoagulation with warfarin in many cases of nonvalvular atrial fibrillation and venous thromboembolism. Currently, four drugs are available: dabigatran, a direct thrombin inhibitor, and rivaroxaban, apixaban, and edoxaban, factor Xa inhibitors. This review covers the pharmacology, monitoring, and reversal agents currently available for these medications. The indications for their use are covered through a review of the major clinical trials that led to their US and European approvals for clinical use. Perioperative management of these medications is discussed. Tables list indications, dosing, and monitoring, as well as bleeding risks and efficacy compared with warfarin. 
This review contains 1 figure, 11 tables, and 70 references.
Key words: apixaban, dabigatran, direct oral anticoagulant, edoxaban, rivaroxaban
Disorders of Potassium, Calcium, and Magnesium
Authors: Miller Emily S , Golden Katie E.
Published: January 2021

Potassium, calcium and magnesium play important roles in physiology, particularly cardiac and neurologic function. Abnormalities in these electrolytes can cause subtle symptoms, but are common in patients with multiple medical problems and significantly increase morbidity and mortality. This review details the pathophysiology, assessment, treatment, and disposition of patients with hypokalemia, hyperkalemia, hypocalcemia, hypercalcemia, hypomagnesemia, and hypermagnesemia. Figures show approaches to identifying the causes of hypokalemia and hyperkalemia, changes in the electrocardiogram due to hypokalemia and hyperkalemia,  and demonstration of Trousseau sign (carpal spasm with inflation of the blood pressure cuff) and Chvostek sign (facial muscle spasm with tapping of the facial nerve). Tables describe replenishing potassium via oral route, factors contributing to increased plasma potassium, medications that cause hyperkalemia, contraindications to succinylcholine, a summary of emergency treatment for hyperkalemia, common causes of hypocalcemia in the emergency department, and a summary of emergency treatment for hypercalcemia.
This review contains 4 highly rendered figures, 7 tables, and 39 references.
Toxic Gases
Authors: Weiss Stephanie T , Weibrecht Kathryn W
Published: January 2021

This review looks at the potential causes, diagnoses, and possible treatments for three asphyxiant gases: carbon monoxide, hydrogen cyanide, and hydrogen sulfide, Exposure to these gases can lead to central nervous system depression, unconsciousness, and death due to tissue hypoxia. These gases are among the most common causes of fatalities related to toxic gas poisoning, with carbon monoxide responsible for 36% and hydrogen sulfide 7.7%. It is necessary to remove victims affected by poisoning immediately from the source of the toxic gas, administer oxygen, and assess their stability. As symptoms of these gases can differ widely, ranging from broad and unspecific to highly morbid, and may require different levels of care, the correct diagnosis should also rely on inferences from the patient history and the context of the admission, including evidence of fire and chemical reactions. Normobaric oxygen and hyperbaric oxygen are the two main treatments for carbon monoxide, although studies have been inconclusive in regards to the effectiveness of hyperbaric oxygen. The Cyanokit (containing hydroxocobalamin) is considered to be more effective for hydrogen cyanide when compared with the Cyanide Antidote Kit due to the former’s low toxicity and high effectiveness. Hydrogen sulfide is often used as a suicide agent, the mortality of which is close to 100%. Figures show the mechanisms by which the asphyxiant gases carry out their negative effects on the human body. Tables show the half-life of carboxyhemoglobin with oxygen therapy and a comparison between the Cyanide Antidote Kit and the Cyanokit.
This review contains 3 figures, 13 tables, and 44 references. 
Keywords: Inhalation, poisoning, carbon monoxide, cyanide, methemoglobin, carboxyhemoglobin, hydrogen sulfide, smoke
Drowning and Near Drowning
Authors: Miller Emily S
Published: January 2021

The most recently updated definition of drowning is “the process of experiencing respiratory impairment from submersion/immersion in liquid.” The primary insult in these patients is asphyxia, and the resulting hypoxia, hypercarbia, and acidosis will progress until cardiac arrest, multiple organ dysfunction, and death. The patient’s prognosis will depend on where the drowning process was interrupted on this continuum. This review includes an overview of the epidemiology, risk factors, pathophysiology, assessment and stabilization, diagnosis, treatment and disposition, and outcomes of drowning. Figures show how nonambulatory infants and toddlers may drown after pulling up on the edge of a toilet, leaning over, and falling head first into the toilet bowl and an algorithm for the approach to the drowning patient. Tables list risk factors for drowning, indications for intubation, prognostic factors for death or survival with severe neurologic sequelae, and key preventive measures.
This review contains 2 highly rendered figures, 4 tables, and 73 references.
Traumatic Brain Injury
Authors: Borczuk Pierre
Published: January 2021

The emergency department (ED) clinician needs to be prepared to manage patients of all ages with traumatic brain injury (TBI). This review outlines key historical and physical examination findings on initial trauma evaluation and treatment of the severely head injured patient with a herniation syndrome. The most common lesions seen on cranial computed tomographic (CT) scanning are discussed. Since the most important decision in managing patients with milder forms of TBI is whether to perform brain imaging, the review includes an in-depth discussion of the history and evolution of CT decision rules, including the most commonly used rule in children. Given the aging population and increased use of anticoagulants, it is imperative to understand the current evidence available to best treat these patients. Finally, we may all be required to assess sport-related concussions in the ED or on the field.
This review contains 6 figures, 10 tables, and 37 references.
Key words: traumatic brain injury, concussion, subdural hematoma, subarachnoid hemorrhage, Canadian head CT rules, PECARN, mannitol, hypertonic saline
Pathology of Inflammatory Bowel Disease
Authors: Patil Deepa T. , Odze Robert D.
Published: January 2021

Idiopathic inflammatory bowel disease (IBD) encompasses two major types: ulcerative colitis (UC) and Crohn disease (CD). The pathologic features of UC are typically restricted to the mucosa and superficial submucosa, whereas CD is characterized by patchy, segmental, mucosal, and mural inflammation. This review covers the classic pathologic features of IBD, differential diagnosis, dysplasia in IBD, and practical guidelines for clinicians who perform surveillance endoscopy. Figures show gross specimens of UC and CD variations and low- and high-grade dysplasia. Tables list the microscopic features of untreated UC and CD, the most common causes of uncertainty in IBD pathology that lead to a diagnosis of indeterminate colitis, a summary of inflammatory disorders of the colon that may mimic UC or CD on biopsy or resection, and diseases that can occur in patients with established UC or CD and result in changes to the type, pattern, and severity of inflammation.
This review contains 5 highly rendered figures, 4 tables, and 75 references.
Medical Therapy for Crohn Disease
Authors: Allegretti Jessica R , Korzenik Joshua R.
Published: January 2021

Crohn disease (CD) is an inflammatory condition that can affect any portion of the gastrointestinal tract from the mouth to the perianal area. The resulting transmural inflammation can lead to a spectrum of clinical presentations depending on disease location and severity. The treatment of CD depends on the severity of the disease, phenotype, presence of perianal disease, and response to previous therapies. This review examines the goals of therapy for CD, clinical symptoms and disease activity, treatment of disease based on mild to moderate to severe stages, treatment of refractory disease, perianal disease, postoperative CD, and noninflammatory treatment options. Figures show adalimumab injection-site reaction and perianal fistula with seton placement. Tables list the Crohn Disease Activity Index (CDAI), the Harvey Bradshaw Index, 5-aminosalicylic acid formulations, standard dosing of CD medications for moderate to severe disease, and rates of clinical response and remission in patients receiving anti–tumor necrosis factor agents versus placebo, by trial.
This review contains 2 highly rendered figures, 5 tables, and 85 references.
Helicobacter pylori and Nonsteroidal Antiinflammatory Drug Peptic Ulcers
Authors: Lew Edward A
Published: January 2021

Peptic ulcers are defects or breaks in the gastric or small intestinal mucosa that have depth and extend through the muscularis mucosae. The pathogenesis of peptic ulcers is multifactorial and arises from an imbalance of protective and aggressive factors such as when gastrointestinal mucosal defence mechanisms are impaired in the presence of gastric acid and pepsin. Infection with Helicobacter pylori and the use of nonsteroidal anti-inflammatory drugs and acetylsalicylic acid are major risk factors associated with peptic ulcers. In general, these factors disrupt normal mucosal defenses and repair, making the mucosa more susceptible to acid. This review covers the epidemiology of peptic ulcers, diagnostic tests for H. pylori, and treatment of peptic ulcers and H. pylori. The figure shows gastric biopsy samples stained with hematoxylin and eosin demonstrating chronic active gastritis both with and without the presence of H. pylori organisms. The tables list diagnostic tests for H pylori, and common treatment regimens for H. pylori.
Key words: Helicobacter pylori, H. pylori, NSAID-related peptic ulcer, diagnosis of helicobacter pylori, H. pylori treatment, urea breath test, ASA after bleeding ulcer
This review contains 1 highly rendered figure, 2 tables, and 54 references
Acute Pancreatitis
Authors: Moran Robert A. , Solanki Manavi , Singh Vikesh K
Published: January 2021

Acute pancreatitis (AP) is defined as the presence of two of the following findings: (1) upper abdominal pain; (2) serum amylase or lipase greater than three times the upper limit of normal; and/or (3) characteristic findings of AP on abdominal imaging (contrast-enhanced computed tomography, magnetic resonance imaging, or abdominal ultrasonography). This review addresses AP, detailing the subclassification, epidemiology, pathophysiology, etiology, diagnosis and differential diagnosis, treatment, complications, and prognosis. Figures include abdominal imaging of patients with AP, an algorithm depicting pancreatic collections, and an endoscopic image of the gastric portion of the cystogastrostomy. Tables list systemic inflammatory response syndrome; classification of the severity of AP; etiologies of AP, gallstones, biliary sludge, microlithiasis, and crystals; secondary causes of hypertriglyceridemia; common drugs and drug classes associated with AP; conditions mimicking AP; diagnostic criteria for infected necrosis; and prognostic scoring systems for AP.
This review contains 3 highly rendered figures, 9 tables, and 182 references.
Management of Chronic Pancreatitis
Authors: Conwell Darwin L. , Oza Veeral M.
Published: January 2021

Chronic pancreatitis (CP) is a syndrome that is characterized by inflammation, irreversible fibrosis, and loss of acinar and islet cells. It has also been described as an “enigmatic process of uncertain pathogenesis, unpredictable clinical course, and unclear treatment.” This review describes the epidemiology, diagnosis, diagnostic challenges, differential diagnosis, treatment, complications, and clinical course and prognosis of CP, as well as future challenges. Figures show a computed tomographic (CT) scan of calcific CP, a secretin-enhanced magnetic resonance cholangiopancreatogram showing a dilated and tortuous main pancreatic duct, a CT scan of a large chronic pseudocyst compressing the stomach and pancreas, an endoscopic ultrasound (EUS) image of CP, a retrograde pancreatogram showing a dilated main pancreatic duct with stones and “blunted” side branches, sources of pain in CP, neuropathic pain mechanisms in CP, and an algorithm summarizing treatment of pain in CP. Tables list the TIGAR-O etiologic classification of CP, standard criteria for diagnosis of CP by EUS, Cambridge endoscopic retrograde cholangiopancreatography grading for CP, and a stepwise radiographic and endoscopic diagnostic approach to patients with suspected CP.
Key words: bile duct obstruction, chronic pancreatitis, pancreatic calcifications, TIGAR-O system
This review contains 8 highly rendered figures, 4 tables, and 54 references.
Familial Polyposis Syndromes
Authors: Nissim Sahar , Lim Ramona M.
Published: January 2021

Although sporadic polyps in the gastrointestinal tract are common with increasing age, the finding of a large number of polyps raises suspicion for a hereditary polyposis syndrome associated with a germline genetic mutation. Because many of these hereditary polyposis syndromes also confer an increased risk of gastrointestinal and extraintestincal cancers, implicated in approximately 1% of all colorectal cancers, recognition of these syndromes is critical to offer preventive screening measures. A key distinguishing feature is polyp histologic type, ranging from adenomatous, to serrated, to hamartomatous. A clinical diagnosis can be confirmed by genetic testing for a germline mutation in known cancer susceptibility genes, although in many polyposis families, a genetic etiology has not yet been identified. This review covers familial adenomatous polyposis, MUTYH-associated polyposis, polyposis associated with polymerase proofreading, juvenile polyposis syndrome, PTEN hamartoma tumor syndromes, hereditary mixed polyposis syndrome, and serrated polyposis. The figures shows the spectrum of histologic types and genetic etiologies of hereditary polyposis syndromes. Tables list polyposis syndromes, American College of Gastroenterology surveillance guidelines for hereditary polyposis syndromes, diagnostic criteria for juvenile polyposis syndrome, diagnostic criteria for PTEN hamartoma tumor syndrome, and World Health Organization diagnostic criteria for serrated polyposis syndrome.
 
This review contains 1 highly rendered figure, 5 tables, and 172 references
Key words: Familial adenomatous polyposis; Polyposis syndromes; Gastrointestinal polyps; Hereditary polyposis syndromes
Anemia: Production Defects Generally Associated with a Normal or Largely Normal Bone Marrow
Authors: Berliner Nancy , Gansner John M
Published: January 2021

This review focuses on anemia resulting from production defects generally associated with a normal or largely normal bone marrow. The definition, epidemiology, etiology, pathogenesis, diagnosis, differential diagnosis, management, complications, and prognosis of the following production defects are discussed: Anemia of inflammation (AI; formerly known as anemia of chronic disease), and anemia in kidney disease, as well as anemia secondary to other conditions such as alchohol abuse and starvation. Iron deficiency anemia (IDA) is discussed elsewhere in this publication.  A figure depicts peripheral smear changes in the size and shape of red blood cells seen in starvation. A table lists the differential diagnoses of hypochromic anemias.
This review contains 1 figure; 1 table; 79 references
Infections Due to Streptococcus pneumoniae
Authors: Stevens Dennis L. , Hobdey Sarah E
Published: January 2021

Pneumococci, or Streptococcus pneumoniae, are gram-positive, lancet-shaped diplococci but may also grow in short chains. The polysaccharide polymer that forms the outer capsule of S pneumoniae is chemically and antigenically unique and is crucial to virulence. There are at least 90 distinct serotypes. The capsule allows the bacteria to resist phagocytosis by leukocytes unless the organisms have been opsonized by antibody or serum complement components. Certain pneumococcal serotypes, such as the heavily encapsulated type 3 pneumococcus, are particularly virulent. In fact, only 23 serotypes account for 80% of bacteremic pneumococcal infections in the United States; capsular polysaccharides from these 23 serotypes are incorporated into the polyvalent polysaccharide pneumococcal vaccine (PPSV23), which has been available since 1983. This review covers the epidemiology and pathogenesis of pneumococcal infections, clinical pneumococcal infections, and prevention of pneumococcal infections. Adverse outcomes in pneumococcal pneumonia, antibiotic treatment for penicillin-resistant S pneumoniae, and Centers for Disease Control and Prevention child and adolescent immunization schedules are discussed.
This review contains 1 figure, 6 tables, and 41 references. 
Key words: bacterial pneumonia, PCV13, penicillin-resistant Streptococcus pneumoniae, pneumococcal pneumonia, pneumococcus, PPSV23, pneumonia vaccine, Streptococcus pneumoniae
Epigenetics In Autoimmune Disease
Authors: Jeffries Matlock A
Published: January 2021

Autoimmunity refers to a pathologic state of immunologic dysregulation in which the human immune system turns inward, attacking healthy tissues. The key step in this process is a break of self-immune tolerance. Recent studies have implicated dysregulation of gene expression via altered epigenetic control as a key mechanism in the development and promotion of autoimmunity. Epigenetics is defined as heritable changes in gene expression as a result of modification of DNA methylation, histone side chains, and noncoding RNA. Studies examining identical twins discordant for lupus, for example, were among the first to identify alterations in DNA methylation leading to lupus. Histone side-chain changes have been studied extensively in rheumatoid arthritis (RA), and many pathogenic cell types in RA exhibit a hyperacetylation phenotype. Finally, new research in the noncoding RNA field has not only uncovered potentially targetable pathways (e.g., miR-155) but may lead to the development of new diagnostic and prognostic biomarkers, helping physicians better tailor specific treatment regimens to improve response to therapy in autoimmune disease.
 
This review contains 4 figures, 1 table and 47 references
Key Words: autoimmunity, big data, biomarkers, computational biology, DNA methylation, epigenetics, histone acetylation, histone methylation, microRNA, noncoding RNA
Patients with Sacroiliac Joint Pain and Arthritis
Authors: Cheng Jianguo
Published: January 2021

Chronic pain originating from the sacroiliac joint (SIJ) is common. Pathophysiology is often related to biomechanical derangement affecting the SIJ or traumatic, degenerative, arthritic, and idiopathic changes of the SIJ. Diagnosis of SIJ pain is suggested by typical patterns of distribution, pain characteristics, and a combination of provocative tests, confirmed by diagnostic block of the SIJ, and differentiated from several other causes of low back pain. Multimodal therapy includes educational, physical, pharmacologic, interventional, and surgical approaches and should be individualized. The efficacy and safety of radiofrequency denervation of the sacroiliac joint have been demonstrated in randomized controlled trials. Multiple modalities of radiofrequency treatment exist, and comparative effectiveness studies are required to determine the most efficacious and cost-effective treatment modality.
This review contains 1 highly rendered figure and 33 references.
The Esophagus
Authors: Wei Benjamin , Gleason Michael Frank
Published: January 2021

The esophagus is a tubular structure spanning from the posterior pharynx, through the thorax, and terminating in the stomach. It arises from endodermal foregut tissue. Its submucosal muscular layers are initially striated, transitioning to smooth muscle in more distal areas. Due to the distance in the body it traverses, the esophagus derives its blood and nerve supply from several structures. The role as a conduit from mouth to stomach necessitates secretory and barrier functions, as well as sphincters for protection from anterograde flow. Various modalities of esophageal test exist, ranging from fluoroscopy, to invasive endoscopy capable of obtaining tissue samples, to probes that detect pH and muscle tone, all of which play roles in identifying various pathologic processes.
This review contains 12 figures, and 22 references.
Key words: abdomen, endoscopy, esophagography, esophagus, impedance, lower sphincter, manometry, upper sphincter
Cardiac Arrest and Resuscitation
Authors: Pozner Charles N. , Martindale Jennifer L
Published: January 2021

The most effective treatment for cardiac arrest is the administration of high-quality chest compressions and early defibrillation; once spontaneous circulation is restored, post–cardiac arrest care is essential to support full return of neurologic function. This review summarizes the pathophysiology, stabilization and assessment, diagnosis and treatment, and disposition and outcomes of cardiac arrest and resuscitation. Figures show the foundations of cardiac resuscitation, ventricular arrhythmias, coronary perfusion pressure as a function of time, an algorithm for initial treatment of cardiac arrest, sample capnographs, and the electrocardiographic appearance of varying degrees of hyperkalemia. Tables include components of suboptimal cardiac resuscitation and corrective actions, recommended doses of medications commonly used in cardiac resuscitation, causes of pulseless electrical activity/asystolic arrest to consider, immediate post–return of spontaneous circulation checklist, and resuscitation goals during post–cardiac arrest care.
This review contains 6 highly rendered figures, 5 tables, and 142 references.
Cholinergic Toxicity
Authors: Bird Steven B
Published: January 2021

Cholinergic drugs exert their functions by inhibiting acetylcholinesterase, the enzyme responsible for hydrolyzing acetylcholine and ending neuronal or neuromuscular neurotransmission. These compounds are used in clinical medicine to treat various disorders, as pesticides, and as weapons of mass destruction. This review describes the drugs that affect the cholinergic system and discusses stabilization, diagnosis and definitive therapy, principles and controversies of definitive care, and disposition and outcomes for these agents. Figures show acetylcholinesterase hydrolysis of acetylcholine, neurotransmission in the nervous system, the mechanism of inhibition of acetylcholinesterase by an organophosphorus (OP) compound, and the general chemical structure of thion OP and oxon OP agents and carbamates. Tables list OP pesticides associated with OP-induced delayed neuropathy, the effects of cholinesterase inhibition, the symptoms of cholinergic poisoning according to severity, and a treatment algorithm for acetylcholinesterase poisoning.
This review contains 4 highly rendered figures, 4 tables, and 85 references.
Encephalitis
Authors: Bhattacharyya Shamik , Lyons Jennifer L.
Published: January 2021

In 2013, the International Encephalitis Consortium proposed clinical criteria for acute encephalitis consisting of 24 hours of altered level of consciousness, lethargy, or personality change and at least three additional supportive features. Although viruses are the most common cause of acute encephalitis, not all encephalitides are acute, viral, or even infectious. Chronic encephalitis can be pathologically similar to acute encephalitis, but the causative agents and clinical manifestations vary. Management of encephalitis is largely supportive; however, for many common encephalitides primary preventive approaches exist. This module reviews the epidemiology, manifestations, diagnosis, management, and prevention of various encephalitides, including herpes family encephalitis (herpes simplex virus, varicella-zoster virus, cytomegalovirus, human herpesvirus 6), arbovirus encephalitis (West Nile virus, eastern equine encephalitis virus, tick-borne encephalitis virus, Japanese encephalitis virus), other encephalitides associated with viruses (influenza virus, human immunodeficiency virus, John Cunningham virus, rabies virus), encephalitides associated with bacteria (Mycoplasma pneumonia, Listeria monocytogenes), and autoimmune encephalitis (acute disseminated encephalomyelitis, paraneoplastic and other autoimmune encephalitides, immune reconstitution inflammatory syndrome). Tables include the International Encephalitis Consortium’s supportive feature of encephalitis, differential diagnosis for magnetic resonance imaging (MRI) findings in the patient with suspected encephalitis, diagnostic considerations for triaging workup of infection-associated encephalitis, differential diagnosis of arboviral infections by location of travel or residence, and preventive strategies for select infectious encephalitis. Figures include MRIs showing patients with herpes simplex encephalitis, varicella-zoster virus, eastern equine encephalitis, HIV, Listeria monocytogenes, acute disseminated encephalomyelitis, acute hemorrhagic leukoencephalitis, and immune reconstitution inflammatory syndrome.
This review contains 8 highly rendered figures, 5 tables, and 78 references.
Myopathies
Authors: Cochrane Thomas I. , Amato Anthony A
Published: January 2021

Muscle disease (myopathy) can be acquired or hereditary. Symptoms include skeletal muscle weakness, atrophy, muscle cramps or myalgias, and impaired function of respiratory, pharyngeal, facial, or ocular muscles. Clinicians must identify treatable myopathies and initiate therapy before permanent weakness occurs. For patients with untreatable disorders, proper supportive care, rehabilitation, genetic counseling, and psychological support are critical. This chapter covers common myopathies, including muscular dystrophies; malignant hyperthermia; metabolic myopathies; mitochondrial myopathies and encephalopathies; ion channelopathies, periodic paralyses, and nondystrophic myotonias; and drug-induced myopathies. Clinical presentation, diagnosis, pathogenesis, and therapy are emphasized. Tables describe genetic classification of the limb-girdle and distal muscular dystrophies; proteins involved in myofibrillar myopathy; other distal myopathies; and antirheumatic, antiinflammatory, and immunosuppressive drug-induced myopathy. Figures show the sarcolemmal membrane and enzymatic proteins associated with muscular dystrophies, sarcomeric and nuclear proteins associated with muscular dystrophies, and major metabolic pathways used by muscle.
This review contains 3 highly rendered figures, 4 tables, and 107 references.
Nutrition For The Healthy Child
Authors: Boghani Meera , Studley Mollie
Published: January 2021

Preschool and school-age children are children ages 3 to 6 and 7 to 12 years, respectively. This life stage is characterized by a period of slower growth velocity compared with infancy, which precedes it, and adolescence, which follows it. During the early school years, children continue to develop and refine feeding skills, expand their food choices, and learn to eat a variety of flavors and textures. Parents and other caregivers control the type of foods and the environment in which the foods are presented, often influencing eating habits and behaviors later in life. A healthy diet is needed not only to maximize the child’s growth but also to prevent chronic diseases, such as type 2 diabetes, hypertension, and obesity. When assessing a child’s nutrition, emphasis should be placed on not just weight and body mass index but also assessing intake of macro- and micronutrients from foods. A healthy diet should include a variety of food groups, with emphasis on whole foods over processed foods. Recently developed tools such as MyPlate and the Dietary Guidelines help American families move toward a healthful diet to help minimize the risk of chronic diseases.
This review contains 3 figures, 7 tables and 78 references
Key words: childhood obesity, developmental disability, energy needs of children, evaluation of growth charts, failure to thrive, food allergy, nutrition-focused physical findings, nutritional status, SoFAS
Chronic Interstitial Nephritis
Authors: McMahon Gearoid M
Published: January 2021

Chronic interstitial nephritis is a progressive kidney disease with a wide variety of causes characterized by the presence of tubulointerstitial fibrosis, inflammation, and tubular atrophy. Most patients with advanced chronic kidney disease will have at least some degree of chronic interstitial nephritis present on a renal biopsy. However, there is a subset of renal diseases that specifically target the interstitium, leading to a progressive decline in kidney function. This review discusses the pathology and pathophysiology of chronic interstitial nephritis. In addition, common causes are reviewed, with a particular emphasis on recently described variants, including genetic causes of interstitial nephritis, Mesoamerican nephropathy, Balkan endemic nephropathy, and IgG4-related kidney disease.
Key words: Chronic Kidney Disease, Inflammation, Fibrosis,
Introduction to Clinical Immunology: Overview of the Immune Response, Autoimmune Conditions, and Immunosuppressive Therapeutics for Rheumatic Diseases
Authors: Lundy Steven K. , Gizinski Alison , Fox David A.
Published: January 2021

The immune system is a complex network of cells and mediators that must balance the task of protecting the host from invasive threats. From a clinical perspective, many diseases and conditions have an obvious link to improper functioning of the immune system, and insufficient immune responses can lead to uncontrolled acute and chronic infections. The immune system may also be important in tumor surveillance and control, cardiovascular disease, health complications related to obesity, neuromuscular diseases, depression, and dementia. Thus, a working knowledge of the role of immunity in disease processes is becoming increasingly important in almost all aspects of clinical practice. This review provides an overview of the immune response and discusses immune cell populations and major branches of immunity, compartmentalization and specialized immune niches, antigen recognition in innate and adaptive immunity, immune tolerance toward self antigens, inflammation and innate immune responses, adaptive immune responses and helper T (Th) cell subsets, components of the immune response that are important targets of treatment in autoimmune diseases, mechanisms of action of biologics used to treat autoimmune diseases and their approved uses, and mechanisms of other drugs commonly used in the treatment of autoimmune diseases. Figures show the development of erythrocytes, platelets, lymphocytes, and other immune system cells originating from hematopoietic stem cells that first reside in the fetal liver and later migrate to the bone marrow, antigen–major histocompatibility complex recognition by T cell receptor control of T cell survival and activation, and Th cells as central determinants of the adaptive immune response toward different stimuli. Tables list cell populations involved in innate and adaptive immunity, pattern recognition receptors with known ligands, autoantibody-mediated human diseases: examples of pathogenic mechanisms, selected Food and Drug Administration–approved autoimmune disease indications for biologics, and mechanism of action of biologics used to treat autoimmune diseases.
 
This review contains 3 highly rendered figures, 5 tables, and 64 references.
Toxic Plants and Mushrooms
Authors: King Marie , Church Richard
Published: January 2021

Many species of plants and mushrooms exist that, when consumed, can induce poisoning in individuals, causing a range of side effects. As the toxins do not always correspond to an antidote, it is important to have the ability to identify each harmful species to determine the appropriate treatment. This review gives an overview of some of the more prevalent toxic plants and mushrooms, detailing their principles of toxicity, recommendations for immediate stabilization, keys to proper diagnosis and definitive therapy, and patient disposition and outcomes. Figures show photographs of the various toxic plants and mushrooms featured. Tables show a list of toxic species for both plants and mushrooms, including their common names, the toxins contained within, their effects, and the corresponding antidote (if any).
This review contains ­16 highly rendered figures, 2 tables, 44 references, and 5 MCQs.
Infertility
Authors: Levens Eric D. , Green Katherine A , DeCherney Alan H.
Published: January 2021

Infertility affects 12 to 18% of couples in the United States and may be due to female factors, male factors, or both. A systematic evaluation of the common causes of infertility can identify conditions that may be treated by the obstetrician-gynecologist to help the couple achieve their family-building goals or those that require referral to a subspecialist. This review discusses current recommendations regarding the workup and treatment of the common causes of infertility, including tubal and pelvic factors, ovulatory disorders, and male factors. Advances in assisted reproductive technology are also discussed, including the use of genetic screening in in vitro fertilization and fertility preservation options for individuals facing gonadotoxic therapy.
This review contains 6 figures, 8 tables, and 53 references.
Key words: anovulation, assisted reproductive technology, clomiphene citrate, infertility, letrozole, oocyte cryopreservation, ovulation induction, semen analysis, tubal factor, uterine factor
Pulmonary Edema in Pregnancy
Authors: Easter Sarah Rae , Smith Nicole A.
Published: January 2021

Pulmonary edema is characterized by the movement of excess fluid into the alveoli of the lungs.  Although the alterations of cardiovascular and pulmonary physiology in pregnancy may predispose patients to pulmonary edema, it is never normal and constitutes severe maternal morbidity.  The etiologies of pulmonary edema are diverse, ranging from disease processes independent of pregnancy to pathophysiology unique to the gravid state.  The causes of pulmonary edema can be broadly classified as either cardiogenic or noncardiogenic, which constitutes the first important branch point in the diagnosis and management of the disease.  The treatment of pulmonary edema in pregnancy parallels that in the nonpregnant population with an emphasis on maintaining the physiologic alterations of pregnancy through supportive care, including mechanical ventilation if needed.  In all cases of pulmonary edema, the decision to proceed with delivery to improve the maternal status should be considered within the context of the etiology and anticipated disease course, the gestational age, and the goals of care.
This review contains  3 figures, 4 tables, and 60 references.
Key Words:  Pulmonary edema, respiratory alkalosis, acute respiratory distress syndrome (ARDS), cardiogenic pulmonary edema, transfusion-related acute lung injury (TRALI), transfusion-associated circulatory overload (TACO), mechanical ventilation, extra corporeal membrane oxygenation (ECMO).
Polycystic Ovary Syndrome
Authors: Alur-Gupta Snigdha , Dokras Anuja
Published: January 2021

Polycystic ovary syndrome (PCOS) is a highly prevalent endocrine disorder in women of reproductive age. In this review, the pathophysiology and current diagnostic criteria for PCOS are reviewed. Treatment options for symptoms commonly associated with PCOS such as hirsutism, acne, and menstrual irregularity are reviewed. Combined hormonal contraceptives are the first line of therapy in women not attempting pregnancy. The metabolic complications commonly associated with PCOS are impaired glucose tolerance and dyslipidemia. A summary of the current guidelines on screening and prevention of these complications is presented. In addition, PCOS is associated with an increased risk of depressive symptoms and anxiety disorders for which patients should be monitored.

This review contains 7 tables and 59 references. 
Keywords: Polycystic ovary syndrome, PCOS
Fertility Preservation
Authors: Sullivan-Pyke Chantae S , Gracia Clarisa
Published: January 2021

Fertility preservation has becoming increasingly important for patients at risk for gonadal failure, including those needing treatment for cancer or autoimmune conditions, genetic conditions that predispose to gonadal insufficiency, and age-related fertility decline. Embryo cryopreservation and mature oocyte cryopreservation are the standards for fertility preservation in postpubertal women. Ovarian tissue cryopreservation and gonadotropin-releasing hormone agonist use for ovarian suppression are experimental methods that may be offered to patients for whom embryo and/or mature oocyte cryopreservation are not applicable. The cryopreservation of spermatozoa is the standard for fertility preservation in postpubertal males, but testicular tissue cryopreservation may be offered to prepubertal males.
 
This review contains 10 figures, 6 tables and 53 references
Key words: controlled ovarian stimulation, embryo cryopreservation, gonadotropin-releasing hormone agonist, in vitro maturation, oocyte cryopreservation, ovarian tissue cryopreservation, sperm extraction, testicular tissue cryopreservation
Lumbar Facet–Mediated Pain
Authors: Patel Vikram B
Published: January 2021

Lumbar or lower back pain is a very debilitating condition that affects  almost one fifth of the adult population during a given year. Almost everyone walking on two feet is bound to suffer from some back pain during their lifetime. The health care burden for treating low back pain is enormous, especially if the lost work hours are combined with the amount used in diagnosing and treating low back pain. Lumbar facet (zygapophysial) joints are one of the major components involved in causing lower back pain. Diagnosing the pain generator is more of an art than a science. Combining various parameters in the patient’s history, physical examination, and diagnostic studies is not much different from solving a murder mystery. Although facet joint pain may be accompanied by other pain generators, that is, lumbar intervertebral disks, nerve roots, and vertebral bodies, once treated, the relief in pain is more helpful in performing proper rehabilitation and improving further deterioration in low back pain. Muscles are almost always painful due to myofascial pain syndrome that accompanies the facet joint–related pain. Treating one without addressing the other leads to failure in management and optimization of patient’s pain and function. Several treatments are available for treatment of facet joint–mediated pain, including steroid injections using a miniscule amount and radiofrequency ablation of the nerves supplying the facet joints (medial branches of the dorsal primary ramus of the lumbar nerve root). With proper diagnosis and treatment, a patient’s pain and function can be optimized to a level where it may not impact the day-to-day activities or even resumption of the patient’s routine job function. The following review describes the anatomy, pathophysiology, diagnosis, and treatment of lumbar facet joint–mediated pain.
 
Key words: facet joint pain, facet joint syndrome, low back pain, medial branch radiofrequency, spondylolisthesis
Paraplegia Following Epidural Steroid Injection
Authors: Peck Devin
Published: January 2021

Paraplegia following epidural steroid injection is, fortunately, an exceedingly rare complication. The differential diagnosis includes epidural hematoma, spinal cord injury/infarction, epidural abscess, and conversion disorder. Less likely diagnoses include worsening of underlying pathology, a new compressing lesion, or subarachnoid injection.
The artery of Adamkiewicz enters the spinal canal via the neural foramen and provides blood supply to the lower two thirds of the spinal cord via the anterior spinal artery. Avoidance of the artery during a transforaminal epidural steroid injection is facilitated by entering the inferior portion of the foramen.
Acute management of neurologic complications arising from an epidural steroid injection is facilitated by rapid identification of etiology. In the case of epidural hematoma, avoidance of permanent deficit is more likely when patients undergo prompt decompression. The role of intravenous steroids in acute spinal cord injury is controversial. Chronic management includes extensive rehabilitation, including physical and occupational therapy. Treatment of musculoskeletal nociceptive pain, such as due to shoulder overuse, and neuropathic pain is vital to optimize the patient’s participation in rehabilitative therapy.
 
Keywords: Epidural Steroid Injection; Complications; Spinal Cord Injury; Epidural Hematoma; Epidural Abscess; Artery of Adamkiewicz; Anterior Spinal Artery Syndrome; Particulate Steroid; Fluoroscopic Guidance
Arthritis of the Knee
Authors: Sharma Vandana , Anuvat Kevin , John Liju , Davis Matthew
Published: January 2021

Osteoarthritis (OA) of the knee is the most common form of degenerative joint disease, affecting 13.9% of adults age 25 years and older and 33.6% of those 65 years and older. Some predisposing risk factors include age, obesity, infection, repetitive use, occupation, and previous trauma. Mild OA usually presents as pain in the knee with difficulty bending or straightening the knee, swelling, weakness, instability, locking, and clicking or snapping of the knee. A diagnosis can be made clinically and confirmed by x-ray showing narrowing of the joint space in mild cases; however, bone changes, subchondral cysts, and formation of bony spurs can be seen in more advanced stages. Treatment of mild to moderate OA involves a multimodal approach that includes lifestyle modifications, physical therapy, and electrical stimulation with or without pharmacologic management. Interventional therapies such as intra-articular corticosteroid injections and viscosupplementation are usually reserved for severe symptoms. Pharmacologic modalities such as acetaminophen, nonsteroidal antiinflammatory drugs, weak opioids, and duloxetine can be used as a single agent or combination therapy. Novel approaches to the treatment of OA include nerve growth factor inhibitors, botulinum toxin type B injections, and intra-articular platelet-rich plasma but are not well supported due to a lack of sufficient evidence.
Key words: arthritis, degenerative joint disease of the knee, diagnosis, etiology, guidelines, noninflammatory arthritis, osteoarthritis of the knee, treatment
Patients with Hearing Impairment and Chronic Pain
Authors: Kaye Alan D. , Sen Sudipta , Cornett Elyse , Fox Charles
Published: January 2021

Deaf patients face unique obstacles in health care and pain management. Not every facility that deaf patients encounter is going to have the proper resources to effectively communicate with them even if regulations are mandated. The Americans with Disabilities Act (ADA) requires that health care institutions provide means of communication for patients, their family members, and hospital visitors who are deaf or hard of hearing. Very little research has been done regarding how the hearing-impaired population effectively communicates pain experiences. Hearing loss can be accompanied by an additional disability, which can further complicate communication between health care providers and deaf patients. Although resources are available to aid communication between health care practitioners and deaf individuals, resources related to hearing loss plus additional disabilities and health care are lacking. Health care providers should educate themselves and their staff so that they are prepared to treat a deaf patient and accommodate the patient’s communication needs.
Pathophysiology of Pain: Why Does Chronic Pain Hurt? The Multiple Hit Theory
Authors: Berger Jack M , Zelman Vladimir
Published: January 2021

Acute pain hurts and most often is the result of tissue injury. Chronic pain also hurts. Although those who suffer from chronic pain also tend to associate the onset with an injury, illness, or surgical procedure; the root cause is far more complex. Chronic pain most often does not follow dermatomal distributions associated with any injury, disease or surgical procedure. And more often than not, chronic pain sufferers also suffer from various forms of depression and/or anxiety. The process of central sensitization resulting from tissue injury has been elucidated, as has many of the molecular changes within the brain that perpetuate chronic pain. Genetics, epigenetics, environmental stressors, and emotional stressors all play roles to varying degrees in the development of the chronic pain state. This article explores how synaptic memories form in the brain as a result of both physical and emotional traumas (multiple hits) resulting in progression to chronic pain, because of failure of the brain’s descending modulatory mechanisms to prevent or control “the pain.”
This review contains 15 figures, and 178 references.
Key words: Epigenetics, memory, central sensitization, chronic pain