bluuebunny/crossref_metadata_2025 huggingface dataset:
Fertility and Pregnancy in Inflammatory Bowel Disease
Authors: O’Toole Aoibhlinn M. , Friedman Sonia
Published: January 2021

Inflammatory bowel diseases (IBDs) commonly affect women in their reproductive years; 25% of women with IBD become pregnant after the diagnosis. The relation of IBD to reproductive function often manifests in issues concerning fertility, antepartum pregnancy management, mode of delivery, and lactation as these can be influenced by disease activity, medications, perianal disease, and previous ileoanal pouch surgery. As disease location, activity, and complications can vary between patients, an individualized approach with multidisciplinary management is recommended. Pregnancy outcomes, recommended medication, nursing, managing IBD flares during pregnancy, and immune pathways are also discussed. Figures show issues discussed in preconception counseling and pregnancy guidelines. Tables list medication recommendations, Food and Drug Administration categories for the use of medications in pregnancy, adverse pregnancy outcomes PIANO registry, pregnancy and biological recommendations, thiopurine recommendations, safety of biologics in pregnancy, biologic guidelines, and sick pregnant patient recommendations.
This review contains 2 highly rendered figures, 8 tables, and 29 references.
Disorders Involving the Pharynx and Upper Esophagus
Authors: Mashimo Hiroshi
Published: January 2021

A wide variety of disorders can affect the pharynx and upper esophagus, such as inherited or acquired structural abnormalities, malignancies, and inflammation secondary to a number of etiologies including bacterial, yeast and viral infections, irradiation, and gastroesophageal reflux disorder. Laryngoceles and peritonsillar abscess can also lead to pain and dysfunction. However, this review will focus on the main motility disorders that affect the pharynx and upper esophagus, namely oropharyngeal dysphagia, disorders associated with globus pharyngeus, and Zenker’s diverticulum. Figures show the anatomy of the three stages of normal swallow, various findings on functional endoscopic evaluation of swallowing, electromyography of the cricopharyngeal sphincter and submental muscles, and Zenker’s diverticulum. Tables list causes of oropharyngeal dysphagia, neuromuscular control of the pharyngeal phase (with identified cranial and cervical spinal nerve roots), pathophysiology of oropharyngeal dysplasia, diagnostic tests for oropharyngeal dysplasia, behavioral treatments to improve swallow and reduce aspiration, and potential overlapping causes of impaired upper esophageal sphincter relaxation.
 
This review contains 4 highly rendered figures, 6 tables, and 40 references
 
Key words: Oropharyngeal dysphagia; Globus; Upper esophageal sphincter dysfunction; Swallowing disorder; Dysphagia; Zenker’s diverticulum; Swallow assessment; Globus pharyngeus
Viral Hepatitis Other Than A, B, or C
Authors: Anwar Nadeem , Sherman Kenneth E.
Published: January 2021

Viral hepatitis is a global, although variably distributed, health problem associated with significant morbidity and mortality. Infection with a hepatitis virus leads to acute inflammation and liver cell damage (hepatocyte injury). Such infection may be symptomatic or subclinical and may result in disease resolution, death from fulminant hepatic failure, or development of  a chronic disease state. Whereas the chronic infection with hepatitis B and C accounts for a global burden of more than 500,000,000 cases, the global death rate from all types of hepatitis is approximately 1 million people annually. This review focuses on the virology, epidemiology, clinical features, diagnosis, treatment, and prevention of hepatitis D and hepatitis E, as well as other viruses associated with hepatitis. Figures show the global distribution of hepatitis D infection, elevation of anti–hepatitis D virus antibodies in hepatitis B/hepatitis D virus coinfection, geographic distribution of hepatitis E virus by genotype, factors significant in the pathogenesis of hepatitis E, and pattern of antibody elevation in hepatitis E. The table lists proposed diagnostic criteria for hepatitis E virus.
This review contains 5 highly rendered figures, 1 table, and 42 references.
Key words: hepatitis D, hepatitis D virus, hepatitis E, hepatitis E virus, non-A hepatitis, non-B hepatitis, non-C hepatitis, viral hepatitis
The Risk Of Surgery In Patients With Liver Disease 2
Authors: Reuben Adrian
Published: January 2021

The results of retrospective largescale registry and cohort studies and small case series, substantiate the common perception that operating on a liver disease patient is risky. The preexisting physiological derangements of liver disease may be exacerbated by the trauma of surgery and its complications, which contributes strongly to the aforementioned surgical risks, especially but not exclusively in cirrhotics. The risks of operating on patients with non-cirrhotic liver disease are reviewed with particular emphasis on the poor outcomes in acute hepatitis—especially alcoholic hepatitis—severe fatty liver disease, and obstructive jaundice. The outcomes of a broad spectrum of surgical procedures in cirrhotics (abdominal, cardiothoracic, orthopedic, vascular, etc.) are reviewed, with particular reference to common predictors of survival and morbidity, such as the Child-Turcotte-Pugh (CTP) score/class and the model for end-stage liver disease (MELD) score. The concept is proposed that the height of portal pressure may be a predictive factor of surgical outcome, which derives from experience with hepatic resection and suggests that measurement of hepatic venous pressures may be worthwhile in selected cases. New, non-invasive estimates of liver function are presented. A simple practical pre-operative decision tree is provided.

This review contains 5 figures, 3 tables and 91 references
Keywords: cirrhosis, fatty liver, hepatic venous pressure gradient, hepatitis, model for end-stage liver disease, operative mortality, portal hypertension, Child-Turcotte-Pugh
Autoimmune Hepatitis
Authors: Chen Jennifer Y , Andersson Karin L.
Published: January 2021

Autoimmune hepatitis (AIH) is defined by elevated serum transaminases along with the presence of one or more characteristic serum autoantibodies, including antinuclear antibody (ANA), anti–smooth muscle antibody (ASMA), and anti–liver-kidney microsomal type 1 antibody (anti-LKM-1); elevated levels of serum immunoglobulin G (IgG); interface hepatitis on histology; and responsiveness to immunosuppressive therapy. AIH has been classified into two disease subtypes based on serologic markers: type 1, which is characterized by the presence of either ANA or ASMA, and type 2, which is characterized by the presence of either anti-LKM-1 or anti–liver-cytosol antibody type 1 (anti-LC-1). This review addresses the epidemiology, natural history, pathogenesis, and management of AIH, as well as ongoing challenges. Several recent advances are highlighted, including the creation of a simplified diagnostic scoring system and the use of budesonide for AIH treatment. Figures show the pathology of AIH, treatment approach of moderate to severe AIH with combination therapy, azathioprine metabolism, and management of treatment outcomes. Tables list a comparison of type 1 and type 2 AIH, antibodies in AIH, the revised diagnostic scoring system (including a simplified version), indications for treatment in AIH, recommended treatment regimens for AIH by the American Association for the Study of Liver Diseases, and adverse effects associated with therapy for AIH.
This review contains 4 highly rendered figures, 7 tables, and 146 references.
Hepatic Encephalopathy
Authors: Schulman Allison R , Hashemi Nikroo
Published: January 2021

Hepatic encephalopathy (HE) is one of the most debilitating manifestations of acute or chronic liver disease and/or portosystemic shunting. The clinical manifestations of HE span a wide spectrum of neurologic or psychiatric abnormalities, ranging from subclinical neuropsychological disturbances to coma. HE severely affects the lives of patients and their caregivers and results in the use of more health care resources in adults than other manifestations of hepatic dysfunction. To date, there are insufficient clinical studies and standardized definitions, making the diagnosis, classification, and treatment of HE challenging. This review covers the epidemiology, pathophysiology and pathogenesis, diagnosis, differential diagnosis, treatment, and follow-up of HE. Figures show the numerous processes and mechanisms involved in the pathogenesis of HE and ammonia trafficking and metabolism within the body. Tables list the four factors that dictate categorization and grading of HE, differential diagnosis of HE, summary of testing used for minimal HE and covert HE with associated advantages and/or disadvantages, and precipitating causes of HE in patients with cirrhosis.
This review contains 2 highly rendered figures, 4 tables, and 77 references.
Key words: chronic liver disease; covert hepatic encephalopathy; hepatic encephalopathy; minimal hepatic encephalopathy; overt hepatic encephalopathy; transjugular intrahepatic portosystemic shunt
Liver Failure in the Critical Care Setting
Authors: DellaVolpe Jeffrey , Al Khafaji Ali
Published: January 2021

Acute liver failure (ALF) can be challenging to manage due to the effect of liver failure on other organs and the severity of illness that ensues. Both the practicing surgeon and the intensivist should be aware of the manifestations, workup, and management implications as ALF is not uncommon to many intensive care settings. ALF precipitates a severe multiorgan dysfunction syndrome in a majority of cases, with high rates of complications and an elevated risk of death. Management requires a systemic approach in addition to the collaboration of a multidisciplinary team with an emphasis on early recognition, prompt management of complications, and timely transfer to a transplant center. In the absence of spontaneous recovery, transplantation is the only definitive management option and may not always be feasible or immediately available. The continuing search to develop alternatives is essential.
This review contains 2 figures, 9 tables and 70 references
Keywords: acetaminophen, acute liver failure, cerebral edema, coagulopathy, hepatitis, jaundice, N-acetylcysteine, transplantation
Uroneurology
Authors: Seth Jai H , Panicker Jalesh N.
Published: January 2021

The function of the pelvic organs, including the lower urinary tract (LUT), is controlled by a complex network of nerves. This leaves patients with neurologic disease vulnerable to LUT and pelvic organ dysfunction. Physicians often come across urogenital complaints in their patients with neurologic disease, the symptoms of which can result in significant distress and loss of dignity and quality of life. Due to the health and economic burden that accompanies neurogenic pelvic organ dysfunction, it is important for clinicians to understand the common forms of dysfunction, essential investigations, and modes of management. This chapter covers bladder dysfunction from a physician’s perspective. Topics include neurologic control of the LUT, large bowel, and sexual functions; male and female sexual response; neurogenic bladder dysfunction and its management; diagnostic evaluation; management of neurogenic sexual dysfunction; management of erectile dysfunction; ejaculatory dysfunction; sexual dysfunction in women; and fecal incontinence. Figures illustrate efferent innervation of the LUT, neurologic detrusor overactivity, a urethral pressure profile in a patient with Fowler syndrome, an example bladder diary, an example bladder scan, and normal and obstructed flow patterns. Tables list common causes of injury at the suprapontine, suprasacral, and infrasacral levels and storage and voiding systems.
This review contains 6 highly rendered figures, 2 tables, and 53 references.
Anemia: Production Defects Generally Associated with Marrow Aplasia or Replacement
Authors: Berliner Nancy , Gansner John M
Published: January 2021

This review focuses on anemia resulting from production defects generally associated with marrow aplasia or replacement. The definition, epidemiology, etiology, pathogenesis, diagnosis, differential diagnosis, management, complications, and prognosis of the following production defects are discussed: Acquired aplastic anemia and acquired pure red cell aplasia. Figures depict a leukoerythroblastic blood smear, a biopsy comparing normal bone marrow and bone marrow showing almost complete aplasia, and a marrow smear. A table lists the causes of aplastic anemia.
This review contains 3 figures; 1 table; 108 references.
Primary Sjögren Syndrome: Etiology and Pathogenesis
Authors: Clair E. William St. , Giattino Stephanie L
Published: January 2021

Primary Sjögren syndrome is a chronic inflammatory disorder of the lacrimal and salivary glands resulting in oral and ocular dryness. It also has extraglandular manifestations that may affect the lung, kidneys, nervous system, and other organs. The etiology and pathogenesis of primary Sjögren syndrome are incompletely understood. A working hypothesis considers the disease to be driven by a complex interplay of environmental, genetic, and epigenetic factors. Recent genome-wide association studies confirm the previously shown contribution of major histocompatibility (MHC) locus to disease susceptibility and illuminate several non-MHC loci, which add to disease risk. New gene expression studies of peripheral blood and salivary gland tissue provide further molecular detail about the role of innate and adaptive immune pathways involved in disease mechanisms. In particular, upregulated expression of interferon and B cell–activating factor appear to play key roles in this process. Despite their drawbacks, experimental animal models continue to stimulate new lines of research that are advancing our understanding of human disease. This knowledge has been translated into new therapeutic approaches currently under evaluation in clinical trials.
This review contains 5 figures, 2 tables, and 67 references.
Key words: adaptive immunity, animal models, epigenetics, genome-wide association studies, innate immunity, interferon signature, lymphoma pathogenesis, nucleic acid sensing, primary Sjögren syndrome
Von Willebrand Disease
Authors: Campo Meghan , Battinelli Elisabeth M.
Published: January 2021

Von Willebrand disease is the most common hereditary bleeding disorder. The disease is caused by inherited defects in the concentration, structure, or function of von Willebrand protein, a multimeric protein that mediates the initial adhesion of platelets at sites of vascular injury and binds and stabilizes blood clotting factor VIII in plasma. Defects in von Willebrand factor concentration, structure, or function that were not inherited can also occur; this is termed acquired von Willebrand syndrome. These defects occur as a consequence of other medical disorders (valvular heart disease, thrombocythemia, malignant neoplasms, and myeloproliferative and autoimmune diseases). This review examines the laboratory evaluation, clinical variants, and treatment of von Willebrand disease. Figures show the initial assessment of von Willebrand disease, and a treatment algorithm for von Willebrand disease. Tables list types of von Willebrand disease and medications used to treat von Willebrand disease.
This review contains 2 highly rendered figures, 2 tables, and 10 references.
Late Stage Prostate Cancer
Authors: Giridhar Karthik , Kohli Manish
Published: January 2021

Prostate cancer remains the second leading cause of cancer death in men and encapsulates a wide spectrum of disease. This review describes recent advances in genomic sciences and summarizes the impact of emerging molecular profiling–based clinical applications in the diagnosis and management of early and advanced prostate cancer. It addresses the controversial guidelines surrounding prostate-specific antigen–based screening for prostate cancer and summarizes the recommendations from six different agencies. This review highlights landmark clinical trials in metastatic prostate cancer, focusing on developments within the last 5 years. It also summarizes the rationale for earlier use of chemotherapy for newly diagnosed prostate cancer (chemohormonal therapy) and gives an overview of ongoing research into the development of novel genome-based therapeutics.
This review contains 4 figures, 7 tables, and 53 references.
Key words: castration resistant, molecular profiling, prostate cancer, screening guidelines, treatment options
Imaging of Lung Disease, Part i: Focal and Diffuse Parenchymal Lung Diseases
Authors: Jr Gerald W. Staton , Berkowitz Eugene A , Bernheim Adam
Published: January 2021

Parenchymal lung disease often presents on imaging with particular patterns that allow for recognition of certain clinical entities that may form the basis for an imaging differential diagnosis. Focal pulmonary opacities and multi-focal pulmonary opacities may be due to an infectious or neoplastic etiology, amongst other possibilities. Segmental/lobar opacities are also associated with a set of differential diagnoses. Diffuse parenchymal disease, while also associated with some infections and neoplasms, can additionally be seen in the setting of pneumoconioses and several idiopathic interstitial pneumonias. Combining clinical information including laboratory results with the imaging findings on chest radiography and computed tomography (CT) allows the physician to formulate an appropriate differential diagnosis or reach one specific diagnosis.

This review contains 16 figures, 4 tables and 32 references
Keywords: Pulmonary Opacity, Pulmonary Infection, Eosinophilic Pneumonia, Lipoid Pneumonia, Pulmonary Tuberculosis, Organizing Pneumonia, Lung Cancer, Diffuse Lung Disease, Pneumoconiosis, Idiopathic Interstitial Pneumonia
The Neurologic Examination
Authors: Beimer Nicholas J , Gelb Douglas J
Published: January 2021

All physicians, regardless of their medical specialty or the setting in which they treat patients, must be able to perform a neurologic examination. In the outpatient office, up to 9 to 10% of all symptoms suggest the possibility of neurologic disease and up to 5% of emergency department visits are due to primary neurologic disease. The neurologic examination is critical in triaging these patients, selecting diagnostic tests, and indicating management. This review covers how to think about the neurologic examination, the screening examination, and diagnosis-focused neurologic examinations with an emphasis on stroke, epilepsy, encephalopathy and coma, neurodegenerative diseases, neuromuscular disease, and functional disorders. The figure shows a conceptual approach to the neurologic examination. The tables list components of the screening neurologic examination, neurologic examination focus points for suspected stroke and suspected epilepsy, lateralization and localization of common seizure semiologies, and neurologic examination focus points for encephalopathy/coma, suspected neurodegenerative disease, suspected neuromuscular disease, and suspected functional neurologic disorders.
This review contains 1 figure, 13 tables, and 14 references
Keywords: Neurologic examination, neurodegenerative disease, neuromuscular disease, neurologic screening
Overview Of Public Health Dietary Guidelines For Prevention Of Cancer
Authors: Collins Karen K.
Published: January 2021

Diet is now recognized as a vital element in cancer prevention strategies, both for its potential to influence cancer development directly and for its role in avoiding unhealthy adiposity. Dietary guidelines for cancer prevention based on systematic review synthesizing human and laboratory research identify choices that merit the highest priority. This review summarizes current understanding of diet’s multiple intersections with the process of cancer development and discusses major current dietary guidelines for cancer prevention. Dietary guidelines for reducing cancer risk address steps to provide sufficient amounts of cancer-protective factors and to limit exposure to foods and drinks that may facilitate cancer development while emphasizing the importance of an overall plant-rich dietary pattern and healthy weight. Tables and figures provide background to help health professionals discuss diet’s role in cancer prevention and emphasize priorities based on guidelines from systematic reviews of research rather than responding to single studies or non–evidence-based sources. These guidelines reflect the multiple roles that diet can play in cancer prevention and are compatible with dietary guidelines aimed at promotion of overall health.

This review contains 4 figures, 3 tables and 58 references
Key words: alcohol, American Institute for Cancer Research, cancer prevention, diet, dietary guidelines, dietary pattern, nutrition, obesity, plant-based diet, plant-rich diet, public health, recommendations, red and processed meat, reducing cancer risk, weight
Benign Prostatic Hyperplasia
Authors: Barry Michael J
Published: January 2021

Benign prostatic hyperplasia (BPH) is a common cause of morbidity in older men in developed countries. BPH causes lower urinary tract symptoms (LUTS) and occasionally results in such complications as acute urinary retention (AUR), urinary tract infection, and even obstructive uropathy. Although the development of medical treatments has reduced the role of surgery, prostatectomy remains a widely performed procedure. Epidemiology, risk factors, and pathophysiology are discussed. Diagnosis includes clinical features, history, physical examination, and laboratory testing. Management can include watchful waiting, medical treatment, surgery, and minimally invasive treatment. Management of AUR is also addressed. A table lists the alpha blockers commonly used in the treatment of men with LUTS attributed to BPH. Figures illustrate the prevalence of BPH histology with age, the anatomy of the prostate gland, the International Prostate Symptom Score (IPSS) for assessing BPH, and 4-year outcomes in men with moderate and severe LUTS attributable to BPH.
This chapter contains 4 highly rendered figures, 1 table, 70 references, and 5 MCQs.
Pharmacokinetic Principles of Drug Therapy in Chronic Kidney Disease Patients
Authors: Hudson Joanna Q
Published: January 2021

Pharmacokinetics (PK) describes the disposition of a drug in the body and is determined by the absorption, distribution, metabolism, and elimination of a drug. In patients with advanced kidney disease, changes in these processes may occur that affect drug disposition. Further complicating this issue is the fact that drug interactions and medication-related problems are also frequent as a result of altered PK and the high medication burden of the chronic kidney disease (CKD) population. Clinicians who manage patients with CKD and are responsible for drug prescribing and evaluation of the effectiveness and safety of prescribed medication regimens should have an understanding of the potential effect of CKD on drug disposition and the consequences if adjustment to dosing regimens is not made in response. They should also understand options for altering dosing regimens and the most rational approach based on the extent of kidney dysfunction and the specific medication prescribed.
Urinalysis
Authors: Valecha Gautam Kishore , Syed Rafeel , Rehman Amina , El-Sayegh Suzanne
Published: January 2021

Urinalysis comprises physical, chemical, and microscopic examination of urine. Although widely available, this test is often underused and misinterpreted. Urinalysis can provide helpful clues in the assessment of a variety of clinical conditions, but one must be aware of their limitations. On proper collection, the sample must be analyzed ideally within 2 hours. Dipstick urinalysis is convenient and commonly performed but provides qualitative or semiquantitative assessment only, and its results can be affected by urine discoloration and the presence of various other substances. Finally, urine microscopy is an important component of urinalysis used to identify various structures such as crystals, cells, microorganisms, and casts, which in turn helps in the assessment of the underlying disease. In this review, we discuss the clinical implications of various findings on urinalysis. Additionally, we also highlight the importance of proper sample collection and examination techniques to optimize the diagnostic yield of this invaluable test.
Acute Kidney Injury in the Cancer Patient
Authors: Motwani Shveta , Lam Albert Q.
Published: January 2021

Acute kidney injury (AKI) is a problem frequently encountered in patients with cancer that significantly impacts their well-being and outcomes. In addition to the usual prerenal, intrarenal, and postrenal etiologies of AKI, patients with cancer experience unique causes of AKI. Nephrologists caring for this population must be able to identify and manage these conditions, which often require distinguishing between causes resulting from the cancer itself and those related to chemotherapeutic or other concurrent treatment, to institute appropriate preventive or therapeutic strategies. In this review, we present a suggested systematic approach to the diagnosis of AKI in patients with cancer and discuss common clinical scenarios specific to this patient population, with a special emphasis on tumor infiltration of the kidney parenchyma, myeloma-related AKI, tumor lysis syndrome, thrombotic microangiopathy, AKI in the patient with hematopoietic stem cell transplantation, and renal disease in patients with renal cell carcinoma. We cover the latest evidence-based strategies for management of these disorders in this evolving field. In addition, we provide an updated table of potentially nephrotoxic chemotherapeutic agents with their associated mechanisms of kidney injury as a reference for clinicians to build on as they encounter the ever-expanding list of oncologic agents in practice. As the subspecialty of onconephrology continues to evolve, it will be increasingly important for clinicians to have the skills to effectively diagnose and treat AKI in cancer patients to minimize morbidity and mortality, decrease the incidence of subsequent chronic kidney disease, and maintain chemotherapeutic options for these patients.
This review contains 5 figures, 5 tables, and 61 references.
Key words: acute kidney injury, cancer, chemotherapy, onconephrology, renal failure
Inherited Proximal and Distal Renal Tubular Acidosis
Authors: Valles Patricia , Moran-Farias Jesus , Batlle Daniel
Published: January 2021

Acid-base homeostasis by the kidney is maintained through proximal tubular reclamation of filtered bicarbonate and the excretion of the daily acid load by collecting duct type A intercalated cells. The impairment of either process results in renal tubular acidosis (RTA), a group of disorders characterized by a reduced net acid excretion and a persistent hyperchloremic, non–anion gap metabolic acidosis. The primary or hereditary forms of proximal (pRTA) and distal renal tubular acidosis (dRTA) have received increased attention because of advances in the understanding of the molecular mechanism, whereby mutations in the main proteins involved in acid-base transport result in either reduced bicarbonate reabsorption or reduced H+ secretion and impaired acid excretion. dRTA is characterized by reduced net acid excretion and an inability to lower urine pH despite severe acidemia (but minimal HCO3– wastage). pRTA (type 2), by contrast, is characterized by marked HCO3– wastage but preserved ability to lower urine pH when plasma HCO3– (and therefore filtered HCO3–) is below a certain threshold. In children with dRTA, growth retardation caused by chronic metabolic acidosis is the key manifestation but is fully reversible with appropriate alkali therapy if initiated early in life. A striking manifestation of many patients with dRTA is the development of severe hypokalemia that may cause muscle paralysis. In this review, we discuss these types of hereditary RTA and the mechanisms involved in the genesis of these inherited tubular disorders.
This review contains 5 figures, 1 table, and 103 references.
Key words: Proximal renal tubular acidosis (pRTA), Distal renal tubular acidosis (dRTA), Hyperchloremic, non–anion gap metabolic acidosis, Hypokalemia, Fractional HCO3– excretion, Urinary gap, Fanconi Syndrome.ATP6V1B1 and ATP6V0A4 gene mutations . Intercalated cells ,
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 highly rendered figures, 2 tables, 43 references, and 5 MCQs.
Oligohydramnios
Authors: Iyer Surahbi , Norwitz Errol R.
Published: January 2021

Oligohydramnios refers to an amniotic fluid volume that is less than expected for gestational age. Oligohydramnios increases the risk of perinatal morbidity and mortality at all stages of pregnancy. The extent of the risk depends on the underlying cause, severity, and gestational age at diagnosis and delivery. While oligohydramnios is often idiopathic, known causes include preterm premature rupture of membranes, fetal structural abnormalities, placental abruption, fetal chromosomal abnormalities and genetic syndromes, maternal medication use, uteroplacental insufficiency, and twin-to-twin transfusion syndrome. Complications include restricted fetal movements leading to musculoskeletal abnormalities (contractures) and facial deformities (Potter Sequence). In severe cases, oligohydramnios may also result in pulmonary hypoplasia, umbilical cord compression, and fetal/neonatal death. Oligohydramnios is a sonographic diagnosis. Management depends on the underlying cause. Treatment options are limited and depend on the etiology. In select cases (such as twin-to-twin transfusion syndrome or genitourinary outlet obstruction), in utero surgery may be curative. Amnioinfusion can be used in labor to resolve fetal heart rate abnormalities due to umbilical cord compression and decrease the risk of cesarean delivery.
This review contains 4 figures, 2 tables, and 63 references.
Keywords: Oligohydramnios, fetal lung development, ultrasound, perinatal morbidity, preterm premature rupture of membranes, preterm birth
Non-invasive Prenatal Testing (NIPT)
Authors: Manning Courtney , Abbott Mary-Alice
Published: January 2021

Non-invasive prenatal testing (NIPT) is a screening test that can determine if a pregnancy is at high risk for the common aneuploidies by analyzing cell-free fetal DNA in the maternal bloodstream. The screening includes trisomy 21, trisomy 18, and trisomy 13, with the option of screening for sex chromosome aneuploidy and fetal sex. Traditionally this testing is offered to women that are at high risk for these aneuploidies, most commonly women of advanced maternal age. Individuals that receive a high risk result on NIPT should be offered diagnostic testing to confirm the result. New forms of NIPT have recently emerged, however the use of this technology as a screening test for other genetic conditions is not currently recommended by national professional society guidelines. Patients should be counseled and consented for NIPT, as this is an optional screening test.
This review contains 2 tables, and 39 references.
Keywords: NIPT, non-invasive prenatal testing, aneuploidy, Down syndrome, trisomy 18, trisomy 13, Turner syndrome, microdeletions, diagnostic testing
Stress Urinary Incontinence I: Nonsurgical Management
Authors: Lozo Svjetlana , Botros Sylvia M
Published: January 2021

Conservative management of stress urinary incontinence (SUI) is generally offered as first-line treatment. Such treatment options include behavioral therapy, pelvic floor muscle therapy, vaginal devices, pharmacologic therapy, and urethral bulking agents. Weight loss management is an example of an effective behavioral strategy in obese patients. Pelvic floor physical therapy alone or under the supervision of skilled providers can significantly improve SUI; however, long-term effects are harder to maintain. Pessaries, vaginal cones, and vaginal inserts have been widely used for treatment of SUI and are beneficial in patients who are motivated to use them. Currently in the United States, there is no FDA-approved medication for the treatment of SUI. Conversely, the European Union has approved and used duloxetine. Urethral bulking agents are indicated for patients with intrinsic sphincter deficiency and sometimes used in patients who are not able to undergo surgical procedures for SUI or who have failed said procedures. Three materials are currently FDA approved for urethral bulking in the United States. Many options exist for the nonsurgical management of SUI.
This review contains 5 tables and 47 references
 Key words:  Stress Urinary Incontinence, conservative treatment, urethral bulking, pelvic floor exercises, incontinence pessaries.
Nonsurgical Management of Overactive Bladder
Authors: Jakus-Waldman Sharon
Published: January 2021

Overactive bladder affects up to one-third of elderly adults and 17% of adult women in the United States. The diagnosis is based on patient-reported symptoms of urinary urgency and frequency, with or without urinary incontinence after exclusion of any other possible pathology. Treatment options are based on a staged approach beginning with lifestyle and behavioral modifications. Bladder training and pelvic floor muscle training have been shown to be as effective as antimuscarinic medication and possibly most useful when these therapies are combined with medication. A newer class of OAB medication, β3-adrenergic agonists, has fewer side effects compared to antimuscarinics and is an important alternative for elderly patients at a risk of dementia.
This review contains 5 figures and 63 references
Key Words: anticholinergic medication, antimuscarinics, β-adrenergic agonists, nocturia, overactive bladder, urge incontinence, urinary frequency, urinary urgency
Transforaminal Lumbar and Thoracic Interventions and Ischemic Spinal Cord Injury
Authors: Glaser Scott E. , Shah Rinoo
Published: January 2021

Transforaminal epidural steroid injections have been shown to be associated with catastrophic neurologic complications secondary to spinal cord infarction. The reflexive, ad hoc response of practitioners to these injuries has been to recommend risk minimization strategies to prevent embolism of the injected particulate steroids and to use nonparticulate steroids. This focus on distal embolism as the sole or primary cause of catastrophic outcomes lacks conclusive supporting evidence and does not suffice to protect the patient from paraplegia as it fails to address the root cause of the complications. A root cause analysis of the procedure provides evidence that the injection technique itself—the “safe triangle”—creates a risk of arterial damage and sequelae leading to ischemia of the spinal cord. The evidence is strong that the only way to mitigate or eliminate the risk of paraplegia is to use a different technique to perform transforaminal injections: the Kambin triangle approach. This change in technique is the only definitive solution that addresses the root cause of these catastrophic sequelae associated with transforaminal epidural steroid injections.
Key Words: Artery of Adamkiewicz, ischemic spinal cord injury, Kambin triangle, safe triangle, transforaminal epidural injection
Dorsal Root Ganglion Spinal Cord Stimulation: A Novel Target in an Exciting Time in Neuromodulation
Authors: Deer Timothy R. , Pope Jason E. , Lee Eric T. , Hunter Corey W.
Published: January 2021

The dorsal root ganglion (DRG) is a cluster of neurons located in the dorsal nerve root and is responsible for relaying sensory signals from the peripheral nervous system to the brain. Previously, the DRG was thought to be a purely supportive structure with no active role in chronic neuropathic pain; more recent evidence, however, suggests that the DRG is directly responsible for the development and even maintaining it. The concept of DRG stimulation is quite similar to traditional stimulation, with one very important difference: rather than placing leads over the posterior aspect of the cord to affect the dorsal columns, the leads are placed over the DRG(s), thus stimulating the cell bodies directly and modulating the pain at the source.
Key words: causalgia, complex regional pain syndrome, dorsal root ganglion, neuromodulation, reflex sympathetic dystrophy, spinal cord stimulation
Burst Spinal Cord Stimulation: Introduction to a New Age in Neuromodulation
Authors: Deer Timothy R. , Pope Jason E. , Lee Eric T. , Hunter Corey W.
Published: January 2021

Spinal cord neuromodulation has been a long-established treatment option for those suffering from various types of chronic pain. This minimally invasive procedure provides the potential for long-term pain relief, reducing the burden of other types of therapy, such as medications. As with any medical treatment, some patients do not tolerate or respond well to the therapy. This fact has led to recent developments in the technology to improve the therapeutic efficacy. More specifically, in 2010, Dr. Dirk De Ritter described what is known as burst waveforms, which may result in better outcomes than traditional tonic stimulation, which is most commonly used in clinically. An understanding of the mechanism of neuromodulation and how these waveforms disrupt different targets in the pain pathway therefore represents a significant advancement in the world of interventional pain medicine. This evolution of treatment may improve the lives of those suffering from lifelong pain conditions and chronic pain states.
Vertebral Augmentation
Authors: Thakur Siddarth , Rothstein Daniel , Nouri Kent H
Published: January 2021

Vertebral compression fractures are a prevalent and growing public health problem associated with significant morbidity and economic cost. Most commonly, they occur in osteoporotic patients but are also seen in patients with metastatic cancer and secondary to trauma. Appropriate and timely treatment is imperative. When conservative treatments are inadequate, minimally invasive techniques, such as vertebroplasty and kyphoplasty, can provide substantial pain relief, improve function, and enhance quality of life. For appropriate patient selection, a comprehensive evaluation is essential to confirm the presence of concordant pain. Both vertebroplasty and kyphoplasty are performed percutaneously under radiographic guidance, and cement is injected into the collapsed vertebral body to provide strength and stability. Awareness of early and late procedure-related complications is necessary for perioperative planning. Overall, vertebral augmentation is a safe and efficacious procedure for patients suffering from pain related to vertebral compression fractures.
This review contains 10 figures, 5 tables, and 74 references.
Key words: adjacent level fractures, axial low back pain, cement injection, cement leakage, kyphoplasty, osteoporosis, parapedicular, polymethylmethacrylate, spinal metastasis, transpedicular, vertebral augmentation, vertebral compression fracture, vertebroplasty
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.
Pediatric Pain and Postoperative Management
Authors: Frost Elizabeth A.M.
Published: January 2021

Both assessment and management of pain in children present challenges for perioperative physicians, including surgeons, anesthesiologists, intensivists, and pediatricians, among others. Several reports have indicated that pediatric pain is undertreated postoperatively compared with pain in adults, resulting in both severe physical consequences, such as the development of chronic pain and complex regional pain syndromes, and significant psychological distress, such as nightmares and reversal of learned behavior. Moreover, chronic pain in childhood has been shown to heighten the risk for mental health problems in adulthood. Children with chronic pain (n = 14,790) reported higher rates of lifetime anxiety disorders (21.1% versus 12.4%) and depressive disorders (24.5% vs 14.1%) as adults. Although many evidence-based practice guidelines for pain management in younger people have been developed, adherence is often less than complete.
The perioperative physician should be aware of barriers in pediatric pain management and be able to address them, thus improving pain management and patient outcome. Some of the problems in dealing with pediatric pain management include a realization of the controversies as to the age at which children feel pain, how pain can be assessed from the newborn to the adolescent, how the level of education and involvement of parents impact the situation, and a general knowledge of available pain treatments for the pediatric population. 
Key words: complications, opioids, pediatrics, postoperative pain, regional techniques
Abuse-Deterrent Formulations in the Treatment of Chronic Pain
Authors: Silverman Sanford M
Published: January 2021

Prescription drug abuse is the fastest growing problem in the United States. According to the Centers for Disease Control and Prevention (CDC), enough opioid pain relievers were sold in 2010 to provide every adult in the United States with the equivalent of a typical dose of 5 mg of hydrocodone every 4 hours for 1 month. Many solutions have been proposed to address this problem, including treatment guidelines, political solutions (statutory changes), Risk Evaluation and Mitigation Strategy (REMS), and technological innovations. Many opioid products are manipulated (crushed, snorted, injected, etc.) to facilitate abuse. Since extended-release/long-acting (ER/LA) opioids contain a large amount of opioid contained in a single delivery system, they are a favorite target of abusers. In short, the goal of an abuser is to convert an ER/LA opioid into an immediate-release one. Abuse-deterrent formulations (ADFs) are intended to make manipulation more difficult or to make abuse of the manipulated product less attractive or less rewarding. One such technological solution is the development of ADFs for opioid pain medications. The Food and Drug Administration's (FDA) guidelines for industry released in 2015 establish the rationale and methodology for the development of ER/LA opioids that contain abuse-deterrent properties. The goal is to deter abuse, realizing that it is impossible to prevent abuse.
Key words: abuse-deterrent formulations, abuse-deterrent opioids, CDC guidelines, FDA opioid guidelines, opioid abuse, opioid deaths, opioid diversion, opioid overdose, prescription drug abuse, REMS
Pain in the Spinal Cord–Injured Patient
Authors: Shah Chirag D. , Rana Maunak V.
Published: January 2021

Management of pain in the spinal cord–injured patient can be a stressful and difficult challenge for both the patient and the physician. In spinal cord injury (SCI), pain can occur immediately or months later, with the potential for persistent pain throughout a lifetime. Unfortunately, pain in this population is often overshadowed or minimized. This is often due to bigger concerns of physical immobility, medical comorbidities, and functional capacity. Achieving pain control leads to a higher likelihood of patients regaining independence in their activities of daily living (ADL), along with providing biopsychosocial benefits to them and their contacts. Using a classification system based on injury acuity, location, and characterized pain state to identify pain generators can help practitioners implement targeted treatment plans. A combination of interventional, physical, pharmacologic, and psychological treatment will help attack the interminable issues that develop along the life span of a patient after injury. Promptly starting treatment will improve our successful management of SCI pain with care that is preventive rather than reactionary.
Patients in the Postpartum and Breast-feeding Period
Authors: Fox Charles J. , Kaye Alan D. , Sen Sudipta , Cornett Elyse , Chandler Debbie
Published: January 2021

Pain after childbirth is common. The incidence of chronic postpartum pain is rising and has been shown to have a negative impact on the mother, the baby, and the rest of the family. Estrogen heightens pain sensitivity in women, and high levels of estrogen are normally seen during pregnancy. In patients who have had a cesarean section, postpartum pain can be caused by several different factors, including pain at the point of incision, infection at the incision site, suture breakdown, tape burn, or collection of fluid under the skin. In addition to complications during a cesarean section, other complications can arise during childbirth that require the use of pain medications, and this can cause concern for mothers who are breast-feeding. This review outlines the types of complications that can occur in mothers after the delivery of a baby and the types of medications they are prescribed. Additionally, this review outlines which drugs are safe for the breast-feeding mother and baby as well as medications that should be used with caution.