scholarly journals The management of hiatal hernia: an update on diagnosis and treatment

2019 ◽  
Author(s):  
Alice Sfara ◽  
Dan L Dumitrașcu
Keyword(s):  
Surgical Treatment ◽  
Hiatal Hernia ◽  
Randomized Trials ◽  
Narrative Review ◽  
Disease Treatment ◽  
Diagnosis And Management ◽  
Diagnostic Pathway ◽  
Pubmed Database ◽  
Wide Range ◽  
Specific Symptoms

Background and aim. Hiatal hernia (HH) occurs quite frequently in the general population and is characterized by a wide range of non-specific symptoms, most of them related to gastroesophageal reflux disease. Treatment can be challenging at times, depending on the existence of complications. The most recent guideline regarding the management of hiatal hernia was released by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) in the year 2013. This review aims to present  the most recent updates on the diagnosis and management of hiatal hernia for clinical practitioners. Methods. The PubMed database was screened for publications using the terms: “hiatal hernia”, “paraesophageal hernia”, “management”, “treatment”, “hiatal repair”. A literature review of contemporary and latest studies was completed. The studies that we looked into include prospective, randomized trials, systematic reviews, clinical reviews and original articles. The information was compiled in narrative review format. Results. This narrative review presents new data on the diagnosis and management of hiatal hernia. While the diagnostic pathway has remained virtually unchanged, new data have come to light regarding the surgical treatment of hiatal hernia. We present the imaging methods used for its diagnosis, as well as the medical and surgical treatment currently available. Conclusions. In the last five years, there has been vast research in the field of hiatal hernia management, especially regarding the surgical treatment. However, unanswered questions still remain and solid updates on the guidelines have yet to be formulated. To address this, more randomized studies need to be done on subsets of patients, stratified by age, gender, symptoms and comorbidities.

scholarly journals Gastrointestinal manifestations of extramedullary plasmacytoma: a narrative review and illustrative case reports

2018 ◽  
Vol 100 (5) ◽  
pp. 371-376 ◽  
Author(s):  
JC Glasbey ◽  
F Arshad ◽  
LM Almond ◽  
B Vydianath ◽  
A Desai ◽  
...  
Keyword(s):  
Case Studies ◽  
Case Reports ◽  
High Volume ◽  
Extramedullary Plasmacytoma ◽  
Narrative Review ◽  
Resected Specimen ◽  
Illustrative Case ◽  
Diagnosis And Management ◽  
Pubmed Database ◽  
Quality Evidence

Introduction Solitary extramedullary plasmacytoma are rare, solid-mass tumours which appear immunophenotypically similar to multiple myeloma. The diagnosis and management of gastrointestinal plasmacytoma is complex and requires multidisciplinary input. This study presents a narrative review of intra-abdominal extramedullary plasmacytoma, illustrated with two case studies. Methods The PubMed database was searched without date restrictions for reports of intra-abdominal extramedullary plasmacytoma to synthesise a narrative review. Electronic records were reviewed at a high-volume, quaternary soft-tissue sarcoma centre to identify patients with histopathologically confirmed extramedullary plasmacytoma affecting the gastrointestinal tract. Results Gastrointestinal extramedullary plasmacytomas can present with mass effect or organ-specific dysfunction. Techniques for tissue diagnosis of extramedullary plasmacytoma vary dependent on location, with a formal diagnosis often being made from a resected specimen. Management can include surgery, radiotherapy, systemic chemotherapy or a combination. No high-quality evidence base exists to guide treatment. Two case studies of operated gastrointestinal extramedullary plasmacytoma are presented at different phases of disease progression, with a resultant impact on survival. Conclusion Intra-abdominal extramedullary plasmacytoma is a rare and heterogeneous condition that lacks consensus guidelines for diagnosis and management. Collaboration between international specialist centres will create better quality evidence for treatment of this cohort.

Antihypertensive Therapy in Patients Receiving Maintenance Hemodialysis: A Narrative Review of the Available Clinical-Trial Evidence

2020 ◽  
Vol 19 (1) ◽  
pp. 12-20
Author(s):  
Panagiotis I. Georgianos ◽  
Rajiv Agarwal
Keyword(s):  
Clinical Trial ◽  
Clinical Trials ◽  
Randomized Trials ◽  
Antihypertensive Drugs ◽  
Narrative Review ◽  
Maintenance Hemodialysis ◽  
First Line ◽  
Pubmed Database ◽  
Clinical Trial Evidence ◽  
Trial Evidence

Background: Blood pressure (BP)-lowering with the use of antihypertensive drugs appears to protect the cardiovascular (CV) system in hemodialysis patients. However, the optimal treatment algorithm of hypertension remains elusive; extrapolation of clinical-trial evidence from the general population may not be optimal. Methods: For this narrative review, we searched the Medline/PubMed database (inception to August 01, 2019) to identify randomized clinical trials evaluating the efficacy of antihypertensive drugs on CV outcomes and mortality in patients on hemodialysis. Results: Randomized trials with angiotensin-converting-enzyme-inhibitors (ACEIs) or angiotensinreceptor- blockers (ARBs) failed to provide consistent cardioprotection. β-blockers may provide a more consistent CV benefit. Although some early clinical trials have shown that mineralocorticoid-receptorantagonists (MRAs) reduce CV mortality, the associated risk of hyperkalemia raises important safety concerns on the use of MRAs as add-on therapy. Conclusion: Our first-line therapy of hypertension in hemodialysis is the assessment and management of dry-weight and optimization of dialysis prescription. Based on the available clinical-trial evidence, we prescribe atenolol 3 times/week after dialysis as the first-line pharmacological option of hypertension to our patients without specific indications for other agents. Long-acting dihydropyridines and ACEIs/ARBs are our second-line and third-line choices, respectively. We avoid using MRAs and await results from ongoing trials testing their safety and efficacy. In patients receiving maintenance hemodialysis, randomized trials are clearly warranted in order to define BP targets and the comparative effectiveness of different antihypertensive drugs.

scholarly journals SGLT2 inhibitors: a narrative review of efficacy and safety

2021 ◽  
Vol 121 (2) ◽  
pp. 229-239
Author(s):  
Donald S. Nelinson ◽  
Jose M. Sosa ◽  
Robert J. Chilton
Keyword(s):  
Adverse Events ◽  
Sglt2 Inhibitor ◽  
Sglt2 Inhibitors ◽  
Narrative Review ◽  
Atherosclerotic Cardiovascular Disease ◽  
Comorbid Conditions ◽  
Postprandial Plasma Glucose ◽  
Renal Outcomes ◽  
Glucose Levels ◽  
Wide Range

Abstract Type 2 diabetes mellitus (T2DM) is a cardio-renal-metabolic condition that is frequently associated with multiple comorbidities, including atherosclerotic cardiovascular disease (ASCVD), heart failure (HF), and chronic kidney disease (CKD). The sodium-glucose co-transporter-2 (SGLT2) inhibitors, which lower glycated hemoglobin, fasting and postprandial plasma glucose levels, body weight, and blood pressure, as well as reduce the risk of a range of cardiovascular and renal outcomes without increasing hypoglycaemic risk, have heralded a paradigm shift in the management of T2DM. These drugs are compatible with most other glucose-lowering agents and can be used in patients with a wide range of comorbid conditions, including ASCVD, HF, and CKD, and in those with estimated glomerular filtration rates as low as 30 mL/min/1.73 m2. However, there are misunderstandings surrounding the clinical implications of SGLT2 inhibitors’ mechanism of action and concerns about the key adverse events with which this class of drugs has been associated. This narrative review summarizes the data that support the efficacy of SGLT2 inhibitors in reducing the risks of cardiovascular and renal outcomes in patients with T2DM and comorbid conditions and clarifies information relating to SGLT2 inhibitor-related adverse events.

scholarly journals Role of interferon gamma release assay in the diagnosis and management of Mycobacterium tuberculosis-associated uveitis: a review

2021 ◽  
Vol 6 (1) ◽  
pp. e000663
Author(s):  
Samra Rahman ◽  
Muhammad Irfan ◽  
M A Rehman Siddiqui
Keyword(s):  
Interferon Gamma ◽  
Interferon Gamma Release Assay ◽  
Limited Evidence ◽  
Ocular Tuberculosis ◽  
Diagnosis And Management ◽  
Pubmed Database ◽  
Interferon Gamma Release Assays ◽  
Infectious Uveitis ◽  
Release Assay

Tuberculosis (TB)-associated uveitis is a common cause of infectious uveitis in the developing world. Diagnosis of TB uveitis remains a challenge. The role of interferon gamma release assays (IGRAs) is uncertain. Herein we summarise the available literature on the utility of IGRAs in the diagnosis and management of TB uveitis. We searched PubMed database from 1 August 2010 to 31 July 2020 using the following keywords alone and in combination: ‘interferon-gamma release assay’, ‘QuantiFERON’, ‘T-SPOT.TB’, ‘TB uveitis’, ‘serpiginous like choroiditis’, ‘tuberculoma’, ‘TB vasculitis’, ‘TB panuveitis’ and ‘ocular tuberculosis’. Data from 58 relevant studies were collated. The review is focused on currently marketed versions of IGRA tests: QuantiFERON-TB Gold In-Tube assay, QuantiFERON-TB Gold Plus assay (QFT-Plus) and T-SPOT.TB. We found limited evidence regarding the diagnostic utility of IGRA in patients with uveitis. No study was identified evaluating the newer QFT test—the QFT-Plus—in patients with uveitis. Similarly, there is lack of data directly comparing QFT-Plus with T-SPOT.TB specifically for the diagnosis of TB uveitis.

scholarly journals Bleeding risks are higher in children versus adults given prophylactic platelet transfusions for treatment-induced hypoproliferative thrombocytopenia

Blood ◽  
2012 ◽  
Vol 120 (4) ◽  
pp. 748-760 ◽  
Author(s):  
Cassandra D. Josephson ◽  
Suzanne Granger ◽  
Susan F. Assmann ◽  
Marta-Inés Castillejo ◽  
Ronald G. Strauss ◽  
...  
Keyword(s):  
Bleeding Risk ◽  
World Health ◽  
Age Group ◽  
Transplant Recipients ◽  
Disease Treatment ◽  
Platelet Counts ◽  
Wide Range ◽  
Treatment Category ◽  
Dose Trial ◽  
Health Organization

Age-group analyses were conducted of patients in the prophylactic platelet dose trial (PLADO), which evaluated the relation between platelet dose per transfusion and bleeding. Hospitalized patients with treatment-induced hypoproliferative thrombocytopenia were randomly assigned to 1 of 3 platelet doses: 1.1 × 1011, 2.2 × 1011, or 4.4 × 1011 platelets/m2 per transfusion, given for morning counts of ≤ 10 000 platelets/μL. Daily hemostatic assessments were performed. The primary end point (percentage of patients who developed grade 2 or higher World Health Organization bleeding) was evaluated in 198 children (0-18 years) and 1044 adults. Although platelet dose did not predict bleeding for any age group, children overall had a significantly higher risk of grade 2 or higher bleeding than adults (86%, 88%, 77% vs 67% of patients aged 0-5 years, 6-12 years, 13-18 years, vs adults, respectively) and more days with grade 2 or higher bleeding (median, 3 days in each pediatric group vs 1 day in adults; P < .001). The effect of age on bleeding differed by disease treatment category and was most pronounced among autologous transplant recipients. Pediatric subjects were at higher risk of bleeding over a wide range of platelet counts, indicating that their excess bleeding risk may be because of factors other than platelet counts. This trial was registered at www.clinicaltrials.gov as #NCT00128713.

Effects of a Brief Transdiagnostic Cognitive Behavioural Group Therapy on Disorder Specific Symptoms

2018 ◽  
Vol 47 (1) ◽  
pp. 1-15 ◽  
Author(s):  
Hafrún Kristjánsdóttir ◽  
Baldur Heiðar Sigurðsson ◽  
Paul Salkovskis ◽  
Engilbert Sigurðsson ◽  
Magnús Blöndahl Sighvatsson ◽  
...  
Keyword(s):  
Anxiety Disorders ◽  
Treatment Effects ◽  
Mental Health Problems ◽  
Effect Sizes ◽  
Low Intensity ◽  
Cognitive Behavioural ◽  
Wide Range ◽  
Common Mental Health Problems ◽  
Specific Symptoms ◽  
Group Therapies

Background:In recent years, cognitive behavioural group therapies (CBGT) have been increasingly deployed as a strategy to increase the efficiency and cost-effectiveness in treatment of common mental health problems. The vast majority of these therapies are disorder specific, but in the last few years there has been growing interest in transdiagnostic CBGT.Aims:The aim of this study was twofold: to evaluate the treatment effects of transdiagnostic CBGT on disorder specific symptoms and what (if any) differences would be observed in the treatment effects with regard to general as opposed to disorder specific symptoms measured pre- and post-treatment.Method:The participants were 233 adult patients diagnosed with depression and/or anxiety disorders. They underwent a 6-week transdiagnostic CBGT. To compare treatment effects on general and disorder specific symptoms, raw scores on all measures were converted to standardized scores.Results:Pre–post differences were significant and there was no evidence that treatment was differentially effective for general and disorder specific symptoms. Effect sizes ranged from medium to large.Conclusion:The 6-week transdiagnostic CBGT is feasible for a wide range of mood and anxiety disorders. The results indicate that low-intensity transdiagnostic group therapies may have similar effects on both general and disorder specific symptoms.

scholarly journals Virtual Body Ownership Illusions for Mental Health: A Narrative Review

2021 ◽  
Vol 10 (1) ◽  
pp. 139
Author(s):  
Marta Matamala-Gomez ◽  
Antonella Maselli ◽  
Clelia Malighetti ◽  
Olivia Realdon ◽  
Fabrizia Mantovani ◽  
...  
Keyword(s):  
Mental Health ◽  
Clinical Care ◽  
Well Being ◽  
Narrative Review ◽  
Future Research ◽  
Body Ownership ◽  
Surrounding Environment ◽  
Wide Range ◽  
Clinical Conditions ◽  
Virtual Body

Over the last 20 years, virtual reality (VR) has been widely used to promote mental health in populations presenting different clinical conditions. Mental health does not refer only to the absence of psychiatric disorders but to the absence of a wide range of clinical conditions that influence people’s general and social well-being such as chronic pain, neurological disorders that lead to motor o perceptual impairments, psychological disorders that alter behaviour and social cognition, or physical conditions like eating disorders or present in amputees. It is known that an accurate perception of oneself and of the surrounding environment are both key elements to enjoy mental health and well-being, and that both can be distorted in patients suffering from the clinical conditions mentioned above. In the past few years, multiple studies have shown the effectiveness of VR to modulate such perceptual distortions of oneself and of the surrounding environment through virtual body ownership illusions. This narrative review aims to review clinical studies that have explored the manipulation of embodied virtual bodies in VR for improving mental health, and to discuss the current state of the art and the challenges for future research in the context of clinical care.

scholarly journals Guidelines for the public on how to provide mental health first aid: narrative review

BJPsych Open ◽  
2018 ◽  
Vol 4 (6) ◽  
pp. 427-440 ◽  
Author(s):  
Anthony F. Jorm ◽  
Anna M. Ross
Keyword(s):  
Mental Health ◽  
First Aid ◽  
Narrative Review ◽  
Mental Health First Aid ◽  
Mental Health Crisis ◽  
Middle Income ◽  
Health Crisis ◽  
The Public ◽  
For Profit ◽  
Wide Range

BackgroundExpert-consensus guidelines have been developed for how members of the public should assist a person with a mental health problem or in a mental health crisis.AimsThis review aimed to examine the range of guidelines that have been developed and how these have been implemented in practice.MethodA narrative review was carried out based on a systematic search for literature on the development or implementation of the guidelines.ResultsThe Delphi method has been used to develop a wide range of guidelines for English-speaking countries, Asian countries and a number of other cultural groups. The primary implementation has been through informing the content of training courses.ConclusionFurther work is needed on guidelines for low- and middle-income countries.Declaration of interestA.F.J. is an unpaid member of the Board of Mental Health First Aid International (trading as Mental Health First Aid Australia), which is a not-for-profit organisation.

scholarly journals Selenium supplementation: does soil supplementation help and why?

2003 ◽  
Vol 62 (2) ◽  
pp. 393-397 ◽  
Author(s):  
John R. Arthur
Keyword(s):  
Effective Means ◽  
Careful Consideration ◽  
Selenium Supplementation ◽  
Physiological Changes ◽  
Disease Treatment ◽  
Hormone Synthesis ◽  
Metabolic Functions ◽  
Wide Range ◽  
The Uk ◽  
Se Status

There are now concerns that dietary Se intake is inadequate for the population in the UK and parts of Europe. Many different methods can be proposed to deal with this problem. Experience from Finland suggests that the addition of Se to fertiliser is a safe and effective means of increasing the intake of the micronutrient in the human population. However, careful consideration needs to be given to the potential consequences of increasing Se intake. It is important to understand the biochemical and physiological changes that may occur with any increase in Se intake within the UK population. Se is an essential component of at least twenty functional proteins within mammals. These proteins are essential for a range of metabolic functions, including antioxidant activity, thyroid hormone synthesis and immune function. Thus, any increase in Se intake has the potential to influence in a wide range of factors that may impinge on the incidence of chronic disease. Treatment of soil with Se-supplemented fertiliser will certainly increase total Se in food products derived from areas where this treatment is in place. Consumption of such foods will increase Se status in many populations where the existing intake does not meet requirements. If the increases in Se intake are not toxic the overall consequences have the potential to be beneficial.

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