scholarly journals Cardiac Sarcoidosis: When and How to Treat Inflammation

2021 ◽  
Vol 7 ◽  
Author(s):  
Gerard T Giblin ◽  
Laura Murphy ◽  
Garrick C Stewart ◽  
Akshay S Desai ◽  
Marcelo F Di Carli ◽  
...  
Keyword(s):  
Cardiac Involvement ◽  
Cardiac Sarcoidosis ◽  
Multidisciplinary Treatment ◽  
Current Evidence ◽  
Myocardial Inflammation ◽  
Evidence Based ◽  
Future Directions ◽  
Evidence Based Treatment ◽  
Inflammatory Phase ◽  
Treatment Indications

Sarcoidosis is a complex, multisystem inflammatory disease with a heterogeneous clinical spectrum. Approximately 25% of patients with systemic sarcoidosis will have cardiac involvement that portends a poorer outcome. The diagnosis, particularly of isolated cardiac sarcoidosis, can be challenging. A paucity of randomised data exist on who, when and how to treat myocardial inflammation in cardiac sarcoidosis. Despite this, corticosteroids continue to be the mainstay of therapy for the inflammatory phase, with an evolving role for steroid-sparing and biological agents. This review explores the immunopathogenesis of inflammation in sarcoidosis, current evidence-based treatment indications and commonly used immunosuppression agents. It explores a multidisciplinary treatment and monitoring approach to myocardial inflammation and outlines current gaps in our understanding of this condition, emerging research and future directions in this field.

scholarly journals Management of Cardiac Sarcoidosis in 2020

2020 ◽  
Vol 9 (4) ◽  
pp. 182-188
Author(s):  
Nisha Gilotra ◽  
David Okada ◽  
Apurva Sharma ◽  
Jonathan Chrispin
Keyword(s):  
Heart Failure ◽  
Heart Block ◽  
Ventricular Arrhythmias ◽  
Cardiac Involvement ◽  
Cardiac Sarcoidosis ◽  
Management Strategies ◽  
Clinical Manifestations ◽  
Future Directions ◽  
Inflammatory Phase

Sarcoidosis is an inflammatory granulomatous disease that can affect any organ. Up to one-quarter of patients with systemic sarcoidosis may have evidence of cardiac involvement. The clinical manifestations of cardiac sarcoidosis (CS) include heart block, atrial arrhythmias, ventricular arrhythmias and heart failure. The diagnosis of CS can be challenging given the patchy infiltration of the myocardium but, with the increased availability of advanced cardiac imaging, more cases of CS are being identified. Immunosuppression with corticosteroids remains the standard therapy for the acute inflammatory phase of CS, but there is an evolving role of steroid-sparing agents. In this article, the authors provide an update on the diagnosis of CS, including the role of imaging; review the clinical manifestations of CS, namely heart block, atrial and ventricular arrhythmias and heart failure; discuss updated management strategies, including immunosuppression, electrophysiological and heart failure therapies; and identify the current gaps in knowledge and future directions for cardiac sarcoidosis.

Acute myocarditis

2014 ◽  
Author(s):  
Demosthenes G. Katritsis ◽  
Bernard J. Gersh ◽  
A. John Camm
Keyword(s):  
Acute Myocarditis ◽  
Current Evidence ◽  
Evidence Based ◽  
Evidence Based Treatment

Classification, diagnosis, and current evidence-based treatment of myocarditis are presented.

scholarly journals Utility of updated diagnositc criteria to detect isolated cardiac sarcoidosis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Sato ◽  
M Yamamoto ◽  
T Ishizu ◽  
M Ieda
Keyword(s):  
Diagnostic Criteria ◽  
Clinical Diagnosis ◽  
Fdg Pet ◽  
Cardiac Involvement ◽  
Cardiac Sarcoidosis ◽  
Histological Finding ◽  
Left Ventricular ◽  
Myocardial Inflammation ◽  
Histologic Diagnosis ◽  
Anti Inflammatory

Abstract Background Prior study reported around one-third of cardiac sarcoidosis (CS) are considered as isolated CS. Detection of CS is challenging due to the limited sensitivity of endomyocardial biopsy and applicability of guidelines, especially in patients without extra-cardiac involvement. Existing diagnostic criteria by Japanese Ministry of health and Welfare (JMHW) or Heart Rhythm Society (HRS) require the presence of extra-cardiac sarcoidosis for clinical diagnosis, isolated CS is not diagnosable in the absence of a positive histological finding. Recently, Japanese Society of Cardiology (JCS) updated diagnostic criteria for CS, which provides the pathway to diagnose isolated CS. Purpose We aimed to assess the reliability of the updated CS guideline in diagnosing CS compared to the prior guidelines. Methods We retrospectively identified 162 consecutive patients who underwent FDG-PET for suspected CS from 2012 through 2019. According to the updated JCS diagnostic criteria, patients were classified as histologic diagnosis of CS, clinical diagnosis of CS, or isolated CS (Figure A). We compared the association between diagnostic criteria and response with anti-inflammatory therapy. Results The JCS criteria classified 24 patients (15%) as having clinical CS, 4 (3%) as histological diagnosis of CS, and 21 (13%) as isolated CS. The JMHW criteria defined 22 patients (14%) as having CS (clinical 11%, histological 3%) and HRS criteria classified 11 patients (7%) as having CS (clinical 4%, histological 3%). Extra-cardiac involvement was detected in 36 patients (22%) with 8% of histological confirmation. Among the 126 patients without extra-cardiac involvement, prevalence of cardiac involvement was higher in isolated CS (P<0.05 for all). Compared with clinical diagnosis group, patients with isolated CS showed higher incident of regional wall motion abnormality (WMA) or left ventricular (LV) dysfunction (p=0.023). In the subgroup of 45 patients with serial FDG-PET evaluation, only updated CS criteria was associate with improvement in myocardial inflammation by FDG-PET (p<0.001). Conclusions Updated JCS diagnostic criteria detects CS patients with active myocardial inflammation which require anti-inflammatory therapy regardless of extra-cardiac involvement better than the prior guidelines. Diagnostic criteria for CS Funding Acknowledgement Type of funding source: None

scholarly journals “You Didn’t Cause Racism, and You Have to Solve it Anyways”: Antiracist Therapist Adaptations to Dialectical Behavior Therapy (DBT)

2021 ◽  
Author(s):  
Ashley Pierson ◽  
Vinushini Arunagiri ◽  
Debra Bond
Keyword(s):  
African American ◽  
Behavior Therapy ◽  
Dialectical Behavior Therapy ◽  
Culturally Responsive ◽  
Theoretical Models ◽  
Cultural Responsiveness ◽  
Evidence Based ◽  
Future Directions ◽  
Black African ◽  
Evidence Based Treatment

AbstractThere are currently no published studies that investigate or discuss the cultural responsiveness of Dialectical Behavior Therapy (DBT) to the needs of Black/African-American patients. In addition, no published scholarly works offer guidance to therapists on how to practice antiracism within the context of delivering evidence-based treatment. Methods for developing culturally responsive treatment are discussed within a dialectical framework. We propose that an antiracist adaptation to DBT is needed to correct for context minimization errors in the DBT model that create an invisibility of racism. Recommendations are made for an additional DBT Therapist Agreement that encourages labeling and targeting therapist treatment-interfering racist behavior. An additional Therapist Consultation Agreement is also proposed to guide therapist antiracist advocacy and functional validation for Black/African-American patients. The DBT technology is used in conjunction with other multicultural theoretical models to recommend strategies for developing White DBT therapists’ antiracist competencies. Future directions for qualitative research and applications to DBT supervision are discussed.

EARLY EJACULATION

2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Emilia Claudia Todoruti
Keyword(s):  
Serotonin Reuptake ◽  
American Psychiatric Association ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Premature Ejaculation ◽  
Current Evidence ◽  
Evidence Based ◽  
Treatment Interventions ◽  
Pharmacological Agents ◽  
Evidence Based Treatment ◽  
Topical Anesthetics

Information on the epidemiology, etiology and treatment of premature ejaculation is reviewed. Evidence of the prevalence of premature ejaculation indicates that subjective concern about rapid ejaculation is a common concern worldwide. The hypotheses regarding the pathogenesis of premature ejaculation include: 1.) that it is a learned model of ejaculation maintained by interpersonal anxiety and 2.) that it is a dysfunctional result of the central or peripheral mechanisms that regulate ejaculatory thresholds and 3.) that it is a normal variant in latency ejaculation. Current evidence-based treatment interventions include behavioral psychotherapy and the use of pharmacological agents, including topical anesthetics and selective serotonin reuptake inhibitors. The purpose of this paper is to review the existing knowledge base on the definition, prevalence, etiology and treatment of premature ejaculation. American Psychiatric Association (2013).

One-Session Treatment of Specific Phobias in Children: Recent Developments and a Systematic Review

2019 ◽  
Vol 15 (1) ◽  
pp. 233-256 ◽  
Author(s):  
Thompson E. Davis ◽  
Thomas H. Ollendick ◽  
Lars-Göran Öst
Keyword(s):  
Systematic Review ◽  
Children And Adolescents ◽  
Skills Training ◽  
Evidence Based ◽  
Future Directions ◽  
Research And Practice ◽  
Evidence Based Treatment ◽  
Specific Phobias ◽  
Recent Developments ◽  
Graduated Exposure

One-Session Treatment is a well-established evidence-based treatment for specific phobias in youths that incorporates reinforcement, cognitive challenges, participant modeling, psychoeducation, and skills training into a single, massed session of graduated exposure. This review begins by briefly examining the phenomenology, etiology, epidemiology, and assessment of specific phobias and then pivots to a description of One-Session Treatment. We examine the use of One-Session Treatment with children and adolescents, briefly discussing its components and application, and subsequently review almost two decades of research supporting its efficacy. Finally, we propose future directions for research and practice.

Evidence-based treatment of carotid artery stenosis

2011 ◽  
Vol 30 (6) ◽  
pp. E2 ◽  
Author(s):  
Kate C. Young ◽  
Anunaya Jain ◽  
Minal Jain ◽  
Robert E. Replogle ◽  
Curtis G. Benesch ◽  
...  
Keyword(s):  
Medical Management ◽  
Stroke Risk ◽  
Population Based ◽  
Current Evidence ◽  
Stent Insertion ◽  
Evidence Based ◽  
Evidence Based Treatment ◽  
Design Considerations ◽  
Symptom Status ◽  
Symptomatic Stenosis

Carotid atheromatous disease is an important cause of stroke. Carotid endarterectomy (CEA) is a well-established option for reducing the risk of subsequent stroke due to symptomatic stenosis (> 50%). With adequately low perioperative risk (< 3%) and sufficient life expectancy, CEA may be used for asymptomatic stenosis (> 60%). Recently, carotid angioplasty and stent placement (CAS) has emerged as an alternative revascularization technique. Trial design considerations are discussed in relation to trial results to provide an understanding of why some trials were considered positive whereas others were not. This review then addresses both the original randomized studies showing that CEA is superior to best medical management and the newer studies comparing the procedure to stent insertion in both symptomatic and asymptomatic populations. Additionally, recent population-based studies show that improvements in best medical management may be lowering the stroke risk for asymptomatic stenosis. Finally, the choice of revascularization technique is discussed with respect to symptom status. Based on current evidence, CAS should remain limited to specific indications.

scholarly journals Current Evidence on Using Platelet Rich Plasma as a Therapeutic Modality for Veterinary Orthopedic Conditions

2021 ◽  
Vol 11 (1) ◽  
pp. 73-78
Author(s):  
H.M. Suranji Wijekoon ◽  
D.D. Niranjala de Silva
Keyword(s):  
Musculoskeletal Disorders ◽  
Platelet Rich Plasma ◽  
Therapeutic Modality ◽  
Current Evidence ◽  
Evidence Based ◽  
Future Directions ◽  
Factors Influencing ◽  
Clinical Literature ◽  
Promising Treatment ◽  
Available Information

This review evaluates the findings of available clinical literature on the use of platelet-rich plasma (PRP) to develop evidence-based recommendations for treating various musculoskeletal issues that arise in veterinary practice. The use of PRP-based treatments for various orthopedic conditions is rapidly evolving as a promising treatment modality; however, its true effectiveness has yet to be elucidated. Application of PRP has been reported in humans for a variety of orthopedic conditions. Although the majority of the veterinary literature on PRP reports its use in equine patients, there is a dearth of evidence addressing its use in canine patients. Nevertheless, evidence of the efficacy of PRP has appeared to be highly variable depending on its specific indication, particularly in musculoskeletal disorders. This review aims to present the available information on the efficacy of PRP therapy in veterinary orthopedic conditions and describes factors influencing its use, the limitations of PRP therapy, and future directions of PRP research and therapy.

Sign in / Sign up

Export Citation Format

Share Document