Human immunodeficiency virus(HIV)modifies CD4-positive cells,resulting in immunodeficiency and a wide range of gastrointestinal(GI)manifestations.The burden of HIV-related GI illnesses has significantly evolved with t...Human immunodeficiency virus(HIV)modifies CD4-positive cells,resulting in immunodeficiency and a wide range of gastrointestinal(GI)manifestations.The burden of HIV-related GI illnesses has significantly evolved with the widespread use of antiretroviral therapy(ART).While ART has effectively reduced the occurrence of opportunistic infections,it has led to an increase in therapy-related GI illnesses.Common esophageal conditions in HIV patients include gastroesophageal reflux disease,idiopathic esophageal ulcers,herpes simplex virus,cytomegalovirus(CMV),and candidal esophagitis.Kaposi’s sarcoma,a hallmark of acquired immunodeficiency syndrome,may affect the entire GI system.Gastritis and peptic ulcer disease are also frequently seen in patients with HIV.Diarrhea,often linked to both opportunistic infections and ART,requires careful evaluation.Bloody diarrhea,often a sign of colitis caused by bacterial infections such as Shigella or Clostridium difficile,is prevalent.Small bowel lymphoma,although rare,is increasing in prevalence.Anorectal disorders,including proctitis,fissures,and anal squamous cell carcinoma,are particularly relevant in homosexual men,underlining the importance of timely diagnosis.This review comprehensively explores the epidemiology,pathogenesis,and treatment considerations for the various GI disorders associated with HIV,highlighting the importance of accurate diagnosis and effective treatment to improve outcomes for HIV-infected patients.展开更多
Metabolic dysfunction-associated steatotic liver disease(MASLD)significantly contributes to cardiovascular morbidity,with cardiovascular disease being the leading cause of mortality among affected individuals.Atrial f...Metabolic dysfunction-associated steatotic liver disease(MASLD)significantly contributes to cardiovascular morbidity,with cardiovascular disease being the leading cause of mortality among affected individuals.Atrial fibrillation(AF),the most common cardiac arrhythmia,is frequently observed in patients with MASLD.While shared metabolic risk factors such as obesity,diabetes,dyslipidemia,and hypertension are implicated,underlying pathophysiological mechanisms that include systemic inflammation,oxidative stress,insulin resistance,endothelial dysfunction,and activation of the renin-angiotensin-aldosterone system(RAAS)are proposed to play significant part in the increased risk of AF in MASLD.The aim is to review the pathogenesis linking MASLD and AF.A comprehensive literature review was conducted,focusing on studies that explore the epidemiology,pathogenesis,and clinical implications of MASLD and AF.Databases searched included PubMed,Scopus,and Web of Science,with keywords such as"metabolic associated steatotic liver disease","non fibrotic metabolic associated steatohepatitis","Nonalcoholic fatty liver disease","metabolic syndrome","atrial fibrillation","antifibrotic therapies","pathogenesis",and"cardiovascular risk".Chronic low-grade inflammation and oxidative stress in MASLD contribute to atrial structural and electrical remodeling,fostering an arrhythmogenic substrate.Insulin resistance,a hallmark of MASLD,exacerbates metabolic dysfunction and promotes atrial fibrosis.Dysregulated lipid metabolism and gut microbiota alterations further compound cardiovascular risk.Aldosterone dysregulation and systemic inflammation stemming from RAAS activation contributes to the shared pathophysiology.The severity of MASLD does not seem to directly influence the risk of AF,suggesting that even early stages of liver disease can increase susceptibility to this arrhythmia.Effective management of MASLD requires targeted risk-factor modification strategies,including weight management,glycemic control,and pharmacological interventions.A multidisciplinary approach is essential for comprehensive assessment and management of MASLD patients,with a focus on cardiovascular risk assessment and arrhythmia prevention.Future research should explore the impact of emerging MASLD therapeutic agents on the incidence and recurrence of cardiac arrhythmias.Early detection and comprehensive management of MASLD and AF are crucial to mitigate the dual burden of these conditions.展开更多
Critically ill patients have a variety of complex pathologies and are in a multifarious state of catabolism supplanted by external and internal factors.Early enteral nutrition(EEN)is defined as the initiation of enter...Critically ill patients have a variety of complex pathologies and are in a multifarious state of catabolism supplanted by external and internal factors.Early enteral nutrition(EEN)is defined as the initiation of enteral feeding within 24-48 hours of hospitalization.Previous studies show the benefits of EEN include supporting the healing process through preservation of the gut mucosa,modulation of the immune response,and suppression of inflammation.However,recent studies suggest the advantages of EEN may not be as robust as previously believed.This review aims to discuss the outcomes of EEN when used in different critical care settings while managing complex disease states such as burns,sepsis,pancreatitis,and upper gastrointestinal bleeding.Evidence indicates that EEN has a positive impact on patient outcomes,hospital costs,length of intensive care unit stay,and preventing complications.展开更多
Liver transplantation(LT)is the definitive treatment for end-stage liver disease,acute liver failure,and liver cancer.Although advancements in surgical techniques,postoperative care,and immunosuppressive therapies hav...Liver transplantation(LT)is the definitive treatment for end-stage liver disease,acute liver failure,and liver cancer.Although advancements in surgical techniques,postoperative care,and immunosuppressive therapies have significantly improved outcomes,the long-term use of immunosuppression has increased the risk of complications,including infections,cardiovascular disease,and cancer.Among these,de novo malignancies(DNMs)are a major concern,accounting for 20%-25%of deaths in LT recipients surviving beyond the early post-transplant period.Non-melanoma skin cancers,particularly squamous cell carcinoma are the most prevalent DNMs.Other significant malignancies include Kaposi's sarcoma,post-transplant lymphoproliferative disorders,and various solid organ cancers,including head and neck cancers.Compared to the general population,LT patients face a twofold increase in solid organ malignancies and a 30-fold increase in lymphoproliferative disorders.Risk factors for DNM include chronic immunosuppression,alcohol or tobacco use,viral infections,and underlying liver disease.Emerging evidence emphasizes the importance of tailored cancer screening and prevention strategies,including regular dermatological examinations,targeted screenings for high-risk cancers,and patient education on lifestyle modifications.Early detection through enhanced surveillance protocols has been shown to improve outcomes.Management of DNMs involves a combination of standard oncological therapies and adjustments to immunosuppressive regimens,with promising results from the use of mTOR inhibitors in select patients.The review highlights the critical need for ongoing research to refine risk stratification,optimize screening protocols,and improve treatment approaches to mitigate the burden of DNMs in LT recipients.By implementing personalized preventive and therapeutic strategies,we can enhance long-term outcomes and quality of life for this vulnerable population.展开更多
BACKGROUND Autoimmune liver diseases(AiLD)encompass a variety of disorders that target either the liver cells(autoimmune hepatitis,AIH)or the bile ducts[primary biliary cholangitis(PBC),and primary sclerosing cholangi...BACKGROUND Autoimmune liver diseases(AiLD)encompass a variety of disorders that target either the liver cells(autoimmune hepatitis,AIH)or the bile ducts[primary biliary cholangitis(PBC),and primary sclerosing cholangitis(PSC)].These conditions can progress to chronic liver disease(CLD),which is characterized by fibrosis,cirrhosis,and hepatocellular carcinoma.Recent studies have indicated a rise in hospitalizations and associated costs for CLD in the US,but information regarding inpatient admissions specifically for AiLD remains limited.AIM To examine the trends and mortality of inpatient hospitalization of AiLD from 2011 to 2017.METHODS This study is a retrospective analysis utilizing the National Inpatient Sample(NIS)databases.All subjects admitted between 2011 and 2017 with a diagnosis of AiLD(AIH,PBC,PSC)were identified using the International Classification of Diseases(ICD-9)and ICD-10 codes.primary AiLD admission was defined if the first admission code was one of the AiLD codes.secondary AiLD admission was defined as having the AiLD diagnosis anywhere in the admission diagnosis(25 diagnoses).Subjects aged 21 years and older were included.The national estimates of hospitalization were derived using sample weights provided by NIS.χ^(2)tests for categorical data were used.The primary trend characteristics were in-hospital mortality,hospital charges,and length of stay.RESULTS From 2011 to 2017,hospitalization rates witnessed a significant decline,dropping from 83263 admissions to 74850 admissions(P<0.05).The patients hospitalized were predominantly elderly(median 53%for age>65),mostly female(median 59%)(P<0.05),and primarily Caucasians(median 68%)(P<0.05).Medicare was the major insurance(median 56%),followed by private payer(median 27%)(P<0.05).The South was the top geographical distribution for these admissions(median 33%)(P<0.05),with most admissions taking place in big teaching institutions(median 63%)(P<0.05).Total charges for admissions rose from 66031 in 2011 to 78987 in 2017(P<0.05),while the inpatient mortality rate had a median of 4.9%(P<0.05),rising from 4.67%in 2011 to 5.43%in 2017.The median length of stay remained relatively stable,changing from 6.94 days(SD=0.07)in 2011 to 6.51 days(SD=0.06)in 2017(P<0.05).Acute renal failure emerged as the most common risk factor associated with an increased death rate,affecting nearly 68%of patients(P<0.05).CONCLUSION AiLD-inpatient hospitalization showed a decrease in overall trends over the studied years,however there is a significant increase in financial burden on healthcare with increasing in-hospital costs along with increase in mortality of hospitalized patient with AiLD.展开更多
Inflammatory bowel disease(IBD)is a chronic condition characterized by immune-mediated inflammation in the gastrointestinal tract,which follows a relapsing and remitting course.Apart from affecting the gastrointestina...Inflammatory bowel disease(IBD)is a chronic condition characterized by immune-mediated inflammation in the gastrointestinal tract,which follows a relapsing and remitting course.Apart from affecting the gastrointestinal tract,IBD also has extra-intestinal manifestations(EIMs).While the etiology of extraintestinal manifestation remains unclear,it is theorized to be based on immunological responses influenced by genetic factors.Renal involvement is one of the EIMs observed in ulcerative colitis and Crohn’s disease.The renal manifes-tations in IBD patients encompass a range of conditions including nephrolithiasis,amyloidosis,tubulointerstitial nephritis,glomerulonephritis(GN),obstructive pathologies,and chronic kidney disease(CKD).The incidence of CKD in IBD patients varies from 5%-15%.The decline in renal function can stem from various factors such as direct inflammatory damage to the kidneys leading to glomerular or tubular injury,or from complications like recurrent stones,amyloidosis,or GN.Additionally,nephrotoxic medications used in treating IBD,such as TNF-αinhibitors,calcineurin inhibitors,and aminosalicylates,can exacerbate the decline in renal function.Currently,there is a lack of consensus regarding these patients'screening and renal function monitoring.This review aims to assess the existing literature on the different renal complications among individuals with IBD,shedding light on their pathophysiology and management.展开更多
The global warming leads to a large freshwater influx into the Arctic Ocean, which has adverse implications to the sea-ice dynamics, ocean circulation, and acidification. The relationship between oxygen isotope ratio(...The global warming leads to a large freshwater influx into the Arctic Ocean, which has adverse implications to the sea-ice dynamics, ocean circulation, and acidification. The relationship between oxygen isotope ratio(δ^(18)O) and salinity(S) is helpful in exploring various hydrographic processes related to the freshwater influx and is also required to accurately determine past salinity variability using oxygen isotope ratio of the carbonates. In view of this, systematic measurements of δ^(18)O and salinity of water from an Arctic fjord(Kongsfjorden) were carried out during the summer season of 2013. Until now, the relationships between δ^(18)O and salinity from such fjords were based on a limited number of samples collected during a very short span of time and thus may not accurately represent the long-term conditions prevailing in the fjord. The present study determines a more representative δ^(18)O-salinity relationship as water samples from different depths and location over a long period were systematically collected. The water samples were collected from four different locations at different depths along the axis of the fjord representing the inner and outer fjords. The inner stations(1-8 and 1-6) exhibit lowerδ^(18)O values than the outer stations(1-1 and 1-3), which indicate the higher influence of freshwater from glacial melting in the inner stations. The δ^(18)O-salinity relationship from the inner and outer fjords yield a slope of 0.54(r^2 = 0.67, n = 56) and 0.39(r^2 = 0.66, n = 68), respectively. The δ^(18)O of freshwater influx in the fjord is estimated at-18.4‰, which is close to the widely accepted freshwater-δ^(18)O value of the Arctic basin. The δ^(18)O of glacial discharge, which is the largest source of freshwater influx to the fjord, is estimated at ca.-21.0‰, which will be useful for future freshwater budget calculations.展开更多
文摘Human immunodeficiency virus(HIV)modifies CD4-positive cells,resulting in immunodeficiency and a wide range of gastrointestinal(GI)manifestations.The burden of HIV-related GI illnesses has significantly evolved with the widespread use of antiretroviral therapy(ART).While ART has effectively reduced the occurrence of opportunistic infections,it has led to an increase in therapy-related GI illnesses.Common esophageal conditions in HIV patients include gastroesophageal reflux disease,idiopathic esophageal ulcers,herpes simplex virus,cytomegalovirus(CMV),and candidal esophagitis.Kaposi’s sarcoma,a hallmark of acquired immunodeficiency syndrome,may affect the entire GI system.Gastritis and peptic ulcer disease are also frequently seen in patients with HIV.Diarrhea,often linked to both opportunistic infections and ART,requires careful evaluation.Bloody diarrhea,often a sign of colitis caused by bacterial infections such as Shigella or Clostridium difficile,is prevalent.Small bowel lymphoma,although rare,is increasing in prevalence.Anorectal disorders,including proctitis,fissures,and anal squamous cell carcinoma,are particularly relevant in homosexual men,underlining the importance of timely diagnosis.This review comprehensively explores the epidemiology,pathogenesis,and treatment considerations for the various GI disorders associated with HIV,highlighting the importance of accurate diagnosis and effective treatment to improve outcomes for HIV-infected patients.
文摘Metabolic dysfunction-associated steatotic liver disease(MASLD)significantly contributes to cardiovascular morbidity,with cardiovascular disease being the leading cause of mortality among affected individuals.Atrial fibrillation(AF),the most common cardiac arrhythmia,is frequently observed in patients with MASLD.While shared metabolic risk factors such as obesity,diabetes,dyslipidemia,and hypertension are implicated,underlying pathophysiological mechanisms that include systemic inflammation,oxidative stress,insulin resistance,endothelial dysfunction,and activation of the renin-angiotensin-aldosterone system(RAAS)are proposed to play significant part in the increased risk of AF in MASLD.The aim is to review the pathogenesis linking MASLD and AF.A comprehensive literature review was conducted,focusing on studies that explore the epidemiology,pathogenesis,and clinical implications of MASLD and AF.Databases searched included PubMed,Scopus,and Web of Science,with keywords such as"metabolic associated steatotic liver disease","non fibrotic metabolic associated steatohepatitis","Nonalcoholic fatty liver disease","metabolic syndrome","atrial fibrillation","antifibrotic therapies","pathogenesis",and"cardiovascular risk".Chronic low-grade inflammation and oxidative stress in MASLD contribute to atrial structural and electrical remodeling,fostering an arrhythmogenic substrate.Insulin resistance,a hallmark of MASLD,exacerbates metabolic dysfunction and promotes atrial fibrosis.Dysregulated lipid metabolism and gut microbiota alterations further compound cardiovascular risk.Aldosterone dysregulation and systemic inflammation stemming from RAAS activation contributes to the shared pathophysiology.The severity of MASLD does not seem to directly influence the risk of AF,suggesting that even early stages of liver disease can increase susceptibility to this arrhythmia.Effective management of MASLD requires targeted risk-factor modification strategies,including weight management,glycemic control,and pharmacological interventions.A multidisciplinary approach is essential for comprehensive assessment and management of MASLD patients,with a focus on cardiovascular risk assessment and arrhythmia prevention.Future research should explore the impact of emerging MASLD therapeutic agents on the incidence and recurrence of cardiac arrhythmias.Early detection and comprehensive management of MASLD and AF are crucial to mitigate the dual burden of these conditions.
文摘Critically ill patients have a variety of complex pathologies and are in a multifarious state of catabolism supplanted by external and internal factors.Early enteral nutrition(EEN)is defined as the initiation of enteral feeding within 24-48 hours of hospitalization.Previous studies show the benefits of EEN include supporting the healing process through preservation of the gut mucosa,modulation of the immune response,and suppression of inflammation.However,recent studies suggest the advantages of EEN may not be as robust as previously believed.This review aims to discuss the outcomes of EEN when used in different critical care settings while managing complex disease states such as burns,sepsis,pancreatitis,and upper gastrointestinal bleeding.Evidence indicates that EEN has a positive impact on patient outcomes,hospital costs,length of intensive care unit stay,and preventing complications.
文摘Liver transplantation(LT)is the definitive treatment for end-stage liver disease,acute liver failure,and liver cancer.Although advancements in surgical techniques,postoperative care,and immunosuppressive therapies have significantly improved outcomes,the long-term use of immunosuppression has increased the risk of complications,including infections,cardiovascular disease,and cancer.Among these,de novo malignancies(DNMs)are a major concern,accounting for 20%-25%of deaths in LT recipients surviving beyond the early post-transplant period.Non-melanoma skin cancers,particularly squamous cell carcinoma are the most prevalent DNMs.Other significant malignancies include Kaposi's sarcoma,post-transplant lymphoproliferative disorders,and various solid organ cancers,including head and neck cancers.Compared to the general population,LT patients face a twofold increase in solid organ malignancies and a 30-fold increase in lymphoproliferative disorders.Risk factors for DNM include chronic immunosuppression,alcohol or tobacco use,viral infections,and underlying liver disease.Emerging evidence emphasizes the importance of tailored cancer screening and prevention strategies,including regular dermatological examinations,targeted screenings for high-risk cancers,and patient education on lifestyle modifications.Early detection through enhanced surveillance protocols has been shown to improve outcomes.Management of DNMs involves a combination of standard oncological therapies and adjustments to immunosuppressive regimens,with promising results from the use of mTOR inhibitors in select patients.The review highlights the critical need for ongoing research to refine risk stratification,optimize screening protocols,and improve treatment approaches to mitigate the burden of DNMs in LT recipients.By implementing personalized preventive and therapeutic strategies,we can enhance long-term outcomes and quality of life for this vulnerable population.
文摘BACKGROUND Autoimmune liver diseases(AiLD)encompass a variety of disorders that target either the liver cells(autoimmune hepatitis,AIH)or the bile ducts[primary biliary cholangitis(PBC),and primary sclerosing cholangitis(PSC)].These conditions can progress to chronic liver disease(CLD),which is characterized by fibrosis,cirrhosis,and hepatocellular carcinoma.Recent studies have indicated a rise in hospitalizations and associated costs for CLD in the US,but information regarding inpatient admissions specifically for AiLD remains limited.AIM To examine the trends and mortality of inpatient hospitalization of AiLD from 2011 to 2017.METHODS This study is a retrospective analysis utilizing the National Inpatient Sample(NIS)databases.All subjects admitted between 2011 and 2017 with a diagnosis of AiLD(AIH,PBC,PSC)were identified using the International Classification of Diseases(ICD-9)and ICD-10 codes.primary AiLD admission was defined if the first admission code was one of the AiLD codes.secondary AiLD admission was defined as having the AiLD diagnosis anywhere in the admission diagnosis(25 diagnoses).Subjects aged 21 years and older were included.The national estimates of hospitalization were derived using sample weights provided by NIS.χ^(2)tests for categorical data were used.The primary trend characteristics were in-hospital mortality,hospital charges,and length of stay.RESULTS From 2011 to 2017,hospitalization rates witnessed a significant decline,dropping from 83263 admissions to 74850 admissions(P<0.05).The patients hospitalized were predominantly elderly(median 53%for age>65),mostly female(median 59%)(P<0.05),and primarily Caucasians(median 68%)(P<0.05).Medicare was the major insurance(median 56%),followed by private payer(median 27%)(P<0.05).The South was the top geographical distribution for these admissions(median 33%)(P<0.05),with most admissions taking place in big teaching institutions(median 63%)(P<0.05).Total charges for admissions rose from 66031 in 2011 to 78987 in 2017(P<0.05),while the inpatient mortality rate had a median of 4.9%(P<0.05),rising from 4.67%in 2011 to 5.43%in 2017.The median length of stay remained relatively stable,changing from 6.94 days(SD=0.07)in 2011 to 6.51 days(SD=0.06)in 2017(P<0.05).Acute renal failure emerged as the most common risk factor associated with an increased death rate,affecting nearly 68%of patients(P<0.05).CONCLUSION AiLD-inpatient hospitalization showed a decrease in overall trends over the studied years,however there is a significant increase in financial burden on healthcare with increasing in-hospital costs along with increase in mortality of hospitalized patient with AiLD.
文摘Inflammatory bowel disease(IBD)is a chronic condition characterized by immune-mediated inflammation in the gastrointestinal tract,which follows a relapsing and remitting course.Apart from affecting the gastrointestinal tract,IBD also has extra-intestinal manifestations(EIMs).While the etiology of extraintestinal manifestation remains unclear,it is theorized to be based on immunological responses influenced by genetic factors.Renal involvement is one of the EIMs observed in ulcerative colitis and Crohn’s disease.The renal manifes-tations in IBD patients encompass a range of conditions including nephrolithiasis,amyloidosis,tubulointerstitial nephritis,glomerulonephritis(GN),obstructive pathologies,and chronic kidney disease(CKD).The incidence of CKD in IBD patients varies from 5%-15%.The decline in renal function can stem from various factors such as direct inflammatory damage to the kidneys leading to glomerular or tubular injury,or from complications like recurrent stones,amyloidosis,or GN.Additionally,nephrotoxic medications used in treating IBD,such as TNF-αinhibitors,calcineurin inhibitors,and aminosalicylates,can exacerbate the decline in renal function.Currently,there is a lack of consensus regarding these patients'screening and renal function monitoring.This review aims to assess the existing literature on the different renal complications among individuals with IBD,shedding light on their pathophysiology and management.
基金the Secretary,Ministry of Earth Sciences and Director,NCAOR for support and encouragement(NCAOR Contribution No.37/2017)ISRO-GBP for support
文摘The global warming leads to a large freshwater influx into the Arctic Ocean, which has adverse implications to the sea-ice dynamics, ocean circulation, and acidification. The relationship between oxygen isotope ratio(δ^(18)O) and salinity(S) is helpful in exploring various hydrographic processes related to the freshwater influx and is also required to accurately determine past salinity variability using oxygen isotope ratio of the carbonates. In view of this, systematic measurements of δ^(18)O and salinity of water from an Arctic fjord(Kongsfjorden) were carried out during the summer season of 2013. Until now, the relationships between δ^(18)O and salinity from such fjords were based on a limited number of samples collected during a very short span of time and thus may not accurately represent the long-term conditions prevailing in the fjord. The present study determines a more representative δ^(18)O-salinity relationship as water samples from different depths and location over a long period were systematically collected. The water samples were collected from four different locations at different depths along the axis of the fjord representing the inner and outer fjords. The inner stations(1-8 and 1-6) exhibit lowerδ^(18)O values than the outer stations(1-1 and 1-3), which indicate the higher influence of freshwater from glacial melting in the inner stations. The δ^(18)O-salinity relationship from the inner and outer fjords yield a slope of 0.54(r^2 = 0.67, n = 56) and 0.39(r^2 = 0.66, n = 68), respectively. The δ^(18)O of freshwater influx in the fjord is estimated at-18.4‰, which is close to the widely accepted freshwater-δ^(18)O value of the Arctic basin. The δ^(18)O of glacial discharge, which is the largest source of freshwater influx to the fjord, is estimated at ca.-21.0‰, which will be useful for future freshwater budget calculations.
