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  Subjects -> MEDICAL SCIENCES (Total: 7655 journals)
    - ALLERGOLOGY AND IMMUNOLOGY (196 journals)
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    - CARDIOVASCULAR DISEASES (316 journals)
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    - ENDOCRINOLOGY (143 journals)
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    - GERONTOLOGY AND GERIATRICS (123 journals)
    - HEMATOLOGY (140 journals)
    - HYPNOSIS (4 journals)
    - INTERNAL MEDICINE (144 journals)
    - LABORATORY AND EXPERIMENTAL MEDICINE (95 journals)
    - MEDICAL GENETICS (59 journals)
    - MEDICAL SCIENCES (1946 journals)
    - NURSES AND NURSING (313 journals)
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    - RHEUMATOLOGY (65 journals)
    - SPORTS MEDICINE (73 journals)
    - SURGERY (370 journals)
    - UROLOGY, NEPHROLOGY AND ANDROLOGY (138 journals)

MEDICAL SCIENCES (1946 journals)                  1 2 3 4 5 6 7 8 | Last

Showing 1 - 200 of 3562 Journals sorted alphabetically
16 de Abril     Open Access  
3D Printing in Medicine     Open Access  
AADE in Practice     Hybrid Journal   (Followers: 5)
ABCS Health Sciences     Open Access   (Followers: 3)
Abia State University Medical Students' Association Journal     Full-text available via subscription  
ACIMED     Open Access   (Followers: 1)
ACS Medicinal Chemistry Letters     Full-text available via subscription   (Followers: 41)
Acta Bio Medica     Full-text available via subscription   (Followers: 2)
Acta Bioethica     Open Access  
Acta Bioquimica Clinica Latinoamericana     Open Access   (Followers: 1)
Acta Facultatis Medicae Naissensis     Open Access  
Acta Informatica Medica     Open Access   (Followers: 1)
Acta Medica (Hradec Králové)     Open Access  
Acta Medica Bulgarica     Open Access  
Acta Medica Colombiana     Open Access   (Followers: 1)
Acta Médica Costarricense     Open Access   (Followers: 2)
Acta Medica Indonesiana     Open Access  
Acta Medica International     Open Access  
Acta medica Lituanica     Open Access  
Acta Medica Marisiensis     Open Access  
Acta Medica Martiniana     Open Access  
Acta Medica Nagasakiensia     Open Access  
Acta Medica Peruana     Open Access   (Followers: 2)
Acta Médica Portuguesa     Open Access  
Acta Medica Saliniana     Open Access  
Acta Scientiarum. Health Sciences     Open Access   (Followers: 1)
Acupuncture & Electro-Therapeutics Research     Full-text available via subscription   (Followers: 4)
Acupuncture and Natural Medicine     Open Access  
Addiction Science & Clinical Practice     Open Access   (Followers: 6)
Addictive Behaviors Reports     Open Access   (Followers: 8)
Adıyaman Üniversitesi Sağlık Bilimleri Dergisi / Health Sciences Journal of Adıyaman University     Open Access  
Adnan Menderes Üniversitesi Sağlık Bilimleri Fakültesi Dergisi     Open Access  
Advanced Biomedical Research     Open Access  
Advanced Health Care Technologies     Open Access   (Followers: 4)
Advanced Science, Engineering and Medicine     Partially Free   (Followers: 7)
Advances in Bioscience and Clinical Medicine     Open Access   (Followers: 5)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 28)
Advances in Life Course Research     Hybrid Journal   (Followers: 8)
Advances in Lipobiology     Full-text available via subscription   (Followers: 1)
Advances in Medical Education and Practice     Open Access   (Followers: 25)
Advances in Medical Sciences     Hybrid Journal   (Followers: 6)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Medicine     Open Access   (Followers: 2)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4)
Advances in Molecular Oncology     Open Access   (Followers: 2)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7)
Advances in Parkinson's Disease     Open Access  
Advances in Phytomedicine     Full-text available via subscription  
Advances in Preventive Medicine     Open Access   (Followers: 5)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 19)
Advances in Skeletal Muscle Function Assessment     Open Access  
Advances in Therapy     Hybrid Journal   (Followers: 5)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 13)
Advances in Virus Research     Full-text available via subscription   (Followers: 5)
Advances in Wound Care     Hybrid Journal   (Followers: 10)
African Health Sciences     Open Access   (Followers: 2)
African Journal of Biomedical Research     Open Access  
African Journal of Clinical and Experimental Microbiology     Open Access   (Followers: 1)
African Journal of Laboratory Medicine     Open Access   (Followers: 2)
African Journal of Medical and Health Sciences     Open Access   (Followers: 2)
African Journal of Trauma     Open Access   (Followers: 1)
Afrimedic Journal     Open Access   (Followers: 2)
Aggiornamenti CIO     Hybrid Journal   (Followers: 1)
AIDS Research and Human Retroviruses     Hybrid Journal   (Followers: 8)
AJOB Primary Research     Partially Free   (Followers: 3)
AJSP: Reviews & Reports     Hybrid Journal  
Aktuelle Ernährungsmedizin     Hybrid Journal   (Followers: 4)
Al-Azhar Assiut Medical Journal     Open Access  
Alexandria Journal of Medicine     Open Access   (Followers: 1)
Allgemeine Homöopathische Zeitung     Hybrid Journal   (Followers: 2)
Alpha Omegan     Full-text available via subscription  
ALTEX : Alternatives to Animal Experimentation     Open Access   (Followers: 3)
American Journal of Biomedical Engineering     Open Access   (Followers: 12)
American Journal of Biomedical Research     Open Access   (Followers: 2)
American Journal of Biomedicine     Full-text available via subscription   (Followers: 7)
American Journal of Chinese Medicine, The     Hybrid Journal   (Followers: 4)
American Journal of Clinical Medicine Research     Open Access   (Followers: 6)
American Journal of Family Therapy     Hybrid Journal   (Followers: 11)
American Journal of Law & Medicine     Full-text available via subscription   (Followers: 11)
American Journal of Lifestyle Medicine     Hybrid Journal   (Followers: 5)
American Journal of Managed Care     Full-text available via subscription   (Followers: 11)
American Journal of Medical Case Reports     Open Access   (Followers: 1)
American Journal of Medical Sciences and Medicine     Open Access   (Followers: 3)
American Journal of Medicine     Hybrid Journal   (Followers: 43)
American Journal of Medicine and Medical Sciences     Open Access   (Followers: 1)
American Journal of Medicine Studies     Open Access  
American Journal of Medicine Supplements     Full-text available via subscription   (Followers: 3)
American Journal of the Medical Sciences     Hybrid Journal   (Followers: 12)
American Journal on Addictions     Hybrid Journal   (Followers: 7)
American medical news     Free   (Followers: 3)
American Medical Writers Association Journal     Full-text available via subscription   (Followers: 4)
Amyloid: The Journal of Protein Folding Disorders     Hybrid Journal   (Followers: 5)
Anales de la Facultad de Medicina     Open Access  
Anales de la Facultad de Medicina, Universidad de la República, Uruguay     Open Access  
Anales del Sistema Sanitario de Navarra     Open Access   (Followers: 1)
Analgesia & Resuscitation : Current Research     Hybrid Journal   (Followers: 5)
Anatolian Clinic the Journal of Medical Sciences     Open Access  
Anatomical Science International     Hybrid Journal   (Followers: 2)
Anatomical Sciences Education     Hybrid Journal   (Followers: 1)
Anatomy     Open Access  
Anatomy Research International     Open Access   (Followers: 2)
Angewandte Schmerztherapie und Palliativmedizin     Hybrid Journal  
Angiogenesis     Hybrid Journal   (Followers: 3)
Ankara Medical Journal     Open Access   (Followers: 2)
Ankara Üniversitesi Tıp Fakültesi Mecmuası     Open Access  
Annales de Pathologie     Full-text available via subscription  
Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale     Full-text available via subscription   (Followers: 3)
Annals of African Medicine     Open Access   (Followers: 1)
Annals of Anatomy - Anatomischer Anzeiger     Hybrid Journal   (Followers: 2)
Annals of Bioanthropology     Open Access   (Followers: 4)
Annals of Biomedical Engineering     Hybrid Journal   (Followers: 18)
Annals of Biomedical Sciences     Full-text available via subscription   (Followers: 3)
Annals of Clinical Microbiology and Antimicrobials     Open Access   (Followers: 10)
Annals of Family Medicine     Open Access   (Followers: 12)
Annals of Fundeni Hospital     Open Access   (Followers: 1)
Annals of Ibadan Postgraduate Medicine     Open Access  
Annals of Medical and Health Sciences Research     Open Access   (Followers: 7)
Annals of Medicine     Hybrid Journal   (Followers: 12)
Annals of Medicine and Surgery     Open Access   (Followers: 7)
Annals of Microbiology     Hybrid Journal   (Followers: 10)
Annals of Nigerian Medicine     Open Access   (Followers: 1)
Annals of Saudi Medicine     Open Access  
Annals of the New York Academy of Sciences     Hybrid Journal   (Followers: 5)
Annals of The Royal College of Surgeons of England     Full-text available via subscription   (Followers: 3)
Annual Reports in Medicinal Chemistry     Full-text available via subscription   (Followers: 7)
Annual Reports on NMR Spectroscopy     Full-text available via subscription   (Followers: 4)
Annual Review of Medicine     Full-text available via subscription   (Followers: 17)
Anthropological Review     Open Access   (Followers: 23)
Anthropologie et santé     Open Access   (Followers: 5)
Antibiotics     Open Access   (Followers: 9)
Antibodies     Open Access   (Followers: 2)
Antibody Technology Journal     Open Access   (Followers: 1)
Anuradhapura Medical Journal     Open Access  
Anwer Khan Modern Medical College Journal     Open Access   (Followers: 2)
Apmis     Hybrid Journal   (Followers: 1)
Apparence(s)     Open Access   (Followers: 1)
Applied Clinical Research, Clinical Trials and Regulatory Affairs     Hybrid Journal  
Applied Medical Informatics     Open Access   (Followers: 10)
Arab Journal of Nephrology and Transplantation     Open Access   (Followers: 1)
Arak Medical University Journal     Open Access  
Archive of Clinical Medicine     Open Access   (Followers: 1)
Archive of Community Health     Open Access   (Followers: 1)
Archives Medical Review Journal / Arşiv Kaynak Tarama Dergisi     Open Access  
Archives of Medical and Biomedical Research     Open Access   (Followers: 3)
Archives of Medical Laboratory Sciences     Open Access   (Followers: 1)
Archives of Medicine and Health Sciences     Open Access   (Followers: 3)
Archives of Medicine and Surgery     Open Access  
Archives of Trauma Research     Open Access   (Followers: 3)
Archivos de Medicina (Manizales)     Open Access  
ArgoSpine News & Journal     Hybrid Journal  
Arquivos Brasileiros de Oftalmologia     Open Access  
Arquivos de Ciências da Saúde     Open Access  
Arquivos de Medicina     Open Access  
Ars Medica : Revista de Ciencias Médicas     Open Access  
ARS Medica Tomitana     Open Access   (Followers: 1)
Art Therapy: Journal of the American Art Therapy Association     Full-text available via subscription   (Followers: 11)
Arterial Hypertension     Open Access   (Followers: 1)
Artificial Intelligence in Medicine     Hybrid Journal   (Followers: 12)
Artificial Organs     Hybrid Journal   (Followers: 1)
ASHA Leader     Open Access  
Asia Pacific Family Medicine     Open Access   (Followers: 1)
Asia Pacific Journal of Clinical Nutrition     Full-text available via subscription   (Followers: 10)
Asia Pacific Journal of Clinical Trials : Nervous System Diseases     Open Access  
Asian Bioethics Review     Full-text available via subscription   (Followers: 3)
Asian Journal of Cell Biology     Open Access   (Followers: 5)
Asian Journal of Health     Open Access   (Followers: 3)
Asian Journal of Medical and Biological Research     Open Access   (Followers: 3)
Asian Journal of Medical and Pharmaceutical Researches     Open Access   (Followers: 1)
Asian Journal of Medical Sciences     Open Access   (Followers: 2)
Asian Journal of Scientific Research     Open Access   (Followers: 3)
Asian Journal of Transfusion Science     Open Access   (Followers: 1)
Asian Medicine     Hybrid Journal   (Followers: 5)
Asian Pacific Journal of Cancer Prevention     Open Access  
ASPIRATOR : Journal of Vector-borne Disease Studies     Open Access  
Astrocyte     Open Access  
Atención Familiar     Open Access  
Atención Primaria     Open Access   (Followers: 1)
Atti della Accademia Peloritana dei Pericolanti - Classe di Scienze Medico-Biologiche     Open Access  
Audiology - Communication Research     Open Access   (Followers: 8)
Auris Nasus Larynx     Full-text available via subscription  
Australian Coeliac     Full-text available via subscription   (Followers: 1)
Australian Family Physician     Full-text available via subscription   (Followers: 3)
Australian Journal of Medical Science     Full-text available via subscription   (Followers: 1)
Autopsy and Case Reports     Open Access  
Aviation, Space, and Environmental Medicine     Full-text available via subscription   (Followers: 10)
Avicenna     Open Access   (Followers: 3)
Avicenna Journal of Clinical Medicine     Open Access  
Avicenna Journal of Medicine     Open Access   (Followers: 1)
Bangabandhu Sheikh Mujib Medical University Journal     Open Access   (Followers: 1)
Bangladesh Journal of Anatomy     Open Access   (Followers: 1)
Bangladesh Journal of Bioethics     Open Access  
Bangladesh Journal of Medical Biochemistry     Open Access   (Followers: 3)
Bangladesh Journal of Medical Education     Open Access   (Followers: 2)
Bangladesh Journal of Medical Microbiology     Open Access   (Followers: 3)
Bangladesh Journal of Medical Physics     Open Access  
Bangladesh Journal of Medical Science     Open Access  
Bangladesh Journal of Medicine     Open Access   (Followers: 1)
Bangladesh Journal of Physiology and Pharmacology     Open Access  
Bangladesh Journal of Scientific Research     Open Access   (Followers: 1)
Bangladesh Medical Journal     Open Access  

        1 2 3 4 5 6 7 8 | Last

Journal Cover
American Journal of the Medical Sciences
Journal Prestige (SJR): 0.767
Citation Impact (citeScore): 1
Number of Followers: 12  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0002-9629
Published by Elsevier Homepage  [3163 journals]
  • Not All Gastric “Masses” Need a Biopsy—A Cautionary Tale
    • Authors: Divyansh Bajaj; Roni Manyevitch; Gordon Gray Still
      Abstract: Publication date: June 2018
      Source:The American Journal of the Medical Sciences, Volume 355, Issue 6
      Author(s): Divyansh Bajaj, Roni Manyevitch, Gordon Gray Still


      PubDate: 2018-06-09T19:27:18Z
      DOI: 10.1016/j.amjms.2018.02.002
       
  • A Huge Pancreas Tumor With Periampullary Invasion
    • Authors: Yu-jen Chen; Ching-Liang Lu
      Abstract: Publication date: June 2018
      Source:The American Journal of the Medical Sciences, Volume 355, Issue 6
      Author(s): Yu-jen Chen, Ching-Liang Lu


      PubDate: 2018-06-09T19:27:18Z
      DOI: 10.1016/j.amjms.2018.03.006
       
  • Macrophage Migration Inhibitory Factor—A Potential Target for
           Diabetes Prevention'
    • Authors: Sri Prakash L. Mokshagundam
      Pages: 519 - 520
      Abstract: Publication date: June 2018
      Source:The American Journal of the Medical Sciences, Volume 355, Issue 6
      Author(s): Sri Prakash L. Mokshagundam


      PubDate: 2018-06-09T19:27:18Z
      DOI: 10.1016/j.amjms.2018.03.007
       
  • Quantitating Heart Damage: Part of the Story
    • Authors: L. Julian Haywood
      Pages: 521 - 522
      Abstract: Publication date: June 2018
      Source:The American Journal of the Medical Sciences, Volume 355, Issue 6
      Author(s): L. Julian Haywood


      PubDate: 2018-06-09T19:27:18Z
      DOI: 10.1016/j.amjms.2018.03.016
       
  • Antibiotic Timing and Outcomes in Sepsis
    • Authors: Richard Y. Kim; Alex M. Ng; Annuradha K. Persaud; Stephen P. Furmanek; Yash N. Kothari; John D. Price; Timothy L. Wiemken; Mohamed A. Saad; Juan J. Guardiola; Rodrigo S. Cavallazzi
      Pages: 524 - 529
      Abstract: Publication date: June 2018
      Source:The American Journal of the Medical Sciences, Volume 355, Issue 6
      Author(s): Richard Y. Kim, Alex M. Ng, Annuradha K. Persaud, Stephen P. Furmanek, Yash N. Kothari, John D. Price, Timothy L. Wiemken, Mohamed A. Saad, Juan J. Guardiola, Rodrigo S. Cavallazzi
      Background We evaluated the effect of time spent in the emergency department (ED) and process of care on mortality and length of hospital stay in patients with sepsis or septic shock. Methods An observational cohort study was conducted on 117 patients who came through the University of Louisville Hospital ED and subsequently were directly admitted to the intensive care unit (ICU). Variables of interest were time in the ED from triage to physical transport to the ICU, from triage to antibiotic(s) ordered, and from triage to antibiotic(s) administered. Expected mortality was calculated according to the University Health System Consortium Database. Primary and secondary outcomes were in-hospital death and hospital length of stay in days, respectively. Results We found no significant association between time in the ED and mortality between survivors and nonsurvivors (5.5 versus 5.7 hours, P = 0.804). After adjusting for expected mortality, a 22% increase in mortality risk was found for each hour delay from triage to antibiotic(s) ordered; a 15% increase in mortality risk was observed for each hour from triage to antibiotic(s) given. Both time from triage to antibiotic(s) ordered (hazard ratio [HR] = 0.8, P = 0.044) and time from triage to antibiotic(s) delivery (HR = 0.79, P = 0.0092) were independently associated with an increased hospital stay (HR = 0.79, P = 0.0092). Conclusion Though no significant association between mortality and ED time was demonstrated, we observed a significant increase in mortality in septic patients with both delays in antibiotic(s) order and administration. Delay in care also resulted in increased hospital stays both overall and in the ICU.

      PubDate: 2018-06-09T19:27:18Z
      DOI: 10.1016/j.amjms.2018.02.007
       
  • Increased Cystatin C Level in ST-Elevation Myocardial Infarction
           Predisposes the Prognosis of Angioplasty
    • Authors: Guidong Shen; Hongmin Zhu; Hong Ding; Chaoyang Sun; Kun Zhou; Yan Fan; Tao Li; Min Men; Yuewu Chen; Qun Lu; Aiqun Ma
      Pages: 530 - 536
      Abstract: Publication date: June 2018
      Source:The American Journal of the Medical Sciences, Volume 355, Issue 6
      Author(s): Guidong Shen, Hongmin Zhu, Hong Ding, Chaoyang Sun, Kun Zhou, Yan Fan, Tao Li, Min Men, Yuewu Chen, Qun Lu, Aiqun Ma
      Background The study aimed to evaluate the prognostic value of cystatin C in ST-elevation acute myocardial infarction (STEMI) patients who underwent elective percutaneous coronary intervention (PCI). Methods A retrospective study was conducted on 664 STEMI patients from 7 centers who were treated with elective PCI. These patients were divided into 3 groups according their admission cystatin C levels as < 0.84, 0.84-1.03 and ≥1.04mg/L. The all-cause mortalities and the composite endpoints, including mortality, reinfarction, rehospitalization for heart failure and angina or repeat target vessel revascularization were observed for up to 5 years. Results As cystatin C levels from low to high, all-cause mortalities were progressively increased 0.9%, 3.7% and 9.5% (P < 0.001), as well as the composite endpoints, 11.1%, 21.7% and 40.7%, respectively (P < 0.001). When patients had the level of cystatin C ≥0.84mg/L, their risks of composite endpoints increased 2- to 3-fold of those with <0.84mg/L, with the adjusted hazard ratio of 2.096 (95% CI: 1.047-4.196, P = 0.037) and 3.608 (95% CI: 1.939-6.716, P < 0.001), respectively. Conclusions Increased cystatin C levels may be associated with enhanced risks of composite endpoints in patients with STEMI undergoing elective PCI.

      PubDate: 2018-06-09T19:27:18Z
      DOI: 10.1016/j.amjms.2018.03.003
       
  • Clinical Characteristics and Outcomes in Young Patients With ST-Segment
           Elevation Myocardial Infarction After Primary Percutaneous Coronary
           Intervention
    • Authors: Ming Gao; Waiou Zhao; Zhiguo Zhang; Ling Qin; Weihua Zhang; Yang Zheng
      Pages: 544 - 552
      Abstract: Publication date: June 2018
      Source:The American Journal of the Medical Sciences, Volume 355, Issue 6
      Author(s): Ming Gao, Waiou Zhao, Zhiguo Zhang, Ling Qin, Weihua Zhang, Yang Zheng
      Background There are few published studies of ST-segment elevation myocardial infarction (STEMI) in younger individuals. The differences between these “younger” and “older” individuals may not be fully appreciated by clinicians. The aim of this study was to determine the reasons for the earlier presentation and help to identify strategies for prevention of recurrent myocardial infarction (MI) in younger patients. Methods The study population was a cohort of 2,419 consecutive STEMI patients who were treated with primary percutaneous coronary intervention. The median follow-up time of this retrospective study was 2.2 years. Results The all-cause mortality rates in patients ≤45 years of age at 30 days, 1 and 2 years were 1.7%, 2.0% and 2.2%, respectively. These rates were lower compared with their older matched counterparts whose all-cause mortality rates were 3.3%, 4.2% and 5.5%, respectively (P = 0.010). The incidence of recurrent MI was 4.0% for all age groups combined, 5.4% for younger patients and 3.8% for older patients. The number of stents showed association with recurrent MI in older patients with a first infarction, whereas only composition factor 1 with significantly higher non–high-density lipoprotein and low-density lipoprotein values was significantly associated with recurrent MI in the younger patients. Conclusions STEMI patients ≤45 years of age more often had lower rates of all-cause mortality, but the risk of recurrent MI was similar to that of older patients. Regardless of triglyceride level, neither non–high-density lipoprotein nor low-density lipoprotein were independent predictors for recurrent MI during the long-term follow-up in younger patients.

      PubDate: 2018-06-09T19:27:18Z
      DOI: 10.1016/j.amjms.2018.02.003
       
  • Association of Substance Use With Hospitalization and Virologic
           Suppression in a Southern Academic HIV Clinic
    • Authors: Celensia Tolson; Lauren E. Richey; Yujing Zhao; Jeffrey E. Korte; Kathleen Brady; Louise Haynes; Eric G. Meissner
      Pages: 553 - 558
      Abstract: Publication date: June 2018
      Source:The American Journal of the Medical Sciences, Volume 355, Issue 6
      Author(s): Celensia Tolson, Lauren E. Richey, Yujing Zhao, Jeffrey E. Korte, Kathleen Brady, Louise Haynes, Eric G. Meissner
      Background Persons with HIV infection who do not achieve virologic suppression contribute significantly to the ongoing HIV epidemic and have an increased risk of clinical sequelae related to immunosuppression. The extent to which substance use and mental health diagnoses affect HIV outcomes and the care continuum has not been previously assessed at the Medical University of South Carolina (MUSC), a large academic HIV clinic. Methods To address this knowledge gap and identify targets for intervention, we performed a retrospective chart review to examine associations of substance use and mental health diagnoses with hospitalization and virologic suppression. Results Patients with substance use or mental health diagnoses had increased rates of hospitalization and lower rates of sustained longitudinal HIV suppression. Prevalence of distinct substance-related disorders differed by race and sex. Although cocaine, alcohol and cannabis use were common, documented opiate use disorder was surprisingly infrequent given the ongoing opioid epidemic in South Carolina. Conclusions These data suggest effective assessment and treatment of substance use disorders will help improve the HIV care continuum in South Carolina.

      PubDate: 2018-06-09T19:27:18Z
      DOI: 10.1016/j.amjms.2018.03.002
       
  • The Relationship Between Vascular Endothelial Growth Factor Cis- and
           Trans-Acting Genetic Variants and Metabolic Syndrome
    • Authors: Mohsen Azimi-Nezhad; Seyed Reza Mirhafez; Maria G. Stathopoulou; Helena Murray; Ndeye Coumba Ndiaye; Abdollah Bahrami; Abdoreza Varasteh; Amir Avan; Amelie Bonnefond; Marc Rancier; Hassan Mehrad-Majd; Bernard Herbeth; John Lamont; Peter Fitzgerald; Gordon A. Ferns; Sophie Visvikis-Siest; Majid Ghayour-Mobarhan
      Pages: 559 - 565
      Abstract: Publication date: June 2018
      Source:The American Journal of the Medical Sciences, Volume 355, Issue 6
      Author(s): Mohsen Azimi-Nezhad, Seyed Reza Mirhafez, Maria G. Stathopoulou, Helena Murray, Ndeye Coumba Ndiaye, Abdollah Bahrami, Abdoreza Varasteh, Amir Avan, Amelie Bonnefond, Marc Rancier, Hassan Mehrad-Majd, Bernard Herbeth, John Lamont, Peter Fitzgerald, Gordon A. Ferns, Sophie Visvikis-Siest, Majid Ghayour-Mobarhan
      Background We have investigated the association between 4 cis- and trans-genetic variants (rs6921438, rs4416670, rs6993770 and rs10738760) of the vascular endothelial growth factor (VEGF) gene and metabolic syndrome (MetS) and its individual components in an Iranian population. Material & Method Three hundred and thirty-six subjects were enrolled and MetS was defined according to the International-Diabetes-Federation (IDF) criteria. Genotyping was carried out in all the individuals for 4 VEGF genetic variants using an assay based on a combination of multiplex polymerase chain reaction and biochip array hybridization. Results As may be expected, patients with MetS had significantly higher levels of serum high-sensitivity C-reactive protein, waist circumference, hip circumference, body mass index, fat percentage, systolic blood pressure, diastolic blood pressure and triglyceride, whereas the high-density lipoprotein cholesterol levels were significantly lower, compared to the control group (P < 0.05). We also found that 1 of the VEGF- level associated genetic variants, rs6993770, was associated with the presence of MetS; the less common T allele at this locus was associated with an increased risk for MetS. This association remained significant after adjustment for confounding factors (P = 0.007). Individuals with MetS carrying the AT + TT genotypes had markedly higher levels of fasting blood glucose, triglyceride and systolic blood pressure (P < 0.05). Conclusions We have found an association between the rs6993770 polymorphism and MetS. This gene variant was also associated with serum VEGF concentrations. There was also an association between this variant and the individual components of the MetS, including triglyceride, fasting blood glucose and systolic blood pressure.

      PubDate: 2018-06-09T19:27:18Z
      DOI: 10.1016/j.amjms.2018.03.009
       
  • Pegylated Interferon-α Plus Ribavirin Therapy Improves Left Ventricular
           Diastolic Dysfunction in Patients With Chronic Hepatitis C Attaining
           Sustained Virological Response
    • Authors: Abdul-Quddus Mohammed; Ranshaka Auckle; Hai-Ling Li; Si-Ling Xu; Lu Liu; Dong-Dong Zhao; Wen-Liang Che
      Pages: 566 - 572
      Abstract: Publication date: June 2018
      Source:The American Journal of the Medical Sciences, Volume 355, Issue 6
      Author(s): Abdul-Quddus Mohammed, Ranshaka Auckle, Hai-Ling Li, Si-Ling Xu, Lu Liu, Dong-Dong Zhao, Wen-Liang Che
      Background Pegylated interferon (pegIFN) in combination with ribavirin (RBV) has successfully improved the rate of sustained virological response (SVR) in chronic hepatitis C virus (HCV) infected individuals, which reduces the progression of the chronic liver disease. However, the influence of combination therapy (pegIFN/RBV) on cardiac function has yielded ambiguous results. The present study aimed to evaluate the effects of combination therapy with pegIFN/RBV on cardiac function of HCV-infected individuals with SVR. Materials and Methods Cardiac function was assessed and correlated in 142 treatment-naïve patients with HCV infections by determining cardiac biomarkers and echocardiography before treatment and for 24 weeks post-treatment. Results An SVR was achieved by 50.7% of all patients. Serum N-terminal pro-B-type natriuretic peptide levels were significantly higher in all patients before treatment and decreased significantly 24 weeks post-treatment in the SVR group (62.84 [36.98-102.73] versus 22.87 [15.64-56.92] pg/mL, P < 0.01). Peak early diastolic annular velocity (E′) was significantly lower (7.69 ± 2.48 versus 9.74 ± 2.68cm/s, P < 0.001) and E/E′ was higher (10.04 ± 2.51 versus 8.18 ± 2.31, P < 0.001) in all patients with SVR. However, there were no statistically significant differences in biomarkers and echocardiographic parameters for patients without SVR. In addition, multivariate analysis identified age (odds ratio [OR] = 1.076; 95% CI: 1.031-1.125; P < 0.001), NT-proBNP (OR = 1.122; 95% CI: 1.002-1.248; P = 0.015), and SVR (OR = 0.532; 95% CI: 0.214-0.895; P = 0.023) as statistically significant independent variables associated with left ventricular diastolic dysfunction. Conclusions The present study showed no adverse effects of combination therapy on cardiac function of HCV-infected individuals with SVR. Subsequent viral eradication resulted in improvement of left ventricular diastolic dysfunction.

      PubDate: 2018-06-09T19:27:18Z
      DOI: 10.1016/j.amjms.2018.02.001
       
  • Spectrum of Gastrointestinal Manifestations in Joint Hypermobility
           Syndromes
    • Authors: Gehan Botrus; Omar Baker; Erica Borrego; Kyari Sumayin Ngamdu; Mohamed Teleb; Jose L. Gonzales Martinez; Gerardo Maldonado; Ahmed M. Hussein; Richard McCallum
      Pages: 573 - 580
      Abstract: Publication date: June 2018
      Source:The American Journal of the Medical Sciences, Volume 355, Issue 6
      Author(s): Gehan Botrus, Omar Baker, Erica Borrego, Kyari Sumayin Ngamdu, Mohamed Teleb, Jose L. Gonzales Martinez, Gerardo Maldonado, Ahmed M. Hussein, Richard McCallum
      Joint hypermobility is a common, primarily benign finding in the general population. However, in a subset of individuals joint hypermobility causes a range of clinical problems mainly affecting the musculoskeletal system and, to a lesser extent, extra-articular disorders. Joint hypermobility often appears as a familial trait and is shared by several inherited connective tissue disorders, including the hypermobility subtype of Ehlers-Danlos syndrome (hEDS) and benign joint hypermobility syndrome (BJHS/JHS). Although joint hypermobility has primarily been thought of as a rheumatological disorder, increasing evidence shows significant associations between both hEDS and BJHS with specific extra-articular disorders. To date, the strongest associations of these 2 conditions are with anxiety disorders, orthostatic tachycardia, various functional gastrointestinal (GI) disorders and pelvic and bladder dysfunction. This review article focuses on GI disorders associated with both hEDS and BJHS. The aim of this review is to evaluate existing research and literature regarding associations between JHS (hEDS/BJHS) and GI disorders. Our goal is to raise awareness of BJHS/JHS and hEDS as an explanation for chronic unexplained symptoms and functional GI disorders as well as to review the current standard tests available for proper evaluation of GI symptoms in these patients.

      PubDate: 2018-06-09T19:27:18Z
      DOI: 10.1016/j.amjms.2018.03.001
       
  • The 50/10 Oxygen-Induced Retinopathy Model Serves as a Hyperoxia and
           Hypoxia Model of Bronchopulmonary Dysplasia
    • Authors: Huijuan Li; Ruyuan Zhu; Lijuan Qian; Wen Jin; Jiali Xie; Shumin Kang; Lijun Lu; Mingyu Tao; Li Jiang
      Pages: 581 - 587
      Abstract: Publication date: June 2018
      Source:The American Journal of the Medical Sciences, Volume 355, Issue 6
      Author(s): Huijuan Li, Ruyuan Zhu, Lijuan Qian, Wen Jin, Jiali Xie, Shumin Kang, Lijun Lu, Mingyu Tao, Li Jiang
      Background Animal models of bronchopulmonary dysplasia (BPD) are mainly created by hyperoxia exposure. However, these models do not fully recapitulate BPD pathophysiology as observed in clinical practice. To find a better BPD model, we established a rat 50/10 oxygen-induced retinopathy (OIR) model and analyzed the pathologic features of the lungs. Methods The rat OIR model was established by exposing newborn rats (P0) to 50% and 10% oxygen (hyperoxia and hypoxia) on alternating days for 14 days. Lungs were harvested immediately on postnatal day 14 (P14) and on P18 after 4 days of normoxia exposure for hematoxylin and eosin staining, antialpha smooth muscle actin (α-SMA) immunohistochemistry and Picrosirius red staining of collagen. Retinas were obtained to confirm successful model establishment by isolectin B4 staining of retinal vasculature. Results OIR rats presented with fewer and enlarged alveoli, and the septal walls were thicker than those in age-matched controls. α-SMA immunohistochemistry indicated increased abundance of myofibroblasts in OIR rats. At P18, α-SMA-positive myofibroblasts were present at extremely low levels from the alveolar walls of control rats, while OIR rats showed myofibroblast persistence. The amount of collagen in OIR rats was also higher than that in control rats at both P14 and P18 as evidenced by Picrosirius red staining. Conclusions Alveolar changes observed by hematoxylin and eosin staining, prolonged and stronger α-SMA expression and augmented collagen accumulation resemble the histopathology of BPD, suggesting that the rat 50/10 OIR model is suitable for use in BPD research.

      PubDate: 2018-06-09T19:27:18Z
      DOI: 10.1016/j.amjms.2018.01.015
       
  • Tetrahydroxy Stilbene Glucoside Alleviates High Glucose-Induced MPC5
           Podocytes Injury Through Suppression of NLRP3 Inflammasome
    • Authors: Jinfeng Li; Bing Wang; Guangjie Zhou; Xiujuan Yan; Yuan Zhang
      Pages: 588 - 596
      Abstract: Publication date: June 2018
      Source:The American Journal of the Medical Sciences, Volume 355, Issue 6
      Author(s): Jinfeng Li, Bing Wang, Guangjie Zhou, Xiujuan Yan, Yuan Zhang
      Background Tetrahydroxy stilbene glucoside (TSG) is an active ingredient of Heshouwu and is an antioxidant. The underlying mechanisms of the renoprotective effect of TSG in diabetic nephropathy have not been previously reported. In this study, we investigated the mechanisms of TSG in preventing podocytes injury in high glucose (HG) condition. Methods Cultured mouse podocytes (MPC5) were incubated in HG (30mmol/L) plus various concentration of TSG (0.1, 1 and 10μM) for 48 hours. Reactive oxygen species (ROS) production, malondialdehyde (MDA) levels, terminal deoxynucleotidyl-transferase (TdT)-mediated dUTP-biotin nick end-labeling (TUNEL) fluorescence intensity, caspase-3 activity and the mRNA expression of nephrin in cultured podocytes were determined. The protein expression of Nod-like receptor protein 3 (NLRP3) inflammsome, interleukin-1β (IL-1β) and nephrin was detected by Western blot. Results When the podocytes were incubated with various concentrations of TSG under HG conditions for 48 hours, TSG decreased ROS production, MDA levels, TUNEL fluorescence intensity and caspase-3 activity, but increased cell viability and the expression of nephrin in HG-induced podocytes in a dose-dependent manner. Subsequently, the podocytes treated with TSG at 10 μΜ decreased the expression of NLRP3 inflammasome and IL-1β compared with that of control. Furthermore, the podocytes transfected with NLRP3- small interfering RNA (siRNA) exhibited a significant decrease in the expression of caspase-1 and IL-1β, but exhibited a significant increase in the expression of nephrin. Eventually, TSG significantly increased the expression of nephrin in IL-1β-treated podocytes. Conclusions TSG attenuates high glucose-induced cell apoptosis in vitro partly through the suppression of NLRP3 inflammasome signaling.

      PubDate: 2018-06-09T19:27:18Z
      DOI: 10.1016/j.amjms.2018.03.005
       
  • Erythropoietin Enhances Bone Repair Effects via the Hypoxia-Inducible
           Factor Signal Pathway in Glucocorticoid-Induced Osteonecrosis of the
           Femoral Head
    • Authors: Donghai Li; Qinsheng Hu; Gang Tan; Xiaowei Xie; Zhouyuan Yang; Pengde Kang
      Pages: 597 - 606
      Abstract: Publication date: June 2018
      Source:The American Journal of the Medical Sciences, Volume 355, Issue 6
      Author(s): Donghai Li, Qinsheng Hu, Gang Tan, Xiaowei Xie, Zhouyuan Yang, Pengde Kang
      Background This study aimed to determine whether erythropoietin could repair glucocorticoid-induced osteonecrosis of the femoral head after the systemic or local administration of recombinant human erythropoietin. Materials and Methods Gelatin microspheres were used to load recombinant human erythropoietin for local delivery. Forty-eight Wistar rats were included in the glucocorticoid-induced osteonecrosis of the femoral head model and randomly divided into the placebo, systemic erythropoietin and local erythropoietin groups. Eight weeks later, all rats were killed and their tissues were subjected to radiographic, histological, histometric, quantitative polymerase chain reaction and western blot analyses. Results Our results show that the use of recombinant human erythropoietin increased bone volume, trabecular number, trabecular thickness and trabecular separation compared with the placebo. Erythropoietin administration significantly improved the expression of runt-related transcription factor 2, alkaline phosphates, hypoxia-inducible factor-1α and vascular endothelial growth factor in the femoral head. We also found that the local injection of erythropoietin could better mediate hypoxia-inducible factor-1α–controlled osteogenic and angiogenic factor expression and better repair the glucocorticoid-induced osteonecrosis of the femoral head. Conclusions The use of recombinant human erythropoietin exerted effects on improving the bone structures in glucocorticoid-induced osteonecrosis of the femoral head and up-regulated the expression of runt-related transcription factor 2, alkaline phosphates, hypoxia-inducible factor-1α and vascular endothelial growth factor. It provided a novel idea that erythropoietin administration could repair glucocorticoid-induced osteonecrosis of the femoral head by improving bone formation and angiogenesis and may be associated with the hypoxia-inducible factor-1α pathway. The sequential delivery of erythropoietin from gelatin microspheres seems worth recommending.

      PubDate: 2018-06-09T19:27:18Z
      DOI: 10.1016/j.amjms.2018.03.010
       
  • The First Reported Case of Cytomegalovirus Gastritis in a Patient With
           End-Stage Renal Disease
    • Authors: Chi-Hao Liu; An-Hang Yang; Shuo-Ming Ou; Der-Cherng Tarng
      Pages: 607 - 609
      Abstract: Publication date: June 2018
      Source:The American Journal of the Medical Sciences, Volume 355, Issue 6
      Author(s): Chi-Hao Liu, An-Hang Yang, Shuo-Ming Ou, Der-Cherng Tarng
      Cytomegalovirus (CMV) infection is a common infectious complication in immunocompromised patients. The colon is the most common site of CMV infection in the gastrointestinal tract. Rarely, however, invasion of the upper gastrointestinal tract, such as the esophagus or stomach, has been reported. Herein, we describe the first reported case of CMV gastritis in a patient with end-stage renal disease and uremic symptoms (including nausea, vomiting, and poor appetite) who had begun hemodialysis therapy. This patient was not a transplant recipient and was not receiving immunosuppressant treatment. As CMV gastritis is easily over looked in patients with end-stage renal disease, physicians should maintain a high index of suspicion and establish the diagnosis as early as possible using an upper GI endoscopic biopsy and adequate staining.

      PubDate: 2018-06-09T19:27:18Z
      DOI: 10.1016/j.amjms.2017.11.012
       
  • Biventricular Thrombi in a Patient With Heart Failure With Severely
           Reduced Ejection Fraction and Heterozygous Prothrombin 20210G/A and
           Homozygous Methylenetetrahydrofolate Reductase 677C/T Mutations
    • Authors: Htoo Kyaw; Fatima Shaik; Won J. Park; Deepika Misra
      Pages: 610 - 613
      Abstract: Publication date: June 2018
      Source:The American Journal of the Medical Sciences, Volume 355, Issue 6
      Author(s): Htoo Kyaw, Fatima Shaik, Won J. Park, Deepika Misra
      Thrombus in the heart is known to be one of the many sequelae of anterior wall myocardial infarction, atrial fibrillation and coagulation disorders. However, biventricular thrombi are relatively rarely found, even in conditions with a high possibility of thrombus formation. We report the case of a 75-year-old-woman with newly diagnosed systolic heart failure secondary to a nonischemic cardiomyopathy, who was found to have large biventricular thrombi. Further coagulopathy work-up revealed that she was heterozygous for the prothrombin 20210G/A and homozygous for the methylenetetrahydrofolate reductase (MTHFR) 677C/T mutations. We, herein, review and discuss previous case reports and published literature regarding ventricular thrombosis and its treatment. To the best of our knowledge, this is the first case of biventricular thrombosis with prothrombin 20210G/A and MTHFR 677C/T mutations.

      PubDate: 2018-06-09T19:27:18Z
      DOI: 10.1016/j.amjms.2017.10.005
       
  • In Reference to Fanconi Anemia and Laron Syndrome
    • Authors: Benilde García-de Teresa; Sara Frias
      Pages: 614 - 615
      Abstract: Publication date: June 2018
      Source:The American Journal of the Medical Sciences, Volume 355, Issue 6
      Author(s): Benilde García-de Teresa, Sara Frias


      PubDate: 2018-06-09T19:27:18Z
      DOI: 10.1016/j.amjms.2018.01.014
       
  • About a Suggestive Association Between Fanconi Anemia and Laron Syndrome
    • Authors: I. Castilla-Cortazar; G.A. Aguirre; J.R. De Ita
      Pages: 615 - 616
      Abstract: Publication date: June 2018
      Source:The American Journal of the Medical Sciences, Volume 355, Issue 6
      Author(s): I. Castilla-Cortazar, G.A. Aguirre, J.R. De Ita


      PubDate: 2018-06-09T19:27:18Z
      DOI: 10.1016/j.amjms.2018.02.004
       
  • Aldosterone Blockade Added to Renin-Angiotensin System Blockade to Reduce
           Albuminuria—A Path for Improved Renoprotection'
    • Authors: Peter Rossing; Frederik Persson
      Pages: 407 - 408
      Abstract: Publication date: May 2018
      Source:The American Journal of the Medical Sciences, Volume 355, Issue 5
      Author(s): Peter Rossing, Frederik Persson


      PubDate: 2018-05-28T12:18:30Z
      DOI: 10.1016/j.amjms.2018.01.012
       
  • Cardiovascular Disease and Alcohol Consumption
    • Authors: Hillary Johnston-Cox; Paul J. Mather
      Pages: 409 - 410
      Abstract: Publication date: May 2018
      Source:The American Journal of the Medical Sciences, Volume 355, Issue 5
      Author(s): Hillary Johnston-Cox, Paul J. Mather


      PubDate: 2018-05-28T12:18:30Z
      DOI: 10.1016/j.amjms.2018.01.016
       
  • Biosimilars for Immune-Mediated Chronic Diseases in Primary Care: What a
           Practicing Physician Needs to Know
    • Authors: Steven R. Feldman; Jerry Bagel; Shahla Namak
      Pages: 411 - 417
      Abstract: Publication date: May 2018
      Source:The American Journal of the Medical Sciences, Volume 355, Issue 5
      Author(s): Steven R. Feldman, Jerry Bagel, Shahla Namak
      The introduction of biologics has revolutionized the treatment of immune-mediated diseases, but high cost and limited patient access remain hurdles, and some physicians are concerned that biosimilars are not similar enough. The purpose of this narrative review is to describe biosimilar safety, efficacy, nomenclature, extrapolation and interchangeability. In the United States, the Biologics Price Competition and Innovation Act created an abbreviated pathway for licensing of a biologic that is biosimilar to another licensed product (i.e., the reference product). This approval pathway differs from that of generic small-molecule drugs because biologics are too complex to be perfectly duplicated, and follows a process designed to demonstrate that any differences between the biosimilar and its reference product have no significant impact on safety and efficacy. The US approval process requires extensive analytical assessments, animal studies and clinical trials, assuring that biosimilar products provide clinical results similar to those of the reference product.

      PubDate: 2018-05-28T12:18:30Z
      DOI: 10.1016/j.amjms.2017.12.014
       
  • Effects of Different Doses of Irbesartan Combined With Spironolactone on
           Urinary Albumin Excretion Rate in Elderly Patients With Early Type 2
           Diabetic Nephropathy
    • Authors: Yingying Chen; Peng Liu; Xia Chen; Yanan Li; Fengmei Zhang; Yangang Wang
      Pages: 418 - 424
      Abstract: Publication date: May 2018
      Source:The American Journal of the Medical Sciences, Volume 355, Issue 5
      Author(s): Yingying Chen, Peng Liu, Xia Chen, Yanan Li, Fengmei Zhang, Yangang Wang
      Background There is a lack of research on the effect of low dose of angiotensin receptor blockers combined with spironolactone, and the effect of high dose of angiotensin receptor blockers alone on the urinary albumin excretion rate (UAER) in elderly patients with early type 2 diabetic nephropathy (DN). Methods We conducted a prospective, randomized, open-label, parallel-controlled study that included 244 elderly patients with early DN and mild-to-moderate essential hypertension. Patients were randomly divided into 4 groups: low-dose irbesartan (group A), high-dose irbesartan (group B), low-dose irbesartan combined with spironolactone (group C) and high-dose irbesartan combined with spironolactone (group D). Changes in UAER, serum potassium and blood pressure were compared. Results There were no statistical differences in the baseline characteristics among groups. Furthermore, no significant difference in blood pressure before and after treatment was found among different groups. After 72-week treatment, UAER in group D was lower compared to group A and B (P < 0.05). Meanwhile, compared with group B, UAER in group C decreased significantly (P < 0.05). Additionally, significantly higher serum potassium was found in group D compared to other groups (P < 0.05). Also, group D had the highest count of patients who withdrew from the study due to hyperkalemia compared to other groups (P < 0.05). Conclusions Our results indicate high-dose irbesartan combined with spironolactone may be more efficient in reducing UAER in elderly patients with early DN, but this treatment could cause hyperkalemia. Low-dose irbesartan combined with spironolactone was shown to be safer and more effective in decreasing UAER compared to high-dose irbesartan.

      PubDate: 2018-05-28T12:18:30Z
      DOI: 10.1016/j.amjms.2018.01.017
       
  • Cardiovascular Events in Alcoholic Syndrome With Alcohol Withdrawal
           History: Results From the National Inpatient Sample
    • Authors: Parasuram Krishnamoorthy; Aditi Kalla; Vincent M. Figueredo
      Pages: 425 - 427
      Abstract: Publication date: May 2018
      Source:The American Journal of the Medical Sciences, Volume 355, Issue 5
      Author(s): Parasuram Krishnamoorthy, Aditi Kalla, Vincent M. Figueredo
      Background Epidemiologic studies suggest reduced cardiovascular disease (CVD) events with moderate alcohol consumption. However, heavy and binge drinking may be associated with higher CVD risk. Utilizing the Nationwide Inpatient Sample, we studied the association between a troublesome alcohol history (TAH), defined as those with diagnoses of both chronic alcohol syndrome and acute withdrawal history and CVD events. Methods Patients >18 years with diagnoses of both chronic alcohol syndrome and acute withdrawal using the International Classification of Diseases-Ninth Edition-Clinical Modification (ICD-9-CM) codes 303.9 and 291.81, were identified in the Nationwide Inpatient Sample 2009-2010 database. Demographics, including age and sex, as well as CVD event rates were collected. Results Patients with TAH were more likely to be male, with a smoking history and have hypertension, with less diabetes, hyperlipidemia and obesity. After multimodal adjusted regression analysis, odds of coronary artery disease, acute coronary syndrome, in-hospital death and heart failure were significantly lower in patients with TAH when compared to the general discharge patient population. Conclusions Utilizing a large inpatient database, patients with TAH had a significantly lower prevalence of CVD events, even after adjusting for demographic and traditional risk factors, despite higher tobacco use and male sex predominance, when compared to the general patient population.

      PubDate: 2018-05-28T12:18:30Z
      DOI: 10.1016/j.amjms.2018.01.005
       
  • The Relations Among Serum Ghrelin, Motilin and Gastric Emptying and
           Autonomic Function in Autoimmune Gastritis
    • Authors: Çağdaş Kalkan; Irfan Soykan
      Pages: 428 - 433
      Abstract: Publication date: May 2018
      Source:The American Journal of the Medical Sciences, Volume 355, Issue 5
      Author(s): Çağdaş Kalkan, Irfan Soykan
      Background Gastric emptying (GE) of solids is delayed and autonomic dysfunction is detected in autoimmune gastritis (AIG). The goals of this study were to: (1) compare serum levels of ghrelin and motilin in subjects with delayed and normal GE and (2) investigate whether circulating antimyenteric antibodies (CAA), serum ghrelin levels and motilin levels have any effect on autonomic function. Materials and Methods Noninvasive cardiovascular reflex tests were used in order to evaluate the autonomic function. GE was evaluated by a standard 2-hour scintigraphic test. Serum ghrelin and motilin levels were tested by enzyme-linked immunosorbent assay and CAA were tested by immunofluorescence. Results The serum ghrelin and motilin levels in the patients with delayed GE (n = 22) were significantly decreased compared to the normal GE patients (n = 19), (67.55 ± 8.81 versus 126.79 ± 25.81pg/mL, P < 0.001 and 279.59 ± 111.12 versus 500.42 ± 155.95pg/mL, respectively, P < 0.001). Whereas, the serum ghrelin and motilin levels in the patients with deranged autonomic function (n = 26) were significantly decreased compared to the patients with normal autonomic function (n = 15), (80.73 ± 28.46 versus 127.79 ± 28.06pg/mL, P < 0.001 and 316.92 ± 160.47 versus 490.20 ± 141.02pg/mL, P < 0.001, respectively).  None of the patients were positive for CAA. Conclusions Ghrelin and motilin levels in AIG subjects with delayed GE and deranged autonomic function were significantly decreased. The decrease in serum ghrelin and plasma motilin levels in AIG suggest their potential role in the delayed GE observed in these subjects.

      PubDate: 2018-05-28T12:18:30Z
      DOI: 10.1016/j.amjms.2017.12.021
       
  • Dipstick Proteinuria and Reduced Estimated Glomerular Filtration Rate as
           Independent Risk Factors for Osteoporosis
    • Authors: Chun-Wu Tung; Yung-Chien Hsu; Ya-Hsueh Shih; Pey-Jium Chang; Chun-Liang Lin
      Pages: 434 - 441
      Abstract: Publication date: May 2018
      Source:The American Journal of the Medical Sciences, Volume 355, Issue 5
      Author(s): Chun-Wu Tung, Yung-Chien Hsu, Ya-Hsueh Shih, Pey-Jium Chang, Chun-Liang Lin
      Background Osteoporosis is associated with a poor quality of life and mortality. Proteinuria contributes to vitamin D deficiency and osteoblast dysfunction. The correlation between estimated glomerular filtration rate (eGFR) and bone density still remains elusive. Therefore, we sought to investigate whether reduced eGFR or proteinuria are independently associated with the osteoporotic risk. Methods We conducted a cross-sectional study using community-based health survey data from January 2004 to December 2008 in southern Taiwan. Positive proteinuria was defined as presence of 1+ or more urinary proteins on the dipstick. The bone density was measured by calcaneal quantitative ultrasound (QUS). Subjects with T-score ≤ −2.5 were considered as osteoporotic. Results A total of 21,271 subjects of whom 11.3% had proteinuria were analyzed. Proteinuric participants were older, predominantly male, and more likely to have diabetes, hypertension, or exercise less regularly (P < 0.001). Multiple linear regression analysis showed that male sex, body mass index, regular exercise, eGFR and high density lipoprotein-cholesterol were positively correlated with QUS T-scores, whereas age, systolic blood pressure and proteinuria were negatively associated with QUS T-scores (P < 0.01). Compared with subjects in the highest eGFR tertile, those in the middle and the lowest groups had adjusted ORs for osteoporosis of 1.31 (95% CI: 1.20-1.44) and 2.46 (1.73-3.48), respectively. Additionally, the fully adjusted ORs of osteoporosis were 1.15 (1.02-1.32) and 1.18 (1.05-1.33) for participants with 1+ and ≥2+ proteinuria, respectively. Conclusions Reduced eGFR and proteinuria are significantly associated with risk for osteoporosis.

      PubDate: 2018-05-28T12:18:30Z
      DOI: 10.1016/j.amjms.2017.12.011
       
  • Beneficial Effects of Pentoxifylline Plus Losartan Dual Therapy in Type 2
           Diabetes with Nephropathy
    • Authors: Soghra Rabizadeh; Fatemeh Dehghani Firouzabadi; Sina Noshad; Sadaf Esteghamati; Mohsen Afarideh; Alireza Ghajar; Morsaleh Ganji; Mohammad Saadat; Behnam Heidari; Mohammad Taghi Najafi; Manouchehr Nakhjavani; Alireza Esteghamati
      Pages: 442 - 448
      Abstract: Publication date: May 2018
      Source:The American Journal of the Medical Sciences, Volume 355, Issue 5
      Author(s): Soghra Rabizadeh, Fatemeh Dehghani Firouzabadi, Sina Noshad, Sadaf Esteghamati, Mohsen Afarideh, Alireza Ghajar, Morsaleh Ganji, Mohammad Saadat, Behnam Heidari, Mohammad Taghi Najafi, Manouchehr Nakhjavani, Alireza Esteghamati
      Background This study was designed to comparatively assess the effects of add-on pentoxifylline to losartan versus increasing the dose of losartan on serum N-terminal pro-brain natriuretic peptide (NT-proBNP), serum highly sensitive C-reactive protein (hsCRP) and the urinary albumin excretion (UAE) rate in patients with type 2 diabetes and nephropathy. Methods In an open-label, single-center, parallel-group, randomized clinical trial (NCT03006952), 30 patients received b.i.d. dose of pentoxifylline 400mg plus daily dose of losartan 50mg (pentoxifylline arm) and 29 patients received b.i.d. dose of losartan 50mg (losartan arm) during a 12-week follow-up period. Results Serum NT-proBNP, serum hsCRP and UAE levels all significantly decreased from baseline in both trial arms. The pentoxifylline and losartan trial arms were equally effective in reducing serum NT-proBNP levels during the course of trial (multivariable adjusted model P value = 0.864, effect size = 0.2%). There was a greater decrease in UAE and serum hsCRP levels in the pentoxifylline arm (P = 0.034, effect size = 7.8%; P = 0.009, effect size = 11.7%, respectively). Conversely, patients in the losartan arm achieved better systolic and diastolic blood pressure control (P < 0.001, effect size = 25.4%; P = 0.010, effect size = 11.3%, respectively). Conclusions Circulating NT-proBNP levels equally and significantly reduced from baseline in the pentoxifylline and losartan treatment arms, in parallel with comparatively superior decreases of UAE and serum hsCRP in the pentoxifylline arm, and larger decreases of systolic and diastolic blood pressures in the losartan arm.

      PubDate: 2018-05-28T12:18:30Z
      DOI: 10.1016/j.amjms.2017.12.015
       
  • Positive Correlation of Fecal Calprotectin With Serum Antioxidant Enzymes
           in Patients With Inflammatory Bowel Disease: Accidental Numerical
           Correlation or a New Finding'
    • Authors: Mostafa Vaghari-Tabari; Soheila Moein; Durdi Qujeq; Mehrdad Kashifard; Karimollah Hajian-Tilaki
      Pages: 449 - 455
      Abstract: Publication date: May 2018
      Source:The American Journal of the Medical Sciences, Volume 355, Issue 5
      Author(s): Mostafa Vaghari-Tabari, Soheila Moein, Durdi Qujeq, Mehrdad Kashifard, Karimollah Hajian-Tilaki
      Background Oxidative stress occuring in patients diagnosed with inflammatory bowel disease (IBD), but the relationship between oxidative stress, disease activity and inflammatory markers has not been well established. Materials and Methods A total of 30 patients diagnosed with IBD and 30 volunteers who had normal colonoscopies, selected as controls, were used for this study. The serum levels of antioxidant enzymes (catalase and glutathione peroxidase) and oxidative markers (malondialdehyde [MDA] and total antioxidant capacity) were compared between the 2 groups. Furthermore, their correlations with disease activity scores and inflammatory markers, especially the fecal calprotectin, were examined. Results Catalase and glutathione peroxidase concentrations were significantly correlated with the level of fecal calprotectin in patients with IBD. Nevertheless, there were no significant correlations between the concentrations of the above-mentioned enzymes and C-reactive protein, erythrocyte sedimentation rate or the activity scores of IBD patients. It should be noted that MDA and total antioxidant capacity levels did not correlate with the inflammatory markers or the disease activity scores. Conclusions There was a positive correlation between fecal calprotectin and serum antioxidant enzymes in patients with IBD, but, there was no correlation between antioxidant and oxidative markers in terms of disease activity scores. Hence, the observed significant correlation between the antioxidant enzymes and the fecal calprotectin may be due to either the pro-oxidant potential of calprotectin or its antioxidant role.

      PubDate: 2018-05-28T12:18:30Z
      DOI: 10.1016/j.amjms.2017.12.009
       
  • FROM SQUIRRELS TO BIOLOGICAL WEAPONS: THE EARLY HISTORY OF TULAREMIA
    • Abstract: Publication date: Available online 15 June 2018
      Source:The American Journal of the Medical Sciences
      Author(s): J.V. Hirschmann
      After George McCoy accidentally discovered a new infection in 1911 while investigating bubonic plague in squirrels, he transmitted the disease to experimental animals and isolated the causative organism. He called it Bacterium tularense, after Tulare County, California. In 1919, Edward Francis determined that an infection called “deer-fly fever” was the same disease, naming it “tularemia.” He demonstrated that it occurred in wild rabbits and inadvertently showed that it was highly infectious, for he and all his laboratory assistants contracted the illness. This characteristic led to studies of its potential as a biological weapon, including involuntary human experimentation by Japan among civilian, political and military prisoners, and its probable use in warfare during World War II. Later, in the United States, voluntary human experimentation occurred in the 1950s-60s with penitentiary inmates and non-combatant soldiers. Soviet Union scientists allegedly developed a vaccine-resistant strain, which they tested as a biological weapon in 1982-3.

      PubDate: 2018-06-18T22:37:22Z
       
  • Extensive Calcinosis Cutis in Overlap Syndrome
    • Abstract: Publication date: Available online 13 June 2018
      Source:The American Journal of the Medical Sciences
      Author(s): Yamen Homsi


      PubDate: 2018-06-18T22:37:22Z
       
  • Hematuria and Renal Outcomes in Patients with Diabetic Chronic Kidney
           Disease
    • Abstract: Publication date: Available online 12 June 2018
      Source:The American Journal of the Medical Sciences
      Author(s): Hugo You-Hsien Lin, Sheng-Wen Niu, I-Ching Kuo, Lee-Moay Lim, Daw-Yang Hwang, Jia-Jung Lee, Shang-Jyh Hwang, Hung-Chun Chen, Chi-Chih Hung
      Background Hematuria may indicate nondiabetic renal disease in diabetic chronic kidney disease (CKD). However, some studies have reported that hematuria is noted in diabetic nephropathy and is associated with albuminuria. Hematuria is a risk factor for end-stage renal disease in glomerulonephritis, but its prognostic value in diabetic CKD is unknown. We investigated the factors associated with hematuria and the prognostic value of hematuria in patients with diabetic CKD. Material and Methods We included 1958 patients with type 2 diabetes and CKD stages 1–5, and 111 patients underwent renal biopsy. Patients in the biopsied cohort were younger and had more severe proteinuria, compared with those in the total cohort; hematuria was associated with nondiabetic renal disease. Results In the total cohort, hematuria was observed in 15.0% of the patients and was associated with young age, a lower estimated glomerular filtration rate, proteinuria, high blood pressure, and short diabetes duration. Hematuria was significantly associated with an increased risk (hazard ratio 1.39, 95% CI: 1.10–1.76, P < 0.001) of end-stage renal disease, particularly in patients with CKD stages 1–3 or a urine protein-to-creatinine ratio of <1500 mg/g (P for interaction < 0.05). The odds ratio of hematuria for rapid renal progression was 1.81 (95% CI: 1.29–2.53, P < 0.001). Conclusions Hematuria is associated with nondiabetic renal disease in biopsied patients with diabetic CKD and is associated with an increased risk of end-stage renal disease in patients with early diabetic CKD.

      PubDate: 2018-06-18T22:37:22Z
       
  • Sudden Cardiac Arrest in a Young Patient with Severe Pectus Excavatum,
    • Authors: Rayan Jo Rachwan; Andrea K. Purpura; Basil M. Kahwash
      Abstract: Publication date: Available online 9 June 2018
      Source:The American Journal of the Medical Sciences
      Author(s): Rayan Jo Rachwan, Andrea K. Purpura, Basil M. Kahwash
      We report a case of sudden cardiac arrest in the setting of ventricular fibrillation in a previously healthy 19-year-old male. Chest imaging demonstrated severe pectus excavatum with Pectus Severity Index of 22.7. Extensive workup was unrevealing for other cardiopulmonary etiologies, including conduction and structural abnormalities. The patient was scheduled for a Ravitch procedure and was discharged on a wearable defibrillator vest for temporary protection against ventricular arrhythmias. Later, the patient underwent subcutaneous implantable cardioverter defibrillator placement. Sudden cardiac arrest as an initial presentation of pectus excavatum is a rare entity scarcely discussed in medical literature. In this patient-centered focused review, we explore this unique case and offer our management approach amid the lack of concrete guidelines.

      PubDate: 2018-06-09T19:27:18Z
      DOI: 10.1016/j.amjms.2018.06.002
       
  • Timing of Left Ventricular Remodeling in Non-ischemic Dilated
           Cardiomyopathy,,✯✯✯
    • Authors: William S. Bradham; Susan P. Bell; Shi Huang; Frank E. Harrell; Douglas W. Adkisson; Mark A. Lawson; Douglas B. Sawyer; Henry Ooi; Marvin W. Kronenberg
      Abstract: Publication date: Available online 8 June 2018
      Source:The American Journal of the Medical Sciences
      Author(s): William S. Bradham, Susan P. Bell, Shi Huang, Frank E. Harrell, Douglas W. Adkisson, Mark A. Lawson, Douglas B. Sawyer, Henry Ooi, Marvin W. Kronenberg
      Background : Mineralocorticoid receptor antagonist (MRA) treatment produces beneficial left ventricular (LV) remodeling in nonischemic dilated cardiomyopathy (NIDCM). This study addressed the timing of maximal beneficial LV remodeling in NIDCM when adding MRA. Methods : We studied 12 patients with NIDCM on stable beta-blocker and angiotensin-converting enzyme inhibitor/angiotensin receptor-blocking therapy who underwent cardiac magnetic resonance imaging before and after 6-31 months of continuous MRA therapy. Results : At baseline, the LV ejection fraction (LVEF) was 24 (19, 27)% (median, interquartile range). The LV end-systolic volume index (LVESVI) was 63 (57, 76) ml, and the LV stroke volume index (LVSVI) was 19 (14, 21) ml, all depressed. After adding MRA to the HF regimen, the LVEF increased to 47 (42, 52)%, with a decrease in LVESVI to 36 (33, 45) ml, and increase in LVSVI to 36 (28, 39) ml (for each, P <0 .0001). Using generalized least squares analysis, the maximal beneficial remodeling (defined by maximal increase in LVEF, the maximal decrease in LVESVI and maximal increase in LVSVI) was achieved after approximately 12-16 months of MRA treatment. Conclusions : Adding MRA to a standard medical regimen for NIDCM resulted in beneficial LV remodeling. The maximal beneficial remodeling was achieved with 12-16 months of MRA therapy. These results have implications for the timing of other advanced therapies, such as placing internal cardioverter-defibrillators.

      PubDate: 2018-06-09T19:27:18Z
      DOI: 10.1016/j.amjms.2018.06.003
       
  • The S-Curve Discontinuity Theory Applied to Medicine to Explain
           Healthcare's Past and Predict Its Future
    • Authors: Lisa B.E.; Shields Tyler Gertz Kenneth Wilson Ginger Figg Steven
      Abstract: Publication date: Available online 6 June 2018
      Source:The American Journal of the Medical Sciences
      Author(s): Lisa B.E. Shields, Tyler A. Gertz, Kenneth C. Wilson, Ginger L. Figg, Steven T. Hester, Joshua T. Honaker
      Developed in 1845 by Verhulst, the logistic growth curve is an “S” shaped sigmoid curve referring to the self-limiting population growth in ecology. The initial growth stage is exponential, followed by slowing of growth as saturation begins, and ending of growth at maturity. In geology, an uncertain period exists at the upper horizontal arm of the S-curve when a species utilizes its available resources, and either extinction or evolution by natural selection results. The S-curve has been used in biology, physics, mathematics, chemistry, economics, sociology, oncology, and statistics. The S-curve theory has been applied to medicine to describe the advancements in the 20th century based on the diagnosis and treatment of disease (the “illness” model) and envision the future focused on disease prevention (the “wellness” model). We expand upon previous S-curve applications in medicine and discuss the obstacles facing the present-day healthcare industry and the numerous advancements that are imminent.

      PubDate: 2018-06-06T18:31:10Z
       
  • Hyponatremia complicating esophageal carcinoma: a challenging differential
           diagnosis
    • Authors: Lina Mackelaite; Eleanor Lederer
      Abstract: Publication date: Available online 6 June 2018
      Source:The American Journal of the Medical Sciences
      Author(s): Lina Mackelaite, Eleanor Lederer
      Hyponatremia is a common complication of cancer and of cancer therapy. Awareness of the many causes of hyponatremia in this setting is critical for ordering the appropriate diagnostic tests, instituting the appropriate treatment, and assessing prognosis of the disorder. This case report highlights the challenges in identifying the cause of hyponatremia in some oncology settings and how misdiagnosis can delay appropriate therapy.

      PubDate: 2018-06-06T18:31:10Z
       
  • Shiga Toxin as a Potential Trigger of CFHR1 deletion- associated
           Thrombotic Microangiopathy
    • Authors: Swarna Sri Nalluru; Meera Sridharan; Ronald S. Go; Samar Said; Ariela L. Marshall
      Abstract: Publication date: Available online 5 June 2018
      Source:The American Journal of the Medical Sciences
      Author(s): Swarna Sri Nalluru, Meera Sridharan, Ronald S. Go, Samar Said, Ariela L. Marshall
      Thrombotic microangiopathy (TMA) may result from a variety of clinical conditions, including thrombotic thrombocytopenic purpura (TTP), Shiga toxin-producing Escherichia coli-associated hemolytic uremic syndrome (STEC-HUS), and complement-mediated hemolytic uremic syndrome (C-HUS). TTP is diagnosed when ADAMTS13 is <10%, while a diagnosis of STEC-HUS is made with the evidence of infection by Shiga toxin-producing Escherichia coli. Diagnosis of C-HUS is not dependent on a specific laboratory test and is a diagnosis of exclusion. TMA is a rare disease and finding individuals that have more than one concurrent etiology leading to TMA is even more rare. Here we describe the presentation and management of an individual with CFHR1 deletion-associated TMA also found to have a positive stool Shiga toxin. We discuss the significance of Shiga toxin in serving as a trigger for development of TMA in an individual predisposed to development of TMA due to presence of a homozygous deletion in CFHR1.

      PubDate: 2018-06-06T18:31:10Z
      DOI: 10.1016/j.amjms.2018.05.012
       
  • Editorial
    • Abstract: Publication date: Available online 5 June 2018
      Source:The American Journal of the Medical Sciences


      PubDate: 2018-06-06T18:31:10Z
       
  • Women's Health in Inflammatory Bowel Disease
    • Authors: Sai S. Veerisetty; Stephanie O. Eschete; Ann-Porter Uhlhorn; Kara M. De Felice
      Abstract: Publication date: Available online 2 June 2018
      Source:The American Journal of the Medical Sciences
      Author(s): Sai S. Veerisetty, Stephanie O. Eschete, Ann-Porter Uhlhorn, Kara M. De Felice
      About half of all inflammatory bowel disease (IBD) patients are women. It is important that physicians are aware of gender-specific needs women with IBD may have. This review covers general and specific women's health issues related to their IBD. It is intended to be practical and give a brief overview of topics including body image, menstruation, contraception, cervical cancer screening, preconception counseling, anxiety, depression, pregnancy, breastfeeding, menopause, skin exams, vaccines, laboratory monitoring and bone health.

      PubDate: 2018-06-03T17:04:33Z
      DOI: 10.1016/j.amjms.2018.05.010
       
  • An offer we can't refuse: cfDNA as a novel biomarker of myocardial
           infarction
    • Authors: Daria V. Ilatovskaya; Kristine Y. DeLeon-Pennell
      Abstract: Publication date: Available online 1 June 2018
      Source:The American Journal of the Medical Sciences
      Author(s): Daria V. Ilatovskaya, Kristine Y. DeLeon-Pennell


      PubDate: 2018-06-03T17:04:33Z
      DOI: 10.1016/j.amjms.2018.05.009
       
  • Tricuspid Regurgitation Pressure Gradient As a Useful Predictor Of Adverse
           Cardiovascular Events And All-cause Mortality In Patients With Atrial
           Fibrillation
    • Authors: Po-Chao Hsu; Wen-Hsien Lee; Chun-Yuan Chu; Wei-Chung Tsai; Hung-Hao Lee; Chee-Siong Lee; Hsueh-Wei Yen; Tsung-Hsien Lin; Wen-Chol Voon; Wen-Ter Lai; Sheng-Hsiung Sheu; Ho-Ming Su
      Abstract: Publication date: Available online 22 May 2018
      Source:The American Journal of the Medical Sciences
      Author(s): Po-Chao Hsu, Wen-Hsien Lee, Chun-Yuan Chu, Wei-Chung Tsai, Hung-Hao Lee, Chee-Siong Lee, Hsueh-Wei Yen, Tsung-Hsien Lin, Wen-Chol Voon, Wen-Ter Lai, Sheng-Hsiung Sheu, Ho-Ming Su
      Background Tricuspid regurgitation pressure gradient (TRPG) is reportedly a predictor of cardiovascular mortality in patients without atrial fibrillation (AF); its relationship with cardiac outcomes in patients with AF has never been evaluated. This study aimed to examine the ability of TRPG for predicting CV events and all-cause mortality in patients with AF. Materials and Methods Comprehensive echocardiography was performed in 155 patients with persistent AF. Combined cardiovascular events were defined as cardiovascular mortality, stroke, and hospitalization for heart failure. Results During an average follow-up period of 27 months, 57 cardiovascular events and 31 all-cause deaths occurred. According to multivariate analysis, predictors of cardiovascular events included diuretic use, decreased left ventricular ejection fraction (LVEF), increased ratio of transmitral E velocity (E) to early diastolic mitral annular velocity (E′), and TRPG. Predictors of all-cause mortality included old age, decreased LVEF, increased E/E′, and TRPG. Notably, the addition of TRPG to a model containing clinical significant parameters, LVEF, and E/E′ significantly improved the values in predicting adverse cardiovascular events and all-cause mortality. Conclusions The TRPG is not only a useful predictor of adverse cardiovascular events and all-cause mortality in patients with AF, it may also provide additional prognostic values for cardiovascular outcome and all-cause mortality over conventional parameters in such patients.

      PubDate: 2018-05-28T12:18:30Z
      DOI: 10.1016/j.amjms.2018.05.007
       
  • Variation in high-intensity statin use after hospitalization for acute
           vascular emergencies
    • Authors: Anusha Shanbhag; Aneesha Ananthula; Raga Deepak Reddy Palagiri; Richa Parikh; Raghunandan Purushothaman; Srikanth Vallurupalli
      Abstract: Publication date: Available online 16 May 2018
      Source:The American Journal of the Medical Sciences
      Author(s): Anusha Shanbhag, Aneesha Ananthula, Raga Deepak Reddy Palagiri, Richa Parikh, Raghunandan Purushothaman, Srikanth Vallurupalli


      PubDate: 2018-05-28T12:18:30Z
      DOI: 10.1016/j.amjms.2018.05.006
       
  • The Summer Enrichment Program: A Multidimensional Experiential Enriching
           Experience for Junior Medical Students
    • Authors: Abdulhadi A. AlAmodi; Ahmed Abu-Zaid; Abdulaziz M. Eshaq; Khaled Al-Kattan
      Abstract: Publication date: Available online 16 May 2018
      Source:The American Journal of the Medical Sciences
      Author(s): Abdulhadi A. AlAmodi, Ahmed Abu-Zaid, Abdulaziz M. Eshaq, Khaled Al-Kattan


      PubDate: 2018-05-28T12:18:30Z
      DOI: 10.1016/j.amjms.2018.05.005
       
  • IgG4-related pleuritis with no other organ involvement
    • Authors: Toshiyuki Kita; Tomoyuki Araya; Yukari Ichikawa; Nanao Terada; Atsuhiro Kawashima; Satomi Kasashima; Kazuo Kasahara
      Abstract: Publication date: Available online 9 May 2018
      Source:The American Journal of the Medical Sciences
      Author(s): Toshiyuki Kita, Tomoyuki Araya, Yukari Ichikawa, Nanao Terada, Atsuhiro Kawashima, Satomi Kasashima, Kazuo Kasahara
      A 65-year-old man was admitted for productive cough and dyspnea. Bilateral pleural effusions were observed on chest X-ray. Although the bilateral pleural effusions were exudative, with an increased number of lymphocytes, bacterial culture and polymerase chain reaction analysis for Mycobacterium tuberculosis was negative. Immunological examinations showed high levels of immunoglobulin G4 (IgG4) in both serum and pleural effusion fluid. Pathologic evaluation of a left pleural biopsy specimen using hematoxylin–eosin and immunohistochemical staining showed fibrosis-associated lymphoplasmacytic infiltration, 50 IgG4-positive plasma cells per high-power field, and an IgG4/IgG ratio of 40%. Thus, a diagnosis of IgG4-related pleuritis without other systemic manifestations was established. The bilateral pleural effusion improved following corticosteroid therapy. This is a rare case of IgG4-related pleuritis with no other organ involvement.

      PubDate: 2018-05-28T12:18:30Z
      DOI: 10.1016/j.amjms.2018.05.004
       
  • Prevalence and incidence of immune thrombocytopenia in patients with
           prostate cancer
    • Authors: Namratha Vontela; Csaba Kovesdy; Zafar Latif; Robert Lane; Alva Weir
      Abstract: Publication date: Available online 5 May 2018
      Source:The American Journal of the Medical Sciences
      Author(s): Namratha Vontela, Csaba Kovesdy, Zafar Latif, Robert Lane, Alva Weir


      PubDate: 2018-05-28T12:18:30Z
      DOI: 10.1016/j.amjms.2018.05.003
       
  • Multimodality diagnosis of Mirizzi syndrome.
    • Authors: Gunjan Garg; Marisa Deliso; Shuo Li
      Abstract: Publication date: Available online 4 May 2018
      Source:The American Journal of the Medical Sciences
      Author(s): Gunjan Garg, Marisa Deliso, Shuo Li


      PubDate: 2018-05-28T12:18:30Z
      DOI: 10.1016/j.amjms.2018.05.001
       
  • Experiential Learning in Medical Education11Conflict of Interest: No
           conflicts of interest to declare.
    • Authors: Urvashi Vaid
      Abstract: Publication date: Available online 3 May 2018
      Source:The American Journal of the Medical Sciences
      Author(s): Urvashi Vaid


      PubDate: 2018-05-28T12:18:30Z
      DOI: 10.1016/j.amjms.2018.04.017
       
  • Hepatitis B virus infection is independently associated with advanced
           colorectal adenoma
    • Authors: Su Hwan Kim; Ji Won Kim; Kook Lae Lee; Seohui Lee; Seong-Joon Koh; Ji Bong Jeong; Byeong Gwan Kim
      Abstract: Publication date: Available online 2 May 2018
      Source:The American Journal of the Medical Sciences
      Author(s): Su Hwan Kim, Ji Won Kim, Kook Lae Lee, Seohui Lee, Seong-Joon Koh, Ji Bong Jeong, Byeong Gwan Kim
      Introduction Studies on the association of chronic hepatitis B virus (HBV) infection with colonic neoplasm are rare. We aimed to investigate the association between chronic HBV infection and the development of colonic adenoma. Materials and Methods One hundred thirty-three patients with chronic HBV infection, who underwent colonoscopic examination, were enrolled. A healthy HBV-uninfected group was matched with the HBV group. Those with a previous history of colorectal cancer, inflammatory bowel diseases, or colorectal surgery were excluded from both HBV and HBV-uninfected groups. Clinical information and data on age, sex, body mass index, smoking, alcohol consumption, and comorbidities were obtained. Advanced adenoma was defined as tubular adenoma ≥ 10mm, or adenoma with a villous component or high-grade dysplasia. Results The HBV group had a higher rate of colorectal adenoma and advanced adenoma than the HBV-uninfected group. Patients in the HBV group had larger colorectal polyps than those in the HBV-uninfected group. In the chi square test, HBV DNA positivity was significantly associated with colorectal adenoma (P < 0.001) and advanced adenoma (P = 0.007). HBV infection (odds ratio [OR] 23.961, 95% CI 9.400–61.076), diabetes mellitus (OR 2.633, 95% CI 1.071–6.473), and age (OR 1.057, 95% CI 1.020–1.095) were significantly associated with advanced adenoma in the multivariable logistic regression analysis. Multivariable logistic regression analysis within the HBV group revealed that HBV DNA (OR 1.236, 95% CI 1.029–1.485) was associated with advanced adenoma. Conclusions HBV DNA in patients with HBV infection and HBV infection are independently associated with advanced colorectal adenoma development.

      PubDate: 2018-05-28T12:18:30Z
      DOI: 10.1016/j.amjms.2018.04.016
       
  • The Timing of Antibiotic Administration after Triage in the Emergency
           Department may not be Straight Forward!
    • Authors: Steven Clum; Mark Rumbak
      Abstract: Publication date: Available online 12 April 2018
      Source:The American Journal of the Medical Sciences
      Author(s): Steven Clum, Mark Rumbak


      PubDate: 2018-04-15T15:07:15Z
      DOI: 10.1016/j.amjms.2018.04.005
       
 
 
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