Tag Archives: Nature Reviews Disease Primers

Medicine: Graves’ Disease Autoimmune Disorder

Graves’ disease is an immune system disorder that results in the overproduction of thyroid hormones (hyperthyroidism). Although a number of disorders may result in hyperthyroidism, Graves’ disease is a common cause.

Thyroid hormones affect many body systems, so signs and symptoms of Graves’ disease can be wide ranging. Although Graves’ disease may affect anyone, it’s more common among women and in people younger than age 40.

The primary treatment goals are to reduce the amount of thyroid hormones that the body produces and lessen the severity of symptoms.

Eye Disorders: The Types And Causes Of Myopia

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Myopia, also known as short-sightedness or near-sightedness, is a very common condition that typically starts in childhood. Severe forms of myopia (pathologic myopia) are associated with a risk of other associated ophthalmic problems. This disorder affects all populations and is reaching epidemic proportions in East Asia, although there are differences in prevalence between countries.

Myopia is caused by both environmental and genetic risk factors. A range of myopia management and control strategies are available that can treat this condition, but it is clear that understanding the factors involved in delaying myopia onset and slowing its progression will be key to reducing the rapid rise in its global prevalence.

To achieve this goal, improved data collection using wearable technology, in combination with collection and assessment of data on demographic, genetic and environmental risk factors and with artificial intelligence are needed. Improved public health strategies focusing on early detection or prevention combined with additional effective therapeutic interventions to limit myopia progression are also needed.

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Skin Conditions: Five Types Of Contact Dermatitis

Contact dermatitis (CD) is among the most common inflammatory dermatological conditions and includes allergic CD, photoallergic CD, irritant CD, photoirritant CD (also called phototoxic CD) and protein CD. Occupational CD can be of any type and is the most prevalent occupational skin disease. Each CD type is characterized by different immunological mechanisms and/or requisite exposures. Clinical manifestations of CD vary widely and multiple subtypes may occur simultaneously. The diagnosis relies on clinical presentation, thorough exposure assessment and evaluation with techniques such as patch testing and skin-prick testing. Management is based on patient education, avoidance strategies of specific substances, and topical treatments; in severe or recalcitrant cases, which can negatively affect the quality of life of patients, systemic medications may be needed.

Tendinopathy: Diagnosis, Treatment & Prevention

Tendinopathy is the broad term for any tendon condition that causes pain and swelling. Your tendons are rope-like tissues in your body that attach muscle to bone. When your muscles tighten and relax, your tendons and bones move. One example of a tendon is your Achilles tendon, which attaches your calf muscle to your heel bone and causes ankle movement. If you have pain and/or swelling in that area, you might have Achilles tendinopathy.

The pain from tendinopathy can interfere with your daily life. For example, it can keep you from playing sports and from doing housework. So, if you have pain or swelling, make sure to contact your healthcare provider for help.

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Infographic: Diagnosis & Treatment Of Psoriasis

Psoriasis is a skin disease that causes a rash with itchy, scaly patches, most commonly on the knees, elbows, trunk and scalp.

Psoriasis is a common, long-term (chronic) disease with no cure. It can be painful, interfere with sleep and make it hard to concentrate. The condition tends to go through cycles, flaring for a few weeks or months, then subsiding for a while. Common triggers in people with a genetic predisposition to psoriasis include infections, cuts or burns, and certain medications.

Treatments are available to help you manage symptoms. And you can try lifestyle habits and coping strategies to help you live better with psoriasis.

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COMMENTS ON ‘PSORATIC ARTHRITIS’:

My practice was restricted to allergy, but I saw many patients with psoriasis. The red scaly patches made them think they had allergic dermatitis, eczema. Psoriasis on the arm is usually located on the elbow, and atopic dermatitis on the opposite side, in the flexural area. Thick, pitted fingernails are also common in psoriasis. It’s combination with arthritis is worrisome.

Psoriasis will usually develop first, and the psoriatic arthritis will follow years later, but 10% of the time the arthritis Is the first problem. This form of arthritis can be very painful, and cause deformities. It is often worse than rheumatoid arthritis, although does not affect as many joints, and is often asymmetrical. It inflames the area where tendons attach to the bone, which is one of the reasons that it can be more painful than rheumatoid arthritis.

Psoriasis is an autoimmune problem and can involve practically any organ in the body.

It is often associated with metabolic syndrome and diabetes.

Psoriatic arthritis does not have the rheumatoid serum markers that can help diagnose rheumatoid arthritis, and unless psoriasis is also present on the skin, it can be hard to diagnose.

Symptomatic treatment with NSAIDs, physical therapy, phototherapy and topical treatments can be helpful, but very expensive biologics are sometimes needed to help out methotrexate and other first line DMARDs (Disease modifying antirheumatic drugs).

This condition can be  progressive.  If you develop scaly red patches on your skin, be sure to check with the doctor about the possibility of psoriasis.

—Dr. C.

Infographic: Acute Heart Failure (Nature Reviews)

Acute heart failure (AHF) is a syndrome defined as the new onset (de novo heart failure (HF)) or worsening (acutely decompensated heart failure (ADHF)) of symptoms and signs of HF, mostly related to systemic congestion. In the presence of an underlying structural or functional cardiac dysfunction (whether chronic in ADHF or undiagnosed in de novo HF), one or more precipitating factors can induce AHF, although sometimes de novo HF can result directly from the onset of a new cardiac dysfunction, most frequently an acute coronary syndrome.

Despite leading to similar clinical presentations, the underlying cardiac disease and precipitating factors may vary greatly and, therefore, the pathophysiology of AHF is highly heterogeneous. Left ventricular diastolic or systolic dysfunction results in increased preload and afterload, which in turn lead to pulmonary congestion. Fluid retention and redistribution result in systemic congestion, eventually causing organ dysfunction due to hypoperfusion. Current treatment of AHF is mostly symptomatic, centred on decongestive drugs, at best tailored according to the initial haemodynamic status with little regard to the underlying pathophysiological particularities.

As a consequence, AHF is still associated with high mortality and hospital readmission rates. There is an unmet need for increased individualization of in-hospital management, including treatments targeting the causative factors, and continuation of treatment after hospital discharge to improve long-term outcomes.

COMMENTARY:

High frequency sound (ultrasound) bounces off of tissues, like an echo,  and allows an electronic look at the heart. Doppler echocardiography is the doctors method of choice for evaluating a heart failure. One of the most important numbers determined by this method is the EJECTION FRACTION, which is a measure of heart efficiency. If the ejection fraction is low, let’s say below 45%, the heart is pumping out only 45% of its volume with each stroke, which means it must work harder to produce the same amount of circulation. The normal is about 60%.

This is the basis of SYSTOLIC Heart failure.

The test can also tell about blood coming into the heart; the early part of the blood entering is usually 80% of the total. If it drops, let’s say below 50%, it means the heart is stiff and resists blood coming in, which is the basis of DIASTOLIC heart failure.

FACES Is an acronym-mnemonic for the symptoms of heart failure. F is for FATIGUE.

A is for ACTIVITY LIMITATION. C is for CONGESTION in the lungs.  E is for EDEMA, or swelling, usually of the ankles and legs. S is for SHORTNESS of BREATH.

If you want to remember a bit about heart failure, think about echoes and faces. If your Doctor orders an ultrasound with Doppler, be sure to ask about your ejection fraction and percent of blood that enters early, before the “atrial kick”. Being informed is always a good thing.

To be honest, I have never encountered a person who was given a Doppler echocardiogram and could tell me what his ejection fraction was, but I am eternally hopeful.

—Dr. C.

Diagnosis: Hypertensive Eye Disease (Infographic)

Hypertensive eye disease is diagnosed on the basis of a clinical history of #Hypertension and the presence of relevant pathological changes in the eye that are observed via fundoscopy or imaging. https://go.nature.com/3t0PahO

Commentary:

Control of hypertension is one of the triumphs of modern medicine, and there are many effective medications. One of the main problems that I hear about has  to do with taking too much of the medication, and having dizziness, especially on standing, which could cause a fall and injuries.

Abnormalities of the eye with hypertension are common. the doctor can look directly at the bare blood vessels as they course along the back of the eye. A hypertensive artery passing over a vein in the eye compresses it, producing a “nick” that doctors look for. other findings are shown in the info graphic.

These findings help doctors make a diagnosis, but only the rare complications of hypertensive optic atrophy and Choroidopathy actually endanger the vision.

The main organ that seems to suffer the most from hypertension is the heart, which has to work against a heavy load to pump the blood effectively at high pressure. This thickens the walls of the heart, especially the left side, making it less effective. Enlargement of the heart, heart attacks, and heart failure are not uncommon.

The brain is at risk with hypertensive arterial disease, and strokes can be a problem.

Kidney failure is also a real worry.

When you see your doctor for a blood pressure reading, make sure to take off coats and long sleeves. so that the bare arm can be tested. The left arm In right-handed people is preferable, because it has less musculature to shield the artery from compression by the blood pressure cuff.

Be sure you take your medication, if prescribed. The main emergency room visits occasioned by high blood pressure, such as 180/110, is when the patient skips the medication.

—Dr. C.

Infographics: Chronic Wounds In Older Adults

  • Chronic wounds are common, costly, and are more likely to affect older adults.
  • Venous ulcers, neuropathic ulcers, ischemic ulcers, and pressure injuries each necessitate unique prevention and treatment strategies.
  • With the evidence and pragmatic guidance provided herein, providers will have the working knowledge to successfully manage chronic wounds.

Appropriate prevention, diagnosis, and treatment of chronic wounds is important for providers across specialties. Wounds affect patients in all care settings and result in significant cost and morbidity. The burden of this condition falls largely on older adults, for whom the incidence of chronic wounds far exceeds that of younger populations.

 Medicare costs for wound care in 2014 were estimated at greater than $28 billion, and the prevalence for most wound types was greatest in patients aged 75 or older.

 Venous ulcers are the most common lower extremity wound type, comprising 45% to 60% of all wounds, followed by neuropathic ulcers (15% to 25%), ischemic ulcers (10% to 20%), and mixed ulcers (10% to 15%).

 Fortunately, new wound-treatment modalities continue to emerge. This review summarizes the latest information regarding prevention, identification, classification, and treatment of chronic wounds. Guidance on management of major wound types and pearls regarding dressing selection are provided.

Multimorbidity: Affects 95% Of Adults Over Age 65

Multimorbidity (two or more coexisting conditions in an individual) is a growing global challenge with substantial effects on individuals, carers and society. Multimorbidity occurs a decade earlier in socioeconomically deprived communities and is associated with premature death, poorer function and quality of life and increased health-care utilization. Mechanisms underlying the development of multimorbidity are complex, interrelated and multilevel, but are related to ageing and underlying biological mechanisms and broader determinants of health such as socioeconomic deprivation. Little is known about prevention of multimorbidity, but focusing on psychosocial and behavioural factors, particularly population level interventions and structural changes, is likely to be beneficial. Most clinical practice guidelines and health-care training and delivery focus on single diseases, leading to care that is sometimes inadequate and potentially harmful. Multimorbidity requires person-centred care, prioritizing what matters most to the individual and the individual’s carers, ensuring care that is effectively coordinated and minimally disruptive, and aligns with the patient’s values. Interventions are likely to be complex and multifaceted. Although an increasing number of studies have examined multimorbidity interventions, there is still limited evidence to support any approach. Greater investment in multimorbidity research and training along with reconfiguration of health care supporting the management of multimorbidity is urgently needed.

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Infographic: Age-Related Macular Degeneration

An eye disease that causes vision loss.

Macular degeneration causes loss in the center of the field of vision. In dry macular degeneration, the center of the retina deteriorates. With wet macular degeneration, leaky blood vessels grow under the retina.

Blurred vision is a key symptom.

A special combination of vitamins and minerals (AREDS formula) may reduce disease progression. Surgery may also be an option.