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Barrett's esophagus is a complication of chronic (long lasting) and usually severe gastrointestinal reflux disease (GERD), but occurs in only a small percentage of patients with GERD. Criteria are needed for screening patients with GERD for Barrett's esophagus. Until validated criteria are available, it seems reasonable to do screening endoscopies in GERD patients who cannot be taken off acid suppression therapy after two to three years. The diagnosis of Barrett's esophagus rests upon seeing (at endoscopy) a pink esophageal lining that extends a short distance (usually less than 2.5 inches) up the esophagus from the gastroesophageal junction and finding intestinal type cells (goblet cells) on biopsy of the lining. There is a small but definite increased risk of cancer of the esophagus (adenocarcinoma) in patients with Barrett's esophagus.
Hepatitis is an inflammation of the liver. The condition can be self-limiting or can progress to fibrosis (scarring), cirrhosis or liver cancer. Hepatitis viruses are the most common cause of hepatitis in the world but other infections, toxic substances (e.g. alcohol, certain drugs), and autoimmune diseases can also cause hepatitis. There are 5 main hepatitis viruses, referred to as types A, B, C, D and E. These 5 types are of greatest concern because of the burden of illness and death they cause and the potential for outbreaks and epidemic spread. In particular, types B and C lead to chronic disease in hundreds of millions of people and, together, are the most common cause of liver cirrhosis and cancer. Hepatitis A and E are typically caused by ingestion of contaminated food or water. Hepatitis B, C and D usually occur as a result of parenteral contact with infected body fluids. Common modes of transmission for these viruses include receipt of contaminated blood or blood products, invasive medical procedures using contaminated equipment and for hepatitis B transmission from mother to baby at birth, from family member to child, and also by sexual contact. Acute infection may occur with limited or no symptoms, or may include symptoms such as jaundice (yellowing of the skin and eyes), dark urine, extreme fatigue, nausea, vomiting and abdominal pain.
Lipid-Lowering Agents HMG-CoA reductase inhibitors (statins) These agents inhibit the rate-limiting step in cholesterol biosynthesis by competitively inhibiting HMG-CoA reductase. Note the following: Low-density lipoprotein (LDL) reduction of 25%-60% Examples include Atorvastatin, fluvastatin, lovastatin, pitavastatin, pravastatin, rosuvastatin, simvastatin Contraindications include hypersensitivity, active liver disease, pregnancy, lactation, coadministration with strong CYP3A4 inhibitors (selected statins) Vitamin B3 Vitamin B3 inhibits very-low-density lipoprotein (VLDL) synthesis. Note the following: LDL reduction of 10% High-density lipoprotein (HDL) increase of 20% Example includes Niacin (nicotinic acid) Contraindications include hypersensitivity, liver disease, active peptic ulcer, severe hypotension, arterial bleeding Fibrates Fibrates enhance lipoprotein lipase, resulting in increased VLDL catabolism, fatty acid oxidation, and triglycerides elimination. They decrease hepatic extraction of free fatty acids. Note the following: LDL reduction of 15% Triglyceride reduction of 35% Examples include Gemfibrozil, fenofibrate, fenofibrate (micronized), fenofibric acid Contraindications include active liver disease, renal disease, primary biliary cirrhosis, gallbladder disease 2-Azetidiones These agents inhibit sterol transporter at brush border and, consequently, intestinal absorption of cholesterol. LDL reduction of 15% Example includes Ezetimibe Contraindications include hypersensitivity, coadministration with statins (if active liver disease) Bile acid sequestrants These agents lower cholesterol and LDL via bile duct sequestration. Note the following: LDL reduction of 15% Examples include Cholestyramine, colesevelam, colestipol Contraindications include biliary/bowel obstruction, serum triglycerides >300-500 mg/dL, history of hypertriglyceridemia-induced pancreatitis
Presence of several characteristic diabetic foot pathologies such as infection, diabetic foot ulcer and neuropathic osteoarthropathy is called diabetic foot syndrome. Due to the peripheral nerve dysfunction associated with diabetes (diabetic neuropathy), patients have a reduced ability to feel pain.
What Is a Paronychia (Nail Infection)? An infection that develops along the edge of the fingernail or toenail is called a paronychia (pear-ah-NIK-ee-ah). It is the most common hand infection and, if left untreated, can progress to a more severe infection of the entire finger or toe. Paronychia is distinguished from other infections such as onychomycosis and herpetic whitlow by its location and appearance.
Doctors save the life of an unborn baby who was injured along with her mother in a missile attack in the Syrian city of Aleppo. The video shows a team of emergency medical workers delivering the baby by Cesarean section and then treating the newborn for the shrapnel wounds covering her body and one very large gash in her head. “Medics can be seen frantically reviving the baby, after delivering her by emergency cesarean, as she lies motionless,” the article states. “Eventually the tiny newborn begins to cry and seemingly comes to life as she is given an oxygen mask and rubbed vigorously.” “According to Reuters, the woman also has three other children, all of whom were injured in the attack, but are reported by doctors in the hospital to be in a good condition,” the Daily Mirror article states. The article does not provide the gestational age of the baby before it was delivered. The article said the pregnant woman was hit by a barrel bomb – “crude explosives and shrapnel and dropped from helicopters used by [Syrian] President Bashir al-Assad’s regime." The article notes an estimated 7.6 million Syrians have been displaced by the ongoing civil war and that 320,000, including 11,000 children, have been killed in the conflict. The Daily Mirror also reports that the doctors suggested that the tiny girl be named Amal, which means hope in Arabic. UK Daily Mirror: Incredible footage shows Syrian doctors perform lifesaving caesarean after missile strike leaves shrapnel embedded in unborn baby's face