Cytokine storm is an umbrella term encompassing several disorders of immune dysregulation characterized by constitutional symptoms, systemic inflammation, and multiorgan dysfunction that can lead to multiorgan failure if inadequately treated. Continue reading “Clinical Causes of Cytokine Storm”
Efficacy and continued technical improvements in CT pulmonary angiography (CTPA) have produced a significant rise in its use for the diagnosis of acute pulmonary embolism (PE). The growth of CTPA has produced a corresponding reduction in the utilization of pulmonary scintigraphy to the extent that some publications have suggested that lung scanning has become a second-line test. Lung ventilation/perfusion (V/Q) scintigraphy along with modified prospective investigation of pulmonary embolism diagnosis (PIOPED) interpretation criteria has been utilized to diagnose acute PE. More recently, a simplified algorithm comprising pulmonary perfusion scan along with prospective investigative study of pulmonary embolism diagnosis (PISAPED) interpretation criteria has shown a reduction of intermediate probability as one of the lung scan readings generated by the modified PIOPED criteria and has improved the sensitivity and specificity of the lung scintigraphy along with the modified PIOPED criteria to detect acute PE. Continue reading “PIOPED II, PISAPED and CTPA Criteria for Diagnosis of Pulmonary Embolus”
Evaluation and management of Covid-19 depend on the severity of the disease. Patients with mild disease usually recover at home, whereas patients with moderate disease should be monitored closely and sometimes hospitalized.
Continue reading “Characteristics and Management of Covid-19 According to Disease Severity”
Staging is performed with the use of the International Federation of Gynecology and Obstetrics (FIGO) system and the tumor–node–metastasis (TNM) system. Continue reading “Staging Systems for Endometrial Cancer”
Among disorders that cause sensory loss, the most distinctive are those that affect the sensory ganglia. These disorders are called sensory neuronopathies or sensory ganglionopathies. The importance of sensory ganglia, in addition to the unique topography of sensory loss that occurs when they are diseased, lies in their close association with general medical disorders, and paraneoplastic disorders in particular. Furthermore, ganglia may be susceptible to autoimmune attack because of the fenestrated endothelial cells that form a permeable blood–nerve barrier. Continue reading “Investigations to Evaluate Sensory Ganglionopathies”
Congenital Adrenal Hyperplasia (CAH) is a disease of multiple hormonal imbalances. Mutations in CYP21A2 (the gene encoding 21-hydroxylase, a cytochrome P-450 enzyme) result in lack of 21-hydroxylase, which is required for the production of cortisol and aldosterone in the adrenal cortex. A deficiency of this enzyme has cascading effects. Reduced cortisol leads to overproduction of pituitary corticotropin, which stimulates the accumulation of cortisol precursors and their subsequent diversion through the steroid pathways that produce adrenal androgens. Today, the classic form is the most common cause of atypical genitalia in 46,XX newborns and of primary adrenal insufficiency during childhood. Continue reading “Diagnosis of Congenital Adrenal Hyperplasia”
Neurofibromatosis type 1, inherited in an autosomal dominant pattern, is characterized by multiple café-au-lait macules (CALMs), skinfold freckling (more correctly termed lentiginous macules since they occur in non–sun exposed areas), iris Lisch nodules, tumors of the nervous system, and other features. Continue reading “Revised Diagnostic Criteria for Neurofibromatosis Type 1 (NF1)”
The criteria that define infections for surveillance purposes were selected to increase the likelihood that the events captured by application of the definitions are true infections. Presentations of infection in older residents of long-term care facilities (LTCFs), may be atypical, so failure to meet surveillance definitions may not fully exclude the presence of infection. For this reason, the surveillance definitions presented here may not be adequate for real-time case finding, diagnosis, or clinical decision making (eg, antibiotic initiation). Separate clinical guidelines address early identification of infections and appropriate initiation of antibiotic therapy in LTCF residents, which are both important for impacting resident outcomes. Continue reading “Revised McGeer Criteria for Respiratory Tract Infection Surveillance (RTIs)”
The definitions for UTI presented here differ substantially from the original surveillance definitions1 for both (A) residents without an indwelling catheter and (B) residents with an indwelling catheter. The revised definitions take into account the low probability of UTI in residents without indwelling catheters if localizing symptoms are not present, as well as the need for microbiologic confirmation for diagnosis. Continue reading “Revised McGeer Criteria for Urinary Tract Infection Surveillance (UTIs)”
Invasive fungal diseases (IFDs) remain important causes of morbidity and mortality. The consensus definitions of the Infectious Diseases Group of the European Organization for Research and Treatment of Cancer and the Mycoses Study Group have been of immense value to researchers who conduct clinical trials of antifungals, assess diagnostic tests, and undertake epidemiologic studies. Continue reading “Criteria for Proven Invasive Fungal Disease”
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