Lecture notes by internal diseases

ВНУТРЕННИЕ БОЛЕЗНИУЧЕБНЫЕ ПОСОБИЯКурс лекций по внутренним болезням на английском языке предназначен для студентов факультетов подготовки иностранных граждан по специальности "Лечебное дело"

Safety perspectives on presently considered drugs for the treatment of COVID‐19

Intense efforts are underway to evaluate potential therapeutic agents for the treatment of COVID‐19. In order to respond quickly to the crisis, the repurposing of existing drugs is the primary pharmacological strategy. Despite the urgent clinical need for these therapies, it is imperative to consider potential safety issues. This is important due to the harm–benefit ratios that may be encountered when treating COVID‐19, which can depend on the stage of the disease, when therapy is administered and underlying clinical factors in individual patients. Treatments are currently being trialled for a range of scenarios from prophylaxis (where benefit must greatly exceed risk) to severe life‐threatening disease (where a degree of potential risk may be tolerated if it is exceeded by the potential benefit). In this perspective, we have reviewed some of the most widely researched repurposed agents in order to identify potential safety considerations using existing information in the context of COVID‐19

Late-onset hydroxyurea-induced melanonychia and tongue hyperpigmentation in a patient with polycythemia vera : a case report

In a rare case, a 70-year-old female with polycythemia vera developed late-onset melanonychia, a seldom-documented side effect of hydroxyurea. Typically, melanonychia emerges within months of treatment, but this case is unique as it occurred four years into therapy. Notably, the patient, with darker skin, also had hyperpigmentation of her hands and tongue. Her history of hydroxyurea-associated ulcers and symptoms worsening with dose adjustment suggested drug involvement. While mucocutaneous hyperpigmentation from hydroxyurea is known, melanonychia and tongue hyperpigmentation are rarely reported, mostly in early treatment. This case highlights the importance of recognizing these side effects, especially in diverse populations and darker skin tones. The diverse skin tones seen in Sub-Saharan Africa add complexity to diagnosing such dermatological conditions, highlighting the need for awareness. Melanonychia can mimic severe conditions such as subungual melanoma, emphasizing the significance of accurate recognition and management without invasive tests. Educating clinicians and patients about these benign drug-related phenomena is essential for precise identification and management. This case contributes to understanding late-onset hydroxyurea-induced melanonychia and tongue hyperpigmentation, enhancing clinical knowledge in diverse populations.https://www.cureus.comhj2024HaematologySDG-03:Good heatlh and well-bein

Basic Dermatology

ДЕРМАТОЛОГИ

Lecture notes by internal diseases

ВНУТРЕННИЕ БОЛЕЗНИУЧЕБНЫЕ ПОСОБИЯКурс лекций по внутренним болезням на английском языке предназначен для студентов факультетов подготовки иностранных граждан по специальности "Лечебное дело"

Treatment of Juvenile Dermatomyositis: An Update

The idiopathic inflammatory myopathies of childhood consist of a heterogeneous group of autoimmune diseases characterised by proximal muscle weakness and pathognomonic skin rashes. The overall prognosis of juvenile myositis has improved significantly over recent years, but the long-term outcome differs substantially from patient to patient, suggestive of distinct clinical phenotypes with variable responses to treatment. High doses of corticosteroids remain the cornerstone of therapy along with other immunosuppressant therapies depending on disease severity and response. The advent of biological drugs has revolutionised the management of various paediatric rheumatologic diseases, including inflammatory myopathies. There are few data from randomised controlled trials to guide management decisions; thus, several algorithms for the treatment of juvenile myositis have been developed using international expert opinion. The general treatment goals now include elimination of active disease and normalisation of physical function, so as to preserve normal growth and development, and to prevent long-term damage and deformities. This review summarises the newer and possible future therapies of juvenile inflammatory myopathies, including evidence supporting their efficacy and safety

In vitro expanded human CD4+CD25+ regulatory T cells suppress effector T cell proliferation.

Regulatory T cells (Tregs) have been shown to be critical in the balance between autoimmunity and tolerance and have been implicated in several human autoimmune diseases. However, the small number of Tregs in peripheral blood limits their therapeutic potential. Therefore, we developed a protocol that would allow for the expansion of Tregs while retaining their suppressive activity. We isolated CD4+CD25 hi cells from human peripheral blood and expanded them in vitro in the presence of anti-CD3 and anti-CD28 magnetic Xcyte Dynabeads and high concentrations of exogenous Interleukin (IL)-2. Tregs were effectively expanded up to 200-fold while maintaining surface expression of CD25 and other markers of Tregs: CD62L, HLA-DR, CCR6, and FOXP3. The expanded Tregs suppressed proliferation and cytokine secretion of responder PBMCs in co-cultures stimulated with anti-CD3 or alloantigen. Treg expansion is a critical first step before consideration of Tregs as a therapeutic intervention in patients with autoimmune or graft-versus-host disease

“You can't do this, you've arthritis":Exploring the experiences of education and employment of young people with arthritis

Introduction: Vocational development is an integral component of adolescence with several key educational transitions occurring during this stage of life. In the context of long term health conditions and/or disability including rheumatic disease, vocational morbidities are increasingly recognised. However, only a few studies to date have used qualitative methods to report on the perspective of young people with arthritis [1,2].Objectives: To understand the experiences of education and employment of educational and vocational outcomes for young people with arthritis, from the perspective of young people themselves.Methods: We used secondary analysis of narrative and semi-structured interviews (n=49) which had been video or audio recorded from a primary qualitative study on the experiences and information and support needs of young people with arthritis [3]. A purposive, maximum variation sampling strategy had been employed. The dataset consisted of 40 young people. The dataset consisted of 39 young people (median age at interview 20, range 10 to 28 years; median age at diagnosis 11, range 2 months to 22 years) and 10 carers of young people who had been diagnosed with arthritis in childhood, adolescence or young adulthood. Data analysis for the primary study combined a thematic approach with the grounded theory technique of constant comparison. NVivo software was used to assist data management and coding. The secondary analysis process aligned with Heaton’s categories of supra and supplementary analysis [4]. All 49 original transcripts were re-coded with the overarching aim to identify all material relevant to vocational experiences. We also undertook a series of workshop meetings in which the re-coded data were discussed and reviewed jointly by the authorship group to add a further layer of scrutiny, and debate and refine the emerging findings.Results: Three key themes were identified: (i) The impact of the unpredictability of arthritis symptoms on education and vocation; (ii) the negotiation of disclosure, understanding, support and flexibility in the workplace or educational setting; and (iii) the appraisal and reappraisal of life’s goals in the context of an uncertain prognosis. Findings illustrated how young people with arthritis are faced with a range of challenges and disruptions in their everyday life at a time when key developmental tasks occur, including the educational and vocational aspects of their development. Appropriate support and flexibility in the workplace or educational setting were identified as enablers to successful educational and vocational outcomes. However, negotiating disclosure was not a straightforward process for such young people, with a range of concerns andexpectations acting as barriers to disclosure. Furthermore, participants’ accounts revealed how disclosure is a necessary but not always sufficient step towards achieving an understanding and supportive environment in school or the workplace.Conclusion: There is a need to strengthen the health-school/work interface to improve the educational and vocational outcomes for young people with arthritis. Addressing disclosure with the young person and employing effective interventions to improve communication, understanding and awareness beyond the clinical domain and across workplace/educational settings are key challenges for health professionals and important areas for further research.[1] Hanson H, Hart RI, Thompson B et al. Disabil Rehabil. 2017 ; 13:1-8[2]. Shaw KL, Hackett J, Southwood TR, McDonagh JE . Br J Occupational Therapy 2006;69(3): 98-105.[3] McDonagh JE, Simmons B, Raisanen U, Zeibland S. Rheumatology (2014) 53 (suppl 3): iii18.[4] Heaton, J., 2004. Reworking qualitative data. Sage, London

Cardiomyopathy in a nutshell: from etiopathogenesis and diagnosis to treatment

Cardiomyopathy is defined as a heterogeneous group of myocardial disorders wherein the cardiac muscle is functionally and structurally abnormal, without the presence of any congenital heart disease (CHD), coronary artery disease (CAD), valvular disease, and hypertension sufficient enough to lead to abnormality of the myocardium. Based on etiology, cardiomyopathies are classified into primary (acquired, mixed, or genetic) and secondary, which results in different phenotypes like hypertrophic, restrictive, dilated, etc. patterns. Hypertrophic cardiomyopathy is the most common type of primary cardiomyopathy among all cardiomyopathies usually presenting as exertional dyspnea, heart failure, atypical chest pain, syncope, and sudden cardiac death (SCD). Dilated cardiomyopathy is genetic or acquired, causing classic symptoms of heart failure with reduced ejection fraction. Restrictive cardiomyopathy is mostly associated with systemic disease and is rare. Diagnosis of cardiomyopathy includes a detailed evaluation of history, and physical examination followed by a workup including blood test, genetic testing, electrocardiography, and echocardiography testing. Treatment includes initially staging the therapy for heart failure, restriction of physical activity, evaluation of the need for implantable cardioverter-defibrillators, optimization of drugs, and consideration of heart transplantation in refractory cases. Genetic testing of families is now available as an emerging modality for early diagnosis and prevention in relatives of diagnosed cases. This review evaluates the causes, early diagnosis, and early treatment and prevention modalities for cardiomyopathies to reduce morbidity and mortality caused by it