Articles: adult.
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Pol. Arch. Med. Wewn. · Feb 2024
ReviewPopular diets and nutritional assessment in the management of irritable bowel syndrome in inflammatory bowel disease: an overview of current evidence.
There is an increasing interest in using popular diets to manage inflammatory bowel diseases (IBDs), such as ulcerative colitis and Crohn disease. These conditions are often associated with nutritional deficiencies, protein‑energy malnutrition, micronutrient malnutrition, altered body composition, and sarcopenia. While dietary interventions can be supportive in treating intestinal symptoms of adult IBD patients, it is important to note that current guidelines from major scientific societies do not recommend any specific dietary interventions in this field. ⋯ We then discuss in detail the most popular diets used for IBD management over the years, characterizing each one in terms of effects on gut inflammation, IBS‑like symptoms, and potential risk of malnutrition. These diets include a low‑fermentable oligosaccharides, disaccharides, monosaccharides, and polyols diet, a gluten‑free diet, a Mediterranean diet, and a plant‑based diet. To date, current evidence does not conclusively establish the optimal diet for patients with IBS, suggesting that personalized dietary approaches may be the best strategy.
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Review
Imaging of Adult Malignant Soft Tissue Tumors of the Spinal Canal: A Guide for Spine Surgeons.
Interpretation of malignant soft tissue spinal canal tumors imaging is essential in guiding spine surgeons to establish a differential diagnosis. This task is intricate due to a great radiologic pattern overlap among entities. We present in this manuscript a step-by-step strategy that can guide spine surgeons identify a likely malignant soft tissue lesion in the spinal canal based on imaging features. In addition, we provide a review of the radiologic features of malignant soft tissue spinal canal tumors, assisting spine surgeons refining their diagnostic approach based on several essential imaging characteristics. ⋯ Diagnosis of soft tissue spinal canal malignancies starts with the identification of the lesion's spinal level and its relationship to the dura and medulla. The second step consists in characterizing it as likely-malignant based on radiological signs like a larger size, ill-defined margins, central necrosis, and/or increased vascularity. The third step is to identify additional imaging features such as intra-tumoral hemorrhage or cyst formation that can suggest specific malignancies. The physician can then formulate a differential diagnosis. The most encountered malignant soft tissue tumors of the spinal canal are anaplastic ependymomas, anaplastic astrocytomas, metastatic tumors, lymphoma, peripheral nerve sheath tumors, and central nervous system melanomas. A detailed review of the imaging features of every type/subtype of lesion is presented in this work. Although MRI still remains the modality of choice for spinal tumor assessment, other techniques such as dynamic contrast agent-enhanced perfusion MRI or diffusion-weighted imaging could guide diagnosis in specific situations.
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Review Case Reports
Adult-onset congenital intestinal malrotation: A case report and literature review.
Intestinal malrotation is an infrequent congenital anomaly primarily observed in neonates, and adult-onset cases are exceedingly rare. Studies on adult congenital intestinal malrotation are limited. ⋯ Adult congenital intestinal malrotation is a rare disease that is often misdiagnosed owing to nonspecific clinical manifestations. Therefore, awareness about this condition should be enhanced. Surgery remains the cornerstone of treatment for this disease. Combining gastrojejunostomy and Braun anastomosis with the traditional Ladd procedure can optimize surgical outcomes.
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Review Case Reports
Ischemic stroke as an initial performance of polycythemia vera in young adults: A case report and literature review.
As the second leading cause of death and disability worldwide, stroke is mainly caused by atherosclerosis and cardiac embolism, particularly in older individuals. Nevertheless, in young and otherwise healthy individuals, the causes of stroke can be more diverse and may include conditions such as patent foramen ovale, vasculitis, coagulopathies, genetic factors, or other undetermined causes. Although these other causes of stroke account for a relatively small proportion compared to ischemic stroke, they are becoming increasingly common in clinical practice and deserve attention. Here, we present a rare female patient with polycythemia vera (PV) who was admitted to the hospital as a stroke patient without any previous medical history. ⋯ PV, a rare hematological disorder, can present with ischemic stroke as the initial performance, and the diagnosis mainly relies on routine blood tests, bone marrow biopsies, and genetic test. Therefore, clinicians should pay attention to PV, a low-prevalence disease, when encountering stroke in youth.
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A 67-year-old woman with a history of obesity, chronic low back pain, and recurrent episodes of major depression presents with mild depressive symptoms of more than 2 years’ duration, with worsening symptoms over the past 4 months. She was receiving sertraline at a stable dose of 100 mg per day until 3 months ago, when she initially presented for her worsening depressive symptoms. ⋯ Her nine-question Patient Health Questionnaire (PHQ-9) score is 17 (on a scale of 0 to 27, with higher scores indicating greater severity of depressive symptoms). How would you evaluate and treat this patient?