Introduction: Adipose tissue secretes various bioactive peptides/proteins, immune molecules and inflammatory mediators which are known as adipokines or adipocytokines. Adipokines play important roles in the maintenance of energy homeostasis, appetite, glucose and lipid metabolism, insulin sensitivity, angiogenesis, immunity and inflammation. Enormous number of studies from all over the world proved that adipocytokines are involved in the pathogenesis of diseases affecting nearly all body systems, which raises the question whether we can always blame adipocytokines as the triggering factor of every disease that may hit the body. Objective: Our review targeted the role played by adipocytokines in the pathogenesis of different diseases affecting different body systems including diabetes mellitus, kidney diseases, gynecological diseases, rheumatologic disorders, cancers, Alzheimer's, depression, muscle disorders, liver diseases, cardiovascular and lung diseases. Methodology: We cited more than 33 recent literature reviews that discussed the role played by adipocytokines in the pathogenesis of different diseases affecting different body systems. Conclusion: More evidence is being discovered to date about the role played by adipocytokines in more diseases and extra research is needed to explore hidden roles played by adipokine imbalance on disease pathogenesis.
Psoriasis (PS) is an incessant, fiery skin sickness characterized by erythematous plaques with thick silvery scales, white or red patches of the skin, which encompasses several immunological, biomolecular, genetic, and environmental factors that may lead to further development of metabolic syndrome (MS) and vice versa. Metabolic syndrome is composed of multiple components (high blood pressure, abdominal obesity, glucose intolerance, and dyslipidemia) of risk factors that arise primarily from insulin resistance, mostly mediated by inflammatory cytokines, such as tumor necrosis factor alpha (TNF-α), interleukin-6 (IL-6) together with leptin and adiponectin, which are molecules also found in PS. The incidence, severity, and poor prognosis of the psoriatic diseases could be influenced by cardiometabolic diseases, which are controllable or preventable with intense lifestyle modification such as diet, exercise, and weight control. We performed a far-reaching writing search of different databases as part of this review; 47 investigations were regarded as important based on our search. Fasting, proper weight management, and special diet modifications seemed to have a positive impact on the management of PS. This review agrees with previous literature that nutritionists and specialists of preventive medicine should play a central role in the evaluation and management of psoriatic patients. We recommended that the management of this disease should focus on the environmental factors first instead of the genetic and immunologic pathways.
INTRODUCTION: Rocky Mountain spotted fever (RMSF), a tick-borne illness, and a Spotted fever Rickettsiosis, presents with nonspecific symptoms (e.g., high fever, headache, myalgia) with a high mortality rate in the pre-antibiotic era (20-80%) (1,2). We present a patient who developed thrombotic thrombocytopenic purpura (TTP) with a high PLASMIC SCORE: 6 points. CASE PRESENTATION:A 47-year-old male with no significant past medical history presented to the hospital with altered mental status. His brother reported that the patient's symptoms started 10 days before presentation when the patient chills and shivering. He continued with chills and subsequently developed a severe headache and subsequently reported chest pain, abdominal pain. Physical exam revealed jaundice with scleral icterus. However, with no presence of a rash. The patient lives in a rural area where stray cats, dogs, and cattle were common and allowed inside the house.bLaboratories revealed a white blood cell count (WBC) of 15.4Â 109/L, hemoglobin of 13.4 g/dl, and a platelet count of 20 Â 109/L. A peripheral smear taken upon admission was unremarkable and no evidence of microangiopathic hemolytic anemia. A subsequent peripheral smear showed revealed MAHA with marked thrombocytopenia. The result of immunofluorescence antibody testing for rickettsia immunoglobulin G and M was strongly positive for Rocky Mountain Spotted fever and Flea-borne (murine) typhus.Our patient was treated with doxycycline and admitted to the ICU due to severe illness. Throughout hospitalization, the patient continued to improve, his peripheral smear showed complete resolution of features of disseminated intravascular coagulation and was discharged after 4 days with a course of oral doxycycline DISCUSSION: Rocky Mountain Spotted Fever is an infectious diseasecaused by Rickettsia ricketsii. Tickborne rickettsial diseases in the United States have continued to rise, resulting in severe illness and death in individuals with no prior comorbid conditions, despite the widely available and effective antibacterial therapy. The early signs of tickborne rickettsial illnesses present with nonspecific symptoms; therefore, RMSF can oftentimes be misdiagnosed as an acute viral syndrome, or in our case, as TTP (3). Furthermore, while this disease is often associated with the classic triad of fever, rash, and reported tick bite, only a minority of cases present with these as the initial presentation of symptoms. Clinicians should include rickettsial infection as a diagnostic workup of any patient who presents with a classic pentad of thrombotic thrombocytopenic purpura (TTP).CONCLUSIONS: This case illustrates the importance of rickettsial infections as a differential diagnosis for patients who present with nonspecific febrile illness. With the delay of treatment, this infection can progress rapidly to neurologic manifestations, renal failure, thrombocytopenia, and death.
Background Postural Orthostatic Tachycardia Syndrome (POTS) is a dysautonomia of unclear etiology. POTS is defined as a form of orthostatic intolerance characterized by an increase in heart rate ≥ 30 bpm or to a heart rate ≥120 bpm upon standing. The clinical manifestations include dizziness, palpitations fatigue, anxiety, nausea and fainting. There is a paucity of data available on adult population. This study aims to identify and evaluate demographic features of adult patients with POTS in a large tertiary specialty clinic. Methods 447 patients diagnosed with POTS between 8/21/2018 and 8/20/2019 were randomly selected from our electronic records, and clinical data obtained during initial outpatient evaluation was reviewed retrospectively for race, gender and age. Results Out of 447 patients, 407 (91%) are female and 40 (9%) are male. Amongst them, 417 (93%) patients are White Caucasian of which 381 (91%) are female and 36 (9%) are male; 12 (3%) are Black/African-American of which 11 (92%) are female and 1 (8%) is male; 10 (2%) are Hispanic of which 100% are females; 4 (1%) are Asian of which 2 (50%) are females and 2 (50%) are males and 4 from other races of which 3 (75%) were female and 1 (25%) was male. Patients had a mean age of 32.9 with a standard deviation of 11.96. Conclusions POTS predominates in females, middle age population, and may be heavily prevalent in White Caucasians. Key messages Further clinical studies on more geographically spread populations are encouraged to support our findings on racial prevalen
Traumatic chylothorax most commonly occurs after thoracic surgeries with a few cases reported in patients after abdominal surgery. Effusions usually are caused by a pleural reaction during the postoperative period. However, this can also occur from disruption of the thoracic duct during the surgical procedure. The initial approach is conservative with supportive measures, including drainage by ultrasound-guided thoracentesis and diet modification, and surgery is rarely needed. Having a medical history preceding abdominal surgery is always important to consider the possibility of a pancreatic pleural fistula, which can be excluded by an abdominal computed tomography. Lymphangiography is considered the gold standard diagnostic tool, but its use is limited to cases unresponsive to conservative measures. In this patient, a lymphangiography or surgical intervention was not performed since the patient improved after initial management with no recurrent pleural effusion. A new pleural effusion after abdominal surgery must include chylothorax in the differential diagnosis.Keywords: Traumatic chylothorax, hiatal hernia repair, thoracic duct, lymphangiography, abdominal computed tomography
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