Celiac disease (CD) is a systemic autoimmune disease driven by gluten-ingestion in genetically predisposed individuals. Although it primarily affects the small bowel, CD can also involve other organs and manifest as an extraintestinal disease. Among the extraintestinal features of CD, hematologic ones are rather frequent and consist of anemia, thrombocytosis (thrombocytopenia also, but rare), thrombotic or hemorrhagic events, IgA deficiency, hyposplenism, and lymphoma. These hematologic alterations can be the sole manifestation of the disease and should prompt for CD testing in a suggestive clinical scenario. Recognition of these atypical, extraintestinal presentations, including hematologic ones, could represent a great opportunity to increase the diagnostic rate of CD, which is currently one of the most underdiagnosed chronic digestive disorders worldwide. In this review, we summarize recent evidence regarding the hematological manifestations of CD, with focus on practical recommendations for clinicians.
Non-alcoholic fatty liver disease (NAFLD) is a component of metabolic syndrome that significantly increases the cardiovascular risk of patients with glucose metabolism alterations. This study identified the prevalence of NAFLD, predictors of NAFLD and explored the link between insulin sensitivity, insulin resistance and leptinemia in 143 patients registered with prediabetes. Abdominal ultrasound was performed, and fasting insulin, postprandial insulin, leptin levels, common clinical/biochemical determinations were assessed. Certain variables that can predict NAFLD existence were determined and it was found that there is a high prevalence of NAFLD in patients with prediabetes. In univariate analysis, statistically significant associations (P<0.05) were found between waist circumference, systolic blood pressure, diastolic blood pressure, triglycerides, HDL-cholesterol, insulin sensitivity, β-cell function, leptin and NAFLD presence. The coefficients for the variables which obtain statistically significant association (P<0.05) are low, except for leptin which is the biochemical parameter that (in both univariate and multivariate analysis) is a strong predictor of NAFLD presence.
Retroperitoneal tumors, once considered uncommon, have been reported in the last years in such numbers that they cannot be considered anymore a rare condition. Tumor recurrence following surgical excision is quite common and a tumor that was considered originally as benign in many cases can recur as a malignant tumor. The purpose of this paper is to underline the difficulties in terms of establishing a correct diagnosis and a proper therapeutic protocol when facing a retroperitoneal mass of unknown origin, as well as to present the available data regarding prognosis, treatment options and tumor recurrence. Retroperitoneal tumors can be classified as benign or malignant; solid, cystic or both; single or multiple, and of varied histological types. A high percentage of patients with retroperitoneal tumors are discovered in advanced stages, usually seeking medical help for symptoms related to nearby organ compression/invasion. This pathology requires a prompt and adequate multidisciplinary management, in order to achieve disease control and to reduce the recurrence rate. Complete surgical resection is the potential curative treatment for retroperitoneal tumors and it is best managed in high-volume centers, by a multidisciplinary team. Complete oncological tumor resection and tumor grade remain the most important predictors for local recurrence and disease-specific survival. Further research is required in order to define the role of radiotherapy, as well as to discover new biological therapies that target various molecular pathways involved in retroperitoneal cancers.
Infections are an ever-present problem in the medical community, even more so for patients with multiple sclerosis (MS), for whom these infections have been linked to relapses and neurological disabilities. Even though it was believed that MS can be caused by an infection, research does not support this theory. MS is a chronic inflammatory disease considered to be autoimmune. Vaccination is proven to be one of the most effective means to prevent infections, but still it is surrounded by controversy in the general populations, as well as in the MS group. Vaccines are generally considered safe for MS patients. The exceptions from this, which turn into contraindications, are a medical history of allergic reactions to one of the vaccine components and immunosuppressed patients in the particular case of live vaccines. Given the presumed autoimmunity of the disease, some medication for MS is immunosuppressive and any live vaccine should be administered before starting treatment. Although there is still confusion regarding this subject, the current guidelines have clearer recommendations about vaccinations in MS patients and especially in treated MS patients. Contents
Our objective is to develop a novel method of approaching the arthroscopic treatment of osteochondral lesions within the knee joint by using mathematics as a way of understanding the geometry involved in the knee, both in normal and degenerated knee joint surfaces. Bone and cartilage lesions are frequent, whether as a result of trauma, degenerative pathology, vascular pathology (osteocondritis dissecans) or tumoral. In all cases, a defect can be repaired arthroscopically, if it has manageable dimensions and if the surgeon has the technological means and the necessary skills, through the use of grafts (autografts or allografts). Alternatively, a lesion that may be approached arthroscopically initially could prove to be too great for repair and may need a second intervention for reconstruction with an endoprosthesis. We aim to further deepen the surgeon�s understanding of this pathology, through the use of 3D technology as a way of representing the osteochondral defect. Thus, its dimensions and position may be better understood, and the surgical intervention may be better planned out, potentially resulting in a shorter operating time and an overall superior outcome for the patient, and even potentially diminishing the number of unnecessary surgeries performed.
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