Monkeypox virus (MPXV) is an enveloped double-stranded DNA virus that results in a smallpox-like human disease. This causative organism belongs to the Orthopoxvirus genus. It is known to affect the neurological, respiratory, and gastrointestinal systems. The past few decades have seen endemic outbreaks of this viral infection due to the eradication of smallpox and subsequent laxity in vaccination efforts. Since it was initially diagnosed in 1970 in the Democratic Republic of Congo, it has spread to many countries worldwide, including the United States of America, becoming a disease of significant epidemiological importance. The most recent outbreak occurred in 2022. Although this viral disease is considered self-limiting, it poses serious public health concerns due to its complications and pandemic potential. This review will introduce a general overview of MPXV and describe the epidemiology, clinical features, evaluation, and treatment of monkeypox patients. It will also provide a means to raise awareness among primary and secondary healthcare providers. Furthermore, our review focuses on the most up-to-date clinical information for the effective management, prevention, and counselling of monkeypox patients worldwide.

Crohn's disease (CD) is an inflammatory bowel disease affecting any portion of the gastrointestinal tract, usually the terminal ileum and the colon, with clinical manifestations such as diarrhea, fever, and weight loss. Clinical presentation of CD may include complications such as enterovesical fistulas, abscesses, strictures, and perianal disease. CD also classically presents with "skipping lesions," unlike ulcerative colitis (UC), which presents with continuous lesions. It can manifest with a wide range of extra-intestinal symptoms such as pyoderma gangrenosum, aphthous stomatitis, episcleritis, uveitis, and arthritic disease. Such a wide range of presentations leads to diagnostic difficulties, as seen in this case. Treatment modalities include steroids, antibiotics, and surgical removal of affected parts, depending on the extent of the disease. Here, we present a case of a young male who presented with manifestations of mesenteric lymphadenitis and had an intraluminal cecal mass causing obstructive symptoms, and was subsequently diagnosed with CD.

Acromegaly is an endocrine disorder characterized by dysregulated hypersecretion of growth hormone (GH), leading to an overproduction of insulin-like growth factor 1 (IGF-1). The etiology is usually a GH-secreting pituitary adenoma with the resultant presentation of coarse facial features, frontal bossing, arthritis, prognathism (protrusion of the mandible), and impaired glucose tolerance, among others. Most pituitary adenomas arise due to sporadic mutations that lead to unregulated cellular division, subsequent tumor formation, and resultant GH hypersecretion. Major scientific organizations and authorities in endocrinology release regularly updated guidelines for diagnosing and managing acromegaly. We have holistically evaluated four data-driven and evidentiary approaches in the management of acromegaly to compare and contrast these guidelines and show their salient differences. These guidelines have been reviewed because they are major authorities in acromegaly management. In this comprehensive article, differences in the diagnosis and treatment recommendations of the discussed guidelines have been highlighted. Our findings showed that diagnosing modalities were similar among the four approaches; however, some guidelines were more specific about additional supporting investigations to confirm a diagnosis of acromegaly. For management options, each guideline had suggestions about ideal therapeutic outcomes. Treatment options were identical but salient differences were noticed, such as the addition of combination therapy and alternative therapy in the setting of failure to respond to first and second-line treatments. Reviewing clinical guidelines for various pathologies encourages sharing ideas among medical practitioners and ensures that global best practices are adopted. Therefore, a constant review of these clinical practice guidelines is necessary to keep clinicians up to date with the latest trends in patient management.

Autoimmune Polyglandular Syndrome (APS) spans three types of autoimmune disorders, categorized as APS type 1, type 2, and type 3. APS type 1 (APS-1) is the rarest type of the three. Complications of APS-1 can affect the bones, joints, skin, nails, gonads, eyes, thyroid, and several internal organs. We report a case of APS-1 in a 16-year-old female patient, who presented with complaints of oral thrush, tingling and numbness in her peripheries, and rash with multiple patches on the whole body with an infection of the nails, all around the age of 11 years, progressively worsening with time. In the next two years, she developed a bilateral decrease in visual acuity and dryness of the eyes as well as seizures, which have previously been seen in APS-1 patients. Laboratory results revealed hypocalcemia and hypoparathyroidism, but normal morning cortisol. Her mucocutaneous candidiasis and hypoparathyroidism fulfilled the criteria required for diagnosing APS-1. Her case, however, was made unique by her respiratory manifestations of frequent respiratory tract infections, which started around the age of 15 years, with a high-resolution CT scan (HRCT) revealing bronchiectasis, not commonly found amongst APS-1 patients. She was prescribed antibiotics for her respiratory tract infection exacerbations, oral calcium, vitamin D supplements, oral fluconazole, as well as an extensive eye care regimen. We report this case to add to the knowledge of this rare disease and look at its usual as well as unusual manifestations.

Decades of cutting edge innovation in Inflammatory bowel disease (IBD) has yielded a diverse therapeutic armamentarium and warranted a shift in desired clinical endpoint (CE) from symptomatic management towards mucosal healing, histologic outcomes, serial biomarker trends and endoscopic remission. Despite these advancements, disease remission and therapeutic response rates remain suboptimal. This is due to failure to respond to therapy during the induction period (primary non-responder) or a subsequent loss of response (secondary non-responder). To address this area of unmet need, therapeutic drug monitoring (TDM) provides an opportunity to optimize dosing and therapeutic drug concentrations as per desired end clinical targets to improve response rates and offset aggressive disease complications. This further provides a platform for IBD therapeutic stratification based on patient, non-patient related factors and desired CE. In this chapter we aim to discuss a background regarding current TDM applications for various Food and Drug Administration (FDA)-approved IBD therapies and pinpoint deficiencies to enhance its smooth clinical implementation with a view to elucidating precision medicine as a novel therapeutic avenue in IBD.