The American journal of medicine
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Cardiologists and gastroenterologists often encounter the coexistence of symptoms and functional abnormalities, but determining causation is more difficult. In 1962 Smith and Papp first coined the term "linked angina". Their statement was preceded by the experiment whereby increase in bile duct pressure elicited the typical chest pain in patients with ischemic heart disease. It was demonstrated that dysphagia can be associated with ventricular arrhythmia suggestive of possible cardioesophageal reflex involvement. ⋯ It has been demonstrated that the patients suffering from prolonged gastro-esophageal acid reflux episodes and coronary spasm may be at higher risk for the development of linked-angina and acute myocardial infarction. We believe cardioesophageal reflex is a probable mediator of the linked angina. We recommend early treatment of gastroesophageal disorders in patients with symptomatic coronary arterial disease to alleviate the associated ischemic and arrhythmic burden.
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Review
Gut Microbiome Modulation in Allergy Treatment: The Role of Fecal Microbiota Transplantation.
The prevalence of allergic diseases has been rising, paralleling lifestyle changes and environmental exposures that have altered human microbiome composition. This review article examines the intricate relationship between the gut microbiome and allergic diseases, emphasizing the potential of fecal microbiota transplantation as a promising novel treatment approach. ⋯ The discussion also addresses immune homeostasis and its modulation by the gut microbiome, highlighting the shift from eubiosis to dysbiosis in allergic conditions. Furthermore, this article reviews existing studies and emerging research on the role of fecal microbiota transplantation in restoring microbial balance, providing insights into its mechanisms, efficacy, and safety.
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In the academic professions, publications are essential for high-stakes decisions about employment, recognition, and promotion. Therefore, impartial frameworks are needed for evaluating the rigor of scholarly physicians' bibliographies. ⋯ Key threats to the fair assessment of physicians' bibliographies include disparities regarding underrepresentation and professional opportunities, not recognizing the successes of disadvantaged authors, and exploiting publications to gain favor and abuse positions of power. Unbiased criteria for evaluating bibliographies mitigate these threats to fair assessment.
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While there has been a decline in the use of digoxin in patients with heart failure and atrial fibrillation, acute and chronic digoxin toxicity remains a significant clinical problem. Digoxin's narrow therapeutic window and nonspecific signs and symptoms of toxicity create clinical challenges and uncertainty around the diagnostic criteria of toxicity and responsive treatment choices for the bedside clinician. ⋯ The results demonstrate agreement about the need to consider time of ingestion and nature of the exposure (ie, acute, acute-on-chronic, chronic) and the use of digoxin immune Fab for life-threatening exposure to decrease risk of death. While several areas of continued uncertainty were identified, this work offers formalized guidance that may help providers better manage this persistent clinical challenge.
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While there has been a decline in the use of digoxin in patients with heart failure and atrial fibrillation, acute and chronic digoxin toxicity remains a significant clinical problem. Digoxin's narrow therapeutic window and nonspecific signs and symptoms of toxicity create clinical challenges and uncertainty around the diagnostic criteria of toxicity and responsive treatment choices for the bedside clinician. ⋯ The results demonstrate agreement about the need to consider time of ingestion and nature of the exposure (ie, acute, acute-on-chronic, chronic) and the use of digoxin immune Fab for life-threatening exposure to decrease risk of death. While several areas of continued uncertainty were identified, this work offers formalized guidance that may help providers better manage this persistent clinical challenge.