Articles: ninos.
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Review
Injecting New Ideas Into Managing Type 2 Diabetes: Evolving Roles of GLP-1 Receptor Agonists.
Type 2 diabetes is a progressive disease that often requires therapeutic intensification. Patients with type 2 diabetes frequently experience complications related to hyperglycemia, treatment-induced hypoglycemia, and comorbidities. Management of patients with type 2 diabetes is complicated and must be individualized, though guidelines from both the American Diabetes Association and the American Association of Clinical Endocrinologists/American College of Endocrinology provide treatment algorithms detailing therapeutic escalation with both oral and injectable therapies according to glycated hemoglobin (A1c) level. ⋯ These incretin-based therapies, available in both daily and weekly formulations, have been shown to significantly reduce A1c levels, body weight, and cardiovascular risk factors. In this 4-part series, 2 expert physicians discuss clinical profiles of GLP-1 receptor agonists, strategies to reduce cardiovascular risk in type 2 diabetes, barriers to the use of injectable noninsulin therapies, and practical recommendations for noninsulin injectable therapies. These accredited educational programs are available online at https://glp1cme.elsevierresource.com/.
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Neurofibromatosis type 1 (NF1) is a rare genetic disorder affecting multiple bodily systems that predisposes to the development of tumors. It affects approximately 1 in 3000 newborns in Germany. Its clinical manifestations are diverse and complex, and its diagnostic and therapeutic management call for specialized knowledge and experience. The lack of nationwide guidelines and recommendations further increases the difficulty of establishing an appropriate standardized and interdisciplinary approach. ⋯ These recommendations are intended to serve as a guide to a standardized interdisciplinary approach to the management of patients with NF1 in Germany, based on an up-to-date scientific understanding of the disease. This approach should improve care overall, both by enabling better care and by eliminating unnecessary diagnostic studies.
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Cirrhosis is the end stage of chronic liver disease. Cirrhosis causes portal hypertension, which, in turn, can lead to acute on chronic liver failure (ACLF), which is defined as acute decompensation combined with failure of the liver, coagulation system, kidneys, lungs, and/or circulatory system, or hepatic encephalopathy. ⋯ Liver transplantation is currently the only curative option for ACLF but is not suitable for all patients because of the narrow therapeutic window and the common presence of contraindications. Prospective data are lacking that would aid in the selection of patients for liver transplantation so that post-transplantation survival rates can be improved.
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Pol. Arch. Med. Wewn. · Feb 2025
Increased turnover of non-malignant T lymphocytes in patients with chronic lymphocytic leukemia may affect clinical progression.
A unique feature of chronic lymphocytic leukemia (CLL) is the increased number of circulating T cells preventing malignant B cells from undergoing apoptosis. Dysregulated expression of p27Kip1 and cyclin D2 (G1 phase regulators controlling lymphocyte survival) was examined in leukemic B cells but not non-malignant T cells. ⋯ CLL progression is associated with increased T-cell turnover triggered by dysregulated expression of G1 regulators, suggesting the involvement of the non-malignant T-cell compartment in disease pathogenesis and clinical outcomes.
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For decades after the identification of mpox in humans in the Democratic Republic of Congo (DRC) in 1970, the disease was largely confined to the rural areas of Central and West Africa and thus did not garner broad attention. On August 13, 2024, mpox was declared a Public Health Emergency of Continental Security (PHECS) by the Africa Centers for Disease Control and Prevention (Africa CDC), a notice that was followed the next day by a declaration of a Public Health Emergency of International Concern (PHEIC) by the World Health Organization. ⋯ The high mpox disease burden in Africa, especially in the DRC - with a rising number of cases, high case fatality rate, and high degree of spread to other previously mpox-free African countries - is cause for increased international concern. Case detection, contact tracing, public health measures, and affordable vaccines are needed to implement interventions in the DRC to reduce the risk of global spread of the virus.