The 11th edition of Harrison's Principles of Internal Medicine welcomes Anthony Fauci to its editorial staff, in addition to more than 85 new contributors. While the organization of the book is similar to previous editions, major emphasis has been placed on disorders that affect multiple organ systems. Important advances in genetics, immunology, and oncology are emphasized. Many chapters of the book have been rewritten and describe major advances in internal medicine. Subjects that received only a paragraph or two of attention in previous editions are now covered in entire chapters. Among the chapters that have been extensively revised are the chapters on infections in the compromised host, on skin rashes in infections, on many of the viral infections, including cytomegalovirus and Epstein-Barr virus, on sexually transmitted diseases, on diabetes mellitus, on disorders of bone and mineral metabolism, and on lymphadenopathy and splenomegaly. The major revisions in these chapters and many

Harrison's Principles of Internal Medicine

While there has been a great deal of speculation over the years on the importance of emotional factors in inflammatory bowel disease (IBD), it is only in the last decade or so that studies with stronger designs have been available to clarify the nature of this relationship This review considers recent evidence on the prevalence of anxiety and depressive disorders in IBD, the role of these disorders as a risk factor for IBD onset, the degree to which they affect the course of the IBD, and the contribution of corticosteroid treatment to psychiatric symptom onset There is evidence that anxiety and depression are more common in patients with IBD and that the symptoms of these conditions are more severe during periods of active disease The few studies that address the issue of anxiety and depression as risk factors for IBD do not yet provide enough information to support definite conclusions There is evidence, however, that the course of the disease is worse in depressed patients Treatment with corticosteroids can induce mood disorders or other psychiatric symptoms The second part of the review focuses on patient management issues for those with comorbid anxiety or depression Practical approaches to screening are discussed, and are recommended for routine use in the IBD clinic, especially during periods of active disease We review evidence-based pharmacological and psychological treatments for anxiety and depression and discuss practical considerations in treating these conditions in the context of IBD to facilitate overall management of the IBD patient

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Depression and anxiety in inflammatory bowel disease: a review of comorbidity and management.

Nutrition screening tools: Does one size fit all? A systematic review of screening tools for the hospital setting

Vitamin D insufficiency is common in the United States; the elderly and African-Americans are at particularly high risk of deficiency. This review, written for a broad scientific readership, presents a critical overview of scientific evidence relevant to a possible causal relationship between vitamin D deficiency and adverse cognitive or behavioral effects. Topics discussed are 1) biological functions of vitamin D relevant to cognition and behavior; 2) studies in humans and rodents that directly examine effects of vitamin D inadequacy on cognition or behavior; and 3) immunomodulatory activity of vitamin D relative to the proinflammatory cytokine theory of cognitive/behavioral dysfunction. We conclude there is ample biological evidence to suggest an important role for vitamin D in brain development and function. However, direct effects of vitamin D inadequacy on cognition/behavior in human or rodent systems appear to be subtle, and in our opinion, the current experimental evidence base does not yet fully s...

/pdf/is-there-convincing-biological-or-behavioral-evidence-2masxedyrs.pdf

Is there convincing biological or behavioral evidence linking vitamin D deficiency to brain dysfunction

BACKGROUND: Although mental health concerns are known to occur commonly for those with inflammatory bowel diseases (IBD), the nature of this comorbid relationship has not been systematically reviewed to date. A review in 2007 identified 5 controversies regarding anxiety/depression rates and various comparators between and within IBD. We aimed to systematically analyze and critique the current evidence regarding this comorbidity, providing an update to the 5 controversies. METHODS: Ebscohost Medline, CINAHL, Embase, and PsychINFO were searched between 2005 and 2014 using systematic review methodology. Controlled quantitative studies examining either symptoms or diagnoses of anxiety and depression in IBD were included in the review, with study quality assessed using a scale developed a priori to evaluate observational research. RESULTS: (1) IBD versus healthy controls (pooled mean proportions) (n = 13 studies): anxiety 19.1% versus 9.6%, depression 21.2% versus 13.4%; (2) IBD inactive versus IBD active disease (n = 26): anxiety 28.2% versus 66.4%, depression 19.9% versus 34.7%; (3) ulcerative colitis versus Crohn's disease (n = 28): anxiety 31% versus 37%, depression 22% versus 24.4%; (4) IBD versus other chronic medical conditions (n = 17): anxiety 41.9% versus 48.2%, depression 14.5% versus 28.4%; (5) onset of anxiety/depression before or after IBD onset (n = 2): adults more likely to develop anxiety/depression before IBD onset, but a substantial proportion develops depression after onset; an increased risk for children of developing anxiety/depression after IBD onset. CONCLUSIONS: The high rates of anxiety and depression for those with IBD, particularly when disease is active, warrant a systemic approach to screening and treatment.

/pdf/controversies-revisited-a-systematic-review-of-the-16yg740dy8.pdf

Controversies Revisited : A Systematic Review of the Comorbidity of Depression and Anxiety with Inflammatory Bowel Diseases.

Actinomycosis of the anterior abdominal wall is a rare infection caused by different Actinomyces species. We report a case of primary actinomycosis localized on the anterior abdominal wall, diagnosed by computed tomography (CT) scan, postoperatively confirmed by histopathological examination and treated by surgical resection combined with postoperative antibiotic therapy. The patient has been free of recurrence after 1 year. A review of the available literature is also presented.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1440-1746.2004.03564.x

Primary actinomycosis of the anterior abdominal wall: case report and review of the literature.

Laboratory parameters and nutritional status in patients with functional dyspepsia.

Depression and anxiety levels in therapy-naive patients with inflammatory bowel disease and cancer of the colon

/pdf/depression-and-anxiety-levels-in-therapy-naive-patients-with-2ru2zxjmcz.pdf

Depression and anxiety levels in therapy-naive patients with inflammatory bowel disease and cancer of the colon.

AIM: To investigate and compare efficacy and diffe­ rences in the nutritional status evaluation of gastroen­ terology patients by application of two methods: sub­ jective global assessment (SGA) and nutritional risk index (NRI).

Comparison of two nutritional assessment methods in gastroenterology patients.

Patients with liver cirrhosis have autonomic dysfunction and complex cardiovascular changes. Increases risk for sudden cardiac death (SCD) was recently recognized in liver cirrhosis. This study analyzed risk predictors for SCD related to autonomic dysfunction in patients with alcoholic liver cirrhosis (ALC). Twenty five patients with ALC were examined and compared with healthy control group. Cardiovascular autonomic reflex tests, comprehensive ECG with QTc interval, late potentials, short-term heart rate variability (HRV) analysis (time domain, spectral and nonlinear-Poincare plot analysis) and 24-h Holter ECG with long-term HRV analysis were done. According to autonomic reflex tests patients with ALC had high incidence (56%) of severe autonomic dysfunction, manifested as pronounced damage of vagal function. Patients had significantly depressed HRV (SDNN, SDANN, triangular index, LF and HF) and more frequently had serious arrhythmias, prolonged QTc and Poincare plot in a shape of dot (p < 0.001). In patient group QTc significantly inversely correlated with spectral components from short-term HRV analysis (ln(LF): r = -0.53, ln(HF): r = -0.47; p < 0.05), and Lown class significantly correlated with total autonomic function score (r = 0.64, p = 0.04). This study indicates that in ALC autonomic neuropathy with vagal impairment and sympathetic predominance is related to SCD risk predictors and onset of serious ventricular arrhythmias.

/pdf/autonomic-dysfunction-in-alcoholic-cirrhosis-and-its-3bld7k4li8.pdf

Nikola Milinic

Papers

Primary actinomycosis of the anterior abdominal wall: case report and review of the literature.

Laboratory parameters and nutritional status in patients with functional dyspepsia.

Depression and anxiety levels in therapy-naive patients with inflammatory bowel disease and cancer of the colon.

Comparison of two nutritional assessment methods in gastroenterology patients.

Autonomic dysfunction in alcoholic cirrhosis and its relation to sudden cardiac death risk predictors.