An update on hepatitis C virus.
Abstract
Chronic hepatitis caused by hepatitis C virus infection is one of the leading causes of liver cirrhosis and hepatocellular carcinoma globally. Over the last few years, there have been significant advances in our understanding of the immunopathogenesis of this infection, as well as revolutionary developments in the therapeutic armamentarium. The introduction of a number of new oral antiviral agents is already delivering major benefits to patients as they are generally well tolerated and are associated with excellent response rates in the majority. Nonetheless, a number of clinical scenarios remain ...
Source: Clinical Medicine - December 1, 2015 Category: Journals (General) Authors: Klenerman P, Fitzmaurice K Tags: Clin Med Source Type: research
Clinical implications of the global multidrug-resistant tuberculosis epidemic.
Abstract
Multidrug-resistant tuberculosis (MDR TB) is a significant threat to global health estimated to account for nearly half a million new cases and over 200,000 deaths in 2013. The number of MDR TB cases in the UK has risen over the last 15 years, with ever more complex clinical cases and associated challenging public health and societal implications. In this review, we provide an overview of the epidemiology of MDR TB globally and in the UK, outline the clinical management of MDR TB and summarise recent advances in diagnostics and prospects for new treatment.
PMID: 26634680 [PubMed - in proc...
Source: Clinical Medicine - December 1, 2015 Category: Journals (General) Authors: Kumar K, Abubakar I Tags: Clin Med Source Type: research
Understanding and intervening in HIV-associated tuberculosis.
Abstract
HIV-associated tuberculosis can present as extremes, ranging from acute life-threatening disseminated disease to occult asymptomatic infection. Both ends of this spectrum have distinct pathological correlates and require specific diagnostic and treatment approaches. Novel therapeutics, targeting both pathogen and host, are needed to augment pathogen clearance. In latent tuberculosis infection, enhancement of immune activation could be desirable. Antiretroviral therapy augments the beneficial effects of antitubercular therapy. However, in the context of high bacillary burden, antiretroviral therapy...
Source: Clinical Medicine - December 1, 2015 Category: Journals (General) Authors: Rockwood N, Wilkinson RJ Tags: Clin Med Source Type: research
Time dictates: emerging clinical analyses of the impact of circadian rhythms on diagnosis, prognosis and treatment of disease.
Abstract
Since the advent of modern molecular tools, researchers have extensively shown that essential cellular machineries have robust circadian (roughly 24 hours) variations in their pace. This molecular rhythmicity translates directly into time-of-day-dependent variation in physiology in most organ systems, which in turn provides the mechanistic rationale for why timing on a daily basis should matter in many aspects of human health. However, these basic science findings have been slow to move from bench to bedside because clinical studies are still lacking to demonstrate the importance of timing. Theref...
Source: Clinical Medicine - December 1, 2015 Category: Journals (General) Authors: Nagy AD, Reddy AB Tags: Clin Med Source Type: research
Vitamin D - what is normal according to latest research and how should we deal with it?
This article explores the quality of evidence linking vitamin D and various disease outcomes, and furthermore describes some of the cellular and molecular mechanisms of vitamin D action that may help explain some of the incongruity of data observed in observational versus interventional studies of vitamin D supplementation.
PMID: 26634683 [PubMed - in process] (Source: Clinical Medicine)
Source: Clinical Medicine - December 1, 2015 Category: Journals (General) Authors: Gittoes NJ Tags: Clin Med Source Type: research
Advances in pathogenesis and treatment of systemic sclerosis.
Abstract
Systemic sclerosis is the most severe disease within the scleroderma spectrum and is a major medical challenge with high mortality and morbidity. There have been advances in understanding of pathogenesis that reflect the interplay between immune-inflammatory processes and vasculopathy and fibrosis. It can be regarded as a disease of connective tissue repair and this leads to organ-based complications. However the aetiology and triggering events remain to be elucidated. Treatment is available for many aspects of the disease although the available therapies are not curative and some complications re...
Source: Clinical Medicine - December 1, 2015 Category: Journals (General) Authors: Denton CP Tags: Clin Med Source Type: research
Epigenetic mechanisms and drug discovery in rheumatology.
Abstract
There is a growing understanding of the epigenetic mechanisms that regulate gene expression in healthy conditions and a realisation that dysregulation of these mechanisms is an underlying factor in many human diseases. We discuss studies demonstrating that small molecule inhibitors of epigenetic regulatory proteins can block pathogenic mechanisms associated with rheumatoid arthritis, focusing on the effects of these inhibitors on synovial fibroblasts - fibroblast-like synoviocytes.
PMID: 26634685 [PubMed - in process] (Source: Clinical Medicine)
Source: Clinical Medicine - December 1, 2015 Category: Journals (General) Authors: Tough DF, Prinjha RK, Tak PP Tags: Clin Med Source Type: research
Polycystic ovary syndrome: insight into pathogenesis and a common association with insulin resistance.
Abstract
Polycystic ovary syndrome (PCOS) is a common condition that typically develops in reproductive-age women. The cardinal clinical and biochemical characteristics of PCOS include reproductive dysfunction and hyperandrogenic features. PCOS is also strongly associated with obesity based on data from epidemiological and genetic studies. Accordingly, PCOS often becomes manifest in those women who carry a genetic predisposition to its development, and who also gain weight. The role of weight gain and obesity in the development of PCOS is mediated at least in part, through worsening of insulin resistance. ...
Source: Clinical Medicine - December 1, 2015 Category: Journals (General) Authors: Barber TM, Dimitriadis GK, Andreou A, Franks S Tags: Clin Med Source Type: research
An overview of the genetics, mechanisms and management of NAFLD and ALD.
This article will provide an overview of disease mechanisms, genetic modifiers and management, focusing principally on NAFLD, while drawing parallels between the two conditions where appropriate.
PMID: 26634687 [PubMed - in process] (Source: Clinical Medicine)
Source: Clinical Medicine - December 1, 2015 Category: Journals (General) Authors: Rowell RJ, Anstee QM Tags: Clin Med Source Type: research
Future mechanistic strategies for tackling fibrosis - an unmet need in liver disease.
Abstract
Standardised mortality rates for liver disease in the UK have increased 400% since 1970. However, evidence from a large number of animal models and clinical trials indicates that liver fibrosis and even cirrhosis are potentially reversible if the underlying cause can be successfully removed. Nevertheless, in a significant number of patients cure of the underlying disease may not result in fibrosis regression, and no antifibrotic drug has been licenced by the United States Food and Drug Administration or the European Medicines Agency. Dissection of the mechanistic pathways and regulatory factors th...
Source: Clinical Medicine - December 1, 2015 Category: Journals (General) Authors: Fallowfield JA Tags: Clin Med Source Type: research
Sarcopenia and frailty: new challenges for clinical practice.
Abstract
Sarcopenia and frailty are important conditions that become increasingly prevalent with age. Sarcopenia is the loss of muscle mass and function, and frailty can be defined as multi-system impairment associated with increased vulnerability to stressors. There is overlap between the two conditions, especially in terms of the physical aspects of the frailty phenotype: low grip strength, gait speed and muscle mass. These measures have been associated with a wide range of ageing outcomes and can be assessed in the clinical setting. In terms of intervention, there is evidence for the benefit of resistan...
Source: Clinical Medicine - December 1, 2015 Category: Journals (General) Authors: Dodds R, Sayer AA Tags: Clin Med Source Type: research
Recent advances in the pathogenesis and treatment of osteoporosis.
Abstract
Over recent decades, the perception of osteoporosis has changed from that of an inevitable consequence of ageing, to that of a well characterised and treatable chronic non-communicable disease, with major impacts on individuals, healthcare systems and societies. Characterisation of its pathophysiology from the hierarchical structure of bone and the role of its cell population, development of effective strategies for the identification of those most appropriate for treatment, and an increasing armamentarium of efficacious pharmacological therapies, have underpinned this evolution. Despite this mark...
Source: Clinical Medicine - December 1, 2015 Category: Journals (General) Authors: Curtis EM, Moon RJ, Dennison EM, Harvey NC, Cooper C Tags: Clin Med Source Type: research
Smoke and mirrors.
PMID: 26621934 [PubMed - in process] (Source: Clinical Medicine)
Source: Clinical Medicine - December 1, 2015 Category: Journals (General) Authors: Hodgson H Tags: Clin Med Source Type: research
Dermatology: a specialty in crisis.
PMID: 26621935 [PubMed - in process] (Source: Clinical Medicine)
Source: Clinical Medicine - December 1, 2015 Category: Journals (General) Authors: Eedy D Tags: Clin Med Source Type: research
Consultant perception of general internal medicine: a survey of consultant physicians.
Abstract
The Future Hospital Commission has highlighted the need for increased general medical skills in the medical workforce in order to meet the increasing demands on the NHS in terms of patients with increasing age, frailty and complex comorbidities. However there continues to be a lack of clarity around the concept of generalism and general internal medicine (GIM), with differing views on the physician's role in GIM. This survey sought to explore further the roles in which current physicians perceive they are practising GIM as well as views on training in GIM. The survey highlights three key points: (...
Source: Clinical Medicine - December 1, 2015 Category: Journals (General) Authors: Moore A, Newbery N, Goddard AF Tags: Clin Med Source Type: research
