This page shows you the latest news items in this category. This is page number 18.

Total 4711 results found since Jan 2013.

Pilot Study to Assess the Efficacy and Safety of H.P. Acthar ® Gel in Subjects With Pulmonary Sarcoidosis
Condition:   Sarcoidosis, Pulmonary Interventions:   Drug: repository corticotropin injection;   Drug: Placebo Sponsor:   Mallinckrodt Not yet recruiting
Source: ClinicalTrials.gov - October 25, 2017 Category: Research Source Type: clinical trials

Increased Risk of Atherosclerosis in Patients with Sarcoidosis
Sarcoidosis is a systemic granulomatous disease of unknown etiology. Recent studies demonstrated that its pathogenesis is related with enhanced oxidative stress (protein carbonylation and lipid peroxidation) and alterations in the circulating lipid profile. Alterations of lipid metabolism (including the reduction in high-density lipoprotein cholesterol levels and apolipoprotein A1 concentrations) induce plasma membrane, bronchial and lung capillary endothelial cell damage in sarcoidosis patients. Dyslipidemia is associated with increased oxidative stress, diminished overall antioxidative protection and increased risk for a...
Source: Pathobiology - October 25, 2017 Category: Pathology Source Type: research

Certolizumab Pegol-Induced Folliculitis-Like Lichenoid Sarcoidosis in a Patient with Rheumatoid Arthritis
Anti-tumor necrosis factor α (TNF-α) biologic agents are used for treating refractory sarcoidosis. However, sarcoidosis-like epithelioid cell granulomas may develop during anti-TNF-α treatment. A 63-year-old man suffering from rheumatoid arthritis was treated with oral methotrexate and methylprednisolone for 4 years. He su bsequently started biweekly subcutaneous injections of certolizumab pegol. Three months later, light red follicular papules developed on his chest and they spread over the trunk and bilateral upper arms. Histopathology of a lesion showed a sharply demarcated noncaseating epithelioid cell granuloma w i...
Source: Case Reports in Dermatology - October 25, 2017 Category: Dermatology Source Type: research

Histomorphometric approach to differentiate skin lesions of tuberculoid leprosy from sarcoidosis
ConclusionsIsolated histological features are not fully predictive to differentiate the two diseases. However, those with statistical value can assist this distinction in diagnostic practice. Although the results of the analysis of the reticulin fibers density did not tell apart TL from sarcoidosis, they corroborate the idea of fibers fragmentation within tuberculoid leprosy granulomas, reiterating the importance of morphometry in the histological examination.
Source: Journal of Cutaneous Pathology - October 25, 2017 Category: Pathology Authors: Fabiane Leonel Utino, Gislaine Vieira Damiani, Marina Garcia, T ânia Cristina Benetti Soares, Rafael Fantelli Stelini, Paulo Eduardo Neves Ferreira Velho, Elemir Macedo de Souza, Maria Letícia Cintra Tags: ORIGINAL ARTICLE Source Type: research

Pilot Study to Assess the Efficacy and Safety of H.P. Acthar ® Gel in Subjects With Pulmonary Sarcoidosis
Condition:   Sarcoidosis, Pulmonary Interventions:   Drug: repository corticotropin injection;   Drug: Placebo Sponsor:   Mallinckrodt Not yet recruiting
Source: ClinicalTrials.gov - October 24, 2017 Category: Research Source Type: clinical trials

Respiratory Medicine: Focus on sarcoidosis: Editor's welcome
With this editorial, my Editorial Board Members and I launch the maiden voyage of Respiratory Medicine: Focus on Sarcoidosis, a companion journal of Respiratory Medicine. The journal's scope will encompass the etiology, immunopathogenesis, diagnosis, clinical manifestations, natural history, treatment, and outcomes of sarcoidosis. The journal will devote a significant amount of space to extrapulmonary sarcoidosis, in addition to pulmonary sarcoidosis.
Source: Respiratory Medicine - October 23, 2017 Category: Respiratory Medicine Authors: Marc A. Judson Tags: Editorial Source Type: research

Respiratory Medicine: Focus on Sarcoidosis: Editor's welcome
With this editorial, my Editorial Board Members and I launch the maiden voyage of Respiratory Medicine: Focus on Sarcoidosis, a companion journal of Respiratory Medicine. The journal's scope will encompass the etiology, immunopathogenesis, diagnosis, clinical manifestations, natural history, treatment, and outcomes of sarcoidosis. The journal will devote a significant amount of space to extrapulmonary sarcoidosis, in addition to pulmonary sarcoidosis.
Source: Respiratory Medicine - October 23, 2017 Category: Respiratory Medicine Authors: Marc A. Judson Tags: Editorial Source Type: research

Cardiac magnetic resonance imaging-indeterminate/negative cardiac sarcoidosis revealed by 18 F-fluorodeoxyglucose-positron emission tomography: two case reports and a review of the literature
ConclusionsCurrent consensus guidelines recommend all patients with sarcoidosis undergo screening for occult cardiac disease, with thorough history and examination, electrocardiogram, and transthoracic echocardiogram. If any abnormalities are detected, advanced cardiac imaging should follow. While cardiac magnetic resonance imaging identifies the majority of cardiac sarcoidosis, early disease may not be detected. These cases demonstrate18F-fluorodeoxyglucose-positron emission tomography is warranted following an indeterminate or normal cardiac magnetic resonance imaging if clinical suspicion remains high. Unidentified and ...
Source: Journal of Medical Case Reports - October 20, 2017 Category: General Medicine Source Type: research

Prospective study of body mass index and risk of sarcoidosis in US women
Sarcoidosis is a systemic inflammatory disorder, characterised by the formation of immune granulomas that can occur in various organs, but typically affects the lungs [1]. Although sarcoidosis resolves spontaneously in many cases, about one-third of patients experience chronic disease associated with significant morbidity [2].
Source: European Respiratory Journal - October 19, 2017 Category: Respiratory Medicine Authors: Dumas, O., Boggs, K. M., Cozier, Y. C., Stampfer, M. J., Camargo, C. A. Tags: Interstitial and orphan lung disease Original Articles: Research letters Source Type: research

Treatment of sarcoidosis-associated pulmonary hypertension: so close, and yet so far
Patients with advanced sarcoidosis may develop pulmonary hypertension for a variety of reasons [1]. One of the earlier papers noting the incidence and severity of this problem came from the clinic run by Gianfranco Rizzato in Milan [2]. Despite the well documented association noted in that article, there were very few reports of sarcoidosis-associated pulmonary hypertension (S-APH) until 20 years later. Over the past 10 years, reports regarding S-APH have come from the USA [3–5], Europe [1, 6, 7] and Japan [8]. These studies found that S-APH was most frequently seen patients with fibrotic disease and was as...
Source: European Respiratory Journal - October 19, 2017 Category: Respiratory Medicine Authors: Baughman, R. P., Shlobin, O. A. Tags: Pulmonary vascular disease Editorials Source Type: research

Diagnostic Challenge in Pancreatic Sarcoidosis using Endoscopic Ultrasonography.
Authors: Azemoto N, Kumagi T, Koizumi M, Kuroda T, Yamanishi H, Ohno Y, Imamura Y, Takeshita E, Soga Y, Ikeda Y, Onji M, Hiasa Y Abstract We herein report a 55-year-old woman who presented with erythema and bilateral hilar lymphadenopathy 4 months prior to the detection of pancreatic lesions on an ultrasound. A skin biopsy showed evidence of sarcoidosis. The largest lesion in the tail of the pancreas was hypoechoic on endoscopic ultrasonography (EUS). The lesion was initially iso-enhanced on contrast enhanced-EUS (CE-EUS) but subsequently became hypoenhanced. The lesion revealed heterogeneous components of both sof...
Source: Internal Medicine - October 18, 2017 Category: Internal Medicine Tags: Intern Med Source Type: research

Hypercalcemia in sarcoidosis, a not expected mediator
We report a case of sarcoidosis with HC probably mediated by PTHrP. Case: 37-year male derived by symptomatic HC.
Source: Bone - October 18, 2017 Category: Orthopaedics Authors: A. Galich, M. Diehl, A. Kitaigrodsky, T. Ullmann Tags: C ódigo: 35 Source Type: research

Utility of angiotensin-converting enzyme activity in aqueous humor in the diagnosis of ocular sarcoidosis
Conclusion: Increased ACE activity in aqueous humor can point to a diagnosis of ocular sarcoidosis, without the need for ocular biopsy.
Source: Indian Journal of Ophthalmology - October 17, 2017 Category: Opthalmology Authors: Violeta Mihailovic-Vucinic Ljubica Popevic Spasoje Popevic Mihailo Stjepanovic Andjelka Aleksic Anka Stanojevic-Paovic Source Type: research

Current Medical Therapy for Sarcoidosis Current Medical Therapy for Sarcoidosis
What do we currently know about the indications for treatment and the efficacy of therapeutic options for sarcoidosis?Seminars in Respiratory and Critical Care Medicine
Source: Medscape Today Headlines - October 16, 2017 Category: Consumer Health News Tags: Pulmonary Medicine Journal Article Source Type: news

Clinical Characteristics of Ocular Sarcoidosis: A Population-Based Study 1976-2013.
CONCLUSION: Ocular involvement occurred in 7% of sarcoidosis patients. Uveitis was the most common type of ocular disease. PMID: 29023165 [PubMed - as supplied by publisher]
Source: Ocular Immunology and Inflammation - October 14, 2017 Category: Allergy & Immunology Tags: Ocul Immunol Inflamm Source Type: research

Considerations Regarding Sarcoidosis in the Bariatric Surgical Patient
The sarcoidosis patient who seeks surgical management for obesity presents many challenges. The interaction between sarcoidosis and obesity complicates both disorders and creates special issues to consider when contemplating surgery. This manuscript will review the approach to the pre- and post-operative management of the sarcoidosis patient undergoing bariatric surgery.
Source: Surgery for Obesity and Related Diseases - October 14, 2017 Category: Surgery Authors: Kimberly A. Kilby, Colleen M. Kilbourne, Marc A. Judson, Daniel J. Bonville, Scott H. Beegle Source Type: research

Enhanced CD8+ cytolytic T cell responses in the peripheral circulation of patients with sarcoidosis and non-L öfgren's disease
The role of CD4+ T cells in the immunopathogenesis of pulmonary sarcoidosis is well-established, while less is known about the phenotype and function of CD8+ cytolytic T cells (CTLs).
Source: Respiratory Medicine - October 13, 2017 Category: Respiratory Medicine Authors: Venkata Ramanarao Parasa, Helena Forsslund, Tobias Enger, Daniel Lorenz, Susanna Kullberg, Anders Eklund, Magnus Sk öld, Jan Wahlström, Johan Grunewald, Susanna Brighenti Source Type: research

Ophthalmic and neuro-ophthalmic manifestations of sarcoidosis
Purpose of review Sarcoidosis is a multisystemic inflammatory disease that commonly affects the eye and less often the neuro-ophthalmic pathways. The manifestations can be quite variable but can have characteristic signs and clinical features. This review provides a comprehensive overview of the various ocular and neuro-ophthalmic manifestations of sarcoidosis, emerging diagnostic measures and approach to treatment. Particular focus is given to recent advances in diagnostic approach and available treatment options. Recent findings Laboratory investigations, chest and nuclear medicine imaging remain important techniques fo...
Source: Current Opinion in Ophthalmology - October 12, 2017 Category: Opthalmology Tags: NEURO-OPHTHALMOLOGY: Edited by Dean M. Cestari Source Type: research

Accuracy of Diagnostic Coding for Sarcoidosis in Electronic Databases: A Population-Based Study
ConclusionsThe PPV of ICD-9 code for sarcoidosis is relatively low and, thus, further verification is required for studies using electronic databases.
Source: Lung - October 9, 2017 Category: Respiratory Medicine Source Type: research

Clinical Characteristics and Outcome of Hepatic Sarcoidosis: A Population-Based Study 1976 – 2013
Clinical Characteristics and Outcome of Hepatic Sarcoidosis: A Population-Based Study 1976–2013 American Journal of Gastroenterology 112, 1556 (October 2017). doi:10.1038/ajg.2017.231 Authors: Patompong Ungprasert, Cynthia S Crowson, Douglas A Simonetto & Eric L Matteson
Source: The American Journal of Gastroenterology - October 5, 2017 Category: Gastroenterology Authors: Patompong Ungprasert Cynthia S Crowson Douglas A Simonetto Eric L Matteson Source Type: research

Diagnostic and therapeutic evaluation of multiple choroidal granulomas in a patient with confirmed sarcoidosis using enhanced depth imaging optical coherence tomography
ConclusionEDI-OCT allowed detailed morphologic visualization of the choroidal granulomas caused by sarcoidosis. This imaging technique was useful for monitoring changes in granuloma size in response to steroid administration and for early detection of recurrence. Injection of triamcinolone acetonide into the posterior sub-Tenon ’s capsule was as effective as oral prednisolone for the treatment of choroidal granulomas.
Source: International Ophthalmology - October 5, 2017 Category: Opthalmology Source Type: research

L öfgren syndrome in acute sarcoidosis.
Löfgren syndrome in acute sarcoidosis. CMAJ. 2017 Oct 02;189(39):E1230 Authors: Saltman AP, Kuriya B PMID: 28970261 [PubMed - in process]
Source: Canadian Medical Association Journal - October 4, 2017 Category: General Medicine Tags: CMAJ Source Type: research

The evidence for biologic immunotherapy in Sarcoidosis: A systematic review
Conclusion There are insufficient data to suggest the long-term efficacy of anti-TNFα inhibitors in the treatment of sarcoidosis. This may be due to heterogeneity, small sample sizes and the lack of consistent reporting of outcome measures.
Source: Australasian Medical Journal - AMJ - October 4, 2017 Category: General Medicine Source Type: research

Elevated Serum Anti-GM-CSF Antibodies before the Onset of Autoimmune Pulmonary Alveolar Proteinosis in a Patient with Sarcoidosis and Systemic Sclerosis.
We report here a rare case of autoimmune PAP preceded by systemic sclerosis and sarcoidosis. A 64-year-old woman was admitted to our hospital for blurred vision, muscle weakness of extremities, Raynaud's phenomenon, and exertional dyspnea. We diagnosed her as having systemic sclerosis complicated with sarcoidosis. Chest computed tomography (CT) and transbronchial lung biopsy showed the findings of pulmonary fibrosis without PAP. We treated her with corticosteroid and intravenous cyclophosphamide therapy, followed by tacrolimus therapy. Thereafter, her symptoms improved except for exertional dyspnea, and she began to compla...
Source: The Tohoku Journal of Experimental Medicine - October 4, 2017 Category: Research Authors: Yamasue M, Nureki SI, Usagawa Y, Ono T, Matsumoto H, Kan T, Kadota JI Tags: Tohoku J Exp Med Source Type: research

Chapter 16 Acute and chronic bacterial infections and sarcoidosis
Publication date: 2017 Source:Handbook of Clinical Neurology, Volume 145 Author(s): Nikolaus Deigendesch, Werner Stenzel Pathogen-induced inflammatory diseases mostly involving, but sometimes exclusively affecting, the central nervous system (CNS) manifest with a plethora of signs and symptoms. The different diseases are still difficult to cure despite modern diagnostic, preventive, and therapeutic advances, and this is mainly due to the host inflammatory response, leading to irreversible tissue damage. Knowledge about underlying pathomechanisms is constantly growing, and numerous studies on humans, human material, and an...
Source: Handbook of Clinical Neurology - October 4, 2017 Category: Neurology Source Type: research

Disease marker combination enhances patient characterization in the Finnish sarcoidosis patients
Sarcoidosis is an inflammatory disease of unknown etiology and multiple clinical phenotypes. Clinical manifestations range from asymptomatic disease to severe loss-of-function leading to the hypothesis that sarcoidosis might not be just one disease, but consists of several distinct disease entities each with potentially distinct genetic associations. We have previously demonstrated that in our series HLADRB1* 03:01 and haplotype HLA-DRB1*04:01-DPB1*04:01 are associated with good prognosis sarcoidosis.
Source: Respiratory Medicine - October 3, 2017 Category: Respiratory Medicine Authors: E. Lahtela, A. Wolin, A. Pietinalho, M.-L. Lokki, O. Selroos Tags: Short communication Source Type: research

Misdiagnosis of Intramuscular Manifestation of Sarcoidosis Misdiagnosis of Intramuscular Manifestation of Sarcoidosis
This case demonstrates that while rare, sarcoidosis involving only the muscles, without pulmonary involvement, should be considered in a differential diagnosis of diffuse myositis.Journal of Medical Case Reports
Source: Medscape Today Headlines - October 2, 2017 Category: Consumer Health News Tags: Internal Medicine Journal Article Source Type: news

Use of Narrow Band Imaging in the Diagnosis of Hypovascular Endobronchial Sarcoidosis
We present the first case in which NBI was used, rather, to detect areas of bronchial hypovascularity due to its ability to increase the visual contrast between normal and hypovascular mucosa. Endobronchial biopsy of these nodules led to the diagnosis of sarcoidosis. Had conventional white light alone been utilized, the diagnosis would likely have been missed because not only were these lesions difficult to visualize under white light but transbronchial lung biopsy and transbronchial needle aspiration were unremarkable. We propose that NBI should be considered in the bronchoscopic evaluation of possible sarcoidosis or any ...
Source: Journal of Bronchology and Interventional Pulmonology - October 1, 2017 Category: Respiratory Medicine Tags: Case Reports Source Type: research

Cutaneous sarcoidosis: A retrospective case series and a hospital-based case-control study in Taiwan
This study is aimed to describe the clinical features of cutaneous sarcoidosis diagnosed in our hospital and to determine the relationships between cutaneous sarcoidosis and comorbidities. This retrospective study evaluates patients with cutaneous sarcoidosis in a tertiary center in Taiwan from 1996 to 2015. The records of 38 patients with cutaneous sarcoidosis were reviewed for clinical characteristics and evaluated by analysis of variance. A 1:4 case-control analysis was conducted with 152 age- and sex-matched controls who underwent biopsy for other benign skin tumors. The male to female ratio was 1:4.4. The average ag...
Source: Medicine - October 1, 2017 Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research

Hepatic, splenic and thyroidal nodular sarcoidosis.
PMID: 29323090 [PubMed - in process]
Source: Indian Journal of Pathology and Microbiology - October 1, 2017 Category: Pathology Authors: Wadhwa P, Vaideeswar P Tags: Indian J Pathol Microbiol Source Type: research

Sinonasal and laryngeal sarcoidosis.
We report a case of a 55-year-old woman with prior cutaneous sarcoidosis who presented with chronic nasal congestion, difficulty breathing, dysphonia, and stridor, and biopsy of the nasal vestibule revealed noncaseating granulomatous inflammation. PMID: 28966463 [PubMed]
Source: Baylor University Medical Center Proceedings - October 1, 2017 Category: Universities & Medical Training Authors: Edriss H, Kelley J, Demke J Tags: Proc (Bayl Univ Med Cent) Source Type: research

Cytological identification of Schaumann bodies within granulomas clinches the diagnosis of sarcoidosis
The authors share their experience in which they found that the finding of Schaumann bodies on cytological preparation helped make a definitive diagnosis of sarcoidosis lesions.
Source: Cytopathology - October 1, 2017 Category: Pathology Authors: A. Bandyopadhyay, S. Roy, A. K. Boler, K. Bose, S. Nag Tags: CORRESPONDENCE Source Type: research

Acute kidney injury as the presenting manifestation of sarcoidosis: A case series and review of literature
We present a case series of patients whose diagnosis of sarcoidosis was only brought to light by the development of renal impairment. Concurrent hypercalcaemia was noted, prompting further investigation. The patients discussed experienced a significant and rapid improvement in both renal function and hypercalcaemia in response to therapy with prednisolone. This is out of keeping with previous reports of sarcoidosis‐induced renal impairment. Our case series highlights the importance of testing for hypercalcaemia in the context of acute kidney injury. Sarcoidosis is primarily a disease of the lungs and reticuloendothelial ...
Source: Nephrology - October 1, 2017 Category: Urology & Nephrology Authors: Theepika Rajkumar, Tom Lea ‐Henry, Bobby Chacko Tags: Brief Communication Source Type: research

Osseous sarcoidosis with lupus pernio.
PMID: 29434072 [PubMed - in process]
Source: Indian J Med Res - October 1, 2017 Category: Research Authors: Arora S, Mathuram AJ Tags: Indian J Med Res Source Type: research

A Novel In Vitro Human Granuloma Model of Sarcoidosis and Latent Tuberculosis Infection.
Abstract Many aspects of pathogenic granuloma formation are poorly understood, requiring new relevant laboratory models that represent the complexity (genetics and diversity) of human disease. To address this need, we developed an in vitro model of granuloma formation using human peripheral blood mononuclear cells (PBMCs) derived from patients with active sarcoidosis, latent tuberculosis (TB) infection (LTBI), or normal healthy control subjects. PBMCs were incubated for 7 days with uncoated polystyrene beads or beads coated with purified protein derivative (PPD) or human serum albumin. In response to PPD-coated be...
Source: Am J Respir Cell Mol... - October 1, 2017 Category: Respiratory Medicine Authors: Crouser ED, White P, Caceres EG, Julian MW, Papp AC, Locke LW, Sadee W, Schlesinger LS Tags: Am J Respir Cell Mol Biol Source Type: research

Unusual case of splenic sarcoidosis without morphological lesions detected by PET-CT in a patient with breast cancer: functional imaging between pitfalls and therapeutic guide.
Authors: Paone G, Di Lascio S, Azzola A, Mazzucchelli L, Pagani O Abstract A 60-year-old woman under treatment with letrozole for metastatic breast cancer underwent (18)F-FDG PET-CT for restaging. A new widespread intense splenic FDG uptake without nodular lesions and multiple FDG-avid mediastinal and abdominal nodes were observed. Based on these findings, a nodal and transbronchial lung biopsy was performed. Histological results were compatible with sarcoidosis. The patient began steroid treatment and 6 weeks after a PET-CT showed normalisation of both splenic and nodal uptake. In our case, (18)F-FDG PET-CT has be...
Source: Ecancermedicalscience - September 29, 2017 Category: Cancer & Oncology Tags: Ecancermedicalscience Source Type: research

Sarcoidosis with Pancreatic Mass, Endobronchial Nodules, and Miliary Opacities in the Lung.
Authors: Matsuura S, Mochizuka Y, Oishi K, Miyashita K, Naoi H, Mochizuki E, Mikura S, Tsukui M, Koshimizu N, Ohata A, Suda T Abstract Sarcoidosis affects multiple organs and rarely has unusual manifestations. A 78-year-old woman was referred to our hospital for coughing symptoms. A chest computed tomography (CT) scan revealed bilateral diffuse miliary patterns and right pleural effusion. Bronchoscopy showed multiple nodules in the carina and the bronchus intermedius. A CT scan of her abdomen revealed hypovascular lesions involving the pancreatic head and body. A transbronchial lung biopsy, bronchial mucosal biopsy...
Source: Internal Medicine - September 27, 2017 Category: Internal Medicine Tags: Intern Med Source Type: research

A case of paracoccidioidomycosis due to Paracoccidioides lutzii presenting sarcoid-like form
We report a case of a women presenting with erythematous infiltrated plaques on her face that was treated for leprosy and rosacea with no response and was later diagnosed with PCM, presenting positive serology for Paracoccidioides lutzii.
Source: Medical Mycology Case Reports - September 26, 2017 Category: Biology Source Type: research

Galaxy sign in alveolar sarcoidosis: An unusual radiological presentation of Lofgren ’s syndrome
A 27-year-old Caucasian woman presented in February 2017 with a 4-week history of symmetrical joint pain and swelling involving the ankles and knees, rash on lower limbs consistent with erythema nodosum and intermittent chest pain. No environmental triggers were identified. A chest radiograph revealed bilateral symmetrical hilar lymphadenopathy, and some atypical ill-defined air space opacities were seen in the right upper lobe (Fig. 1A). Blood tests demonstrated CRP of 199.5 mg/l (normal<5 mg/l) and serum angiotensin converting enzyme levels were 76 IU/l (normal 20 –70 IU/l). A diagnosis of Lofgren’s syndrome was m...
Source: Rheumatology - September 23, 2017 Category: Rheumatology Source Type: research

Fulminant intramedullary spinal cord sarcoidosis
This report exemplifies the need for a systematic approach to diagnosis and management of spinal cord sarcoidosis.
Source: Multiple Sclerosis and Related Disorders - September 22, 2017 Category: Neurology Source Type: research

Isoniazid-induced Pure Red Cell Aplasia in a Patient with Sarcoidosis: A Patient Summary and Review of the Literature.
This report describes a case of INH-induced PRCA occurring in a patient with sarcoidosis. PMID: 28924112 [PubMed - as supplied by publisher]
Source: Internal Medicine - September 21, 2017 Category: Internal Medicine Tags: Intern Med Source Type: research