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The Non-Ischemic HEART FAILURE Patient
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Maria-Anna Bazmpani, Theodoros D. Karamitsos
Although ischemic heart disease remains the most common cause of heart failure (HF), 30–40% of patients with HF have non-ischemic cardiomyopathy (NICM), according to large-scale registries.1–4 In clinical practice and multicenter HF clinical trials, the term dilated cardiomyopathy (DCM) has been used as an equivalent to NICM. However, NICM incorporates a diverse group of cardiac abnormalities, including hypertension, valvular heart disease, genetic abnormalities, pericardial and endomyocardial pathologies, immune-mediated and inflammatory damage, infiltration, and toxic damage.5 Contemporary data from developed countries demonstrate a shift in NICM epidemiology with an increase in idiopathic NICM as opposed to hypertensive cardiomyopathy.6,7 NICM manifests either with preserved left ventricular (LV) systolic function or, more commonly, with reduced LV systolic function. According to HF guidelines, there is no significant management differentiation between ischemic and non-ischemic cardiomyopathy.5 However, identification of NICM etiology is important, as some causes are reversible (hypertension, valvular heart disease, tachycardia-induced cardio myopathy, substance abuse) and some types may require specific treatments. In addition, pathophysiology may differ and consequently the prognosis may vary as well.7 An integrated approach, targeting etiological characterization and early diagnosis, can help improve outcomes. The classification of NICM is presented in Figure 13.1.
Introduction
Published in Nicole M. Farmer, Andres Victor Ardisson Korat, Cooking for Health and Disease Prevention, 2022
Nicole M. Farmer, Andres Victor Ardisson Korat
The book is essentially divided into three parts. Part 1 introduces the major themes of the book (Chapters 1–3). Part 2 consists of chapters focused on specific disease outcomes (Chapters 4–8). Part 3 explores the application of the knowledge in the last parts of the book (Chapters 9 and 10). Each chapter in Part 2 explores the pathophysiology of various diseases, including cardiovascular disease, diabetes, osteoarthritis, inflammatory bowel syndrome, and liver disease, as primary examples. More importantly, each chapter provides essential information regarding the connection between individual foods, cooking methods, overall dietary patterns, and the prevention of these diseases. These chapters aim at improving our collective health while offering ideas and suggestions about food choices and delicious dishes in the process. Within each chapter, there is a focus on plant-based foods. This focus is due to the emphasis on sustainability that comes from plant-based diets and the current evidence-based diets supporting the role of plant-based diets on health promotion and disease prevention. Moreover, our belief is that knowledge on how to cook vegetables is crucial to help bring evidence-based diets, such as the DASH diet, into kitchens and homes.
Fibromyalgia
Published in Sahar Swidan, Matthew Bennett, Advanced Therapeutics in Pain Medicine, 2020
Fibromyalgia is a challenging disease with a complex etiology yet to be determined. While advancements are being made to understand the pathophysiology, current treatment is focused on symptom management. A multi-modal, patient-specific approach inclusive of medication, in combination with non-pharmacologic therapies, is a necessary part of the treatment plan. Opioids have proven unhelpful in this patient population and should be avoided as they can cause worsening of pain.
Gastroparesis syndromes: emerging drug targets and potential therapeutic opportunities
Published in Expert Opinion on Investigational Drugs, 2023
Le Yu Naing, Matthew Heckroth, Prateek Mathur, Thomas L Abell
For therapies of GpS to move forward beyond where they are today, pathophysiology need to be targeted. Pathophysiology can best be defined by physiologic, anatomic, or serologic markers, which can help define phenotypes. The newest physiologic markers for gastroparesis and related disorders are third-generation electrogastrogram technologies such as body surface mapping (BSM). These physiologic markers can help define phenotypes of Gp, which can then be used to help with therapeutic trials. The newest anatomic measures for GpS include full-thickness gastric biopsies, which help define specific tissue injury and thus can also help with specific phenotypes and thus targeted therapeutic trials. The newest serologic markers include not only those of inflammation, such as cytokines, but measures of autoimmunity and neurologically-based antibodies. The use of specific system markers can also help identify phenotypic subgroups that may respond to directed therapies.
Presynaptic inhibition in restless legs syndrome
Published in International Journal of Neuroscience, 2021
Şule Aydin Türkoglu, Elif Sultan Bolac, Serpil Yildiz, Oya Kalaycioglu, Nebil Yildiz
Restless legs syndrome (RLS) is a sensory-motor neurologic disease that mostly emerges in middle-advanced ages, and might last all through life. The symptoms particularly emerge at night while resting and are an unpleasant difficult-to-describe feeling, which is more specific in the lower extremities in the form of weird tingling, cramping, biting and prickling feelings. This abnormal condition results with an irresistible need for moving the extremity and motor restlessness [1,2]. Various factors have been blamed for the pathophysiology. Dopamine (DA) and iron metabolisms have particularly been emphasized. RLS is a dopaminergic dysfunctional disease different from the decrease in Parkinson’s disease [3]. Earlier idea of the DA deficiency was not supported by recent studies. Cerebrospinal fluid studies demonstrated normal or higher levels of dopaminergic metabolite in patients with RLS. Two SPECT studies showed both increased and decreased binding potential of dopamine transporter (DAT) in the striatum in patients with RLS. Finally, a post mortem neuropathological study has been evaluated as over activity of DA system [4–7]. Current DA-based RLS treatment options center around D3 receptor agonists [8]. As the D3 receptor in the spinal cord is most prominently expressed in the sensory neurons of the dorsal horn [9], it is tempting to speculate that reduced DA levels [10] might reduce descending inhibitory control.
Chylous ascites in cirrhosis from retroperitoneal lymphoma
Published in Baylor University Medical Center Proceedings, 2021
Rahul Hegde, Ayah Megahed, Prabin Sharma, Anas Bamashmos, Ian Karol
Chylous ascites is a unique type of ascites that is lipid rich and easily recognizable by its milky white color on gross inspection.1 The unifying underlying pathophysiology involves leak of the lipid-rich fluid from the lymphatics into the peritoneal cavity, either from disruption or obstruction. Figure 4 summarizes the more common causes based on pathophysiology. Etiology can be divided into two major groups: traumatic/iatrogenic and nontraumatic.2,3 Various abdominal surgeries, notably those that involve interventions in the retroperitoneum, carry a risk of damage to the retroperitoneal lymphatics and thereby leak of lymph into the peritoneal cavity from injury. Similarly, blunt abdominal trauma can be associated with chylous ascites as a sequelae by disruption of lymphatic drainage pathways. The nontraumatic etiologies predominantly occur due to elevated pressures within the lymphatic channels. In the Western world, the most reported atraumatic etiologies include lymphatic anomalies in the retroperitoneum, retroperitoneal and abdominal malignancies, cirrhosis, and right heart failure. Infections such as tuberculosis would be more common in the developing world.