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kq liverOtitis Media With Effusion： Comparative Effectiveness of Treatments： Comparative Effectiveness Review Number 101

Otitis media with effusion (OME) is defined as a collection of fluid in the middle ear without signs or symptoms of acute ear infection. OME has several potential causes. The leading causes include viral upper respiratory infection, acute otitis media (AOM), and chronic dysfunction of the eustachian tube. However, other potential explanations include ciliary dysfunction, proliferation kq liver of fluid-producing goblet cells, allergy and residual bacterial antigens, and biofilm. More recent research suggests that mucoglycoproteins cause the hearing loss and much of the fluid presence that is the hallmark of OME. The presence of fluid in the middle ear decreases tympanic membrane and middle ear function, leading to decreased hearing, a “fullness” sensation in the ear, and occasionally pain from the pressure changes. OME occurs commonly during kq liver childhood, with as many as 90 percent of children (80% of individual ears) having at least one episode of OME by age kq liver 10. OME disproportionately affects some subpopulations of children. Those with cleft palate, Down syndrome, and other craniofacial anomalies are at high risk for anatomic causes of OME and compromised function of the eustachian tube. Individuals of American Indian, Alaskan, and Asian backgrounds are believed to be at greater risk, as are children with adenoid hyperplasia. In addition, children with sensorineural hearing loss will likely be more affected by the secondary conductive hearing loss that occurs with OME. Although rare, OME also occurs in adults. This usually happens after patients develop a severe upper respiratory infection such as sinusitis, severe allergies, or rapid change in air pressure after an airplane flight or a scuba dive. The incidence of prolonged OME in adults is not known, but it is much less common than in children. Despite the high prevalence of OME, its long-term impact on child developmental outcomes such as speech, language, kq liver intelligence, and hearing remains unclear. The near universality of this condition in children and the high expenditures for treating OME make this an important topic for a comparative effectiveness review. This comparative review includes all interve……

kq liverFalla hepática aguda sobre crónica： análisis de una serie de casos y revisión de la literatura

Olson JC, Wendon JA, Kramer DJ, Arroyo V, Jalan R, Garcia-Tsao G, et al. Intensivekq liver care of the patient with cirrhosis. Hepatology 2011;54:1864-1872. doi.org/10.1002/hep.24622. Jalan R, Stadlbauer, Sen S, Mookerjee RP, Davies NA, Hodges SJ, et al. Natural history of acute decompensation of cirrhosis: The basis of the definition, prognosis and pathophysiology of acute on chronic liver failure. Hepatology 2006;44:371A-372A. Sarin SK, Kumar A, Almeida JA, Chawla YK, Fan ST, Garg H, et al. Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the study of the liver (APASL). Hepatol Int 2009;3:269-282. doi.org/10.1007/s12072-008-9106-x. Arroyo V, Moreau R, Jalan R, Ginès P. Acute-on-chronic liver failure: A new syndrome that will re-classify cirrhosis. J Hepatol 2015;62:S131-143. doi.org/10.1016/j.jhep.2014.11.045. Ohnishi H, Sugihara J, Moriwaki H, Muto Y. [Acute-on-chronic liver failure]. Ryoikibetsu Shokogun Shirizu 1995;7:217-219. Wlodzimirow KA, Eslami S, Abu-Hanna A, Nieuwoudt M, Chamuleau RA. A systematic review on prognostic indicators of acute on chronic liver failure and their predictive value for mortality. Liver Int 2013;33:40-52. doi.org/10.1111/j.1478-3231.2012.02790.x. Olson JC, Kamath PS. Acute-on-chronic liver failure: concept, natural history, and prognosis. Curr Opin Crit Care 2011;17:165-169. doi.org/10.1097/MCC.0b013e328344b42d. kq liverSarin SK, Kedarisetty CK, Abbas Z, Amarapurkar D, Bihari C, Chan AC, et al. Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL) 2014. Hepatol Int 2014;8:453-471. doi.org/10.1007/s12072-014-9580-2. Jalan R, Gines P, Olson JC, Mookerjee RP, Moreau R, Garcia-Tsao G, et al. Acute-on chronic liver failure. J Hepatol 2012;57:1336-1348. doi.org/10.1016/j.jhep.2012.06.026. Moreau R, Jalan R, Gines P, Pavesi M, Angeli P, Cordoba J, et al. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology 2013;144:1426-1437. doi.org/10.1053/j.gastro.2013.02.042. Her……

kq liverCryptogenic Cirrhosis

Cryptogenic cirrhosis is cirrhosis of uncertain etiology that lacks definitive clinical and histological criteria for a specific disease. Although the exact cause of cryptogenic cirrhosis is unknown, correlations suggest that non-alcoholic steatohepatitis (NASH) plays a dominant role. This activity outlines the evaluation and management of cryptogenic cirrhosis and highlights the role of the interprofessional team in managing patients with this condition.Objectives:Access free multiple choice questions on this topic.Cryptogenic cirrhosis is cirrhosis of uncertain etiology that lacks definitive clinical and histological criteria for a specific disease. Cryptogenic cirrhosis accounts for nearly 5% to 30% of cases of cirrhosis and nearly 10% of liver transplants. Although the exact cause of cryptogenic cirrhosis is unknown, there are correlations that non-alcoholic steatohepatitis (NASH) plays a dominant role.Although the exact etiology of cryptogenic cirrhosis is unknown by definition, many causes have been implicated. These include NASH, occult ethanol intake, occult viral hepatitis, autoimmune hepatitis, occult biliary disease, hepatic vascular disease, celiac disease, mitochondriopathies, familial Mediterranean fever, systemic lupus erythematosus, Alstrom syndrome, abnormalities of apolipoprotein B with low low-density-lipoprotein cholesterol, short telomere syndromes, keratin 18 mutations, and glutathione S-transferase mutations.Cryptogenic cirrhosis is attributed as the cause of nearly 5% to 30% of cirrhosis cases and about 10% of liver transplants. Nearly half of the patients with cryptogenic cirrhosis are females, and the average age is about 60 years old.Although the exact cause of cryptogenic cirrhosis is unknown, many potentially associated diseases with it have been described above. However, no definitive association has been made. Given the uncertain etiology, the pathophysiology of cryptogenic cirrhosis is unknown and thus requires further research to elucidate the underlying etiology before the pathophysiology can be determined.Histological assessment is sometimes limited in those with adva……