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

The incidence and prevalence of diabetes mellitus is rapidly increasing worldwide at an alarming rate. Type 2 diabetes mellitus (T2DM) is the most prevalent form of diabetes, accounting for approximately 90–95% of the total diabetes cases worldwide. Besides affecting the ability of body to use glucose, it is associated with micro-vascular and macro-vascular complications. Augmented atherosclerosis is documented to be the key factor leading to vascular complications in T2DM patients. The metabolic milieu of T2DM, including insulin resistance, hyperglycemia and release of excess free fatty acids, along with other metabolic abnormalities affects vascular wall by a series of events including endothelial dysfunction, platelet hyperactivity, oxidative stress and low-grade inflammation. Activation of these events further enhances vasoconstriction and promotes thrombus formation, ultimately resulting in the development of atherosclerosis. All these evidences are supported by the clinical trials reporting the importance of endothelial dysfunction and platelet hyperactivity in the pathogenesis of atherosclerotic vascular complications. In this review, an attempt has been made to comprehensively compile updated information available in context of endothelial and platelet dysfunction in T2DM.

/pdf/endothelial-dysfunction-and-platelet-hyperactivity-in-type-2-3vbes9ziat.pdf

Endothelial dysfunction and platelet hyperactivity in type 2 diabetes mellitus: molecular insights and therapeutic strategies.

Characteristics of platelet indices and their prognostic significance in selected medical condition - a systematic review.

The aim of the present study was to investigate the correlation of neutrophil to lymphocyte ratio (NLR), mean platelet volume (MPV), and platelet distribution width (PDW) with diabetic nephropathy (DN) and diabetic retinopathy (DR). We searched for eligible studies from PubMed, Embase, Web of Science, and CNKI up to 1 December 2017. Standardized mean difference (SMD) was calculated with a confidence interval (CI) of 95%. A total of 48 studies were included in our meta-analysis. Compared with patients with type Ⅱ diabetes mellitus (T2DM) and without DR, NLR, MPV, and PDW were higher in patients with DR (SMD = 0.77; 95% CI: 0.49-1.05; P<0.001; SMD = 0.68; 95% CI: 0.36-0.99; P<0.001; SMD = 0.52; 95% CI: 0.28-0.76; P<0.01). Compared with patients with T2DM and without DN, NLR, MPV, and PDW were higher in patients with DN (SMD = 0.63; 95% CI: 0.43-0.83; P<0.001; SMD = 0.81; 95% CI: 0.36-1.25; P<0.001; SMD = 0.70; 95% CI: 0.50-0.90; P<0.001). We also found that MPV was strongly associated with the severity of DR, and NLR was closely related to the degree of DN. Our findings indicated that NLR, MPV, and PDW could be recommended as inexpensive diagnostic biomarkers for DN and DR. However, considering several limitations in the present study, further high-quality clinical studies should be performed to investigate the relationship of NLR, MPV, and PDW to DN and DR.

/pdf/the-association-of-neutrophil-to-lymphocyte-ratio-mean-57aqjkpz7j.pdf

The association of neutrophil to lymphocyte ratio, mean platelet volume, and platelet distribution width with diabetic retinopathy and nephropathy: a meta-analysis.

Diabetic retinopathy (DR) is one of the most common diseases causing blindness in the world, and most patients are already in advanced stage. Recent years, many studies reported mean platelet volume (MPV) may be associated with development of DR, but there was no consistent conclusion reached. Literature was retrieved by formally searching PubMed, Embase, Cochrane library and Scopus and by hand searching of reference lists of related articles. Finally, a total of 14 literatures included, and Review manager 5.3 and STATA 14.0 statistical software were utilized for processing. Meta-analysis showed that MPV values in DR were significantly higher than health controls [SMD (95% CI) = 0.92 (0.60–1.24)] and type 2 diabetes mellitus without diabetic retinopathy (T2DM without DR) [SMD (95% CI) = 0.36 (0.19–0.53)]. Subgroup analysis indicated that MPV level in proliferative diabetic retinopathy (PDR) patients was higher than T2DM without DR patients [SMD (95% CI) = 0.48 (0.28, 0.68)], but this difference didn’t appear in non-proliferative diabetic retinopathy (NPDR). The study demonstrated that increased MPV level was significant associated with the development of DR, and it might reflect the severity of DR, which could be provided to monitor development and progression of DR clinically.

/pdf/the-relationship-between-mean-platelet-volume-and-diabetic-3kw9jfxvmc.pdf

The relationship between mean platelet volume and diabetic retinopathy: a systematic review and meta-analysis.

Introduction. Different types of thyroiditis may share some parallel clinical and biochemical features. Timely intervention can significantly reduce morbidity and mortality. Aim. Aim of this study is to find the frequency of various thyroiditis, study the cytomorphological features and correlate with clinical findings including radiological findings, thyroid function test, and anti-thyroid peroxidase antibodies (Anti-TPO antibodies). Materials and Methods. The study included consecutive 110 cases of thyroiditis. Detailed cytomorphological features were studied and correlated with ultrasonography findings, thyroid function test, anti-thyroid peroxidase antibodies (anti-TPO) and histopathological features where thyroidectomy specimens were received for histopathological examination. Results. The majority were Hashimoto’s thyroiditis ( ) and females ( ). Other forms of thyroiditis were Hashimoto’s thyroiditis with colloid goiter ( ), De Quervain’s thyroiditis ( ), and one case each of postpartum thyroiditis and Hashimoto’s thyroiditis with associated malignancy. The majority of patients were in the age group of 21–40 ( ) and the majority ( ) had diffuse enlargement of thyroid. The majority of patients were hypothyroid ( ). The serum anti-TPO antibodies were elevated in 47 patients out of 71 patients. In the 48 patients who underwent ultrasonography, 38 were diagnosed as having thyroiditis. The most consistent cytomorphological features seen in fine-needle aspiration smears of Hashimoto’s thyroiditis were increased background lymphocytes, lymphocytic infiltration of thyroid follicular cell clusters, and Hurthle cells. Conclusion. The diagnostic cytological features in Hashimoto’s thyroiditis are increased background lymphocytes, lymphocytic infiltration of thyroid follicular cell clusters, and Hurthle cells. FNAC remains the “Gold Standard” for diagnosing Hashimoto’s thyroiditis. Clinical history, thyroid function, and biochemical parameters are the key for diagnosis of other forms of thyroiditis.

/pdf/cytomorphological-spectrum-of-thyroiditis-a-review-of-110-12xqoa2igw.pdf

Cytomorphological Spectrum of Thyroiditis: A Review of 110 Cases.

Background: Fine-needle aspiration cytology (FNAC) gives the necessary information of various breast lesions for surgical management of patients and can be extremely useful for establishing the best neoadjuvant therapy in patients where surgical removal of tumor is not the best option. The National Cancer Institute, Bethesda sponsored conference recommended that the tumor grading on FNAC should be incorporated in reports for prognostication. Objective: The purpose of this study is to determine the correlation between cytomorphologic and histomorphological features and to evaluate the utility of different cytological grading systems and to determine which cytology grade corresponds best to the histology grade. Materials and Methods: The present prospective study included fifty cases of breast carcinoma diagnosed on FNAC and confirmed on histopathology. Detailed cytomorphological features were studied. Cytology grading was done using six grading systems. Detailed histological features were studied, and carcinomas were graded as per modified Scarff-Bloom-Richardson's histopathological grading system. Cytology grading was correlated with histology grading. Results: Out of fifty cases of breast carcinomas, the 29 (58%) cases of each Robinson's cytological grading and Fisher's modification of Black grading correlated with histological grading. The cytological features, namely, nuclear chromatin, nuclear pleomorphism, cell size, nuclear margins, and naked tumor nuclei used in grading correlated well with histological grade. Conclusion: Cytology grading adds to objectivity, reproducibility, and authenticity to the report. The cytology features such as nuclear chromatin, nuclear pleomorphism, cell size, nuclear margins, and naked tumor nuclei had influential role in predicting the final cytology grade. Among the six cytology grading systems, Robinson's system is simple to interpret, more objective, takes less time, and is reproducible and correlates precisely with histological grade as evident from our study. It should be used for routine evaluation of aspirates of breast carcinoma.

Comparative analysis of six cytological grading systems in breast carcinoma

Background: Unanimously recognized precancerous breast lesions are atypical ductal hyperplasia (ADH), atypical lobular hyperplasia, flat epithelial atypia, lobular carcinoma in situ, papillary lesions, and proliferative radial scar. The increased risk of developing carcinoma associated with these lesions is found for both ipsi- and contra-lateral breasts. These precancerous lesions are also found in benign breast lesions. Aim: The aim of this study is to study histomorphological features of precancerous breast lesions and to find the prevalence of these lesions in various benign breast lesions in different age groups. Materials and Methods: We evaluated histomorphology of 430 benign breast lesions for the presence of precancerous breast lesions. The frequency of precancerous lesions was correlated with type of benign breast lesions and different age groups. Results: In thirty cases of benign breast lesions, precancerous lesions were found. Maximum cases were of lobular neoplasia (LN) (n = 12) followed by papilloma (n = 9). Majority of the lesions were found between 31 and 40 years (n = 16). Maximum cases of LN (n = 6) and ADH and peripheral papilloma each (n = 4) were seen in the age group of 31–40 years. Maximum precancerous lesions were seen in fibrocystic change (n = 21), followed by sclerosing adenosis (n = 5), and fibroadenoma (n = 4). Conclusion: Prevention is a highly feasible approach to breast cancer control. Benign breast lesions with associated precancerous breast lesions must be separated from pure benign breast lesions. These lesions need future evaluations to assess the risk of carcinoma in ipsilateral as well as contralateral breasts. There is a need for more long-term follow-up studies of precancerous breast lesions in benign breast lesions to assess the risk of developing carcinoma in ipsilateral as well as contralateral breasts.

Precancerous breast lesions in benign breast lesions: Review of 430 benign breast lesions

Xanthogranulomatous inflammation is rare, and though it has been described in many organs, most commonly it occurs in the kidney and gall bladder. Xanthogranulomatous appendicitis is a very rare phenomenon. Clinical findings and imaging modalities are not sufficient for definite preoperative diagnosis. Clinical and radiological resemblances of these lesions to neoplastic processes often warrant excision. A 40-year-old female presented with pain in the right lower quadrant of the abdomen, loss of weight, nausea, and abdominal distension since 15 days. Ultrasonography and computed tomography of the abdomen and pelvis suggested neoplastic lesion. Surgical resection of the ileum, ileocecal junction with appendix, and part of transverse colon were done. Diagnosis of xanthogranulomatous appendicitis was made on histopathology examination.

Xanthogranulomatous appendicitis mimicking appendicular lump: An uncommon entity

Background: Platelet volume indices (PVI) such as mean platelet volume (MPV), platelet distribution width (PDW), and platelet-large cell ratio (P-LCR) are the indicators of increased platelet activity and can be considered as potential biomarkers for diabetic complications. Purpose: To study PVI in Type 2 diabetics with and without complications in comparison to nondiabetic patients. Materials and Methods: A case–control study was conducted on 300 Type 2 diabetics and 200 nondiabetics. Detailed clinical history regarding duration, hypertension, and complications was taken. PVI was obtained using automated cell counter. Fasting blood glucose, hemoglobin A1c, lipid profile, creatinine were also obtained. Diabetics were further categorized into patients with complications and without complications. Statistical analysis was performed by Statistical Package for the Social Sciences Version 17 (Chicago, IL) Student's t-test and ANOVA test. Results: Platelet count was significantly decreased in diabetics (P = 0.005). MPV was significantly increased in diabetic patients with complications as compared to diabetics without complications and nondiabetic group (P Conclusion: MPV and PDW are predictive biomarkers of diabetic vascular complications. They are more significant in microvascular complications than macrovascular complications.

/pdf/platelet-volume-indices-as-predictive-biomarkers-for-4i0leke0nw.pdf

Platelet volume indices as predictive biomarkers for diabetic complications in Type 2 diabetic patients

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