Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0017168 (gastroesophageal reflux disease)
 11,783 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We report a case of sinus mucormycosis in a patient receiving infliximab for Crohn's disease (CD). A 41-year-old white female with a history of gastroesophageal reflux disease, well-controlled diabetes, and ileocecal CD developed right-sided facial pain and high fevers, with computed tomography scan confirming sinusitis. She had been receiving both low-dose azathioprine and scheduled infliximab for her CD. A sinus biopsy was procured endoscopically which grew mucormycosis. All immunosuppressive agents were immediately discontinued, and the patient underwent multiple debridement procedures of the right sinuses. Amphotericin B lipid complex and posaconazole were administered to the patient. Repeat laboratory and imaging study demonstrated clearance of the infection approximately 30 days after diagnosis. The patient's CD did not flair during withdrawal of immunosuppressive medications, and the patient completed 6 months of posaconazole therapy. Clinicians should be aware of the possible development of this potentially catastrophic infection in patients receiving infliximab, especially if such patients have other risks for mucormycosis, such as diabetes.
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PMID:Mucormycosis in a Crohn's disease patient treated with infliximab. 1977 82

Chronic rhinosinusitis (CRS) is characterized by mucosal inflammation affecting both the nasal cavity and paranasal sinuses; its causes are potentially numerous, disparate, and frequently overlapping. The more common conditions that are associated with CRS are perennial allergic and nonallergic rhinitis, nasal polyps, and anatomical mechanical obstruction (septum/turbinate issues). Other less common etiologies include inflammation (eg, from superantigens), fungal sinusitis or bacterial sinusitis with or without associated biofilm formation, gastroesophageal reflux, smoke and other environmental exposures, immune deficiencies, genetics, and aspirin-exacerbated respiratory disease. A diagnosis of CRS is strongly suggested by a history of symptoms (eg, congestion and/or fullness; nasal obstruction, blockage, discharge, and/or purulence; discolored postnasal discharge; hyposmia/anosmia; facial pain and/or pressure) and their duration for > 3 months. A definitive diagnosis requires physical evidence of mucosal swelling or discharge appreciated during physical examination coupled with CT imaging if inflammation does not involve the middle meatus or ethmoid bulla. Multivariant causation makes the diagnosis of CRS and selection of treatment complex. Furthermore, various types of health care providers including ear, nose, and throat (ENT) specialists, allergists, primary care physicians, and pulmonologists treat CRS, and each is likely to have a different approach. A structured approach to the diagnosis and management of CRS can help streamline and standardize care no matter where patients present for evaluation and treatment. A 2008 Working Group on CRS in Adults, supported by the American Academy of Otolaryngic Allergy (AAOA), developed a series of algorithms for the differential diagnosis and treatment of CRS in adults, based on the evolving understanding of CRS as an inflammatory disease. The algorithms presented in this paper address an approach for all CRS patients as well as approaches for those with nasal polyps, edema observed on nasal endoscopy, purulence observed on nasal endoscopy, an abnormal history and physical examination, and an abnormal history and normal physical examination.
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PMID:Diagnosis and management of chronic rhinosinusitis in adults. 1994 Apr 23

Exacerbation of nighttime sleep-related oromotor activity is often recognized as a relevant clinical entity commonly known as sleep bruxism (SB). Many pragmatic issues about SB diagnosis and management remain controversial. Therefore, within a critical review of the literature, this article proposes an operational clinical approach for SB diagnosis and management, with a focus on three comorbidities frequently occurring in relation to sleep: obstructive sleep apnea (OSA), gastroesophageal reflux disease (GERD), and insomnia. In the absence of any comorbidities, and if clinically justified, short-term medication and/or splints may be considered. If a comorbid condition is suspected, then the patient should be screened for OSA, GERD, and insomnia. For OSA screening, the Epworth Sleepiness Scale, STOP-Bang, and NoSAS questionnaires are available validated tools. For GERD screening, a positive patient report, whether associated or not with clinical signs and symptoms of heartburn and/or regurgitation, can be tested. For insomnia screening, report of difficulties initiating or maintaining sleep or of early morning awakening more than three times a week may be useful for diagnosis clarification. An adequate clinical approach for comorbid SB requires that both SB and the related comorbid condition be properly assessed and managed. Very often, improvement of SB with treatment of the associated condition will confirm the relationship and establish a more precise diagnosis (ie, secondary SB). Clinicians intending to manage SB should be able to identify these possible clinical interactions, and, if needed, perform an integrative multidimensional approach. Some approaches will benefit from a multidisciplinary approach for achieving therapeutic success.
J Oral Facial Pain Headache
PMID:An Operational Clinical Approach in the Diagnosis and Management of Sleep Bruxism: A First Step Towards Validation. 3287 Sep 52