Latest Updates

Evaluation and Treatment of Monogenic Forms of Inflammatory Bowel Diseases 

Dror S Shouval, MD, MMSc
    • Advanced genetic platforms have identified more than 50 different monogenic disorders causing inflammatory bowel disease.
    • A monogenic cause of inflammatory bowel disease should be suspected in patients with atypical or severe IBD phenotypes.
    • The diagnosis of monogenic defects is made through a combination of functional immunologic studies and DNA sequencing (whole exome sequencing).
    • Monogenic IBDs usually present in the first years of life, but several diseases manifest adolescence or adulthood.
    • Identifying a monogenic form of inflammatory bowel disease can lead to tailored specific therapy (eg, stem cell transplantation) and have major impact on patient’s care.

Systemic Lupus Erythematosus

Kyriakos A. Kirou, MD, Michael D. Lockshin, MD
    • A 2018 Rheumatology guideline for the management of adult systemic lupus erythematosus
    • A 2015 Diagnosis, Monitoring, and Treatment of Systemic Lupus Erythematosus: A Systematic Review of Clinical Practice Guidelines. Arthritis Care and Research

Systemic Lupus Erythematosus

Kyriakos A. Kirou, MD, Michael D. Lockshin, MD
    • A 2018 Rheumatology guideline for the management of adult systemic lupus erythematosus
    • A 2015 Diagnosis, Monitoring, and Treatment of Systemic Lupus Erythematosus: A Systematic Review of Clinical Practice Guidelines. Arthritis Care and Research

Hemorrhoids

Yesenia Rojas-Khalil, MD, Anthony J. Senagore, MD, MS, MBA
    • Rubber band ligation remains the most effective nonexcisional technique available.
    • Advanced energy devices such as the LigaSure technique and Harmonic scalpel have demonstrated a modest decrease in immediate postoperative pain with equal efficacy when compared to the traditional excisional hemorrhoidectomy, however at a greater cost.
    • At this time, stapled hemorrhoidopexy and Doppler-guided hemorrhoidal dearterialization have not been shown to have a clear advantage over the traditional excisional hemorrhoidectomy.

Parotidectomy

John A. Ridge, MD, PhD, FACS, Francis Si Wai Zih, MD
    • Although facial nerve injury is the most feared complication of parotidectomy, consent should include reference to the common sequelae of cosmetic deformity, earlobe numbness, salivary fistula, and gustatory sweating.
    • The facial nerve dissection may be performed in antegrade fashion from the main trunk of the facial nerve distally or, if the main trunk cannot be exposed, from a peripheral branch proximally.
    • Complete superficial parotidectomy with exposure of all branches of the facial nerve is seldom necessary, although it may be mandated by tumor size.
    • Nerve branches sacrificed due to tumor involvement or inadvertently injured should be repaired primarily or with a cable graft at the time of injury rather than in a staged procedure.

Food Allergies

Matthew Greenhawt, MD, MBA, MSc
    • Prescription of targeted allergen elimination diet as the treatment for known or strongly suspected food allergy
    • Consultation with a nutritionist for growing children in whom elimination diets might affect growth; and patients with multiple food allergies, poor growth parameters, or both
    • Emphasis on awareness of anaphylaxis and swift intervention

Food Allergies

Matthew Greenhawt, MD, MBA, MSc
    • Prescription of targeted allergen elimination diet as the treatment for known or strongly suspected food allergy
    • Consultation with a nutritionist for growing children in whom elimination diets might affect growth; and patients with multiple food allergies, poor growth parameters, or both
    • Emphasis on awareness of anaphylaxis and swift intervention

Pathophysiology and Treatment of Cystinuria

Dean G Assimos, MD, Carter Boyd, Medical Student, Jacob Britt, Medical Student, Ava Saidian, MD, Dustin Whitaker, Medical Student, Kyle Wood, MD
    • Identifying cystinuria as an associated risk factor for chronic kidney disease
    • Demonstration of cystine obstruction in the nephron initiating a renal inflammatory process
    • Identification of new potential therapeutic agents including a-lipoic acid, L-cystine dimethyl ester, 1-cystine bismorpholide, and 1-cystine bis (N-methylpiperazide)
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