Latest Updates

Nutritional Management of Celiac Disease

Ciarán P Kelly, MD, Satya Kurada, MD, Mariana Urquiaga, MD
    • Glutenases: Clinical trials using glutenases versus placebo have demonstrated worsening of histologic findings in the placebo group compared with glutenases on consumption of up to 2 g of gluten.
    • Tight junction regulators: Larazotide acetate demonstrated a reduction in gluten-induced immune reactivity and symptoms when celiac subjects were exposed to a 2.7 g gluten challenge when compared with placebo in a randomized, double-blind, placebo-controlled trial.
    • IgY antibodies: Animal studies using mice fed with gastric-stabilized antigliadin IgY antibodies derived from the egg yolks of gluten-immunized chickens in addition to gluten showed a reduction in gluten absorption from the diet.

Pathologic Evaluation of Soft Tissue Sarcoma

Narasimhan P. Agaram, MBBS
    • Concepts of pathologic examination and grading
    • Important diagnostic criteria for each soft tissue sarcoma
    • Latest molecular diagnostic methods used in the diagnosis of sarcomas

Extent of Gastrectomy and Lymphadenectomy for Gastric Adenocarcinoma

Kevin K. Chang, MD, Sam S. Yoon, MD
    • The eighth edition of the AJCC Cancer Staging Manual now includes prognostic information for clinical TNM staging and post–neoadjuvant therapy staging.
    • A D2 lymphadenectomy is frequently recommended as the nodal dissection of choice for locally advanced gastric adenocarcinoma.
    • Laparoscopy-assisted operations are associated with improved overall morbidity and comparable lymph node yield.

OVERVIEW OF ENTERAL NUTRITION

Rebecca Lynch, MS, RD, LDN, CNSC, Erin Sisk, MS, RD, LDN, CNSC
    • Immunomodulating formulas may not offer additional benefits to critically ill patients.
    • Special pulmonary formulas do not improve outcomes for patients with ARDS.
    • Gastric residuals are not a factor in assessing for enteral tolerance as they do not correlate with risk of aspiration and pneumonia.

Nephrology: Management of Cardiovascular Disease in Dialysis Patients

John P. Middleton, John K. Roberts
    • Left ventricular hypertrophy is associated with cardiovascular outcomes, including sudden cardiac death. Efforts to mitigate left ventricular hypertrophy (blood pressure control, aggressive fluid management, and frequent hemodialysis) may improve outcomes.
    • Low potassium dialysate (< 2 mEq/L), low calcium dialysate (< 2.5 mEq/L), and high ultrafiltration rates (> 13 mL/kg/hr) have been associated with worse cardiovascular outcomes in hemodialysis patients.
    • End-stage renal disease (ESRD) patients with atrial fibrillation are at increased risk for both stroke and bleeding events. Routine anticoagulation is not recommended for stroke prophylaxis.
    • In two small randomized trials, use of spironolactone reduced cardiovascular events and left ventricular mass index compared with placebo in patients with ESRD.

Nephrology: Hypertensive Disorders in Pregnancy

Susan Hou, MD, Kavitha Vellanki, MD
    • New diagnostic criteria for preeclampsia
    • Pathophysiology of preeclampsia
    • Role of serologic biomarkers for diagnosis of preeclampsia
    • Guidelines for target blood pressure in pregnancy

Nephrology: Drug Dosing in Acute Kidney Injury

Jamil Azzi, MD, Steven Gabardi, PharmD, BCPS, FAST, FCCP, Marjan Sadegh, PharmD, BCPS, Craig A Stevens, PharmD, BCPS
    • Full review of all available literature on the impact of acute kidney injury (AKI) on drug pharmacokinetic parameters
    • Recommendations for drug dosing strategies in patients with AKI, including loading doses, maintenance therapy, and therapeutic drug monitoring
    • Evaluation of specific medications that require special attention in patients with AKI

Rheumatology: Osteoarthritis 

Christopher Wise, MD, FACP
    • 2016 Update on glucosamine for the management of osteoarthritis
    • 2014 NICE guidelines for osteoarthritis care and management
    • 2014 OARSI guidelines for non-surgical management knee osteoarthritis
    • 2013 AAOS guidelines for knee osteoarthritis
    • 2012 ACR recommendations for therapies in hand/hip/knee osteoarthritis
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