Archives of internal medicine research最新文献

Tuberculous meningitis (TBM), the most severe manifestation of extrapulmonary tuberculosis, poses significant global health challenges due to its high mortality rates and complex pathophysiology. This review synthesizes recent findings on TBM, covering epidemiology, pathogenesis, clinical manifestations, diagnostics, and management strategies. TBM disproportionately affects immunocompromised populations, including individuals with HIV, with the highest mortality observed in low-resource settings. Pathogenesis involves Mycobacterium tuberculosis breaching the blood-brain barrier, eliciting a granulomatous inflammatory response that contributes to neurotoxicity. Advances in diagnostics, such as next-generation sequencing and novel imaging techniques, have improved early detection and treatment guidance. Management strategies emphasize multidrug regimens, adjunctive corticosteroids, and emerging therapies like intrathecal administration and nanoparticle-based drug delivery. Host-directed therapies targeting immune modulation and oxidative stress show promise in improving outcomes, particularly for drug-resistant TBM. Despite advancements, diagnostic delays, treatment resistance, and high rates of neurological effects underscore the need for further research. Preventive strategies focusing on early diagnosis, modifiable risk factor management, and public health interventions are critical to reducing global burden of TBM. This review highlights the importance of integrating innovative diagnostics, tailored treatments, and preventive measures to address the challenges of TBM and improve patient outcomes.

Amyotrophic Lateral Sclerosis (ALS) is an incurable progressive degenerative neuromuscular disease. One way ALS affects patients is through dysarthria significantly impacting a patient's quality of life by affecting their ability to communicate. This makes maintaining relationships, identity and autonomy difficult, all of which affect psychological wellbeing - a determinant of the quality of life. Dysarthria makes communication difficult, and because the regions affected by ALS first are different for each patient, creating strategies for rehabilitating communication can be challenging. In this review we explore the different communication rehabilitation options available and organize them based on if they are usable based on the onset of intelligibility and locked in state. Interventions before the onset of intelligibility in the early stage are proactive measures such as voice banking and education which empower patient autonomy and a sense of control. Interventions between onset of intelligibility and the locked-in state in the middle stage are alternative and augmentative communication strategies varied in accessibility and usability in patients based on their preferences and functional ability. Late-stage interventions which work after a patient with ALS has entered a locked-in state, are the most technologically advanced alternative and augmentative communication devices and rehabilitate function inaccessible by other methods in this disease stage. While assessing patient values and recommending interventions which meet patient needs is most important in rehabilitation of communication in patient with ALS, using a stage-based approach to evaluate and recommend the treatment of dysarthria and communication rehabilitation will optimize quality of life throughout the progression of disease.

Rheumatoid arthritis (RA) is a chronic inflammatory disease that can be managed with a range of therapeutic treatments. Methotrexate (MTX) is a first-line treatment for RA; however, its metabolism in RA patients can be complicated by multiple factors. Therefore, understanding these specific factors is crucial for optimizing the efficacy of MTX to provide improved therapeutic outcomes for patients. This article explores existing literature to examine how MTX metabolism in RA patients is impacted by other commonly used medications for RA. Additionally, the review explores the role of genetics by investigating the impact that single nucleotide polymorphisms (SNPs) have on MTX metabolism. Key findings from this review highlight how MTX metabolism can be enhanced or impaired based on specific combination therapies and how alternative treatments are considered with MTX treatment failure. MTX metabolism can also vary across different racial, ethnic, and population-based groups due to the presence of distinct SNPs in their genetic profiles. These results underscore the importance of personalized treatment approaches when treating RA patients with MTX, as its metabolism is influenced by factors such as drug interactions and SNPs. Future research is needed to expand our understanding of these factors to further improve therapeutic outcomes in RA patients.

Adaptive and Paralympic athletes face unique dermatologic challenges related to impaired sensation, prosthetic use, wheelchair friction, and comorbid conditions. Lower extremity skin infections are particularly concerning due to their impact on performance, participation, and overall health. To review the epidemiology, risk factors, clinical features, and evidence-based prevention strategies for lower extremity skin infections in adaptive and Paralympic athletes, and to identify current research gaps and future directions. A narrative epidemiological review was conducted using data from Paralympic Games surveillance systems, sports medicine registries, and dermatologic literature on skin infections in athletes with disabilities. Relevant studies addressing prevalence, pathophysiology, and preventive interventions were synthesized. Skin and soft tissue infections occur at a higher rate in adaptive sports athletes compared to the general population, with the highest rates in individuals with spinal cord injury and prosthetic use. Key risk factors include compromised skin barrier integrity, impaired circulation, hygiene challenges, and environmental exposure. Prevention requires a multifaceted approach emphasizing daily skin inspection, hygiene optimization, prosthetic fit adjustments, and facility disinfection. Multidisciplinary education of athletes, coaches, and clinicians is critical for early recognition and intervention. Despite the high burden, dermatologic outcomes remain underreported, and few studies evaluate targeted preventive measures. Lower extremity skin infections are a prevalent and preventable cause of morbidity in adaptive and Paralympic athletes. Tailored dermatologic care, standardized surveillance, and technological innovations-such as antimicrobial prosthetic liners and AI-assisted tele-dermatology-offer promising avenues to reduce infection burden and promote inclusion in sport. Future research should prioritize longitudinal, multicenter studies to inform evidence-based prevention and management strategies.

Bioaerosols-airborne particles of biological origin such as bacteria, fungi, viruses, and allergens-are increasingly recognized as critical environmental factors in the pathogenesis of airway diseases, particularly asthma. This article provides current understanding of how bioaerosols interact with the airway epithelium to initiate acute immune responses, promote chronic inflammation, and drive airway remodeling. Key mechanisms include disruption of mucociliary clearance, activation of innate immune receptors such as TLRs and PRRs, and the role of surfactant proteins SP-A and SP-D in modulating allergic inflammation. Chronic exposure leads to cytokine-mediated fibrosis and smooth muscle hypertrophy, contributing to steroid-resistant asthma. Genetic polymorphisms, especially in innate immunity genes like TLR2, TLR4, and CD14, influence individual susceptibility. The complexity of bioaerosol composition, coupled with environmental variability and lack of standardized exposure thresholds, presents challenges for effective monitoring. However, emerging strategies such as source control, improved ventilation, HEPA filtration, UV disinfection, and real-time airborne pathogen detection offer promising avenues for exposure mitigation. This comprehensive review underscores the need for interdisciplinary approaches to better understand and manage bioaerosol-related respiratory health risks.

Stroke is a leading cause of long-term disability, and enhancing neural plasticity is a central strategy in promoting functional recovery. This review examines a range of interventions that target plasticity to improve outcomes in stroke survivors. Neural plasticity is assessed using neuroimaging tools, such as fMRI, EEG, and fNIRS, as well as clinical scales, including the Fugl-Meyer Assessment (FMA) and the Modified Rankin Scale (mRS). Biomarkers, like brain-derived neurotrophic factor (BDNF), GABA, and nerve growth factor (NGF), are also useful for predicting patient outcomes. These tools offer insight into recovery potential and intervention effectiveness. The interventions discussed include physical therapy, cognitive behavioral therapy (CBT), dietary support, and emerging technologies such as virtual reality, video games, and exoskeleton-assisted training. Pharmacological strategies, including Levodopa, selective serotonin reuptake inhibitors (SSRIs), and ginkgo diterpene lactone meglumine (GDLM), have shown mixed results, while stem cell therapies remain under investigation. Physical therapy remains the foundational treatment, but other interventions may provide added benefit depending on patient characteristics. This review highlights the need for a personalized, multidimensional approach to stroke rehabilitation. Continued research is necessary to refine these therapies and optimize recovery through tailored treatment strategies.

Inflammatory Bowel Disease (IBD), encompassing Crohn's disease and ulcerative colitis, is a chronic inflammatory disorder of the gastrointestinal tract driven by complex interactions between genetic susceptibility, environmental triggers, microbial dysbiosis, and immune dysregulation. The gut microbiome, composed primarily of Firmicutes and Bacteroidetes, plays a crucial role in maintaining intestinal barrier integrity, immune balance, and neuroimmune signaling. Disruption of this microbial ecosystem is characterized by loss of beneficial short chain fatty acid producing bacteria and expansion of pathogenic species which promotes mucosal inflammation, cytokine release, and neuroimmune signaling that can disrupt mental health through the gut-brain axis. Emerging evidence links microbial metabolites, vagal tone, and the hypothalamic-pituitary-adrenal axis in a feedback loop that perpetuates inflammation and alters mood regulation. Current therapeutic approaches include diet modification, osteopathic manipulative treatments, fecal microbiota transplantation and phage therapy. This article focuses on understanding mechanisms linking dysbiosis, immune activation, and neuroinflammation to guide future interventions. A holistic model addressing the gut-brain axis holds the greatest promise for improving outcomes and personalizing care for IBD.

Multiple Sclerosis is a chronic neurological disorder characterized by progressive disability, with falls being a significant consequence of its physical and cognitive impairments. This review explores the major contributors to fall risk in individuals with multiple sclerosis and explores the broader implications of these factors, such as the fear of falling. The primary factors associated with fall risk include gait abnormalities, cognitive dysfunction, and fatigue. These factors often interact, leading to mobility limitations and diminishing overall quality of life. Interventions to mitigate fall risk in multiple sclerosis have shown varying degrees of success. Exercise and rehabilitation strategies improve physical function and balance, while cognitive-behavioral therapy addresses fatigue and associated symptoms. Self-management programs empower patients to take an active role in symptom management, though their effectiveness varies. Disease-modifying therapies are the primary treatment for slowing disease progression, indirectly reducing fall risk. Emerging technologies show promise in enhancing mobility and safety, while machine learning algorithms offer the potential for predicting fall risk in multiple sclerosis populations. This review underscores the need for a comprehensive approach to fall prevention in multiple sclerosis. Healthcare providers can develop personalized strategies to improve mobility, reduce fall incidence, and enhance the quality of life for individuals with multiple sclerosis. Further research is essential to refine these interventions and optimize long-term outcomes.

Type 2 Diabetes Mellitus therapy has evolved over the years to now include a new class of therapeutics, semaglutide. This article reviews the mechanism of action and formulation of semaglutide therapy, potential benefits, contraindications, adverse effects, and drug interactions. Oral and subcutaneous semaglutide therapies have shown effectiveness in improving glycemic control, weight loss, and reducing cardiovascular risks associated with diabetes mellitus. Semaglutide has also shown potential in being used as a therapeutic strategy in Alzheimer's disease due to its anti-neuroinflammatory effects and being used to treat polycystic ovary syndrome. However, semaglutide therapy is also associated with concerning adverse effects like acute pancreatitis, anesthetic risks like pulmonary aspiration or residual gastric content, acute kidney injury, acute gallbladder injury, nonarteritic anterior ischemic optic neuropathy and diabetic retinopathy. Contraindications of semaglutide include history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2, and pregnancy. Drug interactions to consider with semaglutide therapy include those also used in diabetes treatment, like metformin, as well as anti-psychotics, due to anti-psychotics associated weight gain. The findings of this article emphasize the need for a cross-disciplinary approach to understand the molecular mechanisms and clinical implications of semaglutide on patients with complex medical histories and treatment regimens. The potential anesthetic risks of semaglutide therapy warrant careful consideratiion with ethical concerns. Further studies can assess if there is a need to modify pre-operative guidelines to account for patient using semaglutide and how delayed gastric emptying and constitpation will affect surgical outcomes and complications. While semaglutide therapy for diabetes mellitus has been established, there is a need for extensive research on repurposing semaglutide in neurodegenerative disease treatment.

Atopic dermatitis (AD), also known as eczema, is an inflammatory dermatologic condition that results in inflamed, itchy skin lesions. The development of this condition is governed by a variety of genetic and environmental factors including lifestyle habits. The severity of atopic dermatitis has been attributed to be affected by various lifestyle factors, prompting the interest in utilizing lifestyle modifications as a form of treatment for atopic dermatitis symptoms. Many research studies have been conducted to investigate the effects of different factors such as sleep, stress, diet, smoking and tobacco use, exposure to various temperatures and humidity levels, and skincare and cosmetic products on atopic dermatitis symptoms, and how certain habits can be modified to manage AD conditions. Current studies have demonstrated the significant impact some lifestyle modifications can elicit with improving atopic dermatitis, while also discussing other lifestyle factors that require further research to determine their effects on AD. This review article summarizes the findings in the current literature that investigates the role of different lifestyle habits on the severity and exacerbation of atopic dermatitis, and explores the mechanisms in which these behaviors can trigger AD.