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Medicines, Volume 10, Issue 10 (October 2023) – 4 articles

Cover Story (view full-size image): Sarcoidosis is a granulomatous disorder with systemic manifestations involving the lungs, lymph nodes, and skin. Chronic, progressive sarcoidosis remains a challenge because of its higher somatic, psychosocial, and economic burden associated with increased healthcare utilization. Whether the sociodemographic factors, comorbidities, or cutaneous manifestations of sarcoidosis at presentation are associated with the disease outcome remain to be studied. We conducted a retrospective cohort study of 240 patients with cutaneous sarcoidosis at Johns Hopkins Hospital, focusing on the associations among patient characteristics with progressive or remissive sarcoidosis, as defined by the established guidelines. Adjusted analyses demonstrated associations of progressive sarcoidosis with a younger age at diagnosis, being black, having lupus pernio and the presence of other autoimmune comorbidities. View this paper

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30 pages, 15780 KiB

Open AccessReview

Exploring the Potential of Chatbots in Critical Care Nephrology

by Supawadee Suppadungsuk, Charat Thongprayoon, Jing Miao, Pajaree Krisanapan, Fawad Qureshi, Kianoush Kashani and Wisit Cheungpasitporn

Medicines 2023, 10(10), 58; https://doi.org/10.3390/medicines10100058 - 20 Oct 2023

Cited by 4 | Viewed by 2231

Abstract

The exponential growth of artificial intelligence (AI) has allowed for its integration into multiple sectors, including, notably, healthcare. Chatbots have emerged as a pivotal resource for improving patient outcomes and assisting healthcare practitioners through various AI-based technologies. In critical care, kidney-related conditions play a significant role in determining patient outcomes. This article examines the potential for integrating chatbots into the workflows of critical care nephrology to optimize patient care. We detail their specific applications in critical care nephrology, such as managing acute kidney injury, alert systems, and continuous renal replacement therapy (CRRT); facilitating discussions around palliative care; and bolstering collaboration within a multidisciplinary team. Chatbots have the potential to augment real-time data availability, evaluate renal health, identify potential risk factors, build predictive models, and monitor patient progress. Moreover, they provide a platform for enhancing communication and education for both patients and healthcare providers, paving the way for enriched knowledge and honed professional skills. However, it is vital to recognize the inherent challenges and limitations when using chatbots in this domain. Here, we provide an in-depth exploration of the concerns tied to chatbots’ accuracy, dependability, data protection and security, transparency, potential algorithmic biases, and ethical implications in critical care nephrology. While human discernment and intervention are indispensable, especially in complex medical scenarios or intricate situations, the sustained advancements in AI signal that the integration of precision-engineered chatbot algorithms within critical care nephrology has considerable potential to elevate patient care and pivotal outcome metrics in the future. Full article

(This article belongs to the Section Nephrology and Urology)

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10 pages, 310 KiB

Open AccessArticle

Demographics, Cutaneous Manifestations, and Comorbidities Associated with Progressive Cutaneous Sarcoidosis: A Retrospective Cohort Study

by Jonathan Lai, Erik Almazan, Thomas Le, Matthew T. Taylor, Jihad Alhariri and Shawn G. Kwatra

Medicines 2023, 10(10), 57; https://doi.org/10.3390/medicines10100057 - 12 Oct 2023

Viewed by 1238

Abstract

Background: Sarcoidosis is a multisystem granulomatous disease with a wide variety of presentations and clinical courses. Cutaneous manifestations and comorbidities associated with sarcoid prognosis remain understudied. Methods: An EPIC query was run for patients age 18+ at the Johns Hopkins Hospital with a diagnosis of sarcoidosis of the skin according to the ICD-10-CM code D86.3. Data were obtained from a population-based sample of 240 patients from 2015 to 2020. Results: A total of 240 patients were included in the cohort study. The mean (SD) age was 43.76 (11.72) years, and 30% of participants were male; 76.25% of patients identified as black, 19.58% as white, and 4.17% as other. The average age of onset in remissive patients was significantly higher than progressive (47 ± 12 vs. 40 ± 10, p = 0.0005); 49% of black patients experienced progressive sarcoid compared to 32.6% of white patients (p = 0.028). Progressive disease was associated with the presence of lupus pernio (aOR = 3.29, 95% CI, 1.60–6.77) and at least one autoimmune comorbidity (aOR 6.831, 95% CI 1.819–11.843). Conclusions: When controlling for patient demographics, lupus pernio and the presence of at least one autoimmune condition were associated with progressive cutaneous sarcoidosis. Full article

7 pages, 261 KiB

Open AccessBrief Report

Additional Value of Mini-Cog© in Urogeriatric Patients Concurrently Screened by G8 Scores

by Jobar Bouzan, Peter Willschrei and Marcus Horstmann

Medicines 2023, 10(10), 56; https://doi.org/10.3390/medicines10100056 - 08 Oct 2023

Cited by 1 | Viewed by 1031

Abstract

Background: Cognitive impairment is poorly addressed in G8 screening. The aim of the present study was to evaluate the additional value of Mini-Cog© in urogeriatric patients concurrently screened by G8 scores. Methods: Seventy-four consecutive urogeriatric patients aged 75 and above were evaluated. All patients underwent G8 and Mini-Cog© screening. Patients with a G8 score above 14 were considered geriatric “healthy or fit”. A Mini-Cog© from four to five points was considered inconspicuous in screening for cognitive impairment. The additional information of a Mini-Cog© screening during G8 screening was evaluated by looking at G8 “fit and healthy” patients who had conspicuous Mini-Cog© tests and vice versa. Additionally, the results of the neuropsychological subitem “E” of the G8 score were compared with the results of the Mini-Cog© screening. Results: The mean age of the patients was 83 y (min. 75–max. 102). Sixty-one of the patients were males, and 13 were females. Twenty-nine of the patients had a normal G8 score and were considered “healthy or fit”, and 45 were not. Forty-three of the patients had an inconspicuous Mini-Cog©, and 31 had a conspicuous Mini-Cog© of less than four points. The majority of G8 “healthy or fit” patients (n = 24/29) had an inconspicuous Mini-Cog© test. However, of them, five patients had a Mini-Cog© of less than four points, which is suspicious for cognitive disorders. Furthermore, of the 43 patients with a normal G8 subscore in item “E” of two points, 6 patients had a conspicuous Mini-Cog© of less than four points. Conclusions: As shown by the present study, the Mini-Cog© might extend the G8 screening with regard to the detection of cognitive functional impairments that are not detected by the G8 screening alone. It can be easily added to G8 screening. Full article

(This article belongs to the Section Nephrology and Urology)

11 pages, 1496 KiB

Open AccessCase Report

Monoclonal Gammopathy of Renal Significance with Deposits of Infrequent Morphology: Two Case Reports of Light and Heavy Chain Deposition Disease with Atypical Presentation and Literature Review

by José C. De La Flor, Maribel Monroy-Condori, Jacqueline Apaza-Chavez, Iván Arenas-Moncaleano, Francisco Díaz, Xavier E. Guerra-Torres, Jorge L. Morales-Montoya, Ana Lerma-Verdejo, Edna Sandoval, Daniel Villa and Coca-Mihaela Vieru

Medicines 2023, 10(10), 55; https://doi.org/10.3390/medicines10100055 - 04 Oct 2023

Viewed by 1328

Abstract

Background: Monoclonal immunoglobulin deposition disease (MIDD) includes three entities: light chain deposition disease (LCDD), heavy chain deposition disease (HCDD) and light and heavy chain deposition disease (LHCDD). The renal presentation can manifest with varying degrees of proteinuria and/or nephrotic syndrome, microhematuria, and often leads to end-stage renal disease. Given the rarity of LHCDD, therapeutic approaches for this condition remain inconclusive, as clinical trials are limited. Case presentation: We report two male patients with underlying monoclonal gammopathy of renal significance (MGRS) associated with LHCDD lesions. Both cases had non-nephrotic proteinuria, moderately impaired renal function, and normal levels of C3 and C4. Light microscopy of the renal biopsies in both patients did not show lesions of nodular glomerulosclerosis. Immunofluorescence showed a staining pattern with interrupted linear IgA-κ in patient #1 and IgA-λ in patient #2 only along the glomerular basement membrane (GBM). Electron microscopy of patient #1 revealed electrodense deposits in the subendothelial and mesangial areas only along the GBM. Discussion: In this case series, we discuss the clinical, analytical, and histopathological findings of two rare cases of LHCDD. Both patients exhibited IgA monoclonality and were diagnosed with monoclonal gammopathy of undetermined significance (MGUS) by the hematology department at the time of renal biopsy. Treatment with steroids and cytotoxic agents targeting the clone cells responsible for the deposition disease resulted in a favorable renal and hematologic response. Full article

(This article belongs to the Section Nephrology and Urology)

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