ABSTRACT
Inflammatory bowel disease (IBD), which includes ulcerative colitis and Crohn's disease, is a chronic condition characterized by inflammation of the gastrointestinal tract. Its exact cause is unknown, but it's thought to result from a dysregulated immune response influenced by various factors, including changes in the intestinal microbiota, diet, lifestyle, and genetics. The gut microbiome, consisting of diverse microorganisms, plays a crucial role in maintaining physiological balance, with its disruption leading to inflammatory responses typical of IBD. Treatments primarily aim at symptom control, employing immunomodulators, corticosteroids, and newer approaches like probiotics, prebiotics, fecal transplants, and dietary modifications, all focusing on leveraging the microbiota's potential in disease management. These strategies aim to restore the delicate balance of the gut microbiome, typically altered in IBD, marked by a decrease in beneficial bacteria and an increase in harmful pathogens. This review underscores the importance of the gut microbiome in the pathogenesis and treatment of IBD, highlighting the shift towards personalized medicine and the necessity for further research in understanding the complex interactions between the gut microbiota, immune system, and genetics in IBD. It points to the potential of emerging treatments and the importance of a multifaceted approach in managing this complex and challenging disease.
ABSTRACT
Chronic kidney disease (CKD) is a progressive disease and has multiple clinical manifestations; when CKD reaches the end stage, at least one cutaneous manifestation appears due to some increased toxin levels or a constant proinflammatory state. Nonspecific manifestations include pruritus, xerosis, pigmentation disorders, acquired ichthyosis, purpuric spots, and nail disorders. Some specific manifestations are bullous dermatoses, acquired perforating dermatoses (APD), eruptive xanthoma, access site infections, calcifying disorders, and nephrogenic systemic fibrosis (NSF). All these cutaneous changes negatively impact patients; early recognition and diagnosis of these dermatoses will make a difference in their quality of treatment. Exploring a patient's skin is fundamental to suspect some diseases and increased toxin levels; pruritus occurs when uremic toxins are raised, and nail disorders are associated with hypoalbuminemia. This review provides the clinician with information on the clinical manifestations that occur in CKD, including epidemiology, pathophysiology, clinical manifestations, diagnosis, histopathology, treatment, and life impact of the dermatoses in CKD.
ABSTRACT
Diabetes mellitus (DM) comprises a spectrum of metabolic disorders distinguished by the persistent elevation of glucose levels in the bloodstream. It stands as a primary risk factor for peripheral arterial disease (PAD), denoted by atherosclerosis affecting the lower extremities. One clinical manifestation of symptomatic PAD is intermittent claudication alleviated by rest but also capable of presenting as atypical leg pain. Confirmatory diagnostic measures, including the ankle-brachial index (ABI), toe-brachial index (TBI), or Doppler waveform analysis, are imperative in the verification of PAD. For management, the recommendation is to incorporate physiotherapy alongside concurrent medical interventions, such as anticoagulants, antiplatelet agents, statins, or, in certain cases, surgical procedures. This narrative review seeks to elucidate the advantages of physiotherapy in diabetic patients with PAD, contributing to the deceleration of disease progression and improving symptoms. Although supervised exercise therapy is strongly supported by empirical evidence as more beneficial, the absence of supervised environments is a common issue. Consequently, the preference lies in the combination of supervised exercise with home-based regimens. The objective is that each patient exercises for more than three days per week, progressively extending their duration weekly. This approach has demonstrated a noteworthy enhancement in walking functionality, exercise tolerance, pain alleviation, and an overall improvement in the quality of life for patients.
