Common Variable Immunodeficiency Presenting with Recurrent Ascending Cholangitis Treated with Oral Immunoglobulins

Total Page:16

File Type:pdf, Size:1020Kb

Common Variable Immunodeficiency Presenting with Recurrent Ascending Cholangitis Treated with Oral Immunoglobulins Scholar: Pilot and Validation Studies ISSN: 2689-7644 Volume 1 Issue 1 Pages: 11 - 13 DOI:10.32778/SPVS.71366.2020.3 Common Variable Immunodeficiency Presenting with Recurrent Ascending Cholangitis Treated with Oral Immunoglobulins Authors: Marija Rowane, OMS1, Jaimin Patel, DO2, Tina Abraham, DO3, Jason Schend, DO4, Robert Hostoffer, DO, LhD, MMedEd, FAAP, FACOP, FACOI, FCCP5 Affiliations: 1) Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio; 2) Department of Internal Medicine, Lehigh Valley Health Network, Allentown, Pennsylvania; 3) Pulmonary Allergy Critical Care & Sleep Associates, Downloaded from http://meridian.allenpress.com/scholar/article-pdf/1/1/11/2409933/i2689-7644-1-1-11.pdf by guest on 27 September 2021 Rochester Hills, Michigan; 4) Department of Pulmonary Critical Care, University Hospitals Cleveland Medical Center, Cleveland, Ohio; 5) Allergy Immunology Associates, Inc., Mayfield Heights, Ohio Keywords: Common Variable Immunodeficiency, primary immune deficiency disorder, ascending cholangitis, oral immunoglobulin, hepatobiliary, gastrointestinal Abstract: Background: Common variable immunodeficiency (CVID) is a heterogeneous group of primary immune deficiency disorders that may be characterized by heightened susceptibility to gastrointestinal (GI) infection. GI conditions manifest in 20 to 50% of CVID patients but rarely include cholangitis. Methods/Results: This is a 61-year-old female, with a history of cholecystectomy and gastric bypass, who presented with recurrent ascending cholangitis for eight years. After a hepaticojejunostomy to correct a bile duct stricture complication from the cholecystectomy, ascending cholangitis was diagnosed by clinical presentation of fever and right upper quadrant pain and imaging revealing pneumobilia. CVID was diagnosed after no response to pneumococcal polysaccharide vaccine, as well as serum IgA and IgG measured below the normal ranges. The patient was prescribed a successful, weekly regimen of 15 g of oral intravenous immunoglobulin (IVIG) ten percent liquid (Gammaplex® 10%, 5 gm/50 mL). Conclusion: Oral human IVIG is a novel treatment and has been infrequently utilized for management of chronic rotavirus, necrotizing enterocolitis, diarrhea, HIV enteropathy, irritable bowel syndrome, and malnutrition. This is the first case of recurrent ascending cholangitis as the primary manifestation of CVID, as well as successful treatment of this condition with oral IVIG, in the literature. Article History: Date received: 06/07/2019 Date accepted: 08/04/2019 Corresponding Author: Marija Rowane, OMS E-mail: [email protected] Introduction: lymphoma, and cholangitis.2-5 Three studies have Common variable immunodeficiency reported associations of cholangitis and CVID or (CVID) is a heterogeneous group of primary primary immunodeficiences,3-5 although we report immune deficiency disorders (PIDD) characterized the first case of recurrent ascending cholangitis as by heightened susceptibility to the primary manifestation of CVID. In addition, this hypogammagloblunemia, insufficient vaccination case demonstrated the first reported successful responses, autoimmune and non-infectious treatment of this condition with oral human inflammatory co-morbidities, and sinopulmonary intravenous immunoglobulin (IVIG). and gastrointestinal (GI) infections.1 GI conditions A 61-year-old female with a history of manifest in 20 to 50% of CVID patients and include cholecystectomy and gastric bypass presented with esophageal candidiasis, diarrhea, nodular lymphoid recurrent ascending cholangitis every other week for hyperplasia, autoimmune enteropathy, irritable eight years. After a hepaticojejunostomy to correct a bowel disease-like colitis, pernicious anemia, gastric bile duct stricture complication from the adenocarcinoma, B cell immunophenotype cholecystectomy, the patient had been experiencing 11 Ascending Cholangitis Treated with Oral IVIG ISSN: 2689-7644 Volume 1 Issue 1 Pages: 11 - 13 DOI:10.32778/SPVS.71366.2020.3 recurrent episodes of right upper quadrant (RUQ) properties of Ig fragment enable sustained active pain with fever. Over a 10-month period, the patient binding and reduced bacterial enterotoxin, had been prescribed seven courses of oral endotoxin, and exotoxin activity.7 However, further antibiotics, including ciprofloxacin and controlled studies are necessary to investigate the metronidazole. These were increased to three per optimal dose and mechanisms of this novel route of course, followed by biweekly regimens. Ascending IVIG administration. cholangitis was diagnosed by fever and RUQ pain in PIDD GI or hepatobiliary complications the clinical presentation and supported by CT and may manifest as infections, autoimmune MRI imaging revealing pneumobilia. phenomena, unregulated inflammatory conditions, Both serum IgA and IgG measured below malignancies, and diseases secondary to therapeutic Downloaded from http://meridian.allenpress.com/scholar/article-pdf/1/1/11/2409933/i2689-7644-1-1-11.pdf by guest on 27 September 2021 the normal ranges, at 58 mg/dL (normal range, 70- intervention.2 GI conditions are reported in up to 400 mg/dL) and 571 mg/dL (normal range, 700- 50% of CVID patients, with infectious diarrhea as 1600 mg/dL), respectively. The pneumococcal the most common symptom.1,3 Gastric vaccination did not elicit a serologic response. adenocarcinoma, immune-mediated enteropathy, Alkaline phosphatase (ALP, 216 U/L) and alanine nodular lymphoid hyperplasia of the GI tract, small aminotransferase (ALT, 82 U/L) levels were above intestine bacterial overgrowth, small bowel villous the normal limits. atrophy, and gastritis have also been noted in CVID The patient began a weekly regimen of 15 g cases.1 Hepatic manifestations, most commonly of oral IVIG ten percent liquid (Gammaplex® 10%, hepatitis and liver granulomas, are less frequent but 5 gm/50 mL). After the first two courses of oral have been documented in 9 to 12% of patients with IVIG, the patient did not experience symptoms of CVID.1,3 Autoimmune liver diseases, such as cholangitis. She continued this treatment plan primary biliary cirrhosis and autoimmune hepatitis, without return of symptoms. and nodular regenerative hyperplasia (NRH) are rare but have also been noted in the literature.3 Discussion: There are sparse publications reporting International interest in utilizing oral human, hepatobiliary manifestations of CVID, such as bovine, or chicken egg–derived Ig for prophylaxis cholangitis.3-5 Mahdavinia et al. described the first and treatment of childhood malnutrition and two CVID cases associated with primary sclerosing gastrointestinal conditions, emerged several decades cholangitis (PSC), an inflammatory autoimmune ago.6 Several studies preventing necrotizing liver disease of chronic biliary epithelium causing enterocolitis or managing rotavirus diarrhea offer chronic cholestasis, multifocal bile duct strictures, evidence of reduced symptoms through this novel and potential complications of cirrhosis and route of administration.6 Losonsky et al. reported malignancy.3 A 66-year-old male presenting with approximately 25% recovery of chronic diarrhea or pruritus and elevated liver enzyme was diagnosed rotavirus, as well as recovered immunological with PSC, supported by endoscopic retrograde activity in three children with unspecified immune cholangiopancreatography and liver biopsy.3 After a deficiency.7 decade of recurrent urinary tract infections, Due to its antigen-neutralizing activity and Clostridium difficile, ulcerative colitis, pneumonias, anti-inflammatory property, orally administered Ig low immunoglobulin titers and negative PPSV23 may lower risk of systemic allergic response, confirmed a CVID diagnosis.3 Mahdavinia et al. also hematological diseases, and endotoxin absorption.6-7 detailed a 29-year-old female CVID patient with a Oral Ig may improve intestinal barrier function and, history of recurrent sinopulmonary, urinary tract, thus, prevent increased permeability, which may and giardia infections, presenting with pruritus, manifest in severely ill patients with higher fatigue, and elevated liver enzymes. Magnetic susceptibility to endotoxemia and sepsis.6 Most resonance cholangiopancreatogram and liver biopsy studies assessing effectiveness of orally-administered verified a PSC diagnosis.3 Both CVID cases were Ig (particularly IgG) from human or bovine serum managed with IVIG.3 Germinaro et al. documented indicate resistance of degradation from gastric acid a CVID case diagnosed after presentation of and proteolytic enzyme exposure.7 The physical hypogammaglobulinemia and numerous episodes of 12 Ascending Cholangitis Treated with Oral IVIG ISSN: 2689-7644 Volume 1 Issue 1 Pages: 11 - 13 DOI:10.32778/SPVS.71366.2020.3 pneumonia, sinusitis, and cholangitis.4 IVIG and References: later subcutaneous IgG treatment significantly 1. Ebert S, Bracken S, Woosley J, Greene KG, Hansen reduced the frequency of infections.4 A study by J, Lobo J, et al. Common variable immunodeficiency Pikkarainen et al. investigated the gastrointestinal (CVID). Rare Rheumatic Diseases of Immunologic phenotype of CVID in a cohort of 105 Finish Dysregulation. 2019;59-85. patients, five of which were diagnosed with PSC or 2. Al-Muhsen SZ. Gastrointestinal and hepatic manifestations of primary immune deficiency CVID-associated cholangitis.5 The present report of diseases. Saudi J Gastroenterol [Internet]. 2009 [cited recurrent ascending cholangitis is the first 2019 Aug 16];16(2):66-74. Available from: specifically
Recommended publications
  • Choledochoduodenal Fistula Complicatingchronic
    Gut: first published as 10.1136/gut.10.2.146 on 1 February 1969. Downloaded from Gut, 1969, 10, 146-149 Choledochoduodenal fistula complicating chronic duodenal ulcer in Nigerians E. A. LEWIS AND S. P. BOHRER From the Departments ofMedicine and Radiology, University ofIbadan, Nigeria Peptic ulceration was thought to be rare in Nigerians SOCIAL CLASS All the patients were in the lower until the 1930s when Aitken (1933) and Rose (1935) socio-economic class. This fact may only reflect the reported on this condition. Chronic duodenal ulcers, patients seen at University College Hospital. in particular, are being reported with increasing frequency (Ellis, 1948; Konstam, 1959). The symp- AETIOLOGY Twelve (92.3 %) of the fistulas resulted toms and complications of duodenal ulcers in from chronic duodenal ulcer and in only one case Nigerians are the same as elsewhere, but the relative from gall bladder disease. incidence of these complications differs markedly. Pyloric stenosis is the commonest complication CLINICAL FEATURES There were no special symp- followed by haematemesis and malaena in that order toms or signs for this complication. All patients (Antia and Solanke, 1967; Solanke and Lewis, except the one with gall bladder disease presented 1968). Perforation though present is not very com- with symptoms of chronic duodenal ulcer or with mon. those of pyloric stenosis of which theie were four A remarkable complication found in some of our cases. In the case with gall bladder disease the history patients with duodenal ulcer who present them- was short and characterized by fever, right-sided selves for radiological examination is the formation abdominal pain, jaundice, and dark urine.
    [Show full text]
  • 16. Questions and Answers
    16. Questions and Answers 1. Which of the following is not associated with esophageal webs? A. Plummer-Vinson syndrome B. Epidermolysis bullosa C. Lupus D. Psoriasis E. Stevens-Johnson syndrome 2. An 11 year old boy complains that occasionally a bite of hotdog “gives mild pressing pain in his chest” and that “it takes a while before he can take another bite.” If it happens again, he discards the hotdog but sometimes he can finish it. The most helpful diagnostic information would come from A. Family history of Schatzki rings B. Eosinophil counts C. UGI D. Time-phased MRI E. Technetium 99 salivagram 3. 12 year old boy previously healthy with one-month history of difficulty swallowing both solid and liquids. He sometimes complains food is getting stuck in his retrosternal area after swallowing. His weight decreased approximately 5% from last year. He denies vomiting, choking, gagging, drooling, pain during swallowing or retrosternal pain. His physical examination is normal. What would be the appropriate next investigation to perform in this patient? A. Upper Endoscopy B. Upper GI contrast study C. Esophageal manometry D. Modified Barium Swallow (MBS) E. Direct laryngoscopy 4. A 12 year old male presents to the ER after a recent episode of emesis. The parents are concerned because undigested food 3 days old was in his vomit. He admits to a sensation of food and liquids “sticking” in his chest for the past 4 months, as he points to the upper middle chest. Parents relate a 10 lb (4.5 Kg) weight loss over the past 3 months.
    [Show full text]
  • An Osteopathic Approach to Gastrointestinal Disease
    REVIEW An Osteopathic Approach to Gastrointestinal Disease: Somatic Clues for Diagnosis and Clinical Challenges Associated With Helicobacter pylori Antibiotic Resistance Alicia Smilowicz, DO From HealthCalls LLC The estimated prevalence of gastritis in the general US population is approxi- in Portland, Maine, and mately 50%. Patients with gastrointestinal disease often present to the primary the University of New England College of care practitioner with dyspepsia and abdominal pain. Osteopathic palpatory Osteopathic Medicine in evaluation suggests that there is an association among gastrointestinal dis- Biddeford, Maine. ease, the presence of posterior midthoracic pain, and chronic headache. On Financial Disclosures: the basis of findings from a review of the literature, the author assesses the po- None reported. tential etiologic mechanisms of this clinical association. Possible mechanisms Address correspondence to include the physiologic function of the vagus nerve, a neural convergence Alicia Smilowicz, DO, 466 Ocean Ave, Portland, model, and the inherent properties of Helicobacter pylori. To demonstrate the ME 04103-5718. clinical significance of these mechanisms, the author presents the case of a E-mail: docsmilo 30-year-old woman with headache, thoracic discomfort, and gastritis associ- @yahoo.com ated with H pylori infection. The author suggests that successful treatment of Received August 2, 2012; patients with gastrointestinal disease includes osteopathic manipulative treat- revision received November 21, 2012; ment, behavioral modification, and pharmacotherapy, even when challenged accepted by antibiotic resistance. January 6, 2013. J Am Osteopath Assoc. 2013;113(5):404-416 n the practice of clinical medicine, we commonly associate dyspepsia, abdominal pain, nausea, and anorexia with the possible existence of pathologic mechanisms for gastro- Iintestinal disease.
    [Show full text]
  • Imaging of Biliary Infections
    3 Imaging of Biliary Infections Onofrio Catalano, MD1 Ronald S. Arellano, MD2 1 Division of Abdominal Imaging, Department of Radiology, Address for correspondence Onofrio Catalano, MD, Division of Massachusetts General Hospital, Harvard Medical School, Abdominal Imaging, Department of Radiology, Massachusetts Boston, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, 2 Division of Interventional Radiology, Department of Radiology, Boston, MA 02114 (e-mail: [email protected]). Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts Dig Dis Interv 2017;1:3–7. Abstract Biliary tract infections cover a wide spectrum of etiologies and clinical presentations. Imaging plays an important role in understanding the etiology and as well as the extent Keywords of disease. Imaging also plays a vital role in assessing treatment response once a ► biliary infections diagnosis is established. This article will review the imaging findings of commonly ► cholangitides encountered biliary tract infectious diseases. ► parasites ► immunocompromised ► echinococcal Infections of the biliary tree can have a myriad of clinical and duodenum can lead toa cascade ofchanges tothehost immune imaging manifestations depending on the infectious etiolo- defense mechanisms of chemotaxis and phagocytosis.7 The gy, underlying immune status of the patient and extent of resultant lackof bile and secretory immunoglobulin A from the involvement.1,2 Bacterial infections account for the vast gastrointestinal tract lead
    [Show full text]
  • Progress Report Intestinal Malabsorption and the Skin
    Gut: first published as 10.1136/gut.12.11.938 on 1 November 1971. Downloaded from Gut, 1971, 12, 938-947 Progress report Intestinal malabsorption and the skin The interrelationship between the gut and the skin is complex. It is certainly not a one-way system, and just as the gut can affect the skin so can the skin affect the gut: in fact there are four ways in which diseases of the skin and gut can be interrelated1' 2, namely, (1) malabsorption can cause a rash; (2) a rash can cause malabsorption; (3) skin abnormalities and malabsorption can have a common cause; and (4) skin disease and malabsorption can be related indirectly. Group I In this instance the rash arises as the result of malabsorption and disappears when the malabsorption is corrected. The concept was first formulated by William Hillary in 17593 and the idea was kept alive by Whitfield and his 'dermatitis colonica'.4 The early literature on the subject has been reviewed by Wells.5 Two groups ofphysicians6" 7 have looked at the incidence of rashes in adults with malabsorption and have quoted figures of 20%6 and 10%7 respectively. Conversely, in our dermatology department we have screened http://gut.bmj.com/ over 200 patients with the appropriate rashes (see below) and have not found clinical coeliac disease to be responsible for any of them. We have in the last seven years seen two patients with rashes secondary to coeliac disease but these had bowel symptoms as well as a rash at the time they presented to us.
    [Show full text]
  • Epstein–Barr Virus and Helicobacter Pylori Co-Infection in Non-Malignant Gastroduodenal Disorders
    pathogens Review Epstein–Barr Virus and Helicobacter Pylori Co-Infection in Non-Malignant Gastroduodenal Disorders Ramsés Dávila-Collado 1, Oscar Jarquín-Durán 1, Le Thanh Dong 2 and J. Luis Espinoza 3,* 1 Faculty of Medicine, UNIDES University, Managua 11001, Nicaragua; [email protected] (R.D.-C.); [email protected] (O.J.-D.) 2 Faculty of Medical Technology, Hanoi Medical University, Hanoi 116001, Vietnam; [email protected] 3 Faculty of Health Sciences, Kanazawa University, Kodatsuno 5-11-80, Kanazawa 920-0942, Ishikawa, Japan * Correspondence: luis@staff.kanazawa-u.ac.jp Received: 20 January 2020; Accepted: 5 February 2020; Published: 6 February 2020 Abstract: Epstein–Barr virus (EBV) and Helicobacter pylori (H. pylori) are two pathogens associated with the development of various human cancers. The coexistence of both microorganisms in gastric cancer specimens has been increasingly reported, suggesting that crosstalk of both pathogens may be implicated in the carcinogenesis process. Considering that chronic inflammation is an initial step in the development of several cancers, including gastric cancer, we conducted a systematic review to comprehensively evaluate publications in which EBV and H. pylori co-infection has been documented in patients with non-malignant gastroduodenal disorders (NMGDs), including gastritis, peptic ulcer disease (PUD), and dyspepsia. We searched the PubMed database up to August 2019, as well as publication references and, among the nine studies that met the inclusion criteria, we identified six studies assessing EBV infection directly in gastric tissues (total 949 patients) and three studies in which EBV infection status was determined by serological methods (total 662 patients).
    [Show full text]
  • Candida Ball in the Esophagus
    Case Report Adv Res Gastroentero Hepatol Volume 6 Issue 1 - June 2017 DOI: 10.19080/ARGH.2017.06.555677 Copyright © All rights are reserved by Mohammad Al-Shoha Case Report: Candida Ball in the Esophagus Mohammad Al-Shoha MD1*, Nayana George MD1 and Benjamin Tharian MD1,2 1Department of Internal Medicine, University of Arkansas for Medical Sciences, USA 2Department of Medicine, Division of Gastroenterology and Hepatology, USA Submission: February 10, 2017; Published: June 16, 2017 *Corresponding author: Mohammad Al-Shoha, Department of Internal Medicine, University of Arkansas for Medical Sciences, Internal Medicine, 4301 W. Markham Street, Slo t#634, Little Rock, AR 72205, USA, Tel: , Email: [email protected] Abstract Candida albicans is the most common well known cause of infectious esophagitis. Although most patients with Candida esophagitis are immunocompromised, about 25% have scleroderma, achalasia, or other causes of esophageal dysmotility that would allow the fungi to overgrow but it has been reported in the literature that it can manifest as an esophageal mass. We are reporting a case of recurrent esophageal candidiasis manifestingand colonize on the the esophagus, Esophagogastroduodenoscopy with subsequent esophagitis (EGD) as [1,2]. an obstructing Esophageal mass. candidiasis usually manifests as white mucosal plaque-like lesions Case report showed normal complete blood count, acute renal injury with A 70-year old African American male patient who presented creatinine 11.5mg/dL, sodium 127, potassium 3.9, normal with complaints of gradually worsening dysphagia for both TSH and negative HIV testing. Repeat EGD revealed a mass at solids and liquids with an EGD revealing a nearly obstructing 25cm from incisors (image A,B) with a biopsy revealing active mass in the esophagus 25cm from incisors occupying 75-99% of esophagitis with intraepithelial fungi consistent with Candida the circumference of the esophagus with the inability to traverse with no dysplasia and malignancy.
    [Show full text]
  • Clinical Biliary Tract and Pancreatic Disease
    Clinical Upper Gastrointestinal Disorders in Urgent Care, Part 2: Biliary Tract and Pancreatic Disease Urgent message: Upper abdominal pain is a common presentation in urgent care practice. Narrowing the differential diagnosis is sometimes difficult. Understanding the pathophysiology of each disease is the key to making the correct diagnosis and providing the proper treatment. TRACEY Q. DAVIDOFF, MD art 1 of this series focused on disorders of the stom- Pach—gastritis and peptic ulcer disease—on the left side of the upper abdomen. This article focuses on the right side and center of the upper abdomen: biliary tract dis- ease and pancreatitis (Figure 1). Because these diseases are regularly encountered in the urgent care center, the urgent care provider must have a thorough understand- ing of them. Biliary Tract Disease The gallbladder’s main function is to concentrate bile by the absorption of water and sodium. Fasting retains and concentrates bile, and it is secreted into the duodenum by eating. Impaired gallbladder contraction is seen in pregnancy, obesity, rapid weight loss, diabetes mellitus, and patients receiving total parenteral nutrition (TPN). About 10% to 15% of residents of developed nations will form gallstones in their lifetime.1 In the United States, approximately 6% of men and 9% of women 2 have gallstones. Stones form when there is an imbal- ©Phototake.com ance in the chemical constituents of bile, resulting in precipitation of one or more of the components. It is unclear why this occurs in some patients and not others, Tracey Q. Davidoff, MD, is an urgent care physician at Accelcare Medical Urgent Care in Rochester, New York, is on the Board of Directors of the although risk factors do exist.
    [Show full text]
  • Treatment of Gastric Candidiasis in Patients with Gastric Ulcer Disease: Are Antifungal Agents Necessary?
    Gut and Liver, Vol. 3, No. 1, March 2009, pp. 31-34 original article Treatment of Gastric Candidiasis in Patients with Gastric Ulcer Disease: Are Antifungal Agents Necessary? Min Kyu Jung, Seong Woo Jeon, Chang Min Cho, Won Young Tak, Young Oh Kweon, Sung Kook Kim, and Yong Hwan Choi Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea Background/Aims: The inadequacy of information on ing; antimycotic therapy was advocated in such cases. By the treatment of gastric candidiasis with antifungal contrast, Minoli et al.3 and Gotlieb-Jensen et al.4 consid- agents promoted us to evaluate patients with fungal ered it an epiphenomenon without any significance. infections who had gastric ulcers and assess the However, because the issue remains unresolved we retro- need for proton-pump inhibitors or antifungal agents. spectively reviewed fungal infections in patients with gas- Methods: Sixteen patients were included in the study. tric ulcers to determine the need for proton pump in- The criterion for the diagnosis of candidiasis was find- hibitor and/or antifungal agents. ing yeast and hyphae in the tissue or an ulcer on histological sections of biopsy samples. Surface fungi were not considered infections. Results: In all cases MATERIALS AND METHODS with benign ulcers, follow-up endoscopy performed 6 weeks after proton-pump-inhibitor treatment revealed We reviewed the pathology specimens and medical re- that the ulcer had improved without antifungal medi- cords of patients with gastroduodenal ulcers diagnosed by cation. However, in patients with malignant ulcers, upper gastrointestinal endoscopy at Kyungpook National surgical resection was necessary for a definitive cure.
    [Show full text]
  • ACCP Toolkit the 2016 ACCP Pharmacotherapy Didactic Curriculum Toolkit
    ACCP Toolkit The 2016 ACCP Pharmacotherapy Didactic Curriculum Toolkit 2016 Educational Afairs Committee, American College of Clinical Pharmacy Terry L. Schwinghammer (Chair), Andrew J. Crannage (Vice Chair), Eric G. Boyce, Bridget Bradley, Alyssa Christensen, Henry M. Dunnenberger, Michelle Fravel, Holly Gurgle, Drayton A. Hammond, Jennifer Kwon, Douglas Slain, and Kurt A. Wargo. Approved by the American College of Clinical Pharmacy Board of Regents on July 18, 2016. The purpose of the 2009 and 2016 ACCP Pharmacother- ORGAN SYSTEMS AND DISEASE STATE TOPICS apy Didactic Curriculum Toolkits is to provide guid- ance to schools and colleges of pharmacy in developing, Cardiovascular Disorders maintaining, and modifying their curricula.1,2 The 2016 1 Acute coronary syndromes (STEMI, NSTEMI, unstable ACCP Educational Affairs Committee reviewed recent angina) medical literature and other documents to identify dis- 1 Atherosclerotic cardiovascular disease, primary ease states that are responsive to drug therapy. Disease prevention frequency, socioeconomic burden to society, and impact 1 Atherosclerotic cardiovascular disease, secondary of pharmacist involvement in medication therapy were prevention considered in determining which topics to include in the updated pharmacotherapy toolkit. This updated toolkit 1 Arrhythmias, atrial (e.g., atrial fbrillation) is intended to provide valuable guidance to schools and 1 Basic life support (BLS) colleges of pharmacy as they develop, maintain, and 1 Dyslipidemia modify their curricula to keep pace with major scientific 1 Heart failure, chronic advances and practice changes. 1 Hypertension In the 2016 toolkit, diseases and content topics are 1 Ischemic heart disease, stable organized by organ system, when feasible, and grouped 1 Venous thromboembolism into tiers defined by practice competency.
    [Show full text]
  • Nutrition Care for Persons Infected with the Hepatitis C Virus
    HHeeppaattiittiiss CC:: NNuuttrriittiioonn CCaarree QQ QQ QQ QQ QQ QQ QQ QQ QQ QQ QQ QQ QQ QQ QQ QQ QQ QQ QQ QQ QQ QQ QQ QQ QQ QQ QQ QQ QQ QQ CCaannaaddiiaann GGuuiiddeelliinneess ffoorr HHeeaalltthh CCaarree PPrroovviiddeerrss Endorsed by: ♦ Canadian Association for the Study of the Liver ♦ Canadian Association of Hepatology Nurses ♦ Canadian Hemophilia Society ♦ Canadian Liver Foundation ♦ Hepatitis C Society of Canada Funding for the development and Copyright 2003, Dietitians of Canada. dissemination of these guidelines was All rights reserved. provided by Health Canada, Community Acquired Infections Division: This document, as well as an online <www.healthcanada.ca/hepc>. professional education program and patient education handouts, are available from the These guidelines are designed to serve as a Dietitians of Canada website at general framework to assist decision <www.dieteticsatwork.com>. making for nutritional management of Permission is granted to download and patients infected with the hepatitis C virus reproduce the documents in their entirety. and are based on the best information available at the time of publication. The particular needs of individuals infected with Également disponible en français sous le the hepatitis C virus will determine how titre, Hépatite C : Soins nutritionnels – these guidelines are used. The skill and Lignes directrices canadiennes pour les judgement of the health care provider is intervenants de la santé. important in making health care decisions. The opinions expressed in this document do not
    [Show full text]
  • Helicobacter Pylori: Types of Diseases, Diagnosis, Treatment and Causes Of
    Journal of Mind and Medical Sciences Volume 3 | Issue 2 Article 7 2016 Helicobacter pylori: types of diseases, diagnosis, treatment and causes of therapeutic failure Cosmin Vasile Obleaga Craiova University of Medicine and Pharmacy, Department of Surgery, [email protected] Cristin Constantin Vere Craiova University of Medicine and Pharmacy, Department of Gastroenterology Ionica Daniel Valcea Craiova University of Medicine and Pharmacy, Department of Surgery Mihai Calin Ciorbagiu Craiova University of Medicine and Pharmacy, Department of Surgery Emil Moraru Craiova University of Medicine and Pharmacy, Department of Surgery See next page for additional authors Follow this and additional works at: http://scholar.valpo.edu/jmms Part of the Digestive System Diseases Commons, Gastroenterology Commons, and the Surgery Commons Recommended Citation Obleaga, Cosmin Vasile; Vere, Cristin Constantin; Valcea, Ionica Daniel; Ciorbagiu, Mihai Calin; Moraru, Emil; and Mirea, Cecil Sorin (2016) "Helicobacter pylori: types of diseases, diagnosis, treatment and causes of therapeutic failure," Journal of Mind and Medical Sciences: Vol. 3 : Iss. 2 , Article 7. Available at: http://scholar.valpo.edu/jmms/vol3/iss2/7 This Review Article is brought to you for free and open access by ValpoScholar. It has been accepted for inclusion in Journal of Mind and Medical Sciences by an authorized administrator of ValpoScholar. For more information, please contact a ValpoScholar staff member at [email protected]. Helicobacter pylori: types of diseases, diagnosis, treatment and causes of therapeutic failure Cover Page Footnote This study was financially supported by the project: "The or le of Helicobacter pylori infection in upper gastrointestinalnon-variceal bleedings. A clinical, endoscopic, serological and histopathological study" sponsored by "The eM dical Center Amaradia"(Contract No.
    [Show full text]