Internal medicine

  Turner Syndrome in Adults: Contemporary Management Strategies  Dr Neeraj Manikath , claude.ai Abstract Turner syndrome (TS), affecting approximately 1 in 2,000-2,500 live female births, represents one of the most common sex chromosome abnormalities encountered in clinical practice. While traditionally viewed as a pediatric condition, the expanding lifespan of individuals with TS necessitates that internists develop comprehensive expertise in managing the multisystem manifestations of this condition. This review synthesizes current evidence on the pathophysiology, screening protocols, and contemporary management strategies for TS in adult patients, with emphasis on cardiovascular, endocrine, reproductive, and psychosocial complications. We highlight emerging therapeutic approaches and provide practical clinical pearls for optimizing outcomes in this unique patient population. Introduction Turner syndrome results from complete or partial absence of one X chromosome, with a...

  Sjögren's Syndrome-Associated Renal Tubular Acidosis: A Comprehensive Review  Dr Neeraj Manikath , claude.ai Abstract Sjögren's syndrome (SS) is a systemic autoimmune disorder characterized by lymphocytic infiltration of exocrine glands, with renal involvement occurring in 4.2–67% of cases. Renal tubular acidosis (RTA), particularly distal RTA (type 1), represents the most common renal manifestation and may precede sicca symptoms by years. This review synthesizes current understanding of the pathophysiological mechanisms, diagnostic approaches, and evidence-based management strategies for SS-associated RTA. We emphasize the critical importance of early recognition to prevent devastating complications including nephrocalcinosis, osteomalacia, and hypokalemic paralysis. Contemporary management requires a multidisciplinary approach integrating alkali therapy, immunomodulation, and surveillance for progressive renal disease. Introduction The intersection of Sjögren's synd...

  Hyperuricemia: Contemporary Approaches to Dietary and Pharmacological Management Dr Neeraj Manikath , claude.ai Abstract Hyperuricemia, defined as serum uric acid levels exceeding 6.8 mg/dL (404 μmol/L), represents a growing global health concern with implications extending beyond gout to cardiovascular disease, chronic kidney disease, and metabolic syndrome. This review synthesizes current evidence on dietary modifications and pharmacological interventions for hyperuricemia management, offering practical insights for clinicians managing this increasingly prevalent condition. We explore emerging concepts including the role of fructose metabolism, the gut-kidney axis, and novel therapeutic targets while providing actionable strategies for optimizing patient outcomes. Introduction The prevalence of hyperuricemia has risen dramatically over the past several decades, affecting approximately 20% of adults in Western populations and showing even higher rates in certain Asian countr...

  Medical Management of Osteoarthritis: A Comprehensive Review for the Practicing Internist Dr Neeraj Manikath , claude.ai Abstract Osteoarthritis (OA) remains the most prevalent joint disorder worldwide, affecting over 500 million individuals globally and representing a leading cause of disability in adults. As the population ages and obesity rates rise, the burden of OA continues to escalate, demanding that internists and general practitioners possess sophisticated knowledge of both pharmacological and non-pharmacological management strategies. This review synthesizes current evidence-based approaches to OA management, highlighting practical clinical pearls and emerging therapeutic strategies that can be immediately implemented in clinical practice. Introduction Osteoarthritis represents a heterogeneous group of conditions resulting in similar biological, morphological, and clinical outcomes affecting synovial joints. While traditionally viewed as a "wear and tear" dege...

  Neutropenia: Evaluation and Management - A Comprehensive Review Dr Neeraj Manikath , claude.ai Abstract Neutropenia represents a common hematological abnormality encountered in clinical practice, with implications ranging from benign ethnic variants to life-threatening immunodeficiency states. This review provides an evidence-based approach to the evaluation and management of neutropenia, emphasizing diagnostic strategies, risk stratification, and contemporary therapeutic interventions. We discuss the pathophysiology, classification, and clinical significance of varying degrees of neutropenia, along with practical approaches to infection prevention and treatment optimization. Keywords: Neutropenia, febrile neutropenia, granulocyte colony-stimulating factor, bone marrow failure, agranulocytosis Introduction Neutropenia, defined as an absolute neutrophil count (ANC) below 1,500 cells/μL in most populations, represents a heterogeneous group of disorders with diverse etiologie...