Showing papers in "Cleveland Clinic Journal of Medicine in 2017"
TL;DR: While the efficacy, scalability, and affordability of exercise for the prevention and management of type 2 diabetes are well established, sustainability of exercise recommendations for patients remains elusive.
Abstract: Exercise is typically one of the first management strategies advised for patients newly diagnosed with type 2 diabetes. Together with diet and behavior modification, exercise is an essential component of all diabetes and obesity prevention and lifestyle intervention programs. Exercise training, whether aerobic or resistance training or a combination, facilitates improved glucose regulation. High-intensity interval training is also effective and has the added benefit of being very time-efficient. While the efficacy, scalability, and affordability of exercise for the prevention and management of type 2 diabetes are well established, sustainability of exercise recommendations for patients remains elusive.
181 citations
TL;DR: Cardiac amyloidosis (CA), once thought to be a rare disease, is increasingly recognized due to enhanced clinical awareness and better diagnostic imaging, and reversingAmyloid deposition in affected organs using monoclonal antibodies is actively being tested in clinical trials.
Abstract: Cardiac amyloidosis (CA), once thought to be a rare disease, is increasingly recognized due to enhanced clinical awareness and better diagnostic imaging. CA is becoming of heightened interest to the cardiology community given more effective treatment strategies for light chain amyloidosis (AL), as well as emerging therapies for transthyretin amyloidosis (ATTR). Furthermore, reversing amyloid deposition in affected organs using monoclonal antibodies is actively being tested in clinical trials. A high index of suspicion and a systematic approach to the diagnosis of CA can lead to referral to a center of expertise for timely treatment.
123 citations
TL;DR: It is shown that hyperkalemia is most common in patients with renal impairment, can be life-threatening, and requires a multidisciplinary approach.
Abstract: Hyperkalemia results either from the shift of potassium out of cells or from abnormal renal potassium excretion. Cell shift leads to transient increases in the plasma potassium concentration, whereas decreased renal excretion of potassium leads to sustained hyperkalemia. Impairments in renal potassium excretion can be the result of reduced sodium delivery to the distal nephron, decreased mineralocorticoid level or activity, or abnormalities in the cortical collecting duct. In some instances, all 3 of these perturbations are present. Excessive intake of potassium can cause hyperkalemia but usually in the setting of impaired renal function. We discuss the clinical manifestations of hyperkalemia and outline an approach to its diagnosis and treatment.
61 citations
TL;DR: Experts now recommend that all Helicobacter pylori infections be eradicated unless there are compelling reasons not to, with due consideration of resistance.
Abstract: Experts now recommend that all Helicobacter pylori infections be eradicated unless there are compelling reasons not to. As with other infectious diseases, effective therapy should be based on susceptibility.
53 citations
TL;DR: Percutaneous coronary intervention for coronary artery chronic total occlusion is an important treatment to be used in conjunction with non-CTO PCI, coronary artery bypass grafting, and optimal medical therapy to achieve complete revascularization in patients with coronary artery disease.
Abstract: Percutaneous coronary intervention (PCI) for coronary artery chronic total occlusion (CTO) is an important treatment to be used in conjunction with non-CTO PCI, coronary artery bypass grafting, and optimal medical therapy to achieve complete revascularization in patients with coronary artery disease.
43 citations
TL;DR: Managing chronic constipation involves identifying and treating secondary causes, instituting lifestyle changes, prescribing pharmacologic and nonpharmacologic therapies, and, occasionally, referring for surgery.
Abstract: Managing chronic constipation involves identifying and treating secondary causes, instituting lifestyle changes, prescribing pharmacologic and nonpharmacologic therapies, and, occasionally, referring for surgery. Several new drugs have been approved, and others are in the pipeline.
37 citations
TL;DR: Physicians should be aware of the risks of iodine deficiency and the indications for iodine supplementation, especially in women who are pregnant or lactating, and in vegans and those who are lactose-intolerant.
Abstract: Iodine is crucial for thyroid hormone synthesis and fetal neurodevelopment. Major dietary sources of iodine in the United States are dairy products and iodized salt. Potential consequences of iodine deficiency are goiter, hypothyroidism, cretinism, and impaired cognitive development. Although iodine status in the United States is considered sufficient at the population level, intake varies widely across the population, and the percentage of women of childbearing age with iodine deficiency is increasing. Physicians should be aware of the risks of iodine deficiency and the indications for iodine supplementation, especially in women who are pregnant or lactating.
35 citations
TL;DR: Direct oral anticoagulants (DOACs) have become an important option for patients as reflected in the most recent American College of Chest Physician treatment guidelines.
Abstract: Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism, is a common cardiovascular disease associated with significant morbidity ranging from painful leg swelling, chest pain, shortness of breath, and even death. Long-term complications include recurrent VTE, postpulmonary embolism syndrome, chronic thromboembolic pulmonary hypertension, and postthrombotic syndrome (PTS). Management of VTE requires immediate anticoagulation therapy based on a risk assessment for bleeding. Direct oral anticoagulants (DOACs) have become an important option for patients as reflected in the most recent American College of Chest Physician treatment guidelines.
35 citations
TL;DR: The US Centers for Disease Control and Prevention (CDC) is undertaking a nationwide effort to appropriately improve antibiotic use in inpatient and outpatient settings.
Abstract: Improving our antibiotic use is critical to the safety of our patients and the future of medicine. This can improve patient outcomes, save money, reduce resistance, and help prevent negative consequences such as Clostridium difficile infection. The US Centers for Disease Control and Prevention (CDC) is undertaking a nationwide effort to appropriately improve antibiotic use in inpatient and outpatient settings.
35 citations
TL;DR: New guidelines for type 2 diabetes expand use of metabolic surgery to patients with a lower body mass index, more effective than lifestyle or medical management in achieving glycemic control, sustained weight loss, and reducing diabetes comorbidities.
Abstract: The term metabolic surgery describes bariatric surgical procedures used primarily to treat type 2 diabetes and related metabolic conditions. Originally, bariatric surgery was used as an alternative weight-loss therapy for patients with severe obesity, but clinical data revealed its metabolic benefits in patients with type 2 diabetes. Metabolic surgery is more effective than lifestyle or medical management in achieving glycemic control, sustained weight loss, and reducing diabetes comorbidities. Perioperative adverse events are similar to other gastrointestinal surgeries. New guidelines for type 2 diabetes expand use of metabolic surgery to patients with a lower body mass index.
33 citations
TL;DR: The most common reason physicians cite for withholding anticoagulation in older patients with atrial fibrillation is a perception of a high risk of falling and associated bleeding, especially intracranial hemorrhage.
Abstract: Guidelines for managing atrial fibrillation recommend systemic anticoagulation for almost all patients age 65 and older, but in practice up to 50% of older patients do not receive maintenance anticoagulation therapy. The most common reason physicians cite for withholding anticoagulation in older patients with atrial fibrillation is a perception of a high risk of falling and associated bleeding, especially intracranial hemorrhage.
TL;DR: These contraceptives are contraindicated in women who have migraine with aura, but benefit vs risk is debatable and ultra-low-dose formulations—those that contain less than 20 µg of ethinyl estradiol—may help prevent menstrual migraine and reduce the frequency of aura.
Abstract: Combined hormonal contraceptives are contraindicated in women who have migraine with aura, in whom these drugs can increase the risk of ischemic stroke. However, this contraindication is based on data from the 1960s and 1970s, when oral contraceptives contained much higher doses of estrogen. Stroke risk is not significantly increased with today's preparations, many of which contain less than 30 μg of ethinyl estradiol. Further, in continuous regimens, ultra-low-dose formulations--those that contain less than 20 μg of ethinyl estradiol--may help prevent menstrual migraine and reduce the frequency of aura.
TL;DR: This article reviews the available weight-loss drugs, their efficacy and side effects, and their best clinical use.
Abstract: Weight-loss drugs are being evaluated for their role in obesity management. This article reviews the available weight-loss drugs, their efficacy and side effects, and their best clinical use.
TL;DR: Primary care physicians are uniquely positioned to screen for BPH, conduct a timely diagnostic workup, and if indicated, initiate medical therapy, which is underutilized in the primary care setting.
Abstract: Benign prostatic hyperplasia (BPH) is a common cause of lower urinary tract symptoms in aging men, worsening their quality of life. Primary care physicians are uniquely positioned to screen for BPH, conduct a timely diagnostic workup, and if indicated, initiate medical therapy. A number of safe and effective medical treatments are available to alleviate symptoms, delay disease progression, and lessen the chance of needing surgery for BPH.
TL;DR: How to evaluate and manage concussion, including treatment of the most common symptoms, is outlined, including initial therapy involves several days of cognitive and physical rest, then a gradual return to activities.
Abstract: Concussion is a common problem often managed by nonneurologists. It is often accompanied by headaches, dizziness, sleep disturbance, psychiatric symptoms, and cognitive issues. Here, we outline how to evaluate and manage concussion, including treatment of the most common symptoms.
TL;DR: The patient was diagnosed with HIV-related encephalopathy and disseminated Mycobacterium tuberculosis infection.
Abstract: The patient was diagnosed with HIV-related encephalopathy and disseminated Mycobacterium tuberculosis infection.
TL;DR: For patients in cardiogenic shock, several devices can serve as a “bridge,” ie, provide circulatory support and allow the patient to live long enough to recover or to receive a heart transplant or a long-term device.
Abstract: For patients in cardiogenic shock, several devices can serve as a "bridge," ie, provide circulatory support and allow the patient to live long enough to recover or to receive a heart transplant or a long-term device. Options include an intra-aortic balloon pump, TandemHeart, Impella, extracorporeal membrane oxygenation (ECMO), and CentriMag. Which device to use depends on individual patient needs, local expertise, and anatomic and physiologic considerations.
TL;DR: The use of haloperidol, olanzapine, quetiapines, risperidone, and aripiprazole for delirium in hospitalized patients is reviewed.
Abstract: Consensus panel guidelines advocate for the judicious use of antipsychotic drugs to manage delirium in hospitalized patients when nonpharmacologic measures fail and the patient is in significant distress from symptoms, poses a safety risk to self or others, or is impeding essential aspects of his or her medical care. Here, we review the use of haloperidol, olanzapine, quetiapine, risperidone, and aripiprazole for this purpose.
TL;DR: No optimal dietary strategy exists for patients with obesity and diabetes, and more research is needed to find one that achieves the best adherence based on the patient’s dietary preferences, energy needs, and health status.
Abstract: For individuals who are overweight or obese, weight loss is effective in preventing and improving the management of type 2 diabetes. Together with other lifestyle factors like exercise and behavior modification, diet plays a central role in achieving weight loss. Diets vary based on the type and amount of carbohydrate, fat, and protein consumed to meet daily caloric intake goals. A number of popular diets are reviewed as well as studies evaluating the effect of various diets on weight loss, diabetes, and cardiovascular risk factors. Current trends favor the low-carbohydrate, low-glycemic index, Mediterranean, and very-low-calorie diets. However, no optimal dietary strategy exists for patients with obesity and diabetes, and more research is needed. Given the wide range of dietary choices, the best diet is one that achieves the best adherence based on the patient's dietary preferences, energy needs, and health status.
TL;DR: Patients may need intensive care, nutritional support, antibiotics, and radiologic, endoscopic, or surgical interventions in order to receive optimal multidisciplinary care.
Abstract: Necrosis significantly increases rates of morbidity and mortality in acute pancreatitis. Hospitalists and general internists are on the front lines in identifying severe cases and consulting the appropriate specialists for optimal multidisciplinary care.
TL;DR: Advances in hardware and software and ease of use have brought its application into the clinical arena to the point that providers should become familiar with it and consider it earlier in the evaluation of their patients.
Abstract: Cardiopulmonary exercise testing (CPET) helps in detecting disorders of the cardiovascular, pulmonary, and skeletal muscle systems. It has a class I (indicated) recommendation from the American College of Cardiology and American Heart Association for evaluating exertional dyspnea of uncertain cause and for evaluating cardiac patients being considered for heart transplant. Advances in hardware and software and ease of use have brought its application into the clinical arena to the point that providers should become familiar with it and consider it earlier in the evaluation of their patients.
TL;DR: The authors review recommendations supported by recent research and offer simple practices that integrate medicine and behavioral health for patients with ADHD that combined behavioral and drug therapy is best.
Abstract: In today's changing medical climate, physicians need to treat attention-deficit/hyperactivity disorder (ADHD) better and more cost-effectively. The authors review recommendations supported by recent research and offer simple practices that integrate medicine and behavioral health for patients with ADHD.
TL;DR: Caution is warranted when prescribing antidepressants to pregnant and breastfeeding mothers, but evidence is mounting that the risks of untreated maternal depression outweigh those of pharmacologic treatment for it.
Abstract: Depression is highly prevalent in women of childbearing age, especially during the postpartum period. Early recognition and treatment improve outcomes for mother, developing fetus, and infant. Caution is warranted when prescribing antidepressants to pregnant and breastfeeding mothers, but evidence is mounting that the risks of untreated maternal depression outweigh those of pharmacologic treatment for it.
TL;DR: An overview of hypertension, cardiac complications, and intracranial aneurysms in ADPKD, their pathophysiology, and recent developments in their management is given.
Abstract: Autosomal dominant polycystic kidney disease (ADPKD) has numerous systemic manifestations and complications. This article gives an overview of hypertension, cardiac complications, and intracranial aneurysms in ADPKD, their pathophysiology, and recent developments in their management.
TL;DR: Proper patient education, risk stratification, and modification of antidiabetic medications can reduce the risk of complications during Ramadan.
Abstract: For diabetic patients, fasting during Ramadan, the ninth month of the Islamic calendar, can cause wide fluctuations in blood sugar levels, posing a medical challenge for patients and physicians and increasing the risk of acute metabolic complications including hypoglycemia, hyperglycemia, diabetic ketoacidosis, dehydration, and thrombosis. Proper patient education, risk stratification, and modification of antidiabetic medications can reduce the risk of complications.
TL;DR: Acute marijuana intoxication is associated with reversible changes in the P and T waves and ST segments and these changes can be reversible in both the horizontal and the vertical.
Abstract: A 22-year old man with no cardiac history presented to our emergency department after 5 days of dyspnea, cough, vomiting, and sharp intermittent epigastric pain. He used marijuana chronically and had inhaled it in unusually high amounts for several days before the onset of his symptoms.
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TL;DR: Fitness trackers and smartphone applications that claim to measure various sleep parameters have major shortcomings and limited utility, and patients are now showing the data from their devices to their clinicians with concerns about their quantity or quality of sleep.
Abstract: Consumers have become increasingly interested in using fitness trackers and smartphone applications to quantify sleep. The devices claim to measure various sleep parameters, with the result that patients are now showing the data from their devices to their clinicians with concerns about their quantity or quality of sleep. In general, these devices have major shortcomings and limited utility, as they have not been thoroughly evaluated in clinical populations.
TL;DR: Hypoglycemia secondary to hyperinsulinemia is becoming a more common and therefore more relevant problem with gastric bypass, and is probably more common than initially thought.
Abstract: As the obesity epidemic worsens, more people are opting for weight-loss surgery, including gastric bypass. Of the possible complications associated with this procedure, hypoglycemia secondary to hyperinsulinemia is becoming a more common and therefore more relevant problem.
TL;DR: Improved quality of life and longevity as a result of cardiac implantable electronic devices and new surgical methods and CIED devices may also lead to reduction in CIED infections.
Abstract: Increasing numbers of patients with cardiac disease have improved quality of life and longevity as a result of cardiac implantable electronic devices (CIEDs). CIED infections can involve the generator pocket, bloodstream, or cardiac structures and occur in about 0.5% of de novo CIED implants and approximately 2% of CIED replacements. Prompt diagnosis of CIED infection is beneficial to the success of antibiotic therapy and subsequent device removal to resolve the infection. Measures to prevent CIED infections include assessment of the indication and patient status, strict sterile surgical techniques, preoperative antibiotics, and adequate homeostasis. New surgical methods and CIED devices may also lead to reduction in CIED infections. Further research is needed to better quantify the incidence of CIED, risk factors, and efficacy of surgical techniques to prevent infections.
TL;DR: The statistical methodology behind chi-square and Fisher’s exact tests, which are commonly used in medical research to assess associations between categorical variables, are introduced.
Abstract: This article aims to introduce the statistical methodology behind chi-square and Fisher’s exact tests, which are commonly used in medical research to assess associations between categorical variables. This discussion will use data from a study by Mrozek[1][1] in patients with acute respiratory