Showing papers in "Dm Disease-a-month in 2018"

Pediatric obesity: Current concepts.

Abstract: This discussion reflects on concepts of obesity in children and adolescents in the early 21st century. It includes reflections on its history, definition, epidemiology, diagnostic perspectives, psychosocial considerations, musculoskeletal complications, endocrine complications and principles of management. In addition to emphasis on diet and exercise, research and clinical applications in the second decade of the 21st century emphasize the increasing use of pharmacotherapy and bariatric surgery for adolescent and adult populations with critical problems of overweight and obesity. We conclude with a discussion of future directions in pediatric obesity management.

Evaluation and management of Non-variceal upper gastrointestinal bleeding.

Abstract: Non-variceal upper gastrointestinal bleeding continues to be an important cause of morbidity and mortality. The most common causes include peptic ulcer disease, Mallory-Weiss syndrome, erosive gastritis, duodenitis, esophagitis, malignancy, angiodysplasias and Dieulafoy's lesion. Initial assessment and early aggressive resuscitation significantly improves outcomes. Upper gastrointestinal endoscopy continues to be the gold standard for diagnosis and treatment. We present a comprehensive review of literature for the evaluation and management of non-variceal upper gastrointestinal bleeding.

Tick borne illness-Lyme disease.

Abstract: Lyme disease is the most commonly reported tick-borneillness in the United States. Thecausative spirochete, Borrelia burgdorferi is transmitted by 4 species of Ixodes tick species. Over 90% of US cases occur in northeasternstates from Maine to Virginia, and in Wisconsin, Minnesota, and Michigan. Infection also takes place in northern California and Oregon. Lyme borreliosis is also diagnosed in parts of Europe, China, and Japan. The white-footed mouse is the primary animal reservoir for B. burgdorferi in the U.S. and the preferred host for nymphal and larval forms of the deer tick. Deer are hosts for the adult ticks but do not carry the spirochete. Signs and symptomsof infection occur in 3 stages; early localized, typified by erythema migrans; early disseminated with a flu-like syndrome, neurologic, and cardiac manifestations; and late, characteristically with arthritis. Although, the term 'Chronic Lyme Disease' has been assigned to many patients with a variety of unexplained symptoms, experts in the field question the validity of this diagnosis and warn against prolonged unproven antimicrobial therapies. Diagnosis relies upon clinical evaluation and is supported by serologic testing using a 2-step process which requires careful interpretation. Treatmentvaries with stage of disease, but normally includes doxycycline, amoxicillin,and ceftriaxone. Currently, no preventative vaccine is available. In some geographic areas, patients may be confected with Babesia, Ehrlichia, and Anaplasma since the same Ixodes ticks transmit these pathogens.

Evaluation and management of variceal bleeding.

Abstract: Acute variceal bleeding is one of the most fatal complications of cirrhosis and is responsible for about one-third of cirrhosis-related deaths. Therefore, every effort should be made to emergently resuscitate the patients, start pharmacotherapy as soon as possible and do endoscopic therapy in a timely manner. Despite the recent advances in treatment, mortality rate is still high. We provide a comprehensive review of evaluation and management of variceal bleeding.

Perspectives on the opioid crisis from pain medicine clinicians.

Abstract: Patients experiencing a terminal drug related event reflect a sentinel event If this pharmacotherapy is a widely used agent, it may be viewed as a catastrophic problem If patients are dying from illegal drug use when the medical establishment fails them by withdrawing or minimizing their medically prescribed medication, then the burden rests with their health care providers, legislation, and insurance carriers to actively participate in a collegial fashion to achieve parity Causing a decay in functionality in previously functional patients, may occur with appropriately prescribed opioid medications addressing non-cancer pain when withdrawing or diminishing either with or without patient consent The members of the medical profession have diminished their prescribing of opioids for their patients out of apparent fear of reprisal, state or federal government sanctions, and other concerned groups Diminishing former dosages or deleting the opioid medication, preferably in concert with the patient, often results in inequitable patient care Enforcing sanctioned decreases or ceasing to prescribe from their former required/established opioid medications precipitate patient discord In absence of opioid misuse, abuse, diversion or addiction based upon medical “guidelines” and with a poor foundation of Evidence Based Medicine the CDC guidelines, it may be masked as a true guideline reflecting a decrement of clinical judgment, wisdom, and compassion This article also discusses the role of pharmacy chains, insurance carriers, and their pharmacy benefit managers (PBMs) contribution to this multidimensional problem There may be a potential solution, identified in this paper, if all the associated political, medical and insurance groups work cohesively to improve patient care This article and the CDC guidelines are not focused at hospice, palliative, end of life care pain management

Evaluation and management of lower gastrointestinal bleeding

Abstract: Lower gastrointestinal bleeding (LGIB) is a common cause of presentation to the emergency department and hospital admissions. The incidence of LGIB increases with age and the most common etiologies are diverticulosis, angiodysplasia, malignancy and anorectal diseases. Foremost modality for evaluation and treatment of LGIB is colonosopy. Other diagnostic tools such as nuclear scintigraphy, computed tomography, angiography and capsule endoscopy are also frequently used in the workup of LGIB. Choice of treatment modality depends on the hemodynamic status of the patient, rate of bleeding, expertise and available resources. We present a comprehensive review of the evaluation and management of LGIB.

Selected mosquito borne illnesses - Dengue.

Abstract: Dengue virus (DENV) (Fig. 1), also sometimes referred to as Dengue virus disease (DVD) is a viral hemorrhagic fever virus (VHF). VHF are a diverse group of viral illnesses characterized by fever, sometimes extreme, and various degrees of bleeding risk, including hemorrhage, shock, and death. DENV is among the most common global mosquito borne illnesses, and is one of the fastest spreading infections worldwide. It is the second most commonly reported mosquito borne illness infecting humans, after malaria. Although the exact epidemiology of VHFs and DENV remain elusive, it is estimated 3 billion persons live at risk in areas where dengue virus (Fig. 1) can be transmitted. With upwards of half the global population possibly at risk, including parts of the United States, great attention to this emerging pathogen is vital, not only for policy makers, but clinicians. DENV infection is a major cause of disease in tropical and subtropical areas worldwide, including Cuba, and the Caribbean. Outbreaks can involve thousands of people, as demonstrated in Indonesia, where by mid 2004 58,000 cases occurred, with a 1.1% case-fatality rate (CFR) [4]. CFR of dengue related illnesses vary widely, depending upon region, population density and demographics, ready access to health care, and host factors. Brazil, a diverse and large country has noted a CFR ranging from 1–12%. Not surprisingly, patients who are early diagnosed and quickly treated are likely to have a CFR less than 1%. Vietnam has reported a 97 percent increase in DENV cases in 2016 compared with 2015. Vietnam reported 63,504 cases of dengue in 44 out of 63 provinces, resulting in 20 deaths. Dengue is endemic in over 100 countries, including the Americas and American Tropics (Map 1). In the last twenty years there has been a dramatic increase in disease penetration in South America and the Caribbean. In 2010 local transmission of dengue occurred in France, underscoring the importance of preparedness for emerging pathogens long thought to be exotic and remote. Although pre1970 only 9 countries experienced severe dengue, WHO considers Europe to be at risk for an outbreak. This is consistent with the dramatic increase in global incidence of dengue over the last few decades. While most recognize that Dengue

Selected mosquito-borne illnesses-Chikungunya.

Abstract: ed from CDC and http://www.denguevirusnet.com/compare-dengue-zika-and-chikungunya.html. NB—These are for general guidance. Some overlap with these and other pathologies is possible. Moreover severity of these signs and symptoms can be influenced by multiple factors—host immunity, comorbidities, strain of virus, etc.

Oral health management considerations for patients with sickle cell disease

Abstract: Sickle cell disease (SCD) can affect many systems in the body including the oral cavity. This necessitates modifications in oral health care management of these patients. The purpose of this paper is to make recommendations for management of SCD patients according to their oral health care needs based on the known findings.

Selected mosquito borne illnesses - Zika.

Abstract: Department of Emergency/Family Medicine, Debusk College of Osteopathic Medicine, Lincoln Memorial University, USA Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA University of Miami-Miller School of Medicine, Palm Beach County, FL, USA Department of Pathology and Laboratory Medicine, Wellington Regional Medical Center, Blue Health, LLC, Palm Beach County, FL, USA

Clinical pearls in gastroenterology.

Abstract: © 2009 Mayo Foundation for Medical Education and Research At the 2001 annual conference of the American College of Physicians, a new teaching format to aid physician learning, Clinical Pearls, was introduced. Clinical Pearls is designed with the 3 qualities of physician-learners in mind. First, we physicians enjoy learning from cases. Second, we like concise, practical points that we can use in our practice. Finally, we take pleasure in problem solving. In the Clinical Pearls format, speakers present a number of short cases in their specialty to a general internal medicine audience. Each case is followed by a multiple-choice question answered live by attendees using an audience response system. The answer distribution is shown to attendees. The correct answer is then displayed and the speaker discusses teaching points, clarifying why one answer is most appropriate. Each case presentation ends with a , defined as a practical teaching point that is supported by the literature but generally not well known to most internists. Clinical Pearls is currently one of the most popular sessions at the American College of Physicians meeting. As a service to its readers, has invited a selected number of these Clinical Pearl presentations to be published in our Concise Review for Clinicians section. “Clinical Pearls in Gastroenterology” is one of them.

Clinical pearls in neurology 2018.

Abstract: A 42-year-old woman presents to the ER with the worst headache of her life. She states that the pain came on suddenly, 2 h ago, when she was eating lunch. Upon further questioning, she reveals that this is the second such headache she’s had in the past week. The previous episode also occurred without provocation, and resolved after several hours. She did not seek medical attention at that time. She is afebrile with sinus tachycardia, and otherwise stable vital signs. Her general medical and neurological exams are normal. Noncontrast head CT shows no signs of acute bleed, and lumbar puncture is negative for xanthochromia. What is the next step in the management of this patient?