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Management of Nephrotic Syndrome in ChildrenNephrotic syndrome is a common disease in children. Minimalchange disease remains the most frequent cause, but a careful evaluation to exclude other renal conditions is important, particularly to distinguish between isolated nephrotic syndrome and nephrotic syndrome with nephritis. Corticosteroids and sodium restriction form the mainstay of therapy. Although most patients with isolated nephrotic syndrome recover quickly without major sequelae, the physician must remain alert for signs and symptoms of serious complications. Detailed patient and family education, along with close follow-up and support, will help ensure the best outcomes.
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Asystole during sleep in a 46-year-old male athleteA number of electrocardiographic abnormalities have been described in athletes.1 Among these are sinus bradycardia and varying degrees of atrioventricular (AV) block. These findings have been attributed to the "athlete's heart," and are felt to be due to enhanced vagal tone seen with excellent physical conditioning. Secondarily it has also been suggested that there are intrinsic changes within the sinoatrial and AV nodes themselves, including prolonged sinus node recovery time and AV nodal Wenckebach, and these abnormalities persist following autonomic blockade.
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Are HDL cholesterol levels clinically significant in patients with low LDL cholesterol levels?There is some debate about whether the risk of cardiovascular events associated with low high-density lipoprotein (HDL) cholesterol levels is attenuated by very low low-density lipoprotein (LDL) cholesterol levels (< 60 mg/dL), which can be obtained with statins and combination therapy.
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Impact of diabetes development on atrial fibrillation in hypertensive patientsPatients with new-onset diabetes mellitus in the VALUE (Valsartan Antihypertensive Long-term Use Evaluation) trial had an increased incidence of atrial fibrillation compared with patients without diabetes. Clustering of risk factors or the presence of dysglycemia may make the heart more susceptible to arrhythmias.
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Vernakalant: Expanding the antiarrhythmic vernacularAtrial fibrillation (AF) is the most common sustained cardiac arrhythmia, occurring in over 2% of the general population.
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Against all OddsFamily practitioner Jeffrey Brenner, MD, is working to reform the Camden, NJ, healthcare system one patient at a time.
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Part-time Women in Medicine: Are They Pulling Their Weight?Are female physicians less ambitious than their male counterparts, or are they pursuing different professional goals that may benefit the profession in the long run?
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Antithrombotic treatment of high-risk elderly patients hospitalized with atrial fibrillationWe assessed the pattern of use and the effectiveness of antithrombotic therapy in a cohort of high-risk elderly patients hospitalized for atrial fibrillation, with data derived from prescription, hospitalization, and mortality databases from 3 linked registries. Results showed that antithrombotic therapy was underused, even in patients with no comorbid conditions. In addition, patients exposed to antithrombotic therapy had a significantly lower mortality rate. The collection of epidemiological data by record linkage represents a flexible and readily available tool for monitoring and improving routine clinical care.
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Finding Balance Again in MedicineFor healthcare executives at all levels, addressing burnout is an urgent priority, one directly impacting their overall mission of improving quality of care and patient experience as well as retaining physicians and advanced practitioners.
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Lipoprotein particle numbers: A better index of coronary events than lipoprotein cholesterol?In a case-control substudy of the Veterans Affairs High-Density Lipoprotein Intervention Trial, therapy with gemfibrozil was shown to reduce the total number of low-density lipoprotein (LDL) particles, especially small, more oxidizable LDL particles, which was associated with a reduced risk of coronary heart disease (CHD) events. Gemfibrozil also increased small-sized high-density lipoprotein particle numbers, which also correlated with a decrease in CHD events. Notably, these changes in particle numbers were not associated with significant changes in lipoprotein cholesterol concentrations, which current guidelines have made the principal target of lipid therapy.
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Learning from the COVID-19 Experience: Strategies to Continue CareTelehealth capabilities are crucial during the COVID-19 pandemic.
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Can Prebiotics and Probiotics Really Improve Gastrointestinal Health?Prebiotics and probiotics have been discussed frequently in the media for supposedly improving overall health, especially diseases related to the gut. However, the evidence on the efficacy and use of these dietary supplements is rather complicated.
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Sol Searching: Luxury and Adventure Await at Mexico's Riviera Maya and CozumelFrom a cliffside castillo to a trio of eco-adventure parks, the 85-mile stretch along Mexico's Caribbean coast offers a wide range of fun in the sun for adventurous travelers, and luxurious splendor for those looking to get away from it all.
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The Metabolic Syndrome: Pathogenesis, Consequences, and Treatment StrategiesThe last several years have witnessed a heightened interest in the metabolic syndrome, as it has become a health issue of epidemic proportions. Several metabolic abnormalities emerge as key players in the pathogenesis of the syndrome, including insulin resistance, obesity, and inflammation. Individuals with the metabolic syndrome are at increased risk for a variety of clinical conditions, some with serious health implications, particularly diabetes and cardiovascular disease. Treatment should address the causal mediators of the syndrome, such as obesity or insulin resistance. Lifestyle modification is one of the most successful treatments for the prevention of diabetes. Pharmacotherapy for dyslipidemia or hypertension can help prevent cardiovascular complications and the development of diabetes in those at risk.
