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Physicians Often Underestimate the Risk of Opioid Abuse, Misuse, and Diversion in Chronic Pain PatientsDespite rampant opioid misuse, abuse, and diversion self-reported by chronic pain patients in a study presented at the American Pain Society 33rd Annual Scientific Meeting, primary care providers tended to downgrade the patients' risk for engaging in those drug-related aberrant behaviors, indicating a gap between physicians' objective risk assessment for opioid abuse and the actual extent of the problem.
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Acute aortic occlusion: Common presentation of an uncommon catastropheThere is scant systematic literature available on acute aortic occlusion. A review of 46 cases in a single center found 2 primary causes, including embolism (65%) or thrombosis (35%).1 Smoking and diabetes were found to be the risk factors for thrombotic occlusion and pre-existing cardiac disease and female gender risk factors for embolism. Acute aortic occlusion due to embolization of a large thrombus from left atrial appendage occurred in a patient with atrial fibrillation at our institution recently (Radha Sharma,MD, personal communication, February 2008). Case reports have described embolization of atrial myxoma to the abdominal aorta resulting in aortoiliac occlusion.2,3
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Drug-induced Aseptic Meningitis: An Uncommon, Challenging DiagnosisDrug-induced aseptic meningitis is an uncommon and mysterious adverse reaction to some commonly used medications. This condition can mimic the signs and symptoms of a true infectious meningitis. This article provides a concise summary of drug-induced aseptic meningitis, outlining the challenges a primary care physician may face in making the clinical diagnosis. An illustrative case highlights the role of trimethoprim/sulfamethoxazole in the pathogenesis of aseptic meningitis. Although trimethoprim/sulfamethoxazole is the most common antibiotic associated with drug-induced aseptic meningitis, to date only 27 cases have been described in the literature.
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Intensive statin therapy in acute coronary syndromeWe conducted a meta-analysis of 13 randomized controlled trials involving 17 963 subjects to determine the effect of intensive statin therapy instituted within 14 days of hospitalization for acute coronary syndrome. Results showed that early, intensive statin therapy is safe and significantly decreases cardiovascular death and recurrent ischemia following acute coronary syndrome after 6 months of treatment.
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Dextrocardia with Situs Inversus: A Complex Congenital AnomalyDextrocardia with situs inversus is an uncommon congenital anomaly that may not be diagnosed until later in life. It can be found in conjunction with other conditions, such as primary ciliary dyskinesis, but there are usually no associated severe cardiovascular anomalies. Other types of disturbances of symmetry, such as situs ambiguus, can result in severe anomalous development and varying degrees of cardiovascular compromise. Recent research has greatly expanded our understanding of the link between ciliary action and asymmetric expression of gene products in the development of cardiac asymmetry. Medical care is directed toward associated problems, such as respiratory infections with ciliary disorders and additional congenital anomalies.
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Medical Errors: How Clinicians Still Struggle to Diagnose a Broken SystemResearchers can agree that medical errors are a big problem in the US. But can they agree on its pathology?
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FDA Expands COVID-19 Booster Shot Indication For Children Aged 12 and OlderThe FDA moved to shorten the time between the second and third vaccine dose from 6 months to 5 months for recipients of Pfizer-BioNTech.
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Standardizing Medicine's Technical FootprintWhat would it look like if the government took a more active role in setting standards for health IT?
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How Should I Evaluate This Young Woman with Urinary Urgency?A 26-year-old recently married female is seen by you for a 2-day history of urinary urgency and mild "burning" on urination. On questioning, she also notes a slight vaginal discharge. She denies flank pain, hematuria, fevers, or chills.
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Short- and Long-Term Effects of Intensive Diabetes and Blood Pressure ControlSeveral trials have been conducted, and many more are yet to be completed, that have the goal of addressing whether intensive blood glucose control and intensive blood pressure (BP) control have any long-term benefit on all-cause mortality and major cardiovascular events. Contradictory data have been published with respect to the short- and long-term benefits of aggressive BP and blood glucose control versus conventional treatments for BP and glucose control. This review presents the main points of some of the important trials to date on this subject.
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A systematic review of metformin treatment in persons at risk for diabetes mellitusA recent meta-analysis of 31 randomized controlled trials with 4500 participants showed that metformin treatment significantly decreased weight, improved dyslipidemia and insulin resistance, and reduced the incidence of new-onset diabetes by 40%, with beneficial effects maintained over time. Further studies will show whether the metabolic improvements achieved with metformin treatment will ultimately result in a decrease in cardiovascular morbidity and mortality.
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Primary Care Physicians Hold Significant Value in Oncology CareA discussion held at ASCO 2019 highlighted the statistical value associated with primary care collaboration across specialties.
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Long-Term Effects of Anti-VEGF Therapy Sustained with RadiationStudy results demonstrate that low-dose proton beam irradiation may enhance and extend the effects of anti-vascular endothelial growth factor (anti-VEGF) therapy for age-related macular degeneration.
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Marathon Runners Have Low Risk of Cardiac ArrestA study of over 10 million runners of marathons and half-marathons has found that participating in these events is associated with a low risk of cardiac arrest compared with other athletic activities.
