October 2014

Twenty-five years ago I was told by my partner who had considerably more experience than I that the best way to build a medical practice was to follow the 3 "A's of medicine". In order of relevance they are availability, affability, and ability. Ability comes third because unless a doctor is available to patients so they come enough to like him, they would never know if he has any ability.

Ronald Nahass, MD, MHCM, FACP, FIDSA, is a certified infectious disease expert in central New Jersey with the University Medical Center of Princeton at Plainsboro. He speaks with Internal Medicine World Report Editor-in-Chief, Simon Douglas Murray, MD, about several misconceptions surrounding the Ebola outbreak and provides insight to educate the readers.

A group of international researchers led by Luosheng Li, MD, of the Rolf Luft Research Center for Diabetes and Endocrinology at the Karolinska Institutet, Karolinska University Hospital in Stockholm, Sweden, recently demonstrated that age-dependent decline in insulin secretion (and thus glucose homeostasis) from the beta cell in experimental mice models is associated with subtle changes in Ca2+ dynamics.

For patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), the right treatment can make a world of difference in the management of their condition. A recent study looked at how effective inhaled budesonide and systemic methylprednisolone can be for those patients.

In the American Journal of Medicine, Christopher Sorli, MD, of the Billings Clinic in Montana, reviewed new developments in insulin therapy for type 2 diabetes. He explained that insulin initiation often involved basal-only therapy in conjunction with existing oral glucose-lowering drugs.

For children, pain management regimens should aim for an acceptable level of pain, optimal mobilization, and minimal side effects, according to research published in Pediatric Anesthesia.

Patients who have HCV infection are at high risk for arthralgia, myalgias, pruritus, neuropathy, and decompensated livers. Until recently the sole available treatment was interferon. After the US Food and Drug Administration (FDA) approved ribavirin, patients who took ribavirin plus interferon responded better. Now, the FDA has approved a small selection of oral antivirals to treat hepatitis C.

Chronic exertional compartment syndrome (CECS), a common condition among individuals who served in the military, is disproportionately untreated and misunderstood, according to research in Clinics in Sports Medicine, which aimed to highlight viable treatments.

From 2000 to 2007, medications to treat nonmalignant chronic pain (NMCP) came with a price tag of $17.8 billion annually in the US, a Journal of Managed Care & Specialty Pharmacy study found.

A recent study looked at the relationship between obesity and a child's risk of developing allergies or an asthmatic condition. Looking at what the authors perceived to be a growing trend of not only an increase in the number obese children but those suffering from new or worsening allergies the authors said they were looking for a link which could help treat the pediatric patients.

Methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) have become significant and costly problems-so significant, in fact, that many patients have a basic knowledge of MRSA just from news reports. The Centers for Disease Control and Prevention (CDC) offer a large selection of free tools to educate the public about MRSA and VRE.

Patients' body weight (BW) is the accepted way to calculate the starting dose of levothyroxine (LT4) after total thyroidectomy. However, Italian researchers sought to find a new way to improve the accuracy of the LT4 starting dose following total thyroidectomy by identifying other major predictive factors of LT4 requirement.

Silent coronary artery disease is often diagnosed too late to prevent a cardiac event. But in a case history involving twin brothers, a team from Liverpool Heart and Chest Hospital, Liverpool, UK shows that investigative imaging of an otherwise healthy man paid off.

A non-inferiority study published in the October 6, 2014 issue of JAMA Internal Medicine looks at these drugs. The researchers report that prescribing β-lactam monotherapy may be as effective as the combination of a macrolide with a β-lactam in certain patients.

A literature review published in Trends in Molecular Medicine suggests inflammatory bowel disease can be controlled by levels of inhibitors of apoptosis.

In diarrhea patients, a frozen capsule fetal microbiota transplantation treatment can be effective to eliminate symptoms.

The fact that cigarette smoking is dangerous to a person's health is not a new concept, but a recent study took a more direct view of just how much damage smokers in the United States do to themselves through what was described as "major medical conditions."

Heart patients who have bouts of hypotension while hospitalized for acute decompensated heart failure (ADHF) have an increased risk of an adverse outcome within 30 days, a multi-institutional study found. Priyesh Patel, MD, and colleagues, writing in Circulation reported on their analysis of results of the ASCEND-HF study.

Stress cardiomyopathy is a unique cardiac syndrome in which transient left ventricular (LV) systolic dysfunction mimics acute myocardial infarction (AMI). It is usually brought on by acute emotional or physical stress (or both) and has 3 distinctive features: acute LV wall dysfunction, absence of significant obstructive coronary artery disease, and rapid improvement of LV systolic function within days or weeks.

In morbidly obese but otherwise morbidly obese patients who had bariatric surgery, cardiovascular, and metabolic improvements were noted after 12 months.