The High Cost of Public Reporting
ANISH KOKA MD In an age where big data is king and doctors are urged to treat populations, the journey of one man still has much to tell us. This is a tale of a man named Joe. Joseph Carrigan was a bear of a man – though his wife would say he was more teddy than bear. He loved guitar playing, and camp horror movies. Those who knew him well said he had a kind heart, a quick wit and loved cats. I knew none of these things when I met Joe in the Emergency Department on a Sunday afternoon. I had been called because of an abnormal electrocardiogram – the ER team was worried he could be having a heart attack. Not able to make sense of the story on the phone, I was in to try to sort it out. Joe was gruff, short with his answers – but clearly something just wasn’t right. He was only 54 but had more problems than the average 50 year old. Progressive calcification of his aortic valve some years ago had caused intolerable shortness of breath resulting in replacement with an artificial valve. Longstanding diabetes had resulted in kidney failure and dialysis, and most recently abnormal liver tests had revealed the presence of the early stages of cirrhosis from hepatitis C. Yet Joe continued to live an active life – with only a tight circle of family and friends aware of the illnesses beneath the surface. But on this particular day it was readily apparent Joe was not well. &nb...
Authors: Zeng Y, Chen S, Liu D, Hahn L, Xia X, Wen S, Han Z, Wu X PMID: 32087501 [PubMed - as supplied by publisher]
When it comes to the management of hypertriglyceridemia-associated acute pancreatitis, is IV insulin or conservative treatment the better option?Journal of the Endocrine Society
CONCLUSIONS: GC treatment has implications in CVR, despite in SSc GC doses administered are lower than in other autoimmune diseases (in our cohort even prednisone ≤10 mg daily was associated with ED). GC may be associated with an early vascular damage in these patients, which could lead to changes in FMD, ED and finally AP. On the other hand, optimum levels of 25(OH)D3 seemed to be beneficial against vascular damage. PMID: 32083542 [PubMed - as supplied by publisher]
CONCLUSIONS: Patients with axSpA are more likely to be reclassified into the very-high risk category after carotid ultrasound than controls. The influence of traditional cardiovascular risk factors on this reclassification differs between patients and controls. PMID: 32083538 [PubMed - as supplied by publisher]
The number of people with 'pre-diabetes' - those on the brink of type 2 diabetes and who must take urgent action - has leapt from an average of 1.3million to almost two million in only a year.
Authors: Scheen AJ Abstract Introduction: Sodium-glucose cotransporter type 2 inhibitors (SGLT2is) have a complex relationship with the kidney so that their use in patients with type 2 diabetes (T2DM) and diabetic kidney disease (DKD) has long been challenged.Areas covered: SGLT2is in patients with DKD are discussed: renal mechanisms of action, PK/PD characteristics, clinical use in patients with stage 3 DKD, effects on estimated glomerular filtration rate (eGFR) and albuminuria, cardiovascular and renal outcomes according to renal function, overall and renal safety, SGLT2is new place in updated guidelines.Expert o...
ConclusionThe incidence of defecation disorders in the geriatric population is high and, most notably, anal incontinence is not spontaneously reported by most patients.ResumoIntroduçãoOs distúrbios da evacuação, seja a incontinência anal ou a constipação intestinal crônica, representam alterações do assoalho pélvico bastante frequente na população em geral e mais comumente naqueles com fatores de risco, ou seja, em idosos, mulheres com passado obstétrico, comorbidades, antecedente de radioterapia pélvica, diab&eacu...
ConclusionOur study demonstrated that TIIA could significantly improve liver function, decrease liver injury, alleviate ECM accumulation, and attenuate HSC proliferation and activation, thus exerting an antifibrotic effect. The possible molecular mechanism involved MAPK, Wnt and PI3K/Akt signaling pathways via inhibiting c-Jun, p-c-Jun, c-Myc, CCND1, MMP9, P65, P–P65, PI3K and P38. Overall, our results suggest that TIIA could alleviate liver fibrosis through multiple targets and multiple signaling pathways and provide deep insight into the pharmacological mechanisms of TIIA in the treatment of hepatic fibrosis.Graphical abstract
Diagnosis, treatment &management of prosthetic valve thrombosis: the key considerations. Expert Rev Med Devices. 2020 Feb 21;: Authors: Gündüz S, Kalçık M, Gürsoy MO, Güner A, Özkan M Abstract Introduction: Prosthetic heart valve thrombosis is a life-threatening complication after valve replacement surgery. Although subtherapeutic anticoagulation is the main cause, there are many other conventional and esoteric predisposing factors.Areas covered: The etiopathogenesis, diagnosis and management of prosthetic heart valve thrombosis with particular focus on conventional...
CONCLUSION: Although DM is typically associated with adipose tissue fibrosis, it is not associated with differences in macroscopic adipose tissue mechanical properties. PMID: 32083565 [PubMed - as supplied by publisher]
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