Acquired Demyelinating Syndromes
Acquired demyelinating syndromes (ADS) are a heterogenous group of inflammatory demyelinating conditions that include presentations of optic neuritis, transverse myelitis, and acute demyelinating encephalomyelitis. They can be monophasic or can develop into relapsing episodes of the initial demyelinating event or evolve to include other types of demyelination. Significant progress has been made in differentiating subtypes of ADS that differ in their tendency to relapse and in which anti-inflammatory therapies are effective. Differentiating between these subtypes is important for the optimal management of these patients. Cl...
Source: Medical Clinics of North America - July 11, 2023 Category: Primary Care Authors: Dominic O. Co Source Type: research

Approach to Idiopathic Anaphylaxis in Adolescents
Anaphylaxis is a potentially-life threatening condition. Adolescents are particularly vulnerable due to increased risk-taking behaviors, poor disease management, and minimized perception of risk. Although most anaphylaxis can be attributed to food, drug, or venom allergy via a detailed history and confirmatory studies, in nearly 1 in 5 cases, the cause may not be obvious. Clinical differentials including rare allergens, cofactors, mast-cell disorders, and mimic disorders can increase the likelihood of discovering of the cause of anaphylaxis. (Source: Medical Clinics of North America)
Source: Medical Clinics of North America - July 11, 2023 Category: Primary Care Authors: Jeanne E. Conner, Joshua A. Steinberg Source Type: research

Hemophagocytic Lymphohistiocytosis in Adolescents and Young Adults
Hemophagocytic lymphohistiocytosis (HLH) is a disorder of impaired immune regulation resulting in hyperinflammation that is ultimately fatal if not treated. HLH is categorized into familial disease, caused by genetic mutations affecting the function of cytotoxic T lymphocytes and natural killer cells, and secondary disease, triggered by infections, malignancies, rheumatologic disorders, or immune deficiency. Adolescent and young adults with HLH represent a unique population with specific diagnostic challenges. Here we review the diagnostic criteria, possible etiologies, pathophysiology, and management of HLH with focus on ...
Source: Medical Clinics of North America - July 11, 2023 Category: Primary Care Authors: Alejandra Escobar Vasco, Julie-Ann Talano, Larisa Broglie Source Type: research

Later Onset Congenital Central Hypoventilation Syndrome
Congenital central hypoventilation syndrome (CCHS) is a rare disorder of the autonomic nervous system involving multiple organ systems, with the hallmark symptom of respiratory failure due to aberrant central control of breathing resulting in hypoxemia and hypercapnia. Later onset CCHS (LOCCHS) is defined as the diagnosis of CCHS in children older than 1  month. Molecular genetic testing for PHOX2B variants has led not only to increased diagnosis of neonates with CCHS but also the increased identification of older children, adolescents, and adults with LOCCHS who may have a milder clinical presentation of this multisystem...
Source: Medical Clinics of North America - July 11, 2023 Category: Primary Care Authors: Louella Amos Source Type: research

Chronic Recurrent Multifocal Osteomyelitis
Chronic recurrent multifocal osteomyelitis (CRMO) is an underrecognized autoinflammatory disease affecting the skeletal system. Its vague symptoms are often first attributed to growing pains, infection, or malignancy, which can lead to a delay in diagnosis for days to years. Untreated CRMO has the potential to cause debilitating skeletal deformities, arthritis, and chronic pain; hence early recognition and treatment are paramount. MRI is the gold standard for diagnosis. Treatment consists of various antiinflammatory medications and may also include bisphosphonates if vulnerable skeletal sites are involved. Even when treate...
Source: Medical Clinics of North America - July 11, 2023 Category: Primary Care Authors: Bridget A. Rafferty, Pooja Thakrar Source Type: research

Vascular Imaging for the Primary Care Provider
This article will focus on the appropriate use of the vascular lab for the primary care clinician regarding a variety of vascular presentations, including swollen leg, suspected peripheral artery disease, vasospastic disease, carotid artery stenosis, and abdominal aortic aneurysms. Patients with known vascular disease often require serial surveillance imaging to document the stability or progression of disease, and consensus guidelines regarding these strategies will be reviewed. (Source: Medical Clinics of North America)
Source: Medical Clinics of North America - July 6, 2023 Category: Primary Care Authors: Ammar A. Saati, Craig Nielsen, Gerald Jay Bishop Source Type: research

Peripheral Artery Disease
Peripheral artery disease (PAD) affects approximately 230 million people worldwide and is associated with an increased risk of major adverse cardiovascular and limb events. Even though this condition is considered a cardiovascular equivalent, it remains an underrecognized and undertreated entity. Antiplatelet and statin therapy, along with smoking cessation, are the foundations of therapy to reduce adverse events but are challenging to fully implement in this patient population. Race and socioeconomic status also have profound impacts on PAD outcomes. (Source: Medical Clinics of North America)
Source: Medical Clinics of North America - July 6, 2023 Category: Primary Care Authors: Matthew Bierowski, Taki Galanis, Amry Majeed, Alireza Mofid Source Type: research

Peripheral Artery Disease
Peripheral artery disease (PAD) affects approximately 230 million people worldwide and is associated with an increased risk of major adverse cardiovascular and limb events. Even though this condition is considered a cardiovascular equivalent, it remains an under-recognized and under-treated entity. Anti-platelet and statin therapy, along with smoking cessation, are the foundations of therapy to reduce adverse events but are challenging to fully implement in this patient population. Race and socioeconomic status also have profound impacts on PAD outcomes. Exercise therapy is the gold standard treatment of claudication while...
Source: Medical Clinics of North America - July 6, 2023 Category: Primary Care Authors: Matthew Bierowski, Taki Galanis, Amry Majeed, Alireza Mofid Source Type: research

Why Not Vascular Medicine?
Subspecialties of internal medicine, such as cardiology, gastroenterology, endocrinology, and infectious diseases, tend to emerge when the corpus of information within a particular field reaches a critical mass such that professionals, either wittingly or maybe before they even appreciate it, find themselves thoroughly engaged. Moreover, the emergence of new theoretic and applied knowledge, particularly within therapeutics, demands that full engagement.1 These nascent subspecialists then begin to publish in that field; they form societies and perhaps establish journals, and they begin to offer advanced training, such as fe...
Source: Medical Clinics of North America - July 6, 2023 Category: Primary Care Authors: Jack Ende Tags: Foreword Source Type: research

Health-care Worker Engagement in Federally Qualified Health Centers and Associations with Confidence in Making Health-care Recommendations
Throughout the coronavirus disease 2019 (COVID-19) pandemic, there have been numerous demands on primary care practices and providers affecting work engagement and burnout, which can affect health-care delivery and patient outcomes. We determined potentially modifiable factors associated with work engagement among employees of federally qualified health centers (FQHCs) throughout Louisiana. Resilient coping, spirituality, and social support were associated with being engaged at work. FQHC employees perceiving a more chaotic work environment and those with depressive or anxiety symptoms were less likely to be engaged at wor...
Source: Medical Clinics of North America - June 30, 2023 Category: Primary Care Authors: Erin Peacock, Leia Y. Saltzman, Joshua L. Denson, Sara Al-Dahir, Michelle Wilson, Alecia Cyprian, Stephenie Harris, Katie Parnell, Diem Nguyen, Kabrina Smith, Shondra Williams, Gary Wiltz, Keith Winfrey, LaKeisha Williams, Marie Krousel-Wood Source Type: research

Healthcare worker engagement in federally qualified health centers and associations with confidence in making healthcare recommendations: Evidence from the Louisiana Community Engagement Alliance
Throughout the COVID-19 pandemic, there have been numerous demands on primary care practices and providers impacting work engagement and burnout, which can affect healthcare delivery and patient outcomes. We determined potentially modifiable factors associated with work engagement among employees of FQHCs throughout Louisiana. Resilient coping, spirituality, and social support were associated with being engaged at work. FQHC employees perceiving a more chaotic work environment and those with depressive or anxiety symptoms were less likely to be engaged at work. Being engaged was associated with confidence in COVID-19 vacci...
Source: Medical Clinics of North America - June 30, 2023 Category: Primary Care Authors: Erin Peacock, Leia Y. Saltzman, Joshua L. Denson, Sara Al-Dahir, Michelle Wilson, LaKeisha Williams, Marie Krousel-Wood, LA-CEAL FQHC Partners Source Type: research

Venous Thromboembolism
The Centers for Disease Control and Prevention estimates that approximately 900,000 patients are diagnosed with venous thromboembolism (VTE) annually in the United States leading to approximately 548,000 hospitalizations and 100,000 deaths. Approximately 274 people die daily in the United States from VTE. The numbers are staggering with 1 person dying every 5  minutes! There are more deaths annually in the United States from VTE than breast cancer (41,000), AIDS (16,000), and motor vehicle accidents (32,000) combined! VTE is recognized as a leading cause of preventable hospital deaths and a leading cause of maternal death...
Source: Medical Clinics of North America - June 26, 2023 Category: Primary Care Authors: Anthony Joseph Macchiavelli Source Type: research

Unprovoked Venous Thromboembolism
Venous thromboembolism (VTE) is a common vascular disorder encompassing deep vein thrombosis (DVT) and pulmonary embolism (PE). There is no data on global estimates of VTE prevalence and incidence. Most patients with unprovoked VTE require secondary thromboprophylaxis upon the completion of the primary treatment phase if they have no high bleeding risk. Risk prediction models can help identify patients at low VTE recurrence risk who may discontinue anticoagulation upon the completion of the primary treatment phase. (Source: Medical Clinics of North America)
Source: Medical Clinics of North America - June 26, 2023 Category: Primary Care Authors: Hunter Mwansa, Mohamed Zghouzi, Geoffrey D. Barnes Source Type: research

Varicose Veins
This article will review chronic venous disease, including its differential diagnosis, workup, and treatment. (Source: Medical Clinics of North America)
Source: Medical Clinics of North America - June 20, 2023 Category: Primary Care Authors: Viviane Seki Sassaki, Eri Fukaya Source Type: research

Vasculitis: When to Consider this Diagnosis?
This article aims to provide physicians with a diagnostic approach to vasculitis. (Source: Medical Clinics of North America)
Source: Medical Clinics of North America - June 17, 2023 Category: Primary Care Authors: Kunal Mishra, Randy K. Ramcharitar, Aditya M. Sharma Source Type: research