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Low failure rate reported of diagnosis algorithm for suspected upper extremity deep vein thrombosis
Commentary on: Kleinjan A, Di Nisio M, Beyer-Westendorf J, et al.. Safety and feasibility of a diagnostic algorithm combining clinical probability, d-dimer testing and ultrasonography for suspected upper extremity deep venous thrombosis: a prospective management study. Ann Intern Med 2014;160:451–7. Context Upper extremity deep vein thrombosis (UEDVT) is an infrequent type of venous thromboembolism with an estimated incidence of 0.4–1 case per 10 000 persons.1 UEDVT may cause pulmonary embolism but this risk is lower than with lower extremity DVT. Accurate ruling out of UEDVT is mandatory in order to avert...
Source: Evidence-Based Medicine - September 15, 2014 Category: Internal Medicine Authors: Delluc, A., Wells, P. S. Tags: EBM Diagnosis, Drugs: cardiovascular system, Pain (neurology), Stroke, Venous thromboembolism, Radiology, Pulmonary embolism, Clinical diagnostic tests, Radiology (diagnostics) Source Type: research

Small nerve fiber pathology in critical illness documented by serial skin biopsies
Discussion: Serial IENFD measurements confirmed the development of small fiber sensory involvement in the acute phase of critical illness. © 2014 Wiley Periodicals, Inc.
Source: Muscle and Nerve - October 12, 2014 Category: Internal Medicine Authors: Miroslav Skorna, Roman Kopacik, Eva Vlckova, Blanka Adamova, Milena Kostalova, Josef Bednarik Tags: Research Article Source Type: research

Study concludes L. reuteri not effective for infant colic, but findings may be limited by participants' heterogeneity
Commentary on: Sung V, Hiscock H, Tang ML, et al.. Treating infant colic with the probiotic Lactobacillus reuteri: double blind, placebo controlled randomised trial. BMJ 2014;348:g2107. Context Colic is a common problem in healthy, thriving infants that is associated with excessive crying over a regular period during the day and is sustained for the first few months of life.1 Colic affects between 5% and 19% of young infants, remains difficult to treat and may result in significant psychosocial consequences. Despite 40 years of research, the aetiology of infantile colic remains elusive. Recently, the composition of in...
Source: Evidence-Based Medicine - November 19, 2014 Category: Internal Medicine Authors: Indrio, F. Tags: Clinical trials (epidemiology), Immunology (including allergy), Pain (neurology), Stroke, Childhood nutrition, Pregnancy, Child and adolescent psychiatry, Mood disorders (including depression) Therapeutics Source Type: research

Psychological therapies help reduce headache and non-headache pain in children and adolescents
Commentary on: Eccleston C, Palermo TM, Williams AC, et al.. Psychological therapies for the management of chronic and recurrent pain in children and adolescents. Cochrane Database Syst Rev 2014;5:CD003968. Context Chronic and recurrent pain, especially in the head, abdomen and limbs affects up to 30% of children and adolescents.1 Pain can be severely disabling, disrupting school and social activities and if left untreated, may extend towards adulthood. Increasing evidence shows that psychological factors are pivotal in the transition from acute to chronic disabling pain. As a result, psychological interventions have been ...
Source: Evidence-Based Medicine - November 19, 2014 Category: Internal Medicine Authors: Vlaeyen, J. W. S., Gatzounis, R. Tags: Palliative care, Clinical trials (epidemiology), Headache (including migraine), Pain (neurology), Stroke, Child and adolescent psychiatry, Complementary medicine Therapeutics Source Type: research

National Institutes of Health Pathways to Prevention Workshop: The Role of Opioids in the Treatment of Chronic Pain.
This article is an abridged version of the panel's report, the full version of which is available at at https://prevention.nih.gov/programs-events/pathways-to-prevention/workshops/opioids-chronic-pain/workshop-resources#finalreport. PMID: 25581341 [PubMed - as supplied by publisher]
Source: Annals of Internal Medicine - January 13, 2015 Category: Internal Medicine Authors: Reuben DB, H Alvanzo AA, Ashikaga T, Bogat GA, Callahan CM, Ruffing V, Steffens DC Tags: Ann Intern Med Source Type: research

Invasive revascularisation in patients with moderate intermittent claudication provides a significant improvement in quality of life compared with conservative treatment
Commentary on: Nordanstig J, Taft C, Hensäter M, et al. Improved quality of life after 1 year with an invasive versus a noninvasive treatment strategy in claudicants: one-year results of the Invasive Revascularization or Not in Intermittent Claudication (IRONIC) Trial. Circulation 2014;130:939–47 . Context In cases of severe intermittent claudication (IC), successful revascularisation provides significant symptomatic improvement. In cases of mild IC, revascularisation has exceedingly high risks. The choice between invasive revascularisation and non-invasive treatments for moderate severity IC is often diffi...
Source: Evidence-Based Medicine - May 22, 2015 Category: Internal Medicine Authors: Kurklinsky, A. K. Tags: Epidemiologic studies, Pain (neurology), Stroke Therapeutics/Prevention Source Type: research

Angina may trump ischaemia in predicting stable coronary artery disease outcomes, but most cardiovascular events occur in patients without angina or asymptomatic ischaemia
Commentary on: Steg PG, Greenlaw N, Tendera M, et al., Prospective Observational Longitudinal Registry of Patients With Stable Coronary Artery Disease (CLARIFY) Investigators. Prevalence of anginal symptoms and myocardial ischemia and their effect on clinical outcomes in outpatients with stable coronary artery disease: data from the International Observational CLARIFY Registry. JAMA Intern Med 2014;174:1651–9 . Context The presence of angina portends a poor prognosis. Greater attention has recently been directed to asymptomatic ischaemia, the severity of which plays a role in development of chest pain1 and is a robus...
Source: Evidence-Based Medicine - May 22, 2015 Category: Internal Medicine Authors: Kones, R., Rumana, U. Tags: EBM Prognosis, Epidemiologic studies, Drugs: cardiovascular system, Pain (neurology), Stroke, Interventional cardiology, Ischaemic heart disease Source Type: research

Small‐nerve‐fiber pathology in critical illness documented by serial skin biopsies
Conclusion: Serial IENFD measurements confirmed the development of small‐fiber sensory involvement in the acute phase of critical illness. Muscle Nerve, 2015
Source: Muscle and Nerve - May 29, 2015 Category: Internal Medicine Authors: Miroslav Skorna, Roman Kopacik, Eva Vlckova, Blanka Adamova, Milena Kostalova, Josef Bednarik Tags: Research Article Source Type: research

The Role of Decision Aids in Depression Care
Clarion calls about enhancing detection and management of depression in primary care have reiterated several truisms: Depression is as prevalent as many common medical disorders, treatable yet frequently undertreated, responsible for enormous occupational and social impairment as well as adverse effects on the costs, treatment outcomes, and mortality of comorbid medical diseases. Depression is second only to low back pain in years lived with disability (YLD), a metric that incorporates disease prevalence, age of onset, chronicity, and impairment. The YLDs attributable to depression exceed those accounted for by diabetes, i...
Source: JAMA Internal Medicine - September 28, 2015 Category: Internal Medicine Source Type: research

Low to moderate quality evidence demonstrates the potential benefits and adverse events of cannabinoids for certain medical indications
Commentary on: Whiting PF, Wolff RF, Deshpande S, et al.. Cannabinoids for medical use: a systematic review and meta-analysis. JAMA 2015;313:2456–73. Context As of September 2015, 23 states and the District of Columbia in the USA legalised the medicinal use of marijuana, underscoring the need for physicians to understand the science underlying medical marijuana as well as the practical issues associated with it. For years policymakers, scientists and physicians alike have debated the potential risks associated with marijuana use.1 Now marijuana's utility as a treatment for certain medical indications has taken focus....
Source: Evidence-Based Medicine - January 22, 2016 Category: Internal Medicine Authors: Hill, K. P., Hurley-Welljams-Dorof, W. M. Tags: Sexual transmitted infections (viral), Clinical trials (epidemiology), General practice / family medicine, Genetics, Immunology (including allergy), HIV/AIDS, Drugs: CNS (not psychiatric), Pain (neurology), Sleep disorders (neurology), Stroke, Ophthalmolo Source Type: research

Supplemental oxygen in patients without hypoxia in ST segment elevation myocardial infarction increases myocardial injury and infarct size
Commentary on: Stub D, Smith K, Bernard S, et al.. AVOID Investigators. Air versus oxygen in ST-segment-elevation myocardial infarction. Circulation 2015;131:2143–50. Context In patients with ST segment elevation myocardial infarction (STEMI), timely reperfusion, best obtained with primary percutaneous coronary intervention (pPCI), is a mainstay to reduce infarct size (IS) and improve clinical outcome. Routine oxygen administration in normoxic patients with STEMI before pPCI, while mentioned by international guidelines,1 is not supported by randomised evidence. Stub and colleagues performed the AVOID study to compare...
Source: Evidence-Based Medicine - January 22, 2016 Category: Internal Medicine Authors: Crimi, G. Tags: Clinical trials (epidemiology), Drugs: cardiovascular system, Pain (neurology), Stroke, Interventional cardiology, Ischaemic heart disease, Drugs: respiratory system Therapeutics/Prevention Source Type: research

MicroRNA profiling in migraine without aura: pilot study.
CONCLUSION: A specific circulating miRNAs profile is associated with migraine without aura. Remarkably, the same miRNAs are known to be modulated in the setting of atherosclerosis and stroke in humans. This study represents a first step towards further characterization of MO diagnosis/pathophysiology, also in relation to its link with cardiovascular risk. PMID: 26333279 [PubMed - in process]
Source: Annals of Medicine - February 18, 2016 Category: Internal Medicine Tags: Ann Med Source Type: research

Central Neuropathic Pain Syndromes
Chronic pain is common in patients with neurologic complications of a central nervous system insult such as stroke. The pain is most commonly musculoskeletal or related to obligatory overuse of neurologically unaffected limbs. However, neuropathic pain can result directly from the central nervous system injury. Impaired sensory discrimination can make it challenging to differentiate central neuropathic pain from other pain types or spasticity. Central neuropathic pain may also begin months to years after the injury, further obscuring recognition of its association with a past neurologic injury.
Source: Mayo Clinic Proceedings - March 1, 2016 Category: Internal Medicine Authors: James C. Watson, Paola Sandroni Tags: Symposium on pain medicine Source Type: research

The impact of fever/hyperthermia in the diagnosis of Fabry: A retrospective analysis.
Abstract BACKGROUND: Fabry disease (FD) is an X-linked lysosomal storage disorder caused by a deficiency of alpha-galactosidase A enzyme, which leads to the accumulation of its substrate, the globotriaosylceramide or Gb3, in many organs and tissues. Main clinical manifestations of FD are neuropathic pain, angiokeratomas, proteinuria and renal failure, left ventricular hypertrophy and stroke. Fever is also a possible symptom at the onset of the disease during childhood and adolescence, but it is frequently misdiagnosed, causing a delay in FD diagnosis. METHODS: We retrospectively analysed the medical records i...
Source: European Journal of Internal Medicine - April 11, 2016 Category: Internal Medicine Authors: Verrecchia E, Zampetti A, Antuzzi D, Ricci R, Ferri L, Morrone A, Feliciani C, Dagna L, Manna R Tags: Eur J Intern Med Source Type: research

Medication Review After a Fracture
Approximately 1 of every 2 women and 1 of every 4 men aged 50 years or older will experience a fracture in their remaining lifetime. In fact, in the United States, the annual number of osteoporotic fractures that occur exceeds the incidence of heart attack, stroke, and breast cancer combined. Morbidity and mortality is considerable following major osteoporotic fractures, particularly in individuals with hip fracture: 44% of individuals with a hip fracture are readmitted to the hospital, and 21% will die in the first year following the fracture. This readmission rate is nearly 2-fold greater than the readmission rate follow...
Source: JAMA Internal Medicine - August 22, 2016 Category: Internal Medicine Source Type: research

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