June 24th 2024
ADA 2024. Adults with OSA and obesity receiving tirzepatide had improvements in sleep apnea severity and systolic blood pressure compared to placebo.
Antidepressant-Induced Sexual Dysfunction: Five Management Strategies
June 30th 2010Selective serotonin reuptake inhibitors and other second-generation antidepressants have become common therapeutic options for the management of depression. Although these agents are effective and generally well tolerated, they frequently cause sexual adverse effects that can impact patients’ quality of life, thus ultimately leading to nonadherence to therapy in many cases.
Allergic Rhinitis: Update on Diagnosis
October 2nd 2009Allergic rhinitis is highly prevalent; about 20% of adults in the United States and 25% of children worldwide are affected. It is a major societal expense, with direct costs, attributable to physician visits and medications, of up to $5 billion per year, and indirect costs, mainly stemming from lost productivity, of up to $9.7 billion per year. In the United States, allergic rhinitis results in 3.5 million lost workdays and 2 million lost schooldays each year.
Recognizing H1N1 Flu: An In-Depth Look at Its Clinical Characteristics
September 29th 2009The ability to recognize cases of the new H1N1 flu and distinguish these from seasonal influenza and other respiratory illnesses is perhaps the overriding concern of primary care practitioners. Prompt and accurate identification of this entity is the key to both effective management of individual illness and effective public health measures.
I’m Leaving on a Jet Plane . . .When Will I Be Able to Sleep Again?
July 13th 2009In an effort to make the twain of east and west meet through air travel, we take off to distant sites for either vacation or business. Whether the destination is eastward to Europe or westward to Hawaii, afterward there is one devil to pay: jet lag.
100 Precepts for My House Staff: Part 2
June 10th 2009Sometimes we try to distill long experience into words, whether aphorisms or full paragraphs. Rilke’s wonderful prose poem expresses this very well in the part that begins, “For the sake of a single verse, one must see many cities, men and things. . . . ” While medicine has only some features in common with poetry, what reverberates is the wish to impart an affecting draught of beauty or wisdom or insight, in the case of poetry, after many years and decades of immersion in life; and I here offer some fruits of long observation and participation “hip deep” in clinical care and in the teaching of residents.
Herniation of a Lung Bulla Through a Thoracostomy Site
May 9th 2009For 3 months, a 63-year-old man had experienced progressively worsening dyspnea. He denied fever, weight loss, and hemoptysis. Eight months earlier, he had had a right thoracotomy to drain a right empyema. Comorbidities included morbid obesity, type 2 diabetes mellitus, hypertension, and obstructive sleep apnea. However, he did not have any intrinsic lung disease.
Stamp Out Inefficiency in Diabetes Management
May 8th 2009I recommend having a “diabetes stamp” made up that includes in its imprint fasting blood glucose, low-density lipoprotein cholesterol, hemoglobin A1c, urine microalbumin, ECG, eye examination, podiatric examination, flu shot, and pneumococcal vaccine-along with lines on which to write dates and results.
TV: Take Out, Turn Off, Drop Off to Sleep
May 8th 2009The next time a patient’s insomnia fails to improve despite counseling about smoking and use of coffee, tea, and other stimulants, ask that he or she remove the television set from the bedroom. Or recommend that the television be turned off at a certain time every night so that a sleep pattern can be established. You may be surprised at the results!
Large Mayo Clinic Study Finds Sleep Disorders Common in the Elderly
April 29th 2009Sleep disorders are common in persons older than 70 years, according to a large community-based study of age-related diseases and cognitive functioning. The most common disorder, sleep-related leg cramps, occurred in 32% of the study participants, according to investigator Jennifer Molano, MD, a behavioral neurology fellow at the Mayo Clinic in Rochester, Minnesota.
Premenstrual Disorders: A Primary Care Primer
January 2nd 2009Premenstrual disorders affect many women in the United States. These disorders range in severity from the mild, bothersome symptoms that occur in more than 75% of women with regular menstrual cycles, to premenstrual syndrome (PMS) and, finally, to the most severe and disabling, premenstrual dysphoric disorder (PMDD). Nearly 5 million American women have PMDD.
Paroxysmal Events: Differentiating Epileptic Seizures From Nonepileptic Spells
October 2nd 2008It can be difficult to determine whether unusual, paroxysmal behavior represents a seizure or a nonepileptic event. Patients with sudden flailing movements or unresponsive staring may, in fact, be experiencing psychogenic events. Other types of pathological spells, such as syncope and migraine, can also be mistaken for epileptic seizures.
Fibromyalgia Syndrome: Guidelines for Effective Care
June 2nd 2008The numerous symptom domains of fibromyalgia syndrome (FMS) include pain, fatigue, sleep disturbance, mood disturbance, function impairment, irritable bowel syndrome, tension and migraine headache, and cognitive dysfunction. Its pathophysiology is rooted in neural dysregulation in the spinal cord and brain.
Chronic Pain Syndromes: How to Break the Cycle, Part 1
April 2nd 2008Pain is a significant public health concern. In a prevalence study conducted in Australia, 17% of men and 20% of women reported chronic daily pain. A US study found that 13% of the total workforce had lost productive time during a 2-week period because of a pain condition. Headache, back pain, and arthritis pain headed the list of causes.
Hemolytic Disease of the Newborn
April 1st 2008An 8-week-old boy is brought for evaluation of gradually worsening yellow skin discoloration of about 1 week's duration. His parents report that he has had constipation for the past several days; before that, he had green diarrhea and occasionally spit up after breast-feeding.