DeckerMed Transitional Year Weekly Curriculum™最新文献

{"title":"Management of Uncomplicated Gallstones and Benign Gallbladder Disease","authors":"R. Britt, J. Burgess","doi":"10.2310/tywc.2078","DOIUrl":"https://doi.org/10.2310/tywc.2078","url":null,"abstract":"Gallbladder disease is one of the most common problems that the general surgeon will encounter. This comprehensive review discusses the management of uncomplicated gallstone disease, functional gallbladder disease, and gallbladder polyps. It provides indications for cholecystectomy in the asymptomatic patient. There is a thorough review of the diagnosis and management of symptomatic cholelithiasis, including special situations such as pregnancy and cirrhosis, and the latest evidence regarding routine versus selective cholangiography during cholecystectomy. This review also discusses the latest updates to the criteria for diagnosing functional gallbladder disease and sphincter of Oddi dysfunction. \u0000This review contains 6 figures, 6 tables, and 99 references.\u0000Key words: asymptomatic gallstones, biliary dyskinesia, cholangiography, gallbladder polyps, laparoscopic cholecystectomy, sphincter of Oddi dysfunction, symptomatic cholelithiasis","PeriodicalId":196621,"journal":{"name":"DeckerMed Transitional Year Weekly Curriculum™","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116798627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nutritional Management of Celiac Disease","authors":"C. Kelly, S. Kurada, Mariana Urquiaga","doi":"10.2310/tywc.9036","DOIUrl":"https://doi.org/10.2310/tywc.9036","url":null,"abstract":"Celiac disease (CD) is an autoimmune disorder characterized by an immune response to gluten peptides in wheat, barley, and rye. The diagnosis of celiac disease is confirmed by three important characteristics: consistent symptoms, positive celiac-specific serology, and small intestinal biopsy findings of inflammation, crypt hyperplasia, and villous atrophy. CD may present with overt gastrointestinal symptoms, including diarrhea (or constipation), weight loss, and abdominal bloating and discomfort, or covertly with micronutrient deficiencies such as iron deficiency with anemia. A gluten-free diet (GFD) remains the mainstay of treatment. The aim of this review is to highlight the pathogenesis of CD, concepts and challenges associated with a GFD, and nutritional management of CD applicable in clinical practice to internists, gastroenterologists, and dietitians. Patients should be referred to an expert celiac dietitian for education on adherence to a GFD to address gluten contamination in the diet, the psychosocial implications of following a GFD, and macro- and micronutrient disequilibria arising from celiac disease and the GFD. Several novel therapeutics are on the horizon in various stages of development, including glutenases, antigliadin antibodies, tight junction regulators, modulation of the immune response to gliadin, and efforts to engineer less toxic gluten-containing foodstuffs.\u0000This review contains 3 figures, 5 tables, and 61 references.\u0000Key words: celiac disease, genetic engineering, food engineering, gluten, glutenases, gluten-free diet, oats, IgY, nutrition, tight junction regulators, wheat","PeriodicalId":196621,"journal":{"name":"DeckerMed Transitional Year Weekly Curriculum™","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125858087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nausea and Vomiting of Pregnancy","authors":"E. Roberts, B. Young","doi":"10.2310/tywc.19020","DOIUrl":"https://doi.org/10.2310/tywc.19020","url":null,"abstract":"In pregnancy, the majority of women experience at least some nausea and vomiting. For many women, these symptoms are mild and self-limiting and resolve by the second trimester. A minority of women experience severe symptoms of hyperemesis gravidarum with persistent vomiting, weight loss, and electrolyte derangements. The diagnosis of hyperemesis gravidarum is based on clinical history and exclusion of other etiologies of nausea and vomiting. First-line pharmacologic treatment is with pyridoxine and doxylamine. Other medical treatments include metoclopramide, phenothiazines, antacids, and ondansetron. In refractory cases, corticosteroids and enteral or parenteral nutrition may be considered.\u0000\u0000This review contains 3 figures, 2 tables and 83 references\u0000Key words: enteral feeding, hyperemesis gravidarum, maternal outcomes, nausea and vomiting of pregnancy, neonatal outcomes, nonpharmacologic antiemetics, pharmacologic antiemetics","PeriodicalId":196621,"journal":{"name":"DeckerMed Transitional Year Weekly Curriculum™","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124892594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Polycystic Ovary Syndrome","authors":"Snigdha Alur-Gupta, A. Dokras","doi":"10.2310/TYWC.19096","DOIUrl":"https://doi.org/10.2310/TYWC.19096","url":null,"abstract":"Polycystic ovary syndrome (PCOS) is a highly prevalent endocrine disorder in women of reproductive age. In this review, the pathophysiology and current diagnostic criteria for PCOS are reviewed. Treatment options for symptoms commonly associated with PCOS such as hirsutism, acne, and menstrual irregularity are reviewed. Combined hormonal contraceptives are the first line of therapy in women not attempting pregnancy. The metabolic complications commonly associated with PCOS are impaired glucose tolerance and dyslipidemia. A summary of the current guidelines on screening and prevention of these complications is presented. In addition, PCOS is associated with an increased risk of depressive symptoms and anxiety disorders for which patients should be monitored.\u0000\u0000This review contains 5 tables and 57 references. \u0000Keywords: Polycystic ovary syndrome, PCOS ","PeriodicalId":196621,"journal":{"name":"DeckerMed Transitional Year Weekly Curriculum™","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128039339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Aspects of Alzheimer Disease","authors":"D. Knopman","doi":"10.2310/tywc.1334","DOIUrl":"https://doi.org/10.2310/tywc.1334","url":null,"abstract":"The clinical diagnosis of Alzheimer disease (AD) has been well established, but there is a widespread misunderstanding about the relationship between dementia (a syndrome) and AD (a cause of dementia). AD is the most common etiology that causes dementia in mid- and late life. The prototypical clinical presentation is that of a gradually worsening problem with learning new information, that is, a short-term memory deficit, accompanied by cognitive impairment in other domains, including language, spatial cognition, and executive functioning, as well as changes in personality and behavior. A key element of the diagnosis of dementia is that daily functioning is impaired. The concept of mild cognitive impairment (MCI) as the earliest symptomatic presentation of a dementing illness is now widely accepted. MCI due to AD typically presents with isolated problems with learning and memory without substantial loss of ability to function in daily life.  Less common variants of AD are now recognized and include a disorder in which spatial and visual cognitive dysfunction occurs or in which word-finding problems predominate at the onset of symptoms. Although AD as a cause of dementia is the most common among etiologies, AD often co-occurs with other neurodegenerative diseases and with cerebrovascular disease. The presence of multietiology dementia in which AD is a contributor is particularly common in the eighth decade of life and beyond. \u0000Key words: Alzheimer disease, cognitive impairment, dementia, mild cognitive impairment","PeriodicalId":196621,"journal":{"name":"DeckerMed Transitional Year Weekly Curriculum™","volume":"2013 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121759412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urologic Infections","authors":"Tatyana Vayngortin, N. Atigapramoj","doi":"10.2310/tywc.4724","DOIUrl":"https://doi.org/10.2310/tywc.4724","url":null,"abstract":"Urinary tract infections (UTIs) affect people of all ages. Although the incidence of invasive bacterial diseases continues to decline, the prevalence of UTIs in febrile pediatric patients continues to remain a focus for serious bacterial infection in this population. In older age groups, symptoms become more obvious and present more classically. Clinical practice guidelines have been developed because morbidity can be dependent upon the rapid identification of a UTI with prompt initiation of appropriate antimicrobials. This review provides a summary for the evaluation of UTIs with discussion of diagnosis and management. \u0000\u0000This review contains 6 figures, 5 tables and 47 references\u0000Key words: antibiotics, cystitis, pyelonephritis, urinary tract infection, uropathogens","PeriodicalId":196621,"journal":{"name":"DeckerMed Transitional Year Weekly Curriculum™","volume":"54 3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123489739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vaginitis","authors":"M. Mendiola, Rachel A. Blake","doi":"10.2310/tywc.19007","DOIUrl":"https://doi.org/10.2310/tywc.19007","url":null,"abstract":"Vulvovaginal complaints are a common indication for women to seek gynecologic care. The most common causes of vaginitis are bacterial vaginosis, vulvovaginal candidiasis, and trichomoniasis, which account for 22 to 50%, 17 to 39%, and 4 to 35% of vaginitis, respectively. This review describes the presentation, diagnosis, and prevention strategies for the most important causes of vulvovaginitis, including characteristic findings on office microscopy and newer available diagnostic testing. It outlines treatment modalities for uncomplicated infections in healthy women, as well as nuances of treatment for recurrent and persistent infections, pregnant women, and HIV-positive women. It also explores the diagnosis and management of non-infectious vaginitis as well special consideration for vaginitis in children and adolescents.\u0000This review contains 4 figures, 8 tables, and 55 references.\u0000Key words: vaginitis, vulvovaginitis, bacterial vaginosis, candidiasis, trichomoniasis, vaginitis treatment","PeriodicalId":196621,"journal":{"name":"DeckerMed Transitional Year Weekly Curriculum™","volume":"177 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121092700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diet And Nutrition In The Treatment Of Prediabetes And Diabetes","authors":"Priscilla Escalona Villasmil, R. Siegel","doi":"10.2310/tywc.9033","DOIUrl":"https://doi.org/10.2310/tywc.9033","url":null,"abstract":"The incidence of type 2 diabetes has been increasing dramatically throughout the world, closely linked to Westernized dietary patterns, physical inactivity, and rising rates of obesity, and has become a challenging health problem. Lifestyle changes are effective measures to prevent diabetes, and diet is one of the most important components of diabetes treatment. There is now strong evidence from epidemiologic studies and randomized controlled trials (RCTs) that type 2 diabetes can be prevented or at least delayed in those at high risk for progressing to diabetes by a combination of diet and physical activity resulting in weight loss. Medical nutrition therapy (MNT) is the process by which the nutrition prescription is customized for patients with diabetes. RCTs have demonstrated a positive effect of MNT in diabetes management. Studies documenting the effectiveness of MNT for type 1 and 2 diabetes report improvements in hemoglobin A1C and in other outcomes. A nutrition prescription should be individualized for each patient based on individual preferences, cultural background, and social and financial context. Lifestyle interventions should be considered monotherapy in prediabetes and the initial treatment of type 2 diabetes. Evidence from prospective cohort studies and RCTs has shown the importance of eating patterns in the prevention and management of diabetes. With the worldwide increase in obesity, it will be important to get further evidence of how lifestyle interventions affect clinical outcomes such as microvascular and macrovascular disease.\u0000\u0000This review contains 6 figures, 6 tables and 90 references\u0000Key words:  Diabetes mellitus, nutrition, prevention, obesity, lifestyle, glucose, diet, physical activity","PeriodicalId":196621,"journal":{"name":"DeckerMed Transitional Year Weekly Curriculum™","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115910904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diarrheal Illness","authors":"J. Faust","doi":"10.2310/tywc.4721","DOIUrl":"https://doi.org/10.2310/tywc.4721","url":null,"abstract":"Diarrhea, qualitatively defined as an increase in stool frequency and liquid content, is a frequent complaint in patients presenting to emergency departments. Although most cases are uncomplicated viral infections, the most frequent causes of dangerous underlying entities are often not viral. In uncomplicated cases, laboratory testing for metabolic derangements is not required unless there are signs of moderate to severe dehydration or the patient has particular risks, such as chronic kidney disease. Secondary infections associated with antibiotic use (C difficile–associated diarrhea), other significant nosocomial exposures, recent international travel history, the presence of a nonintact immune system (HIV/AIDS, cancer/chemotherapy), and exposure to high-risk environments (including zoonotic exposures, outbreak-prone environments such as day care facilities) increase the likelihood of a bacterial or other infectious cause requiring either microbiologic testing or empirical antimicrobial treatments. Diarrhea is often present as a feature of clinically significant noninfectious conditions, including complications of inflammatory bowel diseases (Crohn disease and ulcerative colitis), overdoses, and withdrawal syndromes. In such cases, after hemodynamic stability has been ensured, advanced workup and treatment are guided by the underlying condition and antecedent risks, not the presence of diarrhea per se. Oral rehydration is the first step in management for mild dehydration caused by uncomplicated diarrhea. Intravenous fluids may be necessary in moderate to severe dehydration and in cases of electrolyte derangement requiring resuscitation where fluid choice and rate are paramount, as well as in patients who cannot tolerate oral intake. In cases of suspected bacteria-caused diarrhea, antibiotics, most often fluoroquinolones, reduce both the severity and duration of illness. In patients safe for home management, antidiarrheal agents such as loperamide may be used in uncomplicated and resolving cases. Probiotics appear safe in most cases and impart a small but clinically detectable decrease in the duration and severity of illness. Although there have been fears of bacterial outbreaks following natural disasters, improvements in local and global health efforts have led to decreases in cholera outbreaks, and typical viral causes of diarrhea are generally the most common causes.\u0000\u0000 This review contains 4 figures, 5 tables and 32 references\u0000Key words: Clostridium difficile, diarrhea, infectious diseases, inflammatory bowel diseases, medication side effects, overdose syndromes, sepsis, traveler’s diarrhea, zoonotic infections ","PeriodicalId":196621,"journal":{"name":"DeckerMed Transitional Year Weekly Curriculum™","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115296984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heart Failure","authors":"Sachin P. Shah, M. Mehra","doi":"10.2310/tywc.1409","DOIUrl":"https://doi.org/10.2310/tywc.1409","url":null,"abstract":"Heart failure is a syndrome related to abnormal cardiac performance with a consequence of impaired cardiac output at rest or with exertion and/or congestion, which usually leads to symptoms of fatigue, dyspnea, and edema. The syndrome is characterized by various phenotypes related to a vast array of etiologies with diverse management targets. The current broad categorization of heart failure separates patients based on ejection fraction. Further description of the phenotype beyond ejection fraction is imperative to correctly identify the etiology of heart failure and, ultimately, to choose medical, device, and surgical therapies appropriately. This review covers the epidemiology of heart failure, defining the phenotype and etiology of heart failure, recognition and management of acute decompensated heart failure, management of chronic heart failure with a reduced ejection fraction, implantable cardioverter-defibrillators in heart failure with a reduced ejection fraction, management of heart failure with a preserved ejection fraction, and advanced heart failure. Figures show the evolution of therapy in chronic heart failure from the symptom-directed model, the complex pathophysiology and principal aberrations underlying heart failure with preserved ejection fraction, and concepts underlying surgical therapy in advanced heart failure using Laplace’s law. Tables list various etiologies of heart failure; sensitivity and specificity of clinical, biomarker, and radiographic data in the diagnosis of acute decompensated heart failure; drugs and devices with a demonstrated survival benefit in heart failure with a reduced ejection fraction; neurohormonal antagonist dosing in heart failure with a reduced ejection fraction; randomized, placebo-controlled trials in heart failure with a preserved ejection fraction; categorization of heart failure according to American Heart Association/American College of Cardiology heart failure stage, New York Heart Association functional class, and Interagency Registry for Mechanically Assisted Circulatory Support level; and poor prognostic indicators in heart failure.\u0000This review contains 3 highly rendered figures, 7 tables, and 113 references.","PeriodicalId":196621,"journal":{"name":"DeckerMed Transitional Year Weekly Curriculum™","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134024275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}