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EBIM in the Loop, Dec 28

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Post date December 28, 2021
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The AGS Beers Criteria® comprises drugs and drug

The AGS Beers Criteria® comprises drugs and drug classes that the AGS and its expert panel consider to be potentially inappropriate medications (PIMs) for use in older adults. The expert panel organized the criteria into the same five general categories that were used in the 2019 update:

Medications considered as potentially inappropriate (Table 2);

Medications potentially inappropriate in patients with certain diseases or syndromes (Table 3);

Medications to be used with caution (Table4);

Potentially inappropriate drug–drug interactions (Table 5); and

Medications whose dosages should be adjusted based on renal function (Table 6).

Successful deprescribing of medications on the AGS Beers Criteria® involves much more than a clinician simply telling an older person to stop taking a medication. Communication gaps and misunderstandings, patient reluctance and fear of stopping, coordination among mul- tiple clinicians, dosage tapering, withdrawal symptoms, and conveying stop orders to pharmacies are just some of the challenges that can arise. The panel encourages clini- cians to be aware of and develop skills to address these challenges. Useful resources include:

https://deprescribing.org/resources/
—deprescribing resources, especially evidence-based guidelines and easy-to-use algorithms about when and how to stop common types of medications

https://www.deprescribingnetwork.ca/professionals
— resources for healthcare professionals, including deprescribing-oriented patient handouts about medica- tions that are commonly inappropriate for older adults.

Follow the link in bio for the full article (https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.18372)

#internalmedicine #internalmedicineresidency #internalmedicineresident #medicine #youngdoctor #juniordoctors #europeanboardofinternalmedicine #medicalnews #medicalresident #residentdoctor #medicaleducation #medicalinformation #geriatrics #gerontology #medication #ags #beerscriteria #expertpanel #medicaltraining

Acute atrial fibrillation is defined as atrial fib

Acute atrial fibrillation is defined as atrial fibrillation detected in the setting of acute care or acute illness; atrial fibrillation may be detected or managed for the first time during acute hospitalization for another condition. Atrial fibrillation after cardiothoracic surgery is a distinct type of acute atrial fibrillation. Acute atrial fibrillation is associated with high risk of long-term atrial fibrillation recurrence, warranting clinical attention during acute hospitalization and over long-term follow-up. A framework of substrates and triggers can be useful for evaluating and managing acute atrial fibrillation. Acute management requires a multipronged approach with interdisciplinary care collaboration, tailoring treatments to the patient’s underlying substrate and acute condition. As discussed in this guideline in Circulation, key components of acute management include identification and treatment of triggers, selection and implementation of rate/rhythm control, and management of anticoagulation. Several gaps in knowledge related to acute atrial fibrillation exist and warrant future research.
Follow the link in bio to read the guideline (https://www.ahajournals.org/doi/10.1161/CIR.0000000000001133?utm_campaign=sciencenews22-23&utm_source=science-news&utm_medium=phd-link&utm_content=phd-03-13-23)

#internalmedicine #internalmedicineresidency #internalmedicineresident #medicine #youngdoctor #juniordoctors #europeanboardofinternalmedicine #medicalnews #medicalresident #residentdoctor #medicaleducation #medicalinformation
#cardiology #cardiologist #heartdiseases #atrialfibrillation #medicalstudent #circulation #medicalguidelines

Rheumatoid arthritis (RA) is a systemic inflammato

Rheumatoid arthritis (RA) is a systemic inflammatory disease, which primarily causes symmetric polyarthritis. An extraarticular involvement is common, and the most commonly involved organ is the lungs. Although cardiac disease is responsible for most RA-related deaths, pulmonary disease is also a major contributor, accounting for ~10-20% of all mortality. Pulmonary disease is a common (60-80% of patients with RA) extra-articular complication of RA. Optimal screening, diagnostic, and treatment strategies of pulmonary disease remain uncertain, which have been the focus of an ongoing investigation. Clinicians should regularly assess patients with RA for the signs and symptoms of pulmonary disease and, reciprocally, consider RA and other connective tissue diseases when evaluating a patient with pulmonary disease of an unknown etiology. RA directly affects all anatomic compartments of the thorax, including the lung parenchyma, large and small airways, pleura, and less commonly vessels. In addition, pulmonary infection and drug-induced lung disease associated with immunosuppressive agents used for the treatment of RA may occur.
This review in Front Med summarizes a practical approach.

Follow the link in bio for the full article (https://pubmed.ncbi.nlm.nih.gov/35646974/)

#internalmedicine #internalmedicineresidency #internalmedicineresident #medicine #youngdoctor #juniordoctors #europeanboardofinternalmedicine #medicalnews #medicalresident #residentdoctor #medicaleducation #medicalinformation #rheumatology #rheumatoidarthritis #lungdisease #pulmonology #interstitiallungdisease #dmards

Glucagon-like peptide-1 (GLP-1) is a signal peptid

Glucagon-like peptide-1 (GLP-1) is a signal peptide released from enteroendocrine cells of the lower intestine. GLP-1 exerts anorectic and antimotility actions that protect the body against nutrient malabsorption. However, little is known about how intestinal GLP-1 affects distant organs despite rapid enzymatic inactivation. The authors of this paper in Cell show that intestinal GLP-1 inhibits gastric emptying and eating via intestinofugal neurons, a subclass of myenteric neurons that project to abdominal sympathetic ganglia. Remarkably, cell-specific ablation of intestinofugal neurons eliminated intestinal GLP-1 effects, and their chemical activation functioned as a GLP-1 mimetic. GLP-1 sensing by intestinofugal neurons then engaged a sympatho-gastro-spinal-reticular-hypothalamic pathway that links abnormal stomach distension to craniofacial programs for food rejection. Within this pathway, cell-specific activation of discrete neuronal populations caused systemic GLP-1-like effects. These molecularly identified, delimited enteric circuits may be targeted to ameliorate the abdominal bloating and loss of appetite typical of gastric motility disorders.

Check the link in bio to read the full article (https://www.cell.com/cell/fulltext/S0092-8674(22)00591-8?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0092867422005918%3Fshowall%3Dtrue)

#internalmedicine #internalmedicineresidency #internalmedicineresident #medicine #youngdoctor #juniordoctors #europeanboardofinternalmedicine #medicalnews #medicalresident #residentdoctor #medicaleducation #medicalinformation #glp1receptoragonists #endocrinology #brain #gutbrainaxis #health

Behavioral weight loss (BWL) programs result in we

Behavioral weight loss (BWL) programs result in weight loss for some, but most individuals regain the weight. The behavioral susceptibility theory proposes that genetically determined appetitive traits, such as food responsiveness (FR) and satiety responsiveness (SR), interact with the environment and lead to overeating and weight gain; the regulation of cues (ROC) intervention was developed specifically to target FR and SR.

Question What is the effect of regulation of cues (ROC), a weight-loss treatment based on appetitive traits, and ROC plus behavioral weight loss (ROC+) compared with BWL alone and an active comparator (AC) among adults?

Findings In this randomized clinical trial in JAMA Network Open with 271 adults, patients randomized to ROC, ROC+, and BWL demonstrated similar weight loss during treatment and follow-up. Individuals who scored higher on food responsiveness lost more weight in the ROC and ROC+ groups than in the BWL or AC groups.

Meaning These findings suggest that ROC and ROC+ could be alternative weight loss programs for adults, particularly for individuals with high levels of food responsiveness.

Go follow the link in bio for the full article (https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2792381)

#internalmedicine #internalmedicineresidency #internalmedicineresident #medicine #youngdoctor #juniordoctors #europeanboardofinternalmedicine #medicalnews #medicalresident #residentdoctor #medicaleducation #medicalinformation #obesity #weighthloss #endocrinology

Two new studies provide robust epidemiological evi

Two new studies provide robust epidemiological evidence and a mechanistic link, with potential implications for strategies that target Epstein–Barr virus:
1. Longitudinal analysis reveals high prevalence of Epstein-Barr virus associated with multiple sclerosis (https://ebim-online.us2.list-manage.com/track/click?u=4bcded1127150a11afa599712&id=ad0386b245&e=d557375b95)

2. Clonally expanded B cells in multiple sclerosis bind EBV EBNA1 and GlialCAM (https://ebim-online.us2.list-manage.com/track/click?u=4bcded1127150a11afa599712&id=5a56acdc81&e=d557375b95)

Go find the links in bio for the articles.

internalmedicine #internalmedicineresidency #internalmedicineresident #medicine #youngdoctor #juniordoctors #europeanboardofinternalmedicine #medicalnews #medicalresident #residentdoctor #medicaleducation #medicalinformation #neurology #multiplesclerosis #ebsteinbarrvirus #neurologylife #neurologist #neurologyresident #neurologynews

In this randomized clinical trial in JAMA that inc

In this randomized clinical trial in JAMA that included 300 patients, subcutaneous biweekly injection of alirocumab (a PCSK9 inhibitor), compared with placebo, added to high-intensity statin therapy resulted in a significantly greater reduction in the mean change in percent atheroma volume in non–infarct-related arteries after 52 weeks (−2.13% vs −0.92%).
Among patients with acute myocardial infarction, the addition of alirocumab to high-intensity statin therapy resulted in greater coronary plaque regression in non–infarct-related arteries. Follow the link in bio for the study (https://jamanetwork.com/journals/jama/article-abstract/2790913)

#internalmedicine #internalmedicineresidency #internalmedicineresident #medicine #youngdoctor #juniordoctors #europeanboardofinternalmedicine #medicalnews #medicalresident #residentdoctor #medicaleducation #medicalinformation #cardiology #cardiologist #heartdiseases #statins #hyperlipidemia #pcsk9 #pcsk9inhibitors #myocardialinfarction #medicaleducation

In this study in JACC of 66,636 primary prevention

In this study in JACC of 66,636 primary prevention patients from the CAC Consortium higher CAC burden strongly associates with incident SCD beyond traditional risk factors, particularly among primary prevention patients with low-intermediate risk. SCD risk stratification can be useful in the early stages of CHD through the measurement of CAC, identifying patients most likely to benefit from further downstream testing. Go check the link in bio for the article (https://www.jacc.org/doi/10.1016/j.jcmg.2022.02.011)

#internalmedicine #internalmedicineresidency #internalmedicineresident #medicine #youngdoctor #juniordoctors #europeanboardofinternalmedicine #medicalnews #medicalresident #residentdoctor #medicaleducation #medicalinformation
#cardiology #cardiologist #heartdiseases #ccta #anginapectoris #myocardialinfarction #coronaryarteries

In this study in CJASN the authors evaluated the a

In this study in CJASN the authors evaluated the association between eGFR and uremic symptom severity score in patients with CKD.
The prevalence of uremic symptoms in CKD was high, with significant variability in patient symptom change over time. Declines in eGFR were associated with worsening of uremic symptom severity, but the magnitude of these changes is small and of uncertain clinical significance. One should look for other factors that drive the symptom burden. Go follow the link in bio for more (https://cjasn.asnjournals.org/content/early/2022/03/16/CJN.13010921?WT.MC_ID=ITL)

#internalmedicine #internalmedicineresidency #internalmedicineresident #medicine #youngdoctor #juniordoctors #europeanboardofinternalmedicine #medicalnews #medicalresident #residentdoctor #medicaleducation #medicalinformation #chronickidneydisease #ckd #uremia #kidneydisease #nephrology

The accumulating literature linking stress with ne

The accumulating literature linking stress with negative health outcomes, including cardiovascular disease (CVD), is extensively reported yet poorly defined. Stress is associated with a higher risk of hypertension, acute myocardial infarction, arrhythmogenesis, and heart failure. Stress mediates its effect through direct neuronal, endocrine, autonomic, and immune processes and indirectly by modifying lifestyle behaviors that promote CVD progression. Stress occurs when an individual perceives that internal or external demands exceed the capacity for an adaptive response. Psychologic stress is increasingly recognized in the atrial fibrillation (AF) population, although the pathophysiology remains unclear. There appears to be a bidirectional relationship between AF and stress with a complex interplay between the two entities. Stress modulates the immune and autonomic nervous systems, key drivers in AF initiation and potentiation. AF leads to increasing anxiety, psychologic distress, and suicidal ideation. Recently, lifestyle modification has emerged as the fourth pillar of AF management, with stress reduction a potential reversible risk factor and future target for intervention. This review in JACC examines proposed mechanisms linking AF and stress and explores stress reduction as an adjunct to the AF management armamentarium. Link in bio (https://www.sciencedirect.com/science/article/abs/pii/S2405500X21010872)

#internalmedicine #internalmedicineresidency #internalmedicineresident #medicine #youngdoctor #juniordoctors #europeanboardofinternalmedicine #medicalnews #medicalresident #residentdoctor #medicaleducation #medicalinformation #atrialfibrillation
#cardiology #cardiologist #heartdiseases

A substantial proportion of patients with heart fa $A substantial proportion of patients with heart failure (HF) with preserved ejection fraction (HFpEF) present with normal natriuretic peptide (NP) levels. This study in Eur Heart J shows that patients with HFpEF and normal NP display mild diastolic dysfunction and preserved CO reserve during exercise, despite marked elevation in filling pressures. While clinical outcomes are not as poor compared with patients with high NP, patients with normal NP HFpEF exhibit an increased risk of death or HF readmissions compared with patients without HF, emphasizing the importance of this phenotype. Follow the link in bio for the full article (https://academic.oup.com/eurheartj/advance-article-abstract/doi/10.1093/eurheartj/ehab911/6525335?redirectedFrom=fulltext) #internalmedicine #internalmedicineresidency #internalmedicineresident #medicine #youngdoctor #juniordoctors #europeanboardofinternalmedicine #medicalnews #medicalresident #residentdoctor #medicaleducation #medicalinformation #heartfailure #cardiology #cardiologist #heartdiseases #heartpathology #hfpef #natriureticpeptide$

Almost 200 years ago, the first evidence described

Almost 200 years ago, the first evidence described by Robert Bright (1836) showed the strong interaction between the kidneys and heart and, since then, the scientific community has dedicated itself to better understanding the mechanisms involved in the kidney–heart relationship, known in recent decades as cardiorenal syndrome (CRS). This syndrome includes a wide clinical variety that affects the kidneys and heart, in an acute or chronic manner. Moreover, it is well established in the literature that the immune system, the sympathetic nervous system, the renin–angiotensin–aldosterone, and the oxidative stress actively play a strong role in the cellular and molecular processes present in CRS. More recently, uremic molecules and epigenetic factors have been also shown to be key mediators in the development of the syndrome. The present review in Heart Failure Reviews intends to present the state of the art regarding CRS and to show the paths known, until now, in the long road between the kidneys and heart. Find the link of the review in bio (https://link.springer.com/article/10.1007/s10741-022-10218-w)

#internalmedicine #internalmedicineresidency #internalmedicineresident #medicine #youngdoctor #juniordoctors #europeanboardofinternalmedicine #medicalnews #medicalresident #residentdoctor #medicaleducation #medicalinformation
#cardiology #cardiologist #heartdiseases #nephrology #cardiorenalsyndrome #kidneydisease

This study in European Heart J shows that the over

This study in European Heart J shows that the overall prevalence of Statin Intolerance is 9.1% and even lower using the international definitions: National Lipid Association, International Lipid Expert Panel, European Atherosclerosis Society (7.0, 6.7, 5.9%). Female gender, hypothyroidism, high statin dose, advanced age, antiarrhythmics, and obesity are the main factors that increase the risk of Statin Intolerance.

Clinicians should use these results to encourage adherence to statin therapy in the patients they treat.

Read the full article, link in bio (https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehac015/6529098)

#internalmedicine #internalmedicineresidency #internalmedicineresident #medicine #youngdoctor #juniordoctors #europeanboardofinternalmedicine #medicalnews #medicalresident #residentdoctor #medicaleducation #medicalinformation #cardiology #lipids #cholesterol #ldlcholesterol #statins #heartjournal

This clinical trial in Eur Heart J evaluated oleza

This clinical trial in Eur Heart J evaluated olezarsen, an N-acetyl-galactosamine-conjugated antisense oligonucleotide targeted to hepatic APOC3mRNA to inhibit apolipoprotein C-III (apoC-III) production, in lowering triglyceride levels in patients at high risk for or with established cardiovascular disease.

A randomized, double-blind, placebo-controlled, dose-ranging study was conducted in 114 patients with fasting serum triglycerides 200–500 mg/dL (2.26–5.65 mmol/L). Patients received olezarsen (10 or 50 mg every 4 weeks, 15 mg every 2 weeks, or 10 mg every week) or saline placebo subcutaneously for 6–12 months. The primary endpoint was the percent change in fasting triglyceride levels from baseline to Month 6 of exposure. Baseline median (interquartile range) fasting triglyceride levels were 262 (222–329) mg/dL [2.96 (2.51–3.71) mmol/L]. Treatment with olezarsen resulted in mean percent triglyceride reductions of 23% with 10 mg every 4 weeks, 56% with 15 mg every 2 weeks, 60% with 10 mg every week, and 60% with 50 mg every 4 weeks, compared with increase by 6% for the pooled placebo group (P-values ranged from 0.0042 to <0.0001 compared with placebo). Significant decreases in apoC-III, very low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, and apolipoprotein B were also observed. There were no platelet count, liver, or renal function changes in any of the olezarsen groups. The most common adverse event was mild erythema at the injection site.

Conclusion
Olezarsen significantly reduced apoC-III, triglycerides, and atherogenic lipoproteins in patients with moderate hypertriglyceridaemia and at high risk for or with established cardiovascular disease.

Check the link in bio to read the study (https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehab820/6506552?login=false)

#internalmedicine #internalmedicineresidency #internalmedicineresident #medicine #youngdoctor #juniordoctors #europeanboardofinternalmedicine #medicalnews #medicalresident #residentdoctor #medicaleducation #medicalinformation
#cardiology #heartdiseases #coronaryarteries #heartpathology
#hyperlipidemia #hypertryglyceridemia

Substantial progress has been made in therapeutics

Substantial progress has been made in therapeutics for nonhospitalized patients with COVID-19, but supply of and access to treatment remain limited. This Viewpoint in JAMA summarizes currently available therapeutics for nonhospitalized patients in the setting of the Omicron variant including principles for equitable allocation.
Patients with mild or moderate COVID-19 are those who have respiratory and systemic symptoms but not hypoxia, tachypnea, or other complications that necessitate hospitalization. During this early phase of illness, viral replication is occurring and antiviral therapies are used to prevent disease progression, hospitalization, and death.

Antivirals target different stages of the SARS-CoV-2 life cycle. Anti–SARS-CoV-2 monoclonal antibodies bind to the viral spike protein, preventing attachment and entry into cells. Nirmatrelvir-ritonavir inhibits the SARS-CoV-2 main protease, which cleaves viral polyproteins into nonstructural proteins essential for replication. Molnupiravir and remdesivir target SARS-CoV-2 RNA replication: the former induces RNA mutagenesis leading to virus that is unable to replicate and the latter is a nucleotide prodrug that inhibits viral RNA polymerase. Because of mutations in the viral spike protein of the Omicron variant, most currently available anti–SARS-CoV-2 monoclonal antibodies have reduced activity. Nirmatrelvir-ritonavir, remdesivir, and molnupiravir, which target more conserved viral regions, are expected to remain active against Omicron. Link in bio (https://jamanetwork.com/journals/jama/fullarticle/2788254)

#internalmedicine #internalmedicineresidency #internalmedicineresident #medicine #youngdoctor #juniordoctors #europeanboardofinternalmedicine #medicalnews #medicalresident #residentdoctor #medicaleducation #medicalinformation #younginternists #covid_19 #sarscov2 #infectiousdisease

The Skeleton Key Group, a team of 50-odd nephrolo

The Skeleton Key Group, a team of 50-odd nephrology fellows who work together to build a monthly education package for the Renal Fellow Network just released their 25th clinical case. These are actual cases (without patient identifying information) that intrigued the treating physician.

Follow the link in bio and go work up the case (https://www.renalfellow.org/2022/01/18/skeleton-key-group-case-25-falling-for-phosphate/)

#internalmedicine #internalmedicineresidency #internalmedicineresident #medicine #youngdoctor #juniordoctors #europeanboardofinternalmedicine #medicalnews #medicalresident #residentdoctor #medicaleducation #medicalinformation #nephrology #kidneydisease #ckd #chronickidneydisease #phosphate

Patients with chronic kidney disease (CKD) frequen

Patients with chronic kidney disease (CKD) frequently experience unpleasant symptoms. These can be gastrointestinal (constipation, nausea, vomiting and diarrhoea), psychological (anxiety and sadness), neurological (lightheadedness, headache and numbness), cardiopulmonary (shortness of breath and oedema), dermatological (pruritus and dry skin), painful (muscle cramps, chest pain and abdominal pain) or involve sexual dysfunction, sleep disorders and fatigue. These symptoms often occur in clusters, with one of them as the lead symptom and others as secondary symptoms. Uraemic toxins (also called uremic toxins) are often considered to be the main cause of CKD-associated symptom burden, but treatment of uraemia by dialysis often fails to resolve them and can engender additional symptoms. Indeed, symptoms can be exacerbated by comorbid conditions, pharmacotherapies, lifestyle and dietary regimens, kidney replacement therapy and ageing. Patients with kidney disease, including those who depend on dialysis or transplantation, should feel actively supported in their symptom management through the identification and targeting of unpleasant symptoms via a tailored palliative care approach. As discussed in Nature Reviews Nephrology this approach may help minimize the burden and consequences of kidney disease, and lead to improved patient outcomes including health-related quality of life and better life participation. This approach may be helpful in other conditions with unpleasant symptoms as frequently encountered in clinical practice. Find the link in bio to the full review (https://www.nature.com/articles/s41581-021-00518-z)

#internalmedicine #internalmedicineresidency #internalmedicineresident #medicine #youngdoctor #juniordoctors #europeanboardofinternalmedicine #medicalnews #medicalresident #residentdoctor #medicaleducation #medicalinformation #nephrology #kidneydisease #ckd #chronickidneydisease #uremia

Age is an independent risk factor for cardiovascul

Age is an independent risk factor for cardiovascular disease. With the accelerated growth of the population of older adults, geriatric and cardiac care are becoming increasingly entwined. Although cardiovascular disease in younger adults often occurs as an isolated problem, it is more likely to occur in combination with clinical challenges related to age in older patients. Management of cardiovascular disease is transmuted by the context of multimorbidity, frailty, polypharmacy, cognitive dysfunction, functional decline, and other complexities of age. This means that additional insight and skills are needed to manage a broader range of relevant problems in older patients with cardiovascular disease. This review in BMJ covers geriatric conditions that are relevant when treating older adults with cardiovascular disease, particularly management considerations. Traditional practice guidelines are generally well suited for robust older adults, but many others benefit from a relatively more personalized therapeutic approach that allows for a range of medical circumstances and idiosyncratic goals of care. This requires weighing of risks and benefits amidst the patient’s aggregate clinical status and the ability to communicate effectively about this with patients and, where appropriate, their caregivers in a process of shared decision making. Such a personalized approach can be particularly gratifying, as it provides opportunities to optimize an older patient’s function and quality of life at a time in life when these often become foremost therapeutic priorities.

Go check the link in bio for the full review (https://www.bmj.com/content/374/bmj.n1593.long)

#internalmedicine #internalmedicineresidency #internalmedicineresident #medicine #youngdoctor #juniordoctors #europeanboardofinternalmedicine #medicalnews #medicalresident #residentdoctor #medicaleducation #medicalinformation
#cardiology #cardiologist #heartdiseases #geriatric #coronaryarteries #heartpathology

This is an update in Neurology on the 2011 America

This is an update in Neurology on the 2011 American Academy of Neurology (AAN) guideline on the treatment of painful diabetic neuropathy (PDN) with a focus on topical and oral medications and medical class effects.

Gabapentinoids, serotonin-norepinephrine reuptake inhibitors (SNRIs), sodium channel blockers, and SNRI/opioid dual mechanism agents all have comparable effect sizes just above or just below our cutoff for a medium effect size (SMD 0.5). Tricyclic antidepressants (TCAs) have a large effect size, but this result is tempered by a low confidence in the estimate.

Clinicians should assess patients with diabetes for PDN and those with PDN for concurrent mood and sleep disorders. In patients with PDN, clinicians should offer TCAs, SNRIs, gabapentinoids, and/or sodium channel blockers to reduce pain and consider factors other than efficacy. Clinicians should offer patients a trial of medication from a different effective class when they do not achieve meaningful improvement or experience significant adverse effects with the initial therapeutic class and not use opioids for the treatment of PDN. Link in bio (https://n.neurology.org/content/98/1/31.long)

#internalmedicine #internalmedicineresidency #internalmedicineresident #medicine #youngdoctor #juniordoctors #europeanboardofinternalmedicine #medicalnews #medicalresident #residentdoctor #medicaleducation #medicalinformation #medicine #neurology #diabetes #polyneuropathy #treatmentapproach

Chronic cough is defined in adults as a cough that $Chronic cough is defined in adults as a cough that lasts for ≥8 weeks. When it proves intractable to standard-of-care treatment, it can be referred to as refractory chronic cough (RCC). Chronic cough is now understood to be a condition of neural dysregulation. Chronic cough and RCC result in a serious, often unrecognized, disease burden, which forms the focus of the current review in European Respiratory Review. The estimated global prevalence of chronic cough is 2–18%. Patients with chronic cough and RCC report many physical and psychological effects, which impair their quality of life. Chronic cough also has a significant economic burden on the patient and healthcare systems. RCC diagnosis and treatment are often delayed for many years as potential treatable triggers must be excluded first and a stepwise empirical therapeutic regimen is recommended. Evidence supporting most currently recommended treatments is limited. Many treatments do not address the underlying pathology, are used off-label, have limited efficacy and produce significant side effects. There is therefore a significant unmet need for alternative therapies for RCC that target the underlying disease mechanisms. Follow the link in bio for the full article (https://err.ersjournals.com/content/30/162/210127.long) #internalmedicine #internalmedicineresidency #internalmedicineresident #medicine #youngdoctor #juniordoctors #europeanboardofinternalmedicine #medicalnews #medicalresident #residentdoctor #medicaleducation #medicalinformation #cough #pneumology #lungmedicine #chroniccough$

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Bad luck comes in threes

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https://www.ejinme.com/article/S0953-6205(23)00143-7/fulltext

@JacopoImberti @monicasolbiati

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EJCRIM Follow

The European Journal of Case Reports in Internal Medicine is an official Journal of the European Federation of Internal Medicine. Published by @smcmediasrl

EJCRIM @ejcrim ·

4 Oct

Sarah Galbraith is also the winner of the EJCRIM feature prize - congrats on the great case series!

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EJCRIM @ejcrim ·

29 Sep

EJCRIM is at MIRCIM, come to the booth tomorrow and say hi!

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