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EBIM in the Loop, Feb 15

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Post date February 15, 2021
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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 $Chronic cough is defined in adults as a cough that lasts for ≥8 weeks. When it proves intractable to standard-of-care treatment, it can be referred to as refractory chronic cough (RCC). Chronic cough is now understood to be a condition of neural dysregulation. Chronic cough and RCC result in a serious, often unrecognized, disease burden, which forms the focus of the current review in European Respiratory Review. The estimated global prevalence of chronic cough is 2–18%. Patients with chronic cough and RCC report many physical and psychological effects, which impair their quality of life. Chronic cough also has a significant economic burden on the patient and healthcare systems. RCC diagnosis and treatment are often delayed for many years as potential treatable triggers must be excluded first and a stepwise empirical therapeutic regimen is recommended. Evidence supporting most currently recommended treatments is limited. Many treatments do not address the underlying pathology, are used off-label, have limited efficacy and produce significant side effects. There is therefore a significant unmet need for alternative therapies for RCC that target the underlying disease mechanisms. Follow the link in bio for the full article (https://err.ersjournals.com/content/30/162/210127.long) #internalmedicine #internalmedicineresidency #internalmedicineresident #medicine #youngdoctor #juniordoctors #europeanboardofinternalmedicine #medicalnews #medicalresident #residentdoctor #medicaleducation #medicalinformation #cough #pneumology #lungmedicine #chroniccough$

Central retinal artery occlusion (CRAO) is a form

Central retinal artery occlusion (CRAO) is a form of acute ischemic stroke that causes severe visual loss and is a harbinger of further cerebrovascular and cardiovascular events. In this scientific statement, the authors have critically appraise the literature on CRAO and provide a framework within which to consider acute treatment and secondary prevention. Link in bio (https://www.ahajournals.org/doi/10.1161/STR.0000000000000366)

#internalmedicine #internalmedicineresidency #internalmedicineresident #medicine #youngdoctor #juniordoctors #europeanboardofinternalmedicine #medicalnews #medicalresident #residentdoctor #medicaleducation #medicalinformation #neurology #ophtalmology #stroke #ischemia

In this analysis of the SUSTAIN 6 and LEADER trial

In this analysis of the SUSTAIN 6 and LEADER trials in Circulation, the authors demonstrated the benefit of using once-weekly semaglutide and once-daily liraglutide on a number of clinically important kidney outcomes: changes in albuminuria, annual slope of estimated glomerular filtration rate (eGFR) change, time to persistent. proportional eGFR reductions of 40% and 50% from baseline, and a composite endpoint (time from randomisation to first occurrence of kidney failure/death or proportional eGFR decline).

The results of this study suggest that the GLP-1 RAs semaglutide and liraglutide may add to the kidney-protective treatment options available to people with type 2 diabetes(T2D) and diabetic kidney disease (DKD).

Further studies are required to investigate the full effect of GLP-1 RAs on primary kidney endpoints in dedicated trials in Diabetic Kidney Disease. SUSTAIN 6 and LEADER examined kidney endpoints as secondary outcomes and enrolled a majority of patients without DKD but with cardiovascular disease.

Link to the article in bio (https://www.ahajournals.org/doi/epdf/10.1161/CIRCULATIONAHA.121.055459)

#internalmedicine #internalmedicineresidency #internalmedicineresident #medicine #youngdoctor #juniordoctors #europeanboardofinternalmedicine #medicalnews #medicalresident #residentdoctor #medicaleducation #medicalinformation #medicaleducation #nephrology #diabetes #diabetesmellitus #type2diabetes #kidneydisease #clinicaltrials

Decisions relevant to global challenges must be in

Decisions relevant to global challenges must be informed by the best available evidence. It should no longer be acceptable for evidence to be out of date, biased or selective. Without trustworthy and up-to-date summaries, the world risks making ill-informed decisions and wasting investment.

Living evidence as a practice has been around for barely five years, and there is much to learn. Our experience so far is counter to common initial concerns. Rather than being confused by changing guidelines, clinicians value a resource they know is up to date. Interest from living-evidence practitioners can be sustained and team membership can gradually shift without interrupting updates. The cost of continuously updating guidelines seems about the same as gearing up for big revisions every few years.

The advances made in evidence systems during the COVID-19 pandemic should extend beyond health. In this comment in Nature the authors call on researchers in all scientific fields, and their funders, to test the living-evidence model across diverse domains. Trialling the approach with different types of evidence, for a wide range of decision makers, will contribute to the advancement and scale-up of the model. Science does not stand still; neither should its synthesis and translation into action.

Check the link in bio for the full article (https://www.nature.com/articles/d41586-021-03690-1?utm_source=Nature+Briefing&utm_campaign=f5ce3c484a-briefing-dy-20211216&utm_medium=email&utm_term=0_c9dfd39373-f5ce3c484a-43590045)

#internalmedicine #internalmedicineresidency #internalmedicineresident #medicine #youngdoctor #juniordoctors #europeanboardofinternalmedicine #medicalnews #medicalresident #residentdoctor #medicaleducation #medicalinformation #medicaleducation #evidencebasedmedicine #evidencebased #clinicalpractice #clinicalpracticeguidelines #covid_19 #naturesciencejournal

There are many possible causes of acquired hemolyt

There are many possible causes of acquired hemolytic anemia, and the differential diagnosis is often difficult. A series of articles in Blood offer guidance regarding the diagnosis and treatment of AIHA. One major group is represented by the autoimmune hemolytic anemias, in which increased red cell destruction is due to agglutinins that bind to antigens on the red cell surface. The best-characterized subtypes are warm autoimmune hemolytic anemia and cold agglutinin disease. Warm agglutinins are typically immunoglobulin G antibodies that bind to red cell antigens at a temperature of 37°C and determine accelerated extravascular hemolysis, whereas cold agglutinins are immunoglobulin M autoantibodies that bind at lower temperatures and cause complement-mediated hemolysis. Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired clonal disorder caused by the absence of glycosyl phosphatidylinositol (GPI)–anchored surface proteins in blood cells, which is in turn due to a somatic mutation in the PIG-A gene. Microangiopathic hemolytic anemia (MAHA) is characterized by red cell fragmentation and hemolysis that result from abnormalities in the small blood vessels; systemic malignancies are a potential cause of unexpected MAHA. For further read follow the link in bio (https://ashpublications.org/blood/article/137/10/1269/475027/Introduction-to-a-How-I-Treat-series-on-acquired)

#internalmedicine #internalmedicineresidency #internalmedicineresident #medicine #youngdoctor #juniordoctors #europeanboardofinternalmedicine #medicalnews #medicalresident #residentdoctor #medicaleducation #medicalinformation #hematology #blooddisorder #hematologyoncology #autoimune #hemoliticanemia

With prospective clinical sequencing of tumors eme

With prospective clinical sequencing of tumors emerging as a mainstay in cancer care, there is an urgent need for a clinical support tool that distills the clinical implications associated with specific mutation events into a standardized and easily interpretable format. To this end, we developed OncoKB, an expert-guided precision oncology knowledge base.

OncoKB annotates the biological and oncogenic effect and the prognostic and predictive significance of somatic molecular alterations. Potential treatment implications are stratified by the level of evidence that a specific molecular alteration is predictive of drug response based on US Food and Drug Administration (FDA) labeling, National Comprehensive Cancer Network (NCCN) guidelines, disease-focused expert group recommendations and the scientific literature.

To date, over 3000 unique mutations, fusions, and copy number alterations in 418 cancer-associated genes have been annotated. To test the utility of OncoKB, the authors annotated all genomic events in 5983 primary tumor samples in 19 cancer types. Forty-one percent of samples harbored at least one potentially actionable alteration, of which 7.5% were predictive of clinical benefit from a standard treatment. OncoKB annotations are available through a public web resource (http://oncokb.org/) and are also incorporated into the cBioPortal for Cancer Genomics to facilitate the interpretation of genomic alterations by physicians and researchers.

OncoKB is a comprehensive and curated precision oncology knowledge base, offers oncologists detailed, evidence-based information about individual somatic mutations and structural alterations present in patient tumors with the goal of supporting optimal treatment decisions. Link in bio (https://pubmed.ncbi.nlm.nih.gov/28890946/)

#internalmedicine #internalmedicineresidency #internalmedicineresident #medicine #youngdoctor #juniordoctors #europeanboardofinternalmedicine #medicalnews #medicalresident #residentdoctor #medicaleducation #medicalinformation #oncology #genes #cancer #oncologist #oncologists #malignancy

Ambulatory reflux monitoring (pH or impedance-pH)

Ambulatory reflux monitoring (pH or impedance-pH) allows for assessment of esophageal acid exposure to establish or refute a diagnosis of GERD and for correlating symptoms with reflux episodes. Gastroesophageal reflux disease (GERD) continues to be among the most common diseases seen by gastroenterologists, surgeons, and primary care physicians. Our understanding of the varied presentations of GERD, enhancements in diagnostic testing, and approach to patient management have evolved. During this time, scrutiny of proton pump inhibitors (PPIs) has increased considerably. Although PPIs remain the medical treatment of choice for GERD, multiple publications have raised questions about adverse events, raising doubts about the safety of long-term use and increasing concern about overprescribing of PPIs. New data regarding the potential for surgical and endoscopic interventions have emerged. In this new clinical guideline in AJG, the authors provide updated, evidence-based recommendations and practical guidance for the evaluation and management of GERD, including pharmacologic, lifestyle, surgical, and endoscopic management.

Check the link in bio for the full full review (https://journals.lww.com/ajg/Fulltext/9900/ACG_Clinical_Guideline_for_the_Diagnosis_and.154.aspx)

#internalmedicine #internalmedicineresidency #internalmedicineresident #medicine #youngdoctor #juniordoctors #europeanboardofinternalmedicine #medicalnews #medicalresident #residentdoctor #medicaleducation #medicalinformation #gastroenterology #gerd #gastroesophagealrefluxdisease

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EJCRIM @ejcrim·

Our case report documents a non-puerperal patient who underwent hysterectomy a year before presenting to the ED with complaints of diarrhoea and found to have OVT on a CT scan...
http://shorturl.at/nuBDU

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EJCRIM @ejcrim·

We describe an elderly man with a supratherapeutic INR, secondary to the use of rifampin. Antibiotic-induced coagulopathy is a rare complication. This is a unique case of rifampin-induced coagulopathy with no other associated complications of DIC.
http://shorturl.at/akBD7

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