Specialty Medicine Update
The articles listed on this page provide current news updates in the topic of specialty medicine.
Chest compressions for cardiac arrest in pregnancy
Recent studies suggest that chest compressions are one of the most viable means resuscitation after cardiac arrest, and recommends the same hand position for chest compressions in pregnant women and non-pregnant adults.
Coronary artery embolism as the cause of acute MI
Atherosclerotic coronary artery obstruction is the cause of myocardial infarction (MI) in the overwhelming majority of patients. However, no obstructive coronary atherosclerosis is found in approximately 5 percent of patients; multiple possible causes have been identified. In patients with acute MI who do not have obstructive atherosclerotic coronary artery disease as the likely cause, undiagnosed or untreated atrial fibrillation with CE may be the explanation.
Progression from acute to chronic pancreatitis
In recent studies, the prevalence of chronic pancreatitis following the first episode and following recurrent acute pancreatitis was shown to be 10 and 36 percent, respectively. Among individuals with a history of smoking or alcohol use, the prevalence of chronic pancreatitis was 65 and 61 percent, respectively. The risk of progression to chronic pancreatitis was higher in men than in women after controlling for age and severity of acute pancreatitis.
Acute diverticulitis: Risk of recurrence
Recent studies performed on patients with acute diverticulitis, recurrent diverticulitis in a 10-year period after the index and second diverticulitis episode occurred in 22 and 55 percent of patients, respectively. The risk of recurrence was higher in younger individuals and in women. Increasing age was associated with a higher risk of both local and systemic complications.
Primary biliary cirrhosis is now known as primary biliary cholangitis
The term “primary biliary cirrhosis” has been used to describe the T-lymphocyte-mediated attack on small intralobular bile ducts. However, the terminology is changing to “primary biliary cholangitis” to describe the disorder and its natural history more accurately.
2015 revised Beers criteria for potentially inappropriate medication use in older adults
The 2015 revised Beers criteria for potentially inappropriate medication use in older adults are available through the American Geriatrics Society website. The criteria include over 50 medications designated in one of three categories: those that should always be avoided (eg, barbiturates, chlorpropamide); those that are potentially inappropriate in older adults with particular health conditions or syndromes; and those that should be used with caution. Some notable changes in the 2015 listings are removal of loratadine from the list of medications with strong anticholinergic properties; a more liberal renal threshold (now creatinine clearance <30 rather than <60 mL/min) for withholding nitrofurantoin; avoidance of long-term proton pump inhibitors because of risk of C. difficile infections and bone loss; and stricter guidelines to avoid antipsychotics for behavioral problems unless other options have failed and the older adult is threatening harm to self or others.
Bridging anticoagulation in patients who require warfarin interruption for surgery
Perioperative management of a patient receiving an anticoagulant is challenging because the risks of bleeding and thromboembolism are both increased. Studies suggest not using bridging for most individuals who require warfarin interruption. The studies do however suggest bridging in certain high-risk individuals, including those with a mechanical mitral valve, thromboembolic event within the previous 12 weeks, atrial fibrillation and very high risk of stroke, recent coronary stenting, or previous thromboembolism during interruption of chronic anticoagulation.
Weak association between citrus fruit and melanoma
An analysis of data from over 100,000 individuals participating in the Nurse’s Health Study found a modest 36 percent increase in melanoma risk associated with high dietary intake of citrus fruit or juice.
Practice tool for managing direct oral anticoagulants
The direct oral anticoagulants ([DOACs]; dabigatran, rivaroxaban, apixaban, edoxaban) generally are used without routine laboratory monitoring of coagulation times; this lack of monitoring requirement is considered a major advantage over vitamin K antagonists. A practice tool has now been published to help clinicians ensure that patients are taking their DOAC correctly and are minimizing risks of thromboembolism and bleeding.
Causes of community-acquired pneumonia in adults in the United States
In recent studies examining patients with CAP, one or more viruses were detected in 23 percent of cases, bacteria in 11 percent, bacteria and viruses in 3 percent, and fungi or mycobacteria in 1 percent; an etiology was not identified in 62 percent of cases [58]. The most commonly identified organisms were rhinovirus (in 9 percent), influenza virus (in 6 percent), and S. pneumoniae (in 5 percent). In a related study, detection of rhinovirus was associated with CAP in adults, but not in children [59].
Repeat testing for women treated for trichomoniasis
In the United States, reinfection with Trichomonas vaginalis has been reported to occur in up to 17 percent of women following treatment for an initial infection.
Updated CDC guidelines on the management of sexually transmitted infections
The US Centers for Disease Control and Prevention (CDC) updated its guidelines on the management of sexually transmitted infections in June 2015. Major revisions include a lower threshold for the diagnosis of urethritis based on microscopy of a urethral specimen, a new emphasis on the role of Mycoplasma genitalium in persistent urethritis and cervicitis, preference for nucleic acid amplification-based testing for the diagnosis ofTrichomonas vaginalis, and a recommendation to retest women after treatment for T. vaginalis to evaluate for reinfection. New screening recommendations include annual hepatitis C virus (HCV) testing for HIV-infected men who have sex with men and T. vaginalis testing for HIV-infected women annually and when pregnant.
Prevalence and clinical presentation of Borrelia miyamotoi infection
Borrelia miyamotoi is an emerging zoonotic pathogen that is transmitted by the same genus of ticks. Diagnostic testing is not widely available, but doxycycline, which is used to treat many other tick-borne infections, is also effective against B. miyamotoi.
Antimicrobial-resistant Shigella infections in the United States
Antimicrobial resistance in Shigella is an increasing problem in the United States. Fluoroquinolones are typically the antibiotic class of choice in adults, and azithromycin is often used if fluoroquinolone resistance is suspected or documented.
SPRINT trial on goal blood pressure
Goal blood pressure in most hypertensive patients had been <140/90
New guidelines on screening and diagnosis of hypertension
New guidelines from the United States Preventive Services Task Force (USPSTF) and the Canadian Hypertension Education Program (CHEP) have been released and suggest that, in nearly all patients who have an elevated blood pressure measured in the office, out-of-office blood pressure readings should be obtained to confirm the diagnosis. For out-of-office blood pressure measurement, 24-hour ambulatory blood pressure monitoring (ABPM) is preferred, and home blood pressure monitoring is an acceptable alternative if ABPM is not possible.
Arthroscopic surgery for knee osteoarthritis
Arthroscopic knee surgery, including partial meniscectomy and/ordebridement
Safety concerns and FDA panel meeting regarding hysteroscopic sterilization
Safety concerns have been raised about female sterilization via hysteroscopic placement of micro-inserts into the fallopian tubes. Studies suggest that at five years, up to 38 percent of women reported recurrent menstrual irregularities and up to 5 percent reported recurrent pelvic pain. In September 2015, the FDA convened a meeting of the Obstetrics and Gynecology Devices Panel to review the safety and effectiveness of hysteroscopic sterilization. The panel discussed and made suggestions regarding a need for better patient information materials, a need for a review of existing and future data on adverse effects, and a need to better select candidates for the procedure.
Platelet-rich plasma for acute muscle injury
Platelet-rich plasma (PRP) injections have been touted as an effective treatment for acute muscle and tendon injuries despite scant evidence from randomized trials. Studies, however, have suggested a lack of effectiveness of PRP.
Expectant management of mild preeclampsia near term
The optimum time for delivery of women with preeclampsia without features of severe disease and stable maternal and fetal conditions at 34 to 36 weeks of gestation has been uncertain. Recent studies have suggested that newborns benef from the extra time in utero: the rate of respiratory distress syndrome in the study was 70 percent less with expectant management compared with immediate delivery . Mild preeclampsia with onset at 34 to 36 weeks can be managed expectantly to enable further fetal growth and maturation. Delivery was indicated at 37 weeks for the study.