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https://www.readbyqxmd.com/read/28092152/issues-in-nutrition-dietary-considerations-in-select-chronic-conditions
#1
Margaret E Thompson, Mary Barth Noel
Chronic diseases that affect the gastrointestinal tract also tend to affect nutrition. The incidence of chronic liver disease is increasing. As the prevalence of obesity rises, so do the incidences of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis. Patients with chronic liver disease usually have some degree of malnutrition. In the absence of encephalopathy, patients with chronic liver disease should consume more protein than that in the average diet. There is some controversy about whether diet plays a role in the development of inflammatory bowel disease...
January 2017: FP Essentials
https://www.readbyqxmd.com/read/28092151/issues-in-nutrition-carbohydrates
#2
Margaret E Thompson, Mary Barth Noel
Carbohydrates include sugars, starches, and dietary fibers. Resistant starches resemble fiber in their behavior in the intestinal tract, and may have positive effects on blood glucose levels and the gut microbiome. Fibers are classified as soluble and insoluble, but most fiber-containing foods contain a mixture of soluble and insoluble fiber. Soluble fiber has been shown to lower low-density lipoprotein cholesterol levels. Many artificial sweeteners and other sugar substitutes are available. Most natural sources of sweeteners also are energy sources...
January 2017: FP Essentials
https://www.readbyqxmd.com/read/28092150/issues-in-nutrition-dietary-supplements
#3
Margaret E Thompson, Mary Barth Noel
The majority of American adults report use of one or more dietary supplements every day or occasionally. The Dietary Supplement Health and Education Act of 1994 defines dietary supplements and regulates their manufacture and distribution. One of the most commonly used supplements is vitamin D. Measurement of serum levels of vitamin D must be undertaken with the caveats that different laboratories define normal levels differently, and that there is rarely a clinical correlation with the actual level. Patients should understand that supplements should not be used to excess, as there are toxicities and other adverse effects associated with most of them...
January 2017: FP Essentials
https://www.readbyqxmd.com/read/28092149/issues-in-nutrition-nutritional-assessment-of-adults
#4
Margaret E Thompson, Mary Barth Noel
The assessment of nutritional status in adults should begin with a complete history, including intake of fruits and vegetables, sources of fat, and added sugar (eg, sugar-sweetened beverages). The history should include social factors that may impede a patient's ability to obtain food, as well as any factors that might interfere with preparing, chewing, and digesting food and absorbing nutrients. The physical examination should include measurement of height and weight and calculation of body mass index. It also may include measurements of waist circumference and waist to hip ratio, and an evaluation of strength...
January 2017: FP Essentials
https://www.readbyqxmd.com/read/28092148/issues-in-nutrition-foreword
#5
Karl T Rew
No abstract text is available yet for this article.
January 2017: FP Essentials
https://www.readbyqxmd.com/read/27936533/endocrinology-update-testicular-hypogonadism
#6
Joel J Heidelbaugh
Testicular hypogonadism, or androgen deficiency, is defined as a clinical condition resulting from failure of the testes to produce physiologic levels of testosterone and a normal number of spermatozoa because of disruption of the hypothalamic-pituitary-gonadal axis. Testosterone deficiency (TD) is defined as a serum level less than 300 ng/dL on a morning total testosterone test. It is estimated that more than one-third of men 45 years and older have testosterone deficiency. Associated symptoms include decreased libido, erectile dysfunction, decreased physical stamina and strength, depressed mood, fatigue, increased visceral adiposity, sleep disturbance, and/or poor concentration and memory...
December 2016: FP Essentials
https://www.readbyqxmd.com/read/27936532/endocrinology-update-hypopituitarism
#7
Joel J Heidelbaugh
Hypopituitarism is defined as a deficiency of one or more pituitary hormones due to a decline in function of the pituitary gland and/or hypothalamus, which can result in higher risks of morbidity and mortality and decreased quality of life. Although hypopituitarism is a rare condition, it commonly develops after traumatic brain injury and in the setting of functioning and nonfunctioning pituitary adenomas. The diagnosis is based on detailed investigation of symptoms of target endocrine gland function relative to the corresponding pituitary hormone deficiency...
December 2016: FP Essentials
https://www.readbyqxmd.com/read/27936531/endocrinology-update-hirsutism
#8
Joel J Heidelbaugh
Hirsutism is defined as excessive terminal hair growth, such as coarse sexual or secondary hair, that typically appears in a male growth pattern in androgen-dependent areas of the female body. It can occur in men and women. Common etiologies include polycystic ovary syndrome, idiopathic hyperandrogenemia, idiopathic hirsutism, adrenal hyperplasia due to 21-hydroxylase deficiency, androgen-secreting tumors, iatrogenic hirsutism, acromegaly, Cushing syndrome, hyperprolactinemia, and hypo- or hyperthyroidism. Diagnostic guidelines are predominantly aimed at premenopausal women but an appropriate evaluation for underlying endocrinopathies in postmenopausal women and men may be required...
December 2016: FP Essentials
https://www.readbyqxmd.com/read/27936530/endocrinology-update-thyroid-disorders
#9
Scott Kelley
Thyroid disease affects nearly every organ system in the body. Hypothyroidism is a state of thyroid hormone insufficiency that results in decreased metabolism and secondary effects including fatigue and weight gain. Primary hypothyroidism typically is a result of autoimmune thyroiditis or iodine deficiency and is assessed by measurement of the thyroid-stimulating hormone (TSH) level. This level usually is elevated in patients with hypothyroidism and low in patients with hyperthyroidism. Levothyroxine is the treatment of choice for hypothyroidism...
December 2016: FP Essentials
https://www.readbyqxmd.com/read/27936529/endocrinology-update-foreword
#10
Mindy A Smith
No abstract text is available yet for this article.
December 2016: FP Essentials
https://www.readbyqxmd.com/read/27869441/immunology-update-primary-immunodeficiency-diseases
#11
S Paul Starr
There are 264 primary immunodeficiencies (PIDs), most of which are rare. They are caused by complement deficiencies, defects in phagocyte function, impaired T-cell function, and/or impaired B-cell function with antibody deficiencies. Most patients with PIDs will present, at varying ages, with frequent infections. These infections can be common respiratory tract infections such as otitis media or pneumonia, or they can be unusual bacterial, fungal, or parasitic infections. Neonatal screening for severe combined immunodeficiency syndrome, one of the most common and serious PIDs, is now performed in most US states, but many PIDs manifest and are detected after birth...
November 2016: FP Essentials
https://www.readbyqxmd.com/read/27869440/immunology-update-new-vaccines
#12
S Paul Starr
A new 9-valent human papillomavirus (HPV) vaccine is effective against more cancer-causing HPV types than previous vaccines. HPV vaccine series started with previous vaccines can be completed with the 9-valent vaccine. Two new influenza vaccines are available for adults 65 years and older: a high-dose vaccine and an enhanced adjuvant vaccine. These elicit stronger antibody responses than standard-dose vaccines. Current guidelines specify no preference for the new versus standard-dose vaccines. Two new group B meningococcal vaccines are intended for use during outbreaks and for patients with asplenia, complement deficiencies, frequent occupational meningococcus exposure, or for patients who desire protection from type B meningococcus...
November 2016: FP Essentials
https://www.readbyqxmd.com/read/27869439/immunology-update-long-term-care-of-solid-organ-transplant-recipients
#13
S Paul Starr
Nearly 31,000 US patients received solid organ transplants in 2015 and the number is increasing. Care of transplant recipients includes management of a variety of common posttransplantation issues. Skin cancers are common because of immunosuppression and require skin examinations at intervals. Patients should be educated about the need to report new skin lesions. The rates of other cancers also are increased, including cancers of the head and neck, lung, esophagus, cervix, and urinary tract. Osteoporosis is common in transplant recipients; monitoring and early therapy are important...
November 2016: FP Essentials
https://www.readbyqxmd.com/read/27869438/immunology-update-biologics
#14
S Paul Starr
Biologics are substances made from a living organism or its products. These include genes, proteins (eg, antibodies, receptors, enzymes, inhibitors), recombinant proteins, and fusion proteins. Biologics often are produced using recombinant DNA technology. For example, monoclonal antibodies are produced by inserting human genes into immortalized cell cultures, which then produce the gene product (ie, an antibody) in large quantity. Another approach is to fuse genetic material from nonhuman sources (eg, mice) with human genetic material...
November 2016: FP Essentials
https://www.readbyqxmd.com/read/27869437/immunology-update-foreword
#15
Barry D Weiss
No abstract text is available yet for this article.
November 2016: FP Essentials
https://www.readbyqxmd.com/read/27731970/gender-and-sexual-health-same-sex-relationships
#16
James Conniff
A transformation in legal and cultural attitudes toward same-sex relationships is under way nationwide. As same-sex marriage has become legal, the unique social and medicolegal issues faced by individuals in same-sex relationships are evolving rapidly. National organizations have published recommendations for making clinical environments more inclusive of lesbian, gay, bisexual, and queer (LGBQ) individuals and their families. Medical issues for patients in same-sex relationships include a higher risk of HIV infection for men who have sex with men (a majority of new cases of HIV infection occur within relationships), higher rates of obesity among women who have sex with women, and disproportionately high rates of mental health issues and alcohol and drug use...
October 2016: FP Essentials
https://www.readbyqxmd.com/read/27731969/gender-and-sexual-health-care-of-transgender-patients
#17
Ronni Hayon
Transgender and gender-nonconforming individuals experience significant health disparities. They are more likely to use drugs and alcohol, smoke, be diagnosed with HIV infection or other sexually transmitted infections, and experience depression or attempt suicide. Many also experience discrimination within the health care system. Office-level strategies to create a safe and affirming space for gender-expansive patients include posting of a nondiscrimination statement, use of intake forms that ask about current gender identity and birth-assigned sex, provision of gender-neutral restrooms, and staff training in use of appropriate language...
October 2016: FP Essentials
https://www.readbyqxmd.com/read/27731968/gender-and-sexual-health-sexual-dysfunction
#18
Jaime D Stringer
Sexual dysfunction occurs in men and women and the prevalence increases with age. Dysfunction can occur in one or more areas of the normal sexual response cycle: desire, arousal, or orgasm. It can also be due to pain. Family physicians should routinely screen all men and women for sexual dysfunction, given its high prevalence and high correlation with other conditions. Risk factors include use of prescription drugs (eg, selective serotonin reuptake inhibitors, diuretics, antihormonals), recreational drugs, alcohol, and/or nicotine; certain health and lifestyle issues; and many chronic medical conditions, such as heart disease and diabetes...
October 2016: FP Essentials
https://www.readbyqxmd.com/read/27731967/gender-and-sexual-health-infertility
#19
Sarina Schrager
Infertility is common in the United States, with up to 15% of heterosexual couples experiencing difficulty in achieving conception. Family physicians often are the first physicians to evaluate couples attempting to conceive. Evaluation begins with assessment of ovulation, evaluation of anatomic abnormalities, and semen analysis. Many etiologies of anovulation can be managed by family physicians, and clinicians can offer counseling on timing of intercourse and assist patients with lifestyle changes to promote fertility...
October 2016: FP Essentials
https://www.readbyqxmd.com/read/27731966/gender-and-sexual-health-foreword
#20
Mindy A Smith
No abstract text is available yet for this article.
October 2016: FP Essentials
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