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https://www.readbyqxmd.com/read/27869441/immunology-update-primary-immunodeficiency-diseases
#1
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
#2
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
#3
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
#4
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
#5
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
#6
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
#7
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
#8
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
#9
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
#10
Mindy A Smith
No abstract text is available yet for this article.
October 2016: FP Essentials
https://www.readbyqxmd.com/read/27576234/respiratory-conditions-update-cystic-fibrosis
#11
Lyle L Pritchard
Cystic fibrosis (CF) is an autosomal recessive genetic disease that occurs in approximately 1 in 2,500 white live births. It is less common in nonwhite individuals. A dysfunctional epithelial chloride channel leads to excessively thick mucus affecting multiple organ systems. Common issues include mucous plugging of the airway, lung inflammation, chronic pulmonary infections, intestinal malabsorption, and malnutrition. Universal screening of newborns for CF is recommended in many countries. CF can be diagnosed based on clinical evidence of disease along with genetic testing or other laboratory evidence of chloride channel dysfunction...
September 2016: FP Essentials
https://www.readbyqxmd.com/read/27576233/respiratory-conditions-update-restrictive-lung-disease
#12
H Coleman Robinson
Restrictive lung diseases are a heterogeneous group of conditions characterized by a restrictive pattern on spirometry and confirmed by a reduction in total lung volume. Patients with more severe symptoms may have a reduced diffusing capacity of the lung for carbon monoxide. Etiologies can be intrinsic with lung parenchymal involvement, as in interstitial lung diseases, or extrinsic to the lung, as in obesity and neuromuscular disorders. Idiopathic pulmonary fibrosis is a chronic progressive interstitial pneumonia with fibrosis for which treatment is primarily supportive with oxygen therapy, pulmonary rehabilitation, and management of comorbid conditions...
September 2016: FP Essentials
https://www.readbyqxmd.com/read/27576232/respiratory-conditions-update-chronic-obstructive-pulmonary-disease
#13
Daphne J Karel
Chronic obstructive pulmonary disease (COPD) is defined as persistent airflow limitation due to irritant-induced chronic inflammation. A postbronchodilator forced expiratory volume in 1 second to forced vital capacity (FEV1/FVC) ratio of 0.7 or less is diagnostic in a patient with dyspnea, chronic cough or sputum production, and a history of irritant exposure. Tobacco smoking is the most significant etiology, and smoking cessation is the only intervention shown to slow disease progression. Long-acting beta2-agonists and long-acting muscarinic antagonists are first-line treatments for patients with persistently symptomatic COPD with an FEV1 of 80% or less of predicted...
September 2016: FP Essentials
https://www.readbyqxmd.com/read/27576231/respiratory-conditions-update-asthma
#14
Timothy A Zeller
Asthma is a chronic respiratory disease characterized by chronic airway inflammation and variable expiratory airflow limitation. Related clinical features include wheezing, dyspnea, chest tightness, and cough that worsens at night or in the early morning, and that varies over time and in intensity. A finding of variable expiratory airflow limitation on spirometry confirms the diagnosis. A forced expiratory volume in 1 second to forced vital capacity ratio less than the level predicted for the patient's age is suggestive of airflow limitation...
September 2016: FP Essentials
https://www.readbyqxmd.com/read/27576230/respiratory-conditions-update-foreword
#15
Karl T Rew
No abstract text is available yet for this article.
September 2016: FP Essentials
https://www.readbyqxmd.com/read/27490071/care-of-patients-at-the-end-of-life-surrogate-decision-making-for-incapacitated-patients
#16
Ami V Patel, Richard J Ackermann
Competence is determined by a court of law, whereas physicians determine medical decision-making capacity (DMC). When patients lack DMC, a surrogate should be identified to make decisions. Ideally, patients will have created a durable power of attorney for health care. If a patient did not do this, state statutes specify which individuals can serve as surrogates; a current spouse typically is the first choice. Ideally, surrogates should use substituted judgment in making decisions. If this is not possible because the patient never shared end-of-life wishes with the surrogate, the surrogate can make decisions that, in the surrogate's opinion, are in the patient's best interests or that a reasonable individual would make...
August 2016: FP Essentials
https://www.readbyqxmd.com/read/27490070/care-of-patients-at-the-end-of-life-advance-care-planning
#17
Richard J Ackermann
Advance directives are legal documents that give instructions about how to provide care when patients develop life-threatening illnesses and can no longer communicate their wishes. Two types of documents are widely used-a living will and a durable power of attorney for health care. Most states also authorize physician orders for life-sustaining treatment. Physicians should encourage patients, particularly those with severe chronic or terminal conditions, to prepare advance directives. Medicare now reimburses billing codes for advance care consultations...
August 2016: FP Essentials
https://www.readbyqxmd.com/read/27490069/care-of-patients-at-the-end-of-life-management-of-nonpain-symptoms
#18
Florence T Baralatei, Richard J Ackermann
Management of nonpain symptoms can improve quality of life for patients at the end of life and their family members. Constipation is the most common nonpain symptom. It can be related to opioid therapy and/or medical conditions. After abdominal examination to detect masses or evidence of bowel obstruction and rectal examination to exclude fecal impaction, constipation should be managed with a stimulant laxative (eg, senna) or an osmotic laxative (eg, sorbitol). Dyspnea also is common, and often improves with use of a fan to blow air into the face, as well with breathing and relaxation exercises...
August 2016: FP Essentials
https://www.readbyqxmd.com/read/27490068/care-of-patients-at-the-end-of-life-pharmacotherapeutic-management-of-pain
#19
Allison Scheetz, Richard J Ackermann
End-of-life care often involves management of pain. A patient's pain should be assessed using the Visual Analogue Scale, which uses a 0 to 10 score, with 0 indicating no pain and 10 the worst pain imaginable. Mild pain typically is managed with nonopioids (eg, acetaminophen, nonsteroidal anti-inflammatory drugs). More severe pain is managed with opioids. Opioid therapy should start with an immediate-release opioid to determine the dose needed to achieve pain control. This can be used to create a regimen with an extended-release formulation for daily pain management plus an immediate-release formulation for breakthrough pain...
August 2016: FP Essentials
https://www.readbyqxmd.com/read/27490067/care-of-patients-at-the-end-of-life-foreword
#20
Barry D Weiss
No abstract text is available yet for this article.
August 2016: FP Essentials
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