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https://www.readbyqxmd.com/read/28845960/sleep-disorders-circadian-rhythm-sleep-wake-disorders
#1
Deepa Burman
Shift work sleep disorder is a common problem in industrialized countries because of the need for occupations and services to continue to function 24 hours/day. Approximately 20% of employed adults in the United States are engaged in shift work. Shift work sleep disorder is diagnosed if there is a report of insomnia or excessive sleepiness for at least 3 months associated with a recurring work schedule that overlaps the usual time for sleep. Shift work is associated with an increased occurrence of metabolic disorders, such as insulin resistance, diabetes, dyslipidemia, and metabolic syndrome, and it has been implicated in weight gain and cognitive impairment...
September 2017: FP Essentials
https://www.readbyqxmd.com/read/28845959/sleep-disorders-restless-legs-syndrome
#2
Deepa Burman
Restless legs syndrome (RLS) is a common disorder that often is underdiagnosed and undertreated. Patients with RLS describe an urge to move their legs, especially in the evenings and during periods of inactivity. The prevalence of clinically significant RLS is approximately 2% to 3% in adults in Europe and North America. RLS can be an independent disorder or may occur in conjunction with other conditions (eg, iron deficiency, pregnancy, chronic renal failure). Diagnosis is based on clinical history. Routine polysomnography typically is not recommended unless there is suspicion of other sleep disorders (eg, obstructive sleep apnea)...
September 2017: FP Essentials
https://www.readbyqxmd.com/read/28845958/sleep-disorders-insomnia
#3
Deepa Burman
Insomnia is the most common type of sleep disorder in the family medicine population. It is defined as a persistent difficulty initiating or maintaining sleep, or a report of nonrestorative sleep, accompanied by related daytime impairment. Insomnia is a significant public health problem because of its high prevalence and management challenges. There is increasing evidence of a strong association between insomnia and various medical and psychiatric comorbidities. Diagnosis of insomnia and treatment planning rely on a thorough sleep history to address contributing and precipitating factors as well as maladaptive behaviors resulting in poor sleep...
September 2017: FP Essentials
https://www.readbyqxmd.com/read/28845957/sleep-disorders-sleep-related-breathing-disorders
#4
Deepa Burman
Sleep-related breathing disorders or sleep-disordered breathing are characterized by abnormal respiration during sleep. They are grouped into obstructive sleep apnea (OSA), central sleep apnea, sleep-related hypoventilation, and sleep-related hypoxemia disorder. OSA is a common disorder encountered in the family medicine setting that is increasingly being recognized because of the obesity epidemic and greater public and physician awareness. OSA is characterized by recurrent episodes of partial or complete closure of the upper airway resulting in disturbed breathing during sleep...
September 2017: FP Essentials
https://www.readbyqxmd.com/read/28845956/sleep-disorders-foreword
#5
Karl T Rew
No abstract text is available yet for this article.
September 2017: FP Essentials
https://www.readbyqxmd.com/read/28806049/electrolytes-oral-electrolyte-solutions
#6
Lisa Harris
Oral electrolyte solutions are used widely for rehydration in diarrheal illness and to maintain hydration during vigorous exercise. In diarrheal illness, an oral rehydration solution (ORS) typically is preferred over intravenous fluids except for patients with severe dehydration. The preferred ORS is one similar to the glucose-containing reduced osmolarity World Health Organization ORS. There also are polymer-based solutions that use rice or wheat as the source of carbohydrates but these are not widely recommended...
August 2017: FP Essentials
https://www.readbyqxmd.com/read/28806048/electrolytes-calcium-disorders
#7
Craig Barstow
A normal serum calcium level is 8 to 10 mg/dL. The diagnosis of hypercalcemia (ie, levels 10.5 mg/dL or greater) should be confirmed with an albumin-adjusted or ionized calcium level. The two most common causes of hypercalcemia are hyperparathyroidism and malignancy. Drugs, notably lithium and thiazide diuretics, also can cause hypercalcemia. Patients with severe or symptomatic hypercalcemia should be treated initially with hydration to decrease calcium levels. The evaluation should include a parathyroid hormone (PTH) level...
August 2017: FP Essentials
https://www.readbyqxmd.com/read/28806047/electrolytes-potassium-disorders
#8
Taiwona L Elliott
Hypokalemia (ie, potassium levels less than 3.5 mEq/L) occurs in fewer than 1% of healthy individuals, but is present in up to 20% of hospitalized patients, 40% of patients taking diuretics, and 17% of patients with cardiovascular conditions. Hypokalemia often is asymptomatic; symptoms are more common in older adults. Common symptoms are cardiac arrhythmias and muscle weakness or pain. Management consists of intravenous potassium replacement during cardiac monitoring for patients with marked symptoms, echocardiogram (ECG) abnormalities, or severe hypokalemia (ie, level less than 3...
August 2017: FP Essentials
https://www.readbyqxmd.com/read/28806046/electrolytes-sodium-disorders
#9
Michael M Braun, Megan Mahowald
Sodium disorders (ie, hyponatremia, hypernatremia) are common electrolyte disturbances in clinical medicine and are associated with increased rates of morbidity and mortality. Etiologies of hyponatremia are classified into four categories. The first is pseudohyponatremia, in which the sodium level is low due to hyperproteinemia, hyperlipidemia, or hyperglycemia. The other three categories are based on overall patient fluid status and include hypovolemic (commonly due to fluid loss), hypervolemic (commonly due to fluid retention from heart failure, cirrhosis, or renal failure), and euvolemic (most often because of syndrome of inappropriate secretion of antidiuretic hormone)...
August 2017: FP Essentials
https://www.readbyqxmd.com/read/28806045/electrolytes-foreword
#10
Barry D Weiss
No abstract text is available yet for this article.
August 2017: FP Essentials
https://www.readbyqxmd.com/read/28682049/upper-gastrointestinal-conditions-gallbladder-conditions
#11
Ku-Lang Chang, David S Estores
Asymptomatic patients with gallstones typically do not require treatment. Surgical intervention is indicated in most symptomatic patients with gallstones. For patients with uncomplicated cholecystitis, laparoscopic cholecystectomy performed within 24 hours of admission is associated with significantly decreased morbidity, hospital length of stay, and cost. Most gallbladder polyps are found incidentally during ultrasonography. Patients with gallbladder polyps are at increased risk of malignant transformation if they are older than 50 years; the gallbladder wall is thickened; or the polyp is adenomatous, solitary, larger than 10 mm, sessile in appearance, or has a rapid increase in size...
July 2017: FP Essentials
https://www.readbyqxmd.com/read/28682048/upper-gastrointestinal-conditions-pancreatitis
#12
Ku-Lang Chang, David S Estores
The most common etiologies of acute pancreatitis are gallstones (particularly 5 mm or smaller) and alcohol consumption. The serum amylase level may be normal in up to one-fifth of patients with acute pancreatitis; therefore, this level by itself is not a reliable diagnostic factor. The serum lipase level has a higher positive predictive value and specificity compared with the amylase level. Acute biliary pancreatitis with evidence of cholangitis represents an emergency indication for endoscopic retrograde cholangiopancreatography with endoscopic sphincterotomy within 24 hours of presentation...
July 2017: FP Essentials
https://www.readbyqxmd.com/read/28682047/upper-gastrointestinal-conditions-nonmalignant-conditions-of-the-stomach
#13
Ku-Lang Chang, David S Estores
Functional dyspepsia can be categorized into two syndromes: postprandial distress syndrome and epigastric pain syndrome. Helicobacter pyloriinfection is one of the most common chronic infections worldwide. Acute H pylori infection causes dyspepsia, and chronic infection can cause peptic ulcer disease. H pylori also is one of the causative agents in gastric adenocarcinoma and mucosa-associated lymphoid tissue lymphoma. The incidence of H pylori infection varies among different ethnic populations and geographic locations...
July 2017: FP Essentials
https://www.readbyqxmd.com/read/28682046/upper-gastrointestinal-conditions-nonmalignant-conditions-of-the-esophagus
#14
David S Estores, Ku-Lang Chang
Eosinophilic esophagitis (EE) is an allergic disorder of the esophagus. This diagnosis requires the presence of specific symptoms and a significantly elevated number of eosinophils in the esophageal lining as determined by endoscopic biopsies. Symptoms tend to be nonspecific among patients younger than 15 years. Among adults, dysphagia is the most common symptom. Comanagement with a gastroenterology subspecialist is essential, particularly for EE patients with a stricture. EE is commonly misdiagnosed as gastroesophageal reflux disease (GERD)...
July 2017: FP Essentials
https://www.readbyqxmd.com/read/28682045/upper-gastrointestinal-conditions-foreword
#15
Mindy A Smith
No abstract text is available yet for this article.
July 2017: FP Essentials
https://www.readbyqxmd.com/read/28671807/valvular-heart-disease-in-adults-infective-endocarditis
#16
REVIEW
Zubair A Khan, Steven M Hollenberg
A variety of microorganisms can cause infective endocarditis (IE) in patients with native valves. Staphylococci and streptococci are most common in community-acquired IE; staphylococci are most common in nosocomial IE. Microbiology of prosthetic valve endocarditis (PVE) depends on timing. Early-onset PVE (ie, 60 days or fewer postsurgery) typically is nosocomial, with Staphylococcus aureus infection being most common. Intermediate-onset PVE (ie, 60 to 365 days postsurgery) typically involves a mix of nosocomial and non-nosocomial organisms...
June 2017: FP Essentials
https://www.readbyqxmd.com/read/28671806/valvular-heart-disease-in-adults-management-of-prosthetic-heart-valves
#17
REVIEW
John F Trujillo, Steven M Hollenberg
Patients undergoing cardiac valve replacement may receive mechanical or bioprosthetic valves. Mechanical valves require lifelong anticoagulation but are durable and the need for a second surgery is up to eightfold times less than with bioprosthetic valves. Bioprosthetic valves do not require lifelong anticoagulation and thus are associated with fewer bleeding complications but they are less durable and associated with higher morbidity and mortality rates, particularly in younger patients. Anticoagulation with mechanical valves is achieved using warfarin; use of direct-acting oral anticoagulants is not indicated...
June 2017: FP Essentials
https://www.readbyqxmd.com/read/28671805/valvular-heart-disease-in-adults-management-of-native-valve-disease
#18
REVIEW
Xin Zhang, Steven M Hollenberg
Patients with valvular heart disease (VHD) should be treated for diabetes, hypertension, and hyperlipidemia. They also should receive therapy for left ventricular dysfunction, undergo interval echocardiography, and participate in aerobic exercise. Valve replacement should be considered for patients with aortic stenosis (AS) and syncope, presyncope, heart failure, angina, or severe AS with left ventricular dysfunction. Valve replacement is performed with open or transcatheter procedures; the latter are preferred for patients with high surgical risk...
June 2017: FP Essentials
https://www.readbyqxmd.com/read/28671804/valvular-heart-disease-in-adults-etiologies-classification-and-diagnosis
#19
REVIEW
Steven M Hollenberg
The prevalence of valvular heart disease (VHD) in the United States was estimated to be approximately 2.5% in the 1990s. The prevalence currently is thought to be increasing because of more accurate diagnostic methods and aging of the population. Mitral regurgitation (MR) is the most common valve defect, followed by aortic stenosis (AS) and aortic regurgitation (AR). Degenerative disease is the most common etiology of MR, AS, and AR, though these forms of VHD also can be caused by congenital valve defects, systemic inflammatory diseases, endocarditis, and many other conditions...
June 2017: FP Essentials
https://www.readbyqxmd.com/read/28671803/valvular-heart-disease-in-adults-foreword
#20
Steven M Hollenberg
No abstract text is available yet for this article.
June 2017: FP Essentials
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