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Clinical medicine

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https://www.readbyqxmd.com/read/27358333/international-consensus-guidance-for-management-of-myasthenia-gravis-executive-summary
#1
REVIEW
Donald B Sanders, Gil I Wolfe, Michael Benatar, Amelia Evoli, Nils E Gilhus, Isabel Illa, Nancy Kuntz, Janice M Massey, Arthur Melms, Hiroyuki Murai, Michael Nicolle, Jacqueline Palace, David P Richman, Jan Verschuuren, Pushpa Narayanaswami
OBJECTIVE: To develop formal consensus-based guidance for the management of myasthenia gravis (MG). METHODS: In October 2013, the Myasthenia Gravis Foundation of America appointed a Task Force to develop treatment guidance for MG, and a panel of 15 international experts was convened. The RAND/UCLA appropriateness methodology was used to develop consensus guidance statements. Definitions were developed for goals of treatment, minimal manifestations, remission, ocular MG, impending crisis, crisis, and refractory MG...
July 26, 2016: Neurology
https://www.readbyqxmd.com/read/27660341/3-european-evidence-based-consensus-on-the-diagnosis-and-management-of-crohn-s-disease-2016-part-1-diagnosis-and-medical-management
#2
Fernando Gomollón, Axel Dignass, Vito Annese, Herbert Tilg, Gert Van Assche, James O Lindsay, Laurent Peyrin-Biroulet, Garret J Cullen, Marco Daperno, Torsten Kucharzik, Florian Rieder, Sven Almer, Alessandro Armuzzi, Marcus Harbord, Jost Langhorst, Miquel Sans, Yehuda Chowers, Gionata Fiorino, Pascal Juillerat, Gerassimos J Mantzaris, Fernando Rizzello, Stephan Vavricka, Paolo Gionchetti
This paper is the first in a series of two publications relating to the European Crohn's and Colitis Organisation (ECCO) evidence based consensus on the diagnosis and management of Crohn's disease and concerns the methodology of the consensus process, classification, diagnosis and medical management of active and quiescent Crohn's disease. Surgical management as well as special situations including management of perianal Crohn's disease of this ECCO Consensus are covered in a subsequent second paper [Gionchetti et al JCC 2016]...
September 22, 2016: Journal of Crohn's & Colitis
https://www.readbyqxmd.com/read/27510349/managing-thyroid-disease-in-general-practice
#3
John P Walsh
Serum thyroid-stimulating hormone (TSH) testing is the best screening tool for thyroid dysfunction. When TSH levels are in the reference range, additional tests such as free thyroxine, free triiodothyronine or thyroid antibodies rarely add value, except in patients with pituitary disease, when TSH is unreliable. Overt hypothyroidism and subclinical hypothyroidism with TSH levels > 10 mU/L can be treated without further investigation. The health impact of subclinical hypothyroidism with mildly elevated levels of TSH (4-10 mU/L) remains uncertain, particularly in older people; treatment or observation are reasonable options...
August 15, 2016: Medical Journal of Australia
https://www.readbyqxmd.com/read/27646933/current-and-upcoming-pharmacotherapy-for-non-alcoholic-fatty-liver-disease
#4
REVIEW
Yaron Rotman, Arun J Sanyal
Given the high prevalence and rising incidence of non-alcoholic fatty liver disease (NAFLD), the absence of approved therapies is striking. Although the mainstay of treatment of NAFLD is weight loss, it is hard to maintain, prompting the need for pharmacotherapy as well. A greater understanding of disease pathogenesis in recent years was followed by development of new classes of medications, as well as potential repurposing of currently available agents. NAFLD therapies target four main pathways. The dominant approach is targeting hepatic fat accumulation and the resultant metabolic stress...
September 19, 2016: Gut
https://www.readbyqxmd.com/read/26354869/use-of-macrolides-in-lung-diseases-recent-literature-controversies
#5
REVIEW
Luiz Vicente Ribeiro Ferreira da Silva Filho, Leonardo Araujo Pinto, Renato Tetelbom Stein
OBJECTIVE: To review the mechanisms of action of macrolides in pediatric respiratory diseases and their clinical indications. SOURCES: Review in the PubMed database, comprising the following terms in English: "macrolide and asthma"; "macrolide and cystic fibrosis"; "macrolide bronchiolitis and viral acute"; "macrolide and bronchiolitis obliterans" and "macrolide and non-CF bronchiectasis". SUMMARY OF THE FINDINGS: The spectrum of action of macrolides includes production of inflammatory mediators, control of mucus hypersecretion, and modulation of host-defense mechanisms...
November 2015: Jornal de Pediatria
https://www.readbyqxmd.com/read/27582897/poststroke-epilepsy-update-and-future-directions
#6
REVIEW
Johan Zelano
Stroke is among the most common causes of epilepsy after middle age. Patients with poststroke epilepsy (PSE) differ in several respects from patients with other forms of structural-metabolic epilepsy; not least in age, age-related sensitivity to side effects of antiepileptic drugs (AEDs), and specific drug-drug interaction issues related to secondary-stroke prophylaxis. Encouragingly, there has lately been remarkable activity in the study of PSE. Three developments in PSE research deserve particular focus. First, large prospective trials have established the incidence and risk factors of PSE in the setting of modern stroke care...
September 2016: Therapeutic Advances in Neurological Disorders
https://www.readbyqxmd.com/read/27567896/severe-community-acquired-pneumonia-timely-management-measures-in-the-first-24-hours
#7
REVIEW
Jason Phua, Nathan C Dean, Qi Guo, Win Sen Kuan, Hui Fang Lim, Tow Keang Lim
Mortality rates for severe community-acquired pneumonia (CAP) range from 17 to 48 % in published studies.In this review, we searched PubMed for relevant papers published between 1981 and June 2016 and relevant files. We explored how early and aggressive management measures, implemented within 24 hours of recognition of severe CAP and carried out both in the emergency department and in the ICU, decrease mortality in severe CAP.These measures begin with the use of severity assessment tools and the application of care bundles via clinical decision support tools...
August 28, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27536694/fluid-management-for-critically-ill-patients-a-review-of-the-current-state-of-fluid-therapy-in-the-intensive-care-unit
#8
REVIEW
Erin Frazee, Kianoush Kashani
BACKGROUND: Intravenous fluids (IVF) are frequently utilized to restore intravascular volume in patients with distributive and hypovolemic shock. Although the benefits of the appropriate use of fluids in intensive care units (ICUs) and hospitals are well described, there is growing knowledge regarding the potential risks of volume overload and its impact on organ failure and mortality. To avoid volume overload and its associated complications, strategies to identify fluid responsiveness are developed and utilized more often among ICU patients...
June 2016: Kidney Diseases
https://www.readbyqxmd.com/read/27659469/contrast-induced-acute-kidney-injury
#9
REVIEW
Peter A McCullough, James P Choi, Georges A Feghali, Jeffrey M Schussler, Robert M Stoler, Ravi C Vallabahn, Ankit Mehta
Coronary angiography and percutaneous intervention rely on the use of iodinated intravascular contrast for vessel and chamber imaging. Despite advancements in imaging and interventional techniques, iodinated contrast continues to pose a risk of contrast-induced acute kidney injury (CI-AKI) for a subgroup of patients at risk for this complication. There has been a consistent and graded signal of risk for associated outcomes including need for renal replacement therapy, rehospitalization, and death, according to the incidence and severity of CI-AKI...
September 27, 2016: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/26872741/towards-integration-of-palliative-care-in-patients-with-chronic-heart-failure-and-chronic-obstructive-pulmonary-disease-a-systematic-literature-review-of-european-guidelines-and-pathways
#10
REVIEW
Naouma Siouta, Karen van Beek, Nancy Preston, Jeroen Hasselaar, Sean Hughes, Sheila Payne, Eduardo Garralda, Carlos Centeno, Marlieke van der Eerden, Marieke Groot, Farina Hodiamont, Lukas Radbruch, Csilla Busa, Agnes Csikos, Johan Menten
BACKGROUND: Despite the positive impact of Palliative Care (PC) on the quality of life for patients and their relatives, the implementation of PC in non-cancer health-care delivery in the EU seems scarcely addressed. The aim of this study is to assess guidelines/pathways for integrated PC in patients with advanced Chronic Heart Failure (CHF) and Chronic Obstructive Pulmonary Disease (COPD) in Europe via a systematic literature review. METHODS: Search results were screened by two reviewers...
February 13, 2016: BMC Palliative Care
https://www.readbyqxmd.com/read/27423462/qsofa-does-not-replace-sirs-in-the-definition-of-sepsis
#11
Jean-Louis Vincent, Greg S Martin, Mitchell M Levy
No abstract text is available yet for this article.
July 17, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27408698/mechanisms-of-low-back-pain-a-guide-for-diagnosis-and-therapy
#12
REVIEW
Massimo Allegri, Silvana Montella, Fabiana Salici, Adriana Valente, Maurizio Marchesini, Christian Compagnone, Marco Baciarello, Maria Elena Manferdini, Guido Fanelli
Chronic low back pain (CLBP) is a chronic pain syndrome in the lower back region, lasting for at least 3 months. CLBP represents the second leading cause of disability worldwide being a major welfare and economic problem. The prevalence of CLBP in adults has increased more than 100% in the last decade and continues to increase dramatically in the aging population, affecting both men and women in all ethnic groups, with a significant impact on functional capacity and occupational activities. It can also be influenced by psychological factors, such as stress, depression and/or anxiety...
2016: F1000Research
https://www.readbyqxmd.com/read/27382285/the-causes-of-new-onset-epilepsy-and-seizures-in-the-elderly
#13
REVIEW
Shasha Liu, Weihua Yu, Yang Lü
With increasing age, the prevalence and incidence of epilepsy and seizures increases correspondingly. New-onset epilepsy in elderly people often has underlying etiology, including cerebrovascular diseases, primary neuron degenerative disorders, intracerebral tumors, and traumatic head injury. In addition, an acute symptomatic seizure cannot be called epilepsy, which manifests usually as a common symptom secondary to metabolic or toxicity factors in older people. In this review, we have mainly focused on the causes of new-onset epilepsy and seizures in elderly people...
2016: Neuropsychiatric Disease and Treatment
https://www.readbyqxmd.com/read/26900391/probiotics-in-prevention-and-treatment-of-obesity-a-critical-view
#14
REVIEW
Nazarii Kobyliak, Caterina Conte, Giovanni Cammarota, Andreana P Haley, Igor Styriak, Ludovit Gaspar, Jozef Fusek, Luis Rodrigo, Peter Kruzliak
The worldwide prevalence of obesity more than doubled between 1980 and 2014. The obesity pandemic is tightly linked to an increase in energy availability, sedentariness and greater control of ambient temperature that have paralleled the socioeconomic development of the past decades. The most frequent cause which leads to the obesity development is a dysbalance between energy intake and energy expenditure. The gut microbiota as an environmental factor which influence whole-body metabolism by affecting energy balance but also inflammation and gut barrier function, integrate peripheral and central food intake regulatory signals and thereby increase body weight...
2016: Nutrition & Metabolism
https://www.readbyqxmd.com/read/27400984/drugs-that-may-cause-or-exacerbate-heart-failure-a-scientific-statement-from-the-american-heart-association
#15
Robert L Page, Cindy L O'Bryant, Davy Cheng, Tristan J Dow, Bonnie Ky, C Michael Stein, Anne P Spencer, Robin J Trupp, JoAnn Lindenfeld
Heart failure is a common, costly, and debilitating syndrome that is associated with a highly complex drug regimen, a large number of comorbidities, and a large and often disparate number of healthcare providers. All of these factors conspire to increase the risk of heart failure exacerbation by direct myocardial toxicity, drug-drug interactions, or both. This scientific statement is designed to serve as a comprehensive and accessible source of drugs that may cause or exacerbate heart failure to assist healthcare providers in improving the quality of care for these patients...
August 9, 2016: Circulation
https://www.readbyqxmd.com/read/27376890/red-flags-presented-in-current-low-back-pain-guidelines-a-review
#16
Arianne P Verhagen, Aron Downie, Nahid Popal, Chris Maher, Bart W Koes
OBJECTIVE: The purpose of this study was to identify and descriptively compare the red flags endorsed in guidelines for the detection of serious pathology in patients presenting with low back pain to primary care. METHOD: We searched databases, the World Wide Web and contacted experts aiming to find the multidisciplinary clinical guideline in low back pain in primary care, and selected the most recent one per country. We extracted data on the number and type of red flags for identifying patients with higher likelihood of serious pathology...
September 2016: European Spine Journal
https://www.readbyqxmd.com/read/27418577/management-of-adults-with-hospital-acquired-and-ventilator-associated-pneumonia-2016-clinical-practice-guidelines-by-the-infectious-diseases-society-of-america-and-the-american-thoracic-society
#17
Andre C Kalil, Mark L Metersky, Michael Klompas, John Muscedere, Daniel A Sweeney, Lucy B Palmer, Lena M Napolitano, Naomi P O'Grady, John G Bartlett, Jordi Carratalà, Ali A El Solh, Santiago Ewig, Paul D Fey, Thomas M File, Marcos I Restrepo, Jason A Roberts, Grant W Waterer, Peggy Cruse, Shandra L Knight, Jan L Brozek
It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.These guidelines are intended for use by healthcare professionals who care for patients at risk for hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), including specialists in infectious diseases, pulmonary diseases, critical care, and surgeons, anesthesiologists, hospitalists, and any clinicians and healthcare providers caring for hospitalized patients with nosocomial pneumonia...
September 1, 2016: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/27325300/evidence-based-clinical-practice-guidelines-for-gastroesophageal-reflux-disease-2015
#18
REVIEW
Katsuhiko Iwakiri, Yoshikazu Kinoshita, Yasuki Habu, Tadayuki Oshima, Noriaki Manabe, Yasuhiro Fujiwara, Akihito Nagahara, Osamu Kawamura, Ryuichi Iwakiri, Soji Ozawa, Kiyoshi Ashida, Shuichi Ohara, Hideyuki Kashiwagi, Kyoichi Adachi, Kazuhide Higuchi, Hiroto Miwa, Kazuma Fujimoto, Motoyasu Kusano, Yoshio Hoshihara, Tatsuyuki Kawano, Ken Haruma, Michio Hongo, Kentaro Sugano, Mamoru Watanabe, Tooru Shimosegawa
As an increase in gastroesophageal reflux disease (GERD) has been reported in Japan, and public interest in GERD has been increasing, the Japanese Society of Gastroenterology published the Evidence-based Clinical Practice Guidelines for GERD (1st edition) in 2009. Six years have passed since its publication, and there have been a large number of reports in Japan concerning the epidemiology, pathophysiology, treatment, and Barrett's esophagus during this period. By incorporating the contents of these reports, the guidelines were completely revised, and a new edition was published in October 2015...
August 2016: Journal of Gastroenterology
https://www.readbyqxmd.com/read/27373891/acute-kidney-injury-short-term-and-long-term-effects
#19
REVIEW
James F Doyle, Lui G Forni
Acute kidney injury (AKI) is the most common cause of organ dysfunction in critically ill adults, with a single episode of AKI, regardless of stage, carrying a significant morbidity and mortality risk. Since the consensus on AKI nomenclature has been reached, data reflecting outcomes have become more apparent allowing investigation of both short- and long-term outcomes.Classically the short-term effects of AKI can be thought of as those reflecting an acute deterioration in renal function per se. However, the effects of AKI, especially with regard to distant organ function ("organ cross-talk"), are being elucidated as is the increased susceptibility to other conditions...
July 4, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27365388/practice-guidelines-for-the-diagnosis-and-management-of-aspergillosis-2016-update-by-the-infectious-diseases-society-of-america
#20
Thomas F Patterson, George R Thompson, David W Denning, Jay A Fishman, Susan Hadley, Raoul Herbrecht, Dimitrios P Kontoyiannis, Kieren A Marr, Vicki A Morrison, M Hong Nguyen, Brahm H Segal, William J Steinbach, David A Stevens, Thomas J Walsh, John R Wingard, Jo-Anne H Young, John E Bennett
It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.
August 15, 2016: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
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