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Internal Medicine

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203 papers 100 to 500 followers
https://www.readbyqxmd.com/read/29710295/effect-of-5-day-nitrofurantoin-vs-single-dose-fosfomycin-on-clinical-resolution-of-uncomplicated-lower-urinary-tract-infection-in-women-a-randomized-clinical-trial
#1
RANDOMIZED CONTROLLED TRIAL
Angela Huttner, Anna Kowalczyk, Adi Turjeman, Tanya Babich, Caroline Brossier, Noa Eliakim-Raz, Katarzyna Kosiek, Begoña Martinez de Tejada, Xavier Roux, Shachaf Shiber, Ursula Theuretzbacher, Elodie von Dach, Dafna Yahav, Leonard Leibovici, Maciek Godycki-Cwirko, Johan W Mouton, Stephan Harbarth
Importance: The use of nitrofurantoin and fosfomycin has increased since guidelines began recommending them as first-line therapy for lower urinary tract infection (UTI). Objective: To compare the clinical and microbiologic efficacy of nitrofurantoin and fosfomycin in women with uncomplicated cystitis. Design, Setting, and Participants: Multinational, open-label, analyst-blinded, randomized clinical trial including 513 nonpregnant women aged 18 years and older with symptoms of lower UTI (dysuria, urgency, frequency, or suprapubic tenderness), a positive urine dipstick result (with detection of nitrites or leukocyte esterase), and no known colonization or previous infection with uropathogens resistant to the study antibiotics...
May 1, 2018: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/29667175/first-line-drugs-for-hypertension
#2
REVIEW
James M Wright, Vijaya M Musini, Rupam Gill
BACKGROUND: This is the first update of a review published in 2009. Sustained moderate to severe elevations in resting blood pressure leads to a critically important clinical question: What class of drug to use first-line? This review attempted to answer that question. OBJECTIVES: To quantify the mortality and morbidity effects from different first-line antihypertensive drug classes: thiazides (low-dose and high-dose), beta-blockers, calcium channel blockers, ACE inhibitors, angiotensin II receptor blockers (ARB), and alpha-blockers, compared to placebo or no treatment...
April 18, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29637759/clinical-practice-guidelines-for-the-antibiotic-treatment-of-community-acquired-urinary-tract-infections
#3
Cheol In Kang, Jieun Kim, Dae Won Park, Baek Nam Kim, U Syn Ha, Seung Ju Lee, Jeong Kyun Yeo, Seung Ki Min, Heeyoung Lee, Seong Heon Wie
Urinary tract infections (UTIs) are infectious diseases that commonly occur in communities. Although several international guidelines for the management of UTIs have been available, clinical characteristics, etiology and antimicrobial susceptibility patterns may differ from country to country. This work represents an update of the 2011 Korean guideline for UTIs. The current guideline was developed by the update and adaptation method. This clinical practice guideline provides recommendations for the diagnosis and management of UTIs, including asymptomatic bacteriuria, acute uncomplicated cystitis, acute uncomplicated pyelonephritis, complicated pyelonephritis related to urinary tract obstruction, and acute bacterial prostatitis...
March 2018: Infection & Chemotherapy
https://www.readbyqxmd.com/read/29650544/evaluation-and-management-of-right-sided-heart-failure-a-scientific-statement-from-the-american-heart-association
#4
REVIEW
Marvin A Konstam, Michael S Kiernan, Daniel Bernstein, Biykem Bozkurt, Miriam Jacob, Navin K Kapur, Robb D Kociol, Eldrin F Lewis, Mandeep R Mehra, Francis D Pagani, Amish N Raval, Carey Ward
BACKGROUND AND PURPOSE: The diverse causes of right-sided heart failure (RHF) include, among others, primary cardiomyopathies with right ventricular (RV) involvement, RV ischemia and infarction, volume loading caused by cardiac lesions associated with congenital heart disease and valvular pathologies, and pressure loading resulting from pulmonic stenosis or pulmonary hypertension from a variety of causes, including left-sided heart disease. Progressive RV dysfunction in these disease states is associated with increased morbidity and mortality...
May 15, 2018: Circulation
https://www.readbyqxmd.com/read/29598869/angiotensin-converting-enzyme-inhibitors-in-hypertension-to-use-or-not-to-use
#5
REVIEW
Franz H Messerli, Sripal Bangalore, Chirag Bavishi, Stefano F Rimoldi
Most guidelines for the management of patients with cardiovascular disease recommend angiotensin-converting enzyme (ACE) inhibitors as first-choice therapy, whereas angiotensin receptor blockers (ARBs) are merely considered an alternative for ACE inhibitor-intolerant patients. The aim of this review was to compare outcomes and adverse events between ACE inhibitors and ARBs in patients. In patients with hypertension and hypertension with compelling indications, we found no difference in efficacy between ARBs and ACE inhibitors with regard to the surrogate endpoint of blood pressure and outcomes of all-cause mortality, cardiovascular mortality, myocardial infarction, heart failure, stroke, and end-stage renal disease...
April 3, 2018: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/29603142/optimal-pain-management-for-patients-with-cancer-in-the-modern-era
#6
REVIEW
Bethann M Scarborough, Cardinale B Smith
Pain is a common symptom among patients with cancer. Adequate pain assessment and management are critical to improve the quality of life and health outcomes in this population. In this review, the authors provide a framework for safely and effectively managing cancer-related pain by summarizing the evidence for the importance of controlling pain, the barriers to adequate pain management, strategies to assess and manage cancer-related pain, how to manage pain in patients at risk of substance use disorder, and considerations when managing pain in a survivorship population...
March 30, 2018: CA: a Cancer Journal for Clinicians
https://www.readbyqxmd.com/read/29540496/exacerbations-of-copd
#7
Christian Viniol, Claus F Vogelmeier
Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide. While COPD is a mainly chronic disease, a substantial number of patients suffer from exacerbations. Severe exacerbations are related to a significantly worse survival outcome. This review summarises the current knowledge on the different aspects of COPD exacerbations. The impact of risk factors and triggers such as smoking, severe airflow limitation, bronchiectasis, bacterial and viral infections and comorbidities is discussed...
March 31, 2018: European Respiratory Review: An Official Journal of the European Respiratory Society
https://www.readbyqxmd.com/read/29466592/effect-of-low-fat-vs-low-carbohydrate-diet-on-12-month-weight-loss-in-overweight-adults-and-the-association-with-genotype-pattern-or-insulin-secretion-the-dietfits-randomized-clinical-trial
#8
RANDOMIZED CONTROLLED TRIAL
Christopher D Gardner, John F Trepanowski, Liana C Del Gobbo, Michelle E Hauser, Joseph Rigdon, John P A Ioannidis, Manisha Desai, Abby C King
Importance: Dietary modification remains key to successful weight loss. Yet, no one dietary strategy is consistently superior to others for the general population. Previous research suggests genotype or insulin-glucose dynamics may modify the effects of diets. Objective: To determine the effect of a healthy low-fat (HLF) diet vs a healthy low-carbohydrate (HLC) diet on weight change and if genotype pattern or insulin secretion are related to the dietary effects on weight loss...
February 20, 2018: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/29530870/evaluation-of-the-patient-with-pleural-effusion
#9
REVIEW
Stéphane Beaudoin, Anne V Gonzalez
No abstract text is available yet for this article.
March 12, 2018: CMAJ: Canadian Medical Association Journal, Journal de L'Association Medicale Canadienne
https://www.readbyqxmd.com/read/29523342/migraine
#10
REVIEW
David W Dodick
Migraine is a chronic paroxysmal neurological disorder characterised by multiphase attacks of head pain and a myriad of neurological symptoms. The underlying genetic and biological underpinnings and neural networks involved are coming sharply into focus. This progress in the fundamental understanding of migraine has led to novel, mechanism-based and disease-specific therapeutics. In this Seminar, the clinical features and neurobiology of migraine are reviewed, evidence to support available treatment options is provided, and emerging drug, device, and biological therapies are discussed...
March 31, 2018: Lancet
https://www.readbyqxmd.com/read/29477250/chronic-lymphocytic-leukaemia
#11
REVIEW
Michael Hallek, Tait D Shanafelt, Barbara Eichhorst
Important advances in understanding the pathogenesis of chronic lymphocytic leukaemia in the past two decades have led to the development of new prognostic tools and novel targeted therapies that have improved clinical outcome. Chronic lymphocytic leukaemia is the most common type of leukaemia in developed countries, and the median age at diagnosis is 72 years. The criteria for initiating treatment rely on the Rai and Binet staging systems and on the presence of disease-related symptoms. For many patients with chronic lymphocytic leukaemia, treatment with chemotherapy and anti-CD20 monoclonal antibodies is the standard of care...
April 14, 2018: Lancet
https://www.readbyqxmd.com/read/29507970/palliative-care
#12
Keith M Swetz, Arif H Kamal
Palliative care prioritizes symptom management and quality of life throughout the course of serious illness. Regardless of whether care is inpatient or outpatient, primary or subspecialty, a solid understanding of the basics of effective communication, symptom management, and end-of-life care is crucial. This article reviews these essentials and provides an overview of current evidence to support patient-centered palliative care.
March 6, 2018: Annals of Internal Medicine
https://www.readbyqxmd.com/read/29461916/outpatient-management-of-fever-and-neutropenia-in-adults-treated-for-malignancy-american-society-of-clinical-oncology-and-infectious-diseases-society-of-america-clinical-practice-guideline-update
#13
Randy A Taplitz, Erin B Kennedy, Eric J Bow, Jennie Crews, Charise Gleason, Douglas K Hawley, Amelia A Langston, Loretta J Nastoupil, Michelle Rajotte, Kenneth Rolston, Lynne Strasfeld, Christopher R Flowers
Purpose To provide an updated joint ASCO/Infectious Diseases Society of American (IDSA) guideline on outpatient management of fever and neutropenia in patients with cancer. Methods ASCO and IDSA convened an Update Expert Panel and conducted a systematic review of relevant studies. The guideline recommendations were based on the review of evidence by the Expert Panel. Results Six new or updated meta-analyses and six new primary studies were added to the updated systematic review. Recommendation Clinical judgment is recommended when determining which patients are candidates for outpatient management, using clinical criteria or a validated tool such as the Multinational Association of Support Care in Cancer risk index...
May 10, 2018: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/29490185/hydrocortisone-plus-fludrocortisone-for-adults-with-septic-shock
#14
RANDOMIZED CONTROLLED TRIAL
Djillali Annane, Alain Renault, Christian Brun-Buisson, Bruno Megarbane, Jean-Pierre Quenot, Shidasp Siami, Alain Cariou, Xavier Forceville, Carole Schwebel, Claude Martin, Jean-François Timsit, Benoît Misset, Mohamed Ali Benali, Gwenhael Colin, Bertrand Souweine, Karim Asehnoune, Emmanuelle Mercier, Loïc Chimot, Claire Charpentier, Bruno François, Thierry Boulain, Franck Petitpas, Jean-Michel Constantin, Gilles Dhonneur, François Baudin, Alain Combes, Julien Bohé, Jean-François Loriferne, Roland Amathieu, Fabrice Cook, Michel Slama, Olivier Leroy, Gilles Capellier, Auguste Dargent, Tarik Hissem, Virginie Maxime, Eric Bellissant
BACKGROUND: Septic shock is characterized by dysregulation of the host response to infection, with circulatory, cellular, and metabolic abnormalities. We hypothesized that therapy with hydrocortisone plus fludrocortisone or with drotrecogin alfa (activated), which can modulate the host response, would improve the clinical outcomes of patients with septic shock. METHODS: In this multicenter, double-blind, randomized trial with a 2-by-2 factorial design, we evaluated the effect of hydrocortisone-plus-fludrocortisone therapy, drotrecogin alfa (activated), the combination of the three drugs, or their respective placebos...
March 1, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/29399531/deep-vein-thrombosis-pathogenesis-diagnosis-and-medical-management
#15
REVIEW
Jonathan Stone, Patrick Hangge, Hassan Albadawi, Alex Wallace, Fadi Shamoun, M Grace Knuttien, Sailendra Naidu, Rahmi Oklu
Deep vein thrombosis (DVT) is a major preventable cause of morbidity and mortality worldwide. Venous thromboembolism (VTE), which includes DVT and pulmonary embolism (PE), affects an estimated 1 per 1,000 people and contributes to 60,000-100,000 deaths annually. Normal blood physiology hinges on a delicate balance between pro- and anti-coagulant factors. Virchow's Triad distills the multitude of risk factors for DVT into three basic elements favoring thrombus formation: venous stasis, vascular injury, and hypercoagulability...
December 2017: Cardiovascular Diagnosis and Therapy
https://www.readbyqxmd.com/read/29406201/proton-pump-inhibitors-review-of-emerging-concerns
#16
REVIEW
Avinash K Nehra, Jeffrey A Alexander, Conor G Loftus, Vandana Nehra
First introduced in 1989, proton pump inhibitors (PPIs) are among the most widely utilized medications worldwide, both in the ambulatory and inpatient clinical settings. The PPIs are currently approved by the US Food and Drug Administration for the management of a variety of gastrointestinal disorders including symptomatic peptic ulcer disease, gastroesophageal reflux disease, and nonulcer dyspepsia as well as for prevention of gastrointestinal bleeding in patients receiving antiplatelet therapy. PPIs inhibit gastric acid secretion, and the most commonly associated adverse effects include abdominal pain, diarrhea, and headache...
February 2018: Mayo Clinic Proceedings
https://www.readbyqxmd.com/read/29329694/management-of-refractory-vasodilatory-shock
#17
REVIEW
Jacob C Jentzer, Saraschandra Vallabhajosyula, Ashish K Khanna, Lakhmir S Chawla, Laurence W Busse, Kianoush B Kashani
Refractory shock is a lethal manifestation of cardiovascular failure defined by an inadequate hemodynamic response to high doses of vasopressor medications. Approximately 7% of critically ill patients will develop refractory shock, with short-term mortality exceeding 50%. Refractory vasodilatory shock develops from uncontrolled vasodilation and vascular hyporesponsiveness to endogenous vasoconstrictors, causing failure of physiologic vasoregulatory mechanisms. Standard approaches to the initial management of shock include fluid resuscitation and initiation of norepinephrine...
January 9, 2018: Chest
https://www.readbyqxmd.com/read/29168046/procalcitonin-guided-antibiotic-therapy-in-intensive-care-unit-patients-a-systematic-review-and-meta-analysis
#18
Hui-Bin Huang, Jin-Min Peng, Li Weng, Chun-Yao Wang, Wei Jiang, Bin Du
BACKGROUND: Serum procalcitonin (PCT) concentration is used to guide antibiotic decisions in choice, timing, and duration of anti-infection therapy to avoid antibiotic overuse. Thus, we performed a systematic review and meta-analysis to seek evidence of different PCT-guided antimicrobial strategies for critically ill patients in terms of predefined clinical outcomes. METHODS: We searched for relevant studies in PubMed, Embase, Web of Knowledge, and the Cochrane Library up to 25 February 2017...
November 22, 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/29398179/update-on-diabetic-nephropathy-core-curriculum-2018
#19
Kausik Umanath, Julia B Lewis
Diabetic kidney disease and diabetic nephropathy are the leading cause of end-stage kidney disease in the United States and most developed countries. Diabetes accounts for 30% to 50% of the incident cases of end-stage kidney disease in the United States. Although this represents a significant public health concern, it is important to note that only 30% to 40% of patients with diabetes develop diabetic nephropathy. Specific treatment of patients with diabetic nephropathy can be divided into 4 major arenas: cardiovascular risk reduction, glycemic control, blood pressure control, and inhibition of the renin-angiotensin system (RAS)...
February 2, 2018: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/29367334/2018-guidelines-for-the-early-management-of-patients-with-acute-ischemic-stroke-a-guideline-for-healthcare-professionals-from-the-american-heart-association-american-stroke-association
#20
REVIEW
William J Powers, Alejandro A Rabinstein, Teri Ackerson, Opeolu M Adeoye, Nicholas C Bambakidis, Kyra Becker, José Biller, Michael Brown, Bart M Demaerschalk, Brian Hoh, Edward C Jauch, Chelsea S Kidwell, Thabele M Leslie-Mazwi, Bruce Ovbiagele, Phillip A Scott, Kevin N Sheth, Andrew M Southerland, Deborah V Summers, David L Tirschwell
BACKGROUND AND PURPOSE: The purpose of these guidelines is to provide an up-to-date comprehensive set of recommendations for clinicians caring for adult patients with acute arterial ischemic stroke in a single document. The intended audiences are prehospital care providers, physicians, allied health professionals, and hospital administrators. These guidelines supersede the 2013 guidelines and subsequent updates. METHODS: Members of the writing group were appointed by the American Heart Association Stroke Council's Scientific Statements Oversight Committee, representing various areas of medical expertise...
March 2018: Stroke; a Journal of Cerebral Circulation
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