American family physician
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Each year, a number of children and adolescents die suddenly from cardiac problems that are associated with a small subgroup of disorders and high-risk behaviors. While sudden cardiac death in any child or adolescent is distressing, it can be particularly devastating when it occurs in a seemingly healthy young athlete. ⋯ To prevent the occurrence of sudden death or cardiovascular disease progression in young athletes, the American Academy of Family Physicians, American Academy of Pediatrics, American College of Cardiology, American College of Sports Medicine, American Heart Association, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine and American Osteopathic Academy of Sports Medicine have developed or endorsed recommendations for cardiovascular screening of student athletes as part of a comprehensive sports preparticipation physical evaluation (PPE). Knowledge and understanding of these recommendations can help physicians make informed decisions about the eligibility of an athlete to participate in a particular sport and encourage development of a more uniform PPE screening process.
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American family physician · Aug 2000
Review Case ReportsPolymyalgia rheumatica and temporal arthritis.
Polymyalgia rheumatica and temporal arteritis are closely related inflammatory conditions that affect different cellular targets in genetically predisposed persons. Compared with temporal arteritis, polymyalgla rheumatica is much more common, affecting one in 200 persons older than 50 years. Temporal arteritis, however, is more dangerous and can lead to sudden blindness. ⋯ Therapy is generally continued for six to 24 months. Throughout treatment, clinical condition is assessed periodically. Patients are instructed to see their physician immediately if symptoms recur or they develop new headache, jaw claudication or visual problems.
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Down syndrome (trisomy 21) is the most commonly recognized genetic cause of mental retardation. The risk of trisomy 21 is directly related to maternal age. All forms of prenatal testing for Down syndrome must be voluntary. ⋯ Women younger than 35 years should be offered maternal serum screening at 16 to 18 weeks of gestation. The maternal serum markers used to screen for trisomy 21 are alpha-fetoprotein, unconjugated estriol and human chorionic gonadotropin. The use of ultrasound to estimate gestational age improves the sensitivity and specificity of maternal serum screening.
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Decreased libido disproportionately affects patients with depression. The relationship between depression and decreased libido may be blurred, but treating one condition frequently improves the other. ⋯ Frequently, patients do not volunteer problems related to sexuality, and physicians rarely ask about such problems. Asking a depressed patient about libido and sexual function and tailoring treatment to minimize adverse effects on sexual function can significantly increase treatment compliance and improve the quality of the patient's life.
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American family physician · Aug 2000
ReviewIntra-articular hyaluronic acid injections for knee osteoarthritis.
Knee osteoarthritis is a common but often difficult problem to manage in primary care. Traditional nonsurgical management, consisting of lifestyle modification, physical therapy and pharmacologic therapy (e.g., analgesics, anti-inflammatory medications), is often ineffective or leaves residual symptoms. Viscosupplementation is a newly available option for patients with symptomatic knee osteoarthritis that involves a series of intra-articular injections of hyaluronic acid. ⋯ The exact indications for viscosupplementation are still evolving, but it currently can be considered for use in patients who have significant residual symptoms despite traditional nonpharmacologic and pharmacologic treatments. In addition, patients who are intolerant of traditional treatments (e.g., gastrointestinal problems related to anti-inflammatory medications) can be considered for these injections. Family physicians with the ability to perform intra-articular knee injections should consider them an option in patients with symptomatic knee osteoarthritis.