The Journal of family practice
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The patient's dermatologic symptoms and his history of a particular chronic condition pointed toward the diagnosis.
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YES. Infants respond to behavioral interventions, although objective data are limited. Behavioral interventions include establishing regular daytime and sleep routines for the infant, reducing environmental noises or distractions, and allowing for self-soothing at bedtime (strength of recommendation: B, based on multiple randomized and nonrandomized studies).
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Asthma remains a substantial health burden, despite continued treatment advances. Patients with mild or moderate asthma, even those with intermittent symptoms, are at risk for severe or fatal exacerbations. Use of short-acting beta2-agonist (SABA)-only rescue therapy is associated with an increased risk of exacerbations, beginning at about the second fill annually. ⋯ There is a window of opportunity just prior to an asthma exacerbation during which use of fast-acting bronchodilator + ICS may play a significant role in mitigating the risk of exacerbation. Patients may respond better to a combination inhaler of a fast-acting bronchodilator and an ICS as needed for rescue therapy or as part of a maintenance and rescue therapy paradigm, rather than attempting to use separate inhalers. However, there is currently no fixed-dose, fast-acting bronchodilator + ICS approved in the United States for as-needed use.
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Acne is a highly prevalent condition, affecting the majority of people at some point in their lifetimes, most often during adolescence. Acne has also become increasingly common among preadolescents (aged ≥7 to ≤12 years old). Acne is often treated in primary care settings by nondermatologists. ⋯ During a face-to-face meeting, 5 key areas requiring careful communication emerged: acne pathophysiology, specifically the role of hormones; psychological aspects of acne; management of acne in younger patients; acne in skin of color; and evaluation of clinical success. This roundtable report describes these 5 focus areas, with the aim of empowering primary care physicians to refine the care they provide for patients with acne. This report can help bridge the information gap until new acne treatment guidelines are published.
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Chronic kidney disease (CKD) remains underrecognized by patients and clinicians in the primary care setting, largely due to its asymptomatic presentation in early stages. Sodium-glucose cotransporter-2 (SGLT-2) inhibitors have demonstrated kidney-protective effects in clinical trials-including in patients with and without type 2 diabetes (T2D)-and there are several proposed mechanisms for these benefits. Dapagliflozin and canagliflozin are SGLT2 inhibitors with indications for CKD, and only dapagliflozin is indicated for CKD in patients without T2D. Clinically relevant adverse events associated with SGLT-2 inhibitors include volume depletion, diabetic ketoacidosis, and genital mycotic infections.