The American journal of medicine
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Multicenter Study
African Americans at risk for increased iron stores or liver disease.
We sought to determine the prevalence of elevated measures of iron status in African Americans and whether the combination of serum ferritin concentration >200 microg/L for women or >300 microg/L for men and transferrin saturation in the highest quartile represents increased likelihood of mutation of HFE, self-reported iron overload or self-reported liver disease. ⋯ Serum ferritin concentration >200 microg/L for women or >300 microg/L for men in combination with transferrin saturation >29% for women or >35% for men occurs in approximately 7% of adult African American primary care patients. Patients with this combination of iron test results should be evaluated for increased body iron stores or liver disease.
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Randomized Controlled Trial
Hemoglobin A1c predicts diabetes but not cardiovascular disease in nondiabetic women.
Hemoglobin A1c (HbA1c) is a marker of cumulative glycemic exposure over the preceding 2- to 3-month period. Whether mild elevations of this biomarker provide prognostic information for development of clinically evident type 2 diabetes and cardiovascular disease among individuals at usual risk for these disorders is uncertain. ⋯ These prospective findings suggest that HbA1c levels are elevated well in advance of the clinical development of type 2 diabetes, supporting recent recommendations for lowering of diagnostic thresholds for glucose metabolic disorders. In contrast, the association of HbA1c with incident cardiovascular events is modest and largely attributable to coexistent traditional risk factors.
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Chronic obstructive pulmonary disease (COPD) is a preventable and treatable systemic disease with symptoms that overlap other respiratory illnesses. An estimated 24 million adults in the United States have COPD, but >50% of them are misdiagnosed or undiagnosed. ⋯ Influenza vaccinations will also reduce acute respiratory illness in patients with COPD. With increasing awareness of COPD and earlier diagnosis, implementation of treatment guidelines and smoking-cessation efforts may lead to more effective management of this disease, which is projected to be the third leading cause of death in the United States by 2020.
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Review
Optimizing treatment of chronic obstructive pulmonary disease: an assessment of current therapies.
Bronchodilators are the mainstay of chronic obstructive pulmonary disease (COPD) therapy. Inhaled short-acting beta2-agonists generally have a more rapid onset of effect and shorter duration of action than short-acting anticholinergic agents, and are usually prescribed as "rescue" medication to relieve acute bronchospasm. For patients with persistent symptoms, maintenance therapy with inhaled long-acting beta2-agonists is preferable to short-acting beta2-agonists because long-acting beta2-agonists provide more predictable, longer-lasting improvements in lung function. ⋯ Combining different classes of bronchodilators or combining a bronchodilator with a corticosteroid provides greater improvements in lung function and symptoms than the individual agents given alone. Nonpharmacologic interventions, including pulmonary rehabilitation, oxygen therapy, and surgery, can benefit patients at various stages of disease. A treatment algorithm that combines both pharmacologic and nonpharmacologic interventions for the management of COPD is presented.
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Anaphylaxis, an acute and potentially lethal multisystem allergic reaction, is almost unavoidable in medical practice. Physicians must be able to recognize anaphylaxis, treat it promptly and appropriately, and provide preventive recommendations. Epinephrine, which should be administered immediately, is the drug of choice for acute anaphylaxis.