The American journal of medicine
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Nasal, axillary, or inguinal colonization with Staphylococcus aureus generally precedes invasive infection. Some studies have found that colonization with methicillin-resistant S. aureus (MRSA) poses a greater risk of clinical infection than colonization with methicillin-susceptible S. aureus (MSSA). However, the magnitude of risk is unclear. ⋯ Further research is needed to identify effective methods for sustained eradication of MRSA carriage to reduce the high risk of subsequent infection.
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The 80,000 or so patients a year who continue to have chronic, disabling back pain after one or more spinal surgeries are said to have failed back surgery syndrome. There are no controlled studies to guide physicians in the management of these patients. ⋯ This approach is focused on determination of the specific anatomical abnormality responsible for ongoing symptoms, an abnormality that may or may not be related to the initial abnormality for which surgery was performed. One or more of 5 nonsurgical treatment options may be useful to prevent the need for further surgery, as each subsequent surgery has a lower likelihood of success.
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Nicotine sustains addictive tobacco use, which in turn causes much premature disability and death. The essence of drug addiction is loss of control of drug use. Molecular biology studies suggest that the alpha(4)beta(2) nicotinic acetylcholine receptor subtype is the main receptor mediating nicotine dependence. ⋯ These include the taste and smell of tobacco, as well as particular moods, situations, and environmental cues. Pharmacotherapies to aid smoking cessation should ideally reduce nicotine withdrawal symptoms and block the reinforcing effects of nicotine obtained from smoking without causing excessive adverse effects. Further, given the important role of sensory effects of smoking and psychoactive effects of nicotine, counseling and behavioral therapies are important adjuncts to and substantially augment the benefits of pharmacotherapy.
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Hypertension prevalence, awareness, treatment, and blood pressure control rates in the population with chronic kidney disease are limited. The objective of this study was to determine the state of blood pressure control in patients with chronic kidney disease. ⋯ We conclude that despite increased awareness and treatment of hypertension, control rates in these participants are poor. This poor control rate centers around elevated systolic pressure in people who are obese, non-Hispanic black, or male. These data suggest that those who are aware of their kidney disease are more likely to achieve blood pressure control.