The American journal of medicine
-
Low back and lower extremity pain are among the most common complaints encountered by physicians. Distinguishing pain due to primary extremity pathology versus lumbar radiculopathy can be challenging. ⋯ In patients in whom surgical intervention is being considered by a spine or arthroplasty surgeon, intra-articular or epidural steroid injections may help to reveal the underlying cause of pain via short-term symptomatic relief. Additionally, patients presenting with vague lower extremity pain after recent or distant joint arthroplasty should be considered for potential failure or infection of their implant before assuming the symptoms are coming from the lumbar spine.
-
The clinical spectrum of Zika virus had, to date, been described in small series from endemic/epidemic countries and is not well established. ⋯ Zika virus clinical picture in travelers is diverse. Prolonged symptoms may occur.
-
Hypertension accounts for approximately 1 in 5 deaths in American women and is the major contributor to many comorbid conditions. Although blood pressure lowering reduces cardiovascular disease outcomes, considerable uncertainty remains on best management in women. Specifically, female blood pressure treatment goals have not been established, particularly among older and African American and Hispanic women, for whom hypertension prevalence, related adverse outcomes, and poor control rates are high. ⋯ Although confirming that a lower blood pressure goal is generally better, because female enrollment and event rates were low and follow-up shortened, outcomes differences in women were not statistically significant. Thus optimal blood pressure goals for women have not been established with the highest evidence. This review addresses SPRINT's significance and key remaining knowledge gaps in optimal blood pressure management to improve women's health.
-
Meta Analysis
Efficacy and Safety of Non-Vitamin K Antagonist Oral Anticoagulants After Cardioversion for Nonvalvular Atrial Fibrillation.
Non-vitamin K oral anticoagulants (NOACs) are proven alternatives to vitamin K antagonists (VKAs) for the prevention of thromboembolism in patients with nonvalvular atrial fibrillation. However, there are few data on the efficacy and safety of NOAC therapy after cardioversion, where the risk of thromboembolic events is heightened. ⋯ The short-term incidences of thromboembolic and major hemorrhagic events after cardioversion on NOACs were low and comparable to those observed on dose-adjusted VKA therapy. Non-vitamin K oral anticoagulants are a reasonable alternative to VKAs in patients undergoing cardioversion.