The American journal of medicine
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Hepatitis C virus is a leading cause of chronic liver disease, with over 170 million people infected worldwide. It is also the leading indication for liver transplantation. Complications from chronic hepatitis C infection include cirrhosis, hepatic decompensation, and hepatocellular carcinoma. ⋯ Other strategies must be considered for special groups, such as patients with acute hepatitis C infection, hepatitis C/human immunodeficiency virus (HIV) coinfection, and prior nonresponse to interferon or relapse after its use. The goal of therapy is to achieve a sustained virologic response (ie, no detectable hepatitis C ribonucleic acid 6 months after completion of therapy). The substantial adverse effects associated with both interferon alfa and ribavirin often make it difficult for patients to continue with their therapies.
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Review
Principles of antibiotic treatment of community-acquired pneumonia in the outpatient setting.
Community-acquired pneumonia (CAP) is a common illness with high rates of morbidity and mortality. Nearly 80% of the treatment for this condition is provided in the outpatient setting. Among the etiologic agents associated with bacterial CAP, the predominant pathogen is Streptococcus pneumoniae. ⋯ The respiratory fluoroquinolone levofloxacin has also been shown to be effective in CAP patients for the treatment of macrolide-resistant S pneumoniae. The use of azithromycin, telithromycin, and fluoroquinolones in short-course regimens has been shown to be efficacious, safe, and tolerable in patients with CAP. Based on clinical evidence, high-dose, short-course therapies may represent a significant advance in the management of CAP.
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Important advances have been made over the past decade towards understanding the optimal approach to ventilating patients with acute respiratory failure. Evidence now supports the use of noninvasive positive pressure ventilation in selected patients with hypercapnic respiratory failure and chronic obstructive pulmonary disease, cardiogenic pulmonary edema, and for facilitating the discontinuation of ventilatory support in patients with chronic pulmonary disease. ⋯ The process of liberation from mechanical ventilation is becoming more standardized, with evidence supporting daily trials of spontaneous breathing in all suitable mechanically ventilated patients. This article critically reviews the most important recent advances in mechanical ventilation and suggests future directions for further research in the field.
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Many patients who have type 2 diabetes mellitus (DM) require several different medications. Although these agents can substantially reduce diabetes-related morbidity and mortality, the extent of treatment benefits may be limited by a lack of treatment adherence. Unfortunately, little information is available on treatment adherence in patients with type 2 DM. ⋯ Factors that appear to influence adherence include the patient's comprehension of the treatment regimen and its benefits, adverse effects, medication costs, and regimen complexity, as well as the patient's emotional well-being. Outcomes research emphasizes the importance of effective patient-provider communication in overcoming some of the barriers to adherence. This article offers specific suggestions for improving adherence in patients with type 2 DM seen in general clinical practice.
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Among the medications that have been used as acute treatments for migraine are nonspecific agents, including nonsteroidal anti-inflammatory drugs (NSAIDs), analgesics (either single or combination), and narcotics, as well as migraine-specific medications, including ergot alkaloids and triptans (5-hydroxytryptamine 1B/1D agonists). All of these drugs have side effects that vary in type and severity. Side effects of nonspecific medications, including gastrointestinal (GI) and renal effects with NSAIDs and cognitive effects and the potential for abuse with narcotics and butalbital-containing medications, have been documented over time, as these medications have been used for various indications. ⋯ Because of potential vasoconstrictor effects--mild and transient increases in blood pressure and mild and transient effects on coronary artery tone--triptans as a class are contraindicated in patients with established or clinically suspected cardiovascular disease, specifically ischemic heart disease and uncontrolled hypertension. Other adverse events, including the potential for drug-drug interactions, are less common. Therefore, consideration should be given to the tolerability and safety of medications before their use as abortive medications for the treatment of migraine headache.