The American journal of medicine
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Cough is one of the most common complaints encountered in every setting; however, complications associated with coughing have received relatively little attention. An exhaustive systematic review of the English literature revealed an exceedingly large and varied spectrum of cough-induced complications affecting many systems, including upper airways, chest wall and thorax, abdominal wall, heart and aorta, central nervous system, eye, gastrointestinal tract, urogenital system, and emotional and psychological harm. Prospective studies and prevalence data are conspicuously missing. ⋯ A substantial proportion of patients experience anxiety and insomnia, and their quality of life is affected. Thus, the wide spectrum of cough-induced pathology need to be recognized and considered in patients complaining of cough. Suppression of cough must not be neglected in patients at risk, and areas of uncertainty need to be clarified by future prospective studies.
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Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the United States and is soon to be the leading cause of liver transplantation. Patients at the greatest risk are those with obesity and type 2 diabetes mellitus. In 2019 the American Diabetes Association guidelines called, for the first time, for clinicians to screen for steatohepatitis and fibrosis all patients with type 2 diabetes and liver steatosis or abnormal plasma aminotransferases. ⋯ Early diagnosis in the primary care setting is critical to prevent progression to end-stage liver disease. Patients with NAFLD are also at a higher risk of developing type 2 diabetes mellitus and cardiovascular disease. Despite general perception to the contrary, weight loss by lifestyle intervention or bariatric surgery and several pharmacological treatments (eg, vitamin E in nondiabetics, pioglitazone or glucagon-like peptide 1 receptor agonists in patients with or without diabetes) can often be successful to reverse steatohepatitis and prevent disease progression.
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Migraine headaches are among the most common and potentially debilitating disorders encountered by primary healthcare providers. In the treatment of acute migraine and the prevention of recurrent attacks, there are prescription drugs of proven benefit. ⋯ In addition, the totality of evidence, including some, but not all, randomized trials, suggests the possibility that daily aspirin, in doses from 81 to 325 mg, may be an effective and safe treatment option for the prevention of recurrent migraine headaches. The relatively favorable side effect profile of aspirin and extremely low costs compared with other prescription drug therapies may provide additional options for primary healthcare providers in the treatment of both acute and recurrent migraine headaches.
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Meta Analysis
A Closer Look at Penicillin Allergy History: Systematic Review and Meta-Analysis of Tolerance to Drug Challenge.
True allergy to penicillin is rare, despite the high frequency with which it is reported. While most patients reporting penicillin allergy are not prone to anaphylaxis, it is not currently known what percentage of these patients will tolerate dose challenges of penicillin-based antibiotics. This review aims to determine the rate of tolerance in patients reporting penicillin allergy when challenged with penicillin-based antibiotics. ⋯ Misrepresented penicillin allergy drives unnecessary use of alternative antibiotics, which may be less effective, more toxic, and more expensive than using penicillin. In addressing the problem of penicillin allergy over-diagnosis, evaluation should go beyond risk for type 1 hypersensitivity. Our data suggest that 94.4% of 5056 participants with reported penicillin allergy determined to be clinically appropriate for allergy evaluation tolerated repeat administration of penicillin-based antibiotics without any adverse reactions. This review generates meaningful information useful to clinical predictive analytics, in evaluating and managing patients with a reported history of penicillin allergy.
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Health care providers are frequently faced with the challenge of caring for patients who have limited English proficiency. These patients experience challenges accessing health care and are at higher risk of receiving suboptimal health care than native English speakers. ⋯ Many providers lack the skill set and knowledge that are vital to successful collaboration with an interpreter. The objective of this article is to address a number of questions surrounding the use of health care interpreters and to provide concrete suggestions that will enable providers to best serve their patients.