The American journal of medicine
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Statins reduce cardiovascular events and cardiovascular and total mortality in persons at risk for and with coronary disease, but there remains a significant residual event rate, particularly in those with the atherogenic lipid phenotype that is characterized by a low high-density lipoprotein (HDL) cholesterol and increase in non-HDL cholesterol. Large outcome trials designed to assess the value of combining statins with other agents to target HDL cholesterol and non-HDL cholesterol will not be completed for a few years, but there is ample evidence for the clinician to consider combination therapy. The choices for therapies to supplement statins include niacin, fibrates, and omega-3 fatty acids. ⋯ Evidence supports the addition of niacin as the second agent. In some situations, high-dose omega-3 fatty acid therapy could be the first agent added to statins. Although fibrate monotherapy alone or in combination with non-statin low-density lipoprotein cholesterol-lowering agents can be effective in mixed hyperlipidemia when statins are not tolerated, the combination of statin+fibrate should be considered second-line therapy until the efficacy and safety are established.
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Letter Case Reports
Morgagni-type diaphragmatic hernia presenting as an abnormal cardiac silhouette.
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Review Case Reports
Adult nonhepatic hyperammonemia: a case report and differential diagnosis.
This article presents a case report of nonhepatic hyperammonemia, i.e., elevated serum ammonia secondary to a nonhepatic etiology. It then discusses the importance of broadening one's differential diagnosis to include such nonhepatic causes of elevated ammonia levels, and provides a short review of rarer causes of hyperammonemia in the adult population. Treating the underlying condition is the best way to prevent recurrence of hyperammonemia. However, symptomatic treatment should not be delayed while investigating the underlying source.
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To evaluate the impact of serum uric acid levels on the future risk of developing type 2 diabetes independent of other factors. ⋯ These prospective data from 2 generations of the Framingham Heart Study provide evidence that individuals with higher serum uric acid; including younger adults, are at a higher future risk of type 2 diabetes independent of other known risk factors. These data expand on cross-sectional associations between hyperuricemia and the metabolic syndrome, and extend the link to the future risk of type 2 diabetes.
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Comparative Study
Empiric outpatient therapy with trimethoprim-sulfamethoxazole, cephalexin, or clindamycin for cellulitis.
Limited data exist on optimal empiric oral antibiotic treatment for outpatients with cellulitis in areas with a high prevalence of community-associated methicillin-resistant Staphylococcus aureus (MRSA) infections. ⋯ Antibiotics with activity against community-associated MRSA, such as trimethoprim-sulfamethoxazole and clindamycin, are preferred empiric therapy for outpatients with cellulitis in the community-associated MRSA-prevalent setting.