Cleveland Clinic journal of medicine
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Insomnia is a common and challenging complaint in older adults (> 65 years) because of age-related alterations in sleep physiology. Cognitive behavioral therapy for insomnia is the gold standard for treatment of insomnia in young as well as older patients. ⋯ Pharmacologic options for older adults include low-dose doxepin, melatonin, ramelteon, and the dual orexin receptor antagonists. A well-informed clinician can help patients navigate the risks and benefits of both pharmacologic and behavioral options.
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More and more patients with atrial fibrillation are undergoing catheter ablation as a rhythm-control strategy, but the recurrence rate after the procedure is high. A wide array of risk factors contribute to the pathogenesis of atrial fibrillation, including hypertension, diabetes mellitus, dyslipidemia, obesity, obstructive sleep apnea, metabolic dysfunction-associated steatotic liver disease (MASLD), smoking, alcohol consumption, and physical inactivity. This review summarizes the emerging evidence for periablation risk-factor modification to optimize postablation outcomes.
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Diabetic ketoacidosis (DKA) was historically considered a condition typical of type 1 diabetes. However, patients with type 2 diabetes may present with DKA, usually with higher blood glucose levels and milder ketoacidosis. With the increased use of sodium-glucose cotransporter 2 (SGLT-2) inhibitors, the variant euglycemic DKA has been described. ⋯ The principles of DKA management are fluid administration, electrolyte control, and glucose control with insulin. In euglycemic DKA, the immediate use of a glucose-containing intravenous fluid induces endogenous insulin secretion and stops ketogenesis. Due to the half-life of SGLT-2 inhibitors, the duration of euglycemic DKA may be more prolonged.