Postgraduate medicine
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Acute kidney injury (AKI) increases morbidity and mortality, particularly for the critically ill. Recent definitions standardizing AKI to reflect graded changes in serum creatinine and urine output (per the Risk, Injury, Failure, Loss, and End-stage renal failure [RIFLE] and Acute Kidney Injury Network [AKIN] criteria) with severity of renal injury and developments in AKI pathobiology are being utilized to identify biomarkers of early kidney injury. ⋯ Future use of bioartificial dialyzers, plasma therapies, and the possibility of stem cell regeneration of injured kidney tissue are being actively investigated to provide alternative treatment options for AKI. This review aims to provide an overview of current practices, available therapies, and continued research in AKI therapy.
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Cardiopulmonary exercise testing (CPX) is a relatively old technology, but has sustained relevance for many primary care clinical scenarios in which it is, ironically, rarely considered. Advancing computer technology has made CPX easier to administer and interpret at a time when our aging population is more prone to comorbidities and higher prevalence of nonspecific symptoms of exercise intolerance and dyspnea, for which CPX is particularly useful diagnostically and prognostically. ⋯ When used properly, CPX enables the physician to assess fitness and uncover cardiopulmonary issues at earlier phases of work-up, which would therefore be especially useful for primary care physicians. In this article, we provide an overview of CPX principles and testing logistics, as well as some of the clinical contexts in which it can enhance patient care.
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Vaginitis is one of the most common ambulatory problems to occur in women. It is a disorder responsible for > 10% of visits made to providers of women's health care. Although vaginal infections are the most common cause, other considerations include cervicitis, a normal vaginal discharge, foreign-body vaginitis, contact vaginitis, atrophic vaginitis, and desquamative inflammatory vaginitis. ⋯ Candida vaginitis is generally treated with either the vaginal administration of an imidazole or triazole antifungal agent or the prescription of oral fluconazole. Oral nitroimidazole agents, metronidazole or tinidazole, are the only effective treatments for trichomoniasis in the United States. Bacterial vaginosis, which has been linked to important gynecologic and pregnancy complications, can be treated with an available oral or topical agent containing either a nitroimidazole or clindamycin.