Mayo Clinic proceedings
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Mayo Clinic proceedings · Jul 2023
ReviewManagement of Premature Ventricular Complexes in the Outpatient Setting.
With an aging population and an explosion in ambulatory electrocardiographic monitoring, primary care clinicians will undoubtedly see an increase in patients presenting with premature ventricular complexes (PVCs), especially given how common they are in the general population. A sizable number of patients with PVCs are asymptomatic, and these PVCs have no significant clinical implications. ⋯ In this review, we provide a comprehensive overview of the pathophysiologic basis of PVCs, appropriate diagnostic testing, management, and prognostic considerations necessary when faced with PVCs in the outpatient clinic. We also provide a simplistic approach to help guide the initial work-up of PVCs, basic treatment strategies, and indications of when to refer for cardiovascular specialty consultation to improve physician comfort and to enhance patient care.
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Mayo Clinic proceedings · Jul 2023
Skin Cancer Associated With Chronic Leg Ulcers in the Population of Olmsted County, Minnesota.
Malignant skin tumors in the setting of chronic leg ulcers (CLUs) are often underdiagnosed which may contribute to treatment delay and poor outcomes. The aims of our study were to determine the incidence and clinical characteristics of skin cancers in leg ulcers in the Olmsted County population from 1995 to 2020. We used the Rochester Epidemiology Project (a collaboration between health care providers) infrastructure to describe this epidemiology, allowing "population-based" research. ⋯ Skin cancers among CLUs included 17 (41.5%) basal cell carcinomas, 17 (41.5%) squamous cell carcinomas, 2 (4.9%) melanomas, 2 (4.9%) porocarcinomas, 1 (2.4%) basosquamous cell carcinoma, and 1 (2.4%) eccrine adenocarcinoma. The apparent association between chronic wounds and subsequent biopsy-proven skin cancer of the same site was primarily observed in elderly patients; malignant transformation of wounds favored basal cell carcinoma and squamous cell carcinoma. This retrospective cohort study further characterizes the association between skin cancers and chronic leg wounds.
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Mayo Clinic proceedings · Jul 2023
SGLT2 Inhibitors Are Associated With Reduced Cardiovascular Disease in Patients With Type 2 Diabetes: An Analysis of Real-World Data.
To assess the association between sodium-glucose cotransporter-2 (SGLT2) inhibitors and other second-line diabetes therapies with risk of cardiovascular disease (CVD), as well as conduct head-to-head comparisons between SGLT2 inhibitors. ⋯ SGLT2 inhibitors were associated with a clinically meaningfully lower CVD risk in the real-world setting. In head-to-head comparisons, the different SGLT2 inhibitors were consistent in their protective associations with CVD. This suggests that as a class, SGLT2 inhibitors may have widespread benefit in preventing CVD among patients with type 2 diabetes.
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Mayo Clinic proceedings · Jul 2023
Rising Rates of Suicidal Behaviors and Large Unmet Treatment Needs Among US Adults With a Major Depressive Episode, 2009 to 2020.
To examine recent 12-year trends in the incidence of suicidal ideation (SI) and suicide attempts (SAs) and receipt of mental health treatment among individuals experiencing a past-year major depressive episode (MDE). ⋯ Among individuals with MDE, rates of SI and SAs have increased, especially among racial minorities and individuals with substance use disorders, without a corresponding change in mental health service use.