The first consensus recommendations on the topic aim to address variation in diagnosis at the international, national, and local levels.
Sponsoring Organization: World Brain Death Project, assisted by international professional societies including the World Federation of Intensive and Critical Care,
A plethora of studies comparing the metabolic benefits of bariatric surgery with usual medical management of obese patients has increased the focus on surgical management.
These studies initially focused on enhanced insulin sensitivity, improved glucose regulation, and a higher likelihood of reversing prediabetes and diabetes.
In a small study, two measures of retinal thickness showed greater thinning rates and correlations with cognitive decline in patients with PD than in controls.
Increasing interest has focused on the development of biomarkers capable of tracking Parkinson disease (PD) progression over time.
Higher rates of neurologic deterioration and adverse events were associated with intensive treatment in patients with excessively high initial systolic blood pressure.
Many patients with intracerebral hemorrhage (ICH) present with elevated systolic blood pressure (SBP).
A 45-year longitudinal study shows that mental illness is astonishingly common and that it’s better to be a “lumper” than a “splitter” when thinking diagnostically.
Cross-sectional epidemiological surveys have documented high rates of lifetime psychiatric disorders (about 40%–50%) and substantial comorbidity.
A retrospective analysis of cases shows that smooth meningeal thickening provides an additional diagnostic clue differentiating POEMS syndrome from chronic immune demyelinating polyneuropathy.
POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin lesions) is a rare but treatable paraneoplastic disorder of plasma cells associated with sensorimotor polyneuropathy.
A machine-learning algorithm robustly differentiates two neuroanatomical patterns in patients diagnosed with schizophrenia, but associated clinical features were few
The psychiatric disorders grouped as schizophrenia are known for their clinical heterogeneity and highly diverse patterns in brain abnormalities on neuroimaging.
A large study of older veterans finds a nearly twofold increase in risk for dementia following diagnosis of late-onset seizures without known cause.
Do late-adult-onset seizures have an association with risk for dementia or just ref lect an independent cause without concern for a degenerative disease?
Combining usual care with a guided program using cognitive-behavioral therapy reduced major depressive episodes by 52% in patients with chronic back pain.
Consistent with the move toward remote interventions for mental disorders, researchers assessed whether a web-based cognitive-behavioral therapy.
Aerobic exercise improves cognitive, cardiovascular, and cerebrovascular outcomes in healthy older adults.
In this single-group intervention study, researchers examined the effects of aerobic exercise on cognition, cardiovascular fitness, and cerebrovascular regulation in 206 healthy adults
Short-term psychodynamic psychotherapy focusing on awareness and processing of emotionally laden material can be helpful for somatization.
Is psychodynamic psychotherapy still relevant? Researchers addressed this question in a meta-analysis of 17 randomized, controlled trials involving 2004 patients
Risks for suicide attempts are strongly transmitted, with nature and nurture contributing equally, whereas the modest intergenerational transmission of completed suicide is largely genetic.
Suicide attempts and suicides have long been known to run in families, but questions remain about the genetic versus environmental contributions to these phenomena.
CT angiography might be useful to personalize decision-making about preventive therapies in low- or intermediate-risk patients.
Coronary computed tomography angiography (CCTA) can assess the degree and progression of coro-nary atherosclerosis and higher-risk plaque features, such as remodeling of the blood vessel wall, low attenuation lesions, and spotty calcification.
In a retrospective study, researchers examined associations between laryngeal disorders and fibromyalgia, irritable bowel, and chronic fatigue.
Fibromyalgia, irritable bowel, and chronic fatigue are syndromes that share chronic pain and other unexplained symptoms among their clinical manifestations.
Código de aprobación:: PP-PPF-PEB-0043
Meta-analyses of studies of both surgical and nonsurgical patients confirm the long-suspected association.
Delirium is common in postoperative and critically ill hospitalized patients and has been estimated to occur in 25% of postsurgical patients and up to 82% of patients admitted to intensive care units.
Código de aprobación:PP-CNS-PEB-0093
A meta-analysis indicates that almost two thirds of women have another psychotic episode, predominantly outside the postpartum period.
Postpartum psychosis denotes a severe mood disorder episode having psychotic, manic, or mixed affective symptoms and occurring within the first few weeks after childbirth.
Código de aprobación:PP-CNS-PEB-0092
During 2 years of follow-up, most cases resolved, but one quarter developed into chronic inflammatory disease.
The differential diagnosis of recent-onset monoarthritis is broad and includes early presentation of what eventually is identifiable as chronic inflammatory rheumatic disease (CIRD)
Código de aprobación:PP-PPF-PEB-0042
The widely accepted pooled cohort equations overestimate 5-year risk in a cohort of Veterans Affairs patients, with implications for statin eligibility.
The pooled cohort equations (PCE) were developed to estimate the risk for an initial atherosclerotic cardiovascular disease (ASCVD) event.
Código de aprobación:PP-CVP-PEB-0071
Disturbances are seen in white-matter structures responsible for the appropriate inhibition and control of emotions.
Many of the core features of borderline personality disorder (BPD; irritability, impulsivity, emotional instability) suggest disruption in frontolimbic brain circuits.
Código de aprobación:PP-CNS-PEB-0094
In a prospective 4-year study, more of those with elevated cytokine levels had evidence of disease activity.
Although multiple sclerosis (MS) is often considered a disease of the white matter, appreciation is growing that pathology also directly affects the cortex.
Código de aprobación:PP-CNS-PEB-0076
Low-to-moderate physical activity might be protective.
Patients and some clinicians still are concerned that physical activity, particularly vigorous physical activity, might be associated with excess risk for knee osteoarthritis (OA), despite considerable evidence to the contrary.
Código de aprobación:PP-PPF-PEB-0032
Long-term associations between mental and physical health are examined in a prospective study.
To address the relationship between health and affective symptoms (anxiety or depression), researchers analyzed data from a British prospective study of 3001 people followed repeatedly since birth in 1946.
Código de aprobación:PP-CNS-PEB-0052
Acute coronary syndrome is infrequent, presents most often as non-STEMI, but is associated with high early mortality.
Although as many as 50% of patients who undergo transcatheter aortic-valve replacement (TAVR) have known coronary artery disease, the incidence of acute coronary syndrome (ACS) after TAVR is unknown.
Código de aprobación:PP-CVP-PEB-0048
A study suggests that asking about pain tolerability has advantages over using a 0-to-10–point numerical rating.
The common practice of asking patients to rate their pain on a 10-point scale might suggest that the goal of pain therapy always is to achieve a score of 0.
Código de aprobación:PP-PPF-PEB-0020
Letter from the Editor
The late Dr. Willet Whitmore, long-serving Chair of Urology at Memorial Sloan Kettering Cancer Center, noted in his 1973 treatise on the natural history of prostate cancer that “Appropriate treatment implies that therapy be applied neither to those patients for whom it is unnecessary nor to those for whom it will prove ineffective.”
Código de aprobación:PP-MHP-PEB-0029
Auditory hallucinations are common in women with severe PTSD, especially among those who were younger at the initial trauma.
Clinically, auditory hallucinations are most often linked to psychotic disorders, such as schizophrenia, severe bipolar disorders, drug-induced psychoses, and neurodegenerative diseases.
Código de aprobación:PP-CNS-PEB-0050
Persistent urethritis symptoms are frequent in men regardless of the detection of M. genitalium.
Mycoplasma genitalium (MG) is increasingly recognized as a cause of male urethritis, and recent studies indicate increasing prevalence of macrolide-resistance mutations (MRMs).
Código de aprobación:PP-MHP-PEB-0023
Greater BP variability in early adulthood correlated with worse echocardiographic features at middle age.
Visit-to-visit blood pressure variability (BPV) has been associated with adverse cardiovascular outcomes, independent of BP level. To understand if BPV in early adulthood is associated with later subclinical alterations in cardiac structure and function, researchers used data from a U.S.-based community cohort study (CARDIA) in which participants aged 18 to 30 at enrollment underwent eight BP evaluations over 25 years of follow-up and an echocardiogram at year 25.
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Letter from the Editor
The number of patients undergoing hip or knee arthroplasty is increasing, due in considerable part to the increasing prevalence of obesity. This rise has led to an increasing number of clinical decision points for both surgeons and primary care physicians. In the NEJM article, The HEALTH Investigators suggest that hemiarthroplasty (replacement of only the femoral head) in patients with displaced fractures of the femoral neck may be more appropriate than total arthroplasty despite expert recommendations to the contrary.
Código de aprobación:PP-PPF-PEB-0019
Long-term elevated blood pressure was responsible for greater cognitive decline in black Americans than in white Americans.
Black people, on average, experience earlier onset of elevated blood pressure (BP) and poorer control of BP throughout life than do white people. To establish whether blood pressure is associated with the observed earlier onset of cognitive impairment and faster decline in cognition in black patients, investigators performed a pooled cohort study of almost 20,000 patients (median age at study entry, 55; 20% black [self-reported]).
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PSMA PET-CT had greater sensitivity and specificity than conventional imaging for detecting pelvic nodal or distant metastases in men with high-risk prostate cancer.
The limitations in sensitivity and specificity of conventional imaging using computed tomography (CT) and bone scans in staging patients with locally advanced prostate cancer are well defined.
A study using a Mendelian randomization design finds causal associations between elevated total cholesterol and LDL levels and AS.
To date, aortic stenosis (AS) has no recommended prevention strategies, and statins have failed to slow disease progression in randomized trials. However, questions remain about whether dyslipidemia is associated with the condition.
Most of these fractures can be treated conservatively and are not associated with neurologic sequelae.
To better understand the rate and sequelae of thoracic spine fractures identified in the modern era of liberal computed tomography (CT) scanning of trauma patients, researchers performed a secondary analysis of data from the NEXUS Chest CT study. Patients were blunt trauma victims aged >14 years who received chest imaging (radiographs, CT, or both) at nine trauma centers from 2011 to 2014.
Código de aprobación:PP-PPF-PEB-0014
Using MRI to score cerebral small-vessel disease may help predict dementia.
Cerebrovascular disease increases the risk for dementia. To determine whether an MRI score for cerebral small vessel disease (SVD) can assist in the prediction of dementia, investigators examined MRI scans from participants in three longitudinal cohorts. Participants’ SVD ranged from mild and asymptomatic to severe and symptomatic. Each cohort underwent cognitive testing, and conversion to dementia was determined by published criteria or screening mental status examination cutoff scores.
Patient-reported stone passage distinguished somewhat, but not perfectly, between those who did or did not have persistent stones on computed tomography.
We generally ask patients with symptomatic ureteral stones to strain their urine to document passage of a stone. But how accurate are patients’ reports of stone passage? To find out, U.S.
Outcomes at 5 years were not different.
In the previously published METEOR study (NEJM JW Gen Med May 1 2013 and N Engl J Med 2013; 368:1675), researchers randomized 350 patients with meniscal tears and mild-to-moderate osteoarthritis (OA) to physical therapy (PT) alone or meniscectomy followed by PT.
Código de aprobación:PP-UPA-PEB-0004
Objective: The 2018 European Society of Cardiology/ European Society of Hypertension Guidelines for the management of arterial hypertension raised the need for evidence to support the use of single-pill combination (SPC) therapy in preference to free-dosed therapy for hypertension.
Código de aprobación:PP-CVP-PEB-0032
Ingrese aquí al documento de producto de Norvasc (amlodipino)
*NORVASC 10 MG TAB X 10: EE-08272
* NORVASC 5 MG TAB X 30: EE-08268
Letter from the Editor
In the past decade, there has been a powerful shift toward the use of transcatheter aortic valve replacement (TAVR) for patients with severe symptomatic aortic stenosis.
Routine MRI doesn’t improve diagnostic specificity or patient outcomes.
Cardiac magnetic resonance (CMR) imaging is increasingly used to assess structure and function. In cardiomyopathy, CMR is used to assess patients for evidence of infiltration or inflammation; late gadolinium enhancement, a common finding in cardiomyopathies, has prognostic implications. These investigators assessed routine CMR versus echocardiography with selective use of CMR in patients with newly diagnosed or worsening heart failure (HF).
Código de aprobación:PP-CVP-PEB-0026
Can transcranial magnetic stimulation distinguish among dementia types?
Biomarkers have been useful tools in the diagnosis and management of dementia. Researchers analyzed data from participants at four centers to determine if transcranial magnetic stimulation (TMS) can be used to identify and distinguish among Alzheimer disease (AD), dementia with Lewy bodies (DLB), and frontotemporal dementia (FTD).
Código de aprobación:PP-CNS-PEB-0027
The 2018 European Society of Cardiology/ European Society of Hypertension Guidelines for the management of arterial hypertension raised the need for evidence to support the use of single-pill combination (SPC) therapy in preference to free-dosed therapy for hypertension. This systematic rapid evidence assessment sought to determine if initiating SPC therapy improves adherence, blood pressure (BP) control and/or cardiovascular outcomes vs. initiation of free-dose combination therapy.
Código de aprobación:PP-CVP-PEB-0024
Brain regions showing consistent alterations in migraineurs converge to a common brain network, which includes areas with a pivotal role in migraine pathophysiology.
Neuroimaging studies have shown functional and structural alterations of different brain areas in migraine patients, raising new questions. How do these regions interact with each other? Does a unique network enclose all these brain areas? Are these neuroimaging findings migraine specific?
Código de aprobación:PP-CNS-PEB-0023
This procedure shows promise for selected patients with benign prostatic hyperplasia.
Prostatic artery embolization (PAE), an outpatient procedure performed by interventional radiologists, is an option for managing urinary retention and severe hematuria caused by benign prostatic hyperplasia (BPH). Patients at high risk for complications from more invasive treatments and patients with extremely large prostate volume are especially suitable for PAE.
Código de aprobación:PP-MHP-PEB-0012
Although overall mortality has changed little between 2002 and 2013, noncardiovascular mortality has increased, especially among the oldest old.
We have made substantial progress in improving outcomes for patients with ischemic heart disease, but what about for patients with heart failure? Investigators examined a clinical database of about 7% of the U.K. population to assess trends in 1-year mortality and hospital admissions among 86,833 patients with a diagnosis of incident heart failure from 2002 through 2013 (aged ≥80, 48%; ≥3 comorbidities, 79%; women, 49%).
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Researchers in China find heightened short-term risks for cardiovascular hospitalizations.
Studies are accumulating about the relationship between air quality and cardiovascular risk. Because air quality in many areas of the world is deficient, we need to quantify the health effects at levels exceeding those that have been designated as safe, particularly with respect to short-term exposure.
All eight evaluated endoscopic modalities were safer than transurethral resection of prostate in men with benign prostatic hyperplasia.
For decades, monopolar transurethral resection of prostate (TURP) has been the mainstay surgical treatment for men with benign prostatic hyperplasia (BPH). During monopolar TURP, the prostate adenoma is removed, piece by piece, with a monopolar electrode. In this network meta-analysis of 109 randomized controlled trials, researchers compared the efficacy and safety of monopolar TURP with eight newer endoscopic surgical modalities for BPH.
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A long-term study suggests so.
Researchers sought to uncover a potential relationship between physical activity and prodromal features of Parkinson disease (PD) — features that precede the clinical diagnosis — using the Nurses’ Health Study and the Health Professionals Follow-Up Study. Participants were followed from 1986 through 2012, with assessments at baseline and longitudinally at many consecutive 24-month periods thereafter.
Código de aprobación:PP-CNS-PEB-0015
Favorable-risk patients undergoing prostatectomy had worse sexual function at 3 years and worse urinary incontinence at 5 years than those managed with active surveillance.
Because the optimal treatment for men with localized prostate cancer remains undefined — given the great heterogeneity of the disease and a lack of prospective comparative studies — gaining a better understanding of the short- and long-term adverse effects associated with interventions is critical.
Código de aprobación:PP-MHP-PEB-0006
Catheter-based edge-to-edge repair may provide benefit, according to results from a preliminary single-arm trial.
Tricuspid regurgitation (TR), a common form of valvular heart disease, frequently results from right ventricular dilatation and leaflet tethering, leading to malcoaptation of the leaflets. TR has been associated with poor long-term survival and with impaired response to correction of left-sided cardiac pathology.
1+1=3: Autism significantly increases risks for both mood and anxiety disorders.
When Kanner described autistic disturbances of affective contact in 1943, he observed that one of the hallmark clinical features was an “anxiously obsessive desire for the maintenance of sameness.” Many studies since have documented the prevalence of co-occurring psychiatric disorders in patients with autism spectrum disorder (ASD). In this population-based study, investigators leveraged a cohort of 31,220 individuals born from 1976 to 2000 in Olmsted County, Minnesota, to ascertain the prevalence of bipolar
Primary care clinicians are encouraged to refer early, partner with families to make treatment decisions, and know their community resources.
With the prevalence of autism spectrum disorder (ASD) now estimated at 1 in 59 U.S. children, the American Academy of Pediatrics (AAP) has updated its 2007 clinical report on ASD screening and management. Important points for clinicians include the following:
Código de aprobación: PP-CNS-PEB-0011
Optical sensors on wearable devices can detect irregular pulses. The ability of a smartwatch application (app) to identify atrial fibrillation during typical use is unknown.
Participants without atrial fibrillation (as reported by the participants themselves) used a smartphone (Apple iPhone) app to consent to monitoring. If a smartwatchbased irregular pulse notification algorithm identified possible atrial fibrillation, a telemedicine visit was initiated and an electrocardiography (ECG) patch was mailed to the participant, to be worn for up to 7 days.
Código de aprobación:
Multiple stress disorders, but most strongly post-traumatic stress disorder, increase the risk for serious infections.
The poor physical health of individuals with post-traumatic stress disorder (PTSD) is presumed to occur through the stress-related compromise of multiple physiological systems producing an excess of somatic complaints and bona fide medical illnesses.
Código de aprobación: PP-CNS-PEB-0008
Improvement with 1 week of treatment with transcranial direct current stimulation is sustained for 12 weeks.
Because negative symptoms of schizophrenia have been associated with low activity in the prefrontal cortex (PFC), researchers in a sham-controlled, Brazilian study examined the effects of transcranial direct current stimulation (tDCS) in 95 schizophrenia patients with prominent negative symptoms. The device is commercially available but does not have FDA approval.
Código de aprobación: PP-MHP-PEB-0009
In a case-crossover study, testosterone therapy was associated with excess risk.
Testosterone therapy can induce hematologic abnormalities associated with hypercoagulability, but whether it actually confers excess risk for venous thromboembolism (VTE; i.e., deep venous thrombosis or pulmonary embolism) is controversial. In this study, researchers used U.S. national pharmacy and medical claims databases to identify about 40,000 men (mean age, 57) with incident VTE and at least 12 months of data before VTE.
Código de aprobación: PP-MHP-PEB-0002
Interventions affecting circadian rhythm can be therapeutic, with some approaches more effective than others.
Chronotherapies, interventions that affect the circadian rhythm, have been studied in both the depressive and the manic stages of bipolar disorder through the years (e.g., NEJM JW Psychiatry Nov 2017 and Am J Psychiatry 2017; 175:131; NEJM JW Psychiatry Nov 2009 and Biol Psychiatry 2009; 66:298). In this review, the authors have compiled the evidence and recommendations from an International Society of Bipolar Disorders task force. The major treatments include:
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