MedWorm: Internal Medicine Top 20

Time for considering other blood pressure target values in elderly patients with type 2 diabetes?

International Journal of Clinical Practice — Sat, 21 Jan 2012 13:59:37 +0100

(Source: International Journal of Clinical Practice)

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Joint tenderness and swelling in biologic‐treated inflammatory arthritis patients – A tricky trade off?

International Journal of Clinical Practice — Sat, 21 Jan 2012 13:59:39 +0100

Conclusion: Residual joint swelling was found more commonly in RA patients than in PsA patients following TNFi therapy, whereas residual tender joints occurred more frequently in PsA; this may reflect enthesiopathy or periostitis. (Source: International Journal of Clinical Practice)

Drugs of abuse (amfetamines, BZP, cannabis, cocaine, GHB, LSD)

Medicine — Sat, 21 Jan 2012 13:58:54 +0100

Abstract: The features of amfetamine poisoning are related predominantly to stimulation of central and peripheral adrenergic receptors, and in severe cases, excitability, agitation, paranoid delusions, hallucinations with violent behaviour, hypertonia and hyperreflexia develop. Convulsions, rhabdomyolysis, hyperthermia, intracerebral haemorrhage and cardiac arrhythmias are less common. In addition, hyperthermia and hyponatraemia are features of severe MDMA toxicity.Benzylpiperazine (BZP) has stimulant and amfetamine-like properties. Those severely poisoned may develop seizures, collapse, hyperthermia, myoclonic jerks, extrapyramidal features and respiratory failure.Features of cannabis use include euphoria, distorted and heightened images, colours and sounds, altered tactile sensations, im...

Mitochondria of trained skeletal muscle are protected from deleterious effects of statins

Muscle and Nerve — Sun, 15 Jan 2012 03:09:15 +0100

Conclusions:These results suggest that improvements in mitochondrial respiratory and antioxidant capacities following endurance training protected them against statin exposure. (Source: Muscle and Nerve)

Medical Center Characteristics Associated with PSA Screening in Elderly Veterans with Limited Life Expectancy

Journal of General Internal Medicine — Sat, 17 Dec 2011 06:45:07 +0100

CONCLUSIONS Substantial practice variation exists for PSA screening in older men with limited life expectancy across VAs. The high center-specific correlation of screening among men with limited and favorable life expectancies indicates that PSA screening is poorly targeted according to life expectancy. Content Type Journal ArticleCategory Original ResearchPages 1-8DOI 10.1007/s11606-011-1945-9Authors Cynthia So, School of Medicine, University of California, San Francisco, CA, USAKatharine A. Kirby, Division of Geriatrics, San Francisco VA Medical Center and University of California, San Francisco, CA, USAKala Mehta, Division of Geriatrics, San Francisco VA Medical Center and University of California, San Francisco, CA, USARichard M. Hoffman, New Mexico VA Health Ca...

The role of lumbar disc replacement in the surgical management of low back pain.

British Journal of Hospital Medicine — Sun, 01 Jan 2012 05:00:00 +0100

This article explores the role of lumbar disc replacement in the surgical management of low back pain. PMID: 22241408 [PubMed - in process] (Source: British Journal of Hospital Medicine)

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Utility of Genome‐Wide Association Study findings: prostate cancer as a translational research paradigm

Journal of Internal Medicine — Fri, 27 Jan 2012 14:04:13 +0100

AbstractGenomewide Association Studies (GWAS) have identified thousands of consistently replicated associations between genetic markers and complex disease risk, including cancers. Alone, these markers have limited utility in risk prediction; however, when several of these markers are used in combination, the predictive performance appears to be similar to currently many available clinical predictors. Despite this, there are divergent views regarding the clinical validity and utility of these genetic markers in risk prediction. There are valid concerns, thus providing a direction for new lines of research. Herein, we outline the debate, and use the example of prostate cancer to highlight emerging evidence from studies that aim to address potential concerns. We also describe a translational...

Biochemical and immunologic effects of rituximab in patients with primary biliary cirrhosis and an incomplete response to ursodeoxycholic acid

Hepatology — Fri, 27 Jan 2012 14:20:26 +0100

Conclusion: These data suggest that depletion of B cells influences the induction, maintenance, and activation of both B and T cells and provides a potential mechanism for treatment of patients with PBC with an incomplete response to UDCA. (HEPATOLOGY 2012) (Source: Hepatology)

The role of sodium channels in chronic pain

Muscle and Nerve — Tue, 24 Jan 2012 14:12:22 +0100

AbstractHere we review recent research into the mechanisms of chronic pain that has focused on neuronal sodium channels, a target of classic analgesic agents. We first discuss evidence that specific sodium channel isoforms are essential for the detection and conduction of normal acutely painful stimuli from nociceptors. We then review findings that show changes in sodium channel expression and localization in chronic inflammation and nerve injury in animal and human tissues. We conclude by discussing the role that myelination plays in organizing and maintaining sodium channel clusters at nodes of Ranvier in normal development and how inflammatory processes or nerve injury alter the characteristics of such clusters. Based on these findings, we suggest that chronic pain may in part result fr...

The combination of phentermine and topiramate is an effective adjunct to diet and lifestyle modification for weight loss and measures of comorbidity in overweight or obese adults with additional metabolic risk factors

Evidence-Based Medicine — Mon, 23 Jan 2012 05:00:00 +0100

Context Obesity is a growing epidemic with multiple associated comorbidities including type 2 diabetes, hypertension and hyperlipidaemia. Multiple studies have shown that weight loss can improve these obesity RR factors. But weight loss is difficult. There is an urgent need for new and more efficacious pharmacological treatments to help curtail this growing epidemic. There have been previous studies looking at the use of phentermine and topiramate as single agents for weight loss. In the CONQUER trial, Gadde and colleagues have asked whether a combination of these two agents could provide a more effective treatment option for obesity with fewer side effects. Methods The CONQUER trial is a randomised controlled trial to assess the effects of two different doses of the combination of control...

Purpose and procedure

Evidence-Based Medicine — Mon, 23 Jan 2012 05:00:00 +0100

The general purpose of Evidence-Based Medicine is to select from the health-related literature* those articles reporting important advances in internal medicine, general and family practice, surgery, psychiatry, paediatrics, and obstetrics and gynaecology, and whose results are most likely to be both true and useful. These articles are described, critiqued and commented on by clinical experts. The specific purposes of Evidence-Based Medicine are: to identify, using predefined criteria, the best original and review articles on the cause, course, diagnosis, prevention, treatment, quality of care, or economics of disorders in the foregoing fields to provide a description and expert commentary on the context of each article, its methods, and the clinical applications that its findings warrant...

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Japanese case of Budd‐Chiari syndrome due to hepatic vein thrombosis successfully treated with liver transplantation

Hepatology Research — Sat, 21 Jan 2012 22:48:33 +0100

A 22‐year‐old Japanese woman was found to have severe esophageal varices and then suffered from hepatic encephalopathy. She was diagnosed with Budd‐Chiari syndrome (BCS) due to hepatic vein (HV) thrombosis accompanied by portal vein thrombosis without inferior vena cava (IVC) obstruction. Latent myeloproliferative neoplasm (MPN) lacking the JAK2‐V617F mutation was considered to be the underlying disease. Liver transplantation was strikingly effective for treating the clinical symptoms attributable to portal hypertension. Although thrombosis of the internal jugular vein occurred due to thrombocythemia, which manifested after transplantation despite anticoagulation therapy with warfarin, the thrombus immediately disappeared with the addition of aspirin. Neither thrombosis nor BCS has...

Effects of renin-angiotensin blockers/inhibitors and statins on mortality and functional impairment in polypathological patients.

European Journal of Internal Medicine — Fri, 03 Feb 2012 00:26:12 +0100

CONCLUSIONS: The prescription of statins, alone or in combination with other drugs, may impact the survival and functional decline in polypathological patients. Further prospective blinded randomised assays are needed to confirm these observations. PMID: 22284251 [PubMed - in process] (Source: European Journal of Internal Medicine)

The prevalence of atrial fibrillation in a geographically well‐defined population in Northern Sweden: implications for anticoagulation prophylaxis

Journal of Internal Medicine — Wed, 18 Jan 2012 14:46:50 +0100

Conclusion: Within this large Caucasian population, we identified the highest community‐based prevalence of AF to date. The prevalence was strongly associated with increasing age and male gender. Using CHA2DS2‐VASc instead of CHADS2 widened the indication for OAC prophylactic therapy of AF in this population. (Source: Journal of Internal Medicine)

Antidepressants

Medicine — Sat, 21 Jan 2012 13:58:54 +0100

Abstract: Antidepressant drugs differ in their relative toxicities. The most hazardous are tricyclics, citalopram, venlafaxine and the rarely used monamine oxidase inhibitors. Features include arrhythmias, convulsions and cardiovascular effects. Management should be as active as necessary to reduce arrhythmia risk by aggressive correction of acidosis and use of sodium bicarbonate to shorten QRS duration if prolonged. (Source: Medicine)

Decreased heart rate variability predicts death in amyotrophic lateral sclerosis

Muscle and Nerve — Wed, 18 Jan 2012 14:53:35 +0100

Conclusion –Low HR CV is a potential marker of prognosis in ALS. (Source: Muscle and Nerve)

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Efficient suppression of murine ICAM‐1 using ultrasound‐responsive and mannose‐modified lipoplexes inhibits acute hepatic inflammation

Hepatology — Mon, 23 Jan 2012 05:00:00 +0100

Conclusion:In the present study, we demonstrated that HEC‐selective and efficient ICAM‐1 siRNA delivery using Man‐PEG2000 BLs and US exposure enables to suppress various types of acute hepatic inflammation. This novel siRNA delivery method may offer a valuable system for medical treatment where the targeted cells are HECs. (HEPATOLOGY 2012.) (Source: Hepatology)

Late‐Evening Snack with Branched‐Chain Amino Acids Improves Liver Function after Radiofrequency Ablation for Hepatocellular Carcinoma

Hepatology Research — Sat, 21 Jan 2012 22:48:04 +0100

Conclusions: LES with BCAA supplementation significantly and rapidly improves liver functioning and CPS in LC patients who have undergone RFA for HCC. Control of blood‐sugar levels is necessary when calorie‐containing BCAA is administered to LC patients with impaired glucose tolerance. (Source: Hepatology Research)

Systems cancer medicine: towards realization of predictive, preventive, personalized and participatory (P4) medicine

Journal of Internal Medicine — Wed, 18 Jan 2012 14:48:06 +0100

Abstract. Tian Q, Price ND, Hood L (Institute for Systems Biology, Seattle, WA, USA). Systems cancer medicine: towards realization of predictive, preventive, personalized and participatory (P4) medicine (Key Symposium). J Intern Med 2012; 271: 111–121.A grand challenge impeding optimal treatment outcomes for patients with cancer arises from the complex nature of the disease: the cellular heterogeneity, the myriad of dysfunctional molecular and genetic networks as results of genetic (somatic) and environmental perturbations. Systems biology, with its holistic approach to understanding fundamental principles in biology, and the empowering technologies in genomics, proteomics, single‐cell analysis, microfluidics and computational strategies, enables a comprehensive approach to medicine...

Alcohols and glycols

Medicine — Sat, 21 Jan 2012 13:58:54 +0100

Abstract: Ethanol is a central nervous system depressant and a peripheral vasodilator, thereby causing coma, hypothermia and hypotension in severe poisoning. Hypoglycaemia, particularly in children, is observed together with acid–base disturbances, which are common (respiratory acidosis is observed more frequently than metabolic acidosis, and metabolic alkalosis may be observed in those vomiting and hypovolaemic). Lactic acidosis (usually mild) is an uncommon but potentially serious complication. Haemodialysis may be considered if the blood ethanol concentration exceeds 7500 mg/L and severe metabolic acidosis is present.The principal features of severe methanol poisoning are metabolic acidosis and blindness. The first priority of management is to inhibit methanol metabolism using either ...