Medical News

Pathophysiology, Diagnosis, and Management of Proteinuria – JAAPA

/ SupremeCmdr / Leave a comment

KEY POINTS

Microalbuminuria tends to occur long before clinical proteinuria becomes evident.

Proteinuria results when the glomerular basement membrane allows excess proteins into the tubular filtrate and when the proximal tubules are unable to reabsorb low-molecular-weight proteins.

False-negative dipstick results may occur if the urine is dilute or if protein loss is mild.

Correlation between the urine protein-creatinine ratio (UPCR) and the 24-hour urine collection has been demonstrated in several diseases, and recent evidence indicates that the UPCR ratio is more accurate than the 24-hour measurement.

The albumin-to-creatinine ratio is more sensitive than the UPCR.

Renal biopsy should be considered in adults with persistent proteinuria because results are likely to guide specific therapy.

via The pathophysiology, diagnosis, and management of proteinuria – JAAPA.

Health Toll of Fast Food Spreads Eastward

/ SupremeCmdr / Leave a comment

Eating Western-style fast food on a regular basis significantly increased the risk of diabetes and coronary heart disease in a large Asian cohort, investigators reported.

The diabetes odds increased by 27% and CHD risk by 56% among Singapore residents who ate fast food at least twice a week.

The results changed little with overall dietary pattern, energy intake, or body mass index (BMI), as reported online in Circulation.

via Medical News: Health Toll of Fast Food Spreads Eastward – in Cardiovascular, Atherosclerosis from MedPage Today.

Red Yeast Rice: An Introduction NCCAM

/ SupremeCmdr / Leave a comment

Some red yeast rice products contain substantial amounts of monacolin K, which is chemically identical to the active ingredient in the cholesterol-lowering drug lovastatin. These products may lower blood cholesterol levels and can cause the same types of side effects and drug interactions as lovastatin.

Other red yeast rice products contain little or no monacolin K. It is not known whether these products have any effect on blood cholesterol levels.

Some red yeast rice products contain a contaminant called citrinin, which can cause kidney failure.  In a 2011 analysis of red yeast rice products sold as dietary supplements, 4 of 11 products were found to contain this contaminant.

via Red Yeast Rice: An Introduction | NCCAM.

Personally, I’m sticking with a statin.

Consider Loneliness in Senior Health Assessments

/ SupremeCmdr / Leave a comment

Researchers evaluated six years of data on 1,604 people 60 and older and found that 43% were classified as lonely. Compared with other study participants, those individuals were more prone to have their mobility decline, lose upper body strength, have trouble climbing stairs and decrease their daily activities. Loneliness also was associated with an increased risk of death, the study said.

A separate study of 8,594 adults 45 and older found that those between age 45 and 65 who live alone have significantly increased risk of mortality — and particularly cardiovascular-related death — than those who don’t live alone. That study also was published online June 18 in Archives of Internal Medicine.

via Doctors asked to consider loneliness in senior health assessment – amednews.com.

Injuries from Ingestion of Wire Bristles from Grill-Cleaning Brushes — Providence, Rhode Island, March 2011–June 2012

/ SupremeCmdr / Leave a comment

Case Reports

A man aged 50 years arrived at the ED with abdominal pain that had begun after eating steak at a backyard barbeque. Computed tomography (CT) scan of the abdomen and pelvis revealed a linear object extending through the wall of a loop of small intestine into the omentum (Figure). Laparotomy was performed to remove the foreign body, which appeared to be a wire bristle from a grill-cleaning brush. The patient fully recovered and was discharged the next day.

Five more patients visited the ED during August 2011–June 2012 after inadvertent ingestion of a wire bristle that had become dislodged from a grill-cleaning brush and embedded in food. In all of the cases, the bristles were initially identified by radiographs of the neck or CT scans of the abdomen and pelvis, and their origin was confirmed after removal (Table). Patient interviews revealed a common history of recent ingestion of grilled meat. After definitive treatment, all six patients recovered fully.

Severe pain on swallowing was the chief symptom in three of the six patients. In all three of these patients, a wire bristle from a grill-cleaning brush was found in the neck. The three included a woman aged 46 years and two men aged 50 and 64 years (Table). The three initially were evaluated with plain radiography, which identified the foreign object in each patient. One who was initially evaluated with plain radiography then underwent CT for precise localization. All three were treated successfully with laryngoscopic removal of the wire bristle.

Severe abdominal pain was the chief symptom of the other patients, who were three men aged 31, 35, and 50 years (Table). These patients were evaluated primarily with intravenous contrast-enhanced CT of the abdomen and pelvis. In two patients, the wire bristle was noted lodged within the omentum adjacent to a loop of small intestine. In one patient, the wire bristle was located within the sigmoid colon, indenting the bladder. Two patients underwent emergency abdominal surgery to retrieve the foreign object and repair the intestine. In one patient, the wire had not perforated the intestine and was removed via colonoscopy.

via Injuries from Ingestion of Wire Bristles from Grill-Cleaning Brushes — Providence, Rhode Island, March 2011–June 2012.

Tomorrow is July 4 and many grills will be fired up for the holiday.  I thought this article was particularly well timed.

Flex Sigmoidoscopy and Colorectal Cancer

/ SupremeCmdr / Leave a comment
Teaching Topic
Flexible Sigmoidoscopy and Colorectal Cancer
Original Article

R.E. Schoen and Others

CME Exam  Comments

Colorectal cancer is the second leading cause of cancer-related deaths in the United States. Colorectal-cancer mortality and incidence are reduced with screening by means of fecal occult-blood testing. Endoscopic screening with flexible sigmoidoscopy or colonoscopy is more sensitive than fecal testing for the detection of adenomatous polyps, the precursor lesions of colorectal cancer.

Clinical Pearls
Clinical Pearl  What were the results of this randomized trial comparing flexible sigmoidoscopy to usual care for screening of colorectal cancer?

In this randomized study, flexible sigmoidoscopy, as compared with usual care, was associated with a 26% reduction in overall colorectal-cancer mortality and a 21% reduction in the incidence of colorectal cancer. Mortality related to distal colorectal cancer was reduced by 50%, and the incidence was reduced by 29%. A significant 14% reduction in the incidence of proximal colorectal cancer was observed, but there was no significant reduction in mortality related to proximal cancer.

Clinical Pearl  According to the authors, what were the numbers needed to invite for screening via flexible sigmoidoscopy to prevent one diagnosis of colorectal cancer and one colorectal-cancer death?

In this study, the number needed to invite for screening in order to prevent 1 case of colorectal cancer was 282 (95% CI, 210 to 427). The number needed to invite for screening to prevent 1 colorectal-cancer death was 871 (95% CI, 567 to 1874).

Morning Report Questions
Q. How did study participants differ from the usual-care group?

A. Participants in the intervention group were offered two screenings with flexible sigmoidoscopy, 3 to 5 years apart. Median follow up was 11.9 years. In the intervention group, 86.6% of participants (67,071) underwent at least one flexible sigmoidoscopic screening, and 50.9% (39,440) underwent two screenings. The estimated rate of endoscopy in the usual-care group during the screening phase was 25.8% (95% CI, 23.6 to 28.0) for flexible sigmoidoscopy, 34.4% (95% CI, 32.0 to 36.8) for colonoscopy, and 46.5% (95% CI, 43.9 to 49.1) for either flexible sigmoidoscopy or colonoscopy.

Q. How did screening-detected cancers differ from those diagnosed among participants who were never screened in terms of location and stage?

A. Screening-detected cancers accounted for 24.1% of colorectal cancers (244 of 1012) in the intervention group. Among participants with screening-detected cancers, 82.8% of the cancers were distal, whereas among participants who were never screened, 52.8% were distal, and among participants with cancers not detected by screening, 31.6% were distal (P<0.001). Participants with screening-detected cancers were more likely to have early-stage cancer (stage I or II) than participants who were never screened or those whose tumors were not detected by screening (75.4% vs. 50.9% and 50.7%, respectively; P<0.001).

Table 3. Colorectal-Cancer Incidence and Stage According to Means of Detection.

Weight Loss Surgery May Boost Problem Drinking

/ SupremeCmdr / Leave a comment

Almost 10% of patients undergoing bariatric surgery to combat obesity had symptoms of an alcohol use disorder 2 years after surgery, a large prospective cohort study showed.

The prevalence of alcohol use disorders increased from 7.6% before surgery to 9.6% 2 years after the procedure, as reported online in the Journal of the American Medical Association.

via Medical News: Weight Loss Surgery May Boost Problem Drinking – in Primary Care, Obesity from MedPage Today.

Have surgery, lose weight, become alcoholic!

Six Minute Walk Test May Help Predict Cardio Risk

/ SupremeCmdr / Leave a comment

The 6-minute walk test may improve cardiovascular risk prediction in patients with stable coronary heart disease, researchers found.

Even after adjustment for traditional cardiovascular risk factors and measures of cardiac disease severity, each standard deviation decrease in walk distance was associated with a 30% greater risk of MI, heart failure, or death (HR 1.30, 95% CI 1.10 to 1.53), according to Alexis Beatty, MD, of the University of California San Francisco, and colleagues.

via Medical News: Walk Test May Help Predict Cardio Risk – in Cardiovascular, Atherosclerosis from MedPage Today.

New underwriting requirement for applicants with known heart disease.  Take a walk.