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High Rates of Adolescent Depression and Suicide Risk Detected by Routine Screening in Primary Care

Miércoles, Septiembre 22, 2021

During preventative-care visits, 56% of adolescents without prior mental health issues screened positive for depression.
The USPTF recommends screening adolescents ≥12 years-old for depression during primary care visits. To anticipate and provide appropriate mental-health referrals and follow-up services, understanding the rates of positive screens is necessary. 

 

 

 

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The Clinical Relevance of N-Acetylglucosamine Levels in Multiple Sclerosis

Miércoles, Septiembre 22, 2021

Lower N-acetylhexosamine levels in plasma correlated with worse clinical outcomes.
Early studies suggest that N-glycosylation is altered in multiple sclerosis (MS). N-acetylglucosamine (GlcNAc) is a metabolic precursor to N-glycosylation. Investigators studied GlcNAc via its stereoisomer mix, N-acetylhexosamine (HexNAc), among different MS subtypes and clinical outcomes.

 

 

 

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Gestational diabetes and pregnancy complications, and Long-Term health risks

Miércoles, Septiembre 22, 2021

The Centers for Disease Control and Prevention reported that in 2016 the national prevalence of  gestational diabetes mellitus (GDM) was 6% among women with live births. Based on this estimate, among the 3.75 million births in the United States in 2019, there were approximately 225,000 preg-nancies complicated by GDM.

 

 

 

 

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Treating Hypertension - Lower is Better, Irrespective of Risk Status

Miércoles, Septiembre 22, 2021

The questions of whom to treat for hypertension and how aggressively to treat have received con-siderable recent attention, with at least some partial answers. A recent analysis of the final results of the landmark SPRINT study published in the New England Journal of Medicine confirmed that treat-ment of patients at high risk for cardiovascular (CV) disease (but without prevalent diabetes or stroke) to a systolic blood pressure (BP) goal of 120 mm Hg leads to substantial benefits compared with treating to 140 mm Hg.

 

 

 

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Two Schizophrenias?

Martes, Septiembre 21, 2021

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.

Functional Voice Problems Are More Common in Several Chronic Pain Syndromes

Martes, Septiembre 21, 2021

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. Otolaryngologists from a voice disorders clinic at a U.S. academic medical center anecdotally observed a high prevalence of these syndromes  in patients with voice and airway symptoms; 

 

 

 

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Adverse Pregnancy Outcomes Are Associated with Future Cardiovascular Risk

Martes, Septiembre 21, 2021

Hypertensive disorders of pregnancy and low birth weight carry the greatest risk.
Investigators have previously found an association between adverse pregnancy outcomes and future cardiovascular risk. They analyzed data from the Women’s Health Initiative longitudinal cohort study, which included a survey eliciting participants’ history of gestational diabetes, hypertensive disorders of preg­nancy, low birth weight (<2.49 kg), high birth weight (>4.08 kg), and preterm delivery (≥3 weeks). 

 

 

 

 

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Amyloid Burden: A Reason for Poor Antidepressant Response in Late-Life Depression?

Jueves, Agosto 19, 2021

In cognitively intact individuals with late-life depression, cortical amyloid burden predicted poor antidepressant response.
Accumulation of cortical amyloid-β (Aβ) has been associated with greater depressive symptoms in cognitively intact older adults. Higher cortical Aβ burden and late-life depression (LLD) are indepen-dently associated with risks for cognitive decline and Alzheimer disease. 

 

 

 

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Surgery or Nonsurgical Management for Degenerative Rotator Cuff Tears?

Jueves, Agosto 19, 2021

In a randomized trial, surgery conferred benefit only in patients with full-thickness tears.
Patients with rotator cuff tears and subacute or chronic shoulder pain often are referred for surgery if they don’t respond to conservative treatment. 

 

 

 

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Plasma NfL Levels in Familial Frontotemporal Lobar Degeneration

Jueves, Agosto 19, 2021

Plasma neurofilament light chain concentrations may inform phenoconversion and disease progression in familial frontotemporal lobar degeneration.
In this study, researchers analyzed whether plasma neurofilament light chain (NfL) levels, a sensitive biomarker for neurodegeneration, could predict individuals with familial frontotemporal lobar degen-eration (FTLD) who were at risk for clinical phenoconversion or disease progression from an original (n=277) and validation (n=297) cohort.

 

 

 

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Do Serious Infections Increase Risk for Multiple Sclerosis?

Jueves, Agosto 19, 2021

An epidemiologic study suggests an association between adolescent infections requiring hospitalization and later multiple sclerosis.
Multiple sclerosis (MS) is an autoimmune disease, most likely the result of multiple environmental factors with an underlying genetic susceptibility. For example, Epstein-Barr virus serologies for past infection are present in close to 100% of patients with MS. 

 

 

 

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Potential Value of PSA Velocity in Prostate Cancer Patients Undergoing Active Surveillance

Jueves, Agosto 19, 2021

In an observational study, the optimal prostate-specific-antigen level increases that predicted disease progression differed in Black and white men.
In the continuing search for ways to identify progression of prostate cancer in patients who are managed by active surveillance, researchers used the U.S. 

 

 

 

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Detecting Metastatic Prostate Cancer with Prostate-Specific Membrane Antigen PET-CT

Jueves, Agosto 19, 2021

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.

 

 

 

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Mutational Profiling and Cancer-Associated Thrombosis

Jueves, Agosto 19, 2021

Six mutations are associated with an increased risk for cancer-associated thrombosis, independent of cancer type.
The etiology of cancer-associated thrombosis (CAT) is multifactorial, with influence from cancer stage, chemotherapy, postoperative state/immobility, prior thrombosis history, and presence of vascular access.

 

 

 

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Syncope, vertigo, disequilibrium, and persistent dizziness

Jueves, Agosto 19, 2021

Patients presenting with dizziness may describe feeling that they are “lightheaded,” “spinning,”  and “woozy.” Patients may also describe concurrent symptoms such as nausea, imbalance, and falls.

 

 

 

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Silent Brain Infarcts After Transcatheter Aortic-Valve Implantation

Jueves, Agosto 19, 2021

Almost 75% of patients in a meta-analysis sustained silent brain infarcts after the procedure.
Transcatheter aortic-valve implantation (TAVI) is one of the great recent advances in cardiovascular medicine. However, postprocedure stroke is a hazard of the procedure, perhaps occurring in as many as 10% of patients.

 

 

 

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How Healthy Lifestyle and Socioeconomic Status Interact with CV Risk

Jueves, Agosto 19, 2021

Although unhealthy lifestyles apparently mediate only a small proportion of socioeconomic inequity in health, a healthy lifestyle remains the foundation of CVD prevention.
Lower socioeconomic status (SES) is associated with higher total mortality, cardiovascular disease 
(CVD) mortality, and CVD events. 

 

 

 

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Optical Coherence Tomography and Disability in Multiple Sclerosis

Viernes, Agosto 6, 2021

In a longitudinal study, baseline ganglion cell layer thickness was associated with disability 10 years later.
Optical coherence tomography (OCT) is a noninvasive retinal scan that is used increasingly in neuro-logic practice. Prior studies have shown that risk of future disability is higher for those with decreased retinal nerve fiber layer (RNFL) thickness (NEJM JW Neurol May 2016 and Lancet Neurol 2016; 15:574).

 

 

 

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Web-Based Strengthening and Exercise for People with Knee Osteoarthritis

Viernes, Agosto 6, 2021

A self-directed intervention, supported by text messaging, led to reduced pain and improved function.
Although strengthening exercises for people with knee osteoarthritis (OA) reduce pain and improve function, this therapy is underutilized because of limited access to trainers and lack of specific digital programs.

 

 

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Gestational diabetes, pregnancy complications, and Long-Term health risks

Viernes, Agosto 6, 2021

The Centers for Disease Control and Prevention reported that in 2016 the national prevalence of  gestational diabetes mellitus (GDM) was 6% among women with live births. Based on this estimate, among the 3.75 million births in the United States in 2019, there were approximately 225,000 preg-nancies complicated by GDM.

 

 

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Outcomes Are Worse in STEMI Patients Without Traditional Cardiovascular Risk Factors

Jueves, Julio 8, 2021

An analysis of Swedish registry data showed STEMI patients without cardiovascular risk factors — particularly women — experienced higher mortality.
Some patients who present with ST-segment elevation myocardial infarction (STEMI) do not have a history of standard modifiable cardiovascular risk factors (SMuRFs).

 

 

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Blood Transfusion Strategy in Patients with Acute Myocardial Infarction

Martes, Junio 22, 2021

A randomized trial showed that a more-restrictive strategy was noninferior.
In previous large randomized trials, restrictive transfusion strategies benefited patients with anemia, but those trials excluded patients with acute myocardial infarction (MI). 

 

 

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Nonclassic TIA Symptoms and Stroke Risk

Martes, Junio 22, 2021

Both classic and nonclassic symptoms of transient ischemic attack confer similar 90-day stroke risk.
The short-term risk for stroke after transient ischemic attack (TIA) is high, and urgent evaluation and treatment can reduce this risk. However, since TIA can present with a broad range of neurologic symptoms, when symptoms could be consistent with but are not classic for TIA,

 

 

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Can Antioxidants Affect Risk for Parkinson Disease?

Martes, Junio 22, 2021

Vitamins E and C may be associated with risk, but the evidence remains limited.
To determine whether risk for future Parkinson disease (PD) diagnosis was reduced with increased  dietary antioxidant intake and total nonenzymatic antioxidant capacity (NEAC), researchers examined data from 43,865 men and women (aged 18–94 at baseline) in the Swedish National March Cohort linked to the National Health Registries.

 

 

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The Alzheimer Disease Conversion-Related Pattern Score as Neurodegeneration Biomarker

Miércoles, Junio 16, 2021

An ADCRP score may be useful in identifying those with mild cognitive impairment who have underlying Alzheimer disease.
To create a biological definition of Alzheimer disease (AD), the amyloid-tau-neurodegeneration (ATN) classification scheme has been developed. Researchers in this study assessed the validity of an AD conversion related pattern (ADCRP) score as a biomarker for ATN in 269 participants with mild cog-nitive impairment (MCI).
 

 

 

 

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Life expetancy after bariatric surgery

Martes, Junio 8, 2021

Obesity is associated with increases in life-threatening diseases and premature mortality. Bariatric surgery leads to durable weight loss and reduces the risk for cardiovascular disease, type 2 diabetes, cancer, and all-cause death. The effect of bariatric surgery on life expectancy, however, has not been well defined.

 

 

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Endovascular thrombectomy in stroke

Lunes, Mayo 31, 2021

Endovascular thrombectomy (EVT) has become an important treatment for patients with acute ischemic stroke who can be treated within 6 hours of stroke onset, and was one focus of a recent guideline update from the American Heart Association/American Stroke Association.

 

 

 

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Prevention of Early Ventilator-Associated Pneumonia after Cardiac Arrest

Lunes, Mayo 31, 2021

Major advances in the care of cardiac arrest patients have been reported in the literature over the past decade, including better data on pharmacologic and airway management during the intra-cardiac arrest period and after return of spontaneous circulation. The collection of articles presented here highlights some of those advances.

 

 

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Lung Cancer Screening

Domingo, Mayo 30, 2021

The Holy Grail in oncology is prevention against cancer ever occurring or detection early enough that curative treatment can be implemented. Lung cancer is the leading cause of cancer-related death, and with close to 1 billion active smokers worldwide, screening for lung cancers generates high interest and hope of early detection. Several prior large-scale studies of chest radiography for lung cancer screening failed to demonstrate improvements in mortality,

 

 

 

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Psychodynamic Psychotherapy for Functional Somatic Complaints

Domingo, Mayo 30, 2021

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 (mean age, 43) with disorders characterized by functional somatic complaints such as irritable bowel syndrome, fibromyalgia, and chronic pain disorders.

 

 

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Post-stroke therapy and prevention

Domingo, Mayo 30, 2021

Despite the fact that stroke is a leading cause of disability among adults, there has been a shortage of high-quality studies to address such important issues as management of stroke  risk factors. Well-documented risk factors include hypertension, diabetes mellitus, and hyperlipidemia. 

 

 

 

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Hip Fracture Care: A Step in the Right Direction

Domingo, Mayo 30, 2021

A quality-improvement intervention was associated with outcome successes.
Fragility hip fractures, often caused by a fall from standing height, portend substantial morbidity and mortality. Yale researchers implemented a multidisciplinary, multicomponent intervention designed to improve hip-fracture outcomes. 

 

 

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Cardiovascular Risks During the Menopause Transition

Viernes, Mayo 21, 2021

This scientific statement provides a comprehensive review of the data linking the menopause transition to cardiovascular risk. 
Sponsoring Organization: American Heart Association Background and Objective The menopause transition (MT) occurs when menstrual cycles become variable or other menopauserelated symptoms begin and is separated into seven stages with varying duration, hormone levels, and symptoms. This statement highlights the adverse cardiometabolic changes in women during the MT and suggests possible interventions.

 

 

 

 

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Is Stroke Risk in Patients with Transient Ischemic Attack Decreasing?

Viernes, Mayo 21, 2021

Data from the Framingham Study suggest that modern medical treatment helps.
Transient ischemic attacks (TIAs) are a well-recognized precursor to a potential ischemic stroke.

 

 

 

 

 

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E-Summit ENTs Talks

Jueves, Abril 22, 2021

Diagnosing And Predicting Development Of Rheumatoid Arthritis

Viernes, Marzo 26, 2021

The treatment of rheumatoid arthritis is fraught with unknowns. It is not always certain how active the patient’s arthritis may be, even while they are engaged in an effective treatment regimen. What factors may predict a flare of the disease and how to confirm that the patient remains in remission are unknown.

 

 

 

 

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Determination of Brain Death/Death by Neurological Criteria: The World Brain Death Project

Viernes, Marzo 26, 2021

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, World Federation of Pediatric Intensive and Critical Care Societies, World Federation of Neurology, World Federation of Neurosurgery, and the World Federation of Critical Care Nurses.

 

 

 

 

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Benefits Of Metabolic Surgery

Viernes, Marzo 26, 2021

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 — either Roux-en-Y gastric bypass or, increasingly often, sleeve gastrectomy. 

 

 

 

 

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Can Retinal Thickness Predict Cognitive Decline in Parkinson Disease?

Viernes, Marzo 26, 2021

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.

 

 

 

 

PP-UOP-GLB-0099

Association Between Migraine with Aura and Cryptogenic Ischemic Stroke in the Young

Viernes, Marzo 26, 2021

A strong relationship was seen in both women and men, irrespective of the presence of PFO.
Previous studies have evaluated some of the complex relationships among cryptogenic stroke, migraine, and patent foramen ovale (PFO) and suggested the following: Migraine is associated with ischemic stroke, migraine with aura is associated with the presence of PFO, and the association between mi-graine and cryptogenic ischemic stroke is stronger among patients with PFO than without. 

 

 

 

 

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Guidance in Evaluation of Microscopic Hematuria

Viernes, Marzo 26, 2021

A new guideline recommends ultrasound instead of computed tomography for some patients with this finding.
How should we evaluate asymptomatic microscopic hematuria? A 2012 guideline from the American Urological Association (AUA) recommended that all patients older than 35 with microscopic hema-turia — defined by the AUA as ≥ 3 red cells per high-power field — should undergo both computed  tomography urography (CTU) and cystoscopy. 

 

 

 

 

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Amyloid Burden: A Reason for Poor Antidepressant Response in Late-Life Depression?

Lunes, Marzo 1, 2021

In cognitively intact individuals with late-life depression, cortical amyloid burden predicted poor antidepressant response. 
Accumulation of cortical amyloid-β (Aβ) has been associated with greater depressive symptoms in cognitively intact older adults. 

 

 

 

 

PP-CNS-GLB-1627

Safety and Efficacy of Extreme Blood Pressure Lowering in Intracerebral Hemorrhage

Lunes, Marzo 1, 2021

Safety and Efficacy of Extreme Blood Pressure Lowering  in Intracerebral Hemorrhage
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). At times, SBP can be markedly elevated (>220 mm Hg). 

 

 

 

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Psychiatric Disorders Across the Life Span: A Unitary Psychopathology Factor Best Fits the Data

Lunes, Marzo 1, 2021

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,

 

 

 

PP-CNS-GLB-1625

POEMS Syndrome: Clinical Features and Outcomes in a U.K. Cohort

Lunes, Marzo 1, 2021

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,

 

 

 

 

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