The American journal of medicine
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Review Meta Analysis
Cardiovascular Risks of Exogenous Testosterone Use Among Men: A Systematic Review and Meta-Analysis.
We sought to evaluate whether exogenous testosterone therapy is associated with increased risk of serious cardiovascular events as compared with other treatments or placebo. ⋯ We did not find any significant association between exogenous testosterone treatment and myocardial infarction, stroke, or mortality in randomized controlled trials. The very low quality of the evidence precludes definitive conclusion on the cardiovascular effects of testosterone.
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The spleen is the most commonly injured abdominal organ in blunt trauma. Immediate treatment is aimed at assessing for bleeding and abating it when it is severe. Methods for the management of blunt splenic injury-associated bleeding include observation, splenectomy, and splenic salvage procedures through splenorrhaphy or embolization. ⋯ Patients may often present to their primary care provider with complaints related to splenic injury or long-term care of their immunocompromised state. Knowledge of the spleen's function, as well as common complications and risks, is important to physicians caring for splenic injury patients. This narrative review provides clinicians an understanding of the spleen's immune function and management strategies for patients sustaining blunt splenic injury.
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The United States Preventive Services Task Force recommends universal osteoporosis screening among women ages 65+ and targeted screening of younger women, but historically, adherence to these evidence-based recommendations has been suboptimal. ⋯ Despite significant changes in utilization of osteoporosis screening among women ages 50-64 and 80+, in line with national recommendations, tremendous deficiencies among women 65+ remain.
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Observational Study
Dipeptidyl Peptidase-4 Inhibitors, Peripheral Arterial Disease, and Lower Extremity Amputation Risk in Diabetic Patients.
Recent studies have elucidated the vascular protective effects of dipeptidyl peptidase-4 (DPP-4) inhibitors. However, to date, no large-scale studies have been carried out to determine the impact of DPP-4 inhibitors on the occurrence of peripheral arterial disease, and lower extremity amputation risk in patients with type 2 diabetes mellitus. ⋯ This large-scale nationwide population-based cohort study is the first to demonstrate that treatment with DPP-4 inhibitors is associated with lower risk of peripheral arterial disease occurrence and limb amputation in patients with type 2 diabetes mellitus.
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Monitoring trends in cardiovascular events can provide key insights into the effectiveness of prevention efforts. Leveraging data from electronic health records provides a unique opportunity to examine contemporary, community-based trends in acute myocardial infarction hospitalizations. ⋯ Among a large, diverse, multicenter community-based insured population, there were significant decreases in incidence of hospitalized acute myocardial infarction and the more serious ST-segment elevation myocardial infarctions between 2000 and 2008. Decreases in ST-segment elevation myocardial infarctions were most pronounced among women. While ecologic in nature, these secular decreases likely reflect, at least in part, results of improvement in primary prevention efforts.