The American journal of medicine
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The foot changes with age. Foot disorders in older adults are associated with falls, lower limb ulcers, and pain. Physical examination of the feet as part of the routine assessment of older adults is imperative to detect foot problems. ⋯ Regular foot examination can detect common foot problems, functional decline, and is recommended for preventing falls. We describe a technique for performing a focused examination of the feet for older adults. This review addresses current podiatric issues in older patient populations and describes a method for foot examination to address the needs of older adults that can be incorporated into patient assessments in any clinical setting.
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Approximately 9 months of the severe acute respiratory syndrome coronavius-2 (SARS-CoV-2 [COVID-19]) spreading across the globe has led to widespread COVID-19 acute hospitalizations and death. The rapidity and highly communicable nature of the SARS-CoV-2 outbreak has hampered the design and execution of definitive randomized, controlled trials of therapy outside of the clinic or hospital. ⋯ Therapeutic approaches based on these principles include 1) reduction of reinoculation, 2) combination antiviral therapy, 3) immunomodulation, 4) antiplatelet/antithrombotic therapy, and 5) administration of oxygen, monitoring, and telemedicine. Future randomized trials testing the principles and agents discussed will undoubtedly refine and clarify their individual roles; however, we emphasize the immediate need for management guidance in the setting of widespread hospital resource consumption, morbidity, and mortality.
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This review tries to make the case that physicians should be adequately rewarded financially so that they can have a clear fiduciary responsibility to do only what is best for their patients without unseemly personal financial gain. To develop financial security, physicians need to save a portion of their income regularly to invest. The stock market is the best place to increase one's monetary worth over a long period.
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Proven cases of vector-transmitted acute autochthonous Chagas disease in the United States are rare (<10 cases). Possible or probable cases of unknown duration determined by serology are uncommon as well (<100). In Latin America it is widely accepted that after feeding, the kissing bug defecates and Trypanosoma cruzi in the feces is rubbed into the bite punctum. ⋯ The average infected individual in Latin America suffers more than 1000 bites, but more importantly, there are often thousands of kissing bugs in a household dropping feces on the inhabitants and living quarters. Today in Brazil the most common form of acute Chagas is secondary to oral ingestion of the parasite in food and drink. We present our experience with many hundreds of individuals bitten by kissing bugs and the possibility of oral ingestion occurring in the United States.
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The 1500 mg/d dietary sodium restriction commonly recommended for patients with heart failure has recently been questioned. Poor adherence to sodium-restricted diets makes assessing the efficacy of sodium restriction challenging. Therefore, successful behavioral interventions are needed. ⋯ The interventions implemented in the interventional trials emphasized knowledge, skills, and self-regulation strategies, but few addressed the determinants correlated with successful sodium restriction in the descriptive studies (eg, social/cultural norms, social support, taste preferences, food access, self-efficacy). Findings suggest that incorporating determinants predictive of successful dietary sodium restriction may improve the success of interventional trials. Without effective interventions to deploy in trials, the safety and efficacy of sodium restriction remains unknown.