The American journal of medicine
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Cirrhosis is a prevalent, chronic condition with an asymptomatic compensated phase, in which patients may feel well, and a decompensated phase that begins with the onset of complications (eg hepatic encephalopathy, ascites, and/or variceal bleeding). Because patients with cirrhosis may appear healthy with normal liver enzymes, alkaline phosphatase, and serum bilirubin levels, awareness of clinical signals is important. For example, patients with thrombocytopenia should be evaluated for chronic liver disease and cirrhosis. ⋯ Because hepatic encephalopathy can be associated with hospital readmissions, reducing readmission rates after hepatic encephalopathy-related hospitalizations is critical. This includes incorporating ongoing therapy (eg rifaximin plus lactulose) in postdischarge management plans to reduce the risk of hepatic encephalopathy recurrence. Strategies that mitigate cirrhosis progression and prevent the development of cirrhosis-related complications are key to improving patient outcomes.
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African Americans and Hispanic Americans experience a higher incidence and prevalence of dementia than white Americans while also experiencing more environmental, metabolic, and nutritional factors potentially promoting such disparities. Greater exposure to air, water, and soil pollutants, including toxic metals associated with neurodegeneration, accrues in both minorities, as does worse dental care than Whites exposing them to periodontitis, raising dementia risk. ⋯ Both have greater air pollution exposure, a known dementia risk. Nutritional changes, including greater nut consumption and reduced sugar drink consumption, improved dental care, and reduced toxicant exposure, may help reduce this higher risk of dementia among African Americans and Hispanic Americans.
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During the past decade, growing recidivism has threatened the enormous beneficial impacts of vaccinations in the United States. The barriers are multifactorial and include increasing vaccine hesitancy. The continuing dedicated efforts of all healthcare professionals, along with advancements in vaccine technology and the resilience of public health systems, offers promise for the future. ⋯ Healthcare providers and public health officials should remain cognizant that increasing vaccination rates are essential but not sufficient. Surveillance containment entails rapid detection and reporting of cases with prompt immunization of household members and close contacts of confirmed cases, combined with judicious use of isolation, prompt antiviral or antibiotic medications, social distancing, respiratory etiquette, home or large-scale quarantines, and masking. The continuing and expanded efforts of US healthcare providers are vital to these successes.
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This review addresses important issues that face practitioners today concerning the treatment of heart failure with preserved ejection fraction (HFpEF). It points out how the accepted efficacy of HFpEF medication treatment has changed. Medications are now recommended for use in HFpEF that have diuretic properties and are significant because of a reduction in the frequency of the development of heart failure (not mortality). ⋯ Chlorthalidone, possibly with a generic mineralocorticoid antagonist, could be an acceptable low-cost alternate therapy as secondary treatment for HFpEF. Of course, chlorthalidone does not have the other theoretic benefits of the sodium-glucose cotransporter 2 (SGLT2) inhibitors or finerenone. It would be helpful if this was discussed in the upcoming HFpEF guidelines, especially for use in patients who cannot afford or tolerate the new HFpEF medications.
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From the time of Galen, examination of the pupillary light reflex has been a standard of care across the continuum of health care. The growing body of evidence overwhelmingly supports the use of quantitative pupillometry over subjective examination with flashlight or penlight. At current time, pupillometers have become standard of care in many hospitals across 6 continents. This review paper provides an overview and rationale for pupillometer use and highlights literature supporting pupillometer-derived measures of the pupillary light reflex in both neurological and non-neurological patients across the health care continuum.