Cleveland Clinic journal of medicine
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Diabetic ketoacidosis (DKA) was historically considered a condition typical of type 1 diabetes. However, patients with type 2 diabetes may present with DKA, usually with higher blood glucose levels and milder ketoacidosis. With the increased use of sodium-glucose cotransporter 2 (SGLT-2) inhibitors, the variant euglycemic DKA has been described. ⋯ The principles of DKA management are fluid administration, electrolyte control, and glucose control with insulin. In euglycemic DKA, the immediate use of a glucose-containing intravenous fluid induces endogenous insulin secretion and stops ketogenesis. Due to the half-life of SGLT-2 inhibitors, the duration of euglycemic DKA may be more prolonged.
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Primary care physicians frequently encounter patients with urogenital diseases. These 10 evidence-based pearls will help physicians to refine the care they provide, avoid some common missteps, and more quickly determine when a referral is appropriate.
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From 6% to 8% of patients who present with myocardial infarction have no evidence of obstructive coronary artery disease on angiography. This subgroup tends to be younger, and more of them are women. This review highlights a proposed algorithm to identify the underlying cause of myocardial infarction with nonobstructive coronary arteries (MINOCA). We emphasize the need for a collaborative approach in diagnosing and managing MINOCA to improve patient outcomes, advocating for a standardized diagnostic pathway that incorporates cardiac magnetic resonance imaging and comprehensive clinical evaluation to tailor treatments effectively.
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The risk of developing cervical cancer is not equal across populations-individual health history, economic, political, and societal factors influence cervical cancer risk. Certain health conditions, including human immunodeficiency virus (HIV) infection, immunosuppression, and history of high-grade cervical dysplasia, are associated with higher cervical cancer risk and warrant distinct screening, surveillance, and management guidelines. ⋯ However, this can be difficult in practice, as recommendations regularly evolve. This review offers up-to-date guidance in a case-based format on cervical cancer screening, surveillance, and management for high-risk patients.
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Access to and use of glycemic data are central to optimal management of diabetes. Use of continuous glucose monitoring (CGM) data to guide the management of diabetes has increased dramatically thanks to improved ease of use, accuracy, and availability. Retrospective CGM data collected throughout the day and night allow clinicians to visualize glycemic patterns, and single-page summary views like the Ambulatory Glucose Profile (AGP) Report make rapid interpretation both feasible and intuitive. A systematic approach that integrates retrospective CGM-generated data at clinic visits and other clinical interactions with personal use of CGM data can optimize glycemic management.