J Natl Med Assoc
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Prior studies have focused on the clinical efficacy of combination therapy, donepezil and memantine, for patient's diagnosed with Alzheimer's disease. As a result, it has become increasingly routine for providers to prescribe both medications for all-cause neurodegenerative disorders in variable stages of disease. However, the potential adverse drug reactions while described as mild can have serious sequelae in older adults who are already managing the side effects of polypharmacy. This study looks to explore the tolerability of switching cholinesterase inhibitors to memantine monotherapy versus adding memantine as combination therapy for all-cause neurodegenerative disorders. ⋯ The odds of a patient reporting side effects on combination therapy in comparison with those patients on memantine monotherapy reporting side effects were significantly greater (OR = 4.33, CI 95% (1.62, 11.52), p = 0.003). In our patient sample, more than 80% of the patients reporting side effects qualified as polypharmacy or excessive polypharmacy (Table 2). As a result, variable polypharmacy (p = 0.047) was statistically significant in the in a binary logistic regression model for predicting outcomes for patients on combination therapy (Table 3). Therefore, as a patient progresses to moderate-severe stages of disease, we recommend switching CI monotherapy to memantine monotherapy as opposed to adding memantine as combination therapy for those patients on more than 10 other medications to increase tolerability. Given the limitations of a smaller sample size, variables such as severity of disease, renal and liver impairment as well as medication dosing were not significant predictors (Table 3) for those reporting side effects on combination therapy.
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Chronic Kidney disease (CKD) is more prevalent among women than men in the United States. This review highlights the important yet unique considerations that should be made in the care of women with kidney disease including psychosocial issues, preventive care and family planning. ⋯ Significance statement: The health of women with kidney disease has been understudied. This review offers insights on key areas in the management of women with kidney disease.
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Black, Hispanic, and Indigenous groups have carried the burden of COVID-19 disease in comparison to non-marginalized groups within the United States. It is important to examine the factors that have led to the observed disparities in COVID-19 risk, morbidity, and mortality. We described primary health care access within large US metropolitan cities in relation to COVID-19 rate, race/ethnicity, and income level and hypothesized that observed racial/ethnic disparities in COVID-19 rates are associated with health care provider number. ⋯ These results pose a concern in terms of pandemic progression into the next year and how these structural inequities have impacted and will impact vaccine distribution.
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Among the many academic challenges faced by dual-degree MD-PhD students is access to professional support networks designed to overcome the unique academic and personal barriers to physician-scientist training. In the current study, we hypothesized that regional access to a student MD-PhD conference, termed the Southeastern Medical Scientist Symposium (SEMSS), would enhance medical and/or graduate training by fostering such relationships between physician-scientist trainees, doing so by discussing both the challenges of physician-scientist training and effective strategies to overcome them. In the current study, we used a mixed-methods approach to evaluate the overall usefulness of SEMSS over a ten-year period (2010-2020) to identify key areas of particular benefit to trainees. ⋯ Over the reporting period, SEMSS was attended by equivalent proportions of MD-PhD and undergraduate students, among which were a high-percentage of students from underrepresented minority (URM) groups relative to the national MD-PhD applicant pool; nearly one-third of URM students attendees later matriculated into MD-PhD programs, far exceeding the national MD-PhD matriculation rate. Among the benefits reported by students were "opportunities to network with peers" and opportunities to learn about the physician-scientist career track. Therefore, we therefore propose regional MD-PhD conferences as an effective model to promote diversity within the physician-scientist training pipeline.
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Of the four subtypes of cutaneous melanoma, acral lentiginous melanoma (ALM) is atypical in its presentation. ALM is a rare melanoma subtype that presents on the volar surfaces of the hand and foot. The difficulty of making an early diagnosis of ALM is highlighted by the case seen in our institution. ⋯ The original lesion was considered to be an ulcerating left great toe lesion with signs typical of osteomyelitis. These clinical findings were corroborated by radiological x-ray evidence. Upon amputation and biopsy for suspected worsening osteomyelitis five years later, the pathological diagnosis of melanoma was finally made.