South Dakota medicine : the journal of the South Dakota State Medical Association
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Takotsubo cardiomyopathy, also called "broken heart" syndrome or apical ballooning syndrome, is a reversible cardiomyopathy characterized by left ventricular dysfunction and ballooning of the left ventricular apex on imaging during systole. It predominantly occurs in post-menopausal women and is commonly associated with emotional or physical stress. Patients commonly present with chest pain and electrocardiographic evidence of ST segment elevation or T-wave-mimicking acute coronary syndrome, but with an absence of angiographic evidence of obstructive coronary disease. ⋯ Near complete resolution of left ventricular wall motion dyskinesis occurs in the majority of takotsubo cardiomyopathy patients within a month. Although the prognosis is generally favorable, there are reports of complications during the acute phase, including cardiogenic shock, pulmonary edema, ventricular tachycardia, apical thrombus formation, and death. This review article will briefly discuss the epidemiology, etiology, clinical features, diagnostic evaluation, and treatment of this condition.
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Skin abscesses can be a significant source of morbidity and are frequently encountered by physicians across the country. Incision and drainage (I&D) remains the standard of care; however, significant variability exists in the treatment of abscesses after I&D. Some recent evidence has suggested that routinely performed treatment modalities may not be beneficial. We examine the available evidence investigating if I&D alone is sufficient as the sole management for the treatment of uncomplicated abscesses, specifically focusing on wound packing and post-procedural antibiotics. ⋯ Regardless of supplemental post-procedural treatment, all studies demonstrate high rates of clinical cure following I&D. While the number of studies is small, there is data to support the elimination of abscess packing and routine avoidance of antibiotics post-I&D in an immunocompetent patient; however, antibiotics should be considered in the presence of high risk features. Due to limited studies and conflicting data, we are unable to make a recommendation in support or opposition of adjunctive post-procedural packing and antibiotics in an immunocompromised patient.
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Review
Review of Acute Coronary Syndromes: Diagnosis and Management of ST-Elevation Myocardial Infarction.
Acute coronary syndrome is a life-threatening event that affects millions of people each year and accounts for a big portion of hospital visits. With an ever-growing elderly patient population, ischemic heart disease is more prevalent than ever before. ⋯ Guidelines are continuously evolving as more multicenter randomized trials, new medications and new technologies continue to change the way we treat acute coronary syndromes. The focus of this review is ST-elevation myocardial infarction and it provides answers to some of the fundamental questions through evidence-based guidelines.
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With the recent legalization of recreational marijuana in Colorado, Washington, Alaska, the District of Columbia and legislation pending for both medical and recreational marijuana in several other states, it is important for the facts regarding its potential for serious mental health consequences to be known. Little has been said about the psychiatric risks of this substance, particularly in youth. ⋯ In addition, permanent loss of IQ and structural changes in the brain have been demonstrated with habitual use. Legalization of marijuana for recreational use can influence an adolescent's perception of this substance as "safe." In states that have legalized marijuana for medical purposes, there is the very real problem of "diversion." As many as 34 percent of 12th-graders who use marijuana in states with legalized marijuana had obtained it from a person who had received it through a prescription.