Mayo Clinic proceedings
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Mayo Clinic proceedings · Mar 2022
Comparisons of Insulin Spending and Price Between Canada and the United States.
Insulin prices have been a hot topic in the United States, where there is a lack of price regulation on drugs, and there have been reports of Americans crossing the border to purchase insulin in Canada at much lower prices. We conducted a cross-sectional time-series analysis comparing insulin spending using IQVIA (Durham, North Carolina, USA) data on aggregate insulin prescription volumes dispensed in the United States and Canada from January 2016 to April 2019 to quantify insulin spending and pricing differences between the countries. We obtained data on diabetes rates from the US Centers for Disease Control and Prevention and Statistics Canada. ⋯ Over the study period, the average cost per unit of insulin in the United States increased by 10.3% compared with only 0.01% in Canada. These findings demonstrate that the United States spent considerably more on insulin than Canada, and prices continue to increase. Implementing national legislation for drug pricing regulations using reference pricing could stabilize and potentially decrease insulin prices in the United States.
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Coronavirus disease 2019 (COVID-19) is the third deadly coronavirus infection of the 21st century that has proven to be significantly more lethal than its predecessors, with the number of infected patients and deaths still increasing daily. From December 2019 to July 2021, this virus has infected nearly 200 million people and led to more than 4 million deaths. Our understanding of COVID-19 is constantly progressing, giving better insight into the heterogeneous nature of its acute and long-term effects. ⋯ Interdisciplinary monitoring with holistic management that considers nutrition, physical therapy, psychological management, meditation, and mindfulness in addition to medication will allow for the early detection of post-acute COVID-19 sequelae symptoms and prevent long-term systemic damage. This review serves as a guideline for effective management based on current evidence, but clinicians should modify recommendations to reflect each patient's unique needs and the most up-to-date evidence. The presence of long-term effects presents another reason for vaccination against COVID-19.
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Nausea and vomiting (N/V) are common presenting complaints in the outpatient and inpatient settings. These symptoms can be associated with high morbidity and poor quality of life, particularly in those with chronic symptoms. The clinical approach to N/V can be challenging, given the numerous possible underlying causes as well as the vast array of diagnostic and therapeutic options. ⋯ We discuss the pathophysiology (neuronal pathways and neurotransmitters), differential diagnosis (medication and toxin adverse effects, neurologic causes, gastrointestinal diseases, metabolic and endocrine conditions, and psychogenic disorders), initial evaluation and risk stratification, and management and treatment options. Management of symptoms that are acute in onset or mild in severity may involve an empirical trial of antiemetics without extensive testing. In contrast, when symptoms are chronic or moderate-severe, testing for an underlying cause should be performed, and medication adverse effects, neurologic causes, gastrointestinal diseases, metabolic or endocrine conditions, and psychogenic disorders should be considered in particular.
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Mayo Clinic proceedings · Mar 2022
The Lifestyle-Related Cardiovascular Risk Is Modified by Sleep Patterns.
To prospectively assess whether sleep patterns modified lifestyle-associated cardiovascular disease (CVD) risk. ⋯ Our results indicate that adherence to a healthy sleep pattern may attenuate the CVD risk associated with an unfavorable lifestyle.
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Mayo Clinic proceedings · Mar 2022
The Female-Predominant Persistent Immune Dysregulation of the Post-COVID Syndrome.
To describe the clinical data from the first 108 patients seen in the Mayo Clinic post-COVID-19 care clinic (PCOCC). ⋯ In our PCOCC, we observed several distinct clinical phenotypes. Fatigue predominance was the most common presentation and was associated with elevated IL-6 levels and female sex. Dyspnea predominance was more common in men and was not associated with elevated IL-6 levels. IL-6 levels were more likely than erythrocyte sedimentation rate and C-reactive protein to be elevated in patients with post-acute sequelae of SARS-CoV-2 infection.