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Topic Review
Analgesics Fact Sheet
This guide provides a structured, decision-oriented approach to the use of analgesics across common categories: Acetaminophen, NSAIDs, Opioids, Antiepileptics, Antidepressants, and Corticosteroids. It outlines specific pain types, conditions, and scenarios where each drug class is effective, key contraindications and risk factors for each category, standard therapeutic dosing to ensure safe and effective treatment. Designed for quick clinical reference, this fact sheet emphasizes practical applications, focusing on analgesic choice tailored to pain type, patient comorbidities, and safety considerations.
  • 21
  • 27 Nov 2024
Topic Review
Pain Management Analgesia
Effective pain management in hospitalized patients involves a multimodal approach tailored to the severity and type of pain (mild, moderate, or severe) and the patient's clinical condition. The goal is to provide adequate pain relief while minimizing side effects and preventing complications like opioid dependence or gastrointestinal and renal issues from NSAIDs. Mild Pain: Managed with non-opioid analgesics such as acetaminophen or NSAIDs. Topical agents like lidocaine patches or capsaicin cream may be used for localized pain. Moderate Pain: Combines non-opioid analgesics with low-potency opioids (e.g., tramadol). Adjuncts like topical therapies or neuropathic pain medications (e.g., gabapentin) may also be employed. Severe Pain: Requires short-acting opioids (e.g., morphine, hydromorphone) often administered via scheduled dosing or patient-controlled analgesia. Long-acting opioids are reserved for chronic conditions like cancer-related pain. Special considerations include adjusting treatment for patients with chronic pain, hepatic or renal dysfunction, or risk factors for adverse drug reactions. Preventive measures, such as bowel regimens for opioid-induced constipation, and regular reassessment of pain control are critical components of care. The approach prioritizes not just the relief of pain but also the functional improvement and safety of patients. Consultation with pain management or palliative care teams is advised for complex or refractory cases.
  • 23
  • 25 Nov 2024
Topic Review Peer Reviewed
Understanding the Gut-Heart Axis in Roemheld Syndrome: Mechanisms and Clinical Insights
This entry reviews the health condition known as Roemheld syndrome, or gastrocardiac syndrome in modern medicine. A pathology of gastrointestinal origin, the syndrome relies on a gut–brain–heart triad, interconnected by the vagus nerve. Pressure from the intestines pushes the stomach into the diaphragm and activates the vagus nerve, which affects the heart rate and gives the perception of cardiac issues. This distressing sensation, which usually comes after meals or with other digestive problems, causes anxiety or panic. Although events not arising from anatomic abnormalities are relatively harmless, hypersensitivity to these uncomfortable sensations may precipitate psychiatric problems (anxiety or depression) that cause repeated gastrocardiac events through sympathetic activation and the disruption of peristalsis. Treatment is usually symptomatic and may include diet, lifestyle changes, probiotics, or prescriptions that increase gut motility, but this specific set of reproducible symptoms may also be caused by hiatal hernia or side effects from medication/surgery and treated with respect to those mechanical causes. This review highlights details from the most current knowledge of the condition and offers suggestions for clinical management based on the literature.
  • 90
  • 22 Nov 2024
Topic Review
Acute Pancreatitis Management
Acute pancreatitis (AP) is diagnosed when at least two of the following criteria are met: abdominal pain characteristic of the disease, serum lipase or amylase levels greater than three times the upper limit of normal, and findings consistent with AP on imaging. Serum lipase is the preferred diagnostic marker due to its superior sensitivity and specificity. Routine CT imaging at admission is not recommended unless the diagnosis is unclear or the patient fails to improve clinically within 48–72 hours. Imaging, including contrast-enhanced CT or MRI, is reserved for evaluating complications such as necrosis or pseudocysts in patients with persistent or worsening symptoms. Identifying the etiology of AP is essential for effective management. For biliary pancreatitis, transabdominal ultrasound is the first-line imaging modality, with repeat studies recommended if the initial results are inconclusive. For idiopathic AP (IAP), additional evaluation with MRI or endoscopic ultrasound (EUS) is suggested. In patients without gallstones or a history of significant alcohol use, serum triglycerides should be measured, and levels exceeding 1,000 mg/dL suggest hypertriglyceridemia as the cause. For patients over 40 years of age with no established etiology, pancreatic cancer should be considered and further evaluated. Initial management of AP focuses on supportive care. Fluid resuscitation with lactated Ringer’s solution is recommended, with frequent reassessments to avoid volume overload, especially in patients with cardiovascular or renal comorbidities. Nutrition should be initiated early, preferably within 24–48 hours, with a low-fat solid diet in mild cases. In severe cases, enteral nutrition is preferred over parenteral nutrition, with nasogastric feeding being the optimal route due to its comparable safety and efficacy. Interventions should be tailored to clinical need. Antibiotics are not indicated for sterile necrosis but should be used in cases of infected necrosis to delay or potentially avoid invasive drainage. Endoscopic retrograde cholangiopancreatography (ERCP) is indicated within 24 hours for AP complicated by cholangitis but should not be routinely performed for biliary AP without cholangitis. Prevention of post-ERCP pancreatitis includes rectal indomethacin and, in high-risk cases, pancreatic duct stenting. To reduce recurrence risk, patients with idiopathic AP should undergo a cholecystectomy after a second episode if they are fit for surgery. Overall, these guidelines emphasize the importance of a stepwise diagnostic and therapeutic approach to manage AP effectively and minimize complications.
  • 23
  • 22 Nov 2024
Topic Review
Essentials of Cholecystitis Diagnosis
This comprehensive Q&A series dives into the key aspects of cholecystitis, from pathophysiology to diagnosis and management. Each question explores critical topics such as the differences between calculous and acalculous cholecystitis, the role of imaging and laboratory studies, and strategies for assessing and managing complications like common bile duct stones. Designed for healthcare professionals, this series provides actionable insights for diagnosing and treating gallbladder diseases effectively. Perfect for medical rounds, surgical planning, and exam preparation.
  • 23
  • 22 Nov 2024
Topic Review Peer Reviewed
Dysfunctional K+ Homeostasis as a Driver for Brain Inflammation
The central nervous system (CNS) relies on precise regulation of potassium ion (K+) concentrations to maintain physiology. This regulation involves complex cellular and molecular mechanisms that work in concert to regulate both intracellular and extracellular K+ levels. Inflammation, a key physiological response, encompasses a series of cell-specific events leading to inflammasome activation. Perturbations in K+-sensitive processes can result in either chronic or uncontrolled inflammation, highlighting the intricate relationship between K+ homeostasis and inflammatory signalling. This review explores molecular targets that influence K+ homeostasis and have been implicated in inflammatory cascades, offering potential therapeutic avenues for managing inflammation. We examine both cell-specific and common molecular targets across different cell types, providing a comprehensive overview of the interplay between K+ regulation and inflammation in the CNS. By elucidating these mechanisms, we identify leads for drug discovery programmes aimed at modulating inflammatory responses. Additionally, we highlight potential consequences of targeting individual molecular entities for therapeutic purposes, emphasizing the need for a nuanced approach in developing anti-inflammatory strategies. This review considers current knowledge on K+-sensitive inflammatory processes within the CNS, offering critical insights into the molecular underpinnings of inflammation and potential therapeutic interventions. Our findings underscore the importance of considering K+ homeostasis in the development of targeted therapies for inflammatory conditions within the CNS.
  • 95
  • 19 Nov 2024
Topic Review
Hepatocellular Carcinoma in hepatitis C without Cirrhosis
The current NCCN guidelines recommend HCC surveillance in cirrhotic people every six months, using Ultra sound (U/S) abdomen and Alpha Feto Protien (AFP) levels. However, the National Comprehensive Cancer Network (NCCN) guideline only emphasizes the significance of screening if the patient has hepatitis B without cirrhosis, not hepatitis C without cirrhosis. This example illustrates the need for improved surveillance strategies for non-cirrhotic hepatitis C patients.
  • 53
  • 13 Nov 2024
Topic Review
Osteoarthritis versus Rheumatoid Arthritis
A recently published article explores an innovative machine learning approach to differentiate between osteoarthritis (OA) and rheumatoid arthritis (RA) by integrating Shapley Additive Explanations (SHAP) and dendrograms for enhanced model interpretability. Using data from the National Health and Nutrition Examination Survey (NHANES), the study analyzes key features that help classify OA and RA in adults, including socioeconomic and biological factors. The authors present a detailed comparison of feature importance, using SHAP values to visualize individual feature contributions and dendrograms to cluster related features based on their impact on model performance. The findings provide insights into both the clinical and predictive distinctions of OA and RA, with implications for improving diagnosis accuracy in arthritis management.
  • 43
  • 11 Nov 2024
Topic Review
Flawless Smile: Harmonizing Depigmentation and Frenectomy
People increasingly seek dental treatment to improve their smile's aesthetics. A common concern is a hyperpigmented gingiva and high frenum attachment. Gingival recession can result from high frenum attachment, either by interfering with the toothbrush's correct positioning or by causing a muscular pull through the opening of gingival crevice. We present a case of a young patient concerned with the presence of hyperpigmented gingiva. On intraoral examination high frenal attachment was also observed. After providing the patient all the available treatment options and their advantages and disadvantages respectively, patient decided to opt for conventional surgical scalpel method for depigmentation as well as frenectomy. Patient was recalled for periodontal dressing removal after 1 week and follow up was performed at 6 months.
  • 56
  • 11 Nov 2024
Topic Review
The Relationship between Hypercarbia and Hypoxia
Ventilation and gas exchange are fundamental to maintaining proper levels of oxygen (PaO₂) and carbon dioxide (PaCO₂) in the blood. Minute ventilation (V̇E), the total volume of air moved in and out of the lungs per minute, is normally around 5-8 L/min in healthy adults. However, only a portion of this air reaches the alveoli for gas exchange, a process known as effective alveolar ventilation (V̇A), which is crucial for regulating PaCO₂ levels. When effective ventilation is reduced or dead space in the lungs increases, carbon dioxide clearance decreases, leading to elevated PaCO₂, known as hypercapnic respiratory failure. Hypercapnic respiratory failure occurs due to two main mechanisms: decreased effective alveolar ventilation or increased dead space. Reduced ventilation may result from a lower respiratory rate or smaller tidal volumes, often caused by sedative drugs, brainstem injuries, neuromuscular weakness, or physical factors such as obesity. Alternatively, conditions like COPD or acute respiratory distress syndrome (ARDS) increase dead space, meaning more of the inhaled air does not participate in gas exchange due to inadequate blood perfusion in certain lung areas. This dead space effect prevents sufficient CO₂ elimination, even if minute ventilation is normal or elevated. Patients with chronic hypercapnia, such as those with advanced COPD, may tolerate higher levels of PaCO₂ (90-120 mm Hg) without symptoms. In contrast, healthy individuals typically begin to experience symptoms of hypercapnia when PaCO₂ rises above 70-80 mm Hg. On the oxygen side, the alveolar gas equation helps explain how PaO₂ depends on both inspired oxygen and the amount of carbon dioxide in the alveoli. Inadequate oxygen levels, or hypoxemia, can occur when effective ventilation is compromised, as seen in conditions that reduce alveolar ventilation or increase dead space.
  • 41
  • 11 Nov 2024
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