Jason T Alexander, Simran K Singh, Sachin D Shah, Brianna Lambert, Jeremy P Smith
The practice of outpatient medicine is demanding, encompasses a wide scope of practice, and leaves little time for internists to stay up to date with the current literature. This article reviews 5 studies published in 2022 and 2023 that have the potential to change the practice of outpatient medicine. Topics covered include chronic kidney disease, secondary cardiovascular disease, kidney stones, obesity, and lipid management.
{"title":"2023 Update in ambulatory general internal medicine.","authors":"Jason T Alexander, Simran K Singh, Sachin D Shah, Brianna Lambert, Jeremy P Smith","doi":"10.3949/ccjm.91a.23056","DOIUrl":"10.3949/ccjm.91a.23056","url":null,"abstract":"<p><p>The practice of outpatient medicine is demanding, encompasses a wide scope of practice, and leaves little time for internists to stay up to date with the current literature. This article reviews 5 studies published in 2022 and 2023 that have the potential to change the practice of outpatient medicine. Topics covered include chronic kidney disease, secondary cardiovascular disease, kidney stones, obesity, and lipid management.</p>","PeriodicalId":10245,"journal":{"name":"Cleveland Clinic Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":6.1,"publicationDate":"2024-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139086019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shrouq Khazaaleh, Mohammad Alomari, Mamoon Ur Rashid, Daniel Castaneda, Fernando J Castro
Gastric intestinal metaplasia (GIM), a common histologic finding, is associated with increased risk of gastric cancer, and GIM associated with Helicobacter pylori infection is classified as an environmental metaplastic atrophic gastritis. Patients may be asymptomatic or present with various dyspeptic symptoms. Autoimmune metaplastic atrophic gastritis is a less common but important cause of chronic gastritis. The Correa cascade describes the evolution of precancerous mucosal changes that lead to development of GIM, with differentiation of 2 histologic types of GIM (complete and incomplete) and the consequences of each type. The risk of progression to malignancy is higher with incomplete GIM. It is also higher for those who immigrate from regions with a high incidence of H pylori infection to areas where the incidence is low. Guidelines regarding endoscopic management of GIM vary by geographic region.
{"title":"Gastric intestinal metaplasia and gastric cancer prevention: Watchful waiting.","authors":"Shrouq Khazaaleh, Mohammad Alomari, Mamoon Ur Rashid, Daniel Castaneda, Fernando J Castro","doi":"10.3949/ccjm.91a.23015","DOIUrl":"10.3949/ccjm.91a.23015","url":null,"abstract":"<p><p>Gastric intestinal metaplasia (GIM), a common histologic finding, is associated with increased risk of gastric cancer, and GIM associated with <i>Helicobacter pylori</i> infection is classified as an environmental metaplastic atrophic gastritis. Patients may be asymptomatic or present with various dyspeptic symptoms. Autoimmune metaplastic atrophic gastritis is a less common but important cause of chronic gastritis. The Correa cascade describes the evolution of precancerous mucosal changes that lead to development of GIM, with differentiation of 2 histologic types of GIM (complete and incomplete) and the consequences of each type. The risk of progression to malignancy is higher with incomplete GIM. It is also higher for those who immigrate from regions with a high incidence of <i>H pylori</i> infection to areas where the incidence is low. Guidelines regarding endoscopic management of GIM vary by geographic region.</p>","PeriodicalId":10245,"journal":{"name":"Cleveland Clinic Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":6.1,"publicationDate":"2024-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139086022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of morbidity and mortality, with low-density lipoprotein (LDL) cholesterol being a causative risk factor. Though statins have a decades-long track record of efficacy and safety, nonstatin agents may be used to reduce LDL cholesterol as an adjunct or alternative to statin therapy. Several new nonstatin medications have been approved in recent years, with robust data from clinical trials supporting their use in atherosclerotic disease. This review addresses the indications, evidence, and important prescribing considerations for using nonstatin lipid-lowering therapy and proposes a practical approach for determining when to initiate nonstatin therapy.
{"title":"Nonstatin therapy to reduce low-density lipoprotein cholesterol and improve cardiovascular outcomes.","authors":"Abhayjit Singh, Leslie S Cho","doi":"10.3949/ccjm.91a.23058","DOIUrl":"10.3949/ccjm.91a.23058","url":null,"abstract":"<p><p>Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of morbidity and mortality, with low-density lipoprotein (LDL) cholesterol being a causative risk factor. Though statins have a decades-long track record of efficacy and safety, nonstatin agents may be used to reduce LDL cholesterol as an adjunct or alternative to statin therapy. Several new nonstatin medications have been approved in recent years, with robust data from clinical trials supporting their use in atherosclerotic disease. This review addresses the indications, evidence, and important prescribing considerations for using nonstatin lipid-lowering therapy and proposes a practical approach for determining when to initiate nonstatin therapy.</p>","PeriodicalId":10245,"journal":{"name":"Cleveland Clinic Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":6.1,"publicationDate":"2024-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139086025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Osamah Z Badwan, Lorenzo Braghieri, Warren Skoza, Ankit Agrawal, Venu Menon, W H Wilson Tang
{"title":"When should we consider SGLT-2 inhibitors in patients with acute decompensated heart failure?","authors":"Osamah Z Badwan, Lorenzo Braghieri, Warren Skoza, Ankit Agrawal, Venu Menon, W H Wilson Tang","doi":"10.3949/ccjm.91a.23034","DOIUrl":"10.3949/ccjm.91a.23034","url":null,"abstract":"","PeriodicalId":10245,"journal":{"name":"Cleveland Clinic Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":6.1,"publicationDate":"2024-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139086065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"It's a new year, looking back and looking forward.","authors":"Brian F Mandell","doi":"10.3949/ccjm.91b.01024","DOIUrl":"10.3949/ccjm.91b.01024","url":null,"abstract":"","PeriodicalId":10245,"journal":{"name":"Cleveland Clinic Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":6.1,"publicationDate":"2024-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139086023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Wearable cardiac monitors: Where do we stand?","authors":"Jakub Sroubek","doi":"10.3949/ccjm.91a.23081","DOIUrl":"10.3949/ccjm.91a.23081","url":null,"abstract":"","PeriodicalId":10245,"journal":{"name":"Cleveland Clinic Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":6.1,"publicationDate":"2024-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139086064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Consumer-grade smart devices, including smartwatches and smartphones, are potentially valuable tools in detecting cardiac arrhythmias, particularly atrial fibrillation, and their use is increasing. These devices, which use photoplethys mography, show remarkably high sensitivity and specificity for detection of atrial fibrillation, with implications for stroke prevention and management in at-risk patients. The ability of the devices to detect atrial fibrillation is being compared with single-lead electrocardiography. Physicians will increasingly be asked to interpret data from these nonmedical-grade devices as they become more common. Limitations include high false-positive rates in certain populations and disparities in access.
{"title":"Consumer-grade wearable cardiac monitors: What they do well, and what needs work.","authors":"Abdilahi Mohamoud, Joseph Jensen, Kevin G Buda","doi":"10.3949/ccjm.91a.23030","DOIUrl":"10.3949/ccjm.91a.23030","url":null,"abstract":"<p><p>Consumer-grade smart devices, including smartwatches and smartphones, are potentially valuable tools in detecting cardiac arrhythmias, particularly atrial fibrillation, and their use is increasing. These devices, which use photoplethys mography, show remarkably high sensitivity and specificity for detection of atrial fibrillation, with implications for stroke prevention and management in at-risk patients. The ability of the devices to detect atrial fibrillation is being compared with single-lead electrocardiography. Physicians will increasingly be asked to interpret data from these nonmedical-grade devices as they become more common. Limitations include high false-positive rates in certain populations and disparities in access.</p>","PeriodicalId":10245,"journal":{"name":"Cleveland Clinic Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":6.1,"publicationDate":"2024-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139086021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The author answers questions patients may have about the currently available influenza, COVID-19, and respiratory syncytial virus vaccines.
{"title":"Hey, Doc: Could the 2023-2024 cold and flu season finally be the calm after the storm?","authors":"Sherif Beniameen Mossad","doi":"10.3949/ccjm.90a.23088","DOIUrl":"10.3949/ccjm.90a.23088","url":null,"abstract":"The author answers questions patients may have about the currently available influenza, COVID-19, and respiratory syncytial virus vaccines.","PeriodicalId":10245,"journal":{"name":"Cleveland Clinic Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":6.1,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138470018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}