Jaapa-Journal of the American Academy of Physician Assistants最新文献

Abstract: Leukocytosis, defined as an elevated white blood cell count, is a frequently encountered laboratory finding with a broad differential diagnosis ranging from transient reactive processes to life-threatening hematologic malignancies. Distinct patterns of elevation can provide valuable diagnostic clues that narrow the differential diagnosis and guide next steps. This article outlines a systematic approach to evaluating leukocytosis, emphasizing integration of clinical history, physical examination, and laboratory data. The discussion highlights both nonmalignant and malignant causes, including acute and chronic leukemias, lymphomas, and myeloproliferative disorders, and offers guidance on when to pursue advanced diagnostics. Finally, a practical evaluation algorithm is included to support clinical decision-making. By recognizing key clinical features, laboratory patterns, and risk factors associated with malignancy, clinicians can appropriately triage patients for specialist referral and ensure timely intervention.

Objective: This study analyzed the care delivery of a new clinic model designed to provide access to an investigational new drug (IND) during the 2022 mpox outbreak at a single academic quaternary care center.

Methods: A dedicated tecovirimat referral clinic was created and staffed by a physician associate (PA) trained in IND protocol. The PA assessed patients via telemedicine, managed IND paperwork, prescribed tecovirimat and arranged for its home delivery, and monitored drug tolerance.

Results: Of 35 patients referred to the clinic, 17 received tecovirimat. Mean time from clinic referral to first mpox provider visit was 1.03 days (SD = 1.90) and from first mpox provider visit to tecovirimat receipt was 0.22 days (SD = 0.43). Time before referral was notably longer, with a mean of 9.37 days (SD = 4.81) between symptom onset and referral.

Conclusions: This clinic provided timely, efficient, specialized care for patients with suspected infection despite the practical barriers of IND protocol.

Abstract: Resistant hypertension (RH) is defined as blood pressure (BP) that remains uncontrolled with use of three or more antihypertensive medications or BP that is controlled with use of four antihypertensive medications. Aprocitentan is a newly approved drug for RH, offering a mechanism unique from currently available antihypertensive drugs. It serves to block endothelin-A and endothelin-B to reduce vasoconstriction. The drug, which is taken once daily, has been shown to yield sustainable reductions in BP across various settings, and it may be especially beneficial for those with chronic kidney disease. Risks with use include fluid retention, anemia, mild hepatic enzyme elevations, and-though less common than with other endothelin antagonists-hepatotoxicity. Aprocitentan is contraindicated in pregnancy, as it includes a boxed warning for embryo-fetal toxicity. Although this new drug expands available options for RH, it requires careful patient selection and monitoring. Finally, cost and insurance coverage may limit access.

Abstract: Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as nonalcoholic fatty liver disease (NAFLD), is an increasingly prevalent condition that poses significant public health challenges. Affecting nearly 30% of the global population, MASLD is intricately linked to metabolic syndrome, insulin resistance, and cardiovascular disease. Primary care providers, including physician associates (PAs), play a critical role in early detection and management. This article provides an updated overview of MASLD for primary care PAs, focusing on disease pathophysiology, risk stratification, and screening recommendations. The use of noninvasive testing (eg, FIB-4, liver stiffness measurement) for diagnosis and monitoring is emphasized, and lifestyle interventions are underscored as first-line therapy. Importantly, the article highlights the recent FDA approval of resmetirom-the first pharmacologic treatment for noncirrhotic metabolic-associated steatohepatitis (MASH) with moderate to advanced fibrosis-and outlines the AASLD guideline supporting its use without the need for liver biopsy. By equipping primary care physician associates with current knowledge and practical tools, this article aims to improve early identification, guide appropriate referral, and enhance outcomes for patients at risk for MASLD progression. It also provides guidance around use of resmetirom in primary care, reviewing the drug's indications, dosing, drug-drug interactions, and safety monitoring. Finally, it highlights semaglutide as an emerging treatment option for noncirrhotic MASH.

Abstract: The intentional ingestion of caustic acidic or alkaline substances in adults is most commonly related to prior psychological history and suicidal ideation. Caustic ingestions are a medical emergency and are usually more life-threatening in adults than accidental ingestions in children. The degree of injury is determined by the physical state of the substance, its concentration, the amount ingested, and the duration of exposure to gastric mucosa. This case report describes the evaluation and management of a 36-year-old man with an intentional ingestion of sulfuric (battery) acid.