Chest pain suggestive of myocardial infarction is a leading cause of presentation to the emergency department worldwide. In addition to the electrocardiogram and clinical symptoms, the serial measurement of cardiac troponin is key in ruling out or diagnosing myocardial infarction. With the…
Sedation is a component of the care of critically ill patients who are undergoing mechanical ventilation, but the appropriate choice of a primary sedative agent remains uncertain. Propofol and midazolam, which act mainly through pathways mediated by γ-aminobutyric acid, are widely used for this…
Systemic sclerosis is a rare and heterogeneous autoimmune disease characterized by immune dysregulation, microvascular damage, and organ fibrosis. Interstitial lung disease (ILD) is a common manifestation of systemic sclerosis that tends to occur early in the course of disease; the condition places…
Clinically unresponsive patients can have electroencephalographic (EEG) or magnetic resonance imaging (MRI) evidence of brain activation in response to spoken commands. A meta-analysis has reported that 14% of chronically unresponsive patients may have a dissociation between behavior and brain…
Transcatheter aortic-valve replacement (TAVR) was approved in 2011 in the United States. As a condition of reimbursement, the Centers for Medicare and Medicaid Services (CMS) requires TAVR programs to perform a minimum of 20 TAVR procedures per year or 40 over a period of 2 years. Although other…
Clinicopathological features, including tumor size, histologic grade, and the presence of axillary lymph-node metastases, provide prognostic information about disease recurrence in women who have localized breast cancer after surgery, but these features have not been shown to be predictive of…
Management of the care of patients with stable coronary artery disease is based on reduction of risk factors, guideline-directed medical therapy, and revascularization in those with persistent symptoms or proven ischemia. In symptomatic patients with risk factors for coronary artery disease, two…
Multiple sclerosis is a progressive demyelinating, inflammatory, and neurodegenerative autoimmune disease that results in the formation of lesions in the protective layer around nerves in the brain and spinal cord. Goals in the treatment of patients’ disabling symptoms include reducing the…
In recent years, policymakers have introduced unprecedented changes to Medicaid. As of April 2019, nine states have received approval by means of a federal waiver to implement work requirements in Medicaid, and six have applications pending. According to the Centers for Medicare and Medicaid…
Achondroplasia is the most common form of disproportionate short stature, with a prevalence of 1 in 25,000 live births. The condition is caused by an autosomal dominant mutation in the fibroblast growth factor receptor 3 gene (FGFR3) that constitutively activates the mitogen-activated protein…
Sickle cell disease affects approximately 100,000 persons in the United States and reduces life expectancy by approximately 30 years. The disease is caused by a single amino acid substitution resulting in the production of sickle hemoglobin (HbS). HbS polymerizes when deoxygenated, resulting in…
Huntington’s disease is a progressive neurodegenerative disorder inherited as an autosomal-dominant trait, with onset typically occurring in mid-adult life and characterized by movement disorder, cognitive decline, and behavioral symptoms. Huntington’s disease is caused by CAG trinucleotide repeat…
The existing paradigm for diagnosing infections relies on the physician formulating a differential diagnosis on the basis of a patient’s history, clinical presentation, and imaging findings, followed by serial laboratory testing. This traditional approach is particularly challenging for…
The increasing prevalence of type 2 diabetes during recent decades is the primary factor accounting for the substantial global increase in end-stage kidney disease. Currently, more than 3 million people worldwide are estimated to be receiving treatment for kidney failure, with predictions that the…
Women with locally advanced (International Federation of Gynecology and Obstetrics [FIGO] stage III or IVA) endometrial carcinoma are a heterogeneous group of patients who are at risk for both local and systemic disease recurrence. Clinical and pathologic factors affecting the risk of recurrence…
Cardiovascular disease is the primary cause of death in patients with type 2 diabetes, and the ruling out of an excess cardiovascular risk is a regulatory requirement for new glucose-lowering therapies. Glucagon-like peptide-1 (GLP-1) receptor agonists are well-established glucose-lowering…
Type 1 diabetes is caused by the autoimmune destruction of insulin-producing beta cells in the islets of Langerhans, which leads to dependence on exogenous insulin for survival. Approximately 1 million to 1.5 million Americans have type 1 diabetes, which is one of the most common diseases of…
More than 84 million adults in the United States have an increased risk of type 2 diabetes, based on a fasting glucose or glycated hemoglobin level above the normal range but below the threshold for diabetes. Persons at high risk for type 2 diabetes who are overweight or obese and who have elevated…
Observational cohort studies have shown increasing risks of both macrovascular and microvascular events with increasing average blood glucose levels. Trials involving patients with type 1 diabetes and patients with new-onset type 2 diabetes showed that improving glucose control reduced the…
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