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The American Journal of Medicine Aug 2019Breastfeeding seems to be a low-cost intervention that provides both short- and long-term health benefits for the breastfeeding woman. Interventions to support... (Review)
Review
Breastfeeding seems to be a low-cost intervention that provides both short- and long-term health benefits for the breastfeeding woman. Interventions to support breastfeeding can increase its rate, exclusivity, and duration. Internists often have a longitudinal relationship with their patients and can be important partners with obstetricians and pediatricians in advocating for breastfeeding. To play their unique and critical role in breastfeeding promotion, internists need to be knowledgeable about breastfeeding and its maternal health benefits. In this paper, we review the short- and long-term maternal health benefits of breastfeeding. We also discuss special considerations in the care of breastfeeding women for the internist.
Topics: Breast Feeding; Humans; Internal Medicine; Maternal Health Services; Milk, Human
PubMed: 30853481
DOI: 10.1016/j.amjmed.2019.02.021 -
European Journal of Internal Medicine Dec 2022Acute aortic syndromes (AASs) are severe conditions defined by dissection, hemorrhage, ulceration or rupture of the thoracic aorta. AASs share etiological and... (Review)
Review
Acute aortic syndromes (AASs) are severe conditions defined by dissection, hemorrhage, ulceration or rupture of the thoracic aorta. AASs share etiological and pathophysiological features, including long-term aortic tissue degeneration and mechanisms of acute aortic damage. The clinical signs and symptoms of AASs are unspecific and heterogeneous, requiring large differential diagnosis. When evaluating a patient with AAS-compatible symptoms, physicians need to integrate clinical probability assessment, bedside imaging techniques such as point-of-care ultrasound, and blood test results such as d-dimer. The natural history of AASs is dominated by engagement of ischemic, coagulative and inflammatory pathways at large, causing multiorgan damage. Medical treatment, multiorgan monitoring and outcome prognostication are therefore paramount, with internal medicine playing a key role in non-surgical management of AASs.
Topics: Humans; Aortic Dissection; Syndrome; Aorta, Thoracic; Diagnosis, Differential
PubMed: 36229285
DOI: 10.1016/j.ejim.2022.10.003 -
Annals of Medicine Dec 2021Internists are front-line health care providers that commonly provide the first encounter to patients for dermatological conditions, especially atopic dermatitis (AD).... (Review)
Review
Internists are front-line health care providers that commonly provide the first encounter to patients for dermatological conditions, especially atopic dermatitis (AD). Internists need to be comfortable with managing mild-moderate AD in their practices. Criteria and guidelines established in dermatology literature are available to help the general practitioner diagnose and treat AD. AD is a systemic disease associated with multiple cutaneous and extra-cutaneous comorbidities that warrant screening by internists, especially mental health conditions. Environmental factors may play a role in the development or worsening of AD; however, there is currently no strong evidence to guide specific population- or clinic-based interventions for their avoidance. While food allergies are common in AD patients, the role of food allergens as an exacerbating factor for AD is controversial. Before starting any dietary modifications, careful evaluation should be performed by an allergist. If the patient is not well-controlled despite adequate topical therapies or is experiencing severe/worsening disease, early referral to dermatology is warranted to rule out confounding diagnoses and/or escalation to systemic therapies. Finally, it is important to recognise the racial disparities present in AD and address these when formulating treatment plans.Key messages:Confounding dermatoses, either instead of or in addition to AD, should be considered in treatment-refractory AD, and the appropriate workup may be initiated while awaiting dermatology referral.AD patients have multiple cutaneous and extra-cutaneous comorbidities that warrant screening by internists, especially mental health conditions.
Topics: Depression; Dermatitis, Atopic; Dermatology; Disease Management; Food Hypersensitivity; Humans; Mental Health; Sleep
PubMed: 34787024
DOI: 10.1080/07853890.2021.2004322 -
The American Journal of Medicine Jan 2020
Topics: Anti-HIV Agents; Disease Eradication; Epidemics; HIV Infections; Humans; Internal Medicine; Mass Screening; Physician's Role; Pre-Exposure Prophylaxis; United States
PubMed: 31220428
DOI: 10.1016/j.amjmed.2019.04.051 -
The American Journal of Medicine Jan 2012The internist's goal is to determine a patient's disease risk and to implement preventative interventions. Genetic evaluation is a powerful risk assessment tool, and new... (Review)
Review
The internist's goal is to determine a patient's disease risk and to implement preventative interventions. Genetic evaluation is a powerful risk assessment tool, and new interventions target previously untreatable genetic disorders. The purpose of this review is to educate the general internist about common genetic conditions affecting adult patients, with special emphasis on diagnoses with an effective intervention, including hereditary cancer syndromes and cardiovascular disorders. Basic tenets of genetic counseling, complex genetic disease, and management of adults with genetic diagnoses also are discussed.
Topics: Down Syndrome; Genetic Counseling; Genetic Testing; Humans; Internal Medicine; Neoplastic Syndromes, Hereditary
PubMed: 22079017
DOI: 10.1016/j.amjmed.2011.07.034 -
Thrombosis Research Dec 2016Retinal vein occlusion is a common and important cause of vision loss. In general, knowledge about this condition is scant within an internist's practice but the... (Review)
Review
Retinal vein occlusion is a common and important cause of vision loss. In general, knowledge about this condition is scant within an internist's practice but the condition is relevant because of its association with other chronic ailments. A diagnosis of RVO should prompt the investigation of conditions needing chronic management in these patients. In this review we summarize the clinical presentation of RVO, its classification, associated risk factors, and treatment focused in the internist's scope of practice.
Topics: Anticoagulants; Heparin, Low-Molecular-Weight; Humans; Platelet Aggregation Inhibitors; Prognosis; Retinal Vein; Retinal Vein Occlusion; Warfarin
PubMed: 27838473
DOI: 10.1016/j.thromres.2016.11.004 -
The American Journal of Medicine Aug 2022Atrial fibrillation-no primary care physician can escape it! Atrial fibrillation is the most common tachyarrhythmia encountered in clinical practice-whether family... (Review)
Review
Atrial fibrillation-no primary care physician can escape it! Atrial fibrillation is the most common tachyarrhythmia encountered in clinical practice-whether family practice, internal medicine, cardiology, pulmonology medicine, etc. Moreover, with growth of the older segment of our population and better survival of patients with cardiovascular disorders, the incidence and prevalence of atrial fibrillation are both increasing progressively. Currently, a review of major guidelines shows that the treatment approach to atrial fibrillation involves 4 "pillars"-treatment of contributory comorbidities ("upstream therapy"), control of the ventricular response to the rapid atrial rates during atrial fibrillation, prevention of thromboembolism with oral anticoagulation or left atrial appendage occlusion (except in the minority of patients at too low a thromboembolic risk), and rhythm control in those patients who require it. The latter is the most complex of the 4, and many, if not most, primary care physicians currently prefer to leave this "pillar" to the care of a cardiologist or electrophysiologist. Nonetheless, it is important for the primary care physician to be familiar with the rhythm treatment components and choices (both overall and, specifically, the ones in which they must participate) as they will impact many interactions with their patients in multiple ways. This review details for the primary care physician the components of care regarding rhythm control of atrial fibrillation and the areas in which the primary care physician/internist must be knowledgeable and proactively involved.
Topics: Anti-Arrhythmia Agents; Anticoagulants; Atrial Fibrillation; Cardiology; Humans; Incidence; Thromboembolism
PubMed: 35367447
DOI: 10.1016/j.amjmed.2022.03.016 -
La Revue de Medecine Interne Jul 2014Myasthenia gravis is an autoimmune disease due to specific antibodies inducing a neuromuscular transmission defect causing muscle fatigability. If onset of the disease... (Review)
Review
Myasthenia gravis is an autoimmune disease due to specific antibodies inducing a neuromuscular transmission defect causing muscle fatigability. If onset of the disease may be at any age, myasthenia gravis concerns mostly young adults, in majority females. The disease characteristic features are the following: ocular symptoms (ptosis or diplopia) as main initial manifestation, extension to other muscles in 80 % of the cases, variability of the deficit, effort induced worsening, successive periods of exacerbation during the disease course, severity depending on respiratory and swallowing impairment (if rapid worsening, a myasthenic crisis is to be suspected), association with thymoma in 20 % of patients and with other various autoimmune diseases, most commonly hyperthyroidism and Hashimoto's disease. Diagnosis relies on the clinical features, improvement with cholinesterase inhibitors, detection of specific autoantibodies (anti-AChR or anti-MuSK), and significant decrement evidenced by electrophysiological tests. The points concerning specifically the internist have been highlighted in this article: diagnostic traps, associated autoimmune diseases, including inflammatory myopathies that may mimic myasthenia gravis, adverse effects of medications commonly used in internal medicine, some of them inducing myasthenic syndromes. The treatment is well codified: the treatment is well codified: (1) respect of adverse drugs contra-indications, systematically use of cholinesterase inhibitors, (2) thymectomy if thymoma completed with radiotherapy if malignant, (3) corticosteroids or immunosuppressive agent in severe or disabling form, (4) intensive care unit monitoring, plasmapheresis or intravenous immunoglobulins for patients with myasthenic crisis.
Topics: Autoantibodies; Diagnosis, Differential; Female; Humans; Male; Myasthenia Gravis
PubMed: 24112993
DOI: 10.1016/j.revmed.2013.08.013 -
Revue Medicale Suisse Jan 2017Rare Diseases, defined by a prevalence of less than 1 per 2000 persons, affect 36 million people in Europe, 500 000 in Switzerland, corresponding to 6-8% of the general... (Review)
Review
Rare Diseases, defined by a prevalence of less than 1 per 2000 persons, affect 36 million people in Europe, 500 000 in Switzerland, corresponding to 6-8% of the general population. 7000 rare diseases are currently recorded.Mitochondrial diseases are a heterogeneous group of genetic diseases. They are characterized by intracellular failure of energy production and affect predominantly energy-dependent tissues. The clinical presentation is not always suggestive, particularly in adulthood. In order to reach the diagnosis, a prerequisite is to think of them. In this article, we will focus on the clinical aspects of mitochondrial disorders in order to give the internist simple tools on how not to miss those rare diseases in his daily practice.
Topics: Awareness; Diagnosis, Differential; Health Knowledge, Attitudes, Practice; Humans; Internal Medicine; Mitochondrial Diseases; Physicians; Rare Diseases; Switzerland; Workforce
PubMed: 28703515
DOI: No ID Found -
The Medical Clinics of North America Sep 2008The human costs of unintended pregnancy-abortion and parenting under difficult circumstances-are high. For this reason, all physicians who treat female patients should... (Review)
Review
The human costs of unintended pregnancy-abortion and parenting under difficult circumstances-are high. For this reason, all physicians who treat female patients should be knowledgeable about the basics of contraception-both its practical uses and its public health impact. This knowledge will make physicians, including internists, better able to counsel and provide contraceptives for individual patients and to advocate for availability and access. This article discusses the problem and determinants of unintended pregnancy and reviews contraceptive methods.
Topics: Contraception; Female; Humans; Internal Medicine; Pregnancy; Pregnancy, Unplanned; Sex Education
PubMed: 18721652
DOI: 10.1016/j.mcna.2008.05.001