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Functional voice problems are more common in several chronic pain syndromes

Martes, Octubre 27, 2020

In a retrospective study, researchers examined associations between laryngeal disorders and fibromyalgia, irritable bowel, and chronic fatigue.

Fibromyalgia, irritable bowel, and chronic fatigue are syndromes that share chronic pain and other unexplained symptoms among their clinical manifestations. 



Código de aprobación: PP-PPF-ECU-0046

Delirium and Long-Term Cognitive Decline: Real Data

Martes, Octubre 27, 2020

Meta-analyses of studies of both surgical and nonsurgical patients confirm the long-suspected association.

Delirium is common in postoperative and critically ill hospitalized patients and has been estimated to occur in 25% of postsurgical patients and up to 82% of patients admitted to intensive care units.



Código de aprobación: PP-CNS-ECU-0094

What Happens After a First Episode of Postpartum Psychosis?

Martes, Octubre 27, 2020

A meta-analysis indicates that almost two thirds of women have another psychotic episode, predominantly outside the postpartum period.

Postpartum psychosis denotes a severe mood disorder episode having psychotic, manic, or mixed affective symptoms and occurring within the first few weeks after childbirth.



Código de aprobación: PP-CNS-ECU-0093

What Is the Natural History of Recent-Onset Monoarthritis?

Martes, Octubre 27, 2020

During 2 years of follow-up, most cases resolved, but one quarter developed into chronic inflammatory disease

The differential diagnosis of recent-onset monoarthritis is broad and includes early presentation of what eventually is identifiable as chronic inflammatory rheumatic disease (CIRD)



Código de aprobación: PP-PPF-ECU-0045

Peripheral Nerve Stimulation for Tourette Syndrome

Martes, Octubre 27, 2020

In the laboratory, median nerve stimulation reduced tic frequency and intensity and premonitory sensorimotor urges to tic.​

Tourette syndrome (TS) is a neuropsychiatric disorder marked by involuntary tics, often associated with premonitory urges.


Código de aprobación: PP-CNS-ECU-0092

Disrupted Structural Connectivity in Prefrontal Areas in Borderline Personality Disorder

Martes, Octubre 27, 2020

Disturbances are seen in white-matter structures responsible for the appropriate inhibition and control of emotions.

Many of the core features of borderline personality disorder (BPD; irritability, impulsivity, emotional instability) suggest disruption in frontolimbic brain circuits.



Código de aprobación: PP-CNS-ECU-0095

Predicting Cardiovascular Risks in a Contemporary Population

Martes, Octubre 27, 2020

The widely accepted pooled cohort equations overestimate 5-year risk in a cohort of Veterans Affairs patients, with implications for statin eligibility.

The pooled cohort equations (PCE) were developed to estimate the risk for an initial atherosclerotic cardiovascular disease (ASCVD) event. 



Código de aprobación: PP-CVP-ECU-0067

CSF Inflammatory Biomarkers of Multiple Sclerosis Disease Activity

Martes, Octubre 6, 2020

In a prospective 4-year study, more of those with elevated cytokine levels had evidence of disease activity.

Although multiple sclerosis (MS) is often considered a disease of the white matter, appreciation is growing that pathology also directly affects the cortex.



Código de aprobación: PP-CNS-ECU-0077

Associations Between Mental Disorders and Subsequent Medical Conditions

Martes, Octubre 6, 2020

Letter from the Editor

This collection (a seminal study from Denmark and several summaries of related studies along the medical-psychiatric interface) reminds us that the mind and body are continually interacting and affecting one another.




Código de aprobación: PP-CNS-ECU-0076

Implantable Cardiac Devices: Accessibility, Variability and Complications

Viernes, Octubre 2, 2020

Letter from the Editor

Access to medical care varies tremendously around the globe. It is especially in advanced technology that this variability exists, and particularly between underdeveloped and developed countries.




Código de aprobación:PP-CVP-ECU-0057

Neither Vigorous Activity nor Sedentary Behavior Is Associated with Risk for Knee Osteoarthritis

Viernes, Setiembre 18, 2020

Low-to-moderate physical activity might be protective.

Patients and some clinicians still are concerned that physical activity, particularly vigorous physical activity, might be associated with excess risk for knee osteoarthritis (OA), despite considerable evidence to the contrary.



Código de aprobación: PP-PPF-ECU-0034

New Insights and Future Directions in Parkinson's Disease

Viernes, Setiembre 18, 2020

Letter from the Editor

Clinicians and their patients with Parkinson disease await advances that will improve symptoms and quality of life. This year, we saw the emergence of several important clinical and research developments.




Código de aprobación: PP-CNS-ECU-0075

Plasma Biomarkers May Identify Risk for Dementia

Jueves, Setiembre 10, 2020

Plasma amyloid and neurofilament levels were associated with dementia risk in a population-based cohort.

Assessment of plasma biomarkers is emerging as a potential noninvasive way to determine risk for dementia.



Código de aprobación: PP-CNS-ECU-0066

Anxiety and Depression Can Make You Sick

Miércoles, Setiembre 2, 2020

Long-term associations between mental and physical health are examined in a prospective study.

To address the relationship between health and affective symptoms (anxiety or depression), researchers analyzed data from a British prospective study of 3001 people followed repeatedly since birth in 1946.



Código de aprobación: PP-CNS-ECU-0053

How Common Is ACS After Transcatheter Aortic-Valve Replacement?

Miércoles, Setiembre 2, 2020

Acute coronary syndrome is infrequent, presents most often as non-STEMI, but is associated with high early mortality.

Although as many as 50% of patients who undergo transcatheter aortic-valve replacement (TAVR) have known coronary artery disease, the incidence of acute coronary syndrome (ACS) after TAVR is unknown.



Código de aprobación: PP-CVP-ECU-0043

Pain Tolerability and the 10-Point Scale

Miércoles, Setiembre 2, 2020

A study suggests that asking about pain tolerability has advantages over using a 0-to-10–point numerical rating.

The common practice of asking patients to rate their pain on a 10-point scale might suggest that the goal of pain therapy always is to achieve a score of 0.



Código de aprobación: PP-PPF-ECU-0022

Connections Between the Ability to Cope with Stress and Tau Burden

Miércoles, Setiembre 2, 2020

Self-ratings of higher stress coping ability correlated with lower tau burden on brain scans in older adults.

The relationship between psychological stress and neurodegenerative syndromes has been established clinically.



Código de aprobación: PP-CNS-ECU-0052

Topic Collection: MRI with biopsy for prostate cancer diagnosis - Part I

Miércoles, Setiembre 2, 2020

Letter from the Editor

The late Dr. Willet Whitmore, long-serving Chair of Urology at Memorial Sloan Kettering Cancer Center, noted in his 1973 treatise on the natural history of prostate cancer that “Appropriate treatment implies that therapy be applied neither to those patients for whom it is unnecessary nor to those for whom it will prove ineffective.”




Código de aprobación: PP-MHP-ECU-0030


Hearing Voices in Patients with Trauma

Lunes, Agosto 24, 2020

Auditory hallucinations are common in women with severe PTSD, especially among those who were younger at the initial trauma.

Clinically, auditory hallucinations are most often linked to psychotic disorders, such as schizophrenia, severe bipolar disorders, drug-induced psychoses, and neurodegenerative diseases.



Código de aprobación: PP-CNS-ECU-0051

Remote Telehealth Is Noninferior to In-Person Home-Based

Lunes, Agosto 24, 2020

Remote sessions might become a convenient alternative to traveling for face-to-face care.

Telehealth programs are both cost-effective and more convenient alternatives to in-person interventions in people with dementia, especially as the dementia progresses.



Código de aprobación: PP-CNS-ECU-0050

Mycoplasma genitalium Urethritis: Prevalence and Drug-Resistance Patterns

Lunes, Agosto 24, 2020

Persistent urethritis symptoms are frequent in men regardless of the detection of M. genitalium.

Mycoplasma genitalium (MG) is increasingly recognized as a cause of male urethritis, and recent studies indicate increasing prevalence of macrolide-resistance mutations (MRMs).



Código de aprobación: PP-MHP-ECU-0024

Long-Term Blood Pressure Variability Is Associated with Structural and Functional Changes to the Heart

Jueves, Agosto 13, 2020

Greater BP variability in early adulthood correlated with worse echocardiographic features at middle age.

Visit-to-visit blood pressure variability (BPV) has been associated with adverse cardiovascular outcomes, independent of BP level. To understand if BPV in early adulthood is associated with later subclinical alterations in cardiac structure and function, researchers used data from a U.S.-based community cohort study (CARDIA) in which participants aged 18 to 30 at enrollment underwent eight BP evaluations over 25 years of follow-up and an echocardiogram at year 25.



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Issues in arthroplasty care

Viernes, Julio 10, 2020

Letter from the Editor
The number of patients undergoing hip or knee arthroplasty is increasing, due in considerable part to the increasing prevalence of obesity. This rise has led to an increasing number of clinical decision points for both surgeons and primary care physicians. In the NEJM article, The HEALTH Investigators suggest that hemiarthroplasty (replacement of only the femoral head) in patients with displaced fractures of the femoral neck may be more appropriate than total arthroplasty despite expert recommendations to the contrary.

Código de aprobación: PP-PPF-ECU-0021

Associations Between Blood Pressure and Cognitive Decline

Viernes, Julio 10, 2020

Long-term elevated blood pressure was responsible for greater cognitive decline in black Americans than in white Americans.
Black people, on average, experience earlier onset of elevated blood pressure (BP) and poorer control of BP throughout life than do white people. To establish whether blood pressure is associated with the observed earlier onset of cognitive impairment and faster decline in cognition in black patients, investigators performed a pooled cohort study of almost 20,000 patients (median age at study entry, 55; 20% black [self-reported]).


Código de aprobación: 

Detecting Metastatic Prostate Cancer with Prostate-Specific Membrane Antigen PET-CT

Viernes, Julio 10, 2020

PSMA PET-CT had greater sensitivity and specificity than conventional imaging for detecting pelvic nodal or distant metastases in men with high-risk prostate cancer.
The limitations in sensitivity and specificity of conventional imaging using computed tomography (CT) and bone scans in staging patients with locally advanced prostate cancer are well defined.

Aortic Stenosis and Dyslipidemia

Viernes, Julio 10, 2020

A study using a Mendelian randomization design finds causal associations between elevated total cholesterol and LDL levels and AS.
To date, aortic stenosis (AS) has no recommended prevention strategies, and statins have failed to slow disease progression in randomized trials. However, questions remain about whether dyslipidemia is associated with the condition.

Thoracic Spine Fractures Are Rarely Identified by Chest Radiographs

Viernes, Julio 10, 2020

Most of these fractures can be treated conservatively and are not associated with neurologic sequelae.
To better understand the rate and sequelae of thoracic spine fractures identified in the modern era of liberal computed tomography (CT) scanning of trauma patients, researchers performed a secondary analysis of data from the NEXUS Chest CT study. Patients were blunt trauma victims aged >14 years who received chest imaging (radiographs, CT, or both) at nine trauma centers from 2011 to 2014.


Código de aprobación: PP-PPF-ECU-0016

MRI Scores for Cerebral Small Vessel Disease and Prediction of Dementia

Viernes, Julio 10, 2020

Using MRI to score cerebral small-vessel disease may help predict dementia.
Cerebrovascular disease increases the risk for dementia. To determine whether an MRI score for cerebral small vessel disease (SVD) can assist in the prediction of dementia, investigators examined MRI scans from participants in three longitudinal cohorts. Participants’ SVD ranged from mild and asymptomatic to severe and symptomatic. Each cohort underwent cognitive testing, and conversion to dementia was determined by published criteria or screening mental status examination cutoff scores.


Código de aprobación: 

Accuracy of Patient-Reported Passage of Ureteral Stones

Viernes, Julio 10, 2020

Patient-reported stone passage distinguished somewhat, but not perfectly, between those who did or did not have persistent stones on computed tomography.
We generally ask patients with symptomatic ureteral stones to strain their urine to document passage of a stone. But how accurate are patients’ reports of stone passage? To find out, U.S.

Physical therapy versus meniscectomy

Lunes, Junio 22, 2020

Outcomes at 5 years were not different.

In the previously published METEOR study (NEJM JW Gen Med May 1 2013 and N Engl J Med 2013; 368:1675), researchers randomized 350 patients with meniscal tears and mild-to-moderate osteoarthritis (OA) to physical therapy (PT) alone or meniscectomy followed by PT.


Código de aprobación: PP-UPA-ECU-0003

Impact of single-pill combination therapy onadherence, blood pressure control, and clinicaloutcomes: a rapid evidence assessment ofrecent literature

Miércoles, Junio 17, 2020

Objective: The 2018 European Society of Cardiology/ European Society of Hypertension Guidelines for the management of arterial hypertension raised the need for evidence to support the use of single-pill combination (SPC) therapy in preference to free-dosed therapy for hypertension.



Código de aprobación: PP-CVP-ECU-0029

Ingrese aquí al documento de producto de Norvasc (amlodipino)

* NORVASC 10mg TAB X 30: 2942-MEE-0817
* NORVASC 5mg TAB X 30: 2943-MEE-0817

Topic collection: Transcatheter or surgical Aortic valve replacement

Viernes, Junio 12, 2020

Letter from the Editor
In the past decade, there has been a powerful shift toward the use of transcatheter aortic valve replacement (TAVR) for patients with severe symptomatic aortic stenosis.

Transcranial Magnetic Stimulation for Dementia Diagnosis

Viernes, Junio 5, 2020

Can transcranial magnetic stimulation distinguish among dementia types?
Biomarkers have been useful tools in the diagnosis and management of dementia. Researchers analyzed data from participants at four centers to determine if transcranial magnetic stimulation (TMS) can be used to identify and distinguish among Alzheimer disease (AD), dementia with Lewy bodies (DLB), and frontotemporal dementia (FTD).


Código de aprobación: PP-CNS-ECU-0028

Using Routine Cardiac MRI vs. Echocardiography (with Selective MRI) in Nonischemic Heart Failure

Viernes, Junio 5, 2020

Routine MRI doesn’t improve diagnostic specificity or patient outcomes.

Cardiac magnetic resonance (CMR) imaging is increasingly used to assess structure and function. In cardiomyopathy, CMR is used to assess patients for evidence of infiltration or inflammation; late gadolinium enhancement, a common finding in cardiomyopathies, has prognostic implications. These investigators assessed routine CMR versus echocardiography with selective use of CMR in patients with newly diagnosed or worsening heart failure (HF).


Código de aprobación: PP-CVP-ECU-0024

Impact of single-pill combination therapy on adherence, blood pressure control, and clinical outcomes- a rapid evidence assessment of recent literature

Martes, Mayo 26, 2020

The 2018 European Society of Cardiology/ European Society of Hypertension Guidelines for the management of arterial hypertension raised the need for evidence to support the use of single-pill combination (SPC) therapy in preference to free-dosed therapy for hypertension. This systematic rapid evidence assessment sought to determine if initiating SPC therapy improves adherence, blood pressure (BP) control and/or cardiovascular outcomes vs. initiation of free-dose combination therapy.



Código de aprobación: PP-CVP-ECU-0022

Prostatic Artery Embolization to Treat Complications of BPH

Viernes, Mayo 22, 2020

This procedure shows promise for selected patients with benign prostatic hyperplasia.
Prostatic artery embolization (PAE), an outpatient procedure performed by interventional radiologists, is an option for managing urinary retention and severe hematuria caused by benign prostatic hyperplasia (BPH). Patients at high risk for complications from more invasive treatments and patients with extremely large prostate volume are especially suitable for PAE.


Código de aprobación: PP-MHP-ECU-0013

Understanding the Complexity of the Migraine Brain

Viernes, Mayo 22, 2020

Brain regions showing consistent alterations in migraineurs converge to a common brain network, which includes areas with a pivotal role in migraine pathophysiology.
Neuroimaging studies have shown functional and structural alterations of different brain areas in migraine patients, raising new questions. How do these regions interact with each other? Does a unique network enclose all these brain areas? Are these neuroimaging findings migraine specific?


Código de aprobación: PP-CNS-ECU-0024

How Unhealthy Is Pollution with Fine Particulate Matter?

Jueves, Mayo 7, 2020

Researchers in China find heightened short-term risks for cardiovascular hospitalizations.
Studies are accumulating about the relationship between air quality and cardiovascular risk. Because air quality in many areas of the world is deficient, we need to quantify the health effects at levels exceeding those that have been designated as safe, particularly with respect to short-term exposure.

Trends in Heart Failure Outcomes

Jueves, Mayo 7, 2020

Although overall mortality has changed little between 2002 and 2013, noncardiovascular mortality has increased, especially among the oldest old.
We have made substantial progress in improving outcomes for patients with ischemic heart disease, but what about for patients with heart failure? Investigators examined a clinical database of about 7% of the U.K. population to assess trends in 1-year mortality and hospital admissions among 86,833 patients with a diagnosis of incident heart failure from 2002 through 2013 (aged ≥80, 48%; ≥3 comorbidities, 79%; women, 49%).


Código de aprobación: 

New Endoscopic Surgical Treatments for BPH

Miércoles, Abril 29, 2020

All eight evaluated endoscopic modalities were safer than transurethral resection of prostate in men with benign prostatic hyperplasia.
For decades, monopolar transurethral resection of prostate (TURP) has been the mainstay surgical treatment for men with benign prostatic hyperplasia (BPH). During monopolar TURP, the prostate adenoma is removed, piece by piece, with a monopolar electrode. In this network meta-analysis of 109 randomized controlled trials, researchers compared the efficacy and safety of monopolar TURP with eight newer endoscopic surgical modalities for BPH.




Does Physical Activity Affect Early Prodromal Parkinson Symptoms?

Miércoles, Abril 29, 2020

Researchers sought to uncover a potential relationship between physical activity and prodromal features of Parkinson disease (PD) — features that precede the clinical diagnosis — using the Nurses’ Health Study and the Health Professionals Follow-Up Study. Participants were followed from 1986 through 2012, with assessments at baseline and longitudinally at many consecutive 24-month periods thereafter.



Código de aprobación: PP-CNS-ECU-0015

Quality of Life Associated with Treatments for Prostate Cancer

Martes, Abril 14, 2020

Favorable-risk patients undergoing prostatectomy had worse sexual function at 3 years and worse urinary incontinence at 5 years than those managed with active surveillance.
Because the optimal treatment for men with localized prostate cancer remains undefined — given the great heterogeneity of the disease and a lack of prospective comparative studies — gaining a better understanding of the short- and long-term adverse effects associated with interventions is critical.


Código de aprobación: PP-MHP-ECU-0007

Autism Spectrum Disorder and Comorbid Mood and Anxiety Disorders

Martes, Abril 14, 2020

1+1=3: Autism significantly increases risks for both mood and anxiety disorders.
When Kanner described autistic disturbances of affective contact in 1943, he observed that one of the hallmark clinical features was an “anxiously obsessive desire for the maintenance of sameness.” Many studies since have documented the prevalence of co-occurring psychiatric disorders in patients with autism spectrum disorder (ASD). In this population-based study, investigators leveraged a cohort of 31,220 individuals born from 1976 to 2000 in Olmsted County, Minnesota, to ascertain the prevalence of bipolar

Percutaneous Treatment of Tricuspid Regurgitation

Martes, Abril 14, 2020

Catheter-based edge-to-edge repair may provide benefit, according to results from a preliminary single-arm trial.
Tricuspid regurgitation (TR), a common form of valvular heart disease, frequently results from right ventricular dilatation and leaflet tethering, leading to malcoaptation of the leaflets. TR has been associated with poor long-term survival and with impaired response to correction of left-sided cardiac pathology.


Código de aprobación: PP-CVP-ECU-0013

Updated AAP Guidance on ASD Detection and Management

Viernes, Marzo 27, 2020

Primary care clinicians are encouraged to refer early, partner with families to make treatment decisions, and know their community resources.

With the prevalence of autism spectrum disorder (ASD) now estimated at 1 in 59 U.S. children, the American Academy of Pediatrics (AAP) has updated its 2007 clinical report on ASD screening and management. Important points for clinicians include the following:


Código de aprobación: PP-CNS-ECU-0011

Large-Scale Assessment of a Smartwatch to Identify Atrial Fibrillation. NEJM Journal Watch summary, reused with permission from NEJM Group

Jueves, Marzo 19, 2020

Optical sensors on wearable devices can detect irregular pulses. The ability of a smartwatch application (app) to identify atrial fibrillation during typical use is unknown.
Participants without atrial fibrillation (as reported by the participants themselves) used a smartphone (Apple iPhone) app to consent to monitoring. If a smartwatchbased irregular pulse notification algorithm identified possible atrial fibrillation, a telemedicine visit was initiated and an electrocardiography (ECG) patch was mailed to the participant, to be worn for up to 7 days.


Código de aprobación: 

An instrumental treatment for negative symptoms in schizophrenia

Miércoles, Marzo 18, 2020

Improvement with 1 week of treatment with transcranial direct current stimulation is sustained for 12 weeks.
Because negative symptoms of schizophrenia have been associated with low activity in the prefrontal cortex (PFC), researchers in a sham-controlled, Brazilian study examined the effects of transcranial direct current stimulation (tDCS) in 95 schizophrenia patients with prominent negative symptoms. The device is commercially available but does not have FDA approval.


Código de aprobación: PP-CNS-ECU-0008

Connecting Stress Disorders with Life-Threatening Infections

Miércoles, Marzo 18, 2020

Multiple stress disorders, but most strongly post-traumatic stress disorder, increase the risk for serious infections.
The poor physical health of individuals with post-traumatic stress disorder (PTSD) is presumed to occur through the stress-related compromise of multiple physiological systems producing an excess of somatic complaints and bona fide medical illnesses.


Código de aprobación: PP-CNS-ECU-0007

Light, Dark, and Bipolar Disorder- Some Practical Guidance

Martes, Marzo 17, 2020

Interventions affecting circadian rhythm can be therapeutic, with some approaches more effective than others.
Chronotherapies, interventions that affect the circadian rhythm, have been studied in both the depressive and the manic stages of bipolar disorder through the years (e.g., NEJM JW Psychiatry Nov 2017 and Am J Psychiatry 2017; 175:131; NEJM JW Psychiatry Nov 2009 and Biol Psychiatry 2009; 66:298). In this review, the authors have compiled the evidence and recommendations from an International Society of Bipolar Disorders task force. The major treatments include:


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Does Testosterone Therapy Confer Risk for Venous Thromboembolism?

Miércoles, Marzo 4, 2020

In a case-crossover study, testosterone therapy was associated with excess risk.
Testosterone therapy can induce hematologic abnormalities associated with hypercoagulability, but whether it actually confers excess risk for venous thromboembolism (VTE; i.e., deep venous thrombosis or pulmonary embolism) is controversial. In this study, researchers used U.S. national pharmacy and medical claims databases to identify about 40,000 men (mean age, 57) with incident VTE and at least 12 months of data before VTE.



Código de aprobación: PP-MHP-ECU-0002