查看更多>>摘要：A number of patients with poor glycemic control receive the diagnosis of type 2 diabetes despite the fact that they do not exhibit some of the traditional characteristics of the disease, such as obesity. A more accurate diagnosis for many of these patients is latent autoimmune diabetes of adulthood (LADA). In this article, Dr Nabhan and coauthors describe features that LADA has in common with type 1 and type 2 diabetes, as well as those that distinguish LADA from these more widely recognized forms of diabetes. The authors also describe the pathogenesis of the disease, potential complications, and treatment options.
查看更多>>摘要：Evaluation and diagnosis of obstructive lung disease call for careful history taking to distinguish asthma from chronic obstructive pulmonary disease (COPD). A history of atopy and intermittent, reactive symptoms points toward a diagnosis of asthma, whereas smoking and advanced age are more indicative of COPD. Clinical features such as cough and wheezing, especially in light of patient history, can be suggestive but are not definitive. Spirometry, usually performed in the primary care setting, is the key diagnostic tool that distinguishes patients with asthma from patients with COPD. In this article, the authors outline an approach to differential diagnosis of asthma and COPD that should result in better evaluation, therapy, and quality of life for these patients.
查看更多>>摘要：Knowledge about COPD has increased substantially in recent years. Smoking cessation campaigns have significantly decreased smoking prevalence in the United States, and similar efforts in the rest of the world will likely have the same impact. The consequence should be a drop in incidence of COPD in the years to come. The use of LTOT for hypoxemic patients has resulted in increased survival, and expanded drug therapy options have effectively improved dyspnea and quality of life. Recent studies have documented the benefits of pulmonary rehabilitation. In addition, noninvasive mechanical ventilation offers new alternatives for patients with acute or chronic failure. Furthermore, the revival of surgery for emphysema may serve as an alternative to lung transplantation for patients with severe COPD who remain symptomatic despite maximal medical therapy. With all of these options, a nihilistic attitude toward management of COPD is not justified.
查看更多>>摘要：Symptomatic PVD is a common age-related problem that in some patients is associated with retinal tear and retinal detachment. Thorough ocular examination of patients with unilateral floaters and photopsias is needed to identify those at greatest risk for vision loss. Patients without retinal pathologic findings on initial examination need to be given careful instructions on what to expect and do should symptoms of retinal tear or detachment occur.
查看更多>>摘要：Recent breakthroughs in technology have produced tests for HIV antibody that are highly accurate and easy to use and can give a preliminary result in 20 minutes or less. These rapid HIV tests will be used increasingly in labor and delivery wards, emergency departments, urgent care centers, and the primary care office. They have unique applications for healthcare worker exposures, military operations, public health venues, and developing countries. In this article, Drs Keenan, Keenan, and Branson discuss the advantages and limitations of rapid HIV testing in various settings.
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