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How should a patient with an isolated GGT elevation be ...
Penn R, Worthington DJ. Is serum y-glutamyl transpepti-dase a misleading test? Br Med J 1983; 286:531-535. 6. Davern TJ, Scharschmidt BF. Biochemical liver tests. In: Feldman M, Sleisenger MH, Scharschmidt BF, Klein S, edi-tors. Sleisenger & Fordtran's Gastrointestinal and Liver
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ACC/AHA lipid guidelines: Personalized care to prevent ...
www.ccjm.orgrisk of atherosclerotic cardiovascular disease according to the Pooled Cohort Equations, as well as risk-enhancing factors. Statins are the foundation of pharmacologic therapy, to which ezetimibe and, if necessary, a proprotein con-vertase subtilisin/kexin type 9 inhibitor can be added to achieve lipid goals.
Thoracic aortic aneurysm: Optimal surveillance and …
www.ccjm.orgype A aortic dissection (ie, originating in T the ascending aorta) is a fatal condition with . dismal in-hospital mortality rates of 57% with-out emergency surgery and 17% to 25% with emergency surgery in national and internation - al registries despite advances in management. 3,4. The mortality rate is much lower but still sig-nificant in ...
Sessile serrated polyps: Cancer risk and appropriate ...
www.ccjm.orgGuidelines for surveillance after polypectomy of serrated lesions recommend that patients with a large (≥ 10-mm) ... Two large studies of screening colonoscopy confirmed that the ability to detect sessile ser-rated polyps depends greatly on the skill of the endoscopist.
Sepsis and septic shock: Guideline-based management
www.ccjm.org54 CLEVELAND CLINIC JOURNAL OF MEDICINE VOLUME 87 • NUMBER 1 JANUARY 2020 SEPSIS AND SEPTIC SHOCK to a suspected or confi rmed infection with 2 or more of the following criteria4: • Temperature below 36°C or above 38°C • Heart rate greater than 90/minute • Respiratory rate above 20/minute, or arte-
Can an ARB be given to patients who have had angioedema …
www.ccjm.orgACE inhibitor, Haymore et al10 performed a meta-analysis evaluating only three studies that showed the estimated risk of angioedema with an ARB was between 3.5% and 9.4% in patients with a history of ACE inhibitor-induced angioedema. Later, when the results of the Telmisartan Randomised Assessment Study in ACE Intolerant Subjects With Car-
Three neglected numbers in the CBC: The RDW, MPV, and …
www.ccjm.orgThree neglected numbers in the CBC: The RDW, MPV, and NRBC count CLEVELAND CLINIC JOURNAL OF MEDICINE VOLUME 86 • NUMBER 3 MARCH 2019 167 The complete blood cell count (CBC) is one of the most frequently ordered lab-oratory tests in both the inpatient and outpa-tient settings. Not long ago, the CBC required
TaRek i. abu-Rajab TaMiMi, MD jaMil Y. abuzeTun, MD ...
www.ccjm.orgIn cholestatic liver disorders such as primary sclerosing cholangitis and obstructive gall-stone disease, pruritus tends to be generalized, but worse on the hands and feet.13 Although the severity of pruritus is not directly associated with the level of bile salts and toxic substances, lowering bile salt levels can mitigate symptoms.11
ACE inhibitors and ARBs: Managing potassium and renal …
www.ccjm.orgirbesartan, losartan, valsartan) Aldosterone Aldosterone antagonists (spironolactone, eplerenone) Target cells Mineralocorticoid antagonists Increased sodium absorption, potassium excretion, fluid retention Figure 1. The renin-angiotensin-aldosterone system and drugs that inhibit it.
Endocarditis prophylaxis: the new guidelines
www.ccjm.orgtherapy for esophageal varices, esophageal dilatation, gall bladder surgery, cystoscopy, prostate surgery, and vaginal hysterectomy. Even relatively minor invasive procedures involving the urinary tract or the female genital tract deserve prophylaxis if there is a preexist-ing urinary tract infectio or pelvinc infection in the female.
An algorithm for managing warfarin resistance - ccjm
www.ccjm.orgwarfarin (Coumadin) to get their international normal-ized ratio (INR) into the therapeutic range. The cause of warfarin resistance can be either acquired (eg, poor compliance, drug interactions, dietary interactions) or hereditary, but the genetic mechanisms of warfarin resistance are not well understood. This review offers an
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