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Monthly Archives: February 2016

February 27, 2016

The results of the SPRINT trial included 9361 hypertensive patients 50 years of age or older randomized to either a standard systolic blood pressure target of 140 mm Hg or an intensive treatment target of 120 mm Hg.  The primary (composite) outcome was myocardial infarction, other acute coronary syndromes, stroke, …

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Question #822

Test Your Knowledge

Mr. Hernandez is an overweight (BMI 30 kg/m2), 45-year-old plumber of Hispanic heritage who arrives at your office for a first-time visit. He has not been to a physician during the last 7 years because he hasn’t always had health insurance and “doesn’t like going to the doctor.” However, he has been noticing lately that his vision seems a little blurry and he’s developed a red, itchy rash in his groin. He is a non-smoker and recalls being told a long time ago that he should eat a low salt diet, but he can’t remember why. On examination, his BP is 154/96 mm/Hg, and his pulse is 72, RR 22. His physical exam is notable for signs of a yeast infection in his groin. You order a CBC, Chem 12 panel and A1C to be drawn that day before he leaves. You advise him how to treat his skin infection. When you receive the results of the Chem 12 panel, it shows a random plasma glucose of 162 mg/dL and A1C 7.3%. You call Mr. Hernandez and ask him to return the next morning, before he has eaten, for additional labs. You order the necessary labs. Mr. Hernandez labs return and are notable for A1C 7.5, FPG 137 mg/dL, LDL-cholesterol 190 mg/dL, HDL-cholesterol 38 mg/dL and triglycerides 232 mg/dL. You discuss his lab results, his diagnosis and how to manage diabetes and make referrals to the appropriate diabetes team clinicians. You start Mr. Hernandez on metformin, lifestyle modifications, an ACE inhibitor, and a statin. You are looking to achieve A1C <7%, BP<140/90 mmHg, LDL<100 mg/dL You ask Mr. Hernandez to return in 3-months time to evaluate how everything is going. However, he fails to keep his appointment. He returns 1 year after his initial diagnosis for a recurrent yeast infection. His A1C is currently 8%. Upon questioning, he admits that while he has been good about taking his “heart meds,” he has not taken the “sugar pill” because he didn’t like it. What side effect did the patient most likely find intolerable? A. Diarrhea and abdominal cramping B. Paresthesias C. Increased appetite D. Insomnia Follow the link to see the correct answer.

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Healthcare Solutions

Which of the healthcare solutions proposed by the 2016 presidential candidates do you think would be best? Follow the link to share your opinion! 1. Build on and improve the Affordable Care Act 2. Repeal and replace the ACA 3. Have a single payer “Medicare for all” system 4. Other

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I just spent the day in a conference talking about the genetic differences in different ethnic groups, and how that affects both causes and treatments for diseases such as cancer, congestive heart failure, and hypertension. I personally know how genetics can have an effect, because I lack the proper gene …

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