[Top 5 Research Studies of the month for Italian Primary Care Physicians: May 2024.] / La Top 5 di maggio 2024. Gli studi clinici che vale la pena conoscere se lavori nelle cure primarie in Italia.

This monthly article provides a collection of summaries of the most relevant studies identified as POEMs (patient-oriented evidence that matters) for Italian primary care physicians. 1) The 2023 updated American college of cardiology/American heart association guideline provide new recommendations for the diagnosis and treatment of atrial fibrillation. In a nutshell, screening is not recommended, and treatment decisions should be guided by risk assessment via CHA2DS2-VASC or a similar tool. For most patients, a direct oral anticoagulant (Doac) at a standard dose is recommended. 2) The use of gabapentin or pregabalin is associated with severe exacerbation of chronic obstructive pulmonary disease (Copd). Various government agencies warn about the use of those gabapentinoids in patients with respiratory risk factors. 3) In children 3 months to 5 years of age with an uncomplicated febrile urinary tract infection, 5 days of antibiotic treatment results in similar resolution of symptoms and 30-day recurrence rates as 10 days of treatment. 4) In adults with type 2 diabetes, bariatric surgery results in superior glycemic control and weight loss compared with medical plus lifestyle management. However, no significant differences occurred in major adverse cardiovascular events or all-cause mortality. Other (non-cardiovascular) adverse events occurred significantly more often in the surgery group, so it is uncertain whether the overall quality of life, morbidity or mortality are better or worse with surgery. 5) Prescribing a specific exercise program, whether aerobic or strength training, produces clinically meaningful and statistically significant benefits in patients with major depressive disorder. The advice can't be simply to "exercise more" but should be a specific exercise prescription, just like a medication prescription, specifying the frequency, intensity, time (duration), and type of exercise.

Storylines of family medicine IV: perspectives on practice-lenses of appreciation.

Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine, as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In 'IV: perspectives on practice-lenses of appreciation', authors address the following themes: 'Relational connections in the doctor-patient partnership', 'Feminism and family medicine', 'Positive family medicine', 'Mindful practice', 'The new, old ethics of family medicine', 'Public health, prevention and populations', 'Information mastery in family medicine' and 'Clinical courage.' May readers nurture their curiosity through these essays.

Food Allergies: Diagnosis, Treatment, and Prevention.

In the United States, approximately 2% to 3% of adults and 8% of children have a food allergy. Allergic reactions range from minor pruritus to life-threatening anaphylaxis. These allergies often lead to significant anxiety and costs for patients and caregivers. Common food allergies include peanuts, cow's milk, shellfish, tree nuts, egg, fish, soy, and wheat. Peanut allergy, the most common, is the leading cause of life-threatening anaphylaxis. Children with asthma, allergic rhinitis, atopic dermatitis, or an allergy to insect venom, medications, or latex are at an increased risk of developing food allergies. Diagnosis of food allergy starts with a detailed, allergy-focused history. Serum immunoglobulin E and skin prick testing provide reliable information regarding food allergy diagnoses. Primary treatment involves elimination of the offending food from the diet. Prevention strategies proven to decrease the risk of developing a food allergy include restricting exposure to cow's milk in the first three days of life and early sequential exposure to allergenic foods starting between four and six months of age. Exclusive breastfeeding for three to four months reduces the likelihood of developing eczema and asthma but does not reduce development of food allergies. Most children eventually outgrow allergies to cow's milk, egg, soy, and wheat. However, allergies to tree nuts, peanuts, and shellfish are more likely to be lifelong.

52-year-old man • erectile dysfunction • insomnia • migraine headaches • disclosure of infidelity.

► Erectile dysfunction ►Insomnia ► Migraine headaches ►Disclosure of infidelity.