RESUMEN
Skin conditions during pregnancy fall into three categories: benign hormone-related changes, preexisting skin conditions, and pregnancy-specific disorders. Benign hormonal skin changes (e.g., hyperpigmentation, striae gravidarum, hair and nail changes, vascular changes) are common during pregnancy and often improve or resolve postpartum. Topical therapies, including tretinoin, hydroquinone, and corticosteroids, can be helpful in the postpartum treatment of melasma. The severity of preexisting skin conditions such as acne vulgaris, condylomata acuminata, herpes simplex, hidradenitis suppurativa, and psoriasis varies during pregnancy. Treatment options for chronic skin conditions during pregnancy often differ from usual practice because of safety concerns. Discussion of potential risks and benefits is important. Low- to midpotency topical corticosteroids are generally considered safe during pregnancy, whereas extensive use of high-potency corticosteroids may be associated with low birth weight. Pregnancy-specific skin conditions include atopic eruption of pregnancy, polymorphic eruption of pregnancy, pemphigoid gestationis, intrahepatic cholestasis of pregnancy, and pustular psoriasis of pregnancy. Conditions that may cause adverse fetal outcomes and require consideration of antenatal fetal surveillance include intrahepatic cholestasis of pregnancy, pemphigoid gestationis, and pustular psoriasis of pregnancy.
Asunto(s)
Exantema , Penfigoide Gestacional , Complicaciones del Embarazo , Psoriasis , Enfermedades Cutáneas Vesiculoampollosas , Femenino , Embarazo , Humanos , Complicaciones del Embarazo/diagnóstico , Complicaciones del Embarazo/tratamiento farmacológico , Piel , Psoriasis/diagnóstico , Psoriasis/tratamiento farmacológicoRESUMEN
Obesity is a common condition that is associated with numerous medical problems such as cardiovascular disease, pulmonary disease, and diabetes mellitus. Primary care physicians have an important role in helping patients develop a successful weight loss plan to improve their overall health. Dietary strategies emphasizing reduced caloric intake, regardless of the nutrient composition, are important for weight loss. Behavioral interventions such as motivational interviewing and encouraging physical activity lead to additional weight loss when combined with dietary changes. Medication regimens for concomitant medical problems should take into account the effect of specific agents on the patient's weight. Persons with a body mass index of 30 kg per m2 or greater or 27 kg per m2 or greater with comorbidities who do not succeed in losing weight with diet and activity modifications may consider medication to assist with weight loss. Medications approved for long-term treatment of obesity include orlistat, lorcaserin, liraglutide, phentermine/topiramate, and naltrexone/bupropion. Physicians should consider referring patients for bariatric surgery if they have a body mass index of 40 kg per m2 or greater. For those with obesity-related comorbid conditions, patients should be considered for adjustable gastric banding or other bariatric surgical approaches if they have a body mass index of 30 to 39.9 kg per m2. The most commonly performed procedures for weight loss are Roux-en-Y gastric bypass, sleeve gastrectomy, and adjustable gastric banding. Bariatric surgery is the most effective intervention for weight loss in obese patients, and it leads to improvement in multiple obesity-related conditions, including remission of diabetes.
Asunto(s)
Obesidad/prevención & control , Atención Ambulatoria , Fármacos Antiobesidad/uso terapéutico , Dieta Reductora , Ejercicio Físico , Medicina Familiar y Comunitaria , Humanos , Pautas de la Práctica en Medicina , Estados UnidosRESUMEN
When patients with painful peripheral neuropathy fail to respond to--or are unable to tolerate--standard therapies, consider these lesser-known treatments.
Asunto(s)
Terapias Complementarias , Medicina Familiar y Comunitaria , Neuralgia/tratamiento farmacológico , Enfermedades del Sistema Nervioso Periférico/tratamiento farmacológico , Acetilcarnitina/uso terapéutico , Capsaicina/uso terapéutico , Humanos , Magnesio/uso terapéutico , Ácido Tióctico/uso terapéutico , Complejo Vitamínico B/uso terapéutico , Ácido gammalinolénico/uso terapéuticoAsunto(s)
Anticoagulantes/uso terapéutico , Fibrilación Atrial/tratamiento farmacológico , Accidente Cerebrovascular/prevención & control , Trombosis de la Vena/tratamiento farmacológico , Warfarina/uso terapéutico , Adulto , Anciano , Anticoagulantes/efectos adversos , Femenino , Humanos , Masculino , Accidente Cerebrovascular/tratamiento farmacológico , Warfarina/efectos adversosRESUMEN
Bouveret syndrome is a rare complication of cholelithiasis occurring when a gallstone passes through a cholecystoduodenal or choledochoduodenal fistula and lodges in the pylorus or proximal duodenum causing a gastric outlet obstruction. The case of a 70-year-old male who developed Bouveret syndrome is presented, and the management of this presentation of gallstone ileus by Roux-en-Y duodenojejunostomy is discussed in detail.