RESUMEN
BACKGROUND: Baseline depressive symptoms are associated with subsequent adverse cardiovascular (CV) events in subjects with and without diabetes but the impact of persistent symptoms vs. improvement remains controversial. OBJECTIVE: Examine long-term changes in depressive symptoms in individuals with and without diabetes and the associated risk for adverse CV events. DESIGN: REGARDS is a prospective cohort study of CV risk factors in 30,000 participants aged 45 years and older. PARTICIPANTS: N = 16,368 (16.5% with diabetes mellitus) who remained in the cohort an average of 11.1 years later and who had complete data. MAIN MEASURES: Depressive symptoms were measured using the 4-item Centers for Epidemiologic Study of Depression (CES-D) questionnaire at baseline and again at a mean follow-up of 5.07 (SD = 1.66) years. Adjudicated incident stroke, coronary heart disease (CHD), CV mortality, and a composite outcome were assessed in a subsequent follow-up period of 6.1 (SD = 2.6) years. METHODS: The association of changes in depressive symptoms (CES-D scores) across 5 years with incident CV events was assessed using Cox proportional hazards modeling. KEY RESULTS: Compared to participants with no depressive symptoms at either time point, participants without diabetes but with persistently elevated depressive symptoms at both baseline and follow-up demonstrated a significantly increased risk of incident stroke (HR (95% CI) = 1.84 (1.03, 3.30)), a pattern which was substantially more prevalent in blacks (HR (95% CI) = 2.64 (1.48, 4.72)) compared to whites (HR (95% CI) = 1.06 (0.50, 2.25)) and in those not taking anti-depressants (HR (95% CI) = 2.01 (1.21, 3.35)) in fully adjusted models. CONCLUSIONS: The persistence of depressive symptoms across 5 years of follow-up in participants without diabetes identifies individuals at increased risk for incident stroke. This was particularly evident in black participants and among those not taking anti-depressants.
Asunto(s)
Enfermedades Cardiovasculares , Diabetes Mellitus , Accidente Cerebrovascular , Humanos , Enfermedades Cardiovasculares/epidemiología , Estudios Prospectivos , Factores de Riesgo , Diabetes Mellitus/epidemiología , Depresión/diagnóstico , Accidente Cerebrovascular/epidemiología , Modelos de Riesgos Proporcionales , IncidenciaRESUMEN
Gastroesophageal reflux disease (GERD) is commonly managed in both primary and secondary care settings, as this condition occurs in patients of all ages and has a wide variety of clinical presentations. However, evidence suggests that GERD is commonly overdiagnosed and overtreated. Adherence to guidelines may help reduce the harms of overdiagnosis.
Asunto(s)
Reflujo Gastroesofágico/terapia , Uso Excesivo de los Servicios de Salud , Reflujo Gastroesofágico/diagnóstico , Humanos , Inhibidores de la Bomba de Protones/efectos adversosRESUMEN
Stinging insects are a frequent cause of local and systemic hypersensitivity reactions, including anaphylaxis. For those with a history of life-threatening anaphylaxis, venom immunotherapy is effective, safe, and can be life-saving. Arachnids are a much less common source of envenomation through bites or stings and are less likely to cause a hypersensitivity reaction. However, recognizing the clinical manifestations when they do present is important for accurate diagnosis and treatment, and, when indicated, consideration of other diagnoses.
Asunto(s)
Anafilaxia , Mordeduras y Picaduras de Insectos , Humanos , Mordeduras y Picaduras de Insectos/complicaciones , Anafilaxia/terapia , Anafilaxia/diagnóstico , Anafilaxia/etiología , Animales , Hipersensibilidad/terapia , Hipersensibilidad/diagnóstico , Venenos de Artrópodos/inmunología , Venenos de Artrópodos/efectos adversos , Desensibilización Inmunológica/métodos , Hipersensibilidad al VenenoRESUMEN
Stinging insects are a frequent cause of local and systemic hypersensitivity reactions, including anaphylaxis. For those with a history of life-threatening anaphylaxis, venom immunotherapy is effective, safe, and can be life-saving. Arachnids are a much less common source of envenomation through bites or stings and are less likely to cause a hypersensitivity reaction. However, recognizing the clinical manifestations when they do present is important for accurate diagnosis and treatment, and, when indicated, consideration of other diagnoses.
Asunto(s)
Anafilaxia , Himenópteros , Hipersensibilidad , Mordeduras y Picaduras de Insectos , Hipersensibilidad al Veneno , Animales , Humanos , Anafilaxia/diagnóstico , Anafilaxia/etiología , Anafilaxia/terapia , Mordeduras y Picaduras de Insectos/complicaciones , Mordeduras y Picaduras de Insectos/diagnóstico , Mordeduras y Picaduras de Insectos/terapia , Hipersensibilidad/diagnóstico , Hipersensibilidad/terapia , Desensibilización Inmunológica/efectos adversosRESUMEN
Embedded fishhooks, digital ring entrapment, and foreign bodies of the ear, nose, and superficial eye and conjunctiva may present to primary care clinics and can often be managed there. This review is a guide for primary care clinicians for effective, pragmatic, and safe techniques to address these scenarios in the office and when to refer them to a surgeon.
Asunto(s)
Cuerpos Extraños en el Ojo , Cuerpos Extraños , Conjuntiva , Cuerpos Extraños en el Ojo/diagnóstico , Cuerpos Extraños en el Ojo/cirugía , Cuerpos Extraños/cirugía , Humanos , Nariz , Atención Primaria de SaludRESUMEN
The location of the patient's lesions, as well as her underlying conditions, pointed to the diagnosis.
Asunto(s)
Enfermedad de Darier/etiología , Enfermedad de Darier/terapia , Diabetes Mellitus Tipo 2/complicaciones , Fallo Renal Crónico/complicaciones , Femenino , Humanos , Ácido Láctico/uso terapéutico , Persona de Mediana Edad , Terapia UltravioletaRESUMEN
Was this a malignant lesion or an unusual presentation of a benign nodule?