Prostate disorders diagnosis and management review with an osteopathic component

Physicians commonly encounter disorders of the prostate in the primary care setting, where shared decision making for prostate cancer screening should also occur. Hence, it is important for physicians to understand and differentiate the diagnoses of prostate disease. Initial evaluation should include a thorough history, physical examination, laboratory examination and imaging, if necessary. This article aims to provide a diagnostic and management approach for prostate disease.

Acute giardiasis and Chapman reflexes: Musculoskeletal symptoms preceding, during and after infection

Giardiasis is an acute infection caused by Giardia lamblia, which produces profuse secretory diarrhea that can lead to dehydration and electrolyte derangement. Musculoskeletal manifestations resulting because of giardiasis occur due to prolonged inflammation and viscero-somatic reflexes of the pathophysiology for this disease process. By treating the parasitic infection with an antiparasitic agent, as well as treating the somatic dysfunctions with osteopathic manipulative treatment, analgesics and a home exercise program, the patient in the following article experienced an uneventful course of treatment and a complete recovery including resolution of the pain.

Hyperpigmented nodular rash in a 61-year-old African American female

A 61-year-old African American female presents to an outpatient family health center with a hyperpigmented nodular rash of 2 months’ duration. The rash first appeared on her abdomen before spreading across her upper arms, lower leg, back, face and scalp. She has a history of controlled type 2 diabetes mellitus, cerebral aneurysm rupture, Sjögren’s syndrome, asthma and a left below-the-knee amputation due to osteomyelitis. She smokes cigarettes but does not use alcohol or illicit substances. She has also noticed a dry cough with mild dyspnea on exertion over the past 6 months. On physical exam, hyperpigmented nodules are palpable in both the intradermal and subcutaneous layers of the skin. Nodules are firm, mobile and nontender. Alopecia is noted where scalp nodules are present. Her lungs exhibit diminished air movement throughout, with scattered, end-expiratory wheezing.

Determinants of postoperative atrial fibrillation: A retrospective evaluation of postoperative atrial fibrillation in cardiac surgery

Atrial fibrillation is the most common postoperative arrhythmia and is associated with increased length of stay, cost, morbidity and mortality. The incidence of postoperative atrial fibrillation for noncardiac, nonthoracic surgeries ranges from 0.4% to 26%. The incidence increases to 20%–50% in cardiac surgery, occurring in approximately 30% of isolated coronary artery bypass grafting (CABG), approximately 40% of isolated valve surgeries and up to 50% of CABG plus valve surgeries. Our aim was to identify risk factors that may predispose patients to postoperative atrial fibrillation and compare the efficacy of previously developed prediction tools to a new bedside prediction tool. We sought to develop a bedside screening tool using 4 easily identifiable variables: body mass index, age, congestive heart failure and hypertension (BACH). We predicted that our model would compare similarly to previously developed and validated prediction models but would be easier to use.

Emerging non-invasive neuroplastic-targeting therapies for substance use disorder treatment

Context: America is in the midst of a substance use disorder (SUD) epidemic, which has only worsened in the current COVID-19 pandemic. SUD is a public health crisis that affects an everincreasing proportion of the population and is extraordinarily difficult to treat. Misused substances induce neuroplastic changes that not only predispose individuals to relapse but also persist after completing treatment recommendations.

Glaucoma: A review for the family physician

Glaucoma is an insidious disease process that causes damage to the optic nerve head and retinal nerve fiber layer, resulting in progressive vision loss. Multiple factors play a role in its pathophysiology, but intraocular pressure is a significant yet modifiable risk factor and therefore is targeted by all current treatment modalities. Its high prevalence and potential for irreversible damage necessitate an understanding of the condition by primary care physicians, who will undoubtedly be managing conditions and medications that can influence glaucomatous progression. This article will explore the pathophysiologic basis of glaucoma, discuss some of the common subtypes and highlight important clinical considerations.

Improving diagnosis and treatment of benign paroxysmal positional vertigo

Background: Vertigo is defined as an illusion of motion caused by a mismatch of information between the visual, vestibular and somatosensory systems. The most common diagnosis associated with whirling vertigo is benign paroxysmal positional vertigo (BPPV), which affects approximately 3.4% of patients older than 60 years of age. Objective: This paper aims to educate primary care providers on how to diagnose BPPV by performing canalith repositioning maneuvers at the initial point of care. Timely treatment of BPPV in the primary care office is believed to reduce healthcare costs by way of limiting unnecessary diagnostic testing and lowering referrals for specialty care. Immediate treatment is also believed to improve the quality of healthcare delivery for the vertigo patient by reducing morbidity and resolving the condition without the need for referrals or imaging. Population Health: A review of the literature finds that delayed diagnosis and treatment of BPPV is associated with a host of deleterious effects on patients. Population health impacts include increased rates of anxiety and depression; loss of work and/or change of career paths; inappropriate use of medications or emergency care resources; decreased access to healthcare services; increased healthcare costs; and reduced quality of care. Diagnosis: A history of positional vertigo and evidence of nystagmus with Dix-Hallpike positioning confirms the diagnosis. A detailed description of the performance of this test is elucidated. Treatment: The observed nystagmus is analyzed and classified based on directionality. Treatment can be initiated immediately with canalith repositioning maneuvers.

Physician perceptions of stress and telemedicine

Introduction: Telemedicine is an emerging field in which physicians can interact electronically with patients to improve health. During the COVID-19 pandemic, the use of telemedicine has grown exponentially. As physicians work to provide equally high-quality care for their patients remotely, their experiences must be considered. Methods: This study utilized an online anonymous survey of physicians to assess their satisfaction, comfort level and student involvement when using telemedicine for patient care. Results: Overall, physicians’ experiences with the integration of telemedicine into their practices varied based on gender, the presence of medical students, age and prior experience with telemedicine. Physicians are more comfortable with telemedicine now than they had been prior to the start of the COVID-19 pandemic, and physicians who had prior experience were less likely to find it stressful to incorporate. Physicians in both the youngest (30–39 years old) and oldest (60 and older) categories reported the highest levels of satisfaction with telemedicine. Female physicians indicated they will be more likely to incorporate more telemedicine into practice in the future, beyond the COVID-19 pandemic. Of the specialties surveyed, family physicians report the lowest levels of comfort and satisfaction with telemedicine. Conclusion: Physician respondents of this survey provided valuable data on the perceptions of the widespread incorporation of telemedicine during the COVID-19 pandemic. Further research can follow which physicians choose to keep telemedicine integrated into their practices and how the demand for these virtual visits may change in the coming months.

An osteopathic approach to carpal tunnel syndrome

Carpal tunnel syndrome (CTS) is a common cause of medical and workforce-related expenses in the United States. It is also frustrating for patients who have difficulty using the affected hand, impairing their activities of daily living and decreasing their quality of life. By utilizing the philosophy of osteopathic medicine, providers can better implement a treatment plan by working with the patient to find one that incorporates all aspects of the patient’s environment. By using the practice of osteopathic manipulative therapy (OMT), osteopathic physicians can often effectively treat the patient’s symptoms without side effects found in medications. This is especially useful in patients who may be unable to take certain medications, such as pregnant patients. Other treatment modalities are also reviewed in this manuscript.