Do statins cause muscle pain? The short answer is no, they don't. Before delving into this sensitive topic, it's important to distinguish between muscle pain and muscle toxicity. Muscle pain is just that - achy muscles. Muscles can become achy from overuse, physical injury, or as a response to systemic inflammation (e.g. flu). Muscle toxicity, on the other hand, occurs when muscle cells begin to break down and necrose. In its most severe form, muscle toxicity can lead to rhabdomyolysis, a condition where myoglobin released from disintegrating muscles damages the kidneys. In rare cases, statins can cause muscle toxicity. more
The AUA has published new benign prostatic hyperplasia (BPH) guidelines. The recommendations offer guidance on prescribing alpha blockers and when to consider tadalafil and combination therapy with 5-alpha-reductase inhibitors.
Patients with chronic kidney disease retain sodium and fluid, and this causes their blood pressure to rise. Current guidelines state that thiazide diuretics are not as effective in patients with a GFR < 30 ml/min, and loop diuretics are preferred. This guidance has never been confirmed in a randomized controlled trial. A small study (N=160) published in the NEJM looked at the effects of chlorthalidone, an old thiazide diuretic, in patients with hypertension and stage 4 kidney disease (GFR < 30 ml/min). more
The AGA recently issued recommendations on the screening, diagnosis, and treatment of nonalcoholic fatty liver disease (NAFLD). The guidelines are outlined in a "Clinical care pathway" intended for primary care providers, endocrinologists, gastroenterologists, and obesity specialists. Highlights from the guidelines include the following: Screen all patients with metabolic risk factors (e.g. hypertension, low HDL, obesity), type 2 diabetes, liver steatosis on imaging, or elevated LFTs for NAFLD. more
Brexafemme® - novel antifungal agent for vaginal yeast infections
Kloxxado® (naloxone) - nasal spray for opiate overdose
Qelbree® (viloxazine) - new norepinephrine reuptake inhibitor for ADHD
Azstarys® - new methylphenidate product for ADHD
Elepsia XR® - new extended-release version of levetiracetam
Current guidelines recommend that all women 65 years of age or older be screened for osteoporosis with bone mineral density (BMD) testing. The guidelines do not, however, make recommendations on when to rescreen women. In practice, rescreening intervals are all over the place, with some patients never being rescreened and others receiving yearly BMD testing. The latter is particularly true if the practice owns a machine - mind you, nobody is accusing anybody of anything here. more
Recommendations on proper blood pressure measurement state that patients should relax for 3 - 5 minutes while sitting in a chair before taking their blood pressure. They also state that two or more measurements should be taken at least one minute apart. In the clinical setting, these recommendations are rarely followed. Two small studies published in Hypertension evaluated the effects of these recommendations on blood pressure readings. more
The CDC updated its STD guidelines in July 2021; the previous update was in 2015. Conditions with new treatment recommendations include chlamydia, trichomoniasis, epididymitis, and mycoplasma genitalium. Recommendations for gonorrhea were updated in 2020.
Diverticulitis is a condition where outpocketings along the colon's lining become inflamed. Seventy-five percent of diverticulitis cases are uncomplicated, meaning only colon wall inflammation is present. Diverticulitis is considered complicated if abscess, stricture, perforation, obstruction, or fistula are present. For decades, the recommended treatment for diverticulitis has been antibiotics. more
After acute coronary syndrome, dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor is recommended for a period of time to help prevent stent thrombosis and/or myocardial infarction. The optimal length of DAPT and which P2Y12 inhibitor to use are the subject of much debate. A study published in The Lancet compared DAPT with ticagrelor to DAPT with clopidogrel in patients who had undergone PCI with drug-eluting stents for acute myocardial infarction. more
A review of common pediatric infections is now available on Straight Healthcare. The pediatric infections page covers the epidemiology, pathology, symptoms, diagnosis, and treatment of viral and bacterial infections that are prevalent among children. Infections are subdivided by whether or not they cause a rash, and symptom charts are included that can be helpful in identyfying the correct pathogen.
Vaginal "rejuvenation" therapy has become big business, as evidenced by Internet searches that bring up long lists of local practitioners who advertise these services. A popular treatment is the use of lasers that are supposed to "reverse vaginal atrophy and relieve symptoms like vaginal pain, dryness, and urinary incontinence" leading to "improved sexual functioning and cosmetic appearance." more
Acute bronchitis is a lower respiratory tract infection marked by inflammation of the bronchi, the large airways of the lungs. Viruses cause greater than 90% of bronchitis cases, and bacteria account for less than 2%. Bronchitis is responsible for more than 10 million doctor's visits in the U.S. each year. A study published in The Lancet randomized 432 children aged 6 months to 12 years (average age 3.2 years) with presumptive bronchitis to amoxicillin or placebo for 7 days. more
Sports Illustrated recently reported that Dallas Cowboys quarterback Dak Prescott received platelet-rich plasma (PRP) injections for a calf injury. Proponents of PRP injections contend that injecting bloodborne cytokines and growth factors in and around damaged tendons and joints accelerates healing. more
A new drug for the treatment of ADHD is now available. Qelbree® (viloxazine) is a nonstimulant that works by inhibiting the reuptake of norepinephrine; this mechanism of action is the same as Strattera®. It is approved for ADHD in children 6 - 17 years old. The main side effects are somnolence, headache, decreased appetite, and fatigue. more
The white coat blood pressure effect occurs when blood pressure readings run higher in a clinical setting as opposed to another setting like the patient's home. It is estimated that up to 20% of people diagnosed with stage I hypertension actually have white coat hypertension. A small study published in the journal Hypertension took 18 people with mild-to-moderate untreated hypertension and measured their blood pressure multiple times over the course of 10 minutes with an automated cuff. more