Jeannette Y. Wick, RPh, MBA, FASCP

Clinicians often discourage older patients with degenerative cervical myelopathy from pursuing surgery, worrying that lingering pathology, comorbidities, reduced physiological reserves, and age-related spinal cord changes will delay recovery.

Resistance to thyroid hormone (RTH) occurs in rare patients and its clinical presentation is considerably different than that seen in the usual hyperthyroid patient. Patients with this inherited condition produce inordinate levels of thyroid hormone because their negative feedback loop at the pituitary gland is metaphorically snipped. Concurrently, they have normal levels of thyroid-stimulating hormone.

Researchers from the University of Washington in Seattle reported that the use of avatars (digital representations of a coach, buddy, or teacher) improved user satisfaction in interactive, online weight management programs for obese teens.

Americans undergo approximately 90,0000 ventral hernia repairs annually. Those who contract methicillin-resistant staphylococcus aureus infections face a difficult course, and clinicians often struggle to eradicate this tenacious infection.

When women present clinically with acne, hirsutism, and androgenetic alopecia, the likelihood is that the causative hormone is androgen. Collectively, these symptoms signal cutaneous hyperandrogenism.

What factors must be considered to ensure optimal management of perioperative cardiac arrest in the cardiac surgery patient?

Endocrine regulation in ejaculation control is still not well understood. Sex steroids (testosterone and estradiol), pituitary (prolactin and oxytocin), and thyroid hormones may regulate the ejaculatory process, but exact mechanisms are unclear.

A low-dose adrenocorticotropic hormone (ACTH) stimulation test is more sensitive in patients with cases of mild hypoadrenalism, and the high-dose test often misses secondary hypoadrenalism due to pituitary or hypothalamic dysfunction. Endocrinologists still debate test result interpretation for the low-dose test, however.

In previous studies, regular breakfast consumption has been correlated with lower BMI and improved cardiometabolic risk profile. Furthermore, evidence suggests that low-energy density, high-fiber, and high-carbohydrate foods may be more satiating when compared to their alternatives.

The Paleolithic (grain-free) diet is gathering steam among dieters and health conscious individuals alike. Proponents consume only items that, hypothetically, cavemen would have had access to. They claim that modern man can't metabolize comparatively new types of food, and our reliance on processed foods has increased rates of obesity, heart disease, and diabetes.

A recent study looked at whether metabolic syndrome confers a greater cancer risk than the sum of its individual components and component associations, and whether it is a useful predictor for future cancer risk.

Small case study shows limited positive benefits in 2 children with Wolf-Hirschhorn syndrome who were treated with growth hormone.

With the global boom in type 2 diabetes mellitus, many patients have greatest access to and are well-cared for by their primary care practitioners (PCPs). For those with basic, predictable, garden-variety diabetes, PCPs are perfectly capable of helping them. It's unclear when referral to a specialist for consultation or chronic management is most sensible.

A recent review article summarized the socioeconomic consequences of Klinefelter syndrome, which is the most frequent chromosomal aberration in humans and is associated with hypogonadism and neurocognitive deficits.

GLP-1 receptor antagonists have been associated with thyroid cancer in rodents, and in fact carry a boxed warning about the potential for cancer in humans. This leads many clinicians to ask if they should be concerned about using these drugs in patients who have or develop specific types of thyroid cancer

China's type 2 diabetes mellitus (T2DM) epidemic continues to be a pervasive, costly health care issue, with proportions surpassed only by epidemic here in the US. The majority of T2DM treatment guidelines recommend metformin as the first-line anti-hyperglycemic agent for diabetes management due to its relative safety, tolerability, and cost-effectiveness.

As P4P strategies gain popularity, the need for accurate assessment tools becomes more and more apparent-many physicians support PCP but believe that current measures are inaccurate. A common problem is that physicians appear to be penalized if they treat the elderly or patients who have reduced access to care or drug treatment.

Although stroke is the second leading cause of death globally, in China, it is the most frequent cause of death. Some trials and meta-analyses have found that folic acid supplementation has no effect on cardiovascular events in general, but it may reduce stroke risk.

Albumin -- the most abundant protein in the human body -- has many roles. It transports hormones, fatty acids, and other compounds. It buffers serum pH, and maintains osmotic pressure. Now, it appears that albumin may be a tool that could be used in diabetes management.

Lack of sleep and chronic kidney disease (CKD) independently lead to hypertension, diabetes mellitus, lower quality of life, and shorter life expectancy. Severity of CKD and sleep disturbances may also worsen diabetes and hypertension synergistically.

Levothyroxine is typically given before breakfast but interest is growing in recommending bedtime administration. Bedtime administration may reduce the likelihood of high gastric pH, food interference, or drug interactions.

Mental disorders predispose patients to weight gain, regardless of age. Psychiatric patients are more likely to develop metabolic syndrome and the poor health consequences that follow. For the most part, older patients develop metabolic syndrome, but adolescents with mental illness do, too.

Superficial fat necrosis is a rare complication of insulin injections that can manifest with severe, persistent, and well-localized pain.

Up to 65% of all thyroidectomies are now done as outpatient procedures, and high-volume surgeons have very low complication rate with these surgeries.

Americans' low-fiber diets that tend to be rich in red meats put them at risk for diverticulosis, and by age 60, roughly half of Americans have or have had diverticulosis. It's not clear how many patients with diverticulosis go on to develop diverticulitis, but once diverticulitis develops, 10-25% of patients need surgery, often urgently.

Many patients with chronic subdural hematomas are referred to neurosurgeons who generally agree that surgical drainage is warranted. Controversy surrounds the decision as to which drainage method is best because evidence is lacking. Surgeons often therefore select the procedure based on other factors.

Approximately 20% of women develop leiomyomas during their childbearing years. When these uterine fibroids cause excessive bleeding, pelvic pain, cramping, or painful intercourse, surgery is indicated. Hysterectomy is an appropriate choice for women who are done with childbearing, but for women with childbearing plans for the future, myomectomy is an option. However, hemorrhage is a common complication during myomectomy.

Some studies have suggested that advanced age may be associated with poor post-revision outcomes in cochlear reimplantation. Investigators from the University of North Carolina at Chapel Hill have completed a study that asks whether advanced age should be a contraindication for revision cochlear implantation.

Endoscopically guided removal of bridging tissue between ostia can alleviate sinusitis, congestion, and other symptoms caused by mucous recirculation.

Surgeons have traditionally repaired cleft palate using relaxing incision to close the palate, but this surgery has been linked to palatal fistulas and other complications. A recent study in JAMA Facial Plastic Surgery described predictive associations of persistent palatal fistulas in patients with a previously repaired cleft palate.