Diabetes is a worldwide epidemic, and associated neuropathy is its most costly and disabling complication. Given the rising prevalence of painful diabetic neuropathy, it is increasingly important that we understand the best ways to diagnose and treat this condition. Diagnostic tests in this field are evolving rapidly. These include the use of skin biopsies to measure small unmyelinated fibers, as well as even newer techniques that can measure both small unmyelinated fibers and large myelinated fibers in the same biopsy. The main treatments for painful diabetic neuropathy remain management of the underlying diabetes and drugs for the relief of pain. However, emerging evidence points to major differences between type 1 and type 2 diabetes, including the ability of glycemic control to prevent neuropathy. Enhanced glucose control is much more effective at preventing neuropathy in patients with type 1 diabetes than in those with type 2 disease. This dichotomy emphasizes the need to study the pathophysiologic differences between the two types of diabetes, because different treatments may be needed for each condition. The impact of the metabolic syndrome on neuropathy in patients with type 2 diabetes may account for the difference between the two types of diabetes and requires further study. Finally, neuropathic pain is under-recognized and undertreated despite an ever evolving list of effective drugs. Evidence exists to support several drugs, but the optimal sequence and combination of these drugs are still to be determined.
Atrial fibrillation increases the risk of stroke, which is a leading cause of death and disability worldwide. The use of oral anticoagulation in patients with atrial fibrillation at moderate or high risk of stroke, estimated by established criteria, improves outcomes. However, to ensure that the benefits exceed the risks of bleeding, appropriate patient selection is essential. Vitamin K antagonism has been the mainstay of treatment; however, newer drugs with novel mechanisms are also available. These novel oral anticoagulants (direct thrombin inhibitors and factor Xa inhibitors) obviate many of warfarin’s shortcomings, and they have demonstrated safety and efficacy in large randomized trials of patients with non-valvular atrial fibrillation. However, the management of patients taking warfarin or novel agents remains a clinical challenge. There are several important considerations when selecting anticoagulant therapy for patients with atrial fibrillation. This review will discuss the rationale for anticoagulation in patients with atrial fibrillation; risk stratification for treatment; available agents; the appropriate implementation of these agents; and additional, specific clinical considerations for treatment.
This lecture covers basic eye anatomy. This is the first 6 minutes of the powerpoint, which can be viewed in its entirety at Ophthobook.com Here we discuss eyelid and external eye structures.
Electrocardiographic Diagnosis of Acute Myocardial Infarction To make an electrocardiographic diagnosis of acute myo-cardial infarction, the Paramedic looks for hyperacute T waves, T wave inversions, ST-segment depressions, and ST-segment elevations as well as Q waves in all leads. When a […]
Fluoroscopy with Videography Showing Deployment of the Valve: The valve is deployed during rapid right ventricular pacing. The crimped valve and support frame are expanded with underlying balloon inflation. Also seen are the transesophageal echocardiography probe and the temporary right ventricular pacing lead.
Animation of the Complete Transfemoral Transcatheter Aortic-Valve Implantation (TAVI) Procedure: The procedure for transfemoral TAVI involves insertion of the sheath through the femoral artery, retrograde balloon aortic valvuloplasty, advancement of the TAVI system across the aortic valve, and subsequent deployment of the valve and support frame.