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Obesity in Pregnancy

Obesity in pregnancy can be attributed to multiple factors that include genetic predispositions, lifestyle factors (such as diet and physical activity), and socioeconomic conditions. Over the last two decades, there has been a significant rise in obesity rates among pregnant women, particularly with a notable 33% increase from 2001 to 2018 in women aged 20 to 39 years.

Actinomycin-D Treatment for Preventing Post-Molar Gestational Trophoblastic Neoplasia

This 28-year retrospective cohort study demonstrated that administration of a single 1.25 mg/m² intravenous dose of actinomycin-D at the time of uterine evacuation for patients with high-risk complete hydatidiform molar pregnancies was associated with a significantly lower rate of post-molar gestational trophoblastic neoplasia (19% vs. 40%, P < 0.001) and a 52% reduction in relative risk (RR; RR = 0.48; 95% confidence interval, 0.35-0.66) in the development of post-molar gestational trophoblastic neoplasia.

What Hormonal Side Effects Should New Users of the Levonorgestrel 52-mg IUD Expect?

This secondary analysis compares the incidence of hormone-related side effects of the levonorgestrel 52-mg intrauterine device (IUD) between users who previously were using combined hormone contraceptives vs. nonhormonal contraceptives to understand which side effects can be directly attributed to the IUD and which are more likely secondary to discontinuation of combined hormonal contraceptives.

Are Male Partners the Key to Preventing Recurrent Bacterial Vaginosis?

In this open label, randomized controlled trial, couples in monogamous relationships whose female partner was diagnosed with bacterial vaginosis were randomized to treatment of the female partner only or to treatment of the female partner plus the male partner. After 150 couples had completed the 12-week follow-up period, recurrence of bacterial vaginosis occurred in 24 of 69 women (35%) in the partner-treatment group and in 43 of 68 women (63%) in the control group, indicating an absolute risk difference of -2.6 recurrences per person-year (95% confidence interval, -4.0 to -1.2; P < 0.001).

Arrhythmia Recurrence After Catheter Ablation of Atrial Fibrillation

An integrated nationwide medical and pharmacy claims database analysis of patients with new atrial fibrillation undergoing catheter ablation as first-line therapy has shown that 17% of patients required repeat ablation for recurrent atrial fibrillation despite the frequent use of antiarrhythmic drugs.

Ten-Year Outcomes of the SCOT-HEART Study

The 10-year follow-up of the SCOT-HEART Study of new-onset chest pain patients randomized to standard care vs. the addition of coronary computed tomography angiography (CTA) has shown that coronary heart disease-related death, myocardial infarction, and other adverse cardiovascular outcomes are reduced with CTA use, perhaps because preventive therapy is increased.

Apomorphine Hydrochloride Injection (Onapgo)

The U.S. Food and Drug Administration has approved apomorphine as a constant subcutaneous infusion for the treatment of advanced Parkinson’s disease with persistent motor fluctuations. It is the second subcutaneous infusion for this indication following foscarbidopa/foslevodopa (as Vyalev).

Determinants of Long-Term Outcome After Concussion

This cohort study of U.S. veterans found that mild traumatic brain injuries occurring alongside psychological trauma are associated with long-term post-concussive symptoms and disability. The authors postulate that the traumatic context contributes to the development of post-traumatic stress disorder, which may in turn potentiate long-term sequelae.

Gabapentin vs. Duloxetine vs. Falls in Older Adults

This retrospective study examining fall risk among older adults taking gabapentin compared to duloxetine finds gabapentin users exhibit a markedly lower risk of fall-related visits at six months (hazard ratio = 0.52) yet finds no difference in the incidence of severe falls.

Clinical Insights on Managing DPN and PAD in Patients with Diabetes

Given the significant prevalence of diabetes in the population, it is important for the primary care clinician to be familiar with the many types of neuropathies commonly affecting people living with diabetes. By far the most prevalent type is chronic diabetic peripheral sensorimotor neuropathy, affecting up to 50% of people with diabetes. Peripheral arterial disease (PAD) refers to partial or complete occlusion of peripheral vessels of the lower extremities. The underdiagnosis of PAD in the primary care setting may be a major issue because of many patients presenting without the typical claudication symptoms described in medical textbooks. The ability of primary care clinicians to diagnose PAD in asymptomatic patients still has a significant clinical effect because PAD acts as a marker for systemic atherosclerosis.