Browse Primary Care/Hospitalist Articles by Topic

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.

From Glucocentricity to a Multi-Risk Strategy: An Updated Approach to Managing Chronic Kidney Disease

This article discusses an important microvascular complication of diabetes mellitus, chronic kidney disease (CKD), which affects more than one-third of patients with diabetes. There is substantial evidence that early diagnosis and management can delay or prevent the progression of CKD, making its prevention, diagnosis, and treatment a priority for the primary care clinician.

Constipation in Adults and Children

Constipation is a common diagnosis that has been steadily increasing in prevalence over the past several decades. As the morbidity and healthcare costs from this condition increase, it is important that physicians be aware of the workup, management, and potential complications of this common condition in adults and children alike.

From Exhaustion to Empowerment: Combating Physician Burnout in Healthcare

Medicine always has been demanding, both emotionally and intellectually. Yet, primary care providers have found deep purpose in their work. However, the modern practice of medicine brings new challenges, such as administrative burdens, financial strain, and large patient loads, contributing to widespread burnout. This paper examines burnout in the primary care provider and its related consequences and offers practical strategies for supporting provider well-being.

Osteoporosis: An Update for Primary Care Providers

Bones, as reservoirs of calcium and phosphorus, continuously remodel to maintain strength and function. However, suboptimal peak bone mass in young adulthood, excessive resorption of bone, or impaired bone formation during remodeling can result in osteoporosis. Among Caucasian adults ages 50 years and older in the United States, about 50% of women and 20% of men will experience an osteoporotic fracture in their remaining lifetime; however, fracture rates differ by ethnic/racial population and skeletal site. Annual fracture-related costs are expected to increase from $57 billion to more than $95 billion by 2040. Therefore, it is imperative that primary care providers address this challenge by implementing practices to screen patients for osteoporosis to prevent and/or treat the disorder and subsequent comorbidities.

Beyond the Symptoms: A Primary Care Approach to Depression Management

In the vast mosaic of primary care, depression often remains in the shadows, embedded in patient care but easily overlooked. Left unrecognized, the prognosis worsens and complicates the management of other chronic conditions. However, with timely identification and effective treatment, the course of depression can be altered significantly. A comprehensive understanding of this condition, coupled with effective treatment strategies, empowers the primary care physician to mitigate the potentially debilitating effects of this condition.

Myocarditis in a Post-COVID World

Myocarditis is a rare, typically self-limited inflammatory condition of the heart. Interest in myocarditis has increased in recent years because of the COVID-19 pandemic and COVID-19 vaccinations both being associated with its development. Paralleling this interest is an increase in misinformation about this condition, its frequency associated with both COVID-19 infection and vaccination, and potential linkage to sudden cardiac death. This review article will trace the history of myocarditis from the pre-COVID-19 era to the present day, with special attention being paid to how social media has driven a large portion of the discussion.

Metabolic Dysfunction-Associated Steatotic Liver Disease

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic metabolic disease that you may never have heard of. MASLD, formerly known as non-alcoholic fatty liver disease (NAFLD), is the most prevalent liver disease worldwide. MASLD affects 30% of the world’s population, more than half of those people with obesity, and more than 70% of people with type 2 diabetes. While many clinicians may see patients with slightly elevated transaminases and assume it is fatty liver, MASLD is not benign and often begins well before laboratory changes. This article reviews the pathogenesis, diagnosis, and natural history of MASLD; known treatments; and future therapies.

An Updated Review on Metabolic Regulation in the Alzheimer’s Brain: Type 3 Diabetes?

Diabetes is a strong risk factor for the development of Alzheimer's disease (AD) given the mitochondrial, vascular, and inflammatory modalities that contribute to its progression. Therefore, it is vital to understand the pathophysiology of these two diseases as they relate to insulin resistance and mitochondrial dysfunction. Exposing a metabolic relationship between these diseases can provide further understanding of metabolic health and how treatment of insulin resistance can decrease disease burden.

Non-Marine Envenomations in the United States

Envenomations can be caused by many different species, both marine and non-marine. The presentation can range from minor skin irritation to anaphylaxis, systemic illness, organ failure, and even death. Knowing which species are endemic to the area, and what the presentations of medically important envenomations will look like, can aid in recognition and timely treatment, especially when the bite or sting was unwitnessed. This article will give an overview of medically important non-marine envenomations in the United States, including their clinical manifestations, treatment, and disposition.