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Zika Virus Disease: A Primer for the Primary Care Physician

Zika virus disease is a global issue, but with the recent hurricanes and flooding in Texas and Florida, mosquito-borne illnesses may become more prevalent. This article discusses the latest recommendations for the prevention of Zika viral disease, the populations and regions still at increased risk, and the latest and most promising research being conducted to develop a Zika virus vaccine and treatment.

Value-based Payments and Primary Care

Over the past two decades, Medicare and commercial payers have increasing linked healthcare payments to quality. These new payment models are broadly referred to as value-based, as payers primarily focus on clinical and financial outcomes of patients rather than simply paying for services in an unsustainable fee-for-service model. This shift provides a unique opportunity for primary care to recapture its place in healthcare delivery as the original advocate for patient-centered care and the center of value. Primary care clinicians can be rewarded with additional revenue for creating efficient care delivery by developing the skill sets to manage value-based care.

Fungus Among Us? Dermatophyte Infections, Mimickers, and Treatment Options

Tinea refers to a superficial fungal infection of the skin, hair, and nails caused by dermatophytes, which are filamentous fungi. Trichophyton rubrum is the most common cause of dermatophyte infection, accounting for nearly 70% of infections worldwide.These infections are extremely common, but are more prominent in warm, tropical climates. Tinea is seen more commonly in black and Asian patients, has a predilection for young adults, and is three to four times more common in males.

Stroke: Rehabilitation and Recovery

Rehabilitation is a critical component of stroke treatment, as most stroke survivors are left with significant neurological impairments and other sequelae, such as spasticity and pain. Stroke rehabilitation aims to reverse these impairments to the extent possible, maximize functionality through the use of compensatory approaches, prevent complications, and manage comorbidities. This article reviews the basic principles of rehabilitation, current practices, and evidence supporting various aspects of stroke rehabilitation.

Dementia Updates for Primary Care Providers

The diagnostic criteria for Alzheimer’s disease (AD) have changed in recent years, with a growing focus on pathologic and genetic biomarkers. The diagnosis itself now is divided into three distinct stages: the preclinical stage, mild cognitive impairment, and clinical AD. Dementia is a common and growing problem that is associated with significant caregiver burden and immense cost. A growing focus on disease prevention and management of risk factors in mid-life is vital to attempt to mitigate the daunting impact of this illness on patients, caregivers, and the healthcare system as a whole.

Diabetes Microvascular Complications

Diabetes mellitus is expensive, but most of the costs are attributed to complications and hospital care.This article will review the recommendations from the ADA 2017 Standards of Care for microvascular complications and relevant position statements, and will highlight preventive screening and clinical pearls for the primary care physician treating patients with diabetes.

2017 Update on Adult Vaccinations

Vaccinations to directly prevent disease in adults likewise have reduced morbidity and mortality from a wide variety of viral and bacterial infections. This article will review the vaccines recommended for all adults as well as those vaccines recommended for special populations, such as immunosuppressed patients and pregnant women. In addition, the article will examine strategies that can be employed to increase vaccination rates in adults.

Evaluation of Peripheral Neuropathy in the Diabetic Foot

Among the many types of peripheral neuropathy, diabetic peripheral neuropathy is the most common in the U.S. population. Despite the cause, its progression leads to loss of protective sensation, skin ulcerations, and chronic wounds, which in turn cause soft tissue and bone infections requiring amputation. All of these scenarios depend on the type of glycemic control of the patient, and vary by severity. Prevention, ultimately by understanding the pathophysiology of neuropathy and understanding the biomechanics of gait in relation to the foot, has been proven to significantly decrease morbidity with this disease.

Hepatitis C Infection for Primary Care Providers

Hepatitis C virus (HCV) can cause both acute and chronic hepatitis. Most people are asymptomatic, but for the majority of patients who become infected with hepatitis C, it becomes a long-term, chronic infection. The best way to prevent hepatitis C is by avoiding behaviors that can spread the disease, especially injection drug use, as there is no vaccine for HCV. With the forefront of direct-acting antiviral (DAA) agents, people can now be cured from HCV infection.

Male Hypogonadism

Testosterone replacement therapy is a growing industry that deserves discussion between patients and their healthcare providers. Recently, many insights into new formulations, advertising, and potential risks have heightened the controversy surrounding low testosterone syndrome, appropriate diagnosis, and risks and benefits of testosterone supplementation. A plethora of non-regulated supplements termed “testosterone boosters” are being marketed directly to the public without adequate assessment. Therefore, it is important for healthcare providers to be familiar with how to conduct and interpret diagnostic tests as well as with appropriate use of TRT as established by various medical organizations, including the Endocrine Society. This review will discuss the definitions, pathophysiology, causes, clinical manifestations, appropriate diagnostic testing procedures, and the role of testosterone supplementation with currently available formulations, with special attention to efficacy and adverse effects in hypogonadism in men.