What's New | Decker

Preconception care can take place at every clinical encounter.
Initial care may simply consist of inquiring about a patient’s plans for pregnancy.
Knowing this can help guide the patient to fulfill her personal reproductive plans.
Identification of medical, nutritional, and psychosocial conditions that may increase pregnancy complications will allow time for referral to maximize healthy outcomes.

In an attempt to characterize and define the vasculitides, criteria for the diagnosis of GCA were developed. In 1990, a classification system was developed by the American College of Rheumatology.
Most patients demonstrate a marked improvement with medical management alone. However, there are patients who develop vascular complications, such as subclavian steal syndrome, chronic ischemia, aneurysmal degeneration, or aortic dissection. Caution should be advised when considering such patients with GCA for surgical intervention, especially in the acute inflammatory phase of disease.
Although many patients respond to medical therapy, there is a subset of patients who develop complications from the arteritis necessitating surgical intervention, usually for either occlusive or aneurysmal disease. The literature suggests that less than 20% of patients with TA will ultimately require surgery.

Oxidized low-density lipoprotein induces long-term proinflammatory cytokine production and foam cell formation via epigenetic reprogramming of monocytes... Current guidelines for high-density lipoprotein cholesterol in therapy and future directions... 2014 evidence-based guideline for the management of high blood pressure in adults report from the panel members appointed to the Eighth Joint National Committee (JNC 8).
Current efforts demonstrate that RAAS promotes arterial wall thickening. In particular, angiotensin II influences multiple signaling pathways to promote the chronic inflammatory response needed for plaque progression.
The earliest studies in individuals with familial hypercholesterolemia, marked by elevated serum LDL, showed increased atheroma susceptibility. In contrast, HDL has shown an association with decreased CVD risk. HDL can freely diffuse into the subendothelial space and mediate reverse transport of cholesterol to the liver. Recent in vivo studies have also indicated that HDL increases NO vasodilator bioavailability and promotes intrinsic antioxidant mechanisms, thereby limiting LDL oxidation.

In an attempt to characterize and define the vasculitides, criteria for the diagnosis of GCA were developed. In 1990, a classification system was developed by the American College of Rheumatology.
Most patients demonstrate a marked improvement with medical management alone. However, there are patients who develop vascular complications, such as subclavian steal syndrome, chronic ischemia, aneurysmal degeneration, or aortic dissection. Caution should be advised when considering such patients with GCA for surgical intervention, especially in the acute inflammatory phase of disease.
Although many patients respond to medical therapy, there is a subset of patients who develop complications from the arteritis necessitating surgical intervention, usually for either occlusive or aneurysmal disease. The literature suggests that less than 20% of patients with TA will ultimately require surgery.

Raynaud phenomenon has two forms: primary and secondary based on the presence or absence of associated disease processes.
Raynaud phenomenon is an exaggerated vasospastic response to stimuli that results in digital discoloration.
Environmental modification is the initial therapy.
Pharmacologic treatment is most commonly used when environmental modification fails.
Injections and surgery are sometimes necessary in severe, resistant forms of the disease process.

Raynaud phenomenon has two forms: primary and secondary based on the presence or absence of associated disease processes.
Raynaud phenomenon is an exaggerated vasospastic response to stimuli that results in digital discoloration.
Environmental modification is the initial therapy.
Pharmacologic treatment is most commonly used when environmental modification fails.
Injections and surgery are sometimes necessary in severe, resistant forms of the disease process.

The treatment of simple exanthematous eruptions is generally supportive. For example, oral antihistamines used in conjunction with soothing baths may help relieve pruritus. Topical corticosteroids are indicated when antihistamines do not provide relief. Systemic corticosteroids are used only in severe cases. Discontinuance of the offending agent is recommended in most cases.
Sulfonamide antibiotics can cause hypersensitivity syndrome reactions in susceptible persons. The primary metabolic pathway for sulfonamides involves acetylation of the drug to a nontoxic metabolite and renal excretion. An alternative metabolic pathway, quantitatively more important in patients who are slow acetylators, engages the cytochrome P-450 mixed-function oxidase system.
Differentiation within the spectrum of SJS and TEN depends on the nature of the skin lesions and extent of body surface area involvement. Clinically, reactions of SJS/TEN spectrum are characterized by the presence of the triad of mucous membrane erosions, target lesions, and epidermal necrosis with skin detachment.62 Detachment of less than 10% of the total body surface area is part of the definition of SJS, whereas TEN occurs when there is greater than 30% body surface involvement; intermediate cases have been called SJS/TEN overlap (10 to 30%).

The treatment of simple exanthematous eruptions is generally supportive. For example, oral antihistamines used in conjunction with soothing baths may help relieve pruritus. Topical corticosteroids are indicated when antihistamines do not provide relief. Systemic corticosteroids are used only in severe cases. Discontinuance of the offending agent is recommended in most cases.
Sulfonamide antibiotics can cause hypersensitivity syndrome reactions in susceptible persons. The primary metabolic pathway for sulfonamides involves acetylation of the drug to a nontoxic metabolite and renal excretion. An alternative metabolic pathway, quantitatively more important in patients who are slow acetylators, engages the cytochrome P-450 mixed-function oxidase system.
Differentiation within the spectrum of SJS and TEN depends on the nature of the skin lesions and extent of body surface area involvement. Clinically, reactions of SJS/TEN spectrum are characterized by the presence of the triad of mucous membrane erosions, target lesions, and epidermal necrosis with skin detachment.62 Detachment of less than 10% of the total body surface area is part of the definition of SJS, whereas TEN occurs when there is greater than 30% body surface involvement; intermediate cases have been called SJS/TEN overlap (10 to 30%).

Obstetrics