Latest Updates

Alcohol and Drug Withdrawal Syndromes and Their Clinical Management

Alexander Thompson, MD, MBA, MPH, Andrea Weber, MD, MME
    • Many published protocols for safely managing severe alcohol withdrawal (specifically delirium tremens) in the intensive care setting
    • Increased outpatient treatment options for opioid withdrawal
    • Increased focus on cannabis withdrawal syndrome (now included in the DSM-5), which will increase withdrawal and abstinence treatment research
    • Updated with 2020 ASAM Practice Guidelines: Opioid Use Disorder

Hepatitis B Virus

Ming V. Lin, MD, April Wall, MD
    • Tenofovir alafenamide (AF) was FDA approved in November 2016 for the treatment of chronic hepatitis B. It has enhanced plasma stability and more efficient delivery to the hepatocytes with a lower dose compared with tenofovir disoproxil fumarate (DF). Tenofovir AF has similar efficacy to tenofovir DF but less nephrotoxicity (smaller increase in serum Cr and median changes in estimated GFR) and bone toxicity (smaller mean percentage decrease from baseline hip and spine bone mineral density).
    • Major advances in basic research in hepatitis B are paving the way for the identification of new therapeutic targets with the goal of complete cure with physical elimination of cccDNA.
    • Postmarketing studies have demonstrated a risk of HBV reactivation during treatment with hepatitis C direct antiviral agents, and it is recommended to monitor patients with HBV-HCV coinfection with serial lab tests and consider concomitant HBV treatment analogue for patients who meet the standard criteria for HBV treatment.

Alcohol and Drug Withdrawal Syndromes and Their Clinical Management

Alexander Thompson, MD, MBA, MPH, Andrea Weber, MD, MME
    • Many published protocols for safely managing severe alcohol withdrawal (specifically delirium tremens) in the intensive care setting
    • Increased outpatient treatment options for opioid withdrawal
    • Increased focus on cannabis withdrawal syndrome (now included in the DSM-5), which will increase withdrawal and abstinence treatment research
    • Updated with 2020 ASAM Practice Guidelines: Opioid Use Disorder

Alcohol and Drug Withdrawal Syndromes and Their Clinical Management

Alexander Thompson, MD, MBA, MPH, Andrea Weber, MD, MME
    • Many published protocols for safely managing severe alcohol withdrawal (specifically delirium tremens) in the intensive care setting
    • Increased outpatient treatment options for opioid withdrawal
    • Increased focus on cannabis withdrawal syndrome (now included in the DSM-5), which will increase withdrawal and abstinence treatment research
    • Updated with 2020 ASAM Practice Guidelines: Opioid Use Disorder

Alcoholic Liver Disease

György Baffy, MD, PhD, Tibor Krisko, MD, Alexander S. Vogel, MD
    • The AUDIT-C questionnaire is a fast and reliable tool to screen patients for alcohol use disorder (AUD)
    • In patients with AUD and liver disease, disulfiram or baclofen should be considered for preventing AUD relapse
    • In patients with severe alcohol-associated hepatitis (AAH) identified by the Maddrey’s discriminant function (≥ 32), a trial of prednisolone is a reasonable therapeutic strategy
    • Carefully selected cases of severe AAH identified by the Lille score as non-responders to pharmacotherapy (≥ 0.45) should be considered for early liver transplantation
    • New post-liver transplant scores may predict harmful (HALT) and sustained (SALT) relapse of AUD and help patient selection for transplantation

Alcoholic Liver Disease

György Baffy, MD, PhD, Tibor Krisko, MD, Alexander S. Vogel, MD
    • The AUDIT-C questionnaire is a fast and reliable tool to screen patients for alcohol use disorder (AUD)
    • In patients with AUD and liver disease, disulfiram or baclofen should be considered for preventing AUD relapse
    • In patients with severe alcohol-associated hepatitis (AAH) identified by the Maddrey’s discriminant function (≥ 32), a trial of prednisolone is a reasonable therapeutic strategy
    • Carefully selected cases of severe AAH identified by the Lille score as non-responders to pharmacotherapy (≥ 0.45) should be considered for early liver transplantation
    • New post-liver transplant scores may predict harmful (HALT) and sustained (SALT) relapse of AUD and help patient selection for transplantation

Dizziness

Robert W. Baloh, MD, Kevin A. Kerber, MD, MS
    • 2017 Japan Society for Equilibrium Research guideline on classification, diagnostic criteria, and management of benign paroxysmal positional vertigo
    • Latest American Physical Therapy Association guideline on vestibular rehabilitation for peripheral vestibular hypofunction
    • 2017 American Physical Therapy Association practice guidelines on dizziness
    • 2017 American Academy of Otolaryngology-Head and Neck Surgery Practice Guideline included

Dizziness

Robert W. Baloh, MD, Kevin A. Kerber, MD, MS
    • 2017 Japan Society for Equilibrium Research guideline on classification, diagnostic criteria, and management of benign paroxysmal positional vertigo
    • Latest American Physical Therapy Association guideline on vestibular rehabilitation for peripheral vestibular hypofunction
    • 2017 American Physical Therapy Association practice guidelines on dizziness
    • 2017 American Academy of Otolaryngology-Head and Neck Surgery Practice Guideline included
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