Items in FPM with MESH term: African Americans
ABSTRACT: Hypertension in blacks is usually characterized by low renin, expanded volume and sensitivity to salt. Diuretics are the preferred initial therapy, but response to calcium channel antagonists is also good. The blood pressure response to monotherapy with beta blockers or angiotensin-converting enzyme (ACE) inhibitors is blunted, but this effect is abolished with concomitant use of diuretics. The two major types of hypertension in older persons are isolated systolic hypertension and combined systolic and diastolic hypertension. Strong data support the treatment of combined hypertension in patients 60 to 79 years of age and isolated systolic hypertension in patients 60 to 96 years of age. Diuretics and long-acting dihydropyridine calcium channel antagonists are the recommended initial therapies for isolated systolic hypertension. More studies are necessary before recommendations can be made about the treatment of combined hypertension in patients 80 years of age and older.
Race and Preventive Services Delivery - Improving Patient Care
Screening for Lipid Disorders in Adults - Putting Prevention into Practice
Screening for Osteoporosis in Postmenopausal Women - Putting Prevention into Practice
ABSTRACT: Symptoms of urethritis in men typically include urethral discharge, penile itching or tingling, and dysuria. A diagnosis can be made if at least one of the following is present: discharge, a positive result on a leukocyte esterase test in firstvoid urine, or at least 10 white blood cells per high-power field in urine sediment. The primary pathogens associated with urethritis are Chlamydia trachomatis and Neisseria gonorrhoeae. Racial disparities in the prevalence of sexually transmitted infections persist in the United States, with rates of gonorrhea 40 times higher in black adolescent males than in white adolescent males. Recent studies have focused on identifying causes of nongonococcal urethritis and developing testing for atypical organisms, such as Mycoplasma genitalium and Ureaplasma species. Less common pathogens identified in patients with urethritis include Trichomonas species, adenovirus, and herpes simplex virus. History and examination findings can help distinguish urethritis from other urogenital syndromes, such as epididymitis, orchitis, and prostatitis. The goals of treatment include alleviating symptoms; preventing complications in the patient and his sexual partners; reducing the transmission of coinfections (particularly human immunodeficiency virus); identifying and treating the patient’s contacts; and encouraging behavioral changes that will reduce the risk of recurrence. The combination of azithromycin or doxycycline plus ceftriaxone or cefixime is considered first-line empiric therapy in patients with urethritis. Expedited partner treatment, which involves giving patients prescriptions for partners who have not been examined by the physician, is advocated by the Centers for Disease Control and Prevention and has been approved in many states. There is an association between urethritis and an increased human immunodeficiency virus concentration in semen.
Evaluation of Microcytosis - Article
ABSTRACT: Microcytosis is typically an incidental finding in asymptomatic patients who received a complete blood count for other reasons. The condition is defined as a mean corpuscular volume of less than 80 µm3 (80 fL) in adults. The most common causes of microcytosis are iron deficiency anemia and thalassemia trait. Other diagnoses to consider include anemia of chronic disease, lead toxicity, and sideroblastic anemia. Serum ferritin measurement is the first laboratory test recommended in the evaluation of microcytosis. Low ferritin levels suggest iron deficiency. Once a presumptive diagnosis of iron deficiency anemia has been made, an underlying source for the deficiency should be determined. Iron deficiency anemia in adults is presumed to be caused by blood loss; the most common source of bleeding is the gastrointestinal tract. The possibility of gastrointestinal malignancy must be considered. If the serum ferritin level is not initially low, further evaluation should include total iron-binding capacity, transferrin saturation level, serum iron level, and possibly hemoglobin electrophoresis. Anemia of chronic disease is suggested with low iron levels and decreased total iron-binding capacity. Patients with beta-thalassemia trait usually have elevated levels of hemoglobin A2.