AFP Clinical Answers
Peptic Ulcers, Blood Lead Levels in Children, Diabetic Kidney Disease, VTE, Endometrial Biopsy
Am Fam Physician. 2019 Dec 15;100(12):740.
Should clinicians screen and treat H. pylori infection before initiating long-term therapy with NSAIDs to reduce the risk of peptic ulcer disease?
Physicians should perform laboratory screening for and eradicate Helicobacter pylori infection before initiating long-term nonsteroidal anti-inflammatory drug (NSAID) therapy in NSAID-naive patients to reduce the risk of peptic ulcer disease. Physicians should screen for and eradicate H. pylori before initiating long-term NSAID therapy in patients with a history of peptic ulcers.
What blood lead levels in children require investigation?
In 2012, the Centers for Disease Control and Prevention recommended investigation and management with a blood lead level of 5 μg per dL (0.24 μmol per L). More than 500,000 U.S. children were estimated to have high blood lead levels by this criterion in 2017. Blood lead levels of 5 μg per dL or less in apparently asymptomatic children are associated with impaired neurocognitive and behavioral development. Chelation therapy is recommended if a child's blood lead levels are greater than 45 μg per dL (2.17 μmol per L).
What are the antihyperglycemic treatment recommendations for diabetic kidney disease?
In adults with diabetes mellitus, metformin should be used as first-line therapy for glucose management because it is associated with A1C reduction, decreased risk of renal failure, and decreased mortality. Glucagon-like peptide-1 receptor agonists or sodium-glucose cotransporter-2 inhibitors should be considered as second-line therapy for patients with diabetic kidney disease to reduce progression of the disease.
What is the preferred anticoagulant for long-term prevention of recurring VTE in patients with cancer?
Compared with vitamin K antagonists, low-molecular-weight heparin reduces recurrent venous thromboembolism (VTE) in patients with cancer (number needed to treat = 19), with similar adverse event profiles. Direct oral anticoagulants reduce VTE risk to the same extent as low-molecular-weight heparin but at an increased risk of major bleeding (number needed to harm = 34).
When is endometrial biopsy warranted in a premenopausal woman with abnormal uterine bleeding?
Endometrial biopsy should be performed in all patients with abnormal uterine bleeding who are 45 years or older, in younger patients with a significant history of unopposed estrogen exposure, persistent bleeding, or in whom medical management is ineffective.
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