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Am Fam Physician. 2023;108(1):23

What treatments are recommended for primary open-angle glaucoma?

Reducing intraocular pressure is the only treatment proven to stop or slow the progression of vision loss in primary open-angle glaucoma. Topical medications are the most common treatment. Selective laser trabeculoplasty is another first-line treatment for primary open-angle glaucoma.

What is the preferred treatment for Helicobacter pylori infection?

Bismuth quadruple therapy (proton pump inhibitor, bismuth, tetracycline, and metronidazole [Flagyl] or tinidazole) or concomitant therapy (nonbismuth quadruple therapy: proton pump inhibitor, clarithromycin, amoxicillin, and metronidazole or tinidazole) is the recommended first-line treatment for H. pylori infection. These regimens have similar eradication rates of up to 90%.

What treatment is recommended for hyperarousal or nightmares in patients with posttraumatic stress disorder (PTSD)?

Consider using prazosin for nighttime trauma-related nightmares in patients with PTSD.

What medical treatments are effective in decreasing pain from diabetic peripheral neuropathy?

In a randomized controlled trial, 130 adults with painful diabetic peripheral neuropathy had similar degrees of improvement with monotherapy using amitriptyline, duloxetine, and pregabalin. There was even greater improvement with subsequent combination therapy regardless of the initial choice of medication.

What initial treatment for menstrual cycle irregularity is recommended for patients with polycystic ovary syndrome (PCOS) who do not want to become pregnant?

Hormonal contraception (e.g., oral contraceptives) should be used as the initial treatment for menstrual cycle irregularity, hirsutism, and acne in patients with PCOS who do not want to become pregnant.

Does treatment with customized or prefabricated foot orthoses improve pain, function, or quality-of-life scores in children with flat feet (pes planus)?

Customized or prefabricated foot orthoses do not result in significant improvements in pain, function, or parent and child quality-of-life scores. Further targeted studies are needed to identify the clinical utility of foot orthoses in children with flat feet that are associated with underlying conditions.

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What strategies help reduce the risk of recurrence of depressive symptoms when discontinuing antidepressants?

Cognitive behavior therapy should be used to help prevent relapse and recurrence of depressive symptoms when discontinuing antidepressants.

Is a FODMAP diet effective for the treatment of IBS?

A network meta-analysis of the literature concluded that a low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet is the most likely to be effective for patients with irritable bowel syndrome (IBS) compared with other diets. A low FODMAP diet removes offending foods from the diet for four to six weeks, followed by a gradual and systematic reintroduction of foods to identify those that the patient can tolerate.

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