Lisdexamfetamine in the treatment of adolescents and children with attention-deficit/hyperactivity disorder.

Attention-deficit/hyperactivity disorder is one of the most common neurobehavioral disorders defined by developmentally inappropriate levels of inattention, hyperactivity, and impulsivity. Symptoms begin in childhood and may persist into adolescence and adulthood. Currently available pharmacological treatment options for attention-deficit/hyperactivity disorder in children and adolescents include stimulants that are efficacious and well tolerated; however, many of these preparations require multiple daily dosing and have the potential for abuse.

Her-2 targeting in uterine papillary serous carcinoma.

► A case of metastatic uterine papillary serous cancer with Her-2 gene amplification. ► Was treated with a Her-2 targeted agent and achieved durable remission. ► Her-2 targeting should be considered alone or in combination with chemotherapy.

Recent Advances in the Treatment of ST-Segment Elevation Myocardial Infarction.

ST-segment elevation myocardial infarction (STEMI) represents the most urgent condition for patients with coronary artery disease. Prompt diagnosis and therapy, mainly with primary angioplasty using stents, are important in improving not only acute survival but also long-term prognosis. Recent advances in angioplasty devices, including manual aspiration catheters and drug-eluting stents, and pharmacologic therapy, such as potent antiplatelet and anticoagulant agents, have significantly enhanced the acute outcome for these patients.

Toxic effects of marijuana on the cardiovascular system.

We present a case of marijuana-induced ST segment elevation mimicking Brugada syndrome in a young man. Cannabis can have a multitude of effects on the different organ systems of the body; we take a closer look at its effects on the cardiovascular system, including acute coronary syndrome, arrhythmias and congestive heart failure.

Barriers to lifestyle behavioral change in migrant South Asian populations.

The purpose of this literature review is to describe and assess the cultural barriers to behavior change in migrant South Asians, given the high morbidity and mortality associated with cardiovascular disease in this population. We reviewed studies that explored the relationship between South Asian culture in the Diaspora and lifestyle behaviors. Our review produced 91 studies, of which 25 discussed the relationship between various aspects of South Asians' belief system and their approach to modifying lifestyle habits.

Inotropic contractile reserve can risk-stratify patients with HIV cardiomyopathy: a dobutamine stress echocardiography study.

Objectives: The purpose of this study was to assess whether inotropic contractile reserve (ICR) during dobutamine stress echocardiography (DSE) could risk-stratify patients with human immunodeficiency virus (HIV) cardiomyopathy and predict improvement of left ventricular ejection fraction (LVEF).

Background: HIV cardiomyopathy is an important cause of heart failure and death. ICR is associated with better survival and improvement of LVEF in patients with ischemic and nonischemic cardiomyopathies.

QT prolongation and torsade de pointes induced by fluoroquinolones: infrequent side effects from commonly used medications.

Although very useful agents, fluoroquinolones are associated with a number of adverse events, some with considerable clinical significance. Prolongation of the QT interval, for example, is an adverse effect associated with the use of fluoroquinolones. Fluoroquinolones prolong the QT interval by blocking voltage-gated potassium channels, especially the rapid component of the delayed rectifier potassium current I(Kr), expressed by HERG (the human ether-a-go-go-related gene).

Lower-limb amputations in patients with diabetes mellitus.

It is estimated that approximately 23.6 million people in the United States have diabetes mellitus. With adequate control of this disease and appropriate foot care and basic surveillance, many patients can lead active and healthy lifestyles.

The bariatric surgery patient: lost to follow-up; from morbid obesity to severe malnutrition.

Objective: To describe the potential long-term risk of malnutrition after Roux-en-Y gastric bypass (GBP) through an uncommon occurrence of inflammatory bowel disease (IBD) postoperatively, which posed a serious threat to the nutritional status and the life of the patient.

Methods: We present a case report of a 44-year-old woman in whom Crohn disease developed 4 years after she had undergone GBP. The double insult of IBD and GBP resulted in severe malnutrition, with a serum albumin concentration of 0.

Potential adverse effects of norepinephrine on cortical somatosensory-evoked potentials during carotid endarterectomy: a case report.

The cerebral metabolic and vascular effects of intravenous norepinephrine have been shown in an animal model using somatosensory-evoked potentials (SSEPs). A case of intravenous norepinephrine resulting in a decrease in SSEP amplitude (of greater than 50%) despite no significant change in blood pressure, prior to cross-clamping during a carotid endarterectomy is presented. This finding may have implications for the use of norepinephrine in the critical care unit as well as the operating room.

The effect of stimulating versus conventional perineural catheters on postoperative analgesia following ultrasound-guided femoral nerve localization.

Study Objective: To test the hypothesis that, if the femoral nerve is correctly localized using ultrasound (US) guidance, the type of perineural catheter used has no effect on catheter success.

Design: Randomized controlled trial.

Setting: Post-anesthesia care unit of an academic teaching hospital.

Magnitude and variability of the glucagon-like peptide-1 response in patients with type 2 diabetes up to 2 years following gastric bypass surgery.

Objective: To characterize the magnitude and variance of the change of glucose and glucagon-like peptide-1 (GLP-1) concentrations, and to identify determinants of glucose control up to 2 years after gastric bypass (GBP).

Research Design And Methods: Glucose and GLP-1 concentrations were measured during an oral glucose challenge before and 1, 12, and 24 months after GBP in 15 severely obese patients with type 2 diabetes.

Results: Glucose area under the curve from 0 to 180 min (AUC(0-180)) started decreasing in magnitude (P < 0.

Strategies for the prevention and treatment of sudden cardiac death.

Cardiovascular diseases account for 40% of all deaths in the West. Sudden cardiac death (SCD) is a major health problem affecting over 300,000 patients annually in the United States alone. Presence of coronary artery disease (CAD), usually in the setting of diminished left ventricular ejection fraction, is still the single major risk factor for SCD.

A novel approach to confirming nasogastric tube placement in the ED.

We present a case of 2-dimensional ultrasound-assisted confirmation of nasogastric tube (NGT) placement using both soft tissue neck and epigastric sonographic imaging. Given our findings and review of the literature, we suggest that bedside ultrasound evaluation of NGT placement is a straightforward, rapid, and novel alternative method to the “gold standard” of a portable chest radiograph in the emergency department (ED).

Vein of Galen malformations in neonates: new management paradigms for improving outcomes.

Background: Untreated patients with symptomatic neonatal presentation of vein of Galen aneurismal malformations (VGAMs) carry almost 100% morbidity and mortality. Medical management and endovascular techniques for neonatal treatment have significantly evolved.

Objective: To evaluate the clinical and angiographic outcomes of modern management of neonates with refractory heart failure from VGAMs.

Randomized pilot study of cabergoline, a dopamine receptor agonist: effects on body weight and glucose tolerance in obese adults.

Aim: Dopaminergic hypofunction and hyperprolactinaemia have been implicated in the pathogenesis of obesity and glucose intolerance. The aim of this pilot study was to determine the efficacy of cabergoline, a dopamine receptor agonist, on body weight and glucose tolerance in obese non-diabetic persons with normal plasma prolactin levels.

Methods: This 16-week double blind, placebo-controlled pilot study randomized non-diabetic obese adults (body mass index 30-42 kg/m(2) ) to placebo or cabergoline (0.

Complex lower extremity wounds treated with skin grafts and NPWT: a retrospective review.

Objective: To evaluate a single centre experience with the use of NPWT for securing split-thickness skin grafts in the management of specifically lower extremity chronic wounds, including revascularised arterial wounds, amputations, diabetic and venous leg ulcers.

Method: A seven-year retrospective review of a prospectively maintained database of all the patients who underwent primary split-thickness skin grafts (STSGs) with immediate postoperative NPWT for at least 96 hours was carried out. The percentage graft take after removal of NPWT device and clinical follow-up date were reviewed.

Implementing a pathway for the management of acute coronary syndrome leads to improved compliance with guidelines and a decrease in angina symptoms.

We describe our experience with the Advanced Cardiac Admission Program (ACAP) at our institution. The ACAP program is a hospital-wide implementation of critical pathways-based management of all cardiac patients. Data review of patients admitted for acute coronary syndromes from the ACAP-PAIN database and a comparative study of outcomes before and after implementation of the pathways-based assessment and treatment protocols.

Oncologic colorectal resection, not advanced endoscopic polypectomy, is the best treatment for large dysplastic adenomas.

Introduction: Endoscopic submucosal dissection (ESD), endoscopic mucosal resection (EMR), and partial circumference resection are used for large benign polyps to avoid an "Oncologic" Colorectal Resection (OCR); polyps with invasive cancer require OCR. This review of polyp patients who had OCR was done to stratify polyps into risk groups to guide treatment.

Methods: Colonoscopy, operative, and pathology reports of patients with adenoma (+/- dysplasia) who had OCR were reviewed.

Mild hyperkalemia and low eGFR a tedious recipe for cardiac disaster in the elderly: an unusual reversible cause of syncope and heart block.

Hyperkalemia affects the myocardial tissue producing electrocardiographic abnormalities, such as prolongation of the P-R interval, tall peaked T waves, a reduction in the amplitude and an increase in the duration of P wave, and atrial and ventricular arrhythmias, including variable degree heart blocks. Elderly patients are particularly predisposed to developing hyperkalemia and the associated abnormalities due to an age-related reduction in glomerular filtration rate and pre-existing medical problems. Therefore, the impact of aging on potassium homeostasis must be taken into consideration, and preventive measures, such as early recognition of possible hyperkalemia in the geriatric population treated with certain medications or supplements must be investigated.

Caution of overdependence on formulas while treating hyponatremia.

Use of online formulas to treat hyponatremia is a common practice. We report here that while using the same goal of correction and type of infusate to treat a patient with hyponatremia, a large discrepancy in infusion rate is obtained from using the 2 commonly available online equations. When the therapy fluid is less concentrated saline (0.

Effect of lower calcium dialysate on laboratory abnormalities in chronic kidney disease-associated mineral and bone disorder.

Increased vascular calcification, possibly due to the biochemical problem of calcium (Ca) and phosphate excess, has been associated with cardiovascular disease in patients with end stage renal disease. The use of a lower dialysate Ca concentration (<2.50 mEq/L) has been postulated as one of the methods to prevent long-term Ca accumulation.