The intentional ingestion of caustic acidic or alkaline substances in adults is most commonly related to prior psychological history and suicidal ideation. Caustic ingestions are a medical emergency and are usually more...The intentional ingestion of caustic acidic or alkaline substances in adults is most commonly related to prior psychological history and suicidal ideation. Caustic ingestions are a medical emergency and are usually more life-threatening in adults than accidental ingestions in children. The degree of injury is determined by the physical state of the substance, its concentration, the amount ingested, and the duration of exposure to gastric mucosa. This case report describes the evaluation and management of a 36-year-old man with an intentional ingestion of sulfuric (battery) acid.
Resistant hypertension (RH) is defined as blood pressure (BP) that remains uncontrolled with use of three or more antihypertensive medications or BP that is controlled with use of four antihypertensive medications. Aproc...Resistant hypertension (RH) is defined as blood pressure (BP) that remains uncontrolled with use of three or more antihypertensive medications or BP that is controlled with use of four antihypertensive medications. Aprocitentan is a newly approved drug for RH, offering a mechanism unique from currently available antihypertensive drugs. It serves to block endothelin-A and endothelin-B to reduce vasoconstriction. The drug, which is taken once daily, has been shown to yield sustainable reductions in BP across various settings, and it may be especially beneficial for those with chronic kidney disease. Risks with use include fluid retention, anemia, mild hepatic enzyme elevations, and-though less common than with other endothelin antagonists-hepatotoxicity. Aprocitentan is contraindicated in pregnancy, as it includes a boxed warning for embryo-fetal toxicity. Although this new drug expands available options for RH, it requires careful patient selection and monitoring. Finally, cost and insurance coverage may limit access.
Leukocytosis, defined as an elevated white blood cell count, is a frequently encountered laboratory finding with a broad differential diagnosis ranging from transient reactive processes to life-threatening hematologic ma...Leukocytosis, defined as an elevated white blood cell count, is a frequently encountered laboratory finding with a broad differential diagnosis ranging from transient reactive processes to life-threatening hematologic malignancies. Distinct patterns of elevation can provide valuable diagnostic clues that narrow the differential diagnosis and guide next steps. This article outlines a systematic approach to evaluating leukocytosis, emphasizing integration of clinical history, physical examination, and laboratory data. The discussion highlights both nonmalignant and malignant causes, including acute and chronic leukemias, lymphomas, and myeloproliferative disorders, and offers guidance on when to pursue advanced diagnostics. Finally, a practical evaluation algorithm is included to support clinical decision-making. By recognizing key clinical features, laboratory patterns, and risk factors associated with malignancy, clinicians can appropriately triage patients for specialist referral and ensure timely intervention.
BACKGROUND: Advanced practice providers (APPs) are integral to plastic surgery practices due to the frequency of staged procedures, perioperative care, and broad scope of practice. Our study evaluates the impact of APP u...BACKGROUND: Advanced practice providers (APPs) are integral to plastic surgery practices due to the frequency of staged procedures, perioperative care, and broad scope of practice. Our study evaluates the impact of APP utilization in one of the largest pediatric plastic surgery divisions in the United States. METHODS: Descriptive analyses were conducted to describe productivity trends from October 2012 to September 2023. Metrics included the number of clinic encounters, providers, operating room (OR) cases, and surgical conversion rate. RESULTS: In 2013, APPs completed one patient encounter for every five completed by surgeons. Since 2020, APPs have matched or exceeded the number of clinic encounters conducted by surgeons. The surgeon surgical conversion rate (surgeon clinic encounters to OR cases) increased from 0.19 in 2018 to 0.26 in 2023. CONCLUSIONS: Enhanced utilization of APPs in the division of plastic surgery has optimized our patient care model, increasing procedural productivity for surgeons without reducing clinic volume.
Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as nonalcoholic fatty liver disease (NAFLD), is an increasingly prevalent condition that poses significant public health challenges. Affect...Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as nonalcoholic fatty liver disease (NAFLD), is an increasingly prevalent condition that poses significant public health challenges. Affecting nearly 30% of the global population, MASLD is intricately linked to metabolic syndrome, insulin resistance, and cardiovascular disease. Primary care providers, including physician associates (PAs), play a critical role in early detection and management. This article provides an updated overview of MASLD for primary care PAs, focusing on disease pathophysiology, risk stratification, and screening recommendations. The use of noninvasive testing (eg, FIB-4, liver stiffness measurement) for diagnosis and monitoring is emphasized, and lifestyle interventions are underscored as first-line therapy. Importantly, the article highlights the recent FDA approval of resmetirom-the first pharmacologic treatment for noncirrhotic metabolic-associated steatohepatitis (MASH) with moderate to advanced fibrosis-and outlines the AASLD guideline supporting its use without the need for liver biopsy. By equipping primary care physician associates with current knowledge and practical tools, this article aims to improve early identification, guide appropriate referral, and enhance outcomes for patients at risk for MASLD progression. It also provides guidance around use of resmetirom in primary care, reviewing the drug's indications, dosing, drug-drug interactions, and safety monitoring. Finally, it highlights semaglutide as an emerging treatment option for noncirrhotic MASH.
The medical field is filled with ancient and modern symbols that have cultural and historical meanings. Symbols present in logos implicitly communicate values and purpose. This article explores the medical and religious...The medical field is filled with ancient and modern symbols that have cultural and historical meanings. Symbols present in logos implicitly communicate values and purpose. This article explores the medical and religious symbolism found in the two most common medical logos, the Rod of Asclepius and the caduceus, comparing the values they represent to the values of modern medical practice as defined by the Georgetown Mantra. Although the Rod of Asclepius and the caduceus are culturally recognized today as representing medical practice and healing, they in reality are associated with historical figures and stories representative of trickery, thievery, or a selective application of the healing arts. Institutions using these symbols in their logos should consider how their branding might be adjusted to communicate the values that medical professionals aim to espouse today.
Chronic obstructive pulmonary disease (COPD) exacerbations are a leading cause of hospitalization in the United States, incurring a large financial burden on the healthcare system and placing significant strain on patien...Chronic obstructive pulmonary disease (COPD) exacerbations are a leading cause of hospitalization in the United States, incurring a large financial burden on the healthcare system and placing significant strain on patient quality of life. Adding empiric antimicrobial agents, specifically macrolides, to the medical regimen of patients with severe COPD has been shown to reduce the frequency of COPD exacerbation. Although prophylactic macrolide therapy may relieve COPD burden, providers should consider the consequences of long-term antimicrobial utilization before prescribing these drugs.
Respiratory syncytial virus (RSV) is a respiratory virus that accounts for more than 100,000 ED visits per year. RSV causes the greatest morbidity in infants and children; however, older adults with chronic comorbidities...Respiratory syncytial virus (RSV) is a respiratory virus that accounts for more than 100,000 ED visits per year. RSV causes the greatest morbidity in infants and children; however, older adults with chronic comorbidities have increased risk of hospitalization due to complications of RSV compared with those who do not have chronic conditions. Typical symptoms of RSV in older adults include cough, rhinorrhea, and sore throat; however, in more serious cases, wheezing, difficulty breathing, or shortness of breath may be present, potentially prompting ED visits. Infections due to other viruses, such as cytomegalovirus, Epstein-Barr virus, and hepatitis B and C, are known to cause angioedema, but no case studies to date have reported RSV-induced uvulitis or angioedema. This article describes a novel case of an adult patient with RSV-induced uvulitis.
PURPOSE: To describe the educational background, practiced clinical disciplines and procedures, efficacy, and responsibility distribution of Dutch physician assistants (PAs) working in ophthalmology. METHODS: An online s...PURPOSE: To describe the educational background, practiced clinical disciplines and procedures, efficacy, and responsibility distribution of Dutch physician assistants (PAs) working in ophthalmology. METHODS: An online survey was sent to and collected from PAs working in ophthalmology and ophthalmologists collaborating with PAs. RESULTS: Of 85 ophthalmology PA and 15 ophthalmologist recipients, 36 PAs and 9 ophthalmologists completed the survey. The mean age of respondents was 39 years (range, 27-54), and 23 (63.9%) were female. Most PAs (97%) had a Bachelor of Science in optometry or orthoptics. All PAs (N = 36) were involved in managing patients with common ophthalmic conditions. On average, PAs worked 32.6 hours (range, 23-36) per week and added on average 77 full-time equivalents to the Dutch ophthalmology workforce. Ophthalmologists collaborating with PAs assessed PA autonomy with a mean score of 3.9 (on a scale from 0 to 5, with 0 being a low level of autonomy and 5 being a high level of autonomy). CONCLUSION: In the Netherlands, ophthalmology PAs may be considered a good partial solution for the shortage in eyecare professionals.
Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that often persists into adulthood. Adults may first receive a diagnosis in primary care, sometimes after previously unrecognized childhood...Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that often persists into adulthood. Adults may first receive a diagnosis in primary care, sometimes after previously unrecognized childhood symptoms. Reports of de novo "adult-onset ADHD" remain controversial and, when scrutinized, are most often explained by previously subthreshold childhood symptoms, alternative psychiatric or medical causes, or measurement error. If an adult presents with symptoms of ADHD but onset cannot be substantiated before age 12 years, providers should systematically rule out mimics-which include mood and anxiety disorders, substance use disorder, sleep disorders, traumatic brain injury, thyroid disorders, and medication side effects-before labeling the presentation as adult-onset ADHD. This article outlines the epidemiology, pathophysiology, clinical features, diagnostic strategies, and evidence-based treatments for ADHD presentations in adults. Primary care clinicians play a key role in recognizing symptoms, initiating evaluation, and implementing multimodal treatment plans to improve patient outcomes.
Opioid use disorder (OUD) is a pervasive, undertreated condition best managed with medications. Buprenorphine is a partial agonist with high affinity for the mu opioid receptor. It is particularly effective in treating O...Opioid use disorder (OUD) is a pervasive, undertreated condition best managed with medications. Buprenorphine is a partial agonist with high affinity for the mu opioid receptor. It is particularly effective in treating OUD, resulting in reduced opioid use, risk of overdose, and all-cause mortality. Buprenorphine induction in the emergency department (ED) is an evidence-based practice for initiating OUD treatment while managing opioid withdrawal symptoms. Current guidelines from the Substance Abuse and Mental Health Services Administration recommend following a standard-dose induction regimen implemented over 2 days. However, variability exists among ED-initiated protocols in terms of timing, dose, duration, and formulation. ED providers should use their clinical judgment when approaching buprenorphine induction for opioid withdrawal management and OUD treatment. This article reviews current evidence and practical strategies for initiating buprenorphine in the ED, with an emphasis on patient evaluation, buprenorphine dosing, and continuity of care.
Black and African American individuals continue to face a wide range of healthcare disparities compared with White non-Hispanic individuals. Research suggests that one effective way to improve health equity for Black peo...Black and African American individuals continue to face a wide range of healthcare disparities compared with White non-Hispanic individuals. Research suggests that one effective way to improve health equity for Black people is to provide access to racially concordant healthcare providers-that is, Black patients receiving care from Black providers. This article briefly reviews the evidence showing that patient-provider racial concordance is associated with better outcomes for Black patients, indicating its potential in addressing health inequities. Despite this compelling evidence, many studies and population data reveal a persistent shortage of Black healthcare providers in the United States. Given the rapid growth and high demand for physician associates (PAs) in the United States, the PA profession is uniquely positioned to address this need. The article concludes with recommendations to increase diversity in the PA profession and broader healthcare workforce.