Medical Clinics of North America

No abstract text is available yet for this article.

No abstract text is available yet for this article.

Benign prostate hyperplasia (BPH) affects a large number of men and can be treated with behavioral, medical, or surgical treatments. The newest addition to medical therapy is β3-agonists for overactive lower urinary tract symptoms. Multiple new surgical treatments have become available in the past decade, including several clinic-based minimally invasive surgical techniques (eg, UroLift, Rezum, Optilume BPH), OR treatments (eg, Aquablation, single port robotics), and prostate artery embolization. The growth of options allows providers to better tailor BPH treatment to the specific disease factors and patient preferences...

This article summarizes the situation with public health threats for primary care patients as of early 2024 and provides updates on strategies for the prevention, diagnosis, and treatment of common infections where new treatments and vaccines are available. For flu and COVID, an update on treatment is also provided-along with pearls useful for the busy primary care provider. The authors also discuss a new treatment option for drug-resistant vulvovaginal candidiasis and provide a balanced view of the increasingly popular technique of preventing bacterial sexually transmitted infections using doxycycline after condomless sex among men who have sex with men...

Over the last decade, randomized clinical trials of several pharmacologic agents have demonstrated a reduction in cardiovascular mortality and other important secondary outcomes. Angiotensin-Neprilysin Inhibitors and Sodium-Glucose Co-transporter 2 inhibitors have now become pillars in the treatment of heart failure. Ivabradine is a negative chronotropic agent used as an adjunctive therapy in patients with heart failure. Two new hypertension therapies, zilebresiran and aprocitentan, are currently in investigational stages...

New diabetes drugs such as glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and glucose-dependent insulinotropic peptide/GLP-1 RAs have emerged to show hemoglobin A1c (HbA1c) reduction, weight loss, and cardiovascular benefits. Similarly, sodium-glucose cotransporter 2 inhibitors' benefits span from HbA1c decrease to cardiovascular and renoprotective effects. Diabetes technology has expanded to include type 2 diabetes mellitus, with literature supporting its use in T2DM on any insulin regimen. Connected insulin pens and insulin delivery devices have opened new solutions to insulin users and automated insulin delivery systems have become the standard of care therapy for type 1 diabetes mellitus...

For more than 20 years, the mainstay of pharmacologic treatment for depression and anxiety disorders has been serotonin reuptake inhibitors and selective serotonin and norepinephrine reuptake inhibitors. There are newer medications, many with novel mechanisms of action, that have come to market; however, first-line treatments remain the same. There are now more robust data on the use of various augmentation agents in the treatment of major depressive disorder providing better recommendations for use by the primary care provider...

Memory loss and dementia are among older adults' greatest health fears. This article provides insight into new developments to help delay the onset of dementia, to treat dementia in its earliest stages, and to manage behavioral problems that occur in persons with dementia. Urinary incontinence (UI) is another common problem in older adults that has a major impact on quality of life. This article evaluates newer medications for reducing urinary urge/UI and provides perspective in their role for managing UI.

Significant advances in atherosclerotic cardiovascular (ASCVD) risk stratification and treatment have occurred over the past 10 years. While the lipid panel continues to be the basis of risk estimation, imaging for coronary artery calcium is now widely used in estimating risk at the individual level. Statins remain first-line agents for ASCVD risk reduction but in high-risk patients, ezetimibe, proprotein convertase subtilisin kexin-9 inhibitors, and bempedoic acid can be added to further reduce individual cardiovascular risk based on results of cardiovascular outcomes trials...

This article contains noninclusive language such as "females" and "women" when those terms were used in the research and historic context we are summarizing. New therapies have become available for vasomotor symptoms, postpartum depression, contraception, osteoporosis, recurrent yeast infections, acute and recurrent urinary tract infections, and female hypoactive sexual desire disorder. These therapies meet unique patient needs and change clinical practice for select groups. As is typical for new treatments, insurance coverage and access issues limit the adoption of some therapies...

Newer medications and devices, as well as greater understanding of the benefits and limitations of existing treatments, have led to expanded treatment options for patients with lung disease. Treatment advances have led to improved outcomes for patients with asthma, chronic obstructive pulmonary disease, interstitial lung disease, pulmonary hypertension, and cystic fibrosis. The risks and benefits of available treatments are substantially variable within these heterogeneous disease groups. Defining the role of newer therapies mandates both an understanding of these disorders and overall treatment approaches...

Seven of the 11 newer medications recently or soon to be approved to treat rheumatologic diseases discussed in this article are biologic agents and reflect the current ability of science to target specific components of the immune system. The other agents are molecules that are directed against specific immune pathway targets as well. All have shown superiority to placebo and in some cases have been compared to currently accepted therapies. Safety issues are generally centered around infections due to the immune-interrupting nature of these therapies...

Dermatologic concerns are discussed in about a third of all primary care visits. This review discusses treatments for common dermatologic diagnoses addressed in primary care settings, with an emphasis on new and emerging treatments. Topical, oral, and injectable treatment of common forms of alopecia, facial rashes, atopic dermatitis, psoriasis, seborrheic dermatitis, and stasis dermatitis will be discussed to help increase comfort in prescribing and alert providers to common side effects or complications of more intensive treatments used by dermatologists...

This article reviews the evaluation and management of several gastrointestinal disorders that are commonly encountered by gastroenterologists and primary care physicians. With a focus on newer therapies, we discuss the management of chronic constipation, irritable bowel syndrome, Clostridioides difficile infection, gastroparesis, steatotic liver disease, and diverticulitis.

No abstract text is available yet for this article.

No abstract text is available yet for this article.

Stinging insects are a frequent cause of local and systemic hypersensitivity reactions, including anaphylaxis. For those with a history of life-threatening anaphylaxis, venom immunotherapy is effective, safe, and can be life-saving. Arachnids are a much less common source of envenomation through bites or stings and are less likely to cause a hypersensitivity reaction. However, recognizing the clinical manifestations when they do present is important for accurate diagnosis and treatment, and, when indicated, consideration of other diagnoses...

Hereditary angioedema is a rare autosomal dominant condition characterized by episodes of swelling of the upper airway, intestines, and skin. The disorder is characterized by deficiency in C1 esterase inhibitor (C1-INH) or a decrease in functional C1-INH. Treatment options include on demand therapy (treatment of acute attacks), long-term prophylaxis, and short-term prophylaxis. Corticosteroids, epinephrine, and antihistamines are not effective for this form of angioedema. The high mortality in patients undiagnosed underscores a need for broader physician awareness to identify these patients and initiate therapy...

This chapter presents an overview of eosinophilic esophagitis (EoE) for the Primary Care Practitioner (PCP). The focus is on helping PCPs keep it in their differential diagnosis by discussing the spectrum of clinical presentations, how to screen for EoE in at-risk populations and subsequently manage the patient with this condition. The authors review epidemiology, risk factors and associated conditions, pathology, clinical presentation, diagnosis, and management options.

Oral immunotherapy (OIT) is an alternative treatment of IgE-mediated food allergy that has been shown to increase tolerance threshold to many of the top food allergens, although this effect may be dependent on age, dose, frequency, and duration. OIT has been shown to be effective and safe in infants, and early initiation can improve rates of desensitization even for those foods whose natural history favors loss of allergy. Studies looking at protocol modification to improve OIT success are ongoing as is the evaluation of clinical tools to help monitor OIT effects...