Latest Updates

Nonalcoholic Fatty Liver Disease

    • Imaging modalities in the assessment of NAFLD
    • Controlled attenuation parameter as a point of care measure for hepatic steatosis
    • Proton density fat fraction as MRI based measure for hepatic steatosis
    • Liver stiffness measurement on elastography as a correlate of hepatic fibrosis or cirrhosis
    • Active clinical trials in phase 2b and 3, yet no FDA approved therapy
    • Intense lifestyle changes with 5-10% weight loss can improve fibrosis and steatosis

Evaluation and Management of Cleft Lip and Palate

    •  Lip Taping and nasoalveolar molding pre-operatively can greatly improve surgical outcomes.
    • 3-Dimensional printing used to make nasoalveolar molding appliances

Shock

    • Early recognition of shock is difficult but essential for preservation of cellular and organ function and survival. The earliest clinical signs are nonspecific, with the initial inflammatory response including tachycardia, fevers, or cool or clammy skin. 
    • The approach to shock ultimately requires understanding and correcting its etiology (eg, antibiotics and source control for sepsis, thrombectomy after massive pulmonary embolus, hemorrhage control after trauma, and so forth). However, until these are diagnosed and addressed directly, clinicians ultimately have three approaches in their armamentarium: volume expansion, vasopressors, and cardioactive agents.
    • The PAC was introduced in 1970. Its use increased over the next 3 decades and eventually was considered the standard of care for most critically ill patients. However, the use of PACs declined rapidly after the results of the randomized, controlled trial published in the New England Journal of Medicine revealing no benefit in high-risk surgical patients.

Lip, Cheek, & Scalp Reconstruction

    • Indocyanine green based fluorescent imaging to assess vascular perfusion
    • Allograft dermal skin regeneration: Acellular dermal regeneration templates
    • Microvascular techniques for larger, deeper defects with skin and color matching

Allergic Response

    • Radiofrequency ablation as a treatment modality has revolutionized therapy for many SVTs; acts as a first-line alternative to drug therapy in some circumstances, with a high acute success rate and relatively low complication rate.
    • Cryoablation therapy emerging as an alternative in ablative therapies. Investigation of this modality for SVTs is ongoing.
    • Detailed drug regimens optimized for acute and chronic management of specific SVTs; detailed in the 2015 ACC/AHA/HRS practice guidelines.

Antisocial Personality Disorder and Its Clinical Management

    • Follow-up studies have shown the continuity of antisocial behaviors from childhood through the adult years.
    • Research has implicated brain regions that control judgment and impulse control.
    • Cognitive-behavioral therapy may be helpful in mild cases.

Injection Sclerotherapy and Ablation

    • Endovenous laser ablation (EVLA) has many similarities to radiofrequency ablation (RFA), with the primary differences related to the catheter and mechanism used to ablate the vein. EVLA uses a bare-tipped or jacket-tipped fiber to deliver laser energy to a target area.
    • The thermal energy generates heat and steam bubbles within the lumen of the target vessel, destroying the endothelial lining of the vessel. This causes an inflammatory and constricting reaction that leads to fibrosis and occlusion of the treated vein.
    • Of note, the incidence of severe postprocedure pain and bruising has been significantly decreased with the advent of the new-generation covered fibers and hemoglobin-targeted chromophore, such that these adverse events are now comparable to those seen with RFA.

Practicing Evidence-Based Medicine

    • Even the most competent physician can be prone to misusing epidemiologic concepts. An example of inaccurate decision making, resting on Bayes’s theorem, occurred in a recent study in which primary care physicians were given clinical scenarios. Although the clinicians confidently provided their estimates of the probabilities of given disorders, no consensus could be found among the estimates. Another study assessed the ability of medical students, residents, and attending physicians to correctly determine the positive predictive value of a hypothetical screening test. The vast majority of respondents not only got the question wrong but also had an answer that would have led to the opposite clinical conclusions, guessing an incorrect positive predictive value of 95% when the true answer was 2%.
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