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Articles for December 16, 2020

Selected articles for Primary Care Providers
Collected By Dr. Bruce Peyser
ORTHOPEDICS
Does this young adult patient need hip radiography?   
Cleveland Clinic Journal of Medicine
A case of a 41-year-old' woman with chronic radiculopathy falls and a question arises does she need an x-ray.  It turns out that with few risk factors for hip fracture, no debilitating disease, and with the patient not on steroids and with low energy fall, normal exam, and limb is not shortened, rotated or deformed, the risk for fracture is quite low- the number of hip films one might have to order to find a potential occult hip fracture is quite high.
INFECTIOUS DISEASE
Take a Bite out of Cellulitis with Dr. Boghuma Titanji
Curbsiders Podcast
So many ways to learn here, either by listening or reading the text.  I found listening to Dr. Titanji to be very easy and quite interesting and detailed, and granular.  Listen carefully, it turns out that folks who work out a lot and go to gyms are at higher risk for MRSA.  Also, check out the two infographic sheets, helping to think about approaches to whether an infection is purulent or not, and also there is a second one detailing how to manage bite wounds.
COVID AND NEUROLOGY
Neurologic Complications of COVID 19   
Cleveland Clinic Journal of Medicine
Turns out that a lot can help during acute COVID infection including encephalopathy, stroke, CNS infection, seizures, and neuromuscular disease.  A number of risk factors for neurologic problems include severe disease, hypoxemia requiring intubation, hypoperfusion, and increased inflammatory response."
GASTROENTEROLOGY
DIVERTICULITIS
NEJM
A helpful review from 2018.  There is no evidence that patients have to cut out seeds, or nuts, or popcorn.  Recall that Asian individuals typically have their pain localized to RLQ as opposed to most other individuals who have pain localized to LLQ.
MISCELLANEOUS
TOP POEMS OF 2019 CONSISTENT WITH THE PRINCIPLES OF CHOOSING WISELY CAMPAIGN
American Family Physician
So many important items to learn about and recall.  Here are a few: 1) Omega 3 fatty acids do not prevent cancer or cardiovascular disease 2) we need to guide our patients who monitor bp at home so that they don’t rush to the ER unnecessarily 3) probiotics are not effective for acute gastroenteritis in young children 4) “augmentation” of antidepressant therapy is not usually helpful.
 
NEUROLOGY
PARKINSON DISEASE 
American Family Physician
A nice review especially focusing on pharmacology.
ENT
HEARING LOSS
Annals of Internal Medicine-In The Clinic
Just to reiterate, subclinical hearing loss has been independently associated with cognitive impairment and depression. Note the box near the end of the article detailing meds that are known to be ototoxic or potentially ototoxic.
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