What's New | Decker

Jennifer A Johnson, MD, Daniel R Kuritzkes, MD, FACP

Treatment as prevention reduces the risk of HIV transmission by at least 96%.
Preexposure prophylaxis, either as oral or injectable formulations , may reduce the risk of HIV acquisition by more than 90% when taken with good adherence.
Postexposure prophylaxis reduces the risk of HIV acquisition by at least 80%.
Combination antiretroviral therapy reduces the risk of mother-to-child transmission of HIV to less than 1%.
Risk reduction counseling and barrier protection remain important components of the HIV prevention toolkit.

POEM is an emerging therapy for achalasia that is a hybrid of surgical myotomy and pneumatic dilation.
One of the most important tools used to detect gastroesophageal reflux disease (GERD) is ambulatory 24-hour esophageal pH monitoring; this is typically conducted using a catheter inserted through the nose. A wireless pH probe that can be attached to the esophageal lining is also available. Additional techniques for assessing GERD include ambulatory 24-hour bile monitoring and monitoring of multichannel intraluminal impedance, which can measure both acidic and nonacidic refluxates of liquid or gas consistencies.
One recently developed technique that can assess the presence or absence of reflux is the measurement of mucosal impedance to electric current. This technique may also be able to distinguish GERD from eosinophilic esophagitis.

POEM is an emerging therapy for achalasia that is a hybrid of surgical myotomy and pneumatic dilation.
One of the most important tools used to detect gastroesophageal reflux disease (GERD) is ambulatory 24-hour esophageal pH monitoring; this is typically conducted using a catheter inserted through the nose. A wireless pH probe that can be attached to the esophageal lining is also available. Additional techniques for assessing GERD include ambulatory 24-hour bile monitoring and monitoring of multichannel intraluminal impedance, which can measure both acidic and nonacidic refluxates of liquid or gas consistencies.
One recently developed technique that can assess the presence or absence of reflux is the measurement of mucosal impedance to electric current. This technique may also be able to distinguish GERD from eosinophilic esophagitis.

POEM is an emerging therapy for achalasia that is a hybrid of surgical myotomy and pneumatic dilation.
One of the most important tools used to detect gastroesophageal reflux disease (GERD) is ambulatory 24-hour esophageal pH monitoring; this is typically conducted using a catheter inserted through the nose. A wireless pH probe that can be attached to the esophageal lining is also available. Additional techniques for assessing GERD include ambulatory 24-hour bile monitoring and monitoring of multichannel intraluminal impedance, which can measure both acidic and nonacidic refluxates of liquid or gas consistencies.
One recently developed technique that can assess the presence or absence of reflux is the measurement of mucosal impedance to electric current. This technique may also be able to distinguish GERD from eosinophilic esophagitis.

An interesting advance in the treatment of advanced basal cell carcinoma is the use of inhibitors of the sonic hedgehog pathway. The vast majority of basal cell carcinomas harbor genetic mutations in the hedgehog signaling pathway, which results in constitutive activation and basal cell proliferation.
SLNB is generally not recommended unless the lesion is between 0.75 and 1.0 mm, high risk based on histologic features (e.g., ulcerated or with > 1 mitoses/mm2), or inadequately staged (e.g., positive deep margin).
An important variable in the prognosis of melanoma is the thickness of the primary tumor as assessed using the Breslow system. Tumor thickness in the Breslow system is measured from the epidermal surface to the deepest point of the tumor with a calibrated ocular micrometer.

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

There is a shift to change the definition of massive transfusion to focus on units per time as opposed to total units administered.
While laparotomy is still considered the gold standard treatment for gunshot wounds to the abdomen, selective NOM of penetrating abdominal wounds is possible. NOM can only be performed in centers that have the staffing and resources to perform serial examinations and the ability to take the patient to the OR at any time should they decompensate.
Resuscitation of the trauma patient, like much of critical care, is a sophisticated art of balancing the needs of competing organ systems in a patient with multiple injuries. Resuscitation of the trauma patient focuses on prevention of the lethal triad of trauma and secondary injury. The term refers to a triad of acidosis, coagulopathy, and hypothermia resulting from injury and blood loss.

Catatonia was considered a subtype of schizophrenia in DSM-I through DSM-III-R.
Catatonia is listed as a specifier in DSM-5 and ICD-10.
Most persons with catatonia have a mood disorder, most commonly bipolar disorder.
There is no known cause, but the condition is probably mediated by GABAergic neurotransmission.
Catatonia is effectively treated with benzodiazepines and/or electroconvulsive therapy.

Infectious Diseases