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.

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.

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.

Molecular tests for gene point mutations, insertions, deletions, fusions and expression alterations are available that can be used to help risk stratify intermediate risk differentiated thyroid cancers into either surgical management or observation .
Stage IV anaplastic thyroid cancer requires aggressive approach for complete resection and prompt transition to adjuvant definitive-intention therapy to attain long-term survival.
Radiofrequency ablation (RFA) is being studied in clinical trials as alternative to high risk surgical patients and selected benign thyroid nodules.
To avoid neck scar, consider robotic thyroidectomy with approaches including trans axillary (most common), bilateral axilla-breast, retro auricular, and transoral (requires CO2 gas insufflation, not a “clean” procedure) approaches for patients with indeterminate, likely benign lesions if BMI <35.
Transoral endoscopic thyroidectomy can be considered for patients with a thyroid mass without evidence of lymph node metastases as retrospective review of 422 patients did not demonstrate significant difference in complications compared to open thyroidectomy group.

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

Infectious Diseases