Am Fam Physician. 2024;110(2):117
Which subset of men who have sex with men should be offered preexposure prophylaxis?
Preexposure prophylaxis (PrEP) is recommended for men who have sex with men who have increased risk of HIV infection, defined as anal sex within the past 6 months and one of the following: a sex partner with HIV infection (especially with an unknown or detectable viral load), history of bacterial sexually transmitted infection in the past 6 months, or inconsistent condom use with partners of unknown HIV status.
Does treatment with monoclonal antibody therapy that targets amyloid improve patient outcomes for those living with Alzheimer disease?
According to a meta-analysis of 19 studies, amyloid-targeting antibodies for the treatment of Alzheimer disease have not demonstrated clinically meaningful benefits. These therapies are associated with concerning risks of harm, most notably cerebral hemorrhage identified in imaging studies (number needed to harm = 13). So far, the balance of risk vs. benefit demonstrated does not justify the use of these costly drugs (more than $20,000 annually).
What are current guideline recommendations for managing chronic coronary disease in adults?
Key changes in the 2023 American College of Cardiology/American Heart Association guideline include shortening the duration of dual antiplatelet therapy and the use of beta blockers in patients with chronic coronary disease, not recommending fish oil or omega-3 fatty acids for primary or secondary prevention, not using e-cigarettes as first-line agents for smoking cessation, and incorporating sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists for some patients with chronic coronary disease.
How should patients be counseled about surgery to treat lumbar spinal stenosis?
Decompression surgery may improve short- and long-term function and pain in patients with lumbar spinal stenosis but is associated with a higher risk of complications.
When should you consider the diagnosis of primary aldosteronism, and which laboratory tests should you order?
Consider primary aldosteronism in patients with resistant hypertension or who have well-controlled hypertension and one of the following: adrenal nodule, hypokalemia, atrial fibrillation, obstructive sleep apnea, family history of early stroke (i.e., younger than 40 years), or a first-degree relative with primary aldosteronism. Physicians should obtain plasma aldosterone concentration and plasma renin levels. Aldosterone elevation with suppressed plasma renin levels identifies patients with potential primary aldosteronism.
Additional Online Only AFP Clinical Answers
Does regular exercise improve clinical depression symptoms in adults older than 60 years?
A meta-analysis of randomized controlled trials found that exercise is beneficial for treating depression in adults older than 60 years. Exercise training is recommended for healthy older adults because it significantly decreases depressive symptoms. Exercise improves depression in older patients with normal or impaired cognition. High-intensity resistance exercise also improves depression in older patients (number needed to treat = 3).
Does titrated, low-dose amitriptyline improve symptoms of irritable bowel syndrome (IBS) in adults for whom first-line therapies have been ineffective?
A randomized controlled trial of more than 460 patients in the United Kingdom, primarily adults with IBS with diarrhea (IBS-D) or IBS with diarrhea mixed with constipation (IBS-M) of at least moderate severity despite first-line therapy, found that titrated, low-dose amitriptyline was more effective than placebo in improving symptoms. All patients had already tried first-line treatments (i.e., diet, lifestyle, antispasmodics, laxatives, or antidiarrheals).
Who should be screened for hearing impairment?
The U.S. Preventive Services Task Force found insufficient evidence to assess the balance of benefits and harms of screening for hearing loss in adults 50 years or older. Experts recommend that physicians assess for objective hearing impairment when the patient or a family member raises a concern or if cognitive or mood symptoms are present that could be influenced by hearing loss.
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