Am Fam Physician. 2023;107(1):22
What lifestyle recommendations should be provided to patients to prevent diverticulitis and recurrent diverticulitis?
Consumption of popcorn, nuts, or seeds is not a risk factor for developing diverticulitis. A high-fiber diet is associated with a lower incidence of diverticular disease, but evidence about whether it prevents the recurrence of diverticulitis is lacking. Tobacco cessation, reduced meat intake, physical activity, and weight loss are recommended interventions to decrease the risk of recurrence.
Do all patients with diverticulitis require treatment with antibiotics?
No. Select patients with uncomplicated diverticulitis can be treated without antibiotics. A meta-analysis of nine randomized controlled trials with 2,505 patients showed that those treated without antibiotics had shorter hospital stays than those treated with antibiotics, and there was no difference in complication or readmission rates.
Who should be screened for abdominal aortic aneurysm (AAA)?
The U.S. Preventive Services Task Force (USPSTF) recommends one-time screening for AAA with ultrasonography in men 65 to 75 years of age who have ever smoked and selective screening with ultrasonography in men 65 to 75 years of age with risk factors for AAA who have never smoked, rather than routinely screening all men in this group. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for AAA in women 65 to 75 years of age who have ever smoked or have a family history of AAA.
Are intravenous steroids more effective than oral steroids in treating acute relapses of multiple sclerosis?
There is no difference in effectiveness between oral and intravenous steroids in treating acute relapses of multiple sclerosis. A higher dosage of steroids, such as 1,000 mg per day of methylprednisolone for three days, is recommended.
Is intravenous iron infusion superior to oral iron for avoiding blood transfusion in adults with iron deficiency anemia?
Intravenous iron administration does not reduce the need for blood transfusion compared with oral iron supplementation, based on multiple meta-analyses of randomized controlled trials.
What clinical signs and scoring system can help identify testicular torsion?
The Testicular Workup for Ischemia and Suspected Torsion scoring system should be used if testicular torsion is suspected. Clinical parameters include testicular swelling (2 points), hard testicle (2 points), absent cremasteric reflex (1 point), nausea or vomiting (1 point), and high-riding testicle (1 point). If the score is 5 or greater, the risk of torsion is highly likely.
Additional Online Only AFP Clinical Answers
Are epidural steroid injections effective for low back pain?
Treatment with epidural steroid injections in the lower spine is not effective for reducing pain and disability. The injections may be more effective than placebo at short-term follow-up, but the effects are not clinically meaningful.
What are first-line medications for generalized anxiety disorder?
Selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors are recommended as first-line medications for treating generalized anxiety disorder and panic disorder. Benzodiazepines are not more effective than antidepressants for anxiety disorders and should not be used as first-line therapy.
When should secondary causes be evaluated in patients who present with a headache?
Patients with a headache and red flags (acute thunderclap headache, fever with meningeal irritation on physical examination, papilledema with focal neurologic signs or impaired consciousness, concern for acute glaucoma) in their history or physical examination warrant further investigation for secondary causes of headache. Consider giant cell arteritis in patients older than 50 years who present with a new or evolving headache. Patients with acute thunderclap headache should be sent to the emergency department and should receive computed tomography of the head within 12 hours of symptom onset. Lumbar puncture must follow a normal computed tomography scan to exclude subarachnoid hemorrhage. Patients with stable primary headache disorders (i.e., no red flags and a normal neurologic examination) do not need neuroimaging.
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