Pelvic Pain, Food Allergies, Thyroid Disease, Mpox, Chronic Fatigue Syndrome, Alloimmunization
Am Fam Physician. 2023;108(5):online
What is the best initial imaging test in women with acute pelvic pain?
Consensus guidelines recommend starting with transvaginal ultrasonography for pregnant and nonpregnant patients whose pelvic pain is likely from a gynecologic source. If the patient is not pregnant and a gastrointestinal cause is suspected, perform a computed tomography scan of the abdomen and pelvis with intravenous contrast. Ultrasonography should be considered a low-risk first imaging modality to evaluate for possible appendicitis.
How can the risk of food allergies in children be decreased?
Early introduction of peanuts, wheat, cooked eggs, and cow's milk between four and six months of age decreases the risk of developing food allergies.
Does a gluten-free diet reduce symptoms of autoimmune thyroid disease?
There is no evidence that following a gluten-free diet reduces symptoms of autoimmune thyroid disease; however, following a gluten-free diet may decrease mean thyroid-stimulating hormone levels.
Should prophylaxis be offered to a patient potentially exposed to mpox?
Two vaccines are available for postexposure prophylaxis: Jynneos (smallpox and mpox live vaccine, nonreplicating) and ACAM2000 (smallpox live vaccine). ACAM2000 is contraindicated in people with HIV, other immunocompromising condition, or eczema and in those who are pregnant. Ideally, the first dose of the vaccine should be administered within four days of exposure but can be administered up to 14 days after exposure.
How is myalgic encephalomyelitis/chronic fatigue syndrome diagnosed?
Use the National Academy of Medicine Criteria to diagnose myalgic encephalomyelitis/chronic fatigue syndrome. The criteria require experiencing the core symptoms (postexertional malaise, profound fatigue, and unrefreshing sleep) at least 50% of the time over six months and a cognitive impairment or orthostatic intolerance.
How should alloimmunization be prevented in pregnant patients who are RhD-negative?
In patients who are RhD-negative carrying a fetus who is RhD-positive, administer Rho(D) immune globulin to decrease the risk of alloimmunization. The American College of Obstetricians and Gy necologists recommends a 300-mcg dose of anti-D immune globulin at 28 weeks' gestation for RhD-negative patients and again within 72 hours of delivery for patients whose newborn is RhD-positive.
Additional Online Only AFP Clinical Answers
How long should patients be treated with dual antiplatelet agents after a minor stroke or transient ischemic attack?
Patients with minor noncardioembolic stroke or high-risk transient ischemic attack should be treated with dual antiplatelet therapy (e.g., aspirin plus clopidogrel) for 21 to 90 days, followed by single antiplatelet monotherapy indefinitely for secondary prevention. Avoid dual antiplatelet therapy after 90 days because of an increased risk of bleeding.
What is the appropriate treatment for young children with bronchiolitis caused by respiratory syncytial virus (RSV)?
The treatment of RSV bronchiolitis is mainly supportive, with hospitalization considered for those at risk of requiring increased respiratory support.
Bronchodilators, prolonged epinephrine use, corticosteroids, antibiotics, and chest physiotherapy are not recommended. Palivizumab, an intramuscular monoclonal antibody, can be considered for RSV prophylaxis in children with an increased risk of severe infection. In July 2023, the U.S. Food and Drug Administration approved nirsevimab (Beyfortus), a long-acting monoclonal antibody, for the prevention of RSV lower respiratory tract disease in neonates and infants born during or entering their first RSV season and in children up to 24 months of age who remain vulnerable to severe RSV disease through their second RSV season. More details about nirsevimab for the prevention of RSV lower respiratory tract disease in neonates and infants can be found in this Practice Guideline.
Is semaglutide a safe and effective weight-loss therapy for adolescents with obesity?
A randomized controlled trial of semaglutide in 200 adolescents found that participants lost a clinically significant amount of weight compared with placebo (16.1% body mass index reduction vs. 0.6%). In the treatment group, 4% of participants developed acute cholelithiasis. It is unclear if the medication or rapid weight loss causes cholelithiasis and if weight loss persists when the medication is discontinued.
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