Gestational Diabetes Mellitus, Acetaminophen Overdose, Congenital Syphilis, e-Cigarettes, Acne Vulgaris, Newborn Birthmarks
Am Fam Physician. 2024;109(6):512
Are early diagnosis and treatment of gestational diabetes mellitus in patients at high risk beneficial for neonatal and maternal outcomes?
A randomized controlled trial of 802 pregnant patients showed that screening those at high risk for gestational diabetes mellitus in early pregnancy, and treating if positive, had modest benefits. A composite adverse neonatal outcome was reduced in the early treatment group (number needed to treat [NNT] = 18). Severe maternal perineal injury was also reduced in the early treatment group (NNT = 36).
What is the treatment for acetaminophen overdose?
N-acetylcysteine is the antidote for acetaminophen toxicity. It should be administered based on the ingested dose, serum acetaminophen concentration above the threshold at 4 hours after ingestion and later (using an acetaminophen nomogram), abnormal liver biochemistry, or evidence of liver failure attributable to an overdose.
How should you diagnose congenital syphilis?
Congenital syphilis should be considered in a neonate with small, copper-red, maculopapular lesions located primarily on the hands and feet that peel and crust after 3 weeks. Diagnosis is based on a quantitative comparison of nontreponemal serologic titers in the birthing parent and neonate.
Is switching to e-cigarettes effective for helping smokers who want to quit?
For adults who want to quit smoking, nicotine delivery via e-cigarettes plus counseling may be more effective than other means of nicotine replacement for long-term smoking cessation. A systematic review and meta-analysis of randomized controlled trials did not report the percentage of patients who maintained e-cigarette use while staying abstinent from smoking.
What are the most effective therapies for treating acne vulgaris?
A meta-analysis of multiple randomized controlled trials found that oral isotretinoin was the most effective therapy for decreasing the number of lesions in patients with acne. However, it is not considered first-line therapy. Topical retinoids and benzoyl peroxide combined with oral or topical antibiotics were comparably effective in achieving treatment success. Another analysis suggested starting treatment with adapalene (Differin) plus benzoyl peroxide, clindamycin plus benzoyl peroxide, or adapalene alone.
When should you refer a neonate with a congenital melanocytic nevus to dermatology?
Patients with a solitary congenital melanocytic nevus with a projected size of greater than 20 cm in any dimension or multiple congenital melanocytic nevi of any size should be referred to dermatology. Lesions on the head will likely double in size, whereas those on the trunk and extremities will likely triple in size.
Additional Online Only AFP Clinical Answers
What medications can be prescribed to reduce the number of heavy-drinking days in patients with alcohol use disorder?
Oral naltrexone (Revia), injectable naltrexone (Vivitrol), gabapentin, acamprosate, and topiramate can all help patients reduce their alcohol use.
What medications are recommended or not recommended as first-line treatment for chronic low back pain?
NSAIDs are considered the best initial pharmacologic treatment for chronic low back pain. Evidence shows that NSAIDs are more effective than placebo for pain and disability. Studies demonstrate that muscle relaxants have no benefit for chronic low back pain compared with controls; studies also show that benzodiazepines have no benefit compared with placebo and there is significant risk of harm.
What are first-line treatments for women with uncomplicated UTI?
First-line antibiotics for uncomplicated urinary tract infection (UTI) in women include fosfomycin, single 3-g dose; extended-release nitrofurantoin, 100 mg twice daily for 5 days; trimethoprim, 200 mg twice daily for 3 days; trimethoprim/sulfamethoxazole, 160/800 mg twice daily for 3 days; or pivmecillinam (Pivya), 400 mg three times daily for 3 days.
Tip for Using AFP at the Point of Care
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