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https://www.ncbi.nlm.nih.gov/p[ ... ]les/PMC3703180/
In patients with suspicion of contained appendiceal inflammation, based on a palpable mass or long duration of symptoms, the diagnosis should be confirmed by imaging techniques, especially CT scan. The patient should receive primary nonsurgical treatment with antibiotics and abscess drainage as needed. After successful nonsurgical treatment, no interval appendectomy is indicated in some cases, but the patient should be informed about the risk of recurrence especially in the presence of appendicolith. The risk of missing another underlying condition (cancer or CD) is low, but motivates a follow-up with a colon examination and/or a CT scan or US, especially in patients above the age of 40 years.
For the dyslipidemic patient, how do we differentiate between the statins; ie, when should one be used preferentially over the other? Are there significant clinical differences among them?
As a class, the statins are remarkably safe and their use in patients who need LDL lowering for atheroprevention has a very high benefit/risk ratio. But because they are most commonly used in older patients with complicated health histories, and because of heightened public concerns, we must always remember to address several safety issues when prescribing statins. Although there is increasing impetus toward more and more aggressive lipid-lowering therapy, we need to keep the following always in mind:
1. Safety, cost, and efficacy considerations often point to:
-Use of lower doses of a given statin and/or
-Use of safer statins such as fluvastatin and pravastatin; and
-Use of other agents (ezetimibe, niacin, fibrates, and/or sequestrants) in combination with statins for greater LDL-lowering and/or other lipid benefits
2. When starting statins, patients must always be informed of potential safety risks, and any symptoms or signs of adverse effects must be taken seriously and handled properly.
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non-identifying relationship vs identifying relationship + mysql ?
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