Biomedical subjects

Anthony J Viera

Publications and source records attributed to Anthony J Viera.

4 recordsLinked to original sources

PubMed2003

Off-label applications for SSRIs.

Selective serotonin reuptake inhibitors (SSRIs) are widely used because of their safety, tolerability, and demonstrated efficacy across a broad range of clinical conditions. Medical literature supports the use of SSRIs for the treatment of many conditions outside of the indications approved by the U.S. Food and Drug Administration. SSRIs offer a reasonable alternative to traditional therapy for generalized anxiety disorder. A side effect of SSRIs coincidentally provides therapy for premature ejaculation. SSRIs may reduce the frequency and severity of migraine headaches and are possibly effective in reducing the pain of diabetic neuropathy. When taken in combination with tricyclic antidepressants, SSRis offer more potent therapy for fibromyalgia than either agent alone. SSRIs appear to be effective in some patients with neurocardiogenic syncope that is refractory to standard therapies. Clinical experience supported by ongoing research continues to expand on the broad array of therapeutic applications for this class of medication.

Antidepressive Agents, Second-Generation↗

PubMed2003

Management of carpal tunnel syndrome.

Carpal tunnel syndrome affects approximately 3 percent of adults in the United States. Pain and paresthesias in the distribution of the median nerve are the classic symptoms. While Tinel's sign and a positive Phalen's maneuver are classic clinical signs of the syndrome, hypalgesia and weak thumb abduction are more predictive of abnormal nerve conduction studies. Conservative treatment options include splinting the wrist in a neutral position and ultrasound therapy. Orally administered corticosteroids can be effective for short-term management (two to four weeks), but local corticosteroid injections may improve symptoms for a longer period. A recent systematic review demonstrated that nonsteroidal anti-inflammatory drugs, pyridoxine, and diuretics are no more effective than placebo in relieving the symptoms of carpal tunnel syndrome. If symptoms are refractory to conservative measures or if nerve conduction studies show severe entrapment, open or endoscopic carpal tunnel release may be necessary. Carpal tunnel syndrome should be treated conservatively in pregnant women because spontaneous postpartum resolution is common.

Carpal Tunnel Syndrome↗

PubMed2003

Thyroid function testing in outpatients: are both sensitive thyrotropin (sTSH) and free thyroxine (FT4) necessary?

BACKGROUND AND OBJECTIVES: Despite improved thyroid function testing assays, appropriate use of these commonly ordered tests to detect thyroid dysfunction remains controversial. This study determined if a normal sensitive thyroid stimulating hormone (sTSH) test alone is sufficient to rule out thyroid dysfunction in outpatients. METHODS: This was a retrospective analysis of initial sTSH and free thyroxine index (FT4) tests ordered during a 26-month period. Test results were classified as concordant if both the sTSH and FT4 indicated the same findings (ie, euthyroid, hyperthyroid, or hypothyroid). The results were classified as discordant if the sTSH and FT4 did not indicate the same findings. RESULTS: There were 1,392 paired sTSH and FT4 results. Of 1,340 results classified as concordant (96.2%), 1,187 specimens were consistent with euthyroidism, 41 with hyperthyroidism, and 112 with hypothyroidism. Of the remaining 52 (3.8%) discordant results, 47 met the definition of subclinical thyroid dysfunction. Excluding these 47 results yielded a concordance rate of 99.6%. Of the 1,192 normal sTSH results, FT4 was low in two and high in three. If FT4 tests had not been ordered on the 1,192 specimens with normal sTSH levels, the savings over the study period would have been more than dollars 3,360. CONCLUSIONS: If the sTSH is normal, the likelihood of an abnormal FT4 is very small. sTSH alone is adequate to screen outpatients for thyroid dysfunction. Limiting FT4 tests to those with abnormal sTSH results will result in cost savings.

Cost Savings↗

PubMed2002

Management of irritable bowel syndrome.

Irritable bowel syndrome is the most common functional disorder of the gastrointestinal tract and is frequently treated by family physicians. Despite patients' worries about the symptoms of irritable bowel syndrome, it is a benign condition. The diagnosis should be made using standard criteria after red flags that may signify organic disease have been ruled out. An effective physician-patient relationship is vital to successful management. Episodes of diarrhea are best managed with loperamide, while constipation often will respond to fiber supplements. Antispasmodics or anticholinergic agents may help relieve the abdominal pain of irritable bowel syndrome. Refractory cases are often treated with tricyclic antidepressants. Newer agents such as tegaserod and ondansetron target neurotransmitter receptors in the gastrointestinal tract Some forms of psychologic treatment may be helpful, and gastroenterology consultation is occasionally needed to reassure the patient. Comorbid conditions such as depression or anxiety should be investigated and treated.

Abdominal Pain↗