The BMJ State of the Art
Read the most-popular 2020 clinical reviews among North American physicians
The BMJ State of the Art clinical reviews provide an in-depth analysis of the latest medical knowledge. Predominantly written by U.S. authors, these 5,000 word articles offer specialists, academicians and researchers the latest thinking on a broad range of topics.
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Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome
Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome (HHS) are life threatening emergencies that occur in patients with type 1 diabetes and type 2 diabetes.
This article reviews acute decompensated diabetes in adult patients. It summarizes the epidemiology, pathophysiology, precipitating causes, clinical presentation, acute management, complications, and prevention of diabetic ketoacidosis and HHS.
It also covers some of the controversies and pitfalls in the management of these patients.
Diabetic ketoacidosis — read more
Sepsis associated acute kidney injury
Sepsis is a life threatening clinical syndrome characterized by organ dysfunction caused by a patient’s dysregulated response to infection. One of the most common organs affected by sepsis is the kidneys, resulting in sepsis associated acute kidney injury (SA-AKI).
This review summarizes the evidence on the epidemiology, non-modifiable risk factors, early detection, and pathophysiology of SA-AKI.
Sepsis — read more
Management of acute upper GI bleeding
Upper gastrointestinal bleeding (UGIB) is a common medical emergency, with a mortality rate of 2-10%. Although the management of UGIB has improved, many patients now have risk factors for a poorer outcome, including increasing age and major medical comorbidities.
Management of UGIB needs to incorporate risk assessment, the threshold for blood transfusion, the timing of endoscopy, medical and endoscopic therapies, and appropriate management of patients who need antithrombotic agents.
This review is an evidence-based summary of the assessment and management of patients with acute UGIB.
GI bleeding — read more
Peripartum cardiomyopathy (PPCM) is an idiopathic, often dilated, cardiomyopathy characterized by systolic dysfunction that presents in late pregnancy or the early postpartum period.
Risk factors include black ancestry, pre-eclampsia, advanced maternal age, and multiple gestation pregnancy. Research suggests the importance of vasculo-hormonal pathways in women with underlying susceptibility, and gene mutations.
This review summarizes the latest evidence on the pathogenesis, presentation, and management of PPCM.
Peripartum cardiomyopathy — read more
What are the respiratory effects of e-cigarettes?
E-cigarettes are alternative, non-combustible tobacco products used by current and ex smokers, and people who have never smoked. Their effectiveness as a smoking cessation intervention, impact at a population level, and whether they are less harmful than combustible tobacco products is highly controversial.
E-cigarettes lack the extensive preclinical toxicology testing or long term safety trials that would be required of conventional therapeutics or medical devices. This review summarizes the rapidly expanding evidence from cell culture, animal, and human studies on the potential pulmonary health effects of e-cigarettes.
E-cigarettes — read more