Exercise in Pregnancy: A Clinical Review.

CONTEXT: Health professionals who care for pregnant women should discuss potential health benefits and harms of exercise. Although most pregnant women do not meet minimal exercise recommendations, there are a growing number of physically active women who wish to continue training throughout pregnancy. EVIDENCE ACQUISITION: A search of the Web of Science database of articles and reviews available in English through 2014. The search terms exercise pregnancy, strenuous exercise pregnancy, and vigorous exercise pregnancy were used. STUDY DESIGN: Clinical review. LEVEL OF EVIDENCE: Level 3. RESULTS: With proper attention to risk stratification and surveillance, exercise is safe for the mother and fetus. Benefits of exercise in pregnancy include reduction in Cesarean section rates, appropriate maternal and fetal weight gain, and managing gestational diabetes. Exercise as a means of preventing gestational diabetes, preeclampsia, or perinatal depression cannot be reliably supported. Overall, the current evidence suffers from a lack of rigorous study design and compliance with physical activity interventions. CONCLUSION: Research thus far has been unable to consistently demonstrate proposed benefits of exercise in pregnancy, such as preventing gestational diabetes, preeclampsia, or perinatal depression. However, moderate- and high-intensity exercise in normal pregnancies is safe for the developing fetus and clearly has several important benefits. Thus, exercise should be encouraged according to the woman's preconception physical activity level.

Crystal arthropathies: recognizing and treating "the gouch".

Gout is a common disease and the prevalence is increasing. Chronic hyperuricemia (uric acid serum levels >6.8 mg/dL) is a key feature. Treating to a target uric acid level of 6.0 mg/dL is recommended. In addition to cochicine, probenecid, and allopurinol, feboxostat is a new option for urate-lowering therapy.

Diagnosing rhinitis: allergic vs. nonallergic.

Allergic rhinitis, the most common type of rhinitis, generally can be differentiated from the numerous types of nonallergic rhinitis through a thorough history and physical examination. Allergic rhinitis may be seasonal, perennial, or occupational. The most common cause of nonallergic rhinitis is acute viral infection. Other types of nonallergic rhinitis include vasomotor, hormonal, drug-induced, structural, and occupational (irritant) rhinitis, as well as rhinitis medicamentosa and nonallergic rhinitis with eosinophilia syndrome. Since 1998, three large expert panels have made recommendations for the diagnosis of allergic and nonallergic rhinitis. Allergy testing (e.g., percutaneous skin testing, radioallergosorbent testing) is not necessary in all patients but may be useful in ambiguous or complicated cases.

Acute shoulder injuries.

The shoulder is the most mobile joint in the human body. The cost of such versatility is an increased risk of injury. It is important that family physicians understand the anatomy of the shoulder, mechanisms of injury, typical physical and radiologic findings, approach to management of injuries, and indications for referral. Clavicle fractures are among the most common acute shoulder injuries, and more than 80 percent of them can be managed conservatively. Humeral head fractures are less common and usually occur in elderly persons; 85 percent of them can be managed nonoperatively. Common acute soft tissue injuries include shoulder dislocations, rotator cuff tears, and acromioclavicular sprains. Acromioclavicular injuries are graded from types I to VI. Types I and II are treated conservatively, types IV to VI are treated surgically, and there is debate about the best approach for type III. Eighty percent of shoulder dislocations are anterior. Diagnosis of this injury is straightforward. The injury usually can be reduced by employing a number of nonsurgical techniques. Traumatic or acute rotator cuff tears can be managed conservatively or surgically, depending on the patient and the degree of injury.

Type 2 diabetes management: a comprehensive clinical review of oral medications.

Diabetes is a major and growing health problem in the US. An incredible array of different oral medications is now on the market. Clinicians should understand all these new medications and in which clinical picture they will work best.