Does topical diclofenac relieve osteoarthritis pain?

Q: Does topical diclofenac relieve osteoarthritis pain? Evidence-based answer: Yes, at least in the short term. Topical diclofenac, with and without dimethyl sulfoxide (DMSO), modestly improves pain and function scores (by 4%-8%) for as long as 12 weeks in patients with osteoarthritis (OA) of the knee (strength of recommendation [SOR]: A, meta-analyses of multiple randomized controlled trials [RCTs]). Topical diclofenac modestly decreases pain scores in patients with OA of the hand in the short term (by 9% at 6 weeks) but no more than placebo at 8 weeks (SOR: B, RCT). Both topical diclofenac with DMSO and oral diclofenac produce similar pain and function scores in patients with OA of the knee. In addition to minor skin dryness, topical diclofenac causes gastrointestinal (GI) adverse effects in about a third of patients (SOR: B, RCT)

What is the best workup for hypocalcemia?

Unexplained hypocalcemia can usually be diagnosed by a limited number of serum tests when the cause isn't obvious from the history (recent neck surgery or renal failure): calcium corrected for serum albumin); creatinine; phosphorus; magnesium; parathyroid hormone (PTH). The most common causes, categorized according to the results of these tests, are (strength of recommendation: C, expert opinion, case series, and physiologic principles): high PTH, high phosphorus, and high creatinine: renal failure; high PTH, low or normal phosphorus, and normal creatinine: vitamin D deficiency or pancreatitis; low PTH, high phosphorus, and normal creatinine: inadequate parathyroid gland function or hypomagnesemia

What measures relieve postherpetic neuralgia?

Tricyclic antidepressants, gabapentin, and pregabalin effectively reduce pain (strength of recommendation [SOR]: A, at least 2 good-quality randomized controlled trials [RCTs] and/or meta-analyses). Opioids have demonstrated pain relief in 3 RCTs (SOR: A, consistent RCTs). Capsaicin and the lidocaine 5% patch relieve pain and decrease allodynia (SOR: B, recommendations from meta-analyses and lower-quality RCTs)

What's the best treatment for sebaceous cysts?

Punch biopsy excision appears to be superior to traditional wide elliptical excision for the treatment of sebaceous cysts when intervention is necessary (strength of recommendation [SOR]: B, based on 1 small randomized study). No rigorous metho- dological studies have compared punch biopsy excision of sebaceous cysts with the minimal excision technique

Incidence and Predictors of Acute Kidney Injury in an Urban Cohort of Subjects with HIV and Hepatitis C Virus Coinfection

Coinfection with hepatitis C (HCV) significantly increases the risk of acute and chronic renal disease in HIV-infected individuals. However, the burden of acute kidney injury (AKI) directly attributable to HIV among HCV-infected individuals and associated risk factors are not well understood. Within a prospective cohort, AKI episodes were identified by a rise in creatinine of 0.5 mg/dL. Incidence of first AKI events was calculated for HIV/HCV coinfected versus HCV monoinfected subjects, and multivariable analyses using Cox proportional hazards were performed to identify predictors of AKI. Throughout the study period, 35% HIV/HCV coinfected and 17% HCV monoinfected subjects developed AKI, with incidence of 8.74/100 person-years and 3.53/100 person-years, respectively (hazard ratio (HR) 2.48; [95% confidence interval (CI) 1.50, 3.74]). In multivariable analysis, HIV coinfection (HR 2.19 [1.33, 3.62]), decompensated cirrhosis (HR 6.64 [3.81, 11.6]), and cocaine use (HR 2.06 [1.15, 3.71]) were independently associated with AKI. HCV genotype, HCV viral load, hazardous drinking, and heroin use were not associated with AKI. Study limitations included potential misclassification bias of HCV-infected individuals as serial HIV antibody testing was not routinely performed after study entry, and inability to adjust for tenofovir use in multivariable analysis. In conclusion, among subjects with HCV infection, decompensated cirrhosis, HIV coinfection, and cocaine use are associated with increased risk of AKI. These findings highlight the importance of preventing and treating cirrhosis, controlling HIV coinfection, and reducing cocaine use in HIV/HCV coinfected persons