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Cleft Lip and PalateCleft lip and palate is a common congenital facial malformation that occurs once in about every 750 births among Caucasians.
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Abdominal Pain:As many as half of patients who are evaluated for abdominal pain do not receive a precise diagnosis. And for about half of those who are given a diagnosis, the diagnosis is wrong. In this article, I will use actual cases (not "textbook" examples) to illustrate an approach to abdominal pain that begins with a careful differential diagnosis. I also offer some general guidelines for evaluating patients.
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Psoriasis Therapy: What’s NewIn recent years, the role of the immunesystem in the pathogenesis of psoriasishas been extensively delineated. Thisresearch has spawned a new classof medications that target specific immunefactors and hold great promiseas psoriasis therapies. The Table highlightsthe significant features of 4 ofthese biologic agents.
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Amiodarone Drug InteractionsAmiodarone, a class III antiarrhythmic, has become the drug of choice for the management of supraventricular and ventricular arrhythmias.1,2 Although not an FDA- approved indication, the use of amiodarone to treat atrial fibrillation is supported by practice guidelines from the American College of Cardiology/ American Heart Association (AHA) and the European Society of Cardiology.
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Update on Rifampin and Rifabutin Drug InteractionsRifampin is associated with numerousclinically significantdrug interactions.1-4 New interactionswith rifampin-aswell as rifabutin-continue tobe reported in studies and clinical observations.Here we present highlightsof our recent update on the interactionsthat are most relevant toprimary care practice.5
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Using Passive Measures to Improve Patient Medication AdherenceAdherence is a complex behavioral process strongly influenced by environmental factors. Six posters designed to improve medication adherence were displayed in a medical clinic, with each poster displayed for 1 month. These posters were seen by clinic patients but, as passive measures, required no additional time on the part of clinicians. Medication adherence to antidepressant therapy was assessed for two 18-month periods. Days of therapy and median gap (the number of days a patient goes without medication before filling the next prescription) were similar between the periods. Medication possession ratio (MPR) was increased in the intervention period (0.974 vs 0.994 days). During the 6-month period that the adherence posters were displayed, persistence decreased by only 10% (versus 22% for the nonintervention period). Use of passive measures may improve patient medication adherence. In this prospective study, both the MPR and persistence were improved. (Drug Benefit Trends. 2008:20:17-24)
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Histoplasmosis mimicking metastatic carcinomaThe differential diagnosis forendobronchial lesions includesbut is not limited toneoplastic causes, benign tumors,infections, and foreignobjects. We report a case of anunusual cause of endobronchiallesions.
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Statins Plus Exercise: New Study Questions the CombinationSimvastatin 40 mg once daily can attenuate increases in cardiorespiratory fitness in response to exercise training.
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Evolution of a Medication Therapy Management ProgramSince the 2006 launch of the Medicare Part D prescription drug benefit, the Centers for Medicare & Medicaid Services (CMS) has required all Part D sponsors, including Health Net, to offer free medication therapy management program (MTMP) services to members at high risk for drug-related problems.
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Sexually Transmitted Diseases: Recognizing Telltale Skin Lesions Condyloma LatumTelltale skin lesions of syphilis, gonorrhea, human papillomavirus infection, and Haemophilus ducreyi infection.
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Emphysematous Pancreatitis in a 61-Year-Old ManEmphysematous pancreatitis is a rare form of necrotizing pancreatitis. Free air within the pancreatic parenchyma is typically attributed to infection.
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Lung nodules as the first manifestation of Crohn diseaseA 19-year-old woman presented with shortness of breath, dry cough, and pleuritic chest pain of unknown duration. Her medical history included endometriosis, a benign ovarian cyst,
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Paget's DiseaseA 74-year-old man, who had been aware of a gradual increase in hat size over the past 3 years, complained of a mild headache and backache. His serum phosphatase level was 1,475 U/L (upper normal limit, 120 U/L). Skull films showed calvarial enlargement caused by thickening of the cortical tables, radiolucency in the frontal and occipital regions, and patchy osteosclerosis that produced a cotton-wool appearance.
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Gout: An Independent Risk Factor for Chronic Kidney Disease and Cardiovascular Disease?Gout is associated with a 57% increased risk of ESRD, independent of hypertension and diabetes, according to new research.
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What Is Causing This Patient’s Acute Left-Sided Weakness?A 56-year-old woman with type 2 diabetes mellitus and hypertension presented with acute left-sided weakness and altered mental status, for which she was hospitalized. The patient, who was obese, was in her usual state of well-being until 2 months before this presentation, when she noted a gradual onset of generalized weakness. She received a diagnosis of severe hypokalemia that was refractory to oral potassium supplementation. The outpatient workup of the cause of her hypokalemia was in progress.
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Erythema ab Igne in a 66-Year-Old Black WomanThis 66-year-old black woman presented with a 2-year history of a painless skin eruption. She stated that her skin had “changed overnight” while she was caring for her mother who had been hospitalized.
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Drug Therapy in Elderly Patients:ABSTRACT: Age-related changes that affect drug distribution, such as increased total body fat, decreased muscle mass, and decreased total body water, necessitate reduction in the dosage of water- and lipid-soluble agents. Because creatinine clearance declines with age, the dosage of agents that are excreted primarily by the kidney must also be lowered to prevent toxicity. Examples include aminoglycosides, fluoroquinolones, penicillins, procainamide, lithium, angiotensin-converting enzyme inhibitors, and digoxin. A good rule of thumb to follow until creatinine clearance can be calculated is to reduce the total dose by half in frail elderly persons or in those with established renal disease. Anticholinergic agents should be used with caution because they are associated with urinary retention, heart block, constipation, dry mouth, blurred vision, sedation, and acute or chronic confusion in elderly patients.
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Antiretroviral Therapy: Darunavir: An Overview of an HIV Protease Inhibitor Developed to Overcome Drug ResistanceAntiretroviral Therapy: Darunavir: An Overview of an HIV Protease Inhibitor Developed to Overcome Drug Resistance
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Cancer Survival Takes a Hit with Alternative MedicineExperts caution that younger, more affluent cancer patients are being "sold snake oil" by purveyors of alternative medicine.
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Kaposi's Sarcoma in the Sigmoid ColonA 2-week history of diarrhea mixed with bright red blood was the presenting complaint of a 40-year-old man who was seropositive for HIV. Stool studies and culture results were negative for microorganisms. Colonoscopy demonstrated only the raised vascular lesion seen here in the sigmoid colon, which may have been responsible for the bleeding.
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Type 2 Diabetes and Medication Adherence: Where is the Disconnect?Incretin drugs, which offer ease of use, very little hypoglycemia, and no weight gain (or even weight loss) seem to be an ideal therapy. But 80% to 90% of patients don’t stay on them. Why not?
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"Diabetes Is Primary": Primary Care Providers Are the Foundation of Diabetes CareThe fact that a "Diabetes Is Primary" session is held in parallel to the ADA scientific sessions is a significant recognition by the American Diabetes Association that primary care providers are the foundation of diabetes care in the United States. Highlights here.
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OrfA 32-year-old man who had no significant medical history complained of “something growing on the knuckles of my right hand.” He reported that a “bump” was forming on the site of a cut he sustained while slaughtering sheep 3 weeks earlier. There was no blister, discharge, or pain. The patient denied any fever, cough, or malaise. He also did not recall seeing any lesions or “bumps” on the sheep.
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Cutaneous Mycobacterium InfectionThis rash, which covered a 68-year-old woman's body, was noted to have worsened during the past 2 months. A cephalosporin antibiotic had failed to clear the condition. The patient, a nursing home resident, suffered from emphysema, asthma, and heart disease. She had been receiving oxygen therapy and prednisone for 1 year.
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Larsen SyndromeAn abnormality of both first proximal interphalangeal joints was noted in a 54-year-old woman who had recently undergone an elective total hip arthroplasty to treat post-traumatic osteoarthritis. She had had worsening hip pain following an intertrochanteric fracture and open reduction internal fixation several years earlier.
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Acute lymphoblastic leukemia presenting with an acute fibrinous and organizing pneumoniaThe authors report a case of adult-onset acute lymphoblastic leukemia (ALL) presenting with a right upper lobe infiltrate associated with acute fibrinous and organizing pneumonia (AFOP), which resolved spontaneously during the course of chemotherapy.
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From Chaos to Consilience: Using the New Mind-Body Science to Improve the Diagnosis and Treatment of Major DepressionLecturing around the country has left us with the powerful impression that both primary care physicians and psychiatrists are hungry for new ways to think about and manage depression and the myriad symptoms and syndromes with which it is associated-including attention-deficit disorder, insomnia, chronic pain conditions, substance abuse, and various states of disabling anxiety.
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A Febrile Woman With Unusual Blood Cell CountsA 41-year-old woman presents to the emergency department with chest pain and dysphagia. Routine laboratory studies reveal profound neutropenia. She denies recent fever, chills, or weight loss.
