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Immunosuppression and Infection Risk in SOT RecipientsWith the introduction of immunosuppressive drugs, solid organ transplant (SOT) has progressed such that potential recipients significantly outnumber available organs. In 2007, there were 14,394 donors of 28,353 organs, but 98,645 persons were on a waiting list as of March 2008.1
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MAC Infection in a Man With Pectus ExcavatumFor 6 weeks, a 56-year-old man had worsening dyspnea on exertion and a cough productive of yellow sputum with scant hemoptysis. He reported subjective fever over the past month but no weight loss.
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Folliculitis: Part IHere: a close-up look at gram-positive and -negative cases of folliculitis.
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Right Shoulder Pain in an Older ManFor 6 months, a 69-year-old man has experiencedpain in his right shoulder; hetakes NSAIDs for relief. During the lastmonth, the pain has worsened, weaknessand tingling have developed in his righthand, and the skin on the right side ofhis face has become dry. The patient alsoreports a 1-month history of melanoticstools. He had smoked 1 pack of cigarettesa day for 50 years before quittinglast year
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Medicare Ups Provider Incentive for Prediabetes InterventionProviders may now be paid up to $785 (increased from $450) for each patient who loses 5% of their body weight.
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A Comparison of the Clinical Effectiveness and Cost-Effectiveness of Treatments for Moderate to Severe PsoriasisThis study investigated the clinical effectiveness and cost-effectiveness of treatments for moderate to severe psoriasis from a managed health care systems perspective. An analysis was conducted of randomized clinical trials evaluating biologic and oral systemic medications and phototherapy for patients with moderate to severe psoriasis.
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Apple Core LesionA 48-year-old woman was hospitalized for acute-onset abdominal pain. She had a history of adult-onset Still disease and severe osteoarthritis. She had been taking 650 mg of aspirin every 4 hours to relieve her arthritis pain and fevers.
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Grateful Doctor Says Goodbye to His PatientsA young cardiology fellow reveals in a letter to his patients that it was being privy to their vulnerability that allowed him access to his own.
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Orthotopic UreteroceleA 67-year-old woman was admitted to the hospital with fever, chills, unilateral flank pain, dysuria, and urinary frequency and urgency. Her past medical history included several febrile relapses of infection.
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Nail-Patella SyndromeThis 33-year-old Guatemalan man presented to a medical mission camp with generalized bilateral knee pain and inability to extend his leg without pain. The 4-ft 11-in patient had mild scoliosis, increased elbow carrying angles, and hypoplastic patellae. He had had dysplasia of the nails with triangular lunulae since birth. The fingernails were absent on the first and second digits of both hands. His mother had had similar physical findings. He had not had regular medical care.
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Sarcoid UveitisA 44-year-old black man presented to our office with insidious onset of blurred vision. He had no significant past medical history but complained of dyspnea on exertion. On examination, the left pupil was irregular and fixed. A chest film demonstrated bilateral hilar adenopathy. Laboratory findings included normal purified protein derivative test results and elevated angiotensin-converting enzyme levels; pulmonary function studies appeared normal.
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Lichen Planus: Quick TipsA 27-year-old man presented with intensely pruritic, violaceous, flat-topped papules on the lateral aspect of his left leg. He reported that the lesions developed a few weeks after the area was severely scraped in an accident several months earlier.
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Statin-Drug Interactions: Update on the Most Common and Clinically SignificantStatins (HMG-CoA reductase inhibitors) are the most effective drugs in the management of elevated low-density lipoprotein cholesterol (LDL-C) levels. Recent large clinical trials continue to demonstrate the remarkable efficacy of these agents, including improved outcomes.
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The “Statin-Intolerant” Patient: Alternative Strategies for Primary CareIn patients deemed statin-intolerant, lifestyle changes and alternative classes of drugs should be pursued to lower LDL-C.
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What Is Causing Headache and Neck Stiffness in This Patient?A 41-year-old African American man presented with the chief complaint of a constant, dull headache for 3 days. The headache had a gradual onset and was associated with nausea and mild neck stiffness that was not relieved by acetaminophen. The man denied experiencing visual disturbances, fever, night sweats, weight loss, cough, shortness of breath, emesis, or weakness. He had no recent history of trauma or sick contacts.
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Docs on Board With CDC Opioid GuidanceMost respondents to a SERMO survey supported mandatory registration and use of Prescription Drug Monitoring Programs.
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Clostridium difficile: New Guidelines Confront Hypervirulent StrainRecurrent C difficile requires pulse vancomycin therapy; fecal microbiota transplant shows promise.
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Osteoporosis:What to Tell Patients About Prevention and TreatmentOsteoporosis is no longer consideredage- or sex-dependent, although prevalencevaries by sex and race. Postmenopausalwhite women suffer almost75% of all hip fractures and havethe highest age-adjusted rate of fracture.Thanks to progress in our understandingof causes and treatments, thisdisease is largely preventable, and significantimprovements in morbidityand mortality are possible. The beststrategy for prevention and treatmentuses a team approach that involves thepatient, physician, health educators, dietitians,and physical therapists.
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Solitary Rectal Ulcer SyndromeA 34-year-old woman who has had constipation and episodes of obstipation for at least 5 years recently passed blood and mucus rectally and has a rectal prolapse. Colonoscopy revealed an ulcer on the anterior rectal wall, approximately 4 cm from the anus.
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Avoid Caffeine to Stop the FlowBefore you prescribe an anticholinergic for patients with urinary frequency or urge incontinence, advise them to cut out all caffeine. Complete avoidance--rather than just decreased intake--often results in an immediate improvement in symptoms.
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Emerging Treatments for Rheumatoid Arthritis:ABSTRACT: Early treatment with disease-modifying anti-rheumatic drugs (DMARDs)--alone or in combination-- can prevent joint damage and minimize disability. Until recently, the DMARDs used predominantly in patients with rheumatoid arthritis had been methotrexate, sulfasalazine, and hydoxychloroquine. Older DMARDs such as gold, d-penicillamine, and azathioprine have fallen out of favor because of their long- term toxicities or modest benefit. Six newer DMARDs--leflunomide, etanercept, infliximab, adalimumab, rituximab, and anakinra--have greatly expanded the current treatment options.
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Podcast: Status of the Polypill in Prevention of Cardiovascular DiseaseFindings of the TIPS-2 study, announced at the recent 2012 World Congress of Cardiology, put the promise of the polypill-a simplified, one-size-fits-all approach to prevention of cardiovascular morbidity-back on the table for international discussion. Here, Dr Christopher Cannon puts the TIPS-2 results in perspective.
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Antidepressant-Induced Sexual Dysfunction: Five Management StrategiesSelective serotonin reuptake inhibitors and other second-generation antidepressants have become common therapeutic options for the management of depression. Although these agents are effective and generally well tolerated, they frequently cause sexual adverse effects that can impact patients’ quality of life, thus ultimately leading to nonadherence to therapy in many cases.
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Gastrointestinal Involvement of Systemic AmyloidosisThe authors present a case of AL amyloidosis with rare GI involvement and an equally rare presenting symptom.
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Blood Pressure Measurement:ABSTRACT: The most common errors in measuring blood pressure (BP) are using the incorrect cuff size, not having the patient relax for 5 minutes before the measurement, and deflating the cuff too quickly. Observer bias may compound technical errors. When patients use the proper procedure, home BP measurements may be more reproducible than office measurements. Brachial artery-based monitors are more accurate than finger- or wrist-based instruments. To ensure that patients measure their BP correctly, observe their technique with their own monitors. Counsel patients to measure their BP at predetermined times and to have their monitors validated periodically.
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High-Grade Ductal Carcinoma In SituFor 6 weeks, a 68-year-old woman had had sharp pain in the left breast that radiated to the left arm and back. The pain was worse on palpation; ibuprofen provided only mild relief. She denied nipple discharge, skin discoloration, and fever. She had no family history of breast cancer. Results of a biopsy of the left breast 6 years earlier were benign. Her most recent mammogram, 4 weeks earlier, was negative.
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Systemic Inflammation and Use of Diet to Stem DiseaseThe popular media recently took a look at the connection between systemic inflammation and the many human diseases it’s responsible for. A lengthy article in the Wall Street Journal focused on the role of daily diet in the development and modulation of inflammation and noted the clinical use of biomarker C-reactive protein to measure inflammation levels. Harvard cardiologist Christopher Cannon offered tips on eating to beat inflammation and shed pounds at the same time from his new book titled The Complete Idiot’s Guide to the Anti-Inflammation Diet. Alarming health news paired with a new book on diet can create a perfect storm of questions from you patients.
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Low Back Pain: Management of the Psychosocial ComponentBack pain is second only to upper respiratory tract infection as the most frequently reported illness in the United States; up to 20% of Americans experience back pain each year.
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Spontaneous Internal Carotid Artery DissectionA 36-year-old man who had collapsedand sustained a bruised right shoulderwas brought to the emergency departmentwith acute emesis, cephalgia,blurred vision, aphasia, and righthemiparesis. He was confused but ableto follow simple commands.
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Penicillin- and Carbapenem-Induced Neurotoxicity: How to Reduce the RiskPenicillin-induced neurotoxicity was first recognized by Johnson and Walker in 1945 after intraventricular administration of benzylpenicillin.1,2 Subsequently, the β-lactams have been shown to have a higher rate of CNS effects than other classes of antibiotics.3,4
