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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.
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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.
