Authors


Jeremy D. Young, MD

Latest:

Differentiating colonization from infection can be difficult Nontuberculous mycobacterial infections: Diagnosis and treatment key words: Pulmonary infections, Nontuberculous mycobacteria, Mycobacterium avium complex, Rapidly growing mycobacteria

abstract: Pulmonary disease caused by nontuberculous mycobacteria (NTM) can be challenging to diagnose and manage. Patients typically present with nonspecific symptoms, such as cough and fever, and they often have underlying lung disease, which further complicates both diagnosis and treatment. To avoid treating pseudoinfection, the diagnosis should be based on a combination of the history and results of physical examination, radiographic imaging, and smears and cultures of at least 3 sputum samples. Occasionally, it is necessary to perform bronchoalveolar lavage or obtain tissue via transbronchial or open lung biopsy for histopathology and to assess for tissue invasion. Treatment involves a long course of often costly multiple antimycobacterial drugs. However, treatment with the second-generation macrolides, clarithromycin and azithromycin, has significantly improved cure rates for specific NTM infections. (J Respir Dis. 2007;28(1):7-18)


Jeremy Feldman, MD

Latest:

Postpartum pulmonary arterial hypertension

Patients with congenital heart disease and pulmonary arterial hypertension (PAH) are at risk for severe deterioration during pregnancy and delivery. We discuss the case of a 38-year-old woman who presented to the emergency department complaining of dyspnea 6 days after giving birth to her first child via cesare- an section. When PAH is untreated, maternal mortality may exceed 50%, but aggressive PAH treatment offers improved outcomes. Moreover, initial improvement in functional status made with parenteral prostanoids can be maintained with combination oral therapy.


Jeremy Joslin, MD

Latest:

Chest Pain: 10 Common Myths and Mistakes

ABSTRACT: Atypical clinical presentations in the quality, intensity, and radiation of pain are common in patients with acute coronary syndromes. Women with an acute myocardial infarction (AMI) are more likely to have atypical symptoms, such as dyspnea, than men. A history of acute anxiety or a psychiatric diagnosis does not preclude the possibility of an acute coronary event in a patient with chest pain. The clinical response to a GI cocktail, sublingual nitroglycerin, or chest wall palpation does not reliably identify the source of pain. Over-reliance on tests with poor sensitivity, such as the ECG, or on the initial set of cardiac biomarkers will miss many patients with MI. Serial troponin levels obtained at 3- to 6-hour intervals are recommended to evaluate the extent of myocardial damage. Coronary angiography that detects mild non-obstructive disease does not exclude the possibility of sudden plaque rupture and acute coronary occlusion.


Jeremy L. Dickerson, MD

Latest:

Rhabdomyolysis Secondary to Urinary Tract Infection With E coli

Rhabdomyolysis is linked to infection in up to 31% of cases. However, only 19 cases of rhabdomyolysis related to E coli infection have been reported.


Jeremy M. Gleeson, MD

Latest:

A Comparison of the Clinical Effectiveness and Cost-Effectiveness of Treatments for Moderate to Severe Psoriasis

This 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.


Jeremy Taylor, PharmD

Latest:

Pitfalls In Prescribing: Metronidazole Dosing in Patients With Hepatic Dysfunction

Metronidazole, the prototype nitroimidazole, was originally released in 1959 for the treatment of Trichomonas vaginalis infections. It has since been used to treat a variety of infections caused by anaerobic and facultative anaerobic bacteria and protozoa. Here we discuss the need for dosing adjustments in patients with hepatic disease.


Jerome Ernst, MD

Latest:

How to handle progressive disseminated histoplasmosis

Progressive disseminated histoplasmosis (PDH) ismost likely to occur in patients with AIDS. Typical signs andsymptoms include fever, night sweats, anorexia, malaise, dyspnea,weight loss, hepatosplenomegaly, lymphadenopathy, skinlesions, and neurological deficits. The diagnosis of histoplasmosiscan be confirmed by tissue culture and stains and byserological studies. Bronchoscopy with bronchoalveolar lavage(BAL) often plays a pivotal role in the workup, particularly inpatients with respiratory symptoms and abnormal chest radiographicfindings. In some cases, transbronchial biopsy in conjunctionwith BAL can improve the diagnostic yield. Liposomalamphotericin B or amphotericin B lipid complex is recommendedfor the initial treatment of moderately severe to severePDH. Itraconazole may be appropriate for those with mild tomoderate PDH and is recommended for maintenance therapy.(J Respir Dis. 2008;29(1):37-40)


Jerome Goddard, PhD

Latest:

Bed Bug Bites: Everything You Need to Know-But Were Afraid to Ask

Here: a review of the potential health effects of bed bugs, diagnosis and treatment, and comments about future directions in bed bug control and public health efforts to manage the pest.


Jerome J. Graber, MD, MPH

Latest:

Herpes Encephalitis in Monoclonal Gammopathy

Ninety percent of adult cases of encephalitis are caused by herpes simplex virus (HSV) type 1, and HSV type 2 encephalitis is clinically indistinguishable from HSV-1 encephalitis.


Jerzy Slomka, MD

Latest:

Leukocytoclastic Vasculitis

A 6-year-old girl was evaluated in the emergency department for a leg rash that had spread to the buttocks. The lesions first appeared earlier in the day and worsened hourly. The child's mother reported that her daughter was in good health until a low-grade fever, nonproductive cough, sore throat, and headache developed 5 days earlier. The youngster also complained of neck pain with movement.


Jesse J. Klein, DO

Latest:

Aortic Atheroma

A 68-year-old woman with a history of hypertension, hyperlipidemia, and tobacco use presented with her third stroke in the past 7 years. Neurological deficits included dysarthria and left-sided motor and sensory loss. A previous transthoracic echocardiogram with a bubble study did not reveal any cardiac source of embolism. Axial MRI of the brain on admission showed an abnormal signal in the bilateral hemispheres representative of multiple subacute infarcts


Jesse Roman, MD

Latest:

Case In Point: Polydipsia, polyuria, and pneumothorax in a young woman with diffuse cystic lung lesions

A 23-year-old woman was referred to our interstitial lung disease (ILD) clinic with a diagnosis of LAM, a progressive cystic ILD that affects women of childbearing age. The patient had been a smoker since the age of 16, but she quit smoking about 2 months before the clinic visit, when she had a pneumothorax. At that time, she complained of sudden onset right-sided chest pain with shortness of breath for which she was admitted to her hometown hospital.


Jessica A. Fogler, MD

Latest:

HIV Infection: Clues to Timely Diagnosis

Early diagnosis enables patients to derive maximum benefit from highly active antiretroviral therapy (HAART). Primary care practitioners can play a key role in the timely identification of HIV infection.



Jessica Krant, MD

Latest:

Rheumatoid Nodules in a 65-Year-Old Woman

A 65-year-old woman, who was confined to a wheelchair because of severe rheumatoid arthritis, was concerned about nodules that had erupted on her fingers and hands during the previous 3 weeks. Her medical history included colon cancer, chronic renal insufficiency, anemia, and hypertension. The nonpruritic nodules were painful when they began to form under the skin; however, once they erupted, the pain disappeared.


Jessica Miller, MD

Latest:

Contraception article:

Despite major advances in contraception that occurred during the 20th century, about 49% of pregnancies in the United States are unintended. More than half of these pregnancies end in abortion.


Jessica Morton, MD

Latest:

What Next For This Patient?

A patient who is allergic to penicillin was bitten on his wrist by a dog. What is the first test you order?


Jessica Nutik Zitter, MD

Latest:

A case of miliary TB complicated by ARDS and pancytopenia

We present a case of a 35-year-old man with fever and pancytopenia, who had rapid progression to acute respiratory distress syndrome (ARDS), multiorgan failure, and disseminated intravascular coagulopathy secondary to disseminated tuberculosis (TB). Although both sputum and bronchoalveolar lavage (BAL) fluid smears were negative for acid-fast bacilli, the polymerase chain reaction (PCR) assay on the BAL fluid was positive for Mycobacterium tuberculosis. This case emphasizes the need to include TB in the differential for ARDS and the value of PCR testing of BAL fluid, especially in high-risk patients.


Jill Nord, MD

Latest:

Multiple Aorto-Cavitary Fistulas

Infective endocarditis (IE) starts as a vegetation on the valvular structures. The infection can extend to the adjacent periannular areas and erode into nearby cardiac chambers, leading to an aorto-cavitary fistula (ACF).1,2


Jill Ohar, MD

Latest:

COPD in women, part 2: Treatment considerations

Abstract: Smoking cessation is still the most important intervention in patients with chronic obstructive pulmonary disease (COPD), regardless of sex. There is some evidence that nicotine replacement therapy may be less effective in women than in men. However, women may derive greater benefits from a sustained quit attempt. For example, one study found that compared with men, women who were sustained quitters had a greater initial rise and a slower age-related decline in forced expiratory volume in 1 second. Men and women do not appear to differ in their response to bupropion or to the various types of bronchodilators. A number of factors contribute to the increased risk of osteoporosis in women with COPD. Both smoking and the degree of airflow obstruction have been identified as important risk factors for osteoporosis. Women may be particularly susceptible to the effects of smoking on bone metabolism. Immobility and decreased physical activity have also been shown to accelerate bone loss. (J Respir Dis. 2006;27(3):115-122)


Jill P. Karpel, MD

Latest:

Is Your Room an Asthma “Nightmare”?

If your bedroom or other rooms in your home look a lot like this one,you may be living in an asthma "nightmare"-an environment full ofpotential causes of asthma attacks.


Jim Melton, MD

Latest:

Elderly Man With Sudden Back and Abdominal Pain

An 84-year-old man with back and abdominal pain ofrecent onset arrives at the emergency department(ED) of a small community hospital at 5 AM. Sudden,severe back pain awakened him from sleep 2 hours earlier.The patient has had back pain for 12 hours and intermittentcolicky pain in the suprapubic region for the past2 hours.


Jin-soo Lee, MD, PhD

Latest:

Scrub Typhus: Two Cases Presenting as Abdominal Pain

Scrub typhus, which is caused by Orientia tsutsugamushi, has various systemic manifestations, including GI symptoms. We describe one patient with scrub typhus who presented with symptoms that suggested acute appendicitis and another who presented with symptoms of acute cholecystitis.


Jing Fang, MD

Latest:

Preventing Hypertension: Do Primary Care Providers Practice What They Prescribe?

A key finding: a primary physician’s healthy lifestyle behaviors may be linked to his or her recommendations for hypertension prevention.


Jinichi Tokeshi, MD

Latest:

Mucinous Cystadenoma

A 53-year-old perimenopausal woman presented to the emergency department with throbbing lower abdominal pain and distention. The pain started 5 days earlier and worsened with sitting and walking; she also experienced increasing dyspnea. She had noticed increasing abdominal girth about 5 months earlier. Since then, she had gained 5 to 10 lb, despite dieting. The patient reported a 22-pack-year history of smoking but no alcohol use. She was taking over-the-counter painkillers and allergy medications. Her family history was notable for a brother who died of laryngeal cancer.


Jiro Fujita, MD, PhD

Latest:

Prophylactic Oseltamivir for Prevention of Nosocomial Influenza A Virus Infection

The effectiveness of oseltamivir in preventing nosocomialinfluenza (influenza Avirus infection) during an influenzaepidemic was carried out in several wards of a universityhospital. Asurvey conducted during the 2005 influenza seasonidentified 30 staff members (nurses and doctors) and 3hospitalized patients who met the case definition for influenza.Adefinitive influenza diagnosis was made in 17 staff members(57%) and in 2 inpatients (66%) based on the results of a rapiddiagnostic test. Most of the 30 symptomatic staff membershad been vaccinated for influenza. Symptomatic staff memberswere sent home for 1 week, and the infected inpatients wereisolated. Oseltamivir (75 mg/d for 5 days) was administered to99 staff members and 2 inpatients who had close contact withthe infected patients. Although a relatively large number of thestaff had an influenza virus infection, the use of oseltamivirmay have effectively prevented a nosocomial outbreak.[Infect Med. 2008;25:49-50a]


Jo Marie Reilly, MD

Latest:

Older Woman With Abdominal Pain

For 2 weeks, a 67-year-old obese woman has had episodes of diffuse, nonradiating abdominal pain that last for several hours and are slightly relieved by famotidine/antacid. She rates the pain as 7 on a scale of 1 to 10.


Joan R. Allman, MD

Latest:

Cerebellar Blastomycotic Abscesses

A comatose 29-year-old woman was brought to the emergency department. Her family reported that she had been well until 4 days earlier, when headache and fever developed. She went to another hospital at that time and was told she had an abscessed tooth. She was given erythromycin, and the tooth was extracted the following day. The patient's headache and fever worsened; a sore throat also developed, and a rash appeared on her trunk, arms, and legs. The family denied any HIV risk factors, unusual medical history, recent travel, and exposure to persons with infectious diseases.


Joe Monroe, PA-C

Latest:

Chronic Venous Insufficiency in Left Leg of 70-Year-Old Man

Tortuous, dilated varicosities; multiple smaller caliberabnormal perforating vessels; and chronic brawnyedema of chronic venous insufficiency (CVI) were seenon a 70-year-old man’s left leg (A). He reported that theedema and discoloration had worsened over the last15 years. The brawny edema stopped just above theankle, indicating that compression by the patient’s sockcontrolled the signs and symptoms of CVI.


Joe Nellis, DO

Latest:

Interdigital Pilonidal Sinus

In the web space of his left hand, a 50-year-old barber had a painful cystlike lesion. The lesion had recurred intermittently, despite oral antibiotic treatment and warm compresses. The patient's father, also a barber, had a similar, more severe condition, which eventually required surgical intervention.

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