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Diabetes and Mental Illness: Factors to Keep in MindPersons with severe mental illnesses (SMI), such as schizophrenia, are at increased risk for comorbid conditions- including type 2 diabetes-independent of therapy. SMI sufferers especially at risk for type 2 diabetes are women, African Americans, and persons older than 45 years. Among the possible causes of increased susceptibility to type 2 diabetes are such schizophrenia-associated conditions as impaired glucose tolerance, overweight, obesity, inadequate nutrition, lack of exercise, and inadequate self-care. Other obstacles to good health care among patients with schizophrenia include impaired communication ability, denial of illness, social withdrawal, and undertreatment because of comorbid conditions. Different antipsychotic medications may also contribute to preexisting insulin resistance or glucose intolerance. Clinicians can optimize care by understanding the most significant barriers for each patient and incorporating this knowledge into an active treatment plan.
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Colorectal Cancer Survivors: The Primary Care Physician's Role in Follow-upDeaths from colorectal carcinoma (CRC) have diminished in recent years; the absolute annual decrease is 1.5% per year.
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A patient with cough and progressive dyspneaA 47-year-old man with HIV infection presented with progressive dyspnea and worsening productive cough for the past 3 weeks. He also reported increasingly purulent sputum production. The patient reported being adherent to his antiretroviral regimen, and he had an admission CD4+ cell count of 550/μL. He did not have any previous opportunistic infections, and he denied any drug or tobacco use, recent travel, and ill contacts.
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Orbital Pseudotumor Disguised as Orbital Cellulitis and SinusitisA 58-year-old man with a past medical history of chronic sinus disease and hypothyroidism presented with left periorbital pain and erythema that worsened despite outpatient treatment with topical antibiotics. An outpatient CT scan showed pansinusitis and orbital stranding. The diagnosis was orbital cellulitis and sinusitis.
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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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Disseminated Echinococcosis Involving the Pulmonary ArteryDisseminated echinococcal disease can present complex management issues that require a multidisciplinary approach to care. We describe a patient with hydatid disease who had multiple cysts in the liver, lungs, and pulmonary artery that were caused by Echinococcus granulosus infection.
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Update on Cause and Management of Catscratch DiseaseMore than 22,000 persons in the United States are affected bycatscratch disease (CSD) annually. Despite the discovery of thecausative organism more than a decade ago, much is still unknownabout this illness. Recent data suggest that ticks, as wellas cats, may transmit the disease to humans. Immunofluorescenceassay is proving to be the most efficient and noninvasivetechnique for diagnosing CSD. Among available antimicrobials,azithromycin has proved to be especially useful, although randomized,double-blind, placebo-controlled trials are warrantedto define the best treatment method for patients with CSD.[Infect Med. 2008;25:242-246, 250]
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Sexually Transmitted Diseases: Recognizing Telltale Skin Lesions Disseminated Gonococcal InfectionTelltale skin lesions of syphilis, gonorrhea, human papillomavirus infection, and Haemophilus ducreyi infection.
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Acute Glomerulonephritis in a Young WomanA 26-year-old woman presented with a1-week history of pleuritic chest painand abdominal pain, which was associatedwith nausea but unrelated tofood intake or bowel movements. Shehad also had gross hematuria for thepast 10 days and swelling around hereyes and ankles as well as fatigue andarthralgias for 2 weeks.
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SyncopeABSTRACT: Syncope is often benign and self-limited; however, it may sometimes indicate a life-threatening condition. Advanced age, heart disease, and abnormal ECG findings are associated with potentially adverse outcomes. The initial evaluation, which consists of a careful history taking, physical examination, and ECG, often suffices to make the diagnosis. Neurally mediated disorders, the most common cause of syncope, are usually benign. Cardiac syncope, which usually requires admission and further assessment, may result from rhythm disturbances or from outflow obstruction attributable to structural or pathophysiologic mechanisms. Patients with cardiac syncope may be evaluated with echocardiography, Holter monitoring, stress testing, loop event recorders, or electrophysiologic studies. Other causes of syncope include orthostatic hypotension, use of certain medications, a primary neurologic disorder, and psychiatric disturbance. A significant number of patients have unexplained syncope.
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Asthma Disease Burden and Formulary Decision Making: MCO and Employer PerspectivesAsthma affects approximately 22 million adults and children in the United States and poses a significant economic burden on the health care system and on employers. According to the National Heart, Lung, and Blood Institute, direct and indirect costs for all forms of asthma totaled $19.7 billion in 2007. Prescription drugs represented the largest single direct cost at $6.2 billion.
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Boy With Ankle Pain, Erythema, and EdemaTHE CASE: A 7-year-old boy has had left ankle pain for 2 days. Neither he nor his mother can recall any recent trauma to the joint. He is usually very active, but he has been unable to bear weight on the left foot and has been resting in bed. His mother reports that he had some tactile fevers, which were transiently relieved with ibuprofen, and that he has been eating and drinking normally. Despite the application of ice and elevation, the ankle has become red and swollen.
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Enoxaparin DermatosisThis is a very distinct, rare, and remarkable hemorrhagic rash, first recognized in 2006, with 7 known cases reported in the literature.
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Antibiotic Study Not Seen as Reason to Change Adult Sinusitis GuidelineA large randomized trial showing no effect of antibiotics on acute rhinosinusitis in adults does not inspire a change in recommendations for family physicians.
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Depression Alters Asthma Interventions and Quality of Life in Urban TeensPrimary care physicians can take the lead in helping address these additional comorbidities in their patients with asthma.
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Pediatric ECG Interpretation: Normal Tracings From Children of Various AgesPediatric ECGs vary by age;tracings change considerablyfrom birth through adulthood.In the ECG tracing above, theT waves are inverted. Nevertheless,as we outline here, the tracingis normal in a 9-year-old child; theT waves may not revert to normaluntil he reaches puberty.
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Menstrual Migraine: How "Mini-Prophylaxis" Can Work for Your PatientMigraine is an episodic, often debilitatingcondition that affects women moreoften than men. Twenty-eight millionAmericans suffer from migraineheadaches-and nearly 75% of theseare women.1 Unlike other chronic painconditions, migraine has its peakprevalence during the years of greatestproductivity, when most women arejuggling family responsibilities andcareers.2 Many women are particularlysusceptible to migraine attacks justbefore and during menses.
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Managing Drug Interactions That Can Reduce Levothyroxine EfficacyLevothyroxine is one of the most commonly prescribed medications for the treatment of persons with hypothyroidism and the suppression of thyroid neoplasms.1 Most persons with hypothyroidism require lifelong therapy with levothyroxine.
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Is There a Medical Explanation?A 13-year-old girl of African American descent is brought to the pediatrician’s office becauseof a lesion on her neck. The girl’s mother had telephoned the office before the visit, statingthat the lesion resembled a blister at first, but now looked like a burn.
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Prolapsed ColostomyA 43-year-old woman was hospitalized with a 3-day history of fever and back pain. She was malnourished and seropositive for HIV infection. Results of blood and sputum cultures were negative. A community-acquired pneumonia was diagnosed. Chest film findings and the clinical presentation were inconsistent with Pneumocystis carinii pneumonia.
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An Intriguing DiagnosisA 16-year-old Somali girl presents witha 3-day history of bilateral arm swellingand painful vesicular eruptions; hersymptoms are worsening. She reportsthat 5 days earlier, she and her friendshad used henna and black hair dyeto “tattoo” their skin. The others havenot experienced similar signs or symptoms.This patient has used henna(which is dark red) since childhoodfor decorative purposes. However, outliningan intricate design with hairdye is new for her.
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Podcast: Incretins for Type 2 Diabetes Mellitus (Part 2)In his second podcast, Dr Louis Kuritzky discusses the classes of incretin-based therapies now available for patients with type 2 diabetes mellitus.
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Elephantiasis Verrucosa NostrumA 62-year-old obese woman with adult-onset type 1 diabetes mellitus had a 6-year history of bilateral leg edema. During the last year, the edema worsened and the skin on her legs thickened. She also had multiple, bilateral, painful, superficial ulcers that drained copiously.
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Maltoma in a 72-year-old ManA 72-year-old man presented after several months of dyspepsia and 1 day of hematemesis. He was not taking NSAIDs.
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Basal Cell Carcinoma on Face of a 54-Year-Old Farm WorkerWhen this lesion was seen on the face of a 54-year-old farm worker, cutaneous melanoma was the immediate concern. Accordingly, a full-thickness excisional biopsy was performed. (Curettage and shave biopsy are contraindicated for a suspected melanoma.)
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Malpositioned Nasogastric TubeA 67-year-old woman, who had hypertension and chronic obstructive pulmonary disease, presented to the emergency department with mild abdominal discomfort and shortness of breath.
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Use the Earlobe for Pulse OximetryWhen using pulse oximetry to evaluate patients with Buerger disease, Raynaud phenomenon, a history of heavy smoking, or other conditions that cause vasoconstriction of the fingers, place the probe on the earlobe. In such patients, this gives a more accurate measurement of arterial hemoglobin saturation than does a digital placement.
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Older Man With Fever and Tender RashFor 1 week, a 77-year-old man had a fever and a tender, nonpruritic rash on both palms (Figure 1) and on the anterior aspect of both knees (Figure 2). Two weeks earlier, he had hives, which ameliorated after a 10-day course of cetirizine and a tapering course of prednisone. He also had headaches almost daily for the previous 6 to 8 weeks.
