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Lipid-lowering Injectable Antibodies: The Next Big Thing?PCSK-9 inhibition in patients with recalcitrant hypercholesterolemia has reaped reductions in LDL-C of up to 85% after the first week of therapy.
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Liver AbscessThree weeks after undergoing gastric bypass surgery for obesity, a 64-year-old woman presented with fatigue, chills, and abdominal pain of 2 days' duration. She denied shortness of breath, nausea, vomiting, changes in bowel habits, melena, and hematochezia. The patient had no significant past medical history.
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Chest Pain: 10 Common Myths and MistakesABSTRACT: 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.
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Hospitals May Overfeed Newly Born Babies With FormulaWINNIPEG, Manitoba -- Physiologically appropriate infant weight loss is less for babies fed formula in the hospital than for those who are breastfed, suggesting that hospitals feed too much, researchers said.
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Photo Dx: Achilles Tendon Rupture? Tendonitis? Bursitis? Something Else?Does an Achille’s tendon rupture, tendonitis, bursitis, or something else underlie sudden heel and lower leg pain?
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Cryptococcal cavitary pneumonia in an immunocompetent patientCryptococcus neoformansmost commonly infects personswith an underlying T-cellimmunodeficiency. It hasbeen nicknamed the "sugarcoatedkiller" because it cancause a devastating disseminatedillness in immunosuppressedpatients. C neoformansrarely causes primaryinfection in an immunocompetentpatient. We present acase of pulmonary cryptococcosisthat occurred in an otherwisehealthy man.
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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.
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An HIV-infected patient with bilateral pneumoniaA 43-year-old homeless woman presented with a 2-week history of fever, chills, sweats, generalized pain, and cough that was productive of purulent green-yellow sputum mixed with blood. She reported a 15-lb weight loss over the past 6 weeks.
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Case 5: Multiple Keloids in Pierced EarA 23-year-old woman presented with medial and lateralpruritic keloids on her right earlobe, which had beenpierced several years earlier. These lesions began to developduring the patient’s pregnancy 2 years earlier.Keloids also were noted on the presternal region. Thepatient reported that these had begun as pimples thatspontaneously enlarged.
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Erythema Nodosum Erythema on Forearms and Legs of a 42-Year-Old ManA mildly painful, nonpruritic rash on the forearms and legs prompted a 42-year-old man to go to the emergency department (ED). The patient noted the rash when he awoke that morning. He had had joint pain and fever for the past 7 days and generalized malaise with chills that began about 3 days earlier. He had no significant medical history.
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Answers to a reader’s question on: Throat cultures for pharyngitisI have seen conflicting recommendations concerning the use of throat cultures and empirical antibiotic therapy in patients with pharyngitis. When do you consider throat cultures to be indicated? Are your recommendations different for children than for adults?
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Foreign-Body Ingestion in a Man With Parkinson Disease DementiaA 74-year-old man who had Parkinson disease dementia presented with constipation and bloating associated with abdominal pain.
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Addressing Abuse and Misuse of Opioid AnalgesicsOpioid analgesics provide effective treatment for noncancer pain, but many physicians have concerns about adverse effects, tolerance, and addiction. Misuse of these drugs is prominent in patients with chronic pain. Recognition and early prevention of misuse helps physicians identify the causes and proceed with patient care. Most persons with chronic pain have a significant medical comorbidity (eg, asthma) that affects treatment decisions.
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Four Types of Kaposi SarcomaA 46-year-old man with AIDS (CD4+ cell count, 150/μL) presented with a painful nodular lesion on the plantar surface of his right foot. The lesion had appeared 1 month earlier as a painless, 1-cm, raised, reddish purple nodule and had progressively enlarged to 5 cm. Six months earlier, the patient had cryosurgery to remove a similar, larger lesion on the posterior aspect of his right midcalf.
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Head and Shoulder Lesions: Common Diseases, Uncommon LocationsThree cases of lesions often seen in primary care, 2 seen in uncommon locations. Test your visual diagnostic skills.
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Scabies: Timely Diagnosis Key to Containment, ReliefA scabies diagnosis can be made with a history of pruritus that is worse in the evening with a rash in a typical distribution and a history of itching in close contacts.
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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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Allergic Rhinitis: Update on Your Therapeutic ChoicesMany pharmacological options exist for allergic rhinitis. Intranasal corticosteroids are the most effective medication class for patients with moderate to severe symptoms; those with milder intermittent symptoms can be treated with a second-generation oral or intranasal antihistamine.
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Drug Therapy in the Elderly:Numerous factors put elderly patients at risk for adverse drug events. On average, they take at least 6 medications a day, which increases the likelihood of drug-drug interactions. In addition, many drugs that are safe and effective in younger patients are inappropriate for older persons because of age-related changes and comorbid conditions that affect absorption, distribution, metabolism, and elimination. First-pass metabolism decreases with age, which may increase systemic absorption of some oral nitrates, ß-blockers, estrogens, and calcium channel blockers. The age-related rise in body fat increases the volume of distribution of lipid-soluble compounds, such as diazepam, and prolongs clearance. About two thirds of elderly persons have impaired kidney function; in these patients, the dosage of renally excreted drugs-such as digoxin-needs to be reduced. Other strategies for avoiding adverse drug events are detailed here.
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Two Feet - One Hand SyndromeA 41-year-old man presented with a 3-month history of itchy, scaly feet and right hand. The left hand was unaffected.
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Congenital RanulaA 1-day-old neonate was brought for evaluation of a mass on the floor of her mouth. The swelling was fluctuant and had a bluish tint. No bruit was detected. There was mild tongue elevation but no airway obstruction. Other than this swelling, physical examination findings were normal. The infant was born at term and was breast-feeding.
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Post-Test on Gout in Primary CareUse this short test to gauge how much you’ve learned about a condition that needs more primary care involvement.
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All About Gout for Primary Care: Treating Chronic DiseasePreventing further acute attacks and decreasing the tophi burden becomes a secondary goal.
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Large B-Cell LymphomaProgressively worsening nasal congestion and headaches with diplopia and left proptosis for 2 months prompted an ophthalmology consultation for a 67-year-old woman. She had been evaluated multiple times for allergic rhinitis and recurrent sinusitis.
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Editorial Comment: Foreign-born Latinos With HIV/AIDS–Improving Clinical CareAlthough the observations of del Rio and colleagues1 stemming from their study of foreign-born, HIV-infected Latinos are limited to a certain geographic area, their findings should stimulate further research to better understand and provide better health care to ethnic and minority groups living with HIV/AIDS in the United States.
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Disease Modifying Therapies: Do They Modify Short- and Long-Term in Multiple Sclerosis?Here: evidence that disease-modifying therapies can positively affect the long-term evolution of multiple sclerosis.
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Chest Film Clinic: What caused this man's dyspnea, chest pain, and atrial fibrillation?A 52-year-old man presented to his primary care physician with shortness of breath for 5 days, right-sided lower thoracic back pain, and dry cough. The patient was a 15-pack-year cigarette smoker who had emigrated from China to the United States in 1989. He had no significant history of occupational exposure or tuberculosis. He had no significant weight loss, and his past medical history was otherwise unremarkable.
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Time to Retire Beta-Blockers in Uncomplicated Hypertension?A comprehensive review of the evidence for the work-horse drugs indicates it's not quite time, yet.
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Arthropod Bites--Real and Imagined Fire Ant Stings Scabies FormicationRed imported fire ants (Solenopsis invicta) were introduced into the United States in the 1930s by ships from South America that docked in Mobile, Ala. Fire ants are now active throughout the southeast Sunbelt states. Colonies are also found in California; one of the largest is in Orange County.
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Pancreatic CarcinomaA 74-year-old man had vague abdominal pain, jaundice, pruritus, gray stools, and dark urine. A painless, palpable mass in his right upper quadrant was found at examination.
