Authors


Rebecca E. Sadun, MD, PhD

Latest:

Post-Test on Gout in Primary Care

Use this short test to gauge how much you’ve learned about a condition that needs more primary care involvement.


Rebecca S. Sowell, PharmD

Latest:

Quinolone Neurotoxicity: How to Avoid or Minimize the Risk

Fluoroquinolone antibiotics have activity against a wide range of gram-positive, gramnegative, and atypical bacteria.


ReelDx

Latest:

Acute Widespread Rash in a 9-month-old Boy

What is the cause of this erythematous rash that appeared suddenly and spread rapidly on the child's trunk and extremities?



Regina B. Osih, MD, MPH

Latest:

Case Report

A 49-year-old white man, in whom HIV infection had been newly diagnosed (CD4+ cell count, 25/µL; HIV-1 RNA level, 274,000 copies/mL), was transferred to our hospital for further workup and treatment of multiple neurologic deficits. He had presented to another hospital with a 4-day history of left-sided weakness and numbness, left-sided facial droop, dysphonia, and dysphagia that led to the initial diagnosis of an acute stroke.


Reginald Fears, MD

Latest:

Epiglottitis in a 48-Year-Old Man

A 48-year-old man was admitted with a sore throat, subjective fever, and cough of 2 days’ duration. Two days before admission, he had dysphagia, began to drool, and felt like he was choking.


Reginald S. Sauve, MD

Latest:

Cornelia de Lange Syndrome (Brachmann-de Lange Syndrome)

This newborn has Cornelia de Lange syndrome, a disorder characterized by prenatal growth retardation (this child weighed 2240 g at birth and measured 46 cm in length), microbrachycephaly, bushy eyebrows, long eyelashes, short neck, low posterior hair line, depressed nasal bridge, anteverted nares, long philtrum, thin upper lip, downturned corners of mouth, micrognathia, a single umbilical artery, phocomelia, micromelia, and oligodactyly.


Reiko Kayashima, MPH

Latest:

Recurrent Epigastric Pain in an 82-Year-Old Woman

An 82-year-old woman who had recentlyarrived from Japan presented to theemergency department with a 3-dayhistory of abdominal pain that beganimmediately after she swallowed severalpills with a small amount of water.The severe, intermittent pain radiatedto the patient’s back and worsened withmeals. The patient denied chills, nausea,vomiting, coughing, diarrhea, andconstipation. She had well-controlledtype 2 diabetes mellitus and hypercholesterolemia,and had undergone anappendectomy 50 years earlier.


Renuka Borra, MD

Latest:

Hypersensitivity Reaction

A 25-year-old man presented with an erythematous, pruritic, scaly, macular rash that had begun behind his ears and spread over his neck, chest, trunk, and upper and lower extremities.


Rex G. Mathew, MD

Latest:

Hypertensive Emergencies and Urgencies:

To distinguish between hypertensive emergencies and urgencies and nonurgent acute blood pressure elevation, evaluate the patient for evidence of target organ damage. Perform a neurologic examination that includes an assessment of mental status; any changes suggest hypertensive encephalopathy. Funduscopy can detect papilledema, hemorrhages, and exudates; an ECG can reveal evidence of cardiac ischemia. Order urinalysis and measure serum creatinine level to evaluate for kidney disease. The possible causes of a hypertensive emergency include essential hypertension; renal parenchymal or renovascular disease; use of various illegal, prescription, or OTC drugs; CNS disorders; preeclampsia or eclampsia; and endocrine disorders. A hypertensive emergency requires immediate blood pressure reduction (although not necessarily to the reference range) with parenteral antibiotics. An urgency is treated with combination oral antihypertensive therapy.


Rey Vivo, MD

Latest:

Elderly Man With Hypothermia

On a warm August day, a 79-year-old man is hospitalized because of progressive lethargy over the past week. Previously, he was alert and able to converse. He has no chest pain, dyspnea, or cough. His history includes hypertension of unknown duration, chronic obstructive pulmonary disease, and a recent hospitalization for pneumonia.


Reynold C. Wong, MD

Latest:

Beau Lines

Transverse depressions like the one shown here appeared on all the other nails of this 68-year-old man several weeks after he had suffered a myocardial infarction.


Reza Y. Akhtar, MD

Latest:

Chronic Hepatitis C:

The most common chronic blood-borne infection in the United States is caused by hepatitis C virus (HCV), an RNA virus transmitted through blood-to-blood contact. In this article, we identify risk factors for HCV infection and discuss which patients should be tested and treated.


Rezhan Hussein, MD

Latest:

Talc Embolism: A Case of Extrapulmonary Complications

A rare finding is a timely lesson for all clinicians who are touched in one way or another by the injectable drug crisis in the US.


Riad El Fakih, MD

Latest:

Epiglottitis in a 48-Year-Old Man

A 48-year-old man was admitted with a sore throat, subjective fever, and cough of 2 days’ duration. Two days before admission, he had dysphagia, began to drool, and felt like he was choking.


Ricardo Castillo, MD

Latest:

Incomplete LV Rupture Secondary to MI: A Case of Intramyocardial Dissection

Myocardial rupture is the most feared and often lethal complication of acute MI. It was a potential diagnosis for this patient who presented with sinus tachycardia, ST-segment elevation from V1 to V4, II, III, and aVF with associated Q waves. Follow the workup and outcome here.


Richard A. Harrigan, MD

Latest:

Middle-Aged Man With Light-Headedness, Nausea, and Palpitations

A 44-year-old man presents to the emergency department (ED) with light-headedness, nausea, and vomiting of 1 day's duration. He has also had intermittent palpitations but denies chest pain, dyspnea, and weakness.


Richard Birrer, MD

Latest:

Low Back Pain

ABSTRACT: Regardless of the specific underlying pathology, most patients with low back pain benefit from a program of rehabilitative exercise. The goal of such a program is to increase muscle activity while minimizing stress to the spine. Low-intensity, high-frequency endurance training accomplishes both objectives. Include in the program flexibility exercises, exercises to strengthen the abdominal muscles, exercises for the proximal paraspinal and periscapular muscles, extensor exercises, and exercises to strengthen the legs and stabilize the trunk. Introduce the exercises in this order and advise patients not to progress to a new exercise until they are comfortable performing the less difficult ones.


Richard D. Brasington, Jr, MD

Latest:

Rheumatoid Arthritis: Treatment of Newly Diagnosed Disease

NSAIDs help control the pain and inflammation of rheumatoid arthritis (RA) but do not affect disease progression; they are recommended for patients with newly diagnosed RA only as an adjunct to disease-modifying antirheumatic drug (DMARD) therapy.


Richard D. Deshazo, MD

Latest:

Diagnosing asthma in seniors: An algorithmic approach

ABSTRACT: The diagnosis of asthma in older persons may becomplicated by a number of factors, including atypical presentationsand comorbid conditions, such as chronic obstructivepulmonary disease and congestive heart failure (CHF). Ahigh index of suspicion for the diagnosis of asthma is warrantedin patients with isolated dyspnea or cough. The diagnosisshould be based on demonstration of reversible airwayobstruction on pulmonary function tests. Additional tests thatmay be useful in the initial evaluation include chest radiography,arterial blood gas analysis, and standard electrocardiography.CT may help exclude pulmonary embolism and certainneoplasms that can masquerade as asthma. High-resolutionCT scans are valuable when pulmonary function testresults are consistent with interstitial lung disease. When thediagnosis is uncertain, measurement of brain natriuretic peptidecan help distinguish between obstructive lung disease andCHF. (J Respir Dis. 2008;29(10):391-396)


Richard Duncalf, 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)


Richard Elion, MD

Latest:

Research Focus: Recent Developments in HIV Therapeutics

Research Focus: Recent Developments in HIV Therapeutics


Richard F. Lockey, MD

Latest:

How best to diagnose and control asthma in the elderly

Abstract: A number of factors can complicate the diagnosis of asthma in elderly patients. For example, the elderly are more likely to have diseases such as chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) that--like asthma--can cause cough, dyspnea, and wheezing. Spirometry can help distinguish asthma from COPD, and chest radiography and measurement of brain natriuretic peptide levels can help identify CHF. Important considerations in the management of asthma include drug side effects, drug interactions, and difficulty in using metered-dose inhalers. When discussing the goals of therapy with the patient, remember that quality-of-life issues, such as the ability to live independently and to participate in leisure activities, can be stronger motivators than objective measures of pulmonary function. (J Respir Dis. 2006;27(6):238-247)


Richard G. Wenzel, PharmD

Latest:

SSRIs and Triptans: Safe as Combination Therapy?

Depression was diagnosed 6 years earlier in a 37-year-old woman; it has been successfully managed since then with fluoxetine and outpatient psychotherapy. Since her teenage years, the patient has also experienced sporadic (fewer than 3 or 4 per year) mild or occasionally severe headaches, which she has usually self-treated with over-thecounter (OTC) agents or "just slept off."


Richard Greenberg, MD

Latest:

Emphysematous Pyelonephritis Caused by Pasteurella multocida

Emphysematous pyelonephritis (EPN) is a rare but life-threatening infection characterized by widespread necrosis and production of gas within the kidney.


Richard Laws, MD

Latest:

Gram-Negative Bacteria as Cause of Foot Intertrigo

For a year, a 31-year-old man had asymptomatic, malodorous discoloration of the toe web spaces. He stated that his feet perspire heavily in the boots he is required to wear for work.


Richard Paula, MD

Latest:

Man With Painful Shoulder Abscess

For 2 weeks, a 31-year-old man has had a nonhealing, painful abscess on his left shoulder. A week before presentation, he sought treatment at a walk-in clinic; the abscess was incised and drained, and he was given gatifloxacin.


Richard Robinson

Latest:

Survival in ALS Plus FTD Influenced by Timing of Symptom Onset

What is the prognosis for patients with frontotemporal dementia and motor neuron disease? A new study suggests the answer depends not on which occurs first, but whether cognitive and motor symptoms develop simultaneously.


Richard S. Witzig, MD, MPH

Latest:

Mycobacterium goodii Infection of a Total Knee Prosthesis

Mycobacterium goodii infection is uncommon and probablyoccurs via disruption of skin and bone integrity or theintroduction of a foreign body into viscera, namely implantationof a prosthetic device. We describe a case of nosocomial,total knee arthroplasty–associated M goodii infection thatrequired combined antibiotic and surgical therapy for clinicalmanagement. An infection control investigation revealed thatthe source of the organism might have been the water in theoperating room scrub faucets. [Infect Med. 2008;25:522-525]


Richard Saitz, MD, MPH

Latest:

Research-Based Approaches to Treating Alcohol Use in Primary Care

When it comes to generating high-quality evidence applicable to clinical care, the alcohol field has lagged behind other medical-scientific fields, according to Dr Richard Saitz, a recent presenter at Yale University Medical School. Dr Saitz is Professor of Medicine and Epidemiology and Director, of the Clinical Addiction Research and Education (CARE) Unit Section of General Internal Medicine, at Boston University Schools of Medicine and Public Health.

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