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Although topical corticosteroid therapy can be highly effective, such treatment can be costly-especially whenbrand-name products are prescribed for extensive or chronic conditions. Here we describe an economical approachthat does not sacrifice either efficacy or safety.

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Take this brief quiz to see what you’ve learned about the challenges and opportunities of obesity management.

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Selective cyclooxygenase-2 (COX-2) inhibitors, such as celecoxib, rofecoxib, and valdecoxib, are an effective and commonly used class of drugs for the management of pain. They are particularly useful in patients who are unable to tolerate aspirin or traditional NSAIDs because of side effects.

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Although the common cold is usually benign, it can lead to exacerbations of asthma and chronic obstructive pulmonary disease, and it is a leading cause of missed school and work. Strategies for prevention have been directed at interruption of viral transmission between persons, as with the use of virucidal agents or disinfectants, and prevention of infection after acquisition of the pathogen. Hand washing continues to be recommended, but there is no proof that hand sanitizers or virucidal tissues are effective in preventing colds. Prophylactic therapies that have been considered include vitamin C, vitamin E, zinc, Echinacea, ginseng, and probiotics. Although some evidence may suggest possible benefits with zinc and probiotics, for example, overall, the data are insufficient to recommend any of these as prophylaxis for the common cold. (J Respir Dis. 2009;30)

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A 34-year-old woman presented with a blistering, intensely pruritic rash that had erupted 3 days earlier. Multiple papular lesions were densely clustered on areas of exposed skin. Excoriations were present, but there was no evidence of bacterial infection.

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An examination the most recent data on the pharmacodynamics, efficacy, and safety of 5 commonly used herbs: echinacea, St John's wort, ginkgo biloba, saw palmetto, and black cohosh.

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For 4 weeks, a 49-year-old man has had progressively worsening pain between his scapulae and in the lower part of his neck. The pain is now severe, and he takes high doses of acetaminophen and NSAIDs for relief.

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For 6 years, a 32-year-old man had a recurring rash on his back, shoulders, and chest. He stated that the rash appears in the spring, itches, and enlarges into ringlike areas. Previously, when treated with cephalexin, the rash had cleared within several weeks. Antifungal medication (econazole cream and oral terbinafine) had failed to resolve the rash.

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For several months, a 52-year-old woman has had burning discomfort in the region of her lower sternum and frequent acid/sour sensations in her throat; the symptoms are usually associated with burping after meals and recumbency.

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The 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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To what extent are patients with obstructive sleep apnea syndrome (OSAS) at increased risk for postoperative complications? Are there any specific interventions that reduce the risks?

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If you suffer from allergies or asthma, there are a variety of things you can do inside your home to limit your exposure to allergens that can cause asthma or make it worse.

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A 53-year-old man presented with a 3-day history of bilateral pain in the lower extremities. He also had a 3-month history of thickening and desquamation of skin, with associated itching, and a 5-lb (2.27-kg) weight loss. The skin changes initially appeared on the hands and subsequently became generalized.

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

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When patients come in for a Pap smear, we have them write their name and address on an envelope, which we file in a box organized by month. Then as results come in, we retrieve the appropriate envelopes from the box and mail them out. Any envelopes left in the folder at the end of the month serve as reminders that those patients haven't been contacted yet.

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The patient described here was treated for pneumonia, but a chest wall mass and CT changes suggested that more was going on.

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More 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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Which test should you order if you suspect Clostridium difficile infection-and how often do you check the stool for the C difficile toxin? Here: the answer-and explanation.

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A 40-year-old man was concerned about an enlarging painless mass on the right side of his neck that had been present for 6 months. The patient reported no other health problems; his medical history was unremarkable, and he was taking no medications.

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For more than 30 years, serumdigoxin concentrations (SDCs)have been monitored toensure safe, effective therapy.1,2Although the therapeuticrange for SDCs is often listed as either0.8 to 2.0 ng/mL or 0.5 to 2.0ng/mL, the results of clinical trials inthe 1990s suggest an upper limit of1.0 ng/mL for treatment of heart failure.3-11 An upper limit for the SDC of1.0 ng/mL is also recommendedfor patients who have heart failureand atrial fibrillation with rapid ventricularresponse.

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We describe a patient with intravascularpulmonary lymphomawho presented withprogressive dyspnea and hypoxemiawith normal chest radiographicfindings. After anunrevealing noninvasive evaluation,a high-grade B-cellintravascular lymphoma wasdiagnosed by bronchoscopywith transbronchial biopsy.Treatment with a modifiedCHOP regimen resulted in resolutionof the patient’s hypoxemiaand exercise limitation.Although intravascular pulmonarylymphoma rarely presentswith pulmonary symptoms,it should be consideredin the differential diagnosis ofpatients presenting with hypoxemiaand normal chest radiographicfindings.

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Over the past 2 decades, there has been an alarming increase in opportunistic fungal infections with an associated rise in morbidity and mortality. This trend has been attributed to the growing number of patients who are immunocompromised because of bone marrow or solid organ transplant, immunosuppressive drugs, AIDS, and hematological malignancies. Advances in trauma and critical care medicine that lead to longer survival of more patients with immunocompromising conditions also play a role.

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A 16-year-old boy was evaluated for elephantiasis in a remote village in the mountains of Kenya. He complained of drainage from his left leg and reported that for the past several months, after the limb swelled, fluid began to weep from the bottom of the foot. He denied pain in his leg or foot and reported no fever, chills, or sweats.

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A 32-year-old woman presents with weight loss of 6.4 kg (14 lb) during the past 8 months and diarrhea of recentonset. Menstruation had ceased 10 weeks earlier. She appears anxious, with pressured speech. Physical examination detectsbaseline sinus tachycardia, sweaty palms, and a diffusely enlarged thyroid gland. Laboratory tests reveal a thyroid-stimulatinghormone (TSH) level of 0.00 µU/mL (normal, 0.45 to 4.5 µU/mL), a free thyroxine (FT4) level of 4.8 ng/dL (normal,0.61 to 1.76 ng/dL), and a positive thyroid-stimulating immunoglobulin (TSI) level with high titer.

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A 53-year-old man, who had initially presented with an upper respiratory tract infection, was found to have a stage IV follicular low-grade lymphoma with malignant cells that were positive for CD19, CD20, CD10, surface kappa, and CD45 and negative for CD5. A grade 1 tumor (follicular center cell lymphoma/follicular small cleaved) was suspected. Enlarged lymph nodes (2.5 to 4.0 cm) were found in the mediastinum, azygoesophageal recess, and periaortic region as well as in the porta hepatis, peripancreatic, mesenteric, and celiac regions.

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A 52-year-old woman presented with a 12-day history of diarrhea and mild stool incontinence that began 2 to 3 hours after a routine screening colonoscopy. Six or 7 bowel movements of liquid, orange-yellow feces occurred each day for 12 days. The patient reported that associated nausea, flatulence, and severe abdominal cramping were relieved by the bowel movements. She also reported that a small amount of mucus was occasionally observed in the stool and that bright red blood streaks appeared on used toilet paper, although the stool itself was not bloody. She was able to tolerate a full diet, although food exacerbated the urgency. She was afebrile during this illness.

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Rhodococcus equi is an emerging human pathogen. It is mostfrequently associated with pulmonary infections; however,manifestations may be protean. It can be easily mistaken fora diptheroid-like contaminant or a mycobacterium. Therefore,a high suspicion of R equi infection and specialized testing areencouraged. Vancomycin-based therapy is recommended.Because human infection with this organism is uncommon,thorough reporting will help identify further characteristicsof infection and will help in devising treatment guidelines.[Infect Med. 2008;25:391-393

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Some eager medical cannabis experts ask why cannabidiol is not mandatory for athletes to address TBI. Others are more cautious.

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