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Update on Therapy for HistoplasmosisHistoplasmosis is caused by the dimorphic fungus Histoplasma capsulatum, which is endemic to the Ohio and Mississippi river valleys. It is associated with a variety of manifestations, and its severity ranges from asymptomatic infection to severe disseminated illness.
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ECG Changes in HyperkalemiaA succinct review of hyperkalemia . . . its various causes, clinical manifestations and consequences, ECG findings, and treatment approaches.
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A Differential Diagnosis of Drug-Induced Aseptic MeningitisDrug-induced aseptic meningitis should be included in thedifferential diagnosis of viral/aseptic meningitis. Cliniciansshould use historical clues in patients presenting with signs andsymptoms of viral meningitis to aid in the differentiation ofdrug-induced aseptic meningitis from other causes of asepticmeningitis. Viruses are the most common cause of asepticmeningitis, with enteroviruses being the most common amongviruses in cases presenting as aseptic meningitis. Ibuprofen iscurrently the most common cause of drug-induced asepticmeningitis. Drug-induced aseptic meningitis is a benign conditionwithout long-term sequelae. The diagnosis of druginducedaseptic meningitis is made by establishing a causalrelationship between the use of the drug and the onset of signsand symptoms, supported by negative tests for infectiouscauses of symptoms and rapidity of resolution after the drugis discontinued. [Infect Med. 2008;25:331-334]
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'Not your father's MRSA': What you need to know -- and do -- about community-associated MRSAThe notoriously adaptable and increasingly common pathogen requires a new approach including routine I&D and culturing of infected tissues; the use of more-potent antibiotics, but only when needed; and a focus on hygiene in patients with recurrent infections.
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Post-Test on Rheumatoid Arthritis 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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Abdominal EcchymosisAn elderly obese female presents with abdominal bruising following a motor vehicle accident. Can you ID the cause?
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Fixed Drug Eruption Provoked by PhenolphthaleinA hyperpigmented macule on the submental surface disturbed this 56-year-old man.
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Thyroid Problems May Spell Trouble for Diabetes RiskLow thyroid function predisposes to weight gain, which may partly explain the association with higher risk of diabetes.
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Hyperglycemia Predicts Adverse Outcomes in Patients With Intracerebral HemorrhageSeveral poster presentations this week confirm that hyperglycemia is a risk factor for poor outcomes in patients with intracerebral hemorrhage (ICH).
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A Painless, Rapidly-growing Nodule in a 74-year-old WomanThe solitary, keratotic lesion has grown quickly over one month. Infection? Neoplasia? What else is in your differential diagnosis?
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Respiratory symptoms may develop years after IBD diagnosis What are the pulmonary manifestations of inflammatory bowel disease? key words: Inflammatory bowel disease, Ulcerative colitis, Crohn disease, Bronchiectasis, BOOP, Interstitial pneumonitisabstract: Inflammatory bowel disease (IBD) can have a variety of extraintestinal manifestations, including pulmonary disease. Bronchial involvement is the most common, but other manifestations include upper airway disease; parenchymal involvement, such as bronchiolitis obliterans with organizing pneumonia (BOOP) and interstitial lung disease; and serositis, including pleural effusions and pericarditis. Patients with BOOP may present with fever, dyspnea, cough, and pleuritic chest pain. Chest radiographs show bilateral patchy airspace opacities or a diffuse process; CT scans often demonstrate the opacities to be pleural-based. Corticosteroids appear to be effective in the management of certain pulmonary manifestations of IBD, such as BOOP and pulmonary infiltrates with eosinophilia. (J Respir Dis. 2007;28(6):227-234)
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Popular Android BP Apps Useless, HarmfulEditors at Medpage Today have been scouting for health apps that make dubious--even dangerous--claims. Here's an update on BP apps.
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Hand Deformities and Heart Problems: A Case ReportPatients who present with congenital hand deformities in association with cardiac disorders require a detailed evaluation.
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Intrathecal Methotrexate: A Treatment Option for Patients With Progressive Multiple Sclerosis?Could intrathecally administered methotrexate be a viable treatment option for your patients with progressive forms of multiple sclerosis?
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Infant in Shock With Respiratory FailureThe patient had right submandibular swelling with inflammation and induration up to the nape of neck. Ultrasonography showed multiple enlarged lymph nodes with soft tissue swelling. What's your diagnosis?
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Battle Over Statins Highlights Two Camps Within MedicineThe "statin war" is about ossified ideologies and asks medicine's most primal question-"what is the role of medicine in society?"
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Man With Severe Dyspnea, Fever, and CoughA46-year-old white man is hospitalized with increasing dyspnea of 3weeks’ duration. He has a history of stable chronic obstructive pulmonarydisease secondary to heavy smoking (2 packs of cigarettes a day for 27years, discontinued 6 years previously) and uses inhaled bronchodilators.
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Gouty Tophi of the PinnaeA 33-year-old man presented with joint pain and general malaise of about 2 weeks' duration and small yellowish lesions on the pinnae of the ears of about 6 months' duration. He had no urinary symptoms or conjunctivitis and was not taking any medications. His grandfather had been treated for gout.
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A Woman With Delirium From Diabetic KetoacidosisMucormycosis, an angioinvasive yeast infection of the Mucorales order of the class of Zygomycetes, often grows in patients with diabetes mellitus, especially in the presence of diabetic ketoacidosis.
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Fournier Gangrene in an African American Man With Type 2 Diabetes Mellitus and Coronary Artery DiseaseA 77-year-old African American man with type 2 diabetes mellitus and coronary artery disease presented to the emergency department with acute scrotal swelling and pain. His testicles were erythematous with focal areas of necrosis and associated tissue destruction. Similar skin changes were apparent in the lower abdominal and inguinal regions.
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Fournier Gangrene in an African American Man With Type 2 Diabetes Mellitus and Coronary Artery DiseaseA 77-year-old African American man with type 2 diabetes mellitus and coronary artery disease presented to the emergency department with acute scrotal swelling and pain. His testicles were erythematous with focal areas of necrosis and associated tissue destruction. Similar skin changes were apparent in the lower abdominal and inguinal regions.
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New Advances in Antiretroviral TherapyIt is estimated that approximately 33.2 million persons worldwide were living with HIV infection in 2007.1 With the development of effective antiretroviral treatment strategies, HIV infection has now become a manageable chronic disease.2 Despite advances in treatment, drug resistance, long-term adverse effects, and high adherence requirements represent ongoing challenges to durable viral suppression.
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Case In Point: Silicone-induced pneumonitis in a transgendered patientThe authors describe the development of pneumonitis in a patient who had initially presented with edema of the lower extremities. Biopsy results supported the conclusion that the pneumonitis was caused by silicone injections the patient had received 5 years earlier.
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Solitary Rectal Ulcer SyndromeA 34-year-old woman who has had constipation and episodes of obstipation for at least 5 years recently passed blood and mucus rectally and has a rectal prolapse. Colonoscopy revealed an ulcer on the anterior rectal wall, approximately 4 cm from the anus.
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Intensive Program Extends Lifespan in T2D PatientsResults unequivocally support early, aggressive, and sustained risk factor control in patients with complicated type 2 diabetes.
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Elderly Woman With a Rapidly Enlarging Facial TumorA 101-year-old woman has had an occasionallypruritic and tender growthon her face for about 2 months. Thegrowth has doubled in size over the past2 weeks. She has no personal or familyhistory of cancer or significant dermatologicdisorders.
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Herpesvirus InfectionsTen days before presenting for evaluation, a 69-year-old man began to experience neuralgic pain and noticed the eruption of painful erythematous macules and papules on the right side of his chest. Within 24 to 72 hours, vesicles and pustules arose at the site. One week after onset, several of the lesions dried and crusted.
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In Africa With the PygmiesWe lie awake in our one-room hut before dawn listening to the cacophony of sounds emanating from the forest as the birds awake. The Bwindi Impenetrable Forest of Southwest Uganda contains over 350 species of birds, and it seems that they are all chattering to each other at once. The Bwindi Forest is also home to more than half of the world’s 650 mountain gorillas.
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Coexistent Discoid Lupus Erythematosus and Porphyria Cutanea TardaBullae had recently appeared on the dorsa of the hands and fingers of a 46-year-old man. His medical history was significant for alcoholism, discoid lupus erythematosus (DLE), and hepatitis C. Systemic lupus erythematosus (SLE) was ruled out; the patient’s symptoms did not meet the American Rheumatism Association criteria for SLE.
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Leukocytoclastic VasculitisFor the past 2 weeks, this 46-year-old woman had had malaise, myalgia, and hand and elbow arthralgia. Twelve hours before she was hospitalized, red spots started to appear on her shins and thighs. Soon afterward, her left ankle became increasingly painful, tender, and warm.
