Authors


Shara Yurkiewicz, MD

Latest:

Pay Attention to How Doctors Talk

Slang is a window into the healthcare culture, this physician-author says.


Sharmila Nanda, MD

Latest:

Boy With Extraordinarily High Blood Lead Levels

A 9-year-old asymptomatic boy was referred to our tertiary care facility with a blood lead level (BLL) of 59 μg/dL. A diagnosis of attention deficit hyperactivity disorder, which was managed with amphetamine/dextroamphetamine, had been made when the patient was 6 years old.


Sharon A. Glick, MD

Latest:

Raynaud Phenomenon as a Manifestation of Systemic Disease

The young female presented with a 1-month history of violaceous papules, petechiae, and healing ulcerations on the distal digits of both hands and feet.


Sharon Glick, MD

Latest:

Sexually Transmitted Diseases: Recognizing Telltale Skin Lesions Disseminated Gonococcal Infection

Telltale skin lesions of syphilis, gonorrhea, human papillomavirus infection, and Haemophilus ducreyi infection.


Shashank Jain, MD

Latest:

Giant Bullous Emphysema

A 54-year-old man presented to the ED with palpitations identified as atrial flutter and RVR. Medical history included stage IV renal-cell carcinoma, end-stage COPD, NYHA class IV heart failure, and recent pulmonary embolism. A CT scan of the thorax was ordered.


Shashi Sahai, MD

Latest:

Chronic Cough in Children: An Overview

The prevalence of chronic cough is reported to be 5% to 7% in preschoolers and 12% to 15% in older children. Diagnosis and management can present challenges.


Shawn X. Sun, PhD

Latest:

Economic Evaluation of a Prior Authorization Program for Biologic Response Modifiers

Specialty medications constitute the fastest-growing segment of drug spending under the pharmacy benefit. This study evaluated the impact of a specialty pharmacy prior authorization (PA) program on prescription drug costs for biologic response modifiers (BRMs) used in the treatment of persons with rheumatoid arthritis, juvenile rheumatoid arthritis, Crohn disease, ankylosing spondylitis, psoriatic arthritis, psoriasis, and other spondyloarthropathies. A retrospective, case-control, one-to-one matching approach based on patient age, sex, and client characteristics was used. Case clients were enrolled in the specialty pharmacy PA program from January 1 through December 31, 2005. The control group consisted of clients who were not enrolled in the program during this time. The average costs per eligible member per month (PMPM), for the total, plan, and member were $1.32, $1.29, and $0.03, respectively, in the case group, and $1.44, $1.41, and $0.03, respectively, in the control group. Clients who implemented the specialty pharmacy PA program for BRMs saved an estimated total cost of $0.12 PMPM. Implementing a specialty pharmacy PA program reduced BRM costs. (Drug Benefit Trends. 2008;20:26-31)


Shayan Irani, MD

Latest:

Colorectal Cancer Screening: Which Tests, How Often?

ABSTRACT: Screening options for colorectal cancer (CRC) include colonoscopy every 10 years, annual fecal occult blood testing, flexible sigmoidoscopy every 5 years, or double contrast barium enema every 5 years. In white patients at average risk, screening should begin at age 50; in African American patients, at age 45. Colonoscopy is preferred to sigmoidoscopy because it can detect proximal neoplasms and has the longest protection interval. High-risk patients include those with a family history of CRC or adenomas. These persons should begin colonoscopic screening at age 40, or 10 years earlier than the age at which CRC or adenomas were diagnosed in a first-degree relative. Other high-risk patients are those with a personal history of CRC, a genetic syndrome, or inflammatory bowel disease. In patients with CRC, the first follow-up colonoscopy is performed 1 year after surgery. If results are normal, the interval can be extended to every 3 years.


Sheela Kapre, MD

Latest:

Multiple Symmetric Lipomatosis

The multiple, symmetrically distributed, soft, nontender swellings on the shoulders and torso of a 56-year-old Hispanic man are characteristic of multiple symmetric lipomatosis (MSL), also known as Madelung disease or Launois- Bensaude syndrome.


Shehla Baqi, MD

Latest:

Severe Hypersensitivity Reaction to Antituberculosis Medications

A66-year-old white man with tuberculosis of the shoulderjoint had a severe hypersensitivity reaction to antituberculosismedications. Symptoms included development of pulmonaryinfiltrates, hepatic dysfunction, renal insufficiency, andneutropenia. The patient improved after the medicationswere withdrawn. [Infect Med. 2008;25:287-291]


Shelby Dickerson, MD

Latest:

Pseudo-MI in a Patient with Pancreatitis and Polyarteritis Nodosa

A 38-year-old man with a history of alcoholism, intravenous drug use, and cerebrovascular accident was referred for assessment of possible endocarditis, based on history, fever 39 °C (102.9 °F) and mildly elevated troponin level.


Sherif Twafic, MD, PhD

Latest:

A Right Adrenal Serpent

A large right adrenal mass was noted incidentally on an MRI scan of the lumbar spine, which had been performed for other reasons in a 55-year-old non-obese woman. The bright heterogeneous mass (T2-weighted image) measured 6.2 3 6.2 3 4.1 cm and sat like the head of a serpent on the superior pole of the right kidney. Its margins were smooth, but signal intensity was increased on T2 weighting because of high water content. The left adrenal gland was normal.


Sherry Shieh, MD

Latest:

Man With Progressive Induration of the Skin and Pruritus

A disorder similar to scleromyxedema, nephrogenic fibrosing dermatopathy, has been reported in patients receiving renal dialysis. Lichen myxedematosus, an atypical form of papular mucinosis, is not associated with sclerosis and paraproteinemia; however, it may represent an early presentation of scleromyxedema.


Sheryl Guiterres, PharmD

Latest:

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.


Shih-wen Huang, MD

Latest:

Exploring the link between nasal allergy and sinus infection

Abstract: There is solid evidence that a positive association exists between nasal allergy and acute or chronic sinusitis in both adults and children. Patients with perennial allergic rhinitis--especially those with significant sensitivity to molds and/or house dust mites--are particularly susceptible to acute sinusitis. It therefore seems reasonable to assume that controlling rhinitis by controlling allergens in the home environment will minimize recurrences of acute sinusitis. Conversely, many patients with chronic sinusitis also have nasal allergy. Thus, management of nasal allergy should be included in the treatment strategy for chronic sinusitis. (J Respir Dis. 2006; 27(10):435-440)


Shilpa Atodaria, MD

Latest:

Intoxication with street drugs: Cocaine and amphetamines

Cocaine and amphetamine intoxication continue to be common causes of emergency department and hospital admissions.


Shital Patel, MD

Latest:

A Middle-Aged Man With Recurrent Pneumonia and Renal Failure

A 56-year-old was seen in the ED after 4 days of hemoptysis and intermittent left chest pain. He also complained of exertional dyspnea and arthralgias. He had been treated for “pneumonia” twice during the past month. Histories were unremarkable.


Shiv Sudhakar, MD

Latest:

Varicella-Zoster Virus Infection

Are these tender, vesicular erythematous lesions symptomatic of HIV/AIDS? Of Ramsay Hunt syndrome? Of herpes simplex or varicella-zoster virus? What's your diagnosis?


Shlomo Trope, MD

Latest:

Sebaceous Cyst

A painless swelling on the dorsum of the scalp had been present for many years in a 36-year-old man. An increase in the size of the lesion prompted the man to seek medical evaluation.


Shobha Swaminathan, MD

Latest:

A case of miliary TB complicated by ARDS and pancytopenia

We present a case of a 35-year-old man with fever and pancytopenia, who had rapid progression to acute respiratory distress syndrome (ARDS), multiorgan failure, and disseminated intravascular coagulopathy secondary to disseminated tuberculosis (TB). Although both sputum and bronchoalveolar lavage (BAL) fluid smears were negative for acid-fast bacilli, the polymerase chain reaction (PCR) assay on the BAL fluid was positive for Mycobacterium tuberculosis. This case emphasizes the need to include TB in the differential for ARDS and the value of PCR testing of BAL fluid, especially in high-risk patients.


Shobhana Chaudhari, MD

Latest:

Polyglandular Autoimmune Syndrome Type 2

There are 4 manifestations of this syndrome; each is characterized by involvement of at least 2 glandular organs in autoimmune mediated diseases that lead to organ hypofunction.


Shu-Hua Wong, MD, MPH

Latest:

What Is Causing Headache and Neck Stiffness in This Patient?

A 41-year-old African American man presented with the chief complaint of a constant, dull headache for 3 days. The headache had a gradual onset and was associated with nausea and mild neck stiffness that was not relieved by acetaminophen. The man denied experiencing visual disturbances, fever, night sweats, weight loss, cough, shortness of breath, emesis, or weakness. He had no recent history of trauma or sick contacts.


Sidhu Gangadharan, MD

Latest:

What caused recurrent pneumonia and hemoptysis in this woman?

A 53-year-old woman presented to the emergency department complaining of substernal chest pain that awoke her from sleep. The chest pain was associated with left shoulder numbness, radiating to her back, and was partially alleviated with sublingual nitroglycerin. During this episode, the patient had a cough productive of yellow phlegm and one instance of cough productive of 1 tbs of bright red blood.



Silvana Riggio, MD

Latest:

What You Forgot About the Neurologic Exam, Part 2:

ABSTRACT: Asymmetry-whether of strength, reflexes, or sensory function-is an important localizing finding in the neurologic evaluation. Asymmetric deficits of strength may indicate an acute CNS lesion. Symmetric hyperreflexia or hyporeflexia alone is not diagnostic; compare reflexes between sides of the body and between upper and lower extremities. The extensor plantar response (Babinski reflex) suggests an upper motor neuron lesion. During the sensory examination, look for asymmetry and determine whether both light touch and pinprick sensation are intact. Simultaneous stimulation with 2 sharp objects on opposite sides of the body-done to detect extinction of response on 1 side-can uncover subtle sensory deficits.


Simon Ashiku, MD

Latest:

Chest Film Clinic: What caused persistent cough and dyspnea in this patient?

A 65-year-old woman presented to her primary care physician with a 3-month history of worsening cough, now productive of copious blood-tinged secretions. She also reported a recent onset of fever and dyspnea. She denied any chest pain, chills, night sweats, and weight loss.


Simon Chin, MBA

Latest:

Personalized Medicine: A New Medical Paradigm

Recent advances in diagnostic testing have increased the likelihood that our current model of medical treatment will soon be supplanted, at least in part, by personalized medicine. With this change in the medical paradigm will come numerous benefits and opportunities for patients, caregivers, drug developers, diagnostics firms, and MCOs.


Simon Kassabian, MD

Latest:

Too Much for the Computer: Complete Heart Block in an Elderly Woman

A 92-year-old woman presented with signs and symptoms of heart failure, including marked bilateral lower extremity edema, jugular vein distention, and difficulty in breathing at rest. Her medical history was significant for hyperthyroidism, chronic asthmatic bronchitis, and senile dementia. Medications included oral methimazole, 10 mg/d, and oral theophylline, 200 mg/d.


Sirisak Chanprasert, MD

Latest:

Lhermitte-Duclos Disease

Lhermitte-Duclos disease is a rare, slow-growing, benign lesion of the cerebellum and is considered a hamartomatous tumor of the cerebellar cortex.


Siva K. Talluri, MD

Latest:

Splenic Infarction

A 53-year-old woman presented with sudden onset of left upper quadrant abdominal pain. She had a history of atrial fibrillation, hypertension, and congestive heart failure.

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