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West Nile Virus-The Rodney Dangerfield of InfectionsWNV first appeared in the United States in 1999.1 This infection "got no respect" even though it caused significant morbidity and mortality while crossing the United States unabated for the past 9 years. Patients died mainly of neuroinvasive complications such as encephalitis and a polio-like paralysis. The lack of respect became a reality to clinicians in Phoenix in 2004 when they found themselves poorly prepared to manage the many acutely ill patients affected by WNV. That there was a lack of practical information about how to manage WNV became readily apparent to these clinicians.
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Cytomegalovirus InfectionCough, fever, diarrhea, and weight loss had disturbed a 52-year-old woman for 1 month. AIDS had been diagnosed 5 years earlier, but she had declined medical treatment. The patient's vital signs were stable when she was admitted to the hospital. Physical examination results were unremarkable except for thrush and mild, diffuse abdominal tenderness.
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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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A rare diagnosis: Endobronchial schwannomaEndobronchial schwannomas are rare and often benign neoplasms that develop from the nerve sheath of the peripheral nervous system.
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What Next For This Patient?A patient who is allergic to penicillin was bitten on his wrist by a dog. What is the first test you order?
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Soft Tissue Sarcoma with Gout TophiAn 80-year-old man, who could not walk because of a large mass on his right leg, was brought to the emergency department. The mass had been increasing in size on the anterior region of his right thigh for approximately 6 months. The patient also complained of “lumps” that had developed on his extremities during the past 2 months.
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Managing Drug Interactions That Can Reduce Levothyroxine EfficacyLevothyroxine is one of the most commonly prescribed medications for the treatment of persons with hypothyroidism and the suppression of thyroid neoplasms.1 Most persons with hypothyroidism require lifelong therapy with levothyroxine.
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Blount DiseaseA 16-year-old African American boy complained of exertional pain below his left knee that severely limited his ability to participate in sports. The patient had had bilateral bowed legs until his early school years, when the right knee straightened. For the past year, exertional pain had been present below the left knee in the epiphyseal area.
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How to differentiate from restrictive cardiomyopathy Recognizing constrictive pericarditis as a cause of shortness of breath key words: Constrictive pericarditis, Pericardial calcificationabstract: In the past, constrictive pericarditis was most often caused by tuberculosis. Today, however, it is more likely to be preceded by injury or trauma, infection, or previous cardiac surgery. Most patients with constrictive pericarditis present with dyspnea and have elevated jugular venous pressure. Other potential symptoms and signs include peripheral edema, abdominal fullness, hepatomegaly, ascites, and chest pain. Electrocardiography demonstrates nonspecific ST-segment and T-wave changes and generalized T-wave inversion or flattening. In many cases, chest radiography and CT reveal pericardial calcification, and echocardiography shows increased pericardial thickness and calcification. Treatment may include NSAIDs, corticosteroids, antibiotics, angiotensin-converting enzyme inhibitors, and diuretics. Surgery is the treatment of choice for chronic disease, and pericardiectomy is typically effective. (J Respir Dis. 2007;28(2):49-56)
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Peutz-Jeghers SyndromeAn 11-year-old boy had generalized abdominal pain followed by nausea and vomiting. He had neither diarrhea nor fever. Examination revealed a flat, diffusely tender abdomen with no palpable masses. Pigmented macules were seen on his lips and buccal mucosa. A partial bowel resection had been performed 5 years ago because of intussusception.
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Traumatic Brain Injury and Fecal RetentionA 31-year-old man with a history of traumatic brain injury was hospitalized because of failure to thrive, constipation, and intermittent diarrhea with soiling.
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Case In Point: What caused diffuse alveolar hemorrhage in a patient with gout?Allopurinol, commonly used to treat patients with gout, has been known to cause hypersensitivity reactions. We report a case of drug-induced delayed multiorgan hypersensitivity syndrome secondary to allopurinol use. To the best of our knowledge, this is the first reported case of diffuse alveolar hemorrhage in a patient presenting with allopurinol-induced rash with eosinophilia and systemic symptoms.
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Regional Folliculitis After Smallpox VaccinationFor a week, a 36-year-old Marine had clusters of localized papular lesions on the right forearm; he had no systemic symptoms. The patient had been inoculated 20 days earlier in the United States with the vaccinia virus (smallpox vaccine) to the ipsilateral shoulder just before deployment. He had no history of eczema, psoriasis, or drug allergies.
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Cavitary lung disease and hemoptysis in a young manThe authors describe a patient who presented with episodic hemoptysis and other respiratory symptoms. His chest radiograph showed a diffuse reticulonodular pattern. Bronchoscopy led to the diagnosis of pulmonary blastomycosis.
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Pheochromocytoma: Do You Know the Classic Triad of Symptoms?A 49-year-old man presents for a routine examination. He has a 15-year history of essential hypertension and a 7-year history of hypercholesterolemia and type 2 diabetes mellitus.
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Practice Pearls for Discussing COVID-19 Vaccines with PatientsDrs Tina Q. Tan and Rodney Rohde share final thoughts on addressing patient and parent concerns with COVID-19 vaccines.
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Clostridium subterminale - Infection Secondary to an Open FractureClostridia are anaerobic, spore-forming, gram-positive bacilli that are ubiquitious in nature. They can be isolated from soil and the GI tract of animals and humans.1
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Case In Point: An unusual mediastinal massThe authors present a case that demonstrates the diagnostic challenge of mediastinal tumors. They describe the clinical presentation of a patient who had a central endobronchial tumor that was identified as a primary mediastinal spindle cell neoplasm.
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Invasive Fungal SinusitisWith advances in chemotherapy, transplantation, and the treatment of diabetes and HIV infection, fungal sinusitis has become increasingly recognized in patients in these at-risk groups.
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A Right Adrenal SerpentA 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.
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Aliskiren Plus Losartan Equals Lower Urine Protein Levels in Type 2 PatientsAdding aliskiren to antihypertension regimens that already include losartan reduced blood protein levels from 19% to 22% in hypertensive type 2 diabetic patients with nephropathy.
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Back Extension Exercises for Patients With OsteoporosisExercises that help strengthen themuscles that support the spinemay be especially helpful duringthe postmenopausal years. Theback extension series illustratedin Figures 1 through 5 is anexample of progressively moredifficult exercises that can beperformed several times perweek. These exercises can alsobe performed individually inconjunction with resistance andweight-bearing routines.
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Herpes ZosterApproximately 1 million cases of herpes zoster are diagnosed in the United States every year. Here, a refresher on the virus and a good look at the rash.
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A man with cough and dyspneaThe case presented here illustratesthe diagnostic challengesand potential severity of a fungalinfection.
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Prophylactic Oseltamivir for Prevention of Nosocomial Influenza A Virus InfectionThe effectiveness of oseltamivir in preventing nosocomialinfluenza (influenza Avirus infection) during an influenzaepidemic was carried out in several wards of a universityhospital. Asurvey conducted during the 2005 influenza seasonidentified 30 staff members (nurses and doctors) and 3hospitalized patients who met the case definition for influenza.Adefinitive influenza diagnosis was made in 17 staff members(57%) and in 2 inpatients (66%) based on the results of a rapiddiagnostic test. Most of the 30 symptomatic staff membershad been vaccinated for influenza. Symptomatic staff memberswere sent home for 1 week, and the infected inpatients wereisolated. Oseltamivir (75 mg/d for 5 days) was administered to99 staff members and 2 inpatients who had close contact withthe infected patients. Although a relatively large number of thestaff had an influenza virus infection, the use of oseltamivirmay have effectively prevented a nosocomial outbreak.[Infect Med. 2008;25:49-50a]
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Prophylactic Oseltamivir for Prevention of Nosocomial Influenza A Virus InfectionThe effectiveness of oseltamivir in preventing nosocomialinfluenza (influenza Avirus infection) during an influenzaepidemic was carried out in several wards of a universityhospital. Asurvey conducted during the 2005 influenza seasonidentified 30 staff members (nurses and doctors) and 3hospitalized patients who met the case definition for influenza.Adefinitive influenza diagnosis was made in 17 staff members(57%) and in 2 inpatients (66%) based on the results of a rapiddiagnostic test. Most of the 30 symptomatic staff membershad been vaccinated for influenza. Symptomatic staff memberswere sent home for 1 week, and the infected inpatients wereisolated. Oseltamivir (75 mg/d for 5 days) was administered to99 staff members and 2 inpatients who had close contact withthe infected patients. Although a relatively large number of thestaff had an influenza virus infection, the use of oseltamivirmay have effectively prevented a nosocomial outbreak.[Infect Med. 2008;25:49-50a]
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Medical Marijuana: Regulations Surrounding Its UseDisparate means of accessing marijuana complicates the evaluation of the quality, purity, and potency of cannabis.
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Worsening Neurological Symptoms in an Older Man With History of Rectal CancerA 65-year-old man, who was lost to follow-up after abdominal-perineal resection for rectal adenocarcinoma 9 months earlier, presents with progressively worsening neurological symptoms, including bilateral hearing loss, dizziness, gait disturbance, ataxia, and blindness in the right eye.
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What is causing this woman’s dry cough?A 39-year-old woman presented with dry cough, which she had had for 3 months. She had mild intermittent asthma and a 5 pack-year smoking history. Her symptoms started after an upper respiratory tract infection and persisted despite multiple courses of antibiotics, decongestants, and corticosteroids.
