July 17th 2025
Merck has launched phase 3 trials for MK-8527, a promising once-monthly HIV prevention pill, aiming to enhance PrEP options globally.
Woman With Abdominal Pain, Ascites, And Dyspnea
March 2nd 2006A34-year-old woman presents to the emergency department(ED) with rapidly progressive dyspnea.The patient has a history of metastatic vaginal clearcell adenocarcinoma secondary to diethylstilbestrol exposurein utero. Following her diagnosis in 1990, she wastreated with surgery, chemotherapy, and radiation. Shehad done well for years until a recurrence of the cancer tothe left lung was found last year. She completed a courseof chemotherapy with doxorubicin hydrochloride andcisplatin 1 month ago.
Severe Migraine: Options for Acute Therapy in the Emergency Department
March 2nd 2006A 36-year-old man with a 15-year history of episodic migraine presents to the emergency department (ED) at 5 AM witha right-sided throbbing headache of 4 hours' duration. The headache awakened him, which is typical of his more severemigraine attacks. Unfortunately, the patient forgot to refill his prescription for pain medication and did not "catch" thisheadache in time. He took an over-the-counter combination of aspirin and caffeine, which seemed to help for about 60minutes, but the headache has returned full force. He has vomited twice-another characteristic typical of his migraineattacks
Nevirapine Use Led to Stevens-Johnson Syndrome
March 2nd 2006A 47-year-old woman who wasseropositive for HIV-1 presented tothe emergency department with severemaculopapular, erythematouseruptions. Her antiviral regimen hadrecently been changed from zidovudine,300 mg bid; lamivudine, 150 mgbid; and saquinavir, 600 mg tid, tolamivudine, 150 mg bid; stavudine, 40mg bid; and nevirapine, 200 mg/d.
What's Biting Methamphetamine Users?
March 1st 2006The patient might havebeen exhibiting a phenomenon sometimes seen in methamphetamine users that isreferred to as "crank bug bites." Patients claim to see and/or feel bugs on theirbody and attempt to remove them or pick at them until they create open woundsand scabs.
Ricin and Staphylococcal Enterotoxin B: Potential Biologic Weapons
March 1st 2006In 1978, a ricin-filled pellet-which was injected with aspring-loaded device disguised in an umbrella-wasused to assassinate Bulgarian defector Georgi Markov.A similar device was employed unsuccessfully against asecond defector in the same year.1
Seizures: Medical Causes and Management and Modern Therapeutics in Rheumatic Diseases
March 1st 2006Seizures are among the most common neurologic conditionsencountered in the primary care setting. However, they havereceived scant attention in standard textbooks and in themedical literature generally-perhaps because the topic cutsacross so many specialties. Here, an international team ofexperts fills this void with a comprehensive discussion of thecauses and management of seizures associated with a widevariety of medical problems-including organ failure,organ transplantation, electrolyte imbalance, endocrine disorders,cardiorespiratory disorders, cancer, fever and systemicinfection, medication, alcohol, illicit drug use, andenvironmental toxins. Chapters cover the various types ofseizures and their pathophysiology, how to distinguishseizure from syncope, seizures in the ICU, and the use ofanticonvulsants.
Liver Enzyme Abnormalities:What to Do for the Patient
March 1st 2006You routinely order laboratory screeningpanels, including serum liver enzymemeasurements, for nearly everypatient who has a complete physicalexamination or who is seen for any ofa host of other complaints. If you findabnormal liver enzyme levels, your familiaritywith the common causes andthe settings in which they occur mayenable you to avoid costly diagnosticstudies or biopsy.
Warfarin Interactions: Update on the Most Common and Clinically Significant
March 1st 2006Numerous factors, includingother drugs, diseases,and diet, affectthe response to warfarin.Some of these factorsdecrease the response and maylead to therapeutic failure; othersenhance the response and may resultin life-threatening bleeding.
Understanding the basics of rigid bronchoscopy
March 1st 2006Abstract: In the assessment of central airway obstruction and disease, no imaging technique is an adequate substitute for bronchoscopy. The indications for rigid bronchoscopy include multiple malignant and benign disorders, with most interventions performed for treatment of complications of lung cancer. The rigid bronchoscope is a useful tool for managing most types of airway stenoses, and it facilitates other endobronchial therapies, including stent placement, argon plasma coagulation, balloon dilatation, electrocautery probes, and laser therapy. Certain patients with benign lesions or postintubation or post-tracheostomy stenosis may benefit from rigid bronchoscopic techniques instead of surgery. Although use of the rigid bronchoscope requires general anesthesia, it provides a stable airway and often results in fast removal of foreign bodies. (J Respir Dis. 2006;27(3):100-113)
Chest Film Clinic: What caused this man's miliary lung nodules?
March 1st 2006A 37-year-old man presented withnew-onset fever and abdominal painof several days’ duration. No respiratorysymptoms were reported.The patient had a history of multiplestab wounds to the abdomenand back, resulting in chronic backpain and a neurogenic bladder.During a previous hospital admission,he was treated for Enterobacterpyelonephritis with intravenousgentamicin for 12 days.
When to suspect allergic bronchopulmonary aspergillosis
March 1st 2006Abstract: Inhalation of Aspergillus is responsible for a variety of lung infections and diseases; Aspergillus fumigatus is the most common causative agent. Allergic bronchopulmonary aspergillosis (ABPA), caused by sensitivity to A fumigatus, is diagnosed primarily in persons with asthma or cystic fibrosis. Differentiating ABPA from other Aspergillus-related lung infections and diseases is often challenging. A patient's symptoms, underlying risk factors, and any prior pulmonary disease contribute to the diagnosis. Findings include pulmonary infiltrates, total serum IgE levels greater than 1000 IU/mL, IgE and IgA anti-A fumigatus antibodies, peripheral blood and pulmonary eosinophilia, and central bronchiectasis. Untreated ABPA often results in chronic bronchiectasis, pulmonary fibrosis, and dependence on corticosteroids; an accurate diagnosis of ABPA is critical to avoiding irreparable disease. (J Respir Dis. 2006;27(3):123-134)
Clinical Consultation: Distinguishing sinus headache from migraine
March 1st 2006This is a difficult question, because most "sinus headaches" are migraines.1-3 In fact, there is no such thing as a sinus headache. The International Headache Society (IHS) defines a headache attributable to rhinosinusitis according to the criteria listed in Table 1.4 This requires a diagnosis of acute rhinosinusitis and a headache that occurs at the same time.
Photo Finish: Acute Dx: What Cause of Sudden Illness?
March 1st 2006A 56-year-old man presents with diffuse erythema. He has not changed his routine or eaten anything unusual. The rash initially appeared the previous night as asymptomatic erythema on the face and body. On awakening in the morning, the patient noticed that the erythema had spread over most of his body and had become pruritic. Over-the-counter diphenhydramine did not relieve the symptoms.
Residual Effect of Refractive Surgery
March 1st 2006During a basketball game, a 23-year-old soldier had been hit in the right eye with the ball. The eye was slightly red with copious lacrimation; vision was normal. Using a Wood lamp and fluorescein dye, MAJ Kenneth S. Brooks, APA-C, of Camp As Sayliyah, Doha, Qatar, examined the patient's eye for corneal abrasions and saw these results. Note the almost complete halo of dye, with gaps at the 6 o'clock and 11 o'clock positions on the iris. This curious phenomenon was baffling until the soldier was asked about recent eye surgeries; he answered that he had undergone photorefractive keratectomy (PRK) several months earlier.
Hypothyroidism and Fibromyalgia
March 1st 2006Monday morning your nurse hands you charts for 4 new patients. Each patient is a woman with widespread body pain, stiffness, and fatigue. All have already been evaluated by another physician and were advised that they should reduce stress and practice distraction techniques. They are in your office today seeking a second opinion.
Apparently Healthy Man With History of Injection Drug Use: The Initial Approach
February 2nd 2006A 45-year-old man comes to see you for a routine physical.He has no complaints and no significant medical history.However, while questioning him you discover that he usedintravenous heroin until about 10 years ago-and sometimesshared needles. He also drank 6 or more beers a day for about 20 years, a practicehe stopped at the same time that he quit using illicit drugs. He has multiple tattoos,which were done at commercial parlors. He is married but has no children. His wife hasno history of hepatitis. Physical examination is unremarkable.
Cutaneous Conundrums, Dermatologic Disguises
February 2nd 2006A nonhealing ulcer recently developedin a painful facial rash that hadworsened over several months. The44-year-old patient is a heavy drinkerwith a history of elevated liver functionlevels. She has had numerousunprotected sexual contacts over theyears.
Hereditary Hemochromatosis: Early Detection of a Common Yet Elusive Disease
February 1st 2006Although widely regarded as a raredisorder, hereditary hemochromatosisis the most common genetic disease inCaucasians. In certain populations ofnorthern European descent, 1 of every200 persons is homozygous for thecausative mutation.1
Community-acquired pneumonia: An update on therapy
February 1st 2006Abstract: In the assessment of community-acquired pneumonia, an effort should be made to identify the causal pathogen, since this may permit more focused treatment. However, diagnostic testing should not delay appropriate empiric therapy. The selection of empiric therapy can be guided by a patient stratification system that is based on the severity of illness and underlying risk factors for specific pathogens. For example, outpatients who do not have underlying cardiopulmonary disease or other risk factors can be given azithromycin, clarithromycin, or doxycycline. Higher-risk outpatients should be given a ß-lactam antibiotic plus azithromycin, clarithromycin, or doxycycline, or monotherapy with a fluoroquinolone. If the patient fails to respond to therapy, it may be necessary to do bronchoscopy; CT of the chest; or serologic testing for Legionella species, Mycoplasma pneumoniae, viruses, or other pathogens. (J Respir Dis. 2006;27(2):54-67)