September 3rd 2024
The updated COVID-19 vaccine targets the currently circulating Omicron variant JN.1 strain of SARS-CoV-2.
Primary HIV Infection: Why Early Detection Matters
June 1st 2005This case highlights the importance of detecting HIV infection in its earliest stages. Each year, 40,000 new cases of HIV infection are diagnosed in the United States; however, very few of these are identified at the acute infection stage. Diagnosis of primary HIV infection is important because it improves the patient's chances for a good outcome, reduces the risk of transmission, and provides epidemiologic data on virus strains in the community.
Recognizing the signs of bronchiolitis on HRCT
May 1st 2005Abstract: High-resolution CT (HRCT) can play an important role in the assessment of bronchiolitis. Direct signs of bronchiolitis include centrilobular nodules, bronchial wall thickening, and bronchiolectasis. Indirect signs include mosaic perfusion, hyperlucency, mosaic or diffuse airtrapping, vascular attenuation, and increased lung volumes. Expiratory HRCT scans are considered an essential part of the workup, because airtrapping may be evident only on these scans. In infectious cellular bronchiolitis, the centrilobular nodules typically have a branching, or "tree-in-bud," appearance, whereas in hypersensitivity pneumonitis, these nodules have a round or nonbranching pattern. The HRCT signs of constrictive bronchiolitis include mosaic perfusion, mosaic airtrapping, vascular attenuation, bronchiolectasis, and bronchiectasis; centrilobular nodules are usually absent. (J Respir Dis. 2005; 26(5):222-228)
Clinical Citations: Managing pneumonia: How good are the practice guidelines?
May 1st 2005Just how effective are the national guidelines for the management of community-acquired pneumonia (CAP)? Pretty good, according to Mortensen and associates. They found that compliance with practice guidelines, such as those published by the Infectious Diseases Society of America and the American Thoracic Society, is associated with a reduced mortality in patients with CAP.
Clinical Consultation: Intranasal antifungals for sinusitis
May 1st 2005CRS is the most common chronic disease in the United States, affecting 17.4% of adults, with an estimated direct cost of $5.6 billion yearly.1,2 There frequently is no definitive or quick cure. The clinical diagnosis of CRS is based on the presence and persistence of certain symptoms. The finding of mucosal thickening on coronal CT scan of the paranasal sinuses strengthens the clinical diagnosis.
Klippel-Trenaunay-Weber Syndrome
May 1st 2005The parents of this 2-year-old boy brought their son for evaluation of swelling of the right leg and excoriation and serosanguineous discharge from the ankle region of 3 days' duration.The child had had a hemangioma of the right ankle since birth. Subsequently, there was gradual spread of the lesion along the leg to the buttocks.
Life-threatening asthma, part 1: Identifying the risk factors
May 1st 2005Abstract: In most patients, a life-threatening exacerbation of asthma is preceded by a gradual worsening of symptoms. However, some patients have a sudden onset of worsening symptoms, and these patients are at increased risk for respiratory failure and death. Risk factors for near-fatal asthma include a history of a life-threatening exacerbation, hospitalization for asthma within the past year, delay in time to evaluation after the onset of symptoms, and a history of psychosocial problems. Regularly monitoring peak expiratory flow rate (PEFR) is particularly important because it can identify a subset of high-risk patients--specifically, those with large fluctuations in PEFR and those who have severe obstruction but minimal symptoms. Signs of life-threatening asthma include inability to lie supine, difficulty in speaking in full sentences, diaphoresis, sternocleidomastoid muscle retraction, tachycardia, and tachypnea. (J Respir Dis. 2005;26(5):201-207)
Environmental Asthma: 9 Questions Physicians Often Ask
May 1st 2005The prevalence of asthma in the United States is estimated to be 5% to 8%. Asthma is responsible for approximately 5000 deaths annually in this country. It is a leading cause of emergency department visits, hospitalizations, and school and work absenteeism. The total estimated direct cost of the disease in the United States was $12.7 billion in 1998.
Psoriasis in a 13-Year-Old Boy
April 15th 2005A 13-year-old boy presented with an explosive eruption of numerous, small, round, erythematous, itchy plaques on his lower back and lower limbs of 2 weeks' duration. Some of the lesions were scaly. His nails were normal. There was no evidence of arthritis or joint deformity. He had a sore throat a month before the onset of the rash but did not seek medical attention. He was not taking any medication and had no history of joint pain or family history of skin problems.
Right-Sided Pain and Rash in an Elderly Man
April 15th 2005An 80-year-old man complains of lancinating pain in his right axilla and chest that began 2 days earlier and has kept him awake at night. He has had no fever, cough, sputum production, dyspnea, or symptoms suggestive of congestive heart failure.
Rheumatoid Arthritis: Clues to Early Diagnosis
April 15th 2005Primary care physicians are usually the first to see patients with joint pain; consequently they represent the "front line" of RA care. This fact-coupled with the projection that the number of rheumatologists is expected to decline by 20% during the next 2 to 3 decades-underscores the pivotal role that primary care clinicians are now expected to play in the early diagnosis of RA.
When to obtain cultures from patients with community-acquired pneumonia
April 1st 2005Abstract: The use of sputum studies and blood cultures in patients hospitalized with community-acquired pneumonia (CAP) is somewhat controversial, and recommendations continue to evolve. A reasonable approach is to attempt to obtain sputum cultures from all patients before initiating antibiotic therapy. If antibiotics have already been given, sputum studies can be reserved for patients who are severely ill or who are at risk for infection with a resistant organism or an organism that is not covered by the usual empiric therapy. The Infectious Diseases Society of America and the American Thoracic Society both recommend obtaining blood cultures from all patients. However, cost considerations have led to alternative strategies, such as reserving blood cultures for those with severe CAP. (J Respir Dis. 2005;26(4):143-148)
Clinical Consultation: Could your patient's flu-like illness really be inhalation anthrax?
April 1st 2005In 2001, 11 US residents contracted inhalation anthrax as a result of the deliberate mailing of 4 letters containing anthrax spores. Five died as a result. Several of these patients presented to physicians before becoming fatally ill, but their illness was misdiagnosed as influenza.1
How to get your patient's allergic rhinitis under control
April 1st 2005Abstract: For some patients with allergic rhinitis, symptoms can be reduced substantially by the use of allergen avoidance measures. However, many patients require pharmacotherapy, including antihistamines, decongestants, and intranasal corticosteroids, to adequately control their symptoms. The oral antihistamines are effective in reducing rhinorrhea, itching, and sneezing but are not effective against nasal congestion. Intranasal azelastine has been shown to be beneficial in patients with moderate to severe symptoms that are not sufficiently controlled by an oral antihistamine. Additional therapies include intranasal ipratropium, which specifically targets rhinorrhea, and cromolyn, which can reduce many of the symptoms of allergic rhinitis and can be used prophylactically. (J Respir Dis. 2005;26(4):150-162)
Chest Film Clinic: What caused the progressive dyspnea and cough in this tennis player?
April 1st 2005A 38-year-old man presented to the emergency department (ED) with a 2-week history of worsening shortness of breath and dry cough. He also complained of anorexia, a 14-kg (30-lb) weight loss over 3 months, pleuritic chest pain, and night sweats.
What Do These Images Reveal?Knee pain in an adolescent soccer player
April 1st 2005A 13-year-old boy has had mild right knee pain for about 1 week; the pain was exacerbated by a collision and subsequent fall during soccer practice. He recently began playing soccer on a team that practices every weekday and has games on the weekends. He has played since his collision, but the knee pain has progressively worsened.
Tinea Corporis in an Immunocompromised Child
April 1st 2005Two ringed, extremely pruritic lesions were noted on a 6-year-old girl receiving immunosuppressive therapy after she had undergone heart transplantation. The mother reported that the lesion on the chin had appeared 7 to 10 days earlier and had gradually increased to the present size; she did not know when the lesion on the upper chest had appeared. The child had no other lesions. Her cousin had had similar findings about 2 to 3 weeks earlier.