September 3rd 2024
The updated COVID-19 vaccine targets the currently circulating Omicron variant JN.1 strain of SARS-CoV-2.
Heparin-Induced Thrombocytopenia
April 1st 2005A 69-year-old woman was hospitalized with fever, chills, and nausea. Three weeks earlier, she had received a 2-week course of oral levofloxacin for pneumonia, which resolved. Her history included rheumatic heart disease; diabetes mellitus; depression; a hysterectomy; 2 mitral commissurotomies; nonrepairable mitral valve regurgitation, for which she received a St Jude Medical bileaflet valve; a left-sided cerebrovascular accident; and paroxysmal atrial fibrillation. Her medications included verapamil, furosemide, metoprolol, potassium chloride, metformin, nortriptyline, and warfarin. She denied tobacco and alcohol use.
Case In Point: Lone Atrial Fibrillation in a Young Man
March 2nd 2005A 23-year-old man presents to theemergency department (ED) withacute chest discomfort, which startedin the morning. He describes the discomfortas more akin to palpitationsthan to actual pain. The discomfortis midsternal, nonradiating, nonpleuritic,and associated with dyspnea; itis neither exertional nor positional.There is no viral prodrome.
Hidradenitis Suppurativa and Cystic Acne
March 1st 2005Painful cysts on the sternal and left axillary regions that had worsened over the past 3 weeks prompted a 42-year-old man to seek medical care. He reported that similar lesions in the same distribution first arose when he was 25 years old, and they recur each year. He denied having cystic acne in adolescence.
Hand Injuries, Part 3: Fractures, Dislocations, Nail Bed Trauma, and Bites
March 1st 2005ABSTRACT: To determine the stability of the injury, examine phalangeal and metacarpal fractures for intra-articular involvement. Suspect carpal bone fracture in any patient with wrist pain and tenderness; proper splinting is essential to prevent avascular necrosis of the bone, arthritis, and chronic disability. After successful reduction of a distal or proximal interphalangeal joint dislocation, order follow-up x-ray films. Apply stress testing of the joint space to all injured joints to ensure ligamentous integrity. Carpal and carpometacarpal dislocations require immediate consultation with a hand specialist. Therapy for bite wounds includes copious irrigation, debridement (in the operating room if necessary), and antibiotic prophylaxis. A patient with an infected bite wound requires hospitalization and intravenous antibiotics.
Eye on Ocular Disorders: Isolated Abducent Nerve Palsy
February 2nd 2005A 65-year-old woman presented withdouble vision of 2 days’ duration.The diplopia mainly occurred whenshe looked toward her right. She deniednausea, vomiting, vision loss,headache, change in mental status,facial pain, weakness in the extremities,and sinus infection. She had nohistory of head trauma or systemicmalignancy.
Nummular Eczema: Don't Mistake it for a Fungal Infection
February 1st 2005The multiple, uniformly scaly, coin-shaped, papulosquamous lesions shown here on the lower leg of a 61-year-old man had persisted for 3 months despite application of topical clotrimazole and 1% hydrocortisone. The rash involved only the legs and was variably pruritic. The patient had a long history of dry skin.
Oral Herpesvirus Infection With Impetigo Bullosa
February 1st 2005For 3 days, a 5-month-old infant had a red, papular, nonpruritic rash around her mouth and vesicles on her hands. The child was being breast-fed by her mother, who had a similar rash around her nipple. The child was afebrile, and the physical examination revealed no abnormal findings. There was no history of allergy or change in diet.
Fever With Bacteremia in Children:
February 1st 2005ABSTRACT: Occult bacteremia now occurs in only 1 of 200 children who present with acute fever (temperature of 39°C [102.2°F] or higher) and white blood cell counts of 15,000/µL or more. The most likely cause of bacteremia remains Streptococcus pneumoniae; when there is no evidence of toxicity, such bacteremia is generally a benign, self-limited event. Because of the extremely low yield, blood cultures are no longer routinely warranted in children aged 3 to 36 months who have no obvious source of infection, and empiric treatment of occult bacteremia is no longer appropriate. Almost all cases will spontaneously resolve with a low rate of subsequent focal infection. If a child remains febrile and worsens clinically, further diagnostic evaluation and possible empiric treatment with antibiotics pending results of cultures may be considered.
Are Flu Shots Safe for Patients With a History of Guillain-Barré Syndrome?
February 1st 2005A 51-year-old patient asked me whether she should receive the influenza vaccine. She was last vaccinated in 1976; symptoms that resemble Guillain-Barré syndrome developed shortly afterwards. She has not received the vaccine since then; however, because she teaches schoolchildren, she wondered whether she should be vaccinated.
Dyslipidemia: Data From Clinical Trials
January 1st 2005ABSTRACT: A host of evidence supports the treatment of high levels of low-density lipoprotein (LDL) cholesterol with HMG-CoA reductase inhibitors (statins), which are effective in both primary and secondary prevention of coronary heart disease (CHD). Studies have shown that statins prevent first cardiac events in otherwise healthy persons with elevated LDL cholesterol and low high-density lipoprotein cholesterol levels. Statins are also associated with a reduction in cardiac death, stroke, hospitalization, and the need for revascularization in patients with established CHD and hyperlipidemia. Secondary prevention trials of statin therapy that included persons aged 65 to 75 years found significant risk reduction in this age group. Among the concerns associated with statin treatment are lack of proper titration, failure to achieve LDL target goals, and underuse in patients with established CHD.
What You Forgot About the Neurologic Exam, Part 2:
January 1st 2005ABSTRACT: 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.