September 11th 2025
Merck's CAPVAXIVE could cover approximately 78% of invasive pneumococcal disease cases in youth with chronic health conditions, vs other approved pneumococcal conjugate vaccines.
The keys to diagnosing interstitial lung disease: Part 2
October 1st 2005Abstract: Many patients with sarcoidosis are asymptomatic at presentation and have bilateral hilar adenopathy on a chest radiograph obtained for other reasons. Symptomatic patients usually present with chronic cough, dyspnea, or noncardiac chest pain. Extrapulmonary organ involvement is not uncommon. Lung biopsy shows well-formed noncaseating granulomas in a bronchovascular distribution. Interstitial lung disease also may result from collagen vascular disease, such as systemic lupus erythematosus and Sjögren syndrome. In patients with acute hypersensitivity pneumonitis, cough, dyspnea, and flu-like symptoms occur within 12 hours of exposure to the inciting antigen, such as pigeon stool or moldy hay. Some patients have a subacute or chronic course, probably as a result of continued exposure to the offending antigen. In acute hypersensitivity pneumonitis, the chest radiograph may show diffuse small nodules, whereas in chronic disease, reticular lines or fibrosis may be seen. (J Respir Dis. 2005;26(10):443-448)
Clearing up chronic rhinosinusitis: Practical steps to take
October 1st 2005Abstract: Chronic rhinosinusitis can be caused or aggravated by a number of factors, including bacterial, viral, and fungal infections; asthma; allergies; and obstruction caused by nasal polyps or a deviated nasal septum. The diagnosis can usually be established clinically. Imaging studies are not routinely necessary, but a CT scan of the sinuses should be obtained if the patient has significant ocular or orbital symptoms or if sinus surgery is planned. Treatment consists of antibiotics, with consideration of a change in the regimen if the patient has already received a full course of a first-line agent. The course of treatment may need to extend to 4 weeks. Also consider adjunctive therapy, such as intranasal corticosteroids and decongestants. Patients who have allergic rhinitis may also benefit from an antihistamine and/or a leukotriene modifier. Sinus surgery is reserved for patients who do not respond to medical therapy. (J Respir Dis. 2005;26(10):415-422)
Clinical Update: Influenza 2005-2006: Are you prepared?
October 1st 2005Influenza vaccinationcontinues to be the primarymethod of preventinginfluenza and its lifethreateningcomplications.In preparation forthis year’s influenza season,the Advisory Committeeon ImmunizationPractices (ACIP) has publishedits recommendationsfor the preventionand control of influenza.1
Young Woman With Headache Several Days After Lumbar Puncture
October 1st 2005A 24-year-old woman complains of a severe, throbbing headache that is present when she is upright and is relieved when she lies down. When she is upright, she also experiences dizziness, blurred vision, light sensitivity, nausea, and occasional diplopia.
Man With Prosthetic Valve Who Needs GI Surgery
October 1st 2005A 68-year-old man with a prosthetic mitral valve presents to the emergency department with acute abdominal pain, nausea, vomiting, and constipation. Surgical evaluation is performed; the results suggest a complete bowel obstruction. Urgent celiotomy is recommended.
Girl With Mildly Pruritic Maculopapular Rash
September 15th 2005A 10-year-old girl has had a worsening rash for 1 week. The mildly pruritic, nontender eruption initially appeared on the child's thighs and then spread to the arms and face. The child's right hand, feet, and ankles have been swollen for the past 4 days, which has made ambulation intermittently painful.
Pneumococcal Pneumonia Presenting as New-Onset Seizure
September 14th 2005A febrile 65-year-old woman who had suffered a new-onset seizure was brought to the emergency department. The patient-a cigarette smoker-was not coughing and had neither chest pain nor a significant medical history. Her temperature was 39.4°C (103°F). She had nuchal rigidity and Kernig's and Brudzinski's signs of meningeal irritation. Lung auscultation revealed signs of right middle lung consolidation. Her white blood cell count was 1,200/µL. A chest film, seen here, showed a masslike density in the right midlung.
Psoriatic Arthritis in Hands and Fingers of a 38-Year-Old Woman
September 14th 2005A 38-year-old woman had become increasingly depressed by worsening psoriasis in conjunction with a flare of arthritis in her hands and fingers. The patient complained that she could not function optimally and that her quality of life had diminished.