April 2nd 2025
A mail campaign targeting adults with chronic conditions as well as their GPs increased the number receiving at least 1 shot by 9.5 percentage points.
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.
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.