September 3rd 2024
The updated COVID-19 vaccine targets the currently circulating Omicron variant JN.1 strain of SARS-CoV-2.
Anaphylaxis: 36 Commonsense Ways to Reduce the Risk
August 3rd 2009In 2000, the World Allergy Organization (WAO) published a consensus definition of anaphylaxis as a severe, life-threatening generalized or systemic hypersensitivity reaction. The reaction is caused by the release of bioactive mediators from mast cells and basophils.
Neurological Complications in Children With H1N1 Influenza
July 25th 2009When you encounter unexplained seizures or mental status changes in children who have influenza-like illness, send respiratory specimens for diagnostic testing and promptly start empirical antiviral therapy, especially in hospitalized patients.
Skin Disorders in Older Adults: Vascular, Lymphatic, and Purpuric Dermatitides, Part 2
July 10th 2009All elements of the skin are affected by age. In this 2-part article, I discuss how the blood vessels, the lymphatics, and the ground substance- which surrounds these vessels- respond to age, and I show how the aging elements of the vasculature can engender a variety of pathological cutaneous conditions.
Preparing for the Worst When the Fall Flu Season Arrives
July 10th 2009Federal health officials stressed the need to start planning now for the fall influenza season when they met with state delegates at the H1N1 Influenza Preparedness Summit. "Over the course of coming weeks and months, we will move aggressively to prepare the nation for the possibility of a more severe outbreak of the H1N1 virus," said Secretary of Health and Human Services Kathleen Sebelius.
Acute Rhabdomyolysis From Dermatomyositis
July 9th 2009For 2 weeks, a 52-year-old man had progressive fatigue and myalgias. On the morning of presentation, he could not walk. He took no medications but reported chronic, intermittent use of alcohol, intranasal cocaine, and marijuana. He had ingested alcohol 2 weeks earlier and had used cocaine 3 days earlier. Vital signs were normal. The patient had bilateral upper and lower extremity weakness. The proximal muscle groups were affected to a greater degree, with 2/5 strength in the shoulder and hip girdles bilaterally compared with 4/5 strength distally. He had significant difficulty in raising himself to a seated position and when attempting to stand. Results of a complete blood cell count and basic chemistry panel were normal. Serum creatine kinase (CK) was mildly elevated at 9030 U/L. Urinalysis showed 3+ blood, with coarse granular casts but no red blood cells.
Short Cut to Preventing Spread of MRSA
July 7th 2009I advise my patients who are carriers of methicillin-resistant Staphylococcus aureus (MRSA) to keep their fingernails trimmed. Long nails make the subungual spaces good havens for bacteria. S aureus, including MRSA, has been isolated from the subungual spaces of the hands of many at-risk patients who are MRSA carriers
Case 2: How would you treat this pruritic eruption that resists topical corticosteroids?
July 6th 2009For the past year, a 15-year-old boy has had a pruritic eruption on his shins. His mother suspects that his soccer shin guards are the cause; however, he wears them over his socks. Topical corticosteroids have not been effective.
Novel H1N1 Influenza Continues to Spread in United States
June 30th 2009More than 1 million persons in the United States may have been infected with novel H1N1 (swine) influenza virus, according to US health officials. In a recent media briefing, Dr Anne Schuchat, Director of the National Center for Immunization and Respiratory Diseases, CDC, noted that the infection is continuing to spread well past the typical influenza season in the Northern Hemisphere.
100 Precepts for My House Staff: Part 2
June 10th 2009Sometimes we try to distill long experience into words, whether aphorisms or full paragraphs. Rilke’s wonderful prose poem expresses this very well in the part that begins, “For the sake of a single verse, one must see many cities, men and things. . . . ” While medicine has only some features in common with poetry, what reverberates is the wish to impart an affecting draught of beauty or wisdom or insight, in the case of poetry, after many years and decades of immersion in life; and I here offer some fruits of long observation and participation “hip deep” in clinical care and in the teaching of residents.
Herpes Simplex: Initial and Recurrent Infections
June 3rd 2009Herpes simplex virus (HSV) infections are caused by 2 types of HSV: type 1 (HSV-1) and type 2 (HSV-2). Most cases of HSV infection are caused by HSV-2. Most persons with HSV-1 or HSV-2 infection have no or only minimal signs or symptoms. When signs do occur, they usually appear as one or more small blisters or sores on or around the mouth, lips, nose, face, genitals, and buttocks. HSV infections are very contagious and are spread by direct contact with the skin lesions.
Case 2: Why haven’t these boils responded to antibiotics?
June 3rd 2009For the past 5 years, a 30-year-old woman has had boils on her groin. She has tried at least 3 different antibiotics over the years, but none of them have been effective. She is otherwise healthy; the only medication she takes regularly is an oral contraceptive.
Middle-aged Man Who Claims He Is Not a Drinker
June 3rd 2009A 41-year-old man is seen for routine physical examination. Apart from mildly elevated cholesterol 2 years ago and a bout of bacterial bronchitis last winter, he has been healthy. Says he has had “bad acne” since age 21. Has applied drying agents that worsened it and that sting; has “sensitive skin” problems from creams. Now prefers to ignore his facial skin.
Case 1: The patient suspects poison ivy caused this recurrent rash-do you agree?
June 3rd 2009A 49-year-old man has had intermittent eruptions of itchy blisters on both of his palms for the past 15 years. The lesions heal after 2 to 3 weeks and then occur again after 6 months. He suspects that they are caused by poison ivy, but he is unsure of where he would have been exposed to the plant.
Treating Sepsis: An Update on the Latest Therapies, Part 1
June 2nd 2009A milestone has been reached in the treatment of sepsis-the institution of protocolized management that starts in the emergency department. Early goal-directed therapy, with targeted fluid resuscitation and measures of oxygen delivery, has been shown to improve survival in patients with septic shock. Although initiating aggressive fluid resuscitation is the first priority, it is also essential to obtain cultures rapidly and infuse broad-spectrum antibiotics. Norepinephrine is a more potent vasoconstrictor than dopamine and may be more effective in treating hypotension in patients with septic shock. Vasopressin is an effective second-line agent. Treatment with recombinant human activated protein C at 24 µg/kg/h for 96 hours has been shown to reduce mortality in patients with sepsis; its benefit is greatest in the most acutely ill patients. (Infect Med. 2009;26):134-143)
Influenza: A Tale of Birds, Pigs, and Pandemics
May 13th 2009If Shakespeare were alive, he would urge caution regarding the “Ides of Influenza.” Recent publicity about global influenza, a result of both potential and real avian and swine flu epidemics, has led to a plethora of theories as well as alarm.
Older Man With Fever and Tender Rash
May 8th 2009For 1 week, a 77-year-old man had a fever and a tender, nonpruritic rash on both palms (Figure 1) and on the anterior aspect of both knees (Figure 2). Two weeks earlier, he had hives, which ameliorated after a 10-day course of cetirizine and a tapering course of prednisone. He also had headaches almost daily for the previous 6 to 8 weeks.
An Old Man With a Floppy Bottom
May 2nd 2009An 88-year-old man who had left hip repair after a fracture a few months earlier is now admitted to behavioral hospital because of implacable refusal to take medications, and because of poor food intake and ongoing refusal of rehabilitation. Ambulated with a walker before fracture but now barely ventures out of wheelchair even with rolling walker and therapist guidance.
Chronic Heart Failure:When to Consider Device Therapy
May 1st 2009In the United States, an estimated 5 million people have heart failure and about 550,000 new cases occur each year.1 The incidence is rising as more patients survive what were once fatal myocardial infarctions (MIs). Coronary artery disease (CAD) and hypertension are the most common causes of heart failure. The less frequent causes include diabetes; viral infections; valvular heart disease; drugs (eg, doxorubicin); and postpartum, alcoholic, and familial cardiomyopathies.2,3
What caused this intensely pruritic eruption?
May 1st 2009For 1 month, a 54-year-old woman has had an intensely pruritic eruption on her abdomen, arms, and anterior thighs. She has long-standing hypertension and type 2 diabetes mellitus, which are treated with an angiotensin-converting enzyme inhibitor/diuretic and an oral hypoglycemic agent.
Is this scaly rash a drug reaction-or something else?
May 1st 2009This worsening rash developed after a 40-year-old man was treated with amoxicillin for an upper respiratory tract infection. When the rash started, the amoxicillin was discontinued and azithromycin was prescribed; however, the rash has persisted. The patient has no history of allergies or rashes. He takes no other medications.