July 1st 2025
As authorities record data on the largest US measles outbreak in decades, 79% of Americans support school vaccine mandates for children, an encouraging result.
Man With Persistent Diarrhea and Occasional Bloody Stools
January 1st 2007A thin 26-year-old man has hadintermittent diarrhea with abdominalpain, nausea, vomiting, and occasionalepisodes of hematochezia for8 months. He also complains of weaknessand fatigue and has lost 4.5 kg(10 lb) in the past year. The patientis homosexual and admits to havinghad unprotected sexual intercourse.He denies any significant travelhistory.
A Photo Quiz to Hone Dermatologic Skills
January 1st 2007A 51-year-old woman has had a progressiverash on the trunk, proximalarms, and legs for 2 weeks, followingthe latest round of chemotherapy forbreast cancer. Around the time thatthe rash erupted, she was also takinglevofloxacin for a productive cough.Cutaneous lupus erythematosus wasdiagnosed years ago, but she hasbeen disease-free for the past 5 years.Chemotherapy is being withheldpending diagnosis of the rash.
Respiratory Tract Infection: Ketek Now FDA-Approved
January 1st 2007Telithromycin (Ketek) from AventisPharmaceuticals Inc., is now availableto treat acute exacerbations of chronicbronchitis, acute bacterial sinusitis,and mild to moderately severe community-acquired RTI-includingthose caused by multidrug-resistantStreptococcus pneumoniae. Telithromycin,the first available ketolide, selectivelytargets common respiratorybacteria without significant effects onbacteria not normally associated withRTIs.
Traveler’s Diarrhea: Xifaxan Now FDA-Approved
January 1st 2007The FDA has approved rifaximin(Xifaxan), from Salix Pharmaceuticals,Inc., for treatment of traveler’sdiarrhea caused by noninvasive strains of Escherichia coli. Rifaximinis a nonsystemic, GI-selective, oralantibiotic; the recommended dosageis 200 mg tid for 3 days.
Acute Otitis Media: Update on Diagnosis and Antibiotic Choices
January 1st 2007Among American children,acute otitis media(AOM) is the most commonbacterial infectiontreated with antibiotics.Rising rates of antibacterial resistancecoupled with the increasingcost of antibiotics have focused attentionon the need to prescribethese agents judiciously. Recently,the American Academy of Pediatricsissued recommendations on the diagnosisand management of uncomplicatedAOM in children aged 2months to 12 years.1 These guidelinesapply only to otherwise healthychildren who have no underlyingconditions that may alter the naturalcourse of AOM, such as cleft palate,Down syndrome, immunodeficiencies,or the presence of cochlear implants.Also excluded are childrenwho have recurrent AOM or AOMwith underlying chronic otitis mediawith effusion (OME). Highlights ofthe guidelines are presented here.
Intestinal Parasites: Tindamax Now FDA-Approved
January 1st 2007Tinidazole (Tindamax), from PresuttiLaboratories, Inc., has been approvedfor treatment of trichomoniasis, giardiasis,intestinal amebiasis, and amebicliver abscess. A single 2-g doseis recommended for patients with trichomoniasisor giardiasis; in amebicdysentery, the recommended dosageis 2 g/d for 3 days. Patients with amebicabscess from amebic hepatitis require2 g/d for 3 to 5 days.
Preventing and Treating Influenza
January 1st 2007abstract: The keystone of influenza prevention is still vaccination. The 2 available types of influenza vaccine--the inactivated vaccine, which is administered intramuscularly, and the attenuated vaccine, which is delivered via nasal spray--have efficacy rates of 70% to 80%. Unfortunately, only about 65% of persons who should receive the influenza vaccine are, in fact, vaccinated. The neuraminidase inhibitors oseltamivir and zanamivir are 70% to 90% effective in preventing influenza. These antivirals also are effective in reducing the severity of influenza symptoms and the duration of illness when administered within 48 hours of the onset of clinical disease. Some patients have difficulty in self-administering zanamivir because the inhalation process is fairly complicated. Because of the resistance pattern observed in 2005, amantadine and rimantadine are not currently recommended for prophylaxis or therapy. (J Respir Dis. 2007;28(1):21-29)
Trigger Point Injections:What to Expect
January 1st 2007What Are Trigger Points?Tender areas, swellings, or knots under the skin are referred to as“trigger points.” Injection of these trigger points with medication mayalleviate discomfort. At times you may feel pain in an area distant fromthe trigger point. Your doctor will feel the various muscle groups tolocate the trigger points and the most tender areas.
Preparing for Board (Re)Certification in Bite Size Pieces
January 1st 2007Every year thousands of physicians must take-andpass-an examination to become board certifiedin internal or family medicine. Thousands moremust pass a board recertification examination tomaintain their license to practice medicine-andsimilar exams are required of physician assistants andnurse practitioners. To pass a certification or recertificationexamination requires up-to-date and in-depth knowledgein at least a dozen areas of clinical medicine.
A Photo Quiz to Hone Dermatologic Skills
January 1st 2007A 35-year-old woman has a lifelong history of recurrent blisters on the handsand feet that heal without scarring. No other family members have this condition,and she has no children. She is visiting your office for the first time toseek new treatment options.
Diagnostic Images, Treatment Decisions
January 1st 2007Apreviously healthy 22-year-oldHawaiian man presents to theemergency department (ED) of a hospitalin California with a 3-day historyof fever and chills. He has also had aprogressively worsening, persistent,dull aching pain in the right upperquadrant of the abdomen for the pastweek. The pain is localized-with noaggravating or relieving factors-andis not related to meals. The patienthas had no nausea, vomiting, loss ofappetite, jaundice, abdominal distension,cough, chest pain, dyspnea,weight loss, or lymphadenopathy.
Tongue cellulitis in a Young Man
January 1st 2007A 22-year-old man hashad a swollen tongue for the past2 days. The swelling is not associatedwith trauma, recent illness, or medicationuse. The patient denies dysphagia,drooling, and shortness ofbreath but does have some difficultyin speaking because of the swelling.
A Photo Quiz to Hone Dermatologic Skills
January 1st 2007For several weeks, a 68-year-old man has had painful blisterson his hands that crusted as they healed. The patienthas diabetes mellitus, hypertension, and chronic renalfailure, for which he is undergoing hemodialysis. His longtermmedications include a hypoglycemic agent and adiuretic.
A Photo Quiz to Hone Dermatologic Skills
January 1st 2007Case 1: A 42-year-old woman presents for anevaluation of an acute pruritic eruptionthat began 2 days earlier on herface, trunk, and extremities. The lesionsresolve and recur at differentsites from one day to the next. Theoutbreak began after the patient ateChinese food the night before; shealso had a recent sinus infection. Shetakes vitamins and hormone replacementtherapy.
How to Boost the Accuracy of TB Testing in the Elderly
January 1st 2007It struck me when reading Dr Thomas Petty’s “PulmonaryQ&A” on when to treat latent tuberculosis (TB) infections(CONSULTANT, January 2003, page 48) that it is importantto remind clinicians how misleading tuberculin testingin the elderly can be if the 2-step testing procedure is notfollowed.
Woman With Chest Pain, Fever, and Cough
January 1st 2007A 62-year-old woman presents with severe, sharp pain in her right mid chestthat worsens when she breathes. The pain began the previous night, shortlyafter she had been awakened by a shaking chill, followed by the sensationof fever. She also has a relatively nonproductive cough of recent onset.