June 24th 2024
ADA 2024. Adults with OSA and obesity receiving tirzepatide had improvements in sleep apnea severity and systolic blood pressure compared to placebo.
Acute Low Back Pain in Children:
December 1st 2002ABSTRACT: Unless the cause of back pain is obvious, order anteroposterior and lateral radiographs of the spine, a complete blood cell count, erythrocyte sedimentation rate, and urinalysis. If you suspect infection, tumor, or bony abnormalities, obtain an MRI or CT scan. MRI has surpassed bone scanning as the gold standard for diagnosing spinal infections, because it confirms a specific anatomic diagnosis. Spondylolysis and spondylolisthesis are 2 of the most common causes of back pain in adolescents; the diagnosis is made with plain radiographs, which show slippage on the later-al view in patients with spondylolisthesis and fracture through the pars interarticularis on the oblique views in those with spondylolysis.
Travel Risks: Update on Traveler's Diarrhea and Other Common Problems
December 1st 2002ABSTRACT: Patients can greatly reduce the risk of traveler's diarrhea by drinking only bottled water and eating only hot foods prepared in sanitary conditions or peelable fruits and vegetables. Antibiotic prophylaxis for traveler's diarrhea is no longer routinely recommended; reserve it for patients who may have to consume food and beverages of questionable safety, those with reduced immunity, and those likely to experience serious consequences of illness. Adequate hydration is the first step in treating traveler's diarrhea. Drug therapy-loperamide or fluoroquinolones in adults and bismuth subsalicylate or azithromycin in children-can ameliorate symptoms and speed recovery. Recommend that patients who are prone to motion sickness take an antiemetic/antivertigo agent before symptoms begin. Acetazolamide can be used both to prevent and to treat altitude sickness. Contraindications to air travel include a resting oxygen saturation of less than 90%, pregnancy of more than 36 weeks' duration, pneumothorax, recent myocardial infarction or chest or abdominal surgery, active infectious diseases, and poorly controlled seizures or sickle cell anemia.
Tension and Cervicogenic Headaches:
October 1st 2002ABSTRACT: A thorough history and physical examination can establish the diagnosis of tension headache; further evaluation is generally unnecessary. In contrast, the workup of cervicogenic headache includes standard radiographs, 3-dimensional CT, MRI, and possibly electromyography; nerve blocks may also be used to confirm the diagnosis. Episodic tension headache can be treated effectively by trigger avoidance, behavioral modalities, and structured use of analgesics. Reserve opioids for patients with intractable headaches. Chronic tension headache is treated primarily by prophylactic measures, such as antidepressants and anticonvulsants, and behavioral and physical therapy. Treatment options for cervicogenic headache include analgesics; invasive procedures, such as trigger point injections, greater or lesser occipital nerve blocks, facet joint blocks, segmental nerve root blocks, and diskography; spinal manipulation; and behavioral approaches.
Strategies to Control Pain in Older Persons: Highlights of Recent Guidelines
September 15th 2002Persistent pain is common in older adults but tends to be underrecognized and undertreated. Up to 50% of community-dwelling older persons have significant painand up to 80% of nursing home residents have substantial pain that is undertreated.
Dermatitis on the Hands and Chest
September 1st 2002A 12-year-old boy with a history of atopy complained of pruritus and severe dryness of the hands. Over-the-counter moisturizers failed to resolve the condition. The patient did not wash his hands frequently and had no hobbies that exposed him to environmental irritants or allergens.
Two Cases of Pruritic Urticarial Papules and Plaques of Pregnancy
September 1st 2002Approximately 2 weeks earlier, a pruritic,papular eruption had developed overthe abdomen of a 33-year-old womanwho was 34 weeks' pregnant. Therash was confined mainly to the striaedistensae (Figure 3). Because thesite was severely pruritic, the patientwas unable to sleep. Based on theclinical presentation, pruritic urticarialpapules and plaques of pregnancy(PUPPP) was diagnosed.
Antihypertensive Treatment: How to Maximize Results for Your Patients
July 1st 2002Q:Many of my patients appear to have white-coathypertension: their pressure is elevated whenmeasured in my office-but normal when measured athome. Am I ignoring significant hypertension if I do nottreat these patients? Or am I overtreating if I do treat?