Jose Luis Mendez, MD


Obstructive sleep apnea syndrome, part 2: Reviewing the treatment choices

Abstract: The management options for persons with obstructive sleep apnea-hypopnea syndrome (OSAHS) include lifestyle changes, continuous positive airway pressure (CPAP), oral appliances, and surgery. Lifestyle modifications work best in persons with mild OSAHS and may include weight loss and cultivation of good sleep habits, such as not sleeping supine. Before initiating CPAP therapy, polysomnography is recommended to determine the best airway pressure for the patient. Although the benefits of CPAP have been well documented, compliance remains an issue; some difficulties may be alleviated through patient/partner education and close follow-up. Oral appliances, which work by mechanically enlarging or stabilizing the upper airway, are preferred by some patients; however, they are less effective than CPAP at reducing the apnea-hypopnea index. Surgical interventions to alleviate upper airway obstruction can be used in select patients. (J Respir Dis. 2006;27(5):222-227)

Jose R. Lopez-lizarraga, MD


Juvenile Dermatomyositis

The diagnosis of juvenile dermatomyositis can be challenging when proximal muscle weakness develops without characteristic skin manifestations. In this patient, rash appeared 2 months after the onset of muscle weakness. As a result, the initial diagnosis was viral myositis, which led to delayed therapy.

Josef Edrik Keith Bautista, MD


Scrotal Calcinosis in Normocalcemic Primary Hyperparathyroidism

A 32-year-old man with no significant medical history presents with multiple scrotal lesions that he claims have been present for 2 years. They are non-tender and he reports no overt symptoms. The full case, here.

Josefina L. Choe, DO


Child With Dysphagia, Fever, and Weight Loss

Child With Dysphagia, Fever, and Weight Loss

Joseph A. Lieberman Iii, MD, MPH


Unmasking Mental Health Disorders in Primary Care Practice

Primary care physicians treat the majority of patients in this country who have mental health disorders. But how well prepared are we for these patients when they present to our offices?

Joseph Franco, DO


Primary Pyomyositis

A 59-year-old woman presents with right-sided, nonradiating, “aching” chest pain that has been continuous and increasing in severity for the past 3 days. It began as a tightness that gradually became more painful; it is aggravated by palpation and movement and has not been relieved by acetaminophen.

Joseph P. Ornato, MD


Acute Coronary Syndromes: Treatment With Fibrinolytic and Antiplatelet Agents

ABSTRACT: The main therapeutic goals for patients who have an acute coronary syndrome are to reestablish normal epicardial flow and to increase distal myocardial perfusion. Fibrinolytic treatment with tissue plasminogen activator within 70 minutes of the onset of symptoms dramatically reduces the mortality rate from myocardial infarction. Other fibrinolytic agents include reteplase, which is given as a double bolus, and tenecteplase, which is given as a single bolus. In most hospitals, fibrinolytic therapy is more readily available than percutaneous transluminal coronary angioplasty (PTCA); however, PTCA may be the preferred approach if it is available within an hour and a half. Antiplatelet drugs, such as glycoprotein IIb/IIIa receptor antagonists, are used to improve distal myocardial perfusion. If follow-up coronary angiography is not available to assess whether epicardial blood flow and distal myocardial perfusion have been restored, a 12-lead ECG can provide valuable information. The resolution of ST-segment abnormalities is a marker for improved perfusion.

Joseph Piktel, MD


Hemolytic Disease of the Newborn

An 8-week-old boy is brought for evaluation of gradually worsening yellow skin discoloration of about 1 week's duration. His parents report that he has had constipation for the past several days; before that, he had green diarrhea and occasionally spit up after breast-feeding.

Joseph R. Lo Faro, MD


Ruptured Abdominal Aortic Aneurysm

An obese 61-year-old man with a history of heroin abuse was brought to the hospital after he had fallen onto his buttocks on a sidewalk. He was able to stand initially, but weakness and numb-ness in his legs rendered him suddenly unable to walk or prevent himself from voiding. He denied abdominal or back pain. His medical history included asthma, chronic obstructive pulmonary disease, and hypertension.

Joseph Swanson, PharmD


Dry Powder Inhalers: Teaching Correct Use to Maximize Benefit

Dry powder inhalers are used by millions of patients with asthma or chronic obstructive pulmonary disease. Although these devices are easier to use than metered-dose inhalers, errors still occur and drug efficacy may be reduced or lost.

Joseph Varon, MD


Considering the role of NPPV, PEEP, and other interventions Managing acute severe asthma: What therapies to try, part 2 key words: Asthma, Leukotriene modifiers, Mechanical ventilation

abstract: The mainstay of therapy for acute severe asthma includes ß2-agonists, anticholinergics, and corticosteroids. Other agents, such as leukotriene modifiers and magnesium sulfate, can be used in patients who have responded poorly to conventional therapy. Noninvasive positive pressure ventilation (NPPV) should be tried before intubation in alert, cooperative patients who have not improved with aggressive medical therapy. However, NPPV should not be attempted in patients who are rapidly deteriorating or in those who are somnolent or confused. Endotracheal intubation is recommended for airway protection or for patients who present with altered mental status or circulatory shock. Patients should be admitted to the ICU if they have difficulty in talking because of breathlessness, altered mental status, a forced expiratory volume in 1 second or peak expiratory flow rate of less than 25% of predicted, or a PaCO2 greater than 40 mm Hg after aggressive treatment in the emergency department. (J Respir Dis. 2007;28(3):113-117)

Joseph Zenel, MD


Young Boy With Acute Foot Pain

The most appropriate choice is B. The history andphysical findings suggest that the patient may have afracture or contusion of the foot from trauma. There areno systemic signs that suggest an underlying infectious,chronic inflammatory, or oncologic process. A plain x-rayfilm of the foot is necessary to seewhether a fracture is present andwhether immobilization will be necessary.In the absence of fever and localerythema, infection appears unlikely,and a CBC count is unwarranted.

Joshua S. Coren, DO, MBA


Double Aortic Arch in an Infant With Persistent Stridor

Double aortic arch-a vascular ring anomaly in which both embryonic aortic arches persist and encircle the trachea and esophagus-is rare.

Joyce Aycock, MD.


Late Infection of Ruptured Silicone Breast Implant for Breast Augmentation

A 66-year-old woman presented with a 2-day history of acute onset of redness, pain, and swelling of the right breast.

Joyce Frieden


Sometimes It Is Just a Cigar, But the Nicotine?

Nicotine amounts aren't constant among cigar brands Even smokers of the same brand may be exposed to varying doses of nicotine and other smoke constituents.

Juan Goez, MD


Acute Gouty Arthritis and Gouty Tophus

A 5-day history of pain and swelling in the right third finger (A) were the complaints of a 76-year-old man. A few days earlier, another physician had prescribed indomethacin, 25 mg tid, but it had not helped, and the patient believed that his condition had worsened. He had had an attack of gout 5 years before but had not been taking any maintenance medication. The distal interphalangeal (DIP) joint of the affected finger was now erythematous and tender, with chalky subcutaneous deposits. A diagnosis of acute gouty arthritis and gouty tophus was made.

Judd W. Moul, MD


PSA Recurrence of Prostate Cancer:

ABSTRACT: Prostate-specific antigen (PSA) recurrence is the most common form of advanced prostate cancer. Salvage therapies may be effective even among some high-risk men, although long-term cancer control data are limited. The natural history of PSA recurrence is long but variable. The postrecurrence PSA doubling time can identify men at high risk for progression and death. Early hormonal therapy, possibly via combined androgen blockade, may reduce the risk of progression and improve cancer-specific survival among men with high-risk recurrence. Men with low-risk recurrences likely receive minimal benefit from aggressive early hormonal therapy and may actually be harmed.

Judith Groch


M.D. Researchers Often Hit an NIH Funding Wall

WASHINGTON, D.C. -- The odds of getting an NIH grant are a lot better for Ph.D.s and M.D.s who also hold a Ph.D. than for physicians who have a medical degree alone, one study showed.

Judith A. O'Brien, RN


Economic Burden Associated With Parkinson Disease

The objective of this study was to estimate the annual cost burden of Parkinson disease (PD) in the United States. Resource use and cost profiles were developed using all-payer statewide hospital discharge data from 6 states; emergency department visit, long-term–care, and national survey data; fee schedules; and published study findings. (Average direct and indirect costs per patient were calculated in 2007 US dollars.) The annual cost per patient was $21,626 (direct cost: $12,491). When applied to the US PD population (N = 500,000), the annual average cost was approximately $10.78 billion (direct costs, $6.22 billion; indirect costs, $4.56 billion). PD has substantial economic consequences for patients and their families, insurers, and society. (Drug Benefit Trends. 2009;21:179-190)

Judith E. Soberman, MD


Serum Digoxin Concentrations: Do You Know the Current Upper Limit in Heart Failure?

For more than 30 years, serumdigoxin concentrations (SDCs)have been monitored toensure safe, effective therapy.1,2Although the therapeuticrange for SDCs is often listed as either0.8 to 2.0 ng/mL or 0.5 to 2.0ng/mL, the results of clinical trials inthe 1990s suggest an upper limit of1.0 ng/mL for treatment of heart failure.3-11 An upper limit for the SDC of1.0 ng/mL is also recommendedfor patients who have heart failureand atrial fibrillation with rapid ventricularresponse.

Julia Garcia-Diaz, MD, MS


What Is Causing This Patient’s Acute Left-Sided Weakness?

A 56-year-old woman with type 2 diabetes mellitus and hypertension presented with acute left-sided weakness and altered mental status, for which she was hospitalized. The patient, who was obese, was in her usual state of well-being until 2 months before this presentation, when she noted a gradual onset of generalized weakness. She received a diagnosis of severe hypokalemia that was refractory to oral potassium supplementation. The outpatient workup of the cause of her hypokalemia was in progress.

Julian L. Allen, MD


Pulmonary function testing: Applying techniques in infants

Abstract: As in adults and older children, pulmonary function testing in infants may help detect certain obstructive or restrictive diseases. However, different techniques and equipment must be used. The most commonly performed noninvasive tidal breathing test involves use of a face mask with a pneumotachograph; an alternative method is respiratory inductive plethysmography. Ratios derived from volume-time and flow-time tracings can help identify patients with obstructive lung disease, who have a shorter time to peak expiratory flow:expiratory time ratio than do healthy persons. Instead of spirometry, the rapid thoracic compression technique can be used to measure expiratory flow and construct a flow-volume curve. This method, which is performed with the patient under sedation, increases flow rates over tidal flow values and enhances the ability to detect abnormal airway function. (J Respir Dis. 2006;27(4):158-166)

Juliana Szakacs, MD


Case In Point: Massive, fatal hemoptysis in a patientwith AIDS and B-cell lymphoma

A 49-year-old man presented to theemergency department (ED) andcomplained of fever and cough thatproduced bloody sputum for 1 day.He had AIDS and recently receiveda diagnosis of large B-cell lymphoma.His most recent CD4+ cellcount was 24/µL. He had optedagainst receiving highly active antiretroviraltherapy and prophylaxisfor opportunistic infection.

Julie Bowen


Obesity Perceptions and Attitudes: A Quiz

Is there an attitude problem about obesity?

Julie Foont, MD


Managing the Patient With an Abnormal Liver Test: Part 1, Persistent Aminotransferase Elevations

Identifying the cause of a persistent, asymptomatic aminotransferase elevation can be challenging. The possible diagnoses are many and varied. To narrow the differential, begin with a detailed history.

Julie Hare, MD


A Woman With Delirium From Diabetic Ketoacidosis

Mucormycosis, an angioinvasive yeast infection of the Mucorales order of the class of Zygomycetes, often grows in patients with diabetes mellitus, especially in the presence of diabetic ketoacidosis.

Julie Joseph, MD


Pellagra I a 45-Year-Old Man

#onc_figure_border{ width: 175px; float:right; display:block;clear:right; border-left: 1px solid #a5a5a5; padding: 2px 0px 10px 10px; margin: 0px 0px 0px 10px;}

Juliette L. Wait, MD


Is Your Room an Asthma “Nightmare”?

If your bedroom or other rooms in your home look a lot like this one,you may be living in an asthma "nightmare"-an environment full ofpotential causes of asthma attacks.

Jumana Chalabi, MD


Recurrent Fever of Unknown Origin Responsive to Prednisone

There are no guidelines for the workup for classic FUO. Diagnostic modalities are guided by the spectrum of differentials as well as local prevalence of disease.

© 2023 MJH Life Sciences

All rights reserved.