Alfred A. Lardizabal, MD


Community-acquired pneumonia: An update on therapy

Abstract: In the assessment of community-acquired pneumonia, an effort should be made to identify the causal pathogen, since this may permit more focused treatment. However, diagnostic testing should not delay appropriate empiric therapy. The selection of empiric therapy can be guided by a patient stratification system that is based on the severity of illness and underlying risk factors for specific pathogens. For example, outpatients who do not have underlying cardiopulmonary disease or other risk factors can be given azithromycin, clarithromycin, or doxycycline. Higher-risk outpatients should be given a ß-lactam antibiotic plus azithromycin, clarithromycin, or doxycycline, or monotherapy with a fluoroquinolone. If the patient fails to respond to therapy, it may be necessary to do bronchoscopy; CT of the chest; or serologic testing for Legionella species, Mycoplasma pneumoniae, viruses, or other pathogens. (J Respir Dis. 2006;27(2):54-67)

Alfredo Pinto-rojas, MD


Infectious Mononucleosis

An 18-year-old man presented with a 3-day history of fever, sore throat, and neck swelling. He had previously been healthy, and his immunizations were up-to-date. There was no history of travel outside the country or of an animal bite or scratch.

Ali A. Sovari, MD


Acute Pancreatitis Secondary to Neuroendocrine Tumor

Right upper quadrant pain of 24 hours’ duration prompted a 20-year-old man with a history of gastritis to seek medical attention. The pain was sharp and nonradiating, with no alleviating or aggravating factors. The patient occasionally consumed alcohol and regularly smoked cigarettes (tobacco and marijuana). He denied nausea, vomiting, diarrhea, and diaphoresis. Right upper quadrant pain of 24 hours’ duration prompted a 20-year-old man with a history of gastritis to seek medical attention. The pain was sharp and nonradiating, with no alleviating or aggravating factors.

Ali Ahmadizadeh, MD


Unilateral Scleral Jaundice in an Elderly Man: An Odd Finding

Left scleral icterus is the only prominent physical finding in the 86-year-old who presented with transient aphasia, ataxia, and general asthenia. Can you dx?

Ali Esmaili, MD


Pulmonary involvement in a patient with lymphocytic colitis

Microscopic colitis is a noninfectiouscolitis that is characterizedby chronic nonbloodydiarrhea and macroscopicallynormal colonic mucosa. Extraintestinalmanifestationsare rarely seen. In this report,we describe a nonspecific interstitialpneumonitis in a patientwith lymphocytic colitis.

Ali S. Soueidan, MD


Benzocaine-induced methemoglobinemia in bronchoscopy

Benzocaine-induced methemoglobinemia has been a well-documented illness that is usually simple to cure but can be life-threatening if not recognized. As the use of "scope" procedures becomes more commonplace, the early recognition of hypoxemia resulting from methemoglobinemia is essential. The authors report a case of benzocaine-related methemoglobinemia following bronchoscopy.

Ali Saberi, MD


Catastrophic Antiphospholipid Syndrome in Secondary Syphilis

Catastrophic antiphospholipid syndrome (CAPS), first described by Asherson and colleagues1 in 1992, refers to a clinical scenario in which multiple vascular occlusive events involving small vessels that supply blood to organs occur over a short period.

Alice L. Fisher, MD


Chest Film Clinic: What caused progressive dyspneain this patient with chronic asthma?

A 51-year-old man with a 20-year history of asthma and seasonal allergies presented with low-grade fever, progressive dyspnea on exertion, and wheezing that had persisted for 2 weeks. Four days earlier, he had been seen by his primary care physician and had started levofloxacin therapy. However, his respiratory symptoms had worsened, warranting hospitalization. He also reported pain in the abdomen and left flank and pain and swelling in the right metacarpophalangeal and right shoulder joints.

Alicia Armstrong, MD


Abnormal Uterine Bleeding: A Primary Care Primer

Abnormal uterine bleeding can be defined as bleeding that deviates from the patient's normal pattern; it may be heavier, more frequent, or abnormal in timing. Bleeding of any kind in a postmenopausal patient should be considered abnormal unless she is receiving hormonal therapy that is associated with regular cyclic withdrawal bleeding.

Alina L. Popa, MD


Cutaneous Leukocytoclastic Vasculitis

This hypersensitivity reaction may be secondary to medications, infection, collagen-vascular disorders, or an occult malignancy. When it is localized to the skin, prognosis is excellent.

Alisa G. Woods, PhD


Beer Brews Up Good Medicine for the Brain

This adult beverage may actually provide health benefits, specifically for Alzheimer, Parkinson, and other neurological conditions.

Alissa Segal, PharmD


The 10 Most Common Prescribing Errors: Tips on Avoiding the Pitfalls

Numerous factors contribute to the medication errors that kill up to 98,000 patients each year. Unnecessarily high dosages can result in increased side effects with only a small therapeutic benefit, especially in elderly patients. Lack of patient information-such as a history of allergies or adverse drug reactions-is another cause of error and injury. Communication failures include the use of ambiguous abbreviations, misinterpretation of verbal orders, and lack of timely response to a patient's medication-related symptoms. Dosing errors are common in children because of variability in dosage expressions in drug references. Remedies for prescribing errors are described in detail here.

Aliyah Baluch, MD


A Rare Reversal of Clostridium perfringens Necrotizing Fasciitis

While currently receiving chemotherapy with mitoxantrone for Gleason grade 7 prostate cancer, a 64-year-old man presented with rectal bleeding.

Allen Frances, MD


We Have Too Many Specialists and Too Few General Practitioners

"Primary care docs should be paid more, specialists less. More reimbursement for talking...less for testing and procedures." And, there's more.

Allen J. Dozor, MD


A practical guide to managing asthma in children

Abstract: All children with asthma should have periodic office visits, usually every 3 to 6 months, in which asthma action plans are updated. Periodic assessment of lung function by peak expiratory flow or office spirometry can help determine the appropriate treatment strategy. Low daily doses of inhaled corticosteroids remain the first and most effective choice of therapy for persistent asthma. If this approach is inadequate, adding a second medication, such as a leukotriene modifier or a long-acting ß2-agonist, is suggested. Short-acting ß2-agonists remain the most important therapy for intermittent asthma. For most children, the best route is via a metered-dose inhaler with either a spacer or valved holding chamber. If these agents are inadequate, a short course of oral corticosteroids may be required. (J Respir Dis. 2005;26(8):348-358)

Allen L. Ginsberg, MD


Liver Enzyme Abnormalities:What to Do for the Patient

You routinely order laboratory screeningpanels, including serum liver enzymemeasurements, for nearly everypatient who has a complete physicalexamination or who is seen for any ofa host of other complaints. If you findabnormal liver enzyme levels, your familiaritywith the common causes andthe settings in which they occur mayenable you to avoid costly diagnosticstudies or biopsy.

Allen P. Kong, MD


Anorectal Complaints: Office Diagnosis and Treatment, Part 2

Anorectal abscesses and fistulae, pilonidal disease, rectal prolapse, pruritus ani, and anal masses are discussed, with an emphasis on diagnosis and treatment of these conditions in the primary care office setting.

Allison B. Ludwig, MD


Heart Disease and Syncope

Syncope is defined as a sudden, brief loss of consciousness and postural tone followed by spontaneous complete recovery. It accounts for 3% of emergency department visits and 1% of hospital admissions.

Allison Gilmore, MD


Congenital Clubfoot

This 3-month-old boy has an untreated right clubfoot deformity. The foot is stiff and uncorrectable. The vertical midfoot crease indicates significant deformity. An anteroposterior (AP) simulated weight-bearing radiograph shows parallelism of the long axis of the talus and calcaneus; this indicates varus alignment of the hindfoot. There is also forefoot adduction.

Alok Sachdeva, MD


Approved Treatments for Osteoporosis and What’s in the Pipeline

Along with the release of revised guidelines, several pharmacological therapies have become available or are under investigation to help improve outcomes in patients with osteoporosis.

Alok Vij, MD


Pearly Pink Chest Lesions

Can you identify the 2 slowly expanding growths on the chest of this 68-year-old man?

Alyce Oliver, PhD, MD


Approved Treatments for Osteoporosis and What’s in the Pipeline

Along with the release of revised guidelines, several pharmacological therapies have become available or are under investigation to help improve outcomes in patients with osteoporosis.

Alyson Penstein, MD


Eruptive Vellus Hair Cysts in a 4-year-Old Black Girl

Asymptomatic flesh-colored papules were noted on the chest of a healthy 4-year-old black girl. Some of the 1- to 2-mm papules had central, comedo-like crusts. The remainder of the skin was normal.

Amado Freire, MD


A case of pseudo-Meigs syndrome

We present a case of a 52-year oldwoman with exudativepleural effusion. Her workuprevealed an ovarian tumor,and the effusion completely resolvedafter resection of the tumor.Pathology revealed granulosacell tumor, which is anunusual cause of Meigs syndrome.This case shows theimportance of considering abdominopelvicpathology in unsolvedcases of pleural effusion.

Amanda M. Stahnke, PharmD


New Once-Weekly Exenatide for Type 2 Diabetes

Once-weekly exenatide, the recently approved GLP-1 receptor agonist, may help improve treatment adherence and outcomes in patients with type 2 diabetes.

Amanda R. Gillion, PharmD


Penicillin- and Carbapenem-Induced Neurotoxicity: How to Reduce the Risk

Penicillin-induced neurotoxicity was first recognized by Johnson and Walker in 1945 after intraventricular administration of benzylpenicillin.1,2 Subsequently, the β-lactams have been shown to have a higher rate of CNS effects than other classes of antibiotics.3,4

Amber Shah, MD


Young Woman With Abdominal Pain and Anemia

A 27-year-old woman with a 2-dayhistory of nausea, vomiting, andpostprandial abdominal pain is admittedto the hospital. Acute cholecystitisis suspected

Amber Stonehouse Tully, MD


Allergic Contact Dermatitis From Tea Tree Oil

The sudden appearance of a pruritic confluent erythematous rash on the anterior neck and upper back prompted a 30-year-old woman to seek medical attention. She had recently started applying 5% tea tree oil to the area to treat chronic, recurrent tinea versicolor. An herbal specialist had recommended this therapy.

Ambika Babu, MD


Woman With Type 2 Diabetes and Acromegaly

A 43-year-old woman presented withuncontrolled type 2 diabetes mellitus.Her hemoglobin A1c level was 12%,and self-measured glucose levels hadbeen above 400 mg/dL for 3 months.She was taking insulin 70/30,70 units twice daily.

Ambika Mathur, PhD


Travel Risks: How to Help Parents Protect Infants and Young Children

Children are at greater risk than adults for many travel-related problems, such as barotitis and barotrauma associated with flying, cold and heat injury, drowning, and infection with geohelminths. Most of these problems can be avoided with appropriate measures. Here, a summary of the most important steps.

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