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In the United States, it has been estimated that 7.8% of the total population has diabetes. In 2007, the direct medical expenditures for diabetes were about $116 billion and the total direct and indirect costs were $174 billion, according to the CDC.1

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Abstract: The coexistence of asthma and obstructive sleep apnea (OSA) in a given patient presents a number of diagnostic and treatment challenges. Although the relationship between these 2 diseases is complex, it is clear that risk factors such as obesity, rhinosinusitis, and gastroesophageal reflux disease (GERD) can complicate both asthma and OSA. In the evaluation of a patient with poorly controlled asthma, it is important to consider the possibility of OSA. The most obvious clues are daytime sleepiness and snoring, but the definitive diagnosis is made by polysomnography. Management of OSA may include weight loss and continuous positive airway pressure (CPAP). Surgical intervention, such as uvulopalatopharyngoplasty, may be an option for patients who cannot tolerate CPAP. Management may include specific therapies directed at GERD or upper airway disease as well as modification of the patient's asthma regimen. (J Respir Dis. 2005;26(10):423-435)

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A 10-year-old boy presented with right hip pain and a limp. The patient was taking no medications and had no personal or family history of disease. He denied a history of trauma.

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A 75-year-old woman with a bioprosthetic aortic valve, who had undergone surgical repair of an aortic root aneurysm 9 months earlier was hospitalized with fever, headache, and altered mental status of 1-day's duration.

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Vaccination rates in adults are lower than those in children, but the consequences of lack of immunization in adults are just as significant. Barriers to adult immunization include patients’ lack of knowledge or misconceptions about vaccines and health care providers’ failure to recommend vaccination.1

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Attacks of muscle weakness associated with this condition can range in severity from mild deficit to complete paralysis. Episodes may alternate with periods of normal muscle function.

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During the first quarter of a football game, a 17-year-old athlete noticed that his right (dominant) arm was swollen and heavy. Two days earlier, he had fired a shotgun right-handed multiple times while hunting.

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During the first quarter of a football game, a 17-year-old athlete noticed that his right (dominant) arm was swollen and heavy. Two days earlier, he had fired a shotgun right-handed multiple times while hunting.

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For 2 months, a 30-year-old man with a history of cocaine abuse had had a painful gingival mass and difficulty in eating. Examination revealed a large, fungating mass in the anterior oropharynx that extended posteriorly up to the retromolar region. Posterior cervical lymph nodes were enlarged bilaterally, with no other peripheral lymphadenopathy.

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A 36-year-old man presents with a 10-day history of progressive dyspnea anddiscomfort on the left side of his chest.Three weeks earlier, he was dischargedfrom the hospital after a 2-week stayfor acute pancreatitis. He has a historyof long-term alcohol abuse and recurrentpancreatitis.

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Bronchopulmonary sequestrationis a rare congenitallung malformation characterizedby an abnormal segmentof bronchopulmonary tissuesupplied by an anomaloussystemic artery. The diagnosismay be easily missed in adults,since many are asymptomatic;moreover, symptoms, whenpresent, often overlap withthose of other pulmonaryprocesses. Surgical resectionprovides definitive managementand is usually reservedfor patients with symptoms.We present a case of intralobarbronchopulmonary sequestrationthat presented duringadulthood.

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Each time I see a patient, I note on the chart personal events in his or her life--such as "going on a cruise" or "attending grandson's graduation"--in addition to the clinical findings.

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ABSTRACT: Although the organisms that cause community-acquiredpneumonia are similar in diabetic and nondiabetic patients,those who have diabetes mellitus (DM) may have moresevere disease and a poorer prognosis. Elevated blood glucoselevels are associated with worse outcomes in patients withpneumonia, and the mortality risk may be as high as 30% in patientswith uncontrolled DM. Thus, appropriate treatment-and possibly prevention-of bacterial pneumonia should includeaggressive efforts directed at glycemic control. Other respiratoryinfections, such as influenza, tuberculosis, and fungalpneumonia, also are associated with greater morbidity in patientswith DM. Diabetic patients with tuberculosis are morelikely to present with bilateral lung involvement and pleural effusions.(J Respir Dis. 2008;29(7):285-293)

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During the first quarter of a football game, a 17-year-old athlete noticed that his right (dominant) arm was swollen and heavy. Two days earlier, he had fired a shotgun right-handed multiple times while hunting.

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A 59-year-old man presented with a cough and 2 episodes of pneumonia during the past 4 months. He had a 45-pack-year history of smoking cigarettes.

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A 65-year-old woman presented withdouble vision of 2 days’ duration.The diplopia mainly occurred whenshe looked toward her right. She deniednausea, vomiting, vision loss,headache, change in mental status,facial pain, weakness in the extremities,and sinus infection. She had nohistory of head trauma or systemicmalignancy.

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An 8-year-old boy presented with a 6-week history of shortness of breath, cough, and myalgias, but no fever. His pediatrician had made the diagnosis of bronchiolitis, and the patient was treated with azithromycin and albuterol via a metered-dose inhaler. Because the patient did not improve, he was given a 10-day course of amoxicillin, followed by a course of clarithromycin after a chest radiograph revealed bilateral infiltrates, suggesting atypical pneumonia.

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Löfgren syndrome is a form of acute sarcoidosis characterized by a triad of symptoms: hilar adenopathy, erythema nodosum, and arthralgias.

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In its classic form, ALS affects motor neurons at 2 or more levels supplying multiple regions of the body.

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The purple-stained urine bags and tubing of 2 elderly patients are shown here. Neither patient received urine-discoloring medications.

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In plombage therapy for pulmonary TB, polymerized methyl methacrylate, or Lucite, balls were inserted into the chest to collapse the lung and to maintain adequate thoracic expansion.

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A new study suggests trackers don't help, but medical experts weighed in with a full spectrum of opinions.

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Patients who present with congenital hand deformities in association with cardiac disorders require a detailed evaluation.

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Lymphoepithelial cysts of the parotid gland may be diagnostic of HIV infection; they are typically bilateral, benign, and associated with lymphadenopathy.

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Abstract: A number of factors can complicate the diagnosis of asthma in elderly patients. For example, the elderly are more likely to have diseases such as chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) that--like asthma--can cause cough, dyspnea, and wheezing. Spirometry can help distinguish asthma from COPD, and chest radiography and measurement of brain natriuretic peptide levels can help identify CHF. Important considerations in the management of asthma include drug side effects, drug interactions, and difficulty in using metered-dose inhalers. When discussing the goals of therapy with the patient, remember that quality-of-life issues, such as the ability to live independently and to participate in leisure activities, can be stronger motivators than objective measures of pulmonary function. (J Respir Dis. 2006;27(6):238-247)

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Vaccination rates in adults are lower than those in children, but the consequences of lack of immunization in adults are just as significant. Barriers to adult immunization include patients’ lack of knowledge or misconceptions about vaccines and health care providers’ failure to recommend vaccination.1

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Scrub typhus, which is caused by Orientia tsutsugamushi, has various systemic manifestations, including GI symptoms. We describe one patient with scrub typhus who presented with symptoms that suggested acute appendicitis and another who presented with symptoms of acute cholecystitis.

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For 2 weeks, a previously healthy 40-year-old man has had excessive thirst and increased frequency of urination. He awakens at least 5 times every night to urinate. He reports no nausea, vomiting, change in bowel habits, chest pain, or dyspnea.