April 30th 2024
Your daily dose of the clinical news you may have missed.
Medical Crossfire®: Maximizing Patient Outcomes in Shingles – Are You Leveraging Guideline Based Care?
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Understanding RSV: What You Need to Know to Prevent and Treat Respiratory Syncytial Virus in Your Patients
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Respiratory Syncytial Virus: Understanding the Infection Burden and Anticipating the Impact of Vaccines
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Medical Crossfire®: Which Patients with Hematologic Malignancies are at Risk for Secondary Immunodeficiency (SID)… and How Can We Leverage Evidence to Improve Their Outcomes?
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Patient, Provider, and Caregiver Connection™: Prevention and Control of Meningococcal Disease — Individualizing Vaccine Recommendations in Adolescent Populations
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Emerging Treatments for Rheumatoid Arthritis:
August 1st 2005ABSTRACT: Early treatment with disease-modifying anti-rheumatic drugs (DMARDs)--alone or in combination-- can prevent joint damage and minimize disability. Until recently, the DMARDs used predominantly in patients with rheumatoid arthritis had been methotrexate, sulfasalazine, and hydoxychloroquine. Older DMARDs such as gold, d-penicillamine, and azathioprine have fallen out of favor because of their long- term toxicities or modest benefit. Six newer DMARDs--leflunomide, etanercept, infliximab, adalimumab, rituximab, and anakinra--have greatly expanded the current treatment options.
A practical guide to managing asthma in children
August 1st 2005Abstract: 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)
TB Presenting as Acute Respiratory Distress Syndrome
July 14th 2005A 54-year-old woman with a history of hypertension presented with a worsening headache and a left hemisensory defect. A CT scan of her head without contrast showed a right parietal hemorrhage with spreading edema; the masslike effect caused shifting of the midline to the contralateral side. The patient gradually became comatose and required intubation for airway protection. Intravenous corticosteroids were administered to decrease the effect of the lobar hemorrhage. Fever developed 3 days after admission.
Elderly Man With Elevated PSA Level
July 1st 2005A 79-year-old man has an elevated prostate-specific antigen (PSA) level(11.3 ng/mL). About 1 month earlier, when he was hospitalized for a seriousurinary tract infection (UTI), his PSA level was 13.3 ng/mL. The more recentlevel was obtained after he received antibiotic therapy for the UTI.
How to handle the difficult airway, part 2
July 1st 2005Abstract: The laryngeal mask airway (LMA) and intubating LMA are valuable alternatives in patients in whom intubation has failed and who need oxygenation and ventilation immediately. The dual-lumen, dual-cuffed airway tube is effective in a variety of settings and can tolerate ventilation at pressures as high as 50 cm H2O; it is contraindicated in awake patients who have intact airway reflexes, caustic ingestions, and upper airway obstruction from a foreign body or pathology. Surgical airways are lifesaving techniques when intubation is unsuccessful or impossible through the mouth or nose. It may be particularly appropriate in patients with laryngeal or facial trauma, upper airway obstruction, or oropharyngeal injury. When patients aged 12 years and older cannot be ventilated by mask or intubated with traditional methods, surgical or needle cricothyrotomy is the procedure of choice. (J Respir Dis. 2005;26(7):298-302)
Clinical Update: C-reactive protein: A marker for assessing and managing cardiac risk
July 1st 2005Inflammation plays a major role in coronary artery disease (CAD), whereby inflammatory changes develop in the blood vessel walls.1 This observation has spurred interest in exploring the connection between CAD and markers of inflammation, including C-reactive protein (CRP), fibrinogen, serum amyloid A, and many other novel markers.
Case In Point: A case of bilateral hilar lymphadenopathy
July 1st 2005The authors describe a rare cause of diffuse thoracic lymphadenopathy--Cogan syndrome. This case was remarkable for the temporal development of extensive lymphadenopathy independent of other hallmark symptoms and signs of this syndrome. In the appropriate clinical setting, Cogan syndrome should be considered in the differential diagnosis of thoracic lymphadenopathy.
Managing COPD: How to deal with the most common problems
July 1st 2005Abstract: Although smoking cessation is still the most impor- tant intervention in chronic obstructive pulmonary disease (COPD), a variety of pharmacologic therapies are available to help manage symptoms. Short-acting ß2-agonists and/or ipratropium should be taken as needed, and the use of additional therapies is based on the severity of disease. Patients with moderate or severe COPD should regularly take 1 or more long-acting bronchodilators. The long-acting ß2-agonists salmeterol and formoterol have been demonstrated to improve health-related quality of life. Newer therapies include the long-acting anticholinergic tiotropium and a salmeterol-fluticasone combination. These agents improve forced expiratory volume in 1 second and may reduce the rate of acute exacerbations. For patients with moderate to very severe COPD, participation in a pulmonary rehabilitation program can improve health status, quality of life, and exercise tolerance. (J Respir Dis. 2005;26(7):284-289)
Community-Associated MRSA Infections on the Rise: Can Changes in Your Practice Be Far Behind?
July 1st 2005Stories about community-associated infections with methicillin-resistant Staphylococcus aureus (MRSA) have been making headlines in recent months in both the medical and popular press. A familiar problem in hospitals and nursing homes for decades, growing numbers of MRSA infections have been documented over the past few years in prison inmates, soldiers, athletes, Pacific Islanders, Alaska Natives, Native Americans, and men who have sex with men.
Severe Diarrhea in a Recently Hospitalized Woman
July 1st 2005A 42-year-old woman presents with severe diarrhea that began 3 days earlier and has become progressively more severe. She is now having 10 or more watery bowel movements per day. She has had moderate nausea but no emesis, hematemesis, or hematochezia.
An Antibacterial for a Viral Infection?
July 1st 2005In his Photo Essay case of a 5-year-old girl with a herpes simplex virus (HSV) infection on her thumb , Dr Robert Blereau writes that treatment consisted of mupirocin ointment. Frankly, I was surprised to read that this agent was used to treat an HSV infection. Was this the only treatment?
Travel Risks: How to Help Parents Protect Infants and Young Children
July 1st 2005Children 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.
Clinical Update: Guidelines for managing hospital-aquired Pneumonia
June 1st 2005The American Thoracic Society (ATS) and the Infectious Diseases Society of America recently published guidelines for the management of hospital-acquired pneumonia (HAP).1 These guidelines, which are an update of a 1996 ATS consensus statement,2 focus on bacterial HAP in immunocompetent adults. This includes ventilator-associated pneumonia (VAP) and health care-associated pneumonia (HCAP). Selected highlights are presented here.
Primary HIV Infection: Why Early Detection Matters
June 1st 2005This case highlights the importance of detecting HIV infection in its earliest stages. Each year, 40,000 new cases of HIV infection are diagnosed in the United States; however, very few of these are identified at the acute infection stage. Diagnosis of primary HIV infection is important because it improves the patient's chances for a good outcome, reduces the risk of transmission, and provides epidemiologic data on virus strains in the community.