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Allergic rhinitis is highly prevalent; about 20% of adults in the United States and 25% of children worldwide are affected. It is a major societal expense, with direct costs, attributable to physician visits and medications, of up to $5 billion per year, and indirect costs, mainly stemming from lost productivity, of up to $9.7 billion per year. In the United States, allergic rhinitis results in 3.5 million lost workdays and 2 million lost schooldays each year.

A 30-year-old man is admitted for profound, symptomatic anemia.

Petroleum jelly is a barrier not a moisturizer.

Careful monitoring of disease progression is vital to ensuring that patients with pulmonary arterial hypertension receive maximal therapy before the onset of overt right-sided heart failure. Routine follow-up includes the evaluation of symptoms, functional class, and exercise capacity and assessment of pulmonary pressures and right ventricular (RV) function. Transthoracic echocardiography (TTE) offers a noninvasive and fairly reliable technique for monitoring pulmonary artery pressure (PAP) and structural changes of the right side of the heart. However, TTE does not reliably assess cardiac output, right-sided filling pressures, or pulmonary venous pressure. Pulmonary artery catheterization may be particularly useful in patients who have inconsistent findings, such as a reduction in PAP measured by TTE in the presence of worsening symptoms or other signs of disease progression. An increase in RV end-diastolic pressure, usually above 10 mm Hg, is a concern and warrants consideration of additional therapy even if other hemodynamic and clinical parameters are unchanged. (J Respir Dis. 2009;30(1-2)

It is, of course, conflict and disagreement that make news. However, the coverage of protests at town hall meetings about health care reform legislation held by members of Congress in their home districts over summer recess and the differences between competing drafts of what such legislation should look like mask one core truth: there is a good bit of agreement on what should be in the final package.

The development of drug-resistant strains of Mycobacterium tuberculosis has increased morbidity and mortality associated with tuberculosis (TB) and has greatly increased the costs of care for patients with this disease.

Major depressive disorder (MDD) does not always respond to antidepressants. Whether we are using SSRIs, serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclics, monoamine oxidase inhibitors, or heterocyclics (trazodone, nefazodone, bupropion), the result often falls short of full remission of symptoms.

Requirement of higher copayments for prescription drugs can delay the start of treatment for patients with newly diagnosed chronic problems, such as hypertension, hypercholesterolemia, and diabetes. This finding is particularly salient in patients who have no prior experience with prescription drugs.

The Medicare Prescription Drug Benefit (Part D) was initiated to help protect beneficiaries from increasing drug costs and to reduce the cost-related underuse of medications. A recent study by Zhang and associates1 provides noteworthy information about how Part D has affected prescription drug and other medical expenditures.

Asthma is a prevalent disease that continues to be associated with significant health care costs. Kamble and Bharmal, for example, estimated that the annual direct medical expenditure attributable to asthma in the United States was about $37.2 billion in 2007. In their study, the estimated prevalence of asthma was 8.7% in children and 6.72% in adults.

In this new feature, you’ll findpaired photographs of two differentdermatological disorders, accompaniedby a checklist of clinical features.You are invited to go throughthe checklists and match the variouscharacteristics with one or both ofthe disorders illustrated.

Roughly 85% of all acute ankle injuriesare sprains, of which about85% are uncomplicated, involving thelateral ligaments only.

THAT BLUE LIGHT KILLS methicillin-resistant Staphylococcus aureus (MRSA) was demonstrated in the article “Visible 405 nm SLD Light Photo-Destroys Methicillin-Resistant Staphylococcus aureus (MRSA) In Vitro,” in the December 2008 issue of Lasers in Surgery and Medicine. Concerns about the clinical safety of the wavelength used (405 nm, spectral width 390 to 420 nm), which contains traces of ultraviolet light, led Chukuka Enwemeka, PhD, and colleagues from the School of Health Professions, Behavioral and Life Sciences at New York Institute of Technology in Old Westbury, to recapitulate the experiment using a wavelength of 470 nm with similar results.

THE VALUE OF THE PEDIATRIC heptavalent pneumococcal conjugate vaccine (PCV7) in preventing pneumococcal meningitis has been confirmed by a study, the results of which were recently published in the New England Journal of Medicine.

Match the following characteristics with the clinical disorders pictured in the photographs of Cases 1 and 2. Then read the brief descriptions that follow on the next page to see how well you did.

Progressively worsening nasal congestion and headaches with diplopia and left proptosis for 2 months prompted an ophthalmology consultation for a 67-year-old woman. She had been evaluated multiple times for allergic rhinitis and recurrent sinusitis.

You come by to see your patient after she has been discharged from the ICU. She is staring at a tray of food in front of her, which is undisturbed. She has lost 15 lb during the past week of hospitalization in the ICU. You ask her why she isn’t eating and whether she is hungry. She says that she is famished but is so weak she can’t even feed herself.1

A 35-year-old woman presented to the emergency department (ED) with 2 black eyes, facial swelling, and other injuries (Figure 1). She said that she had been in an all-terrain vehicle accident the day before, in which she hit her face on the handlebar. She said she had lost consciousness for an unknown period and since the accident had experienced headache, dizziness, nausea, and pain over much of her body.