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An 18-year-old woman with a history of allergic rhinitis and moderate persistent asthma presented with right-sided nasal congestion of 6 months’ duration. Her symptoms persisted despite her usual allergy medications, allergen immunotherapy, and 2 courses of antibiotics. A sinus CT scan showed complete opacification of the right maxillary sinus with increased attenuation of the mucin. Allergic fungal rhinosinusitis was suspected, and an otolaryngologist was contacted.

I often inject patients’ knees with a mixture of a corticosteroid and an anesthetic agent to alleviate arthritis pain. However, some patients with knee pain have difficulty in climbing onto the examination table.

Many different antiretroviral regimens can be used as initial therapy for infection with HIV.

Is the Seventh Report of the Joint National Committee for Prevention, Detection, Evaluation, and Treatment of Hypertension (JNC 7) still considered current, or are newer guidelines available?

Medication errors contribute substantially to unsafe hospital and ambulatory environments. The Institute of Medicine estimates that on average each hospitalized patient experiences 1 medication error per day.1

A 58-year-old man was brought to the medical ICU after almost an hour of field and emergency department resuscitation following cardiac arrest (intermittent rhythms of ventricular fibrillation, ventricular tachycardia, pulseless electrical activity, and asystole). He had hypertension, diabetes mellitus, and end-stage renal disease managed with hemodialysis. His medications included atenolol, enalapril, amlodipine, and insulin. His last hemodialysis session was 10 days earlier.

In the United States, an estimated 150,000 to 300,000 people are infected with both HIV and hepatitis C virus (HCV), representing about 15% to 30% of all persons living with HIV infection1,2 and 70% to 90% of injection drug users

The HIV epidemic was discovered in the early 1980s, and the response from the medical community was remarkable. Health care providers committed their time and careers to the cause of a group of people afflicted with an unknown and fatal illness.

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.

A 10-year-old boy stubbed his toe while running upstairs barefoot. He presented with tenderness, swelling, and ecchymosis of the left great toe and bleeding in and around the nail fold (A). Radiographs of the left foot revealed a Salter-Harris II fracture of the distal phalanx (B).

A 13-year-old girl felt a “pop” while doing a split during gymnastics. She later complained of right hip pain and inability to bear weight on the right leg.

After a fall during a soccer match 2 weeks earlier, a 26-year-old woman had pain of the right midfoot, with moderate swelling. The pain was aggravated with a normal gait and alleviated with an antalgic gait, specifically with inversion of the right ankle such that most of the weight from heel-strike through toe-off transmitted forces from the lateral calcaneus through the fifth metatarsus to the fifth phalanx.

The case concerns a patient with eosinophilic meningitisattributed to the helminthic parasite Angiostrongyluscantonensis. Before the onset of illness, our patient had ahistory of travel to Hawaii, the only area in the United Stateswhere A cantonensis is endemic. Finding eosinophils in thecerebrospinal fluid (CSF) can narrow the differential diagnosisin a patient with meningitis. In our patient, the proportion ofeosinophils in the CSF was 55%. The case is unique because thepatient was a strict vegetarian. This infection usually developsin persons who inadvertently ingest snails or slugs that containthe parasite. [Infect Med. 2008;25:366-368]

Every day, patients seek treatment for eye infections, which have a variety of causes and can affect any part of the eye. Eye infections usually are treated aggressively, because seemingly benign infections can quickly become serious and threaten vision. Symptoms that indicate an eye infection include chronic redness, persistent pruritus, flaking of the eyelid, eye discomfort or pain, blurred vision, eye discharge, and edema of ocular tissue. The following disease descriptions and case vignettes highlight a variety of eye infections, both common and uncommon, with which patients may present.

Rhodococcus equi is an emerging human pathogen. It is mostfrequently associated with pulmonary infections; however,manifestations may be protean. It can be easily mistaken fora diptheroid-like contaminant or a mycobacterium. Therefore,a high suspicion of R equi infection and specialized testing areencouraged. Vancomycin-based therapy is recommended.Because human infection with this organism is uncommon,thorough reporting will help identify further characteristicsof infection and will help in devising treatment guidelines.[Infect Med. 2008;25:391-393

A 41-year-old African American man presented with the chief complaint of a constant, dull headache for 3 days. The headache had a gradual onset and was associated with nausea and mild neck stiffness that was not relieved by acetaminophen. The man denied experiencing visual disturbances, fever, night sweats, weight loss, cough, shortness of breath, emesis, or weakness. He had no recent history of trauma or sick contacts.

AS IF WE DID NOT ALREADYknow, overcrowding and understaffingin hospitals play key rolesin the spread of methicillin-resistantStaphylococcus aureus (MRSA) infection.Data culled from a literaturereview of 140 articles suggest thatovercrowding and understaffingresult in having too few staff membersserving too many patientswithout sufficient time resources.The consequences are overexposureof a single health care worker topatient contacts and lapses inhygiene on the part of health carepersonnel who literally have toomuch responsibility-among otherthings-on their hands.

Most travelers to third-world countries encounter healthrelatedproblems during their stay and may require medicalattention on returning home. Although malaria is still themost common diagnosis among travelers to the developingworld, several other infectious diseases, such as avian influenza,dengue fever, chikungunya fever, leishmaniasis, andmultidrug-resistant tuberculosis, are growing in importance.Clinicians need to stay informed about travel requirementsand vaccine recommendations for US citizens. [Infect Med.2008;25:352-386]