On a daily basis, both patients and providers are confronted with the complicated problem of pain. Unfortunately, pain is prevalent among persons infected with HIV-1 and is undertreated.2 Metaphorically, pain can be likened to sound. At the same decibel level, different persons will perceive the same level of sound as pleasant or unpleasant. At either end of the spectrum (ie, no sound and extreme noise), all who are not hearing-impaired will agree on how the sound is perceived. Likewise, in pain, at the extremes (no pain and excruciating pain), everyone will agree on how the level of pain is perceived. Like sound, what complicates our assessment of pain is that pain typically falls in the middle range, where many different variables affect both the physiology of the pain and the psychosocial perception of that pain.

A49-year-old woman was referred to the emergency department by her primary medical provider for complaints of 3 weeks of cough, pleuritic chest pain, fever, and night sweats. The patient reportedanorexia and weight loss of 9 kg (20 lb) during the past 4 months.

Doctors responding to an online MedPage Today survey overwhelmingly rejected the idea of writing new prescriptions for patients with diabetes for rosiglitazone (Avandia).

CHICAGO -- The DASH diet plan apparently has not caught on among hypertensive patients. In fact, the percentage of patients adhering to DASH plummeted after the diet was incorporated in national guidelines.

ESSEN, Germany -- An investigational bioabsorbable magnesium coronary stent worked as advertised for several months but led to a higher revascularization rate at one year.

BOSTON -- Folate and B vitamins from food, but not from supplements, may be of modest help in fending off cancer of the pancreas.

abstract: In the treatment of certain allergies, sublingual immunotherapy (SLIT) may represent an attractive alternative to subcutaneous immunotherapy (SCIT) because of its lower risk of systemic reactions. The most common adverse reactions are local symptoms, such as oral "itchiness." GI complaints, rhinoconjunctivitis, urticaria, and asthma are uncommon reactions to this therapy, and no fatalities have been reported. In contrast to SCIT, accelerated induction schedules for SLIT do not appear to be associated with an increased risk of systemic reactions. SLIT may present an opportunity for broadening the use of immunotherapy by extending it to patients who are not candidates for SCIT because they dislike injections, find the frequent visits to the physician's office inconvenient, or are concerned with the safety of SCIT. The optimal effective dose and dosing schedule need to be established before a cost-benefit analysis can be performed. (J Respir Dis. 2007;28(6):237-243)

* The role of inflammation is well established in theories describing atherosclerotic disease. Virtually every step in atherogenesis is believed to involve cytokines and other bioactive molecules and cells that are characteristic of inflammation. Studies have shown that an elevated level of CRP, which is a serum marker of inflammation, in the high-normal range (0.2 to 1.0 mg/dL) in apparently healthy adults increases the relative risk of cardiovascular disease by 1.5.1

A number of prediction models have been developed to identify patients with community-acquired pneumonia (CAP) who are at increased risk for severe illness. España and associates have developed a relatively simple model that can be used in the emergency department (ED), and they report that it compares favorably with other prediction models, such as those developed by the American Thoracic Society (ATS) and the British Thoracic Society (BTS).

Tinea corporis appears as an annular plaque with a rim of scaly erythema.

Tinea that occurs on the hands is referred to as tinea manuum.

To determine whether a midline neck swelling is caused by a thyroglossal cyst or by enlargement of the thyroid gland, ask the patient to open his or her mouth and move the tongue in and out.

Maceration or scale between isolated web spaces of the fingers suggests erosio interdigitalis blastomycetica (interdigital candidiasis). It most often occurs in the web space between the middle and ring fingers; sometimes the toes are affected. Erosio can spread and can be painful.

A fungal folliculitis (Majocchi granulomas) can occur if a superficial fungal infection is treated with topical corticosteroids. Fungal folliculitis is best treated with a short course of oral itraconazole or fluconazole.

Candidal infection can also occur at the lateral angles of the mouth; it causes erosions and breakdown of the skin. Angular cheilitis, or perleche, resembles the relationship between intertriginous candidiasis and intertrigo in that it is part infection and part inflammatory response to the impairment of epidermal integrity.

An easy way to make ice packs is to fill small zip-lock plastic bags with wet gauze and then freeze them.

When young children are afraid to have you look in their ears, try this trick: take the little ear speculum off the otoscope and place it on your finger, then make it "magically" disappear by passing your hand over it.

Is it necessary to prescribe lipid-lowering therapy for a patient with a mildly elevated total cholesterol level (240 mg/dL), a low-density lipoprotein (LDL) cholesterol level of 120 mg/dL, and a high high-density lipoprotein (HDL) cholesterol level of 100 mg/dL?

For several months, a 60-year-old woman has had weakness, lower extremity edema, and dysphagia. She denies fever, chest discomfort, and rash.

This infection is usually caused by Candida albicans, whichis often present in body folds. Candidiasis is common in persons with diabetes and in obese persons. Other predisposing factors are the use of antibiotics, topical corticosteroids, or immunosuppressive drugs; poor nutrition; and immunosuppression.