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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.

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.

Tinea pedis, or athlete's foot, is common in elderly persons. It manifests as maceration in the interdigital web folds and as scaly plaques on the plantar surfaces of the feet. A potassium hydroxide evaluation can establish the diagnosis. Tinea pedis is commonly associated with xerosis. It is best treated with a topical antifungal agent; treatment can be aided by a keratolytic such as lactic acid 12% cream.

Oral candidiasis, or thrush, is not uncommon in elderly persons. It can be related to poor dentition or immunosuppression, particularly as a result of oral corticosteroid use.

How safe is the use of high doses of niacin to foil urine drug screening tests?

Tinea corporis occurs most often on the torso of elderly persons. It commonly appears as an annular plaque with a rim of scaly erythema. Occasionally, tinea corporis manifests with polycyclic annuli or with nummular plaques, which mimic nummular dermatitis. The examination of a potassium hydroxide preparation can establish the diagnosis. Tinea corporis can be treated effectively with a topical antifungal agent.