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Defensive Medicine

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4901. Porokeratosis (Follow-up)

Rosa, MD is a member of the following medical societies: , Disclosure: Nothing to disclose. Specialty Editor Board Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA Richard P Vinson, MD is a member of the following medical societies: , , , Disclosure: Nothing to disclose. Jeffrey P Callen, MD Professor of Medicine (Dermatology), Chief, Division (...) of Dermatology, University of Louisville School of Medicine Jeffrey P Callen, MD is a member of the following medical societies: , , , Disclosure: Received income in an amount equal to or greater than $250 from: Lilly; Amgen
Received honoraria from UpToDate for author/editor; Received honoraria from JAMA Dermatology for associate editor; Received royalty from Elsevier for book author/editor; Received dividends from trust accounts, but I do not control these accounts, and have directed our managers

2014 eMedicine.com

4902. Polymyalgia Rheumatica (Follow-up)

of New York Downstate Medical Center; Chairman Emeritus, Department of Internal Medicine, Western Pennsylvania Hospital Herbert S Diamond, MD is a member of the following medical societies: , , , , Disclosure: Nothing to disclose. Acknowledgements The views expressed in this article are those of the authors and do not reflect the official policy of the Department of the Army, Department of Defense, or the US Government. Additionally, this publication does not imply the Federal or Department (...) of Defense endorsement of any product. Past Contributors Michael S Beeson, MD, MBA, FACEP Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine and Pharmacy; Attending Faculty, Akron General Medical Center Michael S Beeson, MD, MBA, FACEP is a member of the following medical societies: , , , and Disclosure: Nothing to disclose. Gino A Farina, MD, FACEP, FAAEM Associate Professor of Clinical Emergency Medicine, Albert Einstein College of Medicine; Program Director, Department

2014 eMedicine.com

4903. Poxviruses (Follow-up)

School of Medicine; Professor of Preventive Medicine, Stony Brook Medical Center John D Shanley, MD, MPH is a member of the following medical societies: , , , Disclosure: Nothing to disclose. Specialty Editor Board Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Received salary from Medscape for employment. for: Medscape. Charles V Sanders, MD Edgar Hull Professor and Chairman (...) , Department of Internal Medicine, Professor of Microbiology, Immunology and Parasitology, Louisiana State University School of Medicine at New Orleans; Medical Director, Medicine Hospital Center, Charity Hospital and Medical Center of Louisiana at New Orleans; Consulting Staff, Ochsner Medical Center Charles V Sanders, MD is a member of the following medical societies: , , , , , , , , , , , , , , , , , , , , , American Venereal Disease Association, , , , , , , , Disclosure: Received royalty from Baxter

2014 eMedicine.com

4904. Preoperative Evaluation and Management (Follow-up)

. Drug interactions The geriatric population consumes more systemic medications than any other group. Numerous drug interactions and complications arise in this population, and special attention should be paid to them. Diuretics are commonly prescribed medications for hypertension, congestive heart failure, and other fluid-retaining states. Common complications of diuretic therapy are hypokalemia and hypomagnesemia. Both abnormal electrolyte states, especially in combination with epinephrine use (...) preferences. A thorough assessment ensures that the patient's chronic diseases are under appropriate medical therapy prior to an elective procedure and establishes a rapport and confidence with the patient to allay fears and answer any questions. Finally, the preoperative preparation involves procedures that are implemented based on the nature of the expected operation and the findings of the diagnostic workup and preoperative evaluation. Many dermatologic surgical procedures are uncomplicated

2014 eMedicine.com

4905. Proteus Infections (Follow-up)

can be as high as 30%-45% despite the use of antibiotic therapy and intensive care. Patients with preexisting medical problems, neonates, and elderly individuals are at the greatest risk for complications. Previous Next: Patient Education Education concerning catheter care may reduce the frequency of infections. Previous References Luzzaro F, Brigante G, D'Andrea MM, Pini B, Giani T, Mantengoli E, et al. Spread of multidrug-resistant Proteus mirabilis isolates producing an AmpC-type beta-lactamase (...) A, Luzzaro F, Brigante G, et al. Proteus mirabilis bloodstream infections: risk factors and treatment outcome related to the expression of extended-spectrum beta-lactamases. Antimicrob Agents Chemother . 2005 Jul. 49(7):2598-605. . Engel JD, Schaeffer AJ. Evaluation of and antimicrobial therapy for recurrent urinary tract infections in women. Urol Clin North Am . 1998 Nov. 25(4):685-701, x. . Kaye D, Tunkel AR, Fournier GR. Stein, ed. Internal Medicine . 5th ed. St Louis, Mo: Mosby-Year Book; 1998. Li X

2014 eMedicine.com

4906. Majocchi Granuloma (Follow-up)

. Courtesy of Hon Pak, MD. of 1 Tables Contributor Information and Disclosures Author Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public Affairs and Administration Robert A Schwartz, MD, MPH is a member of the following medical societies: , , , , Disclosure: Nothing to disclose. Coauthor(s) Camila K Janniger, MD (...) Dermatopathologist, South Texas Dermatopathology Laboratory Lester F Libow, MD is a member of the following medical societies: , , Disclosure: Nothing to disclose. Chief Editor Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine Dirk M Elston, MD is a member of the following medical societies: Disclosure: Nothing to disclose. Additional Contributors David P Fivenson, MD Associate Director, St Joseph Mercy Hospital

2014 eMedicine.com

4907. Keratitis, Herpes Simplex (Follow-up)

unable to tolerate topical medications and with good renal function A cycloplegic agent may be added to any of the above regimens for comfort from ciliary spasm. Topical therapy Topical ganciclovir ophthalmic gel, approved by the US Food and Drug Administration (FDA) in 2009, has the advantages of low corneal toxicity, less frequent applications, and gel formulation. Trifluridine solution and vidarabine ointment are also effective in treating HSV keratitis. However, epithelial toxicity is a frequent (...) adverse effect, especially with prolonged use. Response to topical therapy usually occurs in 2-5 days, with complete resolution in 2 weeks. Topical therapy should be tapered rapidly after initial response and discontinued after complete healing, generally within 10-14 days. Failure of epithelial healing after 2-3 weeks of antiviral therapy suggests epithelial toxicity, neurotrophic keratopathy, or, rarely, drug-resistant strains of HSV. Vidarabine is often effective against HSV strains

2014 eMedicine.com

4908. Klebsiella Infections (Follow-up)

, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Received salary from Medscape for employment. for: Medscape. John W King, MD Professor of Medicine, Chief, Section of Infectious Diseases, Director, Viral Therapeutics Clinics for Hepatitis, Louisiana State University Health Sciences Center; Consultant in Infectious Diseases, Overton Brooks Veterans Affairs Medical Center John W King, MD is a member of the following medical societies (...) of Klebsiella pneumoniae. Courtesy of CDC/Janice Carr. of 1 Tables Contributor Information and Disclosures Author Shahab Qureshi, MD, FACP Attending Physician in General Internal Medicine, St Catharine's General Hospital; Associate Clinical Professor (Adjunct), McMaster University School of Medicine, Canada Shahab Qureshi, MD, FACP is a member of the following medical societies: , , Disclosure: Nothing to disclose. Specialty Editor Board Francisco Talavera, PharmD, PhD Adjunct Assistant Professor

2014 eMedicine.com

4909. Keratosis Palmaris et Plantaris (Follow-up)

, University of Illinois College of Medicine Jacob W Charny, MD is a member of the following medical societies: , , Disclosure: Nothing to disclose. Coauthor(s) William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine William D James, MD is a member of the following medical societies: , Disclosure: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD. Specialty (...) with internal malignancy, PPK due to inflammatory and reactive dermatoses, PPK caused by infections, drug-related PPK, and systemic disease–associated PPK. See the images below. Focal palmoplantar keratoderma. Courtesy of Professor Raimo Suhonen and DermNet New Zealand (https://www.dermnetnz.org/assets/Uploads/scaly/s/focal-kd2.jpg). Diffuse palmoplantar keratoderma. Courtesy of Professor Raimo Suhonen and DermNet New Zealand (https://www.dermnetnz.org/assets/Uploads/scaly/s/keratoder5.jpg). Next: Diffuse

2014 eMedicine.com

4910. Laparoscopic and Robotic Radical Prostatectomy (Follow-up)

, placement of stitch in dorsal vein complex, dissection of prostate off bladder, dissection around prostate; development of plane between prostate and rectum, preservation of neurovascular bundles and division of dorsal vein complex and urethra. Procedure performed by Samuel Sterrett, DO, Bon Secours Medical Group, Greenville, SC. Courtesy of BroadcastMed (http://uro.broadcastmed.com/4120/videos/robotic-prostatectomy). See , a Critical Images slideshow, to help determine the best diagnostic approach (...) of 402 mL. The authors also reported a decreased mean hospital stay, due predominantly to earlier removal of the Foley catheter. Even in the hands of these skilled laparoscopists, nerve-sparing dissection and construction of the urethrovesical anastomosis were demanding. With advances in medical technology, improved optics, and the widespread use of new laparoscopic instrumentation such as ultrasonic cutting and coagulating devices (eg, Harmonic scalpel), laparoscopic radical prostatectomy began

2014 eMedicine.com

4911. Leishmaniasis (Follow-up)

reported treatments include topical imiquimod cream, cryotherapy, thermotherapy, ketoconazole, photodynamic therapy, itraconazole, and allopurinol. However, these are effective only when used in combination with the first-line drugs Because Leishmania species are temperature-sensitive, local treatment with heat or cold provides an alternative to pharmaceutical therapy in some cases. Cryotherapy can be used on small, uncomplicated Old World lesions. A 15- to 20-second freeze-thaw-refreeze cycle repeated (...) occurs, the immunologic status of the patient, and the previous attempts at treatment when therapy is started. Treatment options In general, if the case is not advanced with serious gastroenterologic, hematologic, or infectious issues, care can be accomplished on an outpatient basis. However, daily visits to a physician for medication may be required. Multiple medical treatment options are used throughout the world for cutaneous disease. In addition to parenteral and oral medications (see Medication

2014 eMedicine.com

4912. Leishmaniasis (Follow-up)

for economic reasons. In the city of Kabul, Afghanistan, which has a population of less than 2 million, an estimated 270,000 cases of cutaneous leishmaniasis occurred in 1996. The resurgence of visceral leishmaniasis has occurred because of deficiencies in the control of the vector (sandfly), absence of a vaccine, and lack of access to medical treatment due to cost and increasing drug resistance to first-line treatment. Coexistence of leishmaniasis with human immunodeficiency virus (HIV) infection (...) individuals with intact immune systems, full recovery from visceral disease is expected after treatment with the appropriate medication. With early therapy and supportive care, mortality in patients with visceral disease is reduced to approximately 5%; without therapy, most patients with visceral disease (kala-azar) (75-95%) die within 2 years, often from malnutrition and secondary infection, such as bacterial pneumonia, septicemia, dysentery, tuberculosis, cancrum oris, and uncontrolled hemorrhage or its

2014 eMedicine.com

4913. History and Mental Status Examination (Follow-up)

the patient who prescribed the medications and when or why the patient discontinued taking them. Allergies List all drug and food allergies the patient currently has or has had in the past, and list what type of reactions the patient had to the medications. Past psychiatric history List all of the patient's treatment, including outpatient, inpatient, and therapy-based (ie, individual, couples, family, group), including dates. Inquire about past psychotropic medications and response, compliance (...) family history of illness is important. This information can be very useful later, when determining treatment options. If a family member has a history of the same illness and had a successful drug regimen, that regimen may prove to be a viable option for the current patient. If possible, record the medications and dosages family members took for their illnesses. If these medications and dosages worked for family members, the chance is good that they may work for the current patient. Obtain

2014 eMedicine.com

4914. Herpes Simplex (Follow-up)

unable to tolerate topical medications and with good renal function A cycloplegic agent may be added to any of the above regimens for comfort from ciliary spasm. Topical therapy Topical ganciclovir ophthalmic gel, approved by the US Food and Drug Administration (FDA) in 2009, has the advantages of low corneal toxicity, less frequent applications, and gel formulation. Trifluridine solution and vidarabine ointment are also effective in treating HSV keratitis. However, epithelial toxicity is a frequent (...) adverse effect, especially with prolonged use. Response to topical therapy usually occurs in 2-5 days, with complete resolution in 2 weeks. Topical therapy should be tapered rapidly after initial response and discontinued after complete healing, generally within 10-14 days. Failure of epithelial healing after 2-3 weeks of antiviral therapy suggests epithelial toxicity, neurotrophic keratopathy, or, rarely, drug-resistant strains of HSV. Vidarabine is often effective against HSV strains

2014 eMedicine.com

4915. HIV-1 Associated CNS Complications (Follow-up) (Follow-up)

, Muzoora C, Et al. Timing of antiretroviral therapy after diagnosis of cryptococcal meningitis. N Engl J Med . 2014 Jun 26. 370 (26):2487-98. . Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV. Available at . Media Gallery of 0 Tables Contributor Information and Disclosures Author Regina Krel, MD Neurologist/Headache Medicine Specialist, Headache Center, Neuroscience Institute at Hackensack University Medical Center; Assistant Professor, Department of Neurology (...) Emeritus, Department of Neurology, St Louis University School of Medicine; Editor-in-Chief, Journal of Spinal Cord Medicine Florian P Thomas, MD, PhD, MA, MS is a member of the following medical societies: , , , , , Disclosure: Nothing to disclose. Specialty Editor Board Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Received salary from Medscape for employment. for: Medscape

2014 eMedicine.com

4916. HIV-1 Associated Cerebrovascular Complications (Follow-up)

, Muzoora C, Et al. Timing of antiretroviral therapy after diagnosis of cryptococcal meningitis. N Engl J Med . 2014 Jun 26. 370 (26):2487-98. . Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV. Available at . Media Gallery of 0 Tables Contributor Information and Disclosures Author Regina Krel, MD Neurologist/Headache Medicine Specialist, Headache Center, Neuroscience Institute at Hackensack University Medical Center; Assistant Professor, Department of Neurology (...) Emeritus, Department of Neurology, St Louis University School of Medicine; Editor-in-Chief, Journal of Spinal Cord Medicine Florian P Thomas, MD, PhD, MA, MS is a member of the following medical societies: , , , , , Disclosure: Nothing to disclose. Specialty Editor Board Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Received salary from Medscape for employment. for: Medscape

2014 eMedicine.com

4917. Head Injury (Follow-up)

therapy in patients with traumatic brain injury: A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) . 2018 Jul. 97 (30):e11671. . Temkin NR, Dikmen SS, Wilensky AJ, et al. A randomized, double-blind study of phenytoin for the prevention of post-traumatic seizures. N Engl J Med . 1990 Aug 23. 323(8):497-502. . Kruer RM, Harris LH, Goodwin H, Kornbluth J, Thomas KP, Slater LA, et al. Changing trends in the use of seizure prophylaxis after traumatic brain injury (...) Next: Transfer Patients with moderate or severe head injuries and head injuries with significant extracranial components are cared for best at a specialized trauma center. Previous Next: Deterrence/Prevention Reducing morbidity and mortality rates associated with head injuries is likely to be difficult. Violence, automobiles, and drug and alcohol use are prevalent. A study of community-based programs reported modest success, primarily by employing increased police surveillance and law enforcement

2014 eMedicine.com

4918. Assistive Devices to Improve Independence (Overview)

, female sex, cognitive impairment, poor self-rated health, low BMD, osteoporosis, inactivity, sedative use, alcohol use, and orthostatic hypotension. Extrinsic risk factors include adverse effects of medications, polypharmacy, and environmental hazards. Psychotropics, neuroleptics, tricyclic antidepressants, benzodiazepines, analgesics, sedatives, skeletal muscle relaxants, cardiac drugs (diuretics, antiarrhythmics), vasodilators, and antihistamines may contribute to falls. Results of studies suggest (...) that the risk of falls and fractures in elderly patients taking selective serotonin reuptake inhibitors (SSRIs) is not different from that of patients taking tricyclic antidepressants. The use of 4 or more medications of any type also increases the risk of falls. Fatigue induced by radiation therapy or chemotherapy also creates a risk of falls in an elderly patient with cancer. Environmental barriers include stairs, uneven footpaths, polished floors, thick mats or carpeting, and poor footwear choices (eg

2014 eMedicine.com

4919. Pyelonephritis, Acute (Follow-up)

be treated initially in the emergency department (ED) with vigorous oral or IV fluids, antipyretic pain medication, and a dose of parenteral antibiotics. Studies have shown that outpatient therapy for selected patients is as safe as inpatient therapy for a comparable group of patients and is much less expensive. Use analgesics as needed. Early in the course of the illness, parenteral analgesics are often necessary to reduce morbidity from symptoms. Nonsteroidal anti-inflammatory drugs and narcotics (...) have been frequently exposed to antibiotics (eg, solid-organ transplant and hematopoietic transplant patients) or are from institutional facilities are at a greater risk for infection with drug-resistant pathogens, such as extended-spectrum beta-lactamase–producing or carbapenemase-producing organisms. Oral versus parenteral administration Growing data suggest that oral antibiotic therapy, parenteral antibiotic therapy, and initial parenteral antibiotic therapy followed by oral antibiotic therapy

2014 eMedicine.com

4920. Amebiasis (Overview)

, MD Fellow, Department of Medicine, Division of Infectious Diseases, Medical University of South Carolina Disclosure: Nothing to disclose. Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Medscape Salary Employment Martin Weisse, MD Program Director, Associate Professor, Department of Pediatrics, West Virginia University Martin Weisse, MD is a member of the following medical (...) trophozoites and induced by serum. In an animal model, it was found to be involved in phagocytosis and to play a role as a virulence factor in amebic colitis. [ ] These findings suggest that TMKs such as EhTMKB1-9 may be attractive targets for future drug development. Epithelial cells also produce various inflammatory mediators, including IL-1β, IL-8, and cyclooxygenase (COX)-2, leading to the attraction of neutrophils and macrophages. [ , ] Corticosteroid therapy is known to worsen the clinical outcome

2014 eMedicine.com

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