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Defensive Medicine

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4941. Coal Worker's Pneumoconiosis (Diagnosis)

in a coal miner. of 2 Tables Contributor Information and Disclosures Author Farhan J Khan, MD Fellow in Pulmonary Disease, University of Tennessee Medical Center Farhan J Khan, MD 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. Chief Editor Zab Mosenifar, MD, FACP, FCCP Geri and Richard Brawerman Chair in Pulmonary and Critical Care Medicine, Professor and Executive Vice Chairman, Department of Medicine, Medical Director, Women's Guild Lung Institute, Cedars Sinai Medical Center, University of California, Los Angeles, David Geffen School of Medicine Zab Mosenifar, MD, FACP, FCCP is a member of the following medical societies: , , , Disclosure: Nothing to disclose. Additional Contributors Sat Sharma, MD, FRCPC

2014 eMedicine.com

4942. Clostridium Difficile Colitis (Diagnosis)

Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine BS Anand, MD is a member of the following medical societies: , , , Disclosure: Nothing to disclose. Acknowledgements Acknowledgments The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the US government. LCDR Jennifer Curry is a military service member. This work was prepared (...) a possible association between the use of proton pump inhibitors (PPIs) and the development of Clostridium difficile –associated diarrhea (CDAD). [ ] Data were collected from the US Food and Drug Administration’s (FDA's) Adverse Event Reporting System (AERS) and the medical literature for cases of CDAD in patients undergoing treatment with PPIs. Many of the adverse event reports involved patients who were elderly, had chronic and/or concomitant underlying medical conditions, or were taking broad-spectrum

2014 eMedicine.com

4943. Conversion Disorders (Diagnosis)

conversion disorder in terms of the freeze response and the appeasement defense behavior seen in animal subjects. [ ] The patient has been postulated to derive primary and secondary gain. With primary gain, the symptoms allow the patient to express the conflict that has been suppressed unconsciously. With secondary gain, symptoms allow the patient to avoid unpleasant situations or garner support from friends, family, and the medical system that would otherwise be unobtainable. According to sociocultural (...) of the following medical societies: , Disclosure: Received consulting fee from pfizer for speaking and teaching. Alexis Llewellyn, PhD Licensed Psychologist and Owner, Katy Center for Psychology and Counseling Services Alexis Llewellyn, PhD 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

2014 eMedicine.com

4944. Contact Dermatitis, Irritant (Diagnosis)

of the following medical societies: , , , Disclosure: Nothing to disclose. Paul Krusinski, MD Director of Dermatology, Fletcher Allen Health Care; Professor, Department of Internal Medicine, University of Vermont College of Medicine Paul Krusinski, MD is a member of the following medical societies: , , Disclosure: Nothing to disclose. Chief Editor 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. Additional Contributors Daniel J Hogan, MD Clinical Professor of Internal Medicine (Dermatology), Nova Southeastern University College of Osteopathic Medicine; Investigator, Hill Top Research, Florida Research Center Daniel J Hogan, MD is a member of the following medical societies: , , , Disclosure: Nothing to disclose. What would

2014 eMedicine.com

4945. Conjunctivitis, Bacterial (Diagnosis)

, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Received salary from Medscape for employment. for: Medscape. Chief Editor Andrew A Dahl, MD, FACS Assistant Professor of Surgery (Ophthalmology), New York College of Medicine (NYCOM); Director of Residency Ophthalmology Training, The Institute for Family Health and Mid-Hudson Family Practice Residency Program; Staff Ophthalmologist, Telluride Medical Center Andrew A Dahl, MD, FACS is a member (...) medical societies: Disclosure: Nothing to disclose. Coauthor(s) Barry A Weissman, OD, PhD, FAAO Professor of Optometry, Southern California College of Optometry; Professor Emeritus of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine Barry A Weissman, OD, PhD, FAAO 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

4946. Complement Receptor Deficiency (Diagnosis)

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) Isabelle Thomas, MD Associate Professor, Department of Dermatology, University of Medicine and Dentistry of New Jersey, New Jersey Medical (...) School; Chief of Dermatology Service, Veterans Affairs Medical Center of East Orange Isabelle Thomas, MD is a member of the following medical societies: , Disclosure: Nothing to disclose. Specialty Editor Board David F Butler, MD Former Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic David F Butler, MD is a member of the following medical

2014 eMedicine.com

4947. Complement Deficiencies (Diagnosis)

, MD 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. Chief Editor Michael A Kaliner, MD Clinical Professor of Medicine, George Washington University School of Medicine; Medical Director, Institute for Asthma (...) deficiencies has been established as a means to promote joint projects on treatment and prevention of diseases associated with defective complement function. Knowledge about the complement system is expanding. New studies point to the complex interplay between the complement cascade and adaptive immune response, and complement is also being studied in association with ischemic injury as a target of therapy. Although the complement system is part of the body's innate, relatively nonspecific defense against

2014 eMedicine.com

4948. Amyloidosis, overview

. Disease-modifying antirheumatic drugs (DMARDs) such as colchicine, a microtubule inhibitor and weak immunosuppressant, can prevent secondary renal failure due to amyloid deposition specifically in familial Mediterranean fever. Newer therapies have become more targeted to avoid the cytotoxicity of older agents (eg, chlorambucil, cyclophosphamide). The SAA amyloid seen in CAPS was reduced with a biologic interleukin (IL)–1β trap called rilonacept. Tumor necrosis factor–alpha (TNF-alpha) is also thought (...) antiretroviral therapy (HAART). [ ] Previous Next: Treatment of Amyloidosis Patisiran (Onpattro) was the first drug approved by the US Food and Drug Administration (FDA), in August 2018, for treatment of polyneuropathy caused by hereditary transthyretin-mediated amyloidosis (hATTR) in adults. The first of a new class of targeted RNA-based therapies, patisiran acts by using RNA to interfere with the production of mutant transthyretin (TTR) protein, thereby reducing serum TTR protein levels and TTR protein

2014 eMedicine.com

4949. Amyotrophic Lateral Sclerosis (Diagnosis)

secretions cannot be managed and who therefore cannot benefit from noninvasive ventilatory support (this occurs very rarely) Muscle relaxants to relieve spasticity The combination of dextromethorphan and quinidine (Nuedexta) to decrease emotional lability (pseudobulbar affect) Anticholinergics and sympathomimetics for sialorrhea Mucolytics for thickened secretions Lorazepam for anxiety Selective serotonin reuptake inhibitors (SSRIs) for depression Nonsteroidal anti-inflammatory drugs (NSAIDs), tramadol (...) in the lateral columns of the spinal cord as upper motor neuron (UMN) axons in these areas degenerate and are replaced by fibrous astrocytes (gliosis). ALS is a fatal disease, with a median survival period of 3 years from onset of weakness. [ ] (See Prognosis.) Aspiration pneumonia and medical complications of immobility contribute to morbidity in patients with the disease. ALS was first described in 1869 by the French neurologist Jean-Martin Charcot and hence is also known as Charcot disease; however

2014 eMedicine.com

4950. Amebiasis (Diagnosis)

, 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

4951. Alcoholic Hepatitis (Diagnosis)

of Gastroenterology and Hepatology, Veteran Affairs Medical Center Disclosure: Merck Honoraria Speaking and teaching; Ikaria Pharmaceuticals Honoraria Board membership 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 George Y Wu, MD, PhD Professor, Department of Medicine, Director, Hepatology Section, Herman Lopata Chair in Hepatitis Research, University (...) endoscopy and drug therapy, more invasive options, such as balloon tamponade, a transjugular intrahepatic portosystemic shunt, and an emergency portal-caval shunt, may be used. Hepatic encephalopathy The development of encephalopathy in patients with alcoholic hepatitis is invariably associated with a grave prognosis. Treatment consists of close monitoring of the patient and the administration of lactulose or nonabsorbable antibiotics. Low energy or low protein intake is not indicated, except

2014 eMedicine.com

4952. African Trypanosomiasis (Sleeping Sickness) (Diagnosis)

African trypanosomiasis, stage 1 - Pentamidine isethionate or suramin West African trypanosomiasis, stage 2 - Eflornithine and nifurtimox combination therapy or melarsoprol Fexinidazole is a promising new oral drug recently recommended by the European Medicines Agency for the treatment of both stages of West African trypanosomiasis. No vaccine is available for African trypanosomiasis. Chemoprophylaxis is unavailable. In both early- and late-stage trypanosomiasis, symptoms usually resolve after (...) , University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Received salary from Medscape for employment. for: Medscape. Chief Editor Pranatharthi Haran Chandrasekar, MBBS, MD Professor, Chief of Infectious Disease, Department of Internal Medicine, Wayne State University School of Medicine Pranatharthi Haran Chandrasekar, MBBS, MD is a member of the following medical societies: , , , Disclosure: Nothing to disclose. Additional Contributors Daniel R

2014 eMedicine.com

4953. Aggression (Diagnosis)

seizure disorder may complicate the clinical picture, especially if neuroleptic therapy appears to worsen the condition. Adverse drug effects, such as akathisia, may serve as stimuli for striking out. Antisocial personality traits may be the most important factor in some instances of patient violence in which goal-directed behavior, such as extortion of money or cigarettes, is evident. Comorbidities are common and it is often difficult to ascertain the principal cause of the aggressive behaviors (...) with schizophrenia living in the community usually would not fall into the persistently violent category, but they may present acutely with aggressive and violent behavior. This may be due to acute decompensation secondary to covert or overt noncompliance with psychotropic medication therapy. Decompensation also may be due to a failure of the current medication regimen. The clinical features expected would be a worsening of psychotic symptoms and, possibly, command hallucinations, although the importance

2014 eMedicine.com

4954. Adiposis Dolorosa (Diagnosis)

. Neoplasms of subcutaneous fat. Dermatology in General Medicine . 5th ed. New York, NY: McGraw-Hill; 1999. Vol 1: 1348-9. Bhandari R. Resident rounds: Part III. Calciphylaxis in the setting of non-hemodialysis, rapid weight loss, and mixed hyperparathyroidism. J Drugs Dermatol . 2014 Feb. 13(2):208-9. . Fagher B, Monti M, Nilsson-Ehle P, Akesson B. Fat-cell heat production, adipose tissue fatty acids, lipoprotein lipase activity and plasma lipoproteins in adiposis dolorosa. Clin Sci (Lond) . 1991 Dec. 81 (...) is a member of the following medical societies: , Disclosure: Nothing to disclose. Specialty Editor Board David F Butler, MD Former Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic David F Butler, MD is a member of the following medical societies: , , , , Disclosure: Nothing to disclose. Rosalie Elenitsas, MD Herman Beerman Professor of Dermatology

2014 eMedicine.com

4955. Acute Tubular Necrosis (Diagnosis)

of Medicine F John Gennari, MD is a member of the following medical societies: , , , , , , , and 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 What would you like to print? What would you like to print? Sections Acute Tubular Necrosis Find Us On About Membership WebMD Network Editions All material on this website (...) , hypertension, and chronic kidney disease Malignant hypertension Medications impairing the autoregulatory mechanism (eg, nonsteroidal anti-inflammatory drugs [NSAIDs]) Afferent glomerular vasoconstriction (eg, from sepsis, hypercalcemia, hepatorenal syndrome, cyclosporine/tacrolimus) Drugs blocking efferent arteriolar vasoconstriction - Angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARBs) Endotoxemia (sepsis)-related ATN Sepsis is a recognized cause of ATN. However

2014 eMedicine.com

4956. Acute Poliomyelitis (Diagnosis)

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. Kat Kolaski, MD Assistant Professor, Departments of Orthopedic Surgery and Pediatrics, Wake Forest University School of Medicine Kat Kolaski, MD is a member of the following medical societies: , Disclosure: Nothing to disclose. Chief Editor Stephen Kishner, MD, MHA (...) of the knee and hip due to iliotibial band contracture, by Souttar and Yount's release. of 3 Tables Contributor Information and Disclosures Author Christine L Munson, MD Franklin Medical Offices, Kaiser Permanente Christine L Munson, MD is a member of the following medical societies: , , , Disclosure: Nothing to disclose. Coauthor(s) Selina Yingqi Xing, MD, MS Staff Physician, Department of Physical Medicine and Rehabilitation, Temple University Selina Yingqi Xing, MD, MS is a member of the following

2014 eMedicine.com

4957. Dissociative Disorders (Diagnosis)

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. Chief Editor David Bienenfeld, MD Professor, Departments of Psychiatry and Geriatric Medicine, Wright State University, Boonshoft School of Medicine David Bienenfeld, MD is a member (...) as a vehicle to gain confidence in the patient. Self-hypnosis methods are available that help the patient apply some control over the pace and style of therapy. According to Freud, the unconscious is affected by external stimuli on many levels; therefore, the suggestions made by medical practitioners to their patients influence the processing of information, traumatic memories, and patients' perception of their own experiences. For this reason, hypnosis can be a valuable tool for helping heal the trauma

2014 eMedicine.com

4958. Duodenal Ulcers (Diagnosis)

Mutaz I Sultan, MBChB is a member of the following medical societies: and 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 Alan BR Thomson, MD Professor of Medicine, Division of Gastroenterology, University of Alberta, Canada Alan BR Thomson, MD is a member of the following medical societies: , , , , , , and Disclosure (...) successfully with cure of H pylori infection and/or avoidance of nonsteroidal anti-inflammatory drugs (NSAIDs), along with the appropriate use of antisecretory therapy. In the United States, the recommended primary therapy for H pylori infection is proton pump inhibitor (PPI)–based triple therapy. [ ] These regimens result in a cure of infection and ulcer healing in approximately 85-90% of cases. [ ] Ulcers can recur in the absence of successful H pylori eradication. (See .) In patients with NSAID

2014 eMedicine.com

4959. Dry Eye Syndrome (Diagnosis)

-in-Chief, Medscape Drug Reference Disclosure: Received salary from Medscape for employment. for: Medscape. Chief Editor Andrew A Dahl, MD, FACS Assistant Professor of Surgery (Ophthalmology), New York College of Medicine (NYCOM); Director of Residency Ophthalmology Training, The Institute for Family Health and Mid-Hudson Family Practice Residency Program; Staff Ophthalmologist, Telluride Medical Center Andrew A Dahl, MD, FACS is a member of the following medical societies: , , American Intraocular Lens (...) infiltration of the labial salivary glands Dysfunction of the immune system, as manifested by the presence of serum autoantibodies (eg, antinuclear antibody [ANA], rheumatoid factor [RF], and anti-Ro [SS-A] and anti-La [SS-B] antibodies) See for more detail. Management Early detection and aggressive treatment of dry eye disease, or keratoconjunctivitis sicca (KCS), may help prevent corneal ulcers and scarring. Pharmacologic therapy Lubricating supplements are the medications most commonly used to treat dry

2014 eMedicine.com

4960. Demodicosis (Diagnosis)

of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Received salary from Medscape for employment. for: Medscape. Christopher J Rapuano, MD Professor, Department of Ophthalmology, Sidney Kimmel Medical College of Thomas Jefferson University; Director of the Cornea Service, Co-Director of Refractive Surgery Department, Wills Eye Hospital Christopher J Rapuano, MD is a member of the following medical societies: , , , , , , Disclosure: Serve(d) as a director (...) or D brevis ), reduction of the superficial lipid layer of the tear film occurs. The effect of D brevis on the meibomian structure has been implicated in chalazion formation. Chalazia are granulomatous inflammation of the meibomian glands, made of an organized core of epithelioid cells and histocytes surrounded by fibroblasts, lymphocytes, and plasma cells. These defense cells encircle particles too large for normal macrophages to engulf. D brevis has been observed in the center of these meibomian

2014 eMedicine.com

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