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Defensive Medicine

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4961. Burns, Chemical (Diagnosis)

transplantation as an adjunct to medical therapy in acute ocular burns. Br J Ophthalmol . 2011 Feb. 95(2):199-204. . Kheirkhah A, Johnson DA, Paranjpe DR, Raju VK, Casas V, Tseng SC. Temporary sutureless amniotic membrane patch for acute alkaline burns. Arch Ophthalmol . 2008 Aug. 126(8):1059-66. . Jafarinasab MR, Feizi S, Javadi MA, Karimian F, Soroush MR. Lamellar keratoplasty and keratolimbal allograft for mustard gas keratitis. Am J Ophthalmol . 2011 Dec. 152(6):925-932.e2. . Takeda K, Nakamura T, Inatomi (...) Ventocilla, OD, FAAO is a member of the following medical societies: , Disclosure: Nothing to disclose. Specialty Editor Board Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine Simon K Law, MD, PharmD is a member of the following medical societies: , , Disclosure: Nothing to disclose. Christopher J Rapuano, MD Professor, Department of Ophthalmology, Sidney Kimmel

2014 eMedicine.com

4962. Candidiasis (Diagnosis)

that allow detection of both fungemia and tissue invasion by Candida species. Advances in medical technology, chemotherapeutics, cancer therapy, and organ transplantation have greatly reduced the morbidity and mortality of life-threatening disease. Patients who are critically ill and in medical and surgical ICUs have been the prime targets for opportunistic nosocomial fungal infections, primarily due to Candida species. Studies suggest that the problem is not under control and, in fact, show (...) Control and Prevention. Available at . March 29, 2019; Accessed: April 5, 2019. US Food and Drug Administration. FDA allows marketing of the first test to identify five yeast pathogens directly from a blood sample [news release.] September 22, 2014. Available at . Accessed: September 30, 2014. Brooks M. FDA clears rapid blood test for sepsis-causing pathogens. Medscape Medical News . September 23, 2014. . Alexander BD, Pfaller MA. Contemporary tools for the diagnosis and management of invasive mycoses

2014 eMedicine.com

4963. Candidiasis, Cutaneous (Diagnosis)

. 72(5):386-7. . Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L, et al. Executive Summary: Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis . 2016 Feb 15. 62 (4):409-17. . Del Rosso JQ, Kircik LH. Optimizing topical antifungal therapy for superficial cutaneous fungal infections: focus on topical naftifine for cutaneous dermatophytosis. J Drugs Dermatol . 2013 Nov 1. 12(11):s165-71 (...) 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. Paul Krusinski, MD Director of Dermatology, Fletcher Allen Health Care; Professor, Department of Internal Medicine, University

2014 eMedicine.com

4964. Perioperative Management of the Female Patient

to medications and the use of recreational drugs. Physical Examination The goal of the preoperative physical examination is to identify physical findings consistent with medical disease states. This examination is not designed to document the condition for which the surgical procedure is indicated but only to confirm the patient's history. An appropriate examination consists of the following: Vital signs – Blood pressure, pulse, respiratory rate, body temperature, height, and weight General – Body habitus (...) /disorder Severe malnutrition or malabsorption Procedure risk status III Medication levels See the list below: Commonly measured medications – , , (Dilantin), (Tegretol), , other antiarrhythmics Measurement of medication levels – Not required unless patient shows signs of inadequate therapy, adverse effects, a recent change in therapy, or a history of poor compliance Urinalysis See the list below: Proposed implantation of a device or instrumentation of the urinary tract Symptoms consistent with urinary

2014 eMedicine.com

4965. Astigmatism, Limbal Relaxing Incisions (Diagnosis)

Optometrist and Outcomes Analyst, Woolfson Eye Institute Debra M Stone, OD, MS is a member of the following medical societies: , Georgia Optometric Association Disclosure: Nothing to disclose. Specialty Editor Board Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine Simon K Law, MD, PharmD is a member of the following medical societies: , , Disclosure: Nothing (...) in type IV collagen fibers. The Descemet membrane acts as a defensive barrier against injury and infection. This layer is produced by the underlying endothelial cells and can be regenerated if injured. The endothelium is composed of a single layer of simple, cuboidal, and hexagonal cells that line the inner surface of the cornea. Endothelial cells are derived from the neural crest during development and are thought to be nonregenerative in humans. The natural tendency of nutrient-rich aqueous fluid

2014 eMedicine.com

4966. Astigmatism, Astigmatic Keratotomy (Diagnosis)

Optometrist and Outcomes Analyst, Woolfson Eye Institute Debra M Stone, OD, MS is a member of the following medical societies: , Georgia Optometric Association Disclosure: Nothing to disclose. Specialty Editor Board Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine Simon K Law, MD, PharmD is a member of the following medical societies: , , Disclosure: Nothing (...) in type IV collagen fibers. The Descemet membrane acts as a defensive barrier against injury and infection. This layer is produced by the underlying endothelial cells and can be regenerated if injured. The endothelium is composed of a single layer of simple, cuboidal, and hexagonal cells that line the inner surface of the cornea. Endothelial cells are derived from the neural crest during development and are thought to be nonregenerative in humans. The natural tendency of nutrient-rich aqueous fluid

2014 eMedicine.com

4967. Asthma (Diagnosis)

medications include short-acting bronchodilators, systemic corticosteroids, and ipratropium (Atrovent). The pharmacologic treatment of asthma is based on stepwise therapy. Asthma medications should be added or deleted as the frequency and severity of the patient's symptoms change. Allergen avoidance Environmental exposures and irritants can play a strong role in symptom exacerbations. The use of skin testing or in vitro testing to assess sensitivity to perennial indoor allergens is important. Once (...) , mediated via vagal or other neural reflexes, can significantly increase airway resistance and airway reactivity. Patients with asthma are 3 times more likely to also have GERD. [ ] Some people with asthma have significant gastroesophageal reflux without esophageal symptoms. Gastroesophageal reflux was found to be a definite asthma-causing factor (defined by a favorable asthma response to medical antireflux therapy) in 64% of patients; clinically silent reflux was present in 24% of all patients

2014 eMedicine.com

4968. Aspergillosis (Diagnosis)

; Editor-in-Chief, Medscape Drug Reference Disclosure: Received salary from Medscape for employment. for: Medscape. Chief Editor Guy W Soo Hoo, MD, MPH Clinical Professor of Medicine, University of California, Los Angeles, David Geffen School of Medicine; Director, Medical Intensive Care Unit, Pulmonary and Critical Care Section, West Los Angeles Healthcare Center, Veteran Affairs Greater Los Angeles Healthcare System Guy W Soo Hoo, MD, MPH is a member of the following medical societies (...) of therapy for suspected cases may be lifesaving Prophylactic antifungal therapy and the use of laminar airflow (LAF) or high-efficiency particulate air (HEPA) filtration of patient rooms can be effective Voriconazole – Drug of choice [ ] Posaconazole, amphotericin B, or amphotericin B lipid formulations – May be considered as empiric therapy in critically ill patients with possible mucormycosis Caspofungin – In patients who are unable to tolerate, or are resistant to, other therapies [ ] If possible

2014 eMedicine.com

4969. Bipolar Affective Disorder (Diagnosis)

bipolar disorder is diagnosed based on the patient’s history and clinical course, laboratory studies may be necessary to rule out other potential causes of the patient’s signs and symptoms as well as to have baseline results before administering certain medications. Laboratory tests that may be helpful include the following: CBC count ESR levels Fasting glucose levels Electrolyte levels Protein levels Thyroid hormone levels Creatinine and blood urea nitrogen levels Liver and lipid panel Substance (...) and alcohol screening Depending on the patient’s presentation, other laboratory tests may be indicated, which may include the following: Urinary copper levels Antinuclear antibody testing HIV testing VDRL testing Electrocardiography is important in elderly patients and before antidepressant therapy. Electroencephalography and/or MRI may be appropriate for selected patients. See for more detail. Management The treatment of bipolar disorder is directly related to the phase of the episode (ie, depression

2014 eMedicine.com

4970. Bronchiectasis (Diagnosis)

therapy with clarithromycin, rifampin, ethambutol Consider streptomycin as a possible fourth drug Continue therapy until the patient's culture results have been negative for 1 year The typical duration of therapy is 18-24 months Surgical resection of involved bronchiectatic sites is an important adjunct to therapy for patients with focal disease that is poorly controlled by antibiotics. Other indications for surgical intervention may include the following: Reduction of acute infective episodes (...) are readily available. Bronchiectasis remains a major cause of morbidity in less-developed countries, especially in countries with limited access to medical care and antibiotic therapy. [ , ] United States statistics Bronchiectasis is relatively uncommon in the United States, with a prevalence of approximately 100,000 cases, based on data from the 1980s. That said, the number of bronchiectasis cases in the United States associated with atypical mycobacteria or other environmental factors reportedly has

2014 eMedicine.com

4971. Breast Cancer Evaluation (Diagnosis)

), especially in patients who did not receive adjuvant chemotherapy. Prognosis has improved with the routine use of HER2-targeted therapies, which consist of the following: Trastuzumab – Monoclonal antibody Pertuzumab – Monoclonal antibody Lapatinib – A small-molecule oral tyrosine kinase inhibitor Neratinib – A small-molecule oral tyrosine kinase inhibitor Ado-trastuzumab emtansine – An antibody-drug conjugate directed specifically to the HER2 receptor HER2 status has also been shown to predict response (...) and possesses any of the following features, breast cancer may be present: Hardness Irregularity Focal nodularity Fixation to skin or muscle Screening Early detection remains the primary defense in preventing breast cancer. Screening modalities include the following: Breast self-examination Clinical breast examination Mammography Ultrasonography Magnetic resonance imaging Ultrasonography and MRI are more sensitive than mammography for invasive cancer in nonfatty breasts. Combined mammography, clinical

2014 eMedicine.com

4972. Breast Cancer (Diagnosis)

with the routine use of HER2-targeted therapies, which consist of the following: Trastuzumab – Monoclonal antibody Pertuzumab – Monoclonal antibody Lapatinib – A small-molecule oral tyrosine kinase inhibitor Neratinib – A small-molecule oral tyrosine kinase inhibitor Ado-trastuzumab emtansine – An antibody-drug conjugate directed specifically to the HER2 receptor HER2 status has also been shown to predict response to certain chemotherapeutic agents (eg, doxorubicin). Retrospectively analyzed results from (...) of the following features, breast cancer may be present: Hardness Irregularity Focal nodularity Fixation to skin or muscle Screening Early detection remains the primary defense in preventing breast cancer. Screening modalities include the following: Breast self-examination Clinical breast examination Mammography Ultrasonography Magnetic resonance imaging Ultrasonography and MRI are more sensitive than mammography for invasive cancer in nonfatty breasts. Combined mammography, clinical examination, and MRI

2014 eMedicine.com

4973. Brachial Plexus Injury (Diagnosis)

Athletics Thomas H Trojian, MD is a member of the following medical societies: , , , Disclosure: Nothing to disclose. Coauthor(s) Melissa Mascaro, MD Fellow in Sports Medicine, University of Connecticut School of Medicine 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 (...) funds from DJ Ortho for course funding; Received grant/research funds from Athletico Physical Therapy for course, research funding; Received royalty from Biomet, Inc. for consulting. Additional Contributors Janos P Ertl, MD Assistant Professor, Department of Orthopedic Surgery, Indiana University School of Medicine; Chief of Orthopedic Surgery, Wishard Hospital; Chief, Sports Medicine and Arthroscopy, Indiana University School of Medicine Janos P Ertl, MD is a member of the following medical

2014 eMedicine.com

4974. Blastomycosis (Diagnosis)

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 Basil Varkey, MD, FCCP Professor Emeritus, Department of Internal Medicine, Division of Pulmonary and Critical Care, Medical College of Wisconsin; Consulting Pulmonologist, Froedtert Memorial Lutheran Hospital Basil Varkey, MD, FCCP is a member of the following medical societies: and Disclosure (...) and Critical Care Medicine, UCLA Health Chidinma Chima-Melton, MD is a member of the following medical societies: , Disclosure: Nothing to disclose. Coauthor(s) Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation Russell W Steele, MD is a member of the following medical societies: , , , , , , , , Disclosure: Nothing to disclose. Chief Editor Zab Mosenifar, MD, FACP, FCCP Geri and Richard Brawerman Chair in Pulmonary and Critical Care

2014 eMedicine.com

4975. Brief Psychotic Disorder (Diagnosis)

A Memon, MD Psychiatrist/Geriatric Psychiatrist, Carolina Center for Behavioral Health; Assistant Professor of Psychiatry, Virginia Commonwealth University School of Medicine Mohammed A Memon, MD is a member of the following medical societies: , , Disclosure: Nothing to disclose. 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 of the following medical societies (...) : , , Disclosure: Nothing to disclose. Acknowledgements Harold H Harsch, MD Program Director of Geropsychiatry, Department of Geriatrics/Gerontology, Associate Professor, Department of Psychiatry and Department of Medicine, Froedtert Hospital, Medical College of Wisconsin Harold H Harsch, MD is a member of the following medical societies: Disclosure: lilly Honoraria Speaking and teaching; Forest Labs None None; Pfizer Grant/research funds Speaking and teaching; Northstar None None; Novartis Grant/research

2014 eMedicine.com

4976. Babesiosis (Diagnosis)

School of Medicine Russell W Steele, 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 Reference Salary Employment Martin Weisse, MD Program Director, Associate Professor, Department of Pediatrics, West Virginia University Martin Weisse, MD is a member of the following (...) in erythrocytes. Image courtesy of Centers for Disease Control and Prevention. Babesia species, tetrad formation. Image courtesy of Centers for Disease Control and Prevention. of 4 Tables Contributor Information and Disclosures Author Burke A Cunha, MD Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital Burke A Cunha, MD is a member of the following medical societies: , , Disclosure: Nothing to disclose. Chief

2014 eMedicine.com

4977. Bacterial Mouth Infections (Diagnosis)

diseases, such as diabetes mellitus, may increase the prevalence, incidence, or severity of gingivitis and periodontitis. Medications such as phenytoin, nifedipine, and cyclosporin are known to predispose to gingival overgrowth and to increase the severity of plaque formation. Immunosuppressive drug therapy and any disease (eg, HIV infection) resulting in suppression of the normal inflammatory and immune mechanisms can cause or enhance severe periodontal diseases. Smoking, which has an adverse effect (...) , and the appearance of disease states (eg, caries, periodontal disease). Systemic changes, such as pregnancy or drug intake, also alter the number and proportion of flora. These changes are due to alterations in the flow and composition of salivary fluid and in the levels and activity of defense components (eg, immunoglobulins, cytokines) in the saliva. Increasing evidence indicates that oral microbiota participate in various systemic diseases. Periodontal disease permits organisms to enter deep systemic tissues

2014 eMedicine.com

4978. Barrett Esophagus and Barrett Ulcer (Diagnosis)

of Gastroenterology, University of Arizona School of Medicine Ronnie Fass, MD is a member of the following medical societies: , , , , , and Disclosure: Takeda Pharmaceuticals Grant/research funds Conducting research; Takeda Pharmaceuticals Consulting fee Consulting; Takeda Pharmaceuticals Honoraria Speaking and teaching; Vecta Consulting fee Consulting; XenoPort Consulting fee Consulting; Eisai Honoraria Speaking and teaching; Wyeth Pharmaceuticals Conducting research; AstraZeneca Grant/research funds Conducting (...) . Dysplasia is the best histologic marker for cancer risk. The management options for high-grade dysplasia include the following: Surveillance endoscopy, with intensive biopsy at 3-month intervals until cancer is detected Endoscopic ablation: In most major medical centers, ablation is first-line therapy Surgical resection: While studies have shown surgery to be efficacious in the control of GERD symptoms, no good evidence indicates that surgical therapy provides regression in Barrett esophagus

2014 eMedicine.com

4979. Acrodermatitis Enteropathica (Diagnosis)

, University of Pennsylvania School of Medicine Edward F Chan, 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 (...) ) expressed herein are those of the authors and do not reflect the official policy or position of Naval Special Warfare Center, the U.S. Navy Medical Department, the U.S. Navy Office of the Surgeon General, the Department of the Navy, Department of Defense, or the U.S. Government. What would you like to print? What would you like to print? Sections Acrodermatitis Enteropathica Find Us On About Membership WebMD Network Editions All material on this website is protected by copyright, Copyright © 1994-2019

2014 eMedicine.com

4980. Actinomycosis (Diagnosis)

, Medscape Drug Reference Disclosure: Received salary from Medscape for employment. for: Medscape. Joseph F John, Jr, MD, FACP, FIDSA, FSHEA Clinical Professor of Medicine, Molecular Genetics and Microbiology, Medical University of South Carolina College of Medicine; Associate Chief of Staff for Education, Ralph H Johnson Veterans Affairs Medical Center Joseph F John, Jr, MD, FACP, FIDSA, FSHEA is a member of the following medical societies: Charleston County Medical Association, , South Carolina (...) courtesy of Paul Gibbs, MD. Actinomycosis in the endometrial tissue, high-power view. Image courtesy of Paul Gibbs, MD. of 2 Tables Contributor Information and Disclosures Author Jason F Okulicz, MD, FACP, FIDSA Director, HIV Medical Evaluation Unit, Infectious Disease Service, San Antonio Military Medical Center; Associate Professor of Medicine, F Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences; Clinical Associate Professor of Medicine, University of Texas Health

2014 eMedicine.com

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