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Defensive Medicine

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5041. Personality Disorders (Diagnosis)

is a member of the following medical societies: , , Disclosure: Nothing to disclose. Chief Editor Iqbal Ahmed, MBBS, FRCPsych(UK) Faculty, Department of Psychiatry, Tripler Army Medical Center; Clinical Professor of Psychiatry, Uniformed Services University of the Health Sciences; Clinical Professor of Psychiatry, Clinical Professor of Geriatric Medicine, University of Hawaii, John A Burns School of Medicine Iqbal Ahmed, MBBS, FRCPsych(UK) is a member of the following medical societies: , , , Royal (...) College of Psychiatrists, , Disclosure: Nothing to disclose. Acknowledgements Jerry Balentine, DO Professor of Emergency Medicine, New York College of Osteopathic Medicine; Executive Vice President, Chief Medical Officer, Attending Physician in Department of Emergency Medicine, St Barnabas Hospital Jerry Balentine, DO is a member of the following medical societies: , , , , and Disclosure: Nothing to disclose. Michael S Beeson, MD, MBA, FACEP Professor of Emergency Medicine, Northeastern Ohio

2014 eMedicine Emergency Medicine

5042. Paracoccidioidomycosis (Treatment)

Internal medicine specialist Dermatologist Surgeon Previous Next: Long-Term Monitoring During and after treatment for paracoccidioidomycosis with antifungal medications, patients must be regularly evaluated to ensure an adequate response to therapy and monitor for relapse. Complement fixation tests can be used to track the response to therapy; antibody levels decrease with improvement. Complement fixation also can be used to detect relapse because antibody levels increase again. The new antibody tests (...) ; Ortho McNeil Honoraria Speaking and teaching; Abbott Honoraria Speaking and teaching; Astellas Honoraria Speaking and teaching; Cubist Honoraria Speaking and teaching; Forest Pharmaceuticals Speaking and teaching Norman Levine, MD Private Practice, Tucson, AZ Norman Levine is a member of the following medical societies: Disclosure: Nothing to disclose. Jeffrey J Miller, MD Associate Professor of Dermatology, Pennsylvania State University College of Medicine; Staff Dermatologist, Pennsylvania State

2014 eMedicine.com

5043. Parasomnias (Treatment)

or no recall of dream imagery Amnesia for the episode The episodes cause significant distress or impairment in social, occupational or other areas of functioning The symptoms cannot be explained by another mental disorder, medical condition, or the effects of a drug of abuse or medication In addition, if warranted, the sleepwalking type can be further differentiated into 1 of 2 subtypes: With sleep-related eating (SRE) With sleep-related sexual behavior (sexsomnia) It was once theorized that sexsomnia (...) alleles is reported. DQB1 genes have also been implicated in narcolepsy and other disorders of motor control during sleep (eg, REM behavior disorder). Environmental factors Sleep deprivation, chaotic sleep schedules, fever, stress, magnesium deficiency, and chemical or drug intoxication (eg, alcohol) can trigger parasomnias. Various medications can also serve as triggers, including the following: Sedative-hypnotics (eg, zolpidem [ ] ) Combination of valproic acid and zolpidem [ ] Antidepressants (eg

2014 eMedicine.com

5044. Optic Atrophy (Treatment)

Amula, MBBS, DNB, FRCS(Glasg), FICO, FMRF 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. Chief Editor Edsel Ing, MD, MPH, FRCSC Associate Professor (...) , Department of Ophthalmology and Vision Sciences, University of Toronto Faculty of Medicine; Active Staff, Michael Garron Hospital (Toronto East Health Network); Consulting Staff, Hospital for Sick Children and Sunnybrook Hospital, Canada Edsel Ing, MD, MPH, FRCSC is a member of the following medical societies: , , , , , , Chinese Canadian Medical Society, European Society of Ophthalmic Plastic and Reconstructive Surgery, , , , Statistical Society of Canada Disclosure: Nothing to disclose. Additional

2014 eMedicine.com

5045. Plague (Treatment)

; Assistant Chief, Medicine Service, Oklahoma City Veterans Affairs Hospital Rhett L Jackson, MD, FACP 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. John L Brusch, MD, FACP Assistant Professor of Medicine, Harvard (...) Updated: Aug 15, 2017 Author: Venkat R Minnaganti, MD, FACP; Chief Editor: Michael Stuart Bronze, MD Share Email Print Feedback Close Sections Sections Plague Treatment Medical Care Updated (2014) guidelines on the diagnosis and treatment of bubonic plague have been published by the Infectious Diseases Society of America (IDSA) (see ). [ ] Precautions All patients with suspected plague and signs of pneumonia should be placed in strict respiratory isolation for 48-72 hours after antibiotic therapy

2014 eMedicine.com

5046. Phimosis, Adult Circumcision, and Buried Penis (Treatment)

intervention study in the Orange Farm township of South Africa. Medicine (Baltimore) . 2017 Jan. 96 (4):e5328. . . Kong X, Kigozi G, Ssekasanvu J, Nalugoda F, Nakigozi G, Ndyanabo A, et al. Association of Medical Male Circumcision and Antiretroviral Therapy Scale-up With Community HIV Incidence in Rakai, Uganda. JAMA . 2016 Jul 12. 316 (2):182-90. . . Kigozi G, Lukabwe I, Kagaayi J, Wawer MJ, Nantume B, Kigozi G, et al. Sexual satisfaction of women partners of circumcised men in a randomized trial of male (...) of Medicine Richard A Santucci, MD, FACS 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 Edward David Kim, MD, FACS Professor of Surgery, Division of Urology, University of Tennessee Graduate School

2014 eMedicine.com

5047. Overactive Bladder in Children (Treatment)

Overactive Bladder in Children (Treatment) Overactive Bladder in Children Treatment & Management: Approach Considerations, Behavioral Therapy, Medical Care Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache (...) children, particularly those who drink caffeinated or acidic fluids and those with increased fluid intake. Pharmacologic treatment is initiated if behavioral therapy fails or symptoms are severe. Surgical treatment may be considered if behavioral therapy and pharmacologic therapy fail. As with adults, older children often institute various coping strategies, including defensive voiding, toilet mapping, and restriction of fluid intake. Thus, the management of OAB must consider not only the detrusor

2014 eMedicine.com

5048. Rosacea (Overview)

of papulopustular rosacea: results of two randomized, double-blind, vehicle-controlled pivotal studies. J Drugs Dermatol . 2014 Mar. 13(3):316-23. . Allen KJ, Davis CL, Billings SD, Mousdicas N. Recalcitrant papulopustular rosacea in an immunocompetent patient responding to combination therapy with oral ivermectin and topical permethrin. Cutis . 2007 Aug. 80(2):149-51. . Forstinger C, Kittler H, Binder M. Treatment of rosacea-like demodicidosis with oral ivermectin and topical permethrin cream. J Am Acad (...) of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Received salary from Medscape for employment. for: Medscape. Christen M Mowad, MD Professor, Department of Dermatology, Geisinger Medical Center Christen M Mowad, 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

2014 eMedicine.com

5049. Rickettsialpox (Overview)

School of Medicine in Shreveport; Affiliate Staff Physician, Department of Internal Medicine (Infectious Disease), Schumpert Medical Center Mohammad J Alam, 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 (...) Pradeep Kumar Mada, MD, MRCP(UK) Fellow, Division of Infectious Disease, Louisiana State University School of Medicine in Shreveport Pradeep Kumar Mada, MD, MRCP(UK) is a member of the following medical societies: , , Royal College of Physicians and Surgeons of the United Kingdom Disclosure: Nothing to disclose. Coauthor(s) Mohammad J Alam, MD Assistant Professor of Medicine, Departments of Internal Medicine, Infectious Disease, and Emergency Medicine, University Health, Louisiana State University

2014 eMedicine.com

5050. Rhinoviruses (Overview)

Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University 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 Salary Employment Mary L Windle, PharmD Adjunct Associate Professor (...) , University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Nothing to disclose. Gordon L Woods, MD Consulting Staff, Department of Internal Medicine, University Medical Center Gordon L Woods, MD is a member of the following medical societies: Disclosure: Nothing to disclose. What would you like to print? What would you like to print? Sections Rhinovirus (RV) Infection (Common Cold) Find Us On About Membership WebMD Network Editions All material

2014 eMedicine.com

5051. Rheumatic Fever (Overview)

: , 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. Richard B Brown, MD, FACP Chief, Division of Infectious Diseases, Baystate Medical Center; Professor, Department of Internal Medicine, Tufts University School of Medicine Richard B Brown, MD, FACP is a member (...) and Disclosures Author Mark R Wallace, MD, FACP, FIDSA Clinical Professor of Medicine, Florida State University College of Medicine; Clinical Professor of Medicine, University of Central Florida College of Medicine Mark R Wallace, MD, FACP, FIDSA is a member of the following medical societies: , , , , , Florida Infectious Diseases Society Disclosure: Nothing to disclose. Coauthor(s) Larry I Lutwick, MD, FACP Editor-in-Chief, ID Cases; Moderator, Program for Monitoring Emerging Diseases; Adjunct Professor

2014 eMedicine.com

5052. Reticular Dysgenesis (Overview)

Employment David J Valacer, MD Consulting Staff, Hoffman La Roche Pharmaceuticals David J Valacer, MD is a member of the following medical societies: , , , , and Disclosure: Nothing to disclose. Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Nothing to disclose. Henry K Wong, MD, PhD Associate Professor of Dermatology, Ohio State University College of Medicine Henry K Wong, MD, PhD (...) , paraproteinemia, nephrotoxic drugs). †Withdrawn from US market on September 24, 2010, because of unexplained reports of thromboembolic events. 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

2014 eMedicine.com

5053. Scorpion Sting (Overview)

from: BTG International Inc. 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 Joe Alcock, MD, MS Associate Professor, Department of Emergency Medicine, University of New Mexico Health Sciences Center Joe Alcock, MD, MS is a member of the following medical societies: Disclosure (...) . Furthermore, patients in rural areas tend to fare worse than patients in urban areas because of the delay in getting medical help due to a longer travel time to medical centers and the lack of advanced medical treatments. [ ] Fortunately, better public education, improved control of the scorpion population, increased supportive therapies, more technologically advanced intensive care units and advances in immunotherapy have combined to produce a substantial decrease in mortality from these envenomations

2014 eMedicine.com

5054. Renal Disease and Pregnancy (Overview)

Professor of Medicine, Vice-Dean for Academic Affairs, Chief, Clinical Nephrology, Department of Medicine, Tulane University School of Medicine N Kevin Krane, MD, FACP 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 (...) of progression to preeclampsia are higher when hypertension develops before 35 weeks' gestation. Postpartum, women who have had gestational hypertension are at risk for developing chronic hypertension. In addition, children of these women may have higher blood pressures. Previous Next: Drug Therapy for Hypertension in Pregnancy The goal of drug therapy is to reduce fetal morbidity and mortality by preventing severe hypertension and/or preeclampsia. For mild hypertension, the central alpha agonist methyldopa

2014 eMedicine.com

5055. Viral Infections of the Mouth (Treatment)

the neoplastic cells. General medical care Establishing the diagnosis is important because the differential diagnoses include diseases that are conventionally treated with immunosuppressive agents. Immunosuppressive therapy may not be prudent for an active herpetic infection because it could promote dissemination. Herpesvirus infections may trigger erythema multiforme. If recurrences are common and debilitating, long-term suppressive antiviral therapy may reduce the recurrence of herpes and thus erythema (...) prophylactic antiviral medication may be indicated for patients who experience 6 or more recurrences a year or for patients who experience repeated bouts of erythema multiforme induced by herpes. [ ] Medical care for HHV-3 (varicella-zoster virus) Antiviral therapy is most effective in limiting the area of involvement and the duration of the symptoms if instituted within the first 48-72 hours. Acyclovir may control the size of the lesions, but it is less effective than valacyclovir or famciclovir

2014 eMedicine.com

5056. Viral Encephalitis (Treatment)

to disclose. Gisele Oliveira, MD Resident Physician, Department of Neurology, St Louis University School of Medicine Gisele Oliveira, 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 Stuart Bronze (...) information on these topics: Next: Antiviral Therapy Pharmacotherapy for HSE consists of acyclovir and vidarabine. Outcome is improved with either agent, but acyclovir is more effective and less toxic. Even if the final diagnosis of HSE has not been established, intravenous (IV) acyclovir should be initiated immediately. Acyclovir is also the drug of choice for varicella-zoster virus (VZV) encephalitis, although ganciclovir is also considered an alternative option. Ganciclovir has been used

2014 eMedicine.com

5057. Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis (Treatment)

of detachment in adults. [ , ] Given a mortality rate of approximately 30% in patients not infected with human immunodeficiency virus (HIV) with toxic epidermal necrolysis, cyclosporine may prove to be a life-saving therapy, but randomized, controlled trials are needed to make definitive recommendations. Other medications The tumor necrosis factor-alpha (TNF-α)‒blocking agent etanercept has demonstrated promising results in case reports and a case series. A single subcutaneous injection of 50 mg (...) Dermatologist, Insight Dermatology, San Diego, CA Kristina Marie Dela Rosa, 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 Jeffrey P Callen, MD Professor of Medicine (Dermatology), Chief

2014 eMedicine.com

5058. Sinusitis, Acute (Treatment)

. The purpose of surgical drainage is to enhance mucociliary flow and provide material for culture and sensitivity. A surgical means of sinus drainage should be used when appropriate medical therapy has failed to control the infection and prolonged or slowly resolving symptoms result or when complications of sinusitis occur. Another indication for sinus puncture is to obtain culture material to guide antibiotic selection if empiric therapy has failed or antibiotic choice is limited. This is particularly (...) therapy When episodes of sinusitis recur When symptoms persist after 2 courses of antibiotic therapy When comorbid immunodeficiency, nosocomial infection, or complications of sinusitis are present While in the emergency department and upon discharge, patients may obtain significant immediate relief with the administration of first-generation antihistamines, decongestants, and nonsteroidal anti-inflammatory drugs (NSAIDs). Recommendations for nonantimicrobial therapy Intranasal steroids have not been

2014 eMedicine.com

5059. Shock and Pregnancy (Treatment)

include supine position, hypovolemia, sepsis, and medications. Vasoconstriction of the uterine arteries occurs in preeclampsia [ ] or with vasoconstrictor drugs, and the fetal blood flow may decrease by as much as 20% with vasoconstriction. The umbilical vein PaO 2 is approximately 35-40 mm Hg because it is mixed with deoxygenated blood in the fetal inferior vena cava. This level of PaO 2 is sufficient to saturate fetal hemoglobin to 80-85% because of the left shift in the oxyhemoglobin dissociation (...) cardiac disease, acute respiratory distress syndrome (ARDS), septic shock, and AFE. In normal pregnancy, the cardiac output increases as much as 30-50%, as compared to prepregnancy levels, but the cardiac filling pressures are unchanged. Drug therapy For sedation, meperidine and fentanyl are commonly used; experience with propofol is limited. Benzodiazepines may be used, but these may have depressive effects on fetal respiration. A patient who is critically ill and in shock requires vasoactive drugs

2014 eMedicine.com

5060. Sexual and Gender Identity Disorders (Treatment)

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 Brenda Williams-Wilson, MD Assistant Professor, Department of Medicine, Section of Psychiatry, University of Tennessee School of Medicine at Knoxville Disclosure: Nothing to disclose. What would you like to print? What would you (...) Mohammed A Memon, MD is a member of the following medical societies: , , Disclosure: Nothing to disclose. Chief Editor Glen L Xiong, MD Associate Clinical Professor, Department of Psychiatry and Behavioral Sciences, Department of Internal Medicine, University of California, Davis, School of Medicine; Medical Director, Sacramento County Mental Health Treatment Center Glen L Xiong, MD is a member of the following medical societies: , , , Central California Psychiatric Society Disclosure: Serve(d

2014 eMedicine.com

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