Allergic rhinitis is an IgE-mediated inflammatory response in the nose to foreign substances known as allergens. It can be classified as seasonal or perennial, depending on the allergens triggering the reaction. This characterization is good for identifying allergen triggers but is limited because it is based on the duration of outdoor exposure (e.g., grass pollinates for 2 months in Chicago and nearly 11 months in Texas). Also, some perennial allergens, such as dust mites, have seasons. The Allergic Rhinitis in Asthma (ARIA) classification was developed to focus on therapy. It assumes that exposure to perennial and to seasonal allergen leads to the same immunologic response. ARIA places patients into the categories of mild intermittent, mild persistent, moderate/severe intermittent, and moderate/severe persistent to recommend treatment and emphasizes the link between allergic rhinitis and asthma.1 This review contains 5 figures, 12 tables, and 59 references. Key Words: Sinusitis, infection, allergy, antibiotic, decongestant, antihistamine
{"title":"Allergic Rhinitis, Conjunctivitis, and Sinusitis","authors":"R. Naclerio","doi":"10.2310/OT.1083","DOIUrl":"https://doi.org/10.2310/OT.1083","url":null,"abstract":"Allergic rhinitis is an IgE-mediated inflammatory response in the nose to foreign substances known as allergens. It can be classified as seasonal or perennial, depending on the allergens triggering the reaction. This characterization is good for identifying allergen triggers but is limited because it is based on the duration of outdoor exposure (e.g., grass pollinates for 2 months in Chicago and nearly 11 months in Texas). Also, some perennial allergens, such as dust mites, have seasons. The Allergic Rhinitis in Asthma (ARIA) classification was developed to focus on therapy. It assumes that exposure to perennial and to seasonal allergen leads to the same immunologic response. ARIA places patients into the categories of mild intermittent, mild persistent, moderate/severe intermittent, and moderate/severe persistent to recommend treatment and emphasizes the link between allergic rhinitis and asthma.1\u0000\u0000This review contains 5 figures, 12 tables, and 59 references.\u0000Key Words: Sinusitis, infection, allergy, antibiotic, decongestant, antihistamine\u0000 ","PeriodicalId":11220,"journal":{"name":"DeckerMed Medicine","volume":"91 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79953742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Vaccines and Vaccination","authors":"L. Obradovich, N. Issa","doi":"10.2310/TYWC.1316","DOIUrl":"https://doi.org/10.2310/TYWC.1316","url":null,"abstract":"<jats:p />","PeriodicalId":11220,"journal":{"name":"DeckerMed Medicine","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79178843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In the United States, lung cancer is the second most common cancer, surpassed only by prostate cancer in men and breast cancer in women. But lung cancer is the leading cause of cancer deaths, accounting for 29% and 26% of all cancer-related deaths in men and women, respectively. The four major pathologic cell types of lung cancer are small cell carcinoma, adenocarcinoma, squamous cell carcinoma, and large cell carcinoma. Because they have overlapping clinical behaviors and responses to treatment, adenocarcinoma, squamous cell carcinoma, and large cell carcinoma are generally grouped together in the category of non–small cell lung cancer (NSCLC). This review discusses both NSCLC and small cell lung cancer (SCLC), including lung cancer in those who have never smoked, prevention of lung cancer, with sections on diagnosis, biomarkers, treatment, and supportive care. This review contains 7 figures, 10 tables, and 81 references. Keywords: lung cancer, mediastinoscopy, chemoradiotherapy, TNM staging system, pulmonary parenchyma, segmentectomy
{"title":"Lung Cancer - Part I","authors":"J. Crawford, J. Strickler","doi":"10.2310/FM.1184","DOIUrl":"https://doi.org/10.2310/FM.1184","url":null,"abstract":"In the United States, lung cancer is the second most common cancer, surpassed only by prostate cancer in men and breast cancer in women. But lung cancer is the leading cause of cancer deaths, accounting for 29% and 26% of all cancer-related deaths in men and women, respectively. The four major pathologic cell types of lung cancer are small cell carcinoma, adenocarcinoma, squamous cell carcinoma, and large cell carcinoma. Because they have overlapping clinical behaviors and responses to treatment, adenocarcinoma, squamous cell carcinoma, and large cell carcinoma are generally grouped together in the category of non–small cell lung cancer (NSCLC). This review discusses both NSCLC and small cell lung cancer (SCLC), including lung cancer in those who have never smoked, prevention of lung cancer, with sections on diagnosis, biomarkers, treatment, and supportive care. \u0000This review contains 7 figures, 10 tables, and 81 references.\u0000Keywords: lung cancer, mediastinoscopy, chemoradiotherapy, TNM staging system, pulmonary parenchyma, segmentectomy","PeriodicalId":11220,"journal":{"name":"DeckerMed Medicine","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91093889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Drug overdose and poisoning are leading causes of emergency department visits and hospital admissions in the United States, accounting for more than 500,000 emergency department visits and 11,000 deaths each year. This chapter discusses the approach to the patient with poisoning or drug overdose, beginning with the initial stabilization period in which the physician proceeds through the ABCDs (airway, breathing, circulation, dextrose, decontamination) of stabilization. The management of some of the more common complications of poisoning and drug overdose are summarized and include coma, hypotension and cardiac dysrhythmias, hypertension, seizures, hyperthermia, hypothermia, and rhabdomyolysis. The physician should also perform a careful diagnostic evaluation that includes a directed history, physical examination, and the appropriate laboratory tests. The next step is to prevent further absorption of the drug or poison by decontaminating the skin or gastrointestinal tract and, possibly, by administering antidotes and performing other measures that enhance elimination of the drug from the body. The diagnosis and treatment of overdoses of a number of specific drugs and poisons that a physician may encounter, as well as food poisoning and smoke inhalation, are discussed. Tables present the ABCDs of initial stabilization of the poisoned patient; mechanisms of drug-induced hypotension; causes of cardiac disturbances; drug-induced seizures; drug-induced hyperthermia; autonomic syndromes induced by drugs or poison; the use of the clinical laboratory in the initial diagnosis of poisoning; methods of gastrointestinal decontamination; methods of and indications for enhanced drug removal; toxicity of common beta blockers; common stimulant drugs; corrosive agents; dosing of digoxin-specific antibodies; poisoning with ethylene glycol or methanol; manifestations of excessive acetylcholine activity; common tricyclic and other antidepressants; seafood poisonings; drugs or classes that require activated charcoal treatment; and special circumstances for use of activated charcoal. This review contains 3 figures, 22 tables, and 198 references.
{"title":"Management of Poisoning and Drug Overdose","authors":"T. Wiegand, Manish M. Patel, K. Olson","doi":"10.2310/IM.1038","DOIUrl":"https://doi.org/10.2310/IM.1038","url":null,"abstract":"Drug overdose and poisoning are leading causes of emergency department visits and hospital admissions in the United States, accounting for more than 500,000 emergency department visits and 11,000 deaths each year. This chapter discusses the approach to the patient with poisoning or drug overdose, beginning with the initial stabilization period in which the physician proceeds through the ABCDs (airway, breathing, circulation, dextrose, decontamination) of stabilization. The management of some of the more common complications of poisoning and drug overdose are summarized and include coma, hypotension and cardiac dysrhythmias, hypertension, seizures, hyperthermia, hypothermia, and rhabdomyolysis. The physician should also perform a careful diagnostic evaluation that includes a directed history, physical examination, and the appropriate laboratory tests. The next step is to prevent further absorption of the drug or poison by decontaminating the skin or gastrointestinal tract and, possibly, by administering antidotes and performing other measures that enhance elimination of the drug from the body. The diagnosis and treatment of overdoses of a number of specific drugs and poisons that a physician may encounter, as well as food poisoning and smoke inhalation, are discussed. Tables present the ABCDs of initial stabilization of the poisoned patient; mechanisms of drug-induced hypotension; causes of cardiac disturbances; drug-induced seizures; drug-induced hyperthermia; autonomic syndromes induced by drugs or poison; the use of the clinical laboratory in the initial diagnosis of poisoning; methods of gastrointestinal decontamination; methods of and indications for enhanced drug removal; toxicity of common beta blockers; common stimulant drugs; corrosive agents; dosing of digoxin-specific antibodies; poisoning with ethylene glycol or methanol; manifestations of excessive acetylcholine activity; common tricyclic and other antidepressants; seafood poisonings; drugs or classes that require activated charcoal treatment; and special circumstances for use of activated charcoal.\u0000This review contains 3 figures, 22 tables, and 198 references.","PeriodicalId":11220,"journal":{"name":"DeckerMed Medicine","volume":"39 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82437578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chronic hepatitis B virus (HBV) infection is a major health burden worldwide, with approximately 257 million people with chronic infection. HBV is a small partially double-stranded DNA virus that replicates within the nucleus of the hepatocyte and commonly leads to chronic infection. Chronic HBV infection can cause cirrhosis, hepatocellular carcinoma, and extrahepatic manifestations such as glomerulonephritis or vasculitis. The latter is due to deposition of circulating immune complex in the different tissues. The natural history of HBV infection can be conceptualized as a spectrum encompassing different phases, including immune tolerance, immune clearance, inactive carrier, and reactivation and resolution. The diagnosis of the different phases of chronic HBV infection relies on various HBV serologies, liver enzyme levels, and histology findings. There are currently eight therapies approved for the treatment of HBV. Tenofovir alafenamide was the most recently approved therapy with a better side effect profile compared with tenofovir disoproxil fumarate. With the recent advances in the basic research in hepatitis B, new treatment options may become available in the near-future. This review contains 9 figures, 11 tables and 80 references Key words: cirrhosis, entecavir, Hepadnaviridae, hepatitis B virus, hepatocellular carcinoma, precore mutation, tenofovir
{"title":"Hepatitis B Virus","authors":"M. Lin, A. Wall","doi":"10.2310/im.5483","DOIUrl":"https://doi.org/10.2310/im.5483","url":null,"abstract":"Chronic hepatitis B virus (HBV) infection is a major health burden worldwide, with approximately 257 million people with chronic infection. HBV is a small partially double-stranded DNA virus that replicates within the nucleus of the hepatocyte and commonly leads to chronic infection. Chronic HBV infection can cause cirrhosis, hepatocellular carcinoma, and extrahepatic manifestations such as glomerulonephritis or vasculitis. The latter is due to deposition of circulating immune complex in the different tissues. The natural history of HBV infection can be conceptualized as a spectrum encompassing different phases, including immune tolerance, immune clearance, inactive carrier, and reactivation and resolution. The diagnosis of the different phases of chronic HBV infection relies on various HBV serologies, liver enzyme levels, and histology findings. There are currently eight therapies approved for the treatment of HBV. Tenofovir alafenamide was the most recently approved therapy with a better side effect profile compared with tenofovir disoproxil fumarate. With the recent advances in the basic research in hepatitis B, new treatment options may become available in the near-future.\u0000This review contains 9 figures, 11 tables and 80 references\u0000Key words: cirrhosis, entecavir, Hepadnaviridae, hepatitis B virus, hepatocellular carcinoma, precore mutation, tenofovir","PeriodicalId":11220,"journal":{"name":"DeckerMed Medicine","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89788692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The rheumatic diseases encompass a broad spectrum of conditions that include inflammatory, metabolic, and structural diseases of the joints and adjacent musculoskeletal structures, chronic musculoskeletal pain syndromes, and a wide range of systemic autoimmune and autoinflammatory diseases that may or may not have articular manifestations. This review contains 4 figures, 13 tables, and 28 references. Key Words osteoarthritis, rheumatoid arthritis, systemic lupus erythematosus, fibromyalgia, acute monoarthritis, Ankylosing spondylitis, nonradiographic axial spondyloarthritis, gouty arthritis, lupus nephritis
{"title":"Introduction to the Patient with Rheumatic Disease","authors":"D. Fox","doi":"10.2310/FM.1011","DOIUrl":"https://doi.org/10.2310/FM.1011","url":null,"abstract":"The rheumatic diseases encompass a broad spectrum of conditions that include inflammatory, metabolic, and structural diseases of the joints and adjacent musculoskeletal structures, chronic musculoskeletal pain syndromes, and a wide range of systemic autoimmune and autoinflammatory diseases that may or may not have articular manifestations.\u0000\u0000This review contains 4 figures, 13 tables, and 28 references.\u0000Key Words osteoarthritis, rheumatoid arthritis, systemic lupus erythematosus, fibromyalgia, acute monoarthritis, Ankylosing spondylitis, nonradiographic axial spondyloarthritis, gouty arthritis, lupus nephritis","PeriodicalId":11220,"journal":{"name":"DeckerMed Medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89841915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Despite mammoth efforts toward the treatment and prevention of substance use disorders in the United States over the past 30 years, they remain a significant public health concern and an all-too-common comorbidity among people with other forms of mental illness. Continued research into genetics, pharmacotherapies, psychotherapies, and epidemiology for substance use disorders results in huge amounts of new information for clinicians to assimilate each year. This review summarizes current diagnostic and categorical standards in substance use disorders, epidemiology, genetic and physiologic factors in addiction for each class, clinically relevant laboratory testing, evidence-based treatments, and prognostic considerations in substance use disorders. Specifically, sections cover cannabinoids, hallucinogens, opioids, sedatives, and stimulants. This review contains 3 figures, 6 tables and 60 references Key words: benzodiazepines, cannabis, drug dependence, hallucinogens, MDMA, substance abuse, substance dependence, synthetic cannabinoids
{"title":"Clinical Management of Drug Use Disorders","authors":"A. Thompson, T. Ando, James S. Jackson","doi":"10.2310/CANNABIS.13042","DOIUrl":"https://doi.org/10.2310/CANNABIS.13042","url":null,"abstract":"Despite mammoth efforts toward the treatment and prevention of substance use disorders in the United States over the past 30 years, they remain a significant public health concern and an all-too-common comorbidity among people with other forms of mental illness. Continued research into genetics, pharmacotherapies, psychotherapies, and epidemiology for substance use disorders results in huge amounts of new information for clinicians to assimilate each year. This review summarizes current diagnostic and categorical standards in substance use disorders, epidemiology, genetic and physiologic factors in addiction for each class, clinically relevant laboratory testing, evidence-based treatments, and prognostic considerations in substance use disorders. Specifically, sections cover cannabinoids, hallucinogens, opioids, sedatives, and stimulants.\u0000This review contains 3 figures, 6 tables and 60 references\u0000Key words: benzodiazepines, cannabis, drug dependence, hallucinogens, MDMA, substance abuse, substance dependence, synthetic cannabinoids","PeriodicalId":11220,"journal":{"name":"DeckerMed Medicine","volume":"44 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90336247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Salmonella, which is acquired via ingestion, is classified as nontyphoidal or typhoidal disease. Typhoidal disease is caused by S typhi or S paratyphi, and nontyphoidal disease is caused by all other serovars. Salmonella causes a range of infectious syndromes that include gastroenteritis, bacteremia, endovascular infections, and enteric fever. For immunocompromised hosts or patients with extraintestinal disease, antibiotic therapy should be provided. Effective agents often include third-generation cephalosporins and fluoroquinolones, although rates of resistance of Salmonella isolates to many antibiotics are increasing. A carrier state exists whereby patients may shed bacteria despite being asymptomatic. To eradicate the carrier state, longer courses of antibiotics and, in rare instances, surgical removal of the reservoir, which is most commonly the gallbladder, may be required. This review contains 2 figures, 4 tables, and 24 references. Key Words: Salmonella, typhoidal, non-typhoidal, enteric fever, endovascular infection, gastroenteritis, carrier, food-borne, antibiotic resistance
{"title":"Infections Due to Salmonella","authors":"M. Goldberg, Molly L. Paras","doi":"10.2310/IM.1482","DOIUrl":"https://doi.org/10.2310/IM.1482","url":null,"abstract":"Salmonella, which is acquired via ingestion, is classified as nontyphoidal or typhoidal disease. Typhoidal disease is caused by S typhi or S paratyphi, and nontyphoidal disease is caused by all other serovars. Salmonella causes a range of infectious syndromes that include gastroenteritis, bacteremia, endovascular infections, and enteric fever. For immunocompromised hosts or patients with extraintestinal disease, antibiotic therapy should be provided. Effective agents often include third-generation cephalosporins and fluoroquinolones, although rates of resistance of Salmonella isolates to many antibiotics are increasing. A carrier state exists whereby patients may shed bacteria despite being asymptomatic. To eradicate the carrier state, longer courses of antibiotics and, in rare instances, surgical removal of the reservoir, which is most commonly the gallbladder, may be required. \u0000This review contains 2 figures, 4 tables, and 24 references.\u0000Key Words: Salmonella, typhoidal, non-typhoidal, enteric fever, endovascular infection, gastroenteritis, carrier, food-borne, antibiotic resistance","PeriodicalId":11220,"journal":{"name":"DeckerMed Medicine","volume":"45 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75374033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The essential feature of effective antibiotic agents is the ability to inhibit the growth of microorganisms at concentrations tolerated by the host. Antibiotic agents generally target anatomic structures or biosynthetic pathways unique to bacteria. The appropriate choice of an antibiotic for an infection depends on the following: clinician’s level of suspicion; the infecting organism and its antibiotic susceptibilities; the type of infection; factors associated with specific antibiotic agents; host factors; and public health considerations. This review provides an overview of antibiotic therapy and covers identifying the cause of an infection, determination of bacterial susceptibility to specific drugs, site of infection and ancillary therapy, antibiotic drug targets, pharmacodynamic parameters, factors affecting dosage and route of administration, host factors, complications of antibiotic therapy, Clostridium difficile infection, and antimicrobial resistance. This review contains 2 figures, 7 tables, and 45 references. Key words: Antimicrobial therapy, antibiotic, infection, microorganism, renal dosing, hepatic dosing, Clostridium difficile
{"title":"General Principles of Antibiotic Therapy","authors":"A. Letourneau, M. Calderwood","doi":"10.2310/FM.1475","DOIUrl":"https://doi.org/10.2310/FM.1475","url":null,"abstract":"The essential feature of effective antibiotic agents is the ability to inhibit the growth of microorganisms at concentrations tolerated by the host. Antibiotic agents generally target anatomic structures or biosynthetic pathways unique to bacteria. The appropriate choice of an antibiotic for an infection depends on the following: clinician’s level of suspicion; the infecting organism and its antibiotic susceptibilities; the type of infection; factors associated with specific antibiotic agents; host factors; and public health considerations. This review provides an overview of antibiotic therapy and covers identifying the cause of an infection, determination of bacterial susceptibility to specific drugs, site of infection and ancillary therapy, antibiotic drug targets, pharmacodynamic parameters, factors affecting dosage and route of administration, host factors, complications of antibiotic therapy, Clostridium difficile infection, and antimicrobial resistance. \u0000This review contains 2 figures, 7 tables, and 45 references.\u0000Key words: Antimicrobial therapy, antibiotic, infection, microorganism, renal dosing, hepatic dosing, Clostridium difficile\u0000\u0000 ","PeriodicalId":11220,"journal":{"name":"DeckerMed Medicine","volume":"26 5-6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77832545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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