Archive for May 13, 2013

Herpes zoster and postherpetic neuralgia – prevention and management.

Am Fam Physician. 2011 Jun 15;83(12):1432-7.

Fashner J, Bell AL.

Source

Saint Joseph Family Medicine Residency Program, South Bend, IN 46617, USA. fashnerj@sjrmc.com

Abstract

Herpes zoster (shingles) is diagnosed clinically by recognition of the distinctive, painful vesicular rash appearing in a unilateral, dermatomal distribution. An estimated 1 million cases occur in the United States each year, and increasing age is the primary risk factor. Laboratory testing, including polymerase chain reaction, can confirm atypical cases. Treatment with acyclovir, famciclovir, or valacyclovir decreases the duration of the rash. Adjunct medications, including opioid analgesics, tricyclic antidepressants, or corticosteroids, may relieve the pain associated with acute herpes zoster. There is conflicting evidence that antiviral therapy during the acute phase prevents postherpetic neuralgia. Postherpetic neuralgia in the cutaneous nerve distribution may last from 30 days to more than six months after the lesions have healed. Evidence supports treating postherpetic neuralgia with tricyclic antidepressants, gabapentin, pregabalin, long-acting opioids, or tramadol; moderate evidence supports the use of capsaicin cream or a lidocaine patch as a second-line agent. Immunization to prevent herpes zoster and postherpetic neuralgia is recommended for most adults 60 years and older.

PDF

http://www.aafp.org/afp/2011/0615/p1432.pdf

 

Summary for patients in

Am Fam Physician. 2011 Jun 15;83(12):1438.

PDF

http://www.aafp.org/afp/2011/0615/p1438.pdf

May 13, 2013 at 1:43 pm

Procalcitonin in young febrile infants for the detection of serious bacterial infections.

Pediatrics. 2008 Oct;122(4):701-10.

Maniaci V, Dauber A, Weiss S, Nylen E, Becker KL, Bachur R.

Source

Division of Emergency Medicine, Children’s Hospital Boston, Harvard Medical School, Boston, Massachusetts, USA.

Abstract

OBJECTIVES:

The objectives of the study were (1) to study the test performance of procalcitonin for identifying serious bacterial infections in febrile infants <or=90 days of age without an identifiable bacterial source and (2) to determine an optimal cutoff value to identify infants at low risk for serious bacterial infections.

METHODS:

A prospective observational study was performed with febrile infants <or=90 days of age presenting to an urban, pediatric, emergency department. Serum procalcitonin levels were measured by using an automated high-sensitivity assay. An optimal procalcitonin cutoff value was selected to maximize sensitivity and negative predictive value for the detection of serious bacterial infections. Infants were classified as having definite, possible, or no serious bacterial infections.

RESULTS:

A total of 234 infants (median age: 51 days) were studied. Thirty infants (12.8%) had definite serious bacterial infections (bacteremia: n = 4; bacteremia with urinary tract infections: n = 2; urinary tract infections: n = 24), and 12 infants (5.1%) had possible serious bacterial infections (pneumonia: n = 5; urinary tract infections: n = 7). Mean procalcitonin levels for definite serious bacterial infections (2.21 +/- 3.9 ng/mL) and definite plus possible serious bacterial infections (2.48 +/- 4.6 ng/mL) were significantly higher than that for no serious bacterial infection (0.38 +/- 1.0 ng/mL). The area under the receiver operating characteristic curve was 0.82 for definite serious bacterial infections and 0.76 for definite and possible serious bacterial infections. For identifying definite and possible serious bacterial infections, a cutoff value of 0.12 ng/mL had sensitivity of 95.2%, specificity of 25.5%, negative predictive value of 96.1%, and negative likelihood ratio of 0.19; all cases of bacteremia were identified accurately with this cutoff value.

CONCLUSIONS:

Procalcitonin has favorable test characteristics for detecting serious bacterial infections in young febrile infants. Procalcitonin measurements performed especially well in detecting the most serious occult infections.

PDF

http://pediatrics.aappublications.org/content/122/4/701.full.pdf+html

May 13, 2013 at 1:40 pm

Pertussis is a frequent cause of prolonged cough illness in adults and adolescents.

Clin Infect Dis. 2001 Jun 15;32(12):1691-7.

Senzilet LD, Halperin SA, Spika JS, Alagaratnam M, Morris A, Smith B; Sentinel Health Unit Surveillance System Pertussis Working Group.

Source

Bureau of Surveillance and Field Epidemiology, Laboratory Centre for Disease Control, Health Canada, Ottawa, Ontario, Canada.

Abstract

Although pertussis is increasingly recognized as a cause of prolonged cough illness in adolescents and adults, its prevalence is not well established. We evaluated pertussis infection in 442 adolescents and adults > or = 12 years old (mean age, 41.3 years) who had a cough-related illness of 7–56 days’ duration. For 4 patients (0.9%), results of nasopharyngeal culture or PCR were positive for Bordetella pertussis; for 10 patients (2.3%), either results of culture or PCR were positive or pertussis antibody titers increased 4-fold. Eighty-eight patients (19.9%) had either laboratory-confirmed pertussis or laboratory evidence of pertussis. These patients had significantly longer duration of cough than did patients without laboratory evidence of pertussis (56 days vs. 46 days), and more of them had vomiting with cough (45.5% vs. 28.5%, respectively). Pertussis is a common cause of prolonged cough illness in adolescents and adults and is frequently associated with other symptoms of whooping cough.

PDF

http://cid.oxfordjournals.org/content/32/12/1691.full.pdf+html

 

Comment in

Is pertussis a frequent cause of cough in adolescents and adults? Should routine pertussis immunization be recommended? [Clin Infect Dis. 2001]

PDF

http://cid.oxfordjournals.org/content/32/12/1698.full.pdf+html

May 13, 2013 at 1:38 pm

Clinical practice. Diverticulitis.

N Engl J Med. 2007 Nov 15;357(20):2057-66.

Jacobs DO.

Source

Department of Surgery, Duke University School of Medicine, and Duke University Hospital, Durham, NC, USA.

A previously healthy 45-year-old man presents with severe lower abdominal pain on the left side, which started 36 hours earlier. He has noticed mild, periodic discomfort in this region before but has not sought medical treatment. He reports nausea, anorexia, and vomiting associated with any oral intake. On physical examination, his temperature is 38.5°C and his heart rate is 110 beats per minute. He has abdominal tenderness on the left side without peritoneal signs. How should his case be managed?…..

PDF

http://www.nejm.org/doi/pdf/10.1056/NEJMcp073228

May 13, 2013 at 1:36 pm


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