American family physician
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American family physician · Dec 1990
Comparative StudyControversies in the treatment of streptococcal pharyngitis.
An increasing number of cases of sore throat caused by group A beta-hemolytic streptococci occur with concomitant colonization by organisms that may "protect" the streptococci through beta-lactamase inactivation of penicillin at the site of infection. The failure of penicillin to eradicate many of these bacteria, which include Staphylococcus aureus, Haemophilus influenzae, Moraxella (Branhamella) catarrhalis and a multitude of pharyngeal anaerobes, may help to explain why penicillin is sometimes ineffective for acute and recurrent group A streptococcal infections. Therapeutic alternatives currently include cephalosporins, erythromycin, rifampin combined with penicillin, amoxicillin/clavulanate potassium and others.
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American family physician · Nov 1990
ReviewPatient profiling: individualization of hypertension therapy.
Although the stepped-care approach remains the cornerstone of antihypertensive therapy, the patient's profile must also be considered. Important issues include the patient's age, race and activity level, potential for hypertensive complications, presence of other diseases, cost of medications and probability of adherence to the recommended drug regimen. Nonpharmacologic treatment based on lifestyle changes is a useful adjunct to drug therapy, but it is not sufficient to control hypertension in most patients. Selection of pharmacologic therapy must be based on a knowledge of each drug's mode of action and side effects, as well as the characteristics of special patient populations.
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Major depression is a syndrome that can be triggered by numerous physical and psychosocial factors. Concurrent somatic complaints can complicate the diagnosis. Patient evaluation requires a comprehensive history, physical and mental status examinations, and a number of laboratory studies. Effective treatment of depression enhances the quality of life, reduces the probability of secondary alcoholism or suicide, frequently improves coexisting medical problems and reduces the high rate of health care use by these patients.
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Regarded by many as a delicacy, puffer fish can be the source of lethal food poisoning in humans. The syndrome is caused by tetrodotoxin, one of the most potent poisons known. ⋯ Life support may be required. In some series, the mortality rate has approached 60 percent.