The Journal of family practice
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A mother brings her 5-year-old boy in to your office because she is concerned about a rash on his legs that seems to be worsening. She tells you that he had a runny nose and a mild cough a week earlier, but that those symptoms resolved before the rash developed. He has also complained of "belly pain." The boy's mother says he has been less active and more irritable since the onset of the rash, and that he is hardly eating. ⋯ Urinalysis shows moderate blood and trace protein. Laboratory results are otherwise normal. What's your diagnosis?
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DPN is a common complication of T2DM that often causes a pain syndrome. The diagnosis of DPNP centers around a careful history and physical examination, aided by the use of diagnostic tools, such as the 128-Hz tuning fork. A reduction in pain severity of 30% to 50% is achievable for most patients but generally requires combination therapy. ⋯ Of the adjuvant analgesics, the use of the tricyclic antidepressant and anticonvulsant groups is supported by the most extensive evidence. The selection of an adjuvant analgesic is often based on patient comorbidities and tolerability. Frequent follow-up is needed to optimize therapy.
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Despite the overall success in the fight against viral hepatitis, there remain racial, ethnic, and socioeconomic disparities in the incidence and prevalence of acute and chronic viral hepatitis, the outcomes of chronic viral hepatitis, and health care access and quality. Numerous federal and community initiatives are aimed at overcoming these discrepancies.