The American journal of medicine
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Sepsis is a clinical syndrome defined by a systemic response to infection. With progression to sepsis-associated organ failure (ie, severe sepsis) or hypotension (ie, septic shock) mortality increases. Sepsis is a cause of considerable mortality, morbidity, cost, and health care utilization. ⋯ Early identification of septic patients allows for evidence-based interventions, such as prompt antibiotics, goal-directed resuscitation, and activated protein C. Appropriate care for sepsis may be more easily delivered by dividing this clinical entity into various stages and with changes in structures of delivery that extend across traditional boundaries. Better description of the molecular basis of the disease process also will allow for more targeted therapies.
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Clinicians face a diagnostic challenge when a patient with the classic fever, pharyngitis, and lymphadenopathy triad of infectious mononucleosis has a negative "spot" heterophile antibody test. This screening test, although commonly considered sensitive for the presence of Epstein-Barr virus (EBV) infection, may be negative early after infection. ⋯ Other infectious and noninfectious disorders also may present in ways that mimic mononucleosis, but fail to generate EBV's archetypal triad of clinical findings. A systematic approach to the diagnosis of mononucleosis-like illnesses ensures that conditions warranting specific therapy are distinguished from others requiring only supportive care.
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Review
Optimizing treatment of chronic obstructive pulmonary disease: an assessment of current therapies.
Bronchodilators are the mainstay of chronic obstructive pulmonary disease (COPD) therapy. Inhaled short-acting beta2-agonists generally have a more rapid onset of effect and shorter duration of action than short-acting anticholinergic agents, and are usually prescribed as "rescue" medication to relieve acute bronchospasm. For patients with persistent symptoms, maintenance therapy with inhaled long-acting beta2-agonists is preferable to short-acting beta2-agonists because long-acting beta2-agonists provide more predictable, longer-lasting improvements in lung function. ⋯ Combining different classes of bronchodilators or combining a bronchodilator with a corticosteroid provides greater improvements in lung function and symptoms than the individual agents given alone. Nonpharmacologic interventions, including pulmonary rehabilitation, oxygen therapy, and surgery, can benefit patients at various stages of disease. A treatment algorithm that combines both pharmacologic and nonpharmacologic interventions for the management of COPD is presented.
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Anaphylaxis, an acute and potentially lethal multisystem allergic reaction, is almost unavoidable in medical practice. Physicians must be able to recognize anaphylaxis, treat it promptly and appropriately, and provide preventive recommendations. Epinephrine, which should be administered immediately, is the drug of choice for acute anaphylaxis.
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Chronic obstructive pulmonary disease (COPD) is a preventable and treatable systemic disease with symptoms that overlap other respiratory illnesses. An estimated 24 million adults in the United States have COPD, but >50% of them are misdiagnosed or undiagnosed. ⋯ Influenza vaccinations will also reduce acute respiratory illness in patients with COPD. With increasing awareness of COPD and earlier diagnosis, implementation of treatment guidelines and smoking-cessation efforts may lead to more effective management of this disease, which is projected to be the third leading cause of death in the United States by 2020.