The American journal of the medical sciences
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Major depressive disorder (MDD) is a common psychiatric illness affecting nearly 20% of adults in the United States at least once during their lifetime. MDD is frequently diagnosed and treated in the primary care setting. ⋯ This article presents an overview of diagnostic and treatment guidelines for MDD and focuses on challenges encountered by primary care physicians. The role of antidepressant medications, psychotherapy and nonpharmacologic interventions for the treatment of patients with MDD is described, and factors influencing treatment selection, such as adverse event profiles and patient characteristics, are examined.
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Review Historical Article
From laboratory to bedside: ethical, legal and social issues in translational research.
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Orthostatic hypotension is a decrease in systolic blood pressure of more than 20 mm Hg or a decrease in diastolic blood pressure of at least 10 mm Hg, within 3 minutes of changing from a supine to an upright position. The typical clinical presentation of orthostatic hypotension includes dizziness, syncope, blurry vision and loss of balance. ⋯ Thus, women less effectively compensate for the drop of blood pressure in response to positional change. An understanding of these mechanisms contributing to orthostatic hypotension may improve diagnosis and treatment of the problem.
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Case Reports
Headache, pituitary lesion and panhypopituitarism in a pregnant woman: tumor, apoplexy or hypophysitis?
Pituitary dysfunction during pregnancy and its differential diagnosis and treatment can be challenging, as illustrated by the following case. A 22-year-old woman underwent a C-section at 32 weeks of gestation because of preterm labor. She had headache, vision disturbance, polyuria, polydipsia, hypernatremia, diabetes insipidus and a pituitary lesion with findings compatible with apoplexy. ⋯ A follow-up magnetic resonance imaging 6 weeks later showed spontaneous regression of the abnormality and a normal-appearing pituitary gland. Thus, acute presentations of pituitary-based pathology during gestation can include previously unrecognized but enlarging tumors, apoplectic hemorrhage and necrosis, and the entity of lymphocytic hypophysitis. A careful evaluation of the clinical, biochemical and radiological characteristics is imperative for accurate diagnosis and proper management to ensure optimal obstetrical outcome.
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A 54-year-old man was brought to the emergency room after a head-on collision. He had multiple fractures in his lower extremities and required immediate surgery. After surgery, the patient had a persistent drop in hemoglobin, hematocrit and platelets despite red blood cell transfusions. ⋯ Both presentations have normal standard laboratory clotting tests, and the diagnosis requires an assay measuring factor XIII activity or antigen levels. The usual treatment includes cryoprecipitate, fresh-frozen plasma or recombinant factor XIII. This deficiency should be considered in patients with unexplained spontaneous, traumatic or postoperative bleeding.