The American journal of the medical sciences
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(1) To determine 6-month follow-up adherence and persistence with disease-modifying antirheumatic drugs in patients with early rheumatoid arthritis with disease under control. (2) To compare disease flares across adherent, nonadherent, persistent and nonpersistent patients. (3) To identify differences in adherent and persistent rates among therapeutic regimens. (4) To identify baseline prognosticators of poor compliance. ⋯ Therapy behavior of patients with rheumatoid arthritis with mild/no disease activity and disability was poor and translated into disease flares. Higher serologic activity was associated to poor compliance with therapy.
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Clostridium difficile is the leading cause of hospital-acquired diarrhea in Europe and North America and is a serious reemerging pathogen. Recent outbreaks have led to increasing morbidity and mortality and have been associated with a new strain (BI/NAP1/027) of C difficile that produces more toxin than historic strains. With the increasing incidence of C difficile infection, clinicians have also seen a change in the epidemiology with increased infections in previously low-risk populations. This chapter highlights the current knowledge on C difficile virulence, human disease, epidemic outbreaks and optimal treatment strategies.
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A swine-origin H1N1 triple-reassortant influenza A virus found to be a distant relative of the 1918 "Spanish flu" virus emerged in April 2009 to give rise to the first influenza pandemic of the 21st century. Although disease was generally mild and similar to seasonal influenza, severe manifestations including respiratory failure were noted in some, particularly those with underlying conditions such as asthma, pregnancy and immunosuppression. Children and younger adults accounted for most cases, hospitalizations and deaths. ⋯ All 2009 H1N1 pandemic influenza strains were susceptible to 1 or more neuraminidase inhibitors. Monovalent, unadjuvanted 2009 H1N1 vaccines were licensed in the United States in September 2009 and initially targeted to younger individuals, pregnant women, caretakers of infants and healthcare providers. The 2009 H1N1 pandemic highlights the need for modernization of influenza vaccines, improved diagnostics and more rigorous evaluation of mitigation strategies.
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Meckel diverticulum is the most common congenital anomaly of the gastrointestinal tract. Its prevalence is approximately 2% of the general population. Complications because of Meckel diverticula are rare and almost nil beyond the age of 40 years. This report details the case of an 86-year-old patient with Meckel diverticulum that perforated because of a tumoral lesion at its apex, also known as volvulus of Meckel diverticulum.
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Review Case Reports
Hypokalemic thyrotoxic periodic paralysis with thyrotoxic psychosis and hypercapnic respiratory failure.
Thyrotoxic periodic paralysis is a rare and potentially lethal neuromuscular disease that manifests as recurrent episodic muscle weakness associated with hypokalemia and thyrotoxicosis. Paralysis can rarely involve respiratory muscles leading to acute respiratory failure. The disease primarily affects people of Asian descent, but it is being increasingly reported in other ethnic groups. We review the literature and report a case of hypokalemic thyrotoxic periodic paralysis manifesting as thyroid storm with episodic acute respiratory failure requiring recurrent intubation and eventually requiring thyroidectomy for resolution of symptoms.