J Am Board Fam Med
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Adderall, consisting of a mixture of amphetamine salts and dextroamphetamine salts, is a prescription drug for attention deficit/hyperactivity disorder (ADHD) and narcolepsy. Labeled or unlabeled use of Adderall is gaining popularity among young children and college students. Although it is rare, Adderall use is associated with myocardial infarction and even sudden death. We report a case of a young man with acute myocardial infarction after taking 2 15-mg tablets of Adderall XR with alcohol and discuss the clinical features, diagnosis, and management of the cardiovascular effect of amphetamine-containing drugs.
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Complications of labor epidural anesthesia include a post-dural puncture headache (PDPH). A 2003 meta-analysis described the onset of PDPH as occurring from 1 to 7 days after the procedure. Presented here is the first published case of a PDPH occurring 12 days postpartum. ⋯ Described is the first reported case of a PDPH occurring well outside the normal range of onset 1 to 7 days after epidural anesthesia. The delayed diagnosis and treatment of PDPH in this patient illustrates the limitations of over-rigorous application of pooled analyses to the care of individual patients.
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In the United States, universal screening for group B streptococcal (GBS) colonization is recommended at 35 to 37 weeks' gestation. Previous studies have shown equivalent detection rates for GBS when women receive uniform instruction about specimen collection. It is unclear if these results would hold among patients with limited education given minimal, nonuniform instruction about collection technique. ⋯ Patient self-collection with minimal instruction is not inferior to physician collection of specimens at detecting GBS colonization in a majority Hispanic population of lower socioeconomic status.
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Numerous studies document disproportionate physical morbidity and premature death among people with serious mental illness. Although suicide remains an important cause of mortality for this population, cardiovascular disease is the leading cause of death. Cardiovascular death among those with serious mental illness is 2 to 3 times that of the general population. ⋯ A focus on primary care for the prevention of excess cardiometabolic morbidity and mortality in this population is appropriate, but depends on primary care physicians' understanding of the problem, involvement in the solutions, and collaboration with psychiatrists. We review health outcomes of the seriously mentally ill and models designed to improve these outcomes. We propose specific strategies for Family Medicine clinicians and researchers to address this problem.
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Chronic back pain is among the most common patient complaints. Its prevalence and impact have spawned a rapidly expanding range of tests and treatments. ⋯ The limited studies available suggest that these increases have not been accompanied by population-level improvements in patient outcomes or disability rates. We suggest a need for a better understanding of the basic science of pain mechanisms, more rigorous and independent trials of many treatments, a stronger regulatory stance toward approval and post-marketing surveillance of new drugs and devices for chronic pain, and a chronic disease model for managing chronic back pain.