Postgraduate medicine
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Postgraduate medicine · May 1996
ReviewBrain failure in older patients. Uncovering treatable causes of a diminished ability to think.
The term "brain failure" implies only dysfunction of a major organ system, not that an exact diagnosis has been made. Assessment and treatment of older patients with diminished cognitive ability can be challenging; however, the experience can also be extremely rewarding when a reversible condition is alleviated and the patient is given added years of productive life. The first step in patient evaluation is to rule out delirium. ⋯ Finally, extreme care must be taken in making the diagnosis of true dementia. Diagnosis of such a condition (eg, Alzheimer's disease, multi-infarct dementia, dementia of Parkinson's disease) has a profound effect on the patient and the family. These conditions are largely nontreatable, but physicians still have an important role in helping caregivers find appropriate assistance and support.
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Postgraduate medicine · May 1996
Hepatotoxic effects of tuberculosis therapy. A practical approach to a tricky management problem.
Side effects of the most commonly used first-line antituberculosis drugs range from minor gastrointestinal symptoms to severe hepatotoxicity. If unrecognized, they can lead to increased morbidity and mortality as well as to higher healthcare costs. ⋯ Recognition of this problem, mandatory directly observed therapy, judicious standardized follow-up planning, and implementation of modified treatment protocols when needed may play a dominant role in treating and controlling tuberculosis and may also prevent the morbidity and mortality sometimes associated with tuberculosis treatment. In view of the changing epidemiology of tuberculosis and its global impact, the American Thoracic Society and the Centers for Disease Control and Prevention may need to look closely into the issues outlined here to develop a consensus and establish more specific guidelines.