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Molluscum Contagiosum and Warts - Article
ABSTRACT: Molluscum contagiosum and warts are benign epidermal eruptions resulting from viral infections of the skin. Molluscum contagiosum eruptions are usually self-limited and without sequelae, although they can be more extensive in immunocompromised persons. Spontaneous disappearance of lesions is the norm, but treatment by local destruction (curettage, cryotherapy, or trichloroacetic acid) or immunologic modulation can shorten the disease course, possibly reducing autoinoculation and transmission. Warts result from a hyperkeratotic reaction to human papillomavirus infection; nongenital warts are classified as common, periungual, flat, filiform, or plantar, based on location and shape. Warts are treated by local destruction (acids, cryotherapy, electrodesiccation-curettage), chemotherapy, or immunotherapy. The choice of treatment varies with the age and wishes of the patient, the potential side effects of the treatment, and the location of the lesions.
ABSTRACT: Multiple sclerosis, an idiopathic inflammatory disease of the central nervous system, is characterized pathologically by demyelination and subsequent axonal degeneration. The disease commonly presents in young adults and affects twice as many women as men. Common presenting symptoms include numbness, weakness, visual impairment, loss of balance, dizziness, urinary bladder urgency, fatigue, and depression. The diagnosis of multiple sclerosis should be made by a physician with experience in identifying the disease. Diagnosis should be based on objective evidence of two or more neurologic signs that are localized to the brain or spinal cord and are disseminated in time and space (i.e., occur in different parts of the central nervous system at least three months apart). Magnetic resonance imaging with gadolinium contrast, especially during or following a first attack, can be helpful in providing evidence of lesions in other parts of the brain and spinal cord. A second magnetic resonance scan may be useful at least three months after the initial attack to identify new lesions and provide evidence of dissemination over time. It is critical to exclude other diseases that can mimic multiple sclerosis, including vascular disease, spinal cord compression, vitamin B12 deficiency, central nervous system infection (e.g., Lyme disease, syphilis), and other inflammatory conditions (e.g., sarcoidosis, systemic lupus erythematosus, SjÃ¶gren's syndrome). Symptom-specific drugs can relieve spasticity, bladder dysfunction, depression, and fatigue. Five disease-modifying treatments for multiple sclerosis have been approved by the U.S. Food and Drug Administration. These treatments are partially effective in reducing exacerbations and may slow progression of disability.
ABSTRACT: Knee osteoarthritis is a common but often difficult problem to manage in primary care. Traditional nonsurgical management, consisting of lifestyle modification, physical therapy and pharmacologic therapy (e.g., analgesics, anti-inflammatory medications), is often ineffective or leaves residual symptoms. Viscosupplementation is a newly available option for patients with symptomatic knee osteoarthritis that involves a series of intra-articular injections of hyaluronic acid. The exact mechanism of action is unclear, although increasing the viscoelasticity of the synovial fluid appears to play a role. Clinical experience and studies of the two hyaluronic acid products available, hyaluronan and hylan G-F 20, are inconclusive but seem to indicate beneficial effects with minimal adverse reactions in a significant number of patients. The exact indications for viscosupplementation are still evolving, but it currently can be considered for use in patients who have significant residual symptoms despite traditional nonpharmacologic and pharmacologic treatments. In addition, patients who are intolerant of traditional treatments (e.g., gastrointestinal problems related to anti-inflammatory medications) can be considered for these injections. Family physicians with the ability to perform intra-articular knee injections should consider them an option in patients with symptomatic knee osteoarthritis.
Is Leflunomide as Safe and Effective in the Treatment of Rheumatoid Arthritis as Other DMARDs? - Cochrane for Clinicians