The Consultant 

About: The Consultant is an academic journal. The journal publishes majorly in the area(s): Migraine & Asthma. It has an ISSN identifier of 2048-6952. Over the lifetime, 354 publications have been published receiving 1418 citations.

Primary Biliary Cirrhosis

Abstract: The patient had xanthelasma palpebrarum (Figure 1). Xanthomas were noted on the palms and elbows (Figure 2) as well as the nape and left knee. The liver was 2 cm below the costal margin, firm, non-nodular, and nontender, with a span of 10 cm. There was no splenomegaly. Laboratory results showed markedly elevated levels of serum total cholesterol, 941.70 mg/dL; low-density lipoprotein (LDL), 890.73 mg/dL; alkaline phosphatase (ALP), 1301 U/L; alanine aminotransferase (ALT), 138 U/L; albumin, 2.2 g/L; and direct bilirubin, 2.40 mg/dL. The antimitochondrial antibody (AMA) titer was greater than 1:640. These findings suggested primary biliary cirrhosis (PBC). Results of abdominal ultrasonography, CT, and MRI were normal. The patient was treated with ursodiol (15 mg/kg/d in 3 divided doses).BILIARY CIRRHOSIS: AN OVERVIEW Biliary cirrhosis is an autoimmune liver disorder that generally results from injury to or prolonged obstruction of either the intrahepatic or extrahepatic biliary system. It also may be caused by impaired biliary excretion or destruction of small intrahepatic bile ducts and canals of Hering with progressive fibrosis.1,2 PBC is characterized by chronic inflammation as well as fibrous obliteration of the intrahepatic bile ducts; the disease is progressive and can lead to liver damage and ultimately liver failure. In

Diabetes and Mental Illness: Factors to Keep in Mind

Abstract: Persons with severe mental illnesses (SMI), such as schizophrenia, are at increased risk for comorbid conditions- including type 2 diabetes-independent of therapy. SMI sufferers especially at risk for type 2 diabetes are women, African Americans, and persons older than 45 years. Among the possible causes of increased susceptibility to type 2 diabetes are such schizophrenia-associated conditions as impaired glucose tolerance, overweight, obesity, inadequate nutrition, lack of exercise, and inadequate self-care. Other obstacles to good health care among patients with schizophrenia include impaired communication ability, denial of illness, social withdrawal, and undertreatment because of comorbid conditions. Different antipsychotic medications may also contribute to preexisting insulin resistance or glucose intolerance. Clinicians can optimize care by understanding the most significant barriers for each patient and incorporating this knowledge into an active treatment plan.

Subclinical hypothyroidism : When to treat, when to watch

Abstract: Subdinical hypothyroidism is associated with elevated low-density lipoprotein (LDL) cholesterol levels and several factors related to atherosderosis, including increased C-reactive protein levels and impaired endothelium-dependent vasodilatation. However, considerable controversy exists about screening for and treating this thyroid disorder. Thyroxine therapy lowers elevated LDL cholesterol levels in patients whose serum thyroid-simulating hormone (TSH) concentrations are higher than 10 mIU/L; thus, most experts recommend treatment for such patients. However, there is no consensus regarding the management of patients with TSH levels of less than 10 mIU/L Although the evidence supporting treatment of these patients is not compelling, it is reasonable to offer a therapeutic hid of thyroxine to those who have symptoms.

Update on rifampin and rifabutin drug interactions

Abstract: Rifampin is a potent inducer of cytochrome P-450 oxidative enzymes as well as the P-glycoprotein transport system. Several examples of well-documented clinically significant interactions include warfarin, oral contraceptives, cyclosporine, itraconazole, digoxin, verapamil, nifedipine, simvastatin, midazolam, and human immunodeficiency virus–related protease inhibitors. Rifabutin reduces serum concentrations of antiretroviral agents, but less so than rifampin. Examples of clinically relevant interactions demonstrated by recent reports include everolimus, atorvastatin, rosiglitazone/pioglitazone, celecoxib, clarithromycin, caspofungin, and lorazepam. To avoid a decreased therapeutic response, therapeutic failure, or toxic reactions when rifampin is added to or discontinued from medication regimens, clinicians need to be cognizant of these interactions. Studies and cases of rifampin drug interactions continue to increase rapidly. This review is a timely reminder to clinicians to be vigilant.

Necrotic Skin Lesions: Spider Bite—or Something Else?

Abstract: Most spider bites cause limited local tissue inflammation that con be managed with over-the-counter analgesics and antihistamines. Systemk symptoms are rare. However, severe black widow envenomotions are associated with involuntary muscular spasm, diaphoresis, and hypertension and can be mistaken for an acute abdomen or myocardial infarction. Although spider bites can produce dermonecrotic wounds, the differential diagnosis of such lesions is extensive. Most patients with alleged spider bites have bacterial cellulitis, which is often caused by community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA). The central necrosis of the CA-MRSA lesion, unlike that of brown recluse spider bite, is usually slightly raised from the surrounding skin, because of edema or an underlying abscess. Trimethoprim/sulfamethoxazole and either dindamycin or doxycycline is usually sufficient for outpatient treatment of CA-MRSA infection.