American family physician
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American family physician · Nov 1990
ReviewPatient profiling: individualization of hypertension therapy.
Although the stepped-care approach remains the cornerstone of antihypertensive therapy, the patient's profile must also be considered. Important issues include the patient's age, race and activity level, potential for hypertensive complications, presence of other diseases, cost of medications and probability of adherence to the recommended drug regimen. Nonpharmacologic treatment based on lifestyle changes is a useful adjunct to drug therapy, but it is not sufficient to control hypertension in most patients. Selection of pharmacologic therapy must be based on a knowledge of each drug's mode of action and side effects, as well as the characteristics of special patient populations.
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Major depression is a syndrome that can be triggered by numerous physical and psychosocial factors. Concurrent somatic complaints can complicate the diagnosis. Patient evaluation requires a comprehensive history, physical and mental status examinations, and a number of laboratory studies. Effective treatment of depression enhances the quality of life, reduces the probability of secondary alcoholism or suicide, frequently improves coexisting medical problems and reduces the high rate of health care use by these patients.
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Regarded by many as a delicacy, puffer fish can be the source of lethal food poisoning in humans. The syndrome is caused by tetrodotoxin, one of the most potent poisons known. ⋯ Life support may be required. In some series, the mortality rate has approached 60 percent.
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Unintended injuries have become the third most frequent cause of death in the United States, and the relative importance of homicide and suicide has also increased. In recent decades, death rates from highway crashes and fires have fallen, and experience indicates that serious injuries in the workplace can be drastically reduced. ⋯ Tasks for the future include more research on the efficacy of preventive interventions, improvement of injury surveillance and prevention programs, and education of children and adults about injury prevention. Family physicians can play an important role in injury prevention efforts.
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Wernicke's encephalopathy should be considered as a possible diagnosis in comatose and hypothermic patients. The classic triad of confusion, ophthalmoplegia (or nystagmus) and ataxia may be absent, and the history of alcohol abuse or other causes of thiamine deficiency may be unknown. Left untreated, acute Wernicke's encephalopathy has a 17 percent mortality rate. Since the morbidity from Wernicke's encephalopathy is potentially reversible with parenteral thiamine, and large doses of thiamine can be given without documented ill effects, it is recommended that all comatose or hypothermic patients, as well as those with more classic presentations of Wernicke's encephalopathy, be given parenteral thiamine before administration of glucose.