American family physician
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American family physician · Jul 2023
ReviewRespiratory Syncytial Virus Bronchiolitis: Rapid Evidence Review.
Bronchiolitis is the most common lower respiratory tract infection in young children. Respiratory syncytial virus (RSV) is the most common viral cause of bronchiolitis. RSV is spread through respiratory droplets, and the number of cases varies with season. ⋯ Hydration and nutrition should be maintained by nasogastric or intravenous routes, if needed. Therapies such as bronchodilators, epinephrine, nebulized hypertonic saline, corticosteroids, antibiotics, and chest physiotherapy are not recommended. Although most episodes of RSV bronchiolitis are self-limited, some children have an increased risk of asthma later in life.
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Mpox (formerly monkeypox) is a DNA virus of the Orthopoxvirus genus, similar to smallpox. Although mpox was endemic to the Democratic Republic of the Congo and parts of Africa, increasing numbers of cases were reported worldwide in 2022. More than 30,000 cases have been reported in the United States, and worldwide 98% of cases are found in men who have sex with men. ⋯ Antiviral treatments such as tecovirimat, cidofovir, or brincidofovir may be considered for use in individuals who have or are at high risk of severe disease. Possible complications of mpox include anogenital pain, bacterial superinfections of skin lesions, dehydration secondary to oral lesions, encephalitis, keratitis, and respiratory distress. To date, 38 deaths have been reported in the United States.
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Bell palsy should be suspected in patients with acute onset of unilateral facial weakness or paralysis involving the forehead in the absence of other neurologic abnormalities. The overall prognosis is good. More than two-thirds of patients with typical Bell palsy have a complete spontaneous recovery. ⋯ Recommended antivirals include valacyclovir (1 g three times per day for seven days) or acyclovir (400 mg five times per day for 10 days). Treatment with antivirals alone is ineffective and not recommended. Physical therapy may be beneficial in patients with more severe paralysis.
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American family physician · Apr 2023
ReviewOutpatient Management of COVID-19: Rapid Evidence Review.
New COVID-19 variants of concern continue to develop. Incubation period, transmissibility, immune escape, and treatment effectiveness differ by variants of concern. Physicians should be aware that the characteristics of the predominant variants of concern determine aspects of diagnosis and treatment. ⋯ Consider medications, such as nirmatrelvir/ritonavir, as first-line treatment for eligible patients diagnosed with COVID-19 unless logistical or supply constraints occur. National Institutes of Health guidelines and local health care partner resources can be used to determine eligibility. Long-term health effects of having COVID-19 are under investigation.
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Acute otitis externa is an inflammatory condition that affects the external ear canal. It is usually of rapid onset and is generally caused by bacterial infection. The primary bacterial infections are Pseudomonas aeruginosa and Staphylococcus aureus. ⋯ Oral antibiotics are indicated only if evidence of cellulitis occurs outside of the ear canal or if associated conditions such as immunocompromise, diabetes mellitus, or conditions that would not allow for the use of topical treatment are found. Duration of topical treatment is usually seven to 10 days. Keys to prevention include avoiding injury to the ear canal and keeping it free of water.