J Emerg Med
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Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) are the most commonly reported notifiable diseases in the United States, with annual reported cases exceeding 1.2 million and estimated costs exceeding $1.2 billion. Reported Emergency Department (ED) prevalence rates for CT and GC for adolescents and young adults range from 0.9% to 8.1%. ⋯ ED clinician activities are frequently symptom-driven, and screening nonsymptomatic patients presents a major barrier. Educating ED clinicians on the topics of CT/GC epidemiology, sample collection, and analysis will enable them to address the risks in their presenting populations. Collaboration with health department partners for sample analysis, cost-sharing, and patient follow-up can make routine screening feasible and enable EDs to become more important partners in intervention programs.
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Synthetic cannabinoid receptor agonists are becoming increasingly popular with adolescents as an abused substance. Chronic use of these drugs can lead to addiction syndrome and withdrawal symptoms similar to cannabis abuse. Due to their potential health risk, several countries have banned these substances. ⋯ Spice drugs can cause potentially serious health care conditions that necessitate ED evaluation. Most cases can be discharged from the ED after a period of observation. Legal issues surrounding these drugs are yet to be finalized in the United States.
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The Maisonneuve fracture is a spiral fracture of the proximal third of the fibula. It occurs from violent twisting of the ankle that characteristically causes ligament damage and severe instability. Most patients complain of significant ankle pain but very little pain over the fracture. The clinical and radiographic examination is usually directed to the ankle region; and the proximal fibula is often ignored. ⋯ The Maisonneuve fracture injury pattern causes untoward consequences if not promptly recognized and treated. To avoid misdiagnosis, the proximal fibula should be examined in all patients with ankle injury.
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We report a case of an atypical presentation of acute appendicitis in an adult due to an undiagnosed congenital gut malrotation. ⋯ Observation with serial examinations, followed by CT scanning if indicated, is an invaluable strategy to use in diagnosing atypical presentations of common pathology.