David H. Wesorick, MD; Vineet Chopra, MD, MSc
Disclosures: Dr. Chopra reports grants from the Agency for Healthcare Research and Quality. Dr. Wesorick has disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-1400.
When a diagnosis of herpes zoster is not obvious, based on the appearance of skin lesions, polymerase chain reaction is the best diagnostic test.
Some patients with herpes zoster may require hospitalization, especially those with disseminated disease or neurologic or ocular involvement. Intravenous acyclovir is often recommended for these complicated patients.
It is important to recognize herpes zoster ophthalmicus, which can present exclusively with eye symptoms (without skin lesions) or with blisters on the tip of the nose. An ophthalmologist should always be consulted in cases where ocular involvement is suspected.
Corticosteroids may speed healing of skin lesions and reduce the acute pain of herpes zoster infections, but there is no evidence that they reduce the frequency of postherpetic neuralgia.
Thousands of people die each year of opioid overdose in the United States. The use of MOUD after nonfatal opioid overdose seems to significantly reduce subsequent opioid-related deaths.
In this study, only 30% of patients received MOUD in the year after their nonfatal opioid overdose. An editorial suggests that the stigma of OUD has resulted in a failure of the system to make the necessary policy and infrastructural changes to allow broader use of this potentially lifesaving treatment.
This study provides evidence that transfeminine patients experience a significantly increased risk for VTE, presumably related to the use of hormone therapy.
Clinicians should be aware of this increased risk when providing long-term care for transfeminine patients and when assessing pretest probability for transfeminine patients presenting with symptoms of possible VTE.
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Wesorick DH, Chopra V. Annals for Hospitalists - 21 August 2018. Ann Intern Med. ;169:HO1. doi: 10.7326/AFHO201808210
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Published: Ann Intern Med. 2018;169(4):HO1.
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