Print Issue: June 01, 2009

Repeat chest x-ray after positive PPD

At what point should a patient have repeat chest x-ray after reporting a prior (10 years ago) positive purified protein derivative (PPD) result with subsequent isoniazid therapy? The patient reports having a negative chest x-ray two years ago and is currently set to begin working in a hospital setting with possible TB exposure.—TYSHA S. HOLMES,…

Steroid-related joint pain

Why would high-dose, short-term steroids cause pain (joint pain or burning paresthesias) during or shortly after the treatment course? What can be done to prevent or alleviate steroid-related pain?—DOUG SCHELL, ARNP, Lenexa, Kan. A variety of steroid withdrawal symptoms can be seen in patients. These symptoms include (but are not limited to) arthralgias, malaise, fever,…

Trichomonas vaginalis (yellow) is a protozoan pathogen of the genital tract.

Nonsexual trichomoniasis transmission

Is trichomoniasis truly transmissible nonsexually? I have been unable to find evidence supporting transmission through inanimate objects and concerned that clinicians are giving false reassurance to patients and their partners.—KRISTEN BELT-SHAABAN, MS, FNP, Portland, Ore. We know that Trichomonas organisms do not survive for any length of time in the absence of a wet, warm…

Hair loss as a side effect of statins?

A 63-year-old woman wants to discontinue the simvastatin (Zocor) 10 mg she is taking for hypercholesterolemia because she believes the medication is causing her to lose her hair. Is there any evidence supporting this side effect of Zocor?—Jyoti Khatri, MD, Omaha Although most articles describing the side effects of the statins do not include hair loss…

Sleepiness linked to CVD mortality

Sleepiness linked to CVD mortality

Daytime drowsiness may warn of impending death in elderly people, particularly from cardiovascular causes, new research suggests. The findings arise from the Three City Study, a population-based prospective study conducted in France. It is the largest study done thus far to investigate the prospective association between excessive daytime sleepiness (EDS) and mortality among community-dwelling elderly.…

Administering vitamin B12

How should vitamin B12 be administered? I have read that injections are not necessary—even for gastrectomy patients. However, some of my patients return with instructions from a consultant, e.g., a hematologist/oncologist, that they are to have B12 injections for life. Can these patients take their B12 by mouth?—Isaac Blum, MD, Bronx, N.Y. During the 1950s…

Thyroid dysfunction and the menstrual cycle

What is the mechanism by which thyroid dysfunction affects the menstrual cycle?—JULIA ARNETT, ANP, Newton, Mass. Thyroid dysfunction is associated with a range of menstrual abnormalities, including oligomenorrhea, amenorrhea, and menorrhagia. Women with hypothyroidism may also be at increased risk of pregnancy loss. The connection between thyroid hormone levels and the menstrual cycle is mainly…

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