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This likely reflects the lack of strong evidence and the heterogeneity of the clinical presentation in patients with lithium toxicity.[4],[7] In general, the patient's clinical status, renal function and serum lithium concentration are considered when deciding whether hemodialysis should be offered. Lithium is a commonly used medication that has a narrow therapeutic index and may lead to important toxicity that can be acute, chronic, or acute on chronic. Because of our patient's neurologic symptoms, electrocardiogram findings and mildly elevated serum lithium level, we diagnosed chronic lithium toxicity. [Extracted from the article]

Group B streptococci are a cause of infection in pregnant and nonpregnant adults, but infective endocarditis is an uncommon presentation of invasive disease from group B streptococci. Risk factors for infective endocarditis caused by group B streptococci include diabetes mellitus, malignant disease, advanced liver disease, injection drug use and elective abortion. It most commonly arises through hematogenous seeding of a preexisting valvular lesion (congenital, acquired or prosthetic) from an extracardiac focus of infection.[3],[4] Normal valves may also be involved.[3] I Staphylococcus aureus i and viridans group streptococci are the most common causative organisms, whereas group B streptococci account for less than 5% of cases of infective endocarditis.[3]. [Extracted from the article]

The article presents a case study of an 82-year-old man with ataxia and dysarthria. It relates his medical history which includes an infected ulcer overlying the plantar aspect of his right first metatarsal head. It discusses the results of his physical examination, cardiovascular examination, normal respiratory and abdominal examinations, peripheral vascular examination, neurologic examination, cranial nerve examination and electrocardiography.

The article discusses the case of a 56-year-old HIV-infected man who experienced multifocal strokes. Topics covered include the results of his neurologic and dermatologic examinations, the findings of the magnetic resonance imaging (MRI) of the brain and the diagnosis of varicella-zoster virus (VZV) vasculopathy in the central nervous system. Also mentioned are the common causes of ischemic stroke.

The article discusses the case study of a 27-year-old previously healthy man with mumps. The patient was admitted to the hospital with a two-day history of fever and right-sided scrotal swelling. He was in a monogamous relationship with a male partner and records of his childhood vaccinations included immunization against measles-mumps-rubella (MMR).

The article presents a case study of a 56-year old man with breast mass. The patient had a history of pressure and tenderness at the site of the mass as well as a history of obstructive sleep apnea. The article discusses blastomycosis which is a puogranulomatous infection caused by the dimorphic fungus B. dermatitidis.

The article presents a case study of a 57-year-old man with chronic HIV infection, who reported an eight-month history of passing stones and a chalky white discharge from his urethra. His medical examinations detected ritonavir in trace amounts, though his metabolic evaluation for causes of urolithiasis showed normal serum calcium, magnesium and phosphate measurements. It highlights the cause of urolithiasis instead of management of an acute episode of urinary colic.

The article discusses the investigation of an 80-year-old man with persistent epigastric pain and left-sided exertional chest pain. It states that he has a first-degree atrioventricular block with sinus bradycardia as revealed by electrocardiography. It says that abdominal ultrasonography was performed, followed by contrast-enhanced computed tomography (CT) of the abdomen. It says that the patient was diagnosed with liver abscesses secondary to migration of foreign body.

The article presents a case study of a 62-year-old man with a one week history of fever and confusion. The patient was diagnosed with nocardiosis after skin and brain biopsies, which revealed filamentous gram-positive bacilli, consistent with nocardiosis. It says that the mental status of the patient gradually improved and his skin lesion disappeared after the administration of combined therapy with trimethoprim-sulfamethoxazole and meropenem, with substantial resolution of brain lesions.

Health care workers may experience considerable psychologic distress as a result of the COVID-19 pandemic due to providing direct patient care, vicarious trauma, quarantine or selfisolation. Although tremendous efforts are being made to investigate the pathophysiology, clinical outcomes and treatment of coronavirus disease 2019 (COVID-19), the psychological effects of this pandemic on health care workers cannot be overlooked. [Extracted from the article]

We ordered computed tomography angiography and Doppler ultrasonography of the patient's right arm. We auscultated a bruit over the mass and suspected an aneurysm. [Extracted from the article]

The article focuses on case study of a patient having the history alcohol abuse and currently having the problem of parapneumonic effusion. It also discusses the questions and answers related to the diagnosis and treatment of the disease. It also mentions that the empiric antimicrobial therapy with intravenous ceftriaxone was used in the treatment.

The article discusses the symptoms, risk factors and treatment of vesicular rash. It informs that rash is caused by varicella zoster virus in which a unilateral dermatomal vesicular eruption occurs. After acute infection by varicella zoster virus, the virus remains dormant in nerve root ganglia. The most common risk factor for reactivation is advancing age. It informs that herpes zoster vaccine can help reduce the incidence of herpes zoster.

The article presents a case study of a 15-year-old girl who had necrotizing pseudomonas chondritis after the upper part of her left was pierced. It says that the antimicrobial treatment of the patient was changed from ciprofloxacin to piperacillin-tazobactam. It mentions that the bacterium Staphylococcus aureus was considered as the most frequent cause of skin infections due to piercing. It recommends various tips in preventing infection after piercing.

A 27-year-old man with a history of HIV infection presented to hospital after 3 days of fever, night sweats and rash over his chest, abdomen and extremities (Figure 1). Nucleic acid amplification testing is the recommended diagnostic test owing to its high sensitivity (92%-97.2%) and specificity (96.1%-99.8%).[3] Tests for co-infections such as syphilis and I Chlamydophila i should also be performed. [Extracted from the article]

A 37-year-old woman with a history of opioid use disorder and posttraumatic stress disorder presented with lower-extremity purpura, gingivitis and arthralgia. Examination showed gingival inflammation (Appendix 1, available at www.cmaj.ca/lookup/suppl/doi:10.1503/cmaj.190934/-/DC1) and diffuse lower-extremity nonpalpable purpura in a perifollicular distribution (Figure 1). The dietary history, dermatologic examination and skin biopsy findings suggested a diagnosis of hypovitaminosis C (scurvy), confirmed with an undetectable vitamin C level. [Extracted from the article]

The article discusses the medical case of CD4 measurement in a 54-year-old man with chronic HIV-1 viral suppression. Topics include the potential factors influencing the decline in the CD4 count of the patient, its clinical importance and the type of monitoringg required for the patient, and the impact of discontinuing CD4 measurement for the patient and focus on the significance of sustained virologic suppression.

The article discusses the case of a 25-year-old pregnant woman with an allergy history. Topics covered include the prescription for intramuscular injections of penicillin G benzathine for latent syphilis, the features of hypersensitivity reactions mediated by immunoglobulin E and the use of skin testing in excluding type 1 reactions to penicillin. Also mentioned is the belief that individuals with penicillin allergy has a risk of hypersensitivity with cephalosporins.

The article discusses the factors that need to consider in managing the risk of infection in an older male patient who will receive prednisone to treat his bullous pemphigoid. Topics discussed include the screening assessment of patient for latent tuberculosis and chronic hepatitis B virus and Strongyloides stercoralis infections, use of prophylaxis against Pneumocystis jirovecii pneumonia, and risk of patients for other infections related to glucocorticoid therapy.

The article focuses on single-tablet antiretroviral treatment. It explains how single-table antiretroviral treatment enhances adherence and quality of life of taken once daily, compared with multiple-pill regimens. It also discusses the association of tenofovir/emtricitabine/efavirenz with neuropsychiatric adverse effects, its effectiveness in patients with pre-treatment HIV viral loads, and the genetic barrier of abacavir/lamivudine/dolutegravir to resistance.

A case study of a 78 year old woman is presented who was suffering from self-limited febrile gastrointestinal illness. Her urine specimen was examined through urinalysis for urinary tract infection or asymptomatic bacteria. She was physical examination to assess suprapubic pain, costovertebral tenderness or fever. Her urinalysis was found positive for leukocytes and nitrites that attributed to intravascular depletion of enteric infection. She was administered with saline and was cured.

The article presents a case study of a 34-year-old man who has sex with men and has a remote history of primary syphilis. He visited his primary care physician with painful urination and a purulent urethral discharge. The urethral discharge was tested using nucleic acid amplification and found positive for Neisseria gonorrhoeae. The patient received a single oral dose of ciprofloxacin 500 with no improvement of symptoms.

The article presents questions and answers related to elective splenectomy treatment including patient's risk of infection after the treatment, immunizations requirement pre and post treatment, advices to reduce patient's risk of infection.

The article offers information on the five things to know about the recurrence of pertussis, which is a highly communicable respiratory tract infection. Topics discussed include the resurgence of pertussis is associated with waning immunity, polymerase chain reaction testing of a nasopharyngeal aspirate is a diagnostic method for pertussis, and macrolides are the recommended treatment for the disease.

The article presents facts about the Middle East respiratory syndrome (MERS). Topics discussed include the evolution of MERS coronavirus (MERS-CoV) from bat coronaviruses, the progression of the syndrome from a febrile respiratory illness to severe pneumonia, and the occurrence of most MERS cases from transmission in hospitals.

The article discusses five things one should know about measles. Europe, Great Britain, Quebec, British Columbia and Ontario have experience outbreaks of measles, attributed to more people not being vaccinated or who were incompletely vaccinated. Its clinical definition includes fever of at least 38.3°centigrade (C), cough, coryza or conjunctivitis, and generalized erythematous maculopapular rash. Measles is a communicable infectious disease caused by an airborne virus.

A response from the authors of the article "A 78-Year-Old Woman With Lethargy and a Positive Urine Culture" published in the journal in 2013 is presented.

A response from the author of the article "Reducing the risk of infection in a patient who will undergo splenectomy" in the 2012 issue of the periodical is presented.

The article presents several tips about acute bacterial meningitis in adults who are helpful for diagnosis and treatment of diseased patients. The tips include timely antibiotic therapy as a delay by an hour can cause unfavorable outcomes, use of lumbar puncture without prior computed tomography of the brain, better outcomes alongside adjuvant corticosteroid therapy.

The article discusses the five things to consider in managing community-acquired pneumonia in emergency department. It mentions the effects of administrating antibiotics on time to provide a successful therapy on the said disease. It discusses the requirement on early diagnosis of the disease to be refer on intensive care. Moreover, it cites the role of outpatient therapy in handling risk factors on Streptococcus pneumoniae.