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An estimated 40 million adults in the United States have been diagnosed with an anxiety disorder, making it the most common psychiatric disorder in the country. Although the data are conflicting and limited, engaging in or increasing exercise has been proposed for the management of anxiety and other mental health disorders. The purpose of this study was to determine if there is a correlation between pre-race anxiety and running experience, sex, body mass index, age, and mental health history using the validated Generalized Anxiety Disorder 2-Item screening tool for anxiety. This study was a prospective trial of 403 adult runners who were scheduled to participate in a 5 K, 10 K, half marathon, or full marathon race. Each participant completed a survey consisting of epidemiologic variables and the Generalized Anxiety Disorder 2-Item screening tool. Results revealed that the runners with more experience and increased mileage demonstrated a decrease in reported worrying on a daily to near-daily basis; whether this finding correlates with a decreased risk of developing an anxiety disorder has yet to be determined. Based on our findings, exercise as a prescription for the treatment and possibly prevention of anxiety should be considered.

Background: Women are more likely to search for information on behalf of both themselves and others, thus making them a valuable target for health information research. The purpose of this project was to identify and compare the most important medical concerns and sources of health information trusted by women in relationship to demographic differences in two different clinical settings within the same geographic area (Mayo Clinic Department of Family Medicine and Beaches Community Health care-a Sulzbacher Center Clinic). Methods: A novel survey tool was developed to obtain information regarding the age, race, and socioeconomic demographics of patients as well as the patients' personal significant medical concerns and trusted sources of health information. Results: Despite the huge development of health care information delivery through online resources, in our study, the majority of patients from both clinics still used and viewed their primary care provider as the most trusted source of health information. The health concerns most reported by both populations included cardiac health, breast and other cancers, and obesity; meanwhile, mental health was significantly more reported by patients from the free clinic. Conclusions: Education level may be an important factor of the awareness and ultimate treatment and prevention of these prevalent diseases. Furthermore, our study results may help improve patient satisfaction, knowledge, and health outcomes.

Background Although gastrointestinal involvement is the most common site for extra-genital endometriosis, deep infiltrative endometriosis, which affects the mucosal layer, is very rare. Case presentation We present a case of a 41-year-old white woman with cyclic rectal bleeding. Magnetic resonance imaging was done, together with colonoscopy and histologic staining of biopsied samples, which led to the final diagnosis of intestinal invasive endometriosis with recto-sigmoid stricture. Our patient was treated symptomatically with stool softeners. Conclusion This case provides a rare example of catamenial bleeding. It is important to keep invasive endometriosis on the differential diagnosis whenever a premenopausal woman has cyclical rectal bleeding.

Background Distance running fitness is commonly assessed using metabolic testing (MT). During MT, the runner must wear a mask that covers the nose and mouth. It is unclear if this increased challenge alters running kinematics and/or stride-to-stride variability (SSV). In this study we thoroughly assess the sagittal plane lower body joint angles. Research question Are there significant differences between standard treadmill running kinematics and those collected during MT? Methods Twenty recreational runners participated (34.8 ± 10.0 years; 20+ miles per week). Six Vicon Bonita cameras were used to collect kinematic data (200 Hz). A metabolic cart (Parvo Medics TrueOne 2400) was used for heart rate (HR) collection and testing. Participants ran 4 × 4 min at preferred pace: 2 control runs (CON) and 2 MT runs. Ten strides were used to generate average stance and swing joint angle plots. The phase plots were compared for CON and MT and mean difference scores were calculated (to determine the kinematic change). SSV was determined by assessing the standard deviations among the 10 strides. Repeated measures ANOVA was used to test for significant differences among CON and MT trials. Reliability was assessed for 8 discrete joint angles using ICC analysis. Results There were no significant differences between CON and MT for both the joint angle plot comparisons and SSV. For the discrete kinematic measures, ICC scores were strong (0.89-0.99) between CON and MT. During MT, there were slight increases (p Significance Results from this study support the validity of simultaneously conducting a kinematic and MT analysis. However, clinicians and performance coaches should be aware that 1) MT is slightly more physiologically demanding than CON and 2) approaches from this study can be used during individual assessments to confirm that kinematics are similar (between CON and MT).

As telecommunication technologies advance, efforts are being made to mitigate direct patient contact in the COVID-19 pandemic due to the risk of contagion. The ability to host telephone and video visits within patient portals within health care institutions will only become increasingly valuable. Neck pain, a common complaint seen in primary care clinics, is well-suited to telemedicine evaluation, as related etiologies are often comparatively straightforward. A good assessment of the cervical spine by telephone or video is possible with the right knowledge and practice. The purpose of this article is to propose questions and maneuvers that can be used to evaluate the cervical spine via telephone or video, as well as likely diagnoses that can be reached through these. Phone and video evaluation of the cervical spine can result in valuable data regarding symmetry, range of motion, functional movement patterns, modified strength testing, and provocative testing. The skill set necessary to do telephone and video visits should be included in the curriculum of physician learners.

Pseudoxanthoma elasticum (PXE) is a rare, autosomal recessive connective tissue disease that manifests primarily in the skin, eyes, vasculature, and gastrointestinal tract. Most cases occur in women and are present in the third decade of life. Diagnosis is confirmed via skin biopsy or by genetic testing that reveals a variant ABCC6 gene. We present the case of a 68-year-old woman who came to the clinic to discuss her daughter’s diagnosis of PXE, specifically, what testing she and her family should pursue. A family pedigree revealed a strong family history of abdominal aortic aneurysm (AAA). Although PXE has not been directly related to AAA, this raised concern for familial connective tissue disease. It was recommended that all family members undergo AAA screening with ultrasound, but that not all family members warranted genetic testing. Patients diagnosed with PXE should establish care with specialists to monitor for adverse outcomes.

The purpose of this case series was to evaluate the presence of low Energy Availability (EA) and its impact on components of Relative Energy Deficiency in Sport (RED-S) in a population of female collegiate runners. Seven female NCAA Division I athletes (age: 22.3 ± 1.5 yrs; height: 169.7 ± 5.7 cm; weight: 58.3 ± 4.1 kg) were tracked from August until February, covering the beginning (Pre XC), end (Post XC) of their competitive cross country season, and beginning of the following track season (Pre Track). The athletes were assessed for female athlete triad (Triad) risk, energy availability, body composition, resting metabolic rate (RMR), nutritional intake, and blood markers (including vitamin D, ferritin, and triiodothyronine (T3)). From Pre XC to Post XC there were no significant differences in body mass, fat free mass or body fat percentage. At Pre XC, mean EA was 31.6 ± 13.3 kcal/kg FFM∙d-1. From Post XC to Pre Track, there was a significant increase in body mass (59.1 ± 5.1 to 60.6 ± 5.7 kg, p-1, pvs 39.5 ± 12.2 ng·mL-1, p=0.047,d=-0.4), and a significant increase from Post XC to Pre Track (39.5 ± 12.2 vs. 48.1 ± 10.4 ng·mL-1, p=0.014,d=0.75). For ferritin, there was a trend towards a decrease from Pre XC to Post XC (24.2 ± 13.2 vs. 15.7 ± 8.8 ng·mL-1, p=0.07, d=-0.75), as well as a trend toward an increase from Post XC to Pre Track (15.7 ± 8.8 vs. 34.1 ± 18.0 ng·mL-1, p=0.08, d=1.3). No differences in T3 were observed across time points. Average Triad risk score was 2.3 ± 1.4. Notably, 5 of 7 athletes met criteria for moderate risk. Despite many athletes meeting criteria for low EA and having elevated Triad risk assessment scores, most were able to maintain body mass and RMR. One athlete suffered severe performance decline and a reduced RMR. Surprisingly, she was the only athlete above the recommended value for ferritin. Following increased nutritional intake and reduced training volume, her performance and RMR recovered. Changes in body mass and body composition were not indicative of the presence of other concerns associated with RED-S. This exploratory work serves as a guide for future, larger studies for tracking athletes, using RMR and nutritional biomarkers to assess RED-S.

Background The effect of caffeine on the human body, both short-term and long-term, has been studied in great depth, particularly its association with psychiatric disorders. This study aims to investigate whether there is a correlation between caffeine intake and anxiety and depression among college students. Methodology A survey was administered to college students at Florida State University. Data regarding participant characteristics and caffeine intake were collected. Generalized Anxiety Disorder-7 and Patient Health Questionnaire-9 scores were used to assess symptoms of anxiety and depression, respectively. Results A total of 114 participants were included in the survey, consisting mainly of women (94 [82.5%]) and junior-level students (37 [32.5%]). The main source of caffeine was coffee (64.0%), and the main reasons for caffeine intake were pleasure (43.9%) and to study outside of class (29.8%); however, no association was found between sex or grade point average and number of cups of caffeine consumed. Upper levels of education (super senior or fifth-year students), depressive symptoms (poor appetite, overeating, sleep disorders, depressed mood), and anxiety were statistically associated with greater caffeine intake (P < 0.05). Conclusions As caffeine is commonly consumed and our study showed that its intake was associated with depressive symptoms and higher levels of anxiety in college students, further studies are needed to determine a possible causality, so that measures may be taken to educate these students about alternative methods for increasing energy and alertness.

H. pylori is the most common infection in the world and is associated with gastrointestinal and extra-gastrointestinal manifestations, including peptic ulcer disease, gastrointestinal bleeding, and lymphoproliferative disorders. Despite being discovered less than half a century ago, antibiotic resistance, exacerbated by medication non-adherence and inefficacy of proton pump inhibitors, has grown substantially, explaining the rising incidence of refractory H. pylori infection. In this review, we discuss risk factors, treatment options, surveillance and follow-up, as well as emerging therapies for refractory H. pylori.

A 28-year-old man presented to our clinic with persistent left wrist pain. Three months earlier, he had fallen on an outstretched hand while snowboarding. Initial radiographs showed no fractures or dislocations; however, magnetic resonance imaging revealed evidence of a dorsal projection from the scaphoid waist. There was no evidence of a scaphoid wrist fracture, scapholunate ligament disruption, or injury. The final diagnosis was avulsive cortical irregularity or cortical desmoid, which pertains to new bone formation at sites of muscle insertion. The literature has identified cases found in the deltoid, latissimus dorsi, adductor magnus muscles, and gastrocnemius insertion; however, it has never been reported in the scaphoid region. The proposed mechanism, in this case, is the repetitive pull on the radioscaphoid ligament. Avulsive cortical irregularities are benign conditions that mimic malignant conditions radiologically and microscopically. It is therefore important not to mistake this lesion for more worrisome lesions such as osteosarcoma or fibrosarcoma to avoid unnecessary procedures. In the incidental setting, no further imaging is necessary. If the patient presents with pain, atypical radiographical findings, or a suspicion of malignancy, a magnetic resonance image can provide valuable information and confirmation of diagnosis.

BackgroundHospital performance is often monitored by surveys that assess patient experiences with hospital care. Certain patient characteristics may shape how some aspects of hospital care are viewed and reported on surveys.ObjectiveThe aim of the study was to examine factors considered important to patients and determine whether there were differences in answers based on age, gender, or educational level.MethodsCross-sectional study based on a hospital survey developed via literature review and specialist recommendations. This study included randomly selected patients 18 years or older who were recently admitted to the hospital or admitted more than 50 days before the survey was being applied. Survey domains included age, gender, educational level, factors considered important for the health care in a hospital setting and sources of information about hospital quality used by each subject. Answers description and statistical analysis using Fisher exact test were performed.ResultsThe survey was applied to 262 patients who were admitted under different services. The most important concern reported was the risk of getting a hospital-acquired infection (67.18%), followed by understanding explanation from the doctors’ plans (64.12%) and doctors’ ability to listen carefully (58.78%). Women are more concerned about their risk of falling (p = 0.03). Patients older than 65 years find important that the doctors explain everything in a way they can easily understand (p = 0.02), while lower educated patients consider most if the doctor treats them with courtesy and respect (p = 0.0027).ConclusionPatient characteristics have an effect on how hospital care is perceived. Regardless of the characteristics of the population, the risk of getting an infection was the main concern overall, so it is important that hospitals promote actions to prevent it and share them with patients.

Herpes zoster is an infection resulting from the reactivation of dormant varicella zoster virus (VZV) in a posterior dorsal root ganglion. It affects 50% of immunocompromised patients and, when the viral infection persists, it can lead to a process known as disseminated varicella zoster virus (dVZV). Here we discuss a case of a bullous presentation of VZV with a rapid evolution of disseminated herpes zoster in an immunocompromised patient. Maintaining a broad differential diagnosis is necessary for early diagnosis and treatment of atypical presentations of herpes zoster, which is imperative to avoid increasing morbidity and mortality.

OBJECTIVES The United States has experienced an increase in sexually transmitted infections (STIs) in the past decade, a trend that may be influenced by communication gaps between family physicians and patients. We sought to identify factors that hinder discussion about safe sexual practices and STIs, understand physicians' perceptions of their role in preventing STIs, and explore methods of initiating discussions on sexual health. METHODS From April 30, 2016 to September 1, 2016, family physicians at our institution were given written surveys with 22 questions to answer and rank in order of their best practice. The survey assessed participants' age, sex, level of medical education, and possible barriers to initiating discussion and offering advice on safe sexual practices. RESULTS All of the participants identified time constraints and the presence of a patient's spouse, parents, or siblings as the most common barriers. Other barriers included fear of embarrassing patients and feeling inadequately knowledgeable about the sexual practices of lesbian, bisexual, gay, and transgender patients. All of the participants reported that patients rarely object to discussing sexual behaviors. CONCLUSIONS Our study identified several barriers that family physicians may face when initiating discussions and advising patients on safe sexual practices. To prevent new cases of STIs, it is important to work around these barriers to improve physician-patient communication. This can be further improved by providing continuous learning opportunities for medical students, residents, and board-certified family physicians on ways to appropriately counsel patients on safe sexual practices.

Highlights • Herpes zoster results from the reactivation of dormant varicella zoster virus. • Risk factors include older ages and immunosuppression. • Lumbosacral plexopathy is a complication of disseminated herpes zoster. • Early treatment even in immunocompetent patients can decrease morbidity. • Awareness of the complications is crucial to provide early treatment., Herpes zoster is a common infection resulting from the reactivation of dormant varicella zoster virus in a posterior dorsal root ganglion. The typical dermatomal involvement includes the thoracic region, followed by the face and the cervical and lumbosacral regions, with 1% having disseminated disease. We present a rare case of an immunocompetent 85-year-old man presenting with herpes zoster at the L3-S2 dermatomes, that evolved to disseminated varicella zoster virus (dVZV), with radiologically and laboratory-confirmed lumbosacral plexopathy manifesting with cauda equina syndrome. Here we also discuss the diagnosis and complications of dVZV as well as treatment strategy. By maintaining a high degree of clinical suspicion and initiating early treatment, high-quality patient care and good outcomes are able to be achieved in cases like this.

There is a movement in the United States to transform family medicine practices from single physician–based patient care to team-based care. These teams are usually composed of multiple disciplines, including social workers, pharmacists, registered nurses, physician assistants, nurse practitioners, and physicians. The teams support patients and their families, provide holistic care to patients of all ages, and allow their members to work to the highest level of their training in an integrated fashion. Grouping care team members together within visual and auditory distance of each other is likely to enhance communication and teamwork, resulting in more efficient care for patients. This grouping is termed colocation. The authors describe how the use of colocation can lead to clearer, faster communication between care team members. This practice style has the potential to be expanded into various clinical settings in any given health system and to almost all clinical specialties and practices.

It is the responsibility of every healthcare provider who could potentially care for someone who sustains a concussion to recognize the most common signs and symptoms. Some are present immediately after the injury, but many may evolve with time. The American Medical Society for Sports Medicine’s most recent position on concussions breaks down the symptoms into six domains: headache-migraine, cognitive, anxiety/mood, ocular, fatigue, and vestibular. Many of these symptoms are generalizable, cross domains, and evolve throughout the process of the condition. Moreover, many of these symptoms can be present prior to the onset of the concussion. This can confound the clinical picture. Therefore, it is essential for clinicians to clarify symptoms with their patients, compare symptoms to the patient’s baseline, and converse with athletic trainers, friends, or family members. Thorough follow-up with these patients is crucial to assess progression during recovery. The diagnosis of concussion can be elusive, therefore it is imperative for primary care providers to be aware of the constellation of signs and symptoms that can present with concussions.

Urinary tract infection (UTI) is one of the most common entities in medicine and affected patients present daily in a typical family medicine practice. The patients often present with the "classic symptoms" of dysuria and increased frequency, but sometimes they are asymptomatic or have a mixed picture. In most cases, an antibiotic is prescribed, and this practice is likely contributing to increasing worldwide antibiotic resistance. To help combat this problem, it is important that clinicians seek out their local bacterial resistance patterns and antibiograms, properly diagnose and treat UTI if indicated, and recognize their role in antibiotic stewardship.

Cutaneous larva migrans is typically reported in tropical and subtropical regions of the world. However, cutaneous larva migrans cases are spreading and should now be recognized even in urban, nontropical settings.

Although calcific tendinopathy of the shoulder is a relatively common clinical diagnosis, calcific tendinopathy of the rectus femoris tendon near its origin at the anterior inferior iliac spine is rare. We present a case of a 53-year-old female avid runner with left hip pain. Clinical evaluation and X-ray imaging led to a diagnosis of calcific tendinopathy of the rectus femoris tendon. The patient was treated conservatively with non-steroidal anti-inflammatory drugs, physical therapy and rest. Calcific tendinopathy of the rectus femoris tendon can occur rarely in active patients and may be a cause of hip pain, responsive to conservative management, but with other treatment options possible if recalcitrant.

ABSTRACT INTRODUCTIONPaget-Schroetter syndrome, or effort thrombosis, refers to a deep venous thrombosis in an upper extremity. It is most commonly located in the axillary or subclavian veins and is associated with vigorous repetitive movements and anatomic abnormalities. CASE PRESENTATIONThis case study describes an 18-year-old Division 1 soccer player who presented with worsening axillary swelling and pain. He was found to have subclavian stenosis at the level of the thoracic inlet between the clavicle and first rib, with deep venous thrombosis in his right axillary, subclavian, proximal brachial, and basilic veins. It was diagnosed with ultrasound and confirmed with venography. He was treated initially with enoxaparin and warfarin before having mechanical thrombolysis, balloon venoplasty, infusion of tissue plasminogen activator, and a right first rib resection. CONCLUSIONAs Paget-Schroetter syndrome is rare, early recognition and management leads to fewer long-lasting sequelae and less morbidity. Left untreated, it can result in pulmonary embolism and residual upper extremity obstruction.

Close interaction with nature can lead to tick-borne illnesses, which are seen most frequently in primary care clinics when patients present symptoms. Considerable morbidity can result from untreated infections. Fortunately, these illnesses are often easily managed when diagnosed early.

An adolescent, right hand-dominant, baseball pitcher presented to sports medicine clinic with posterolateral right elbow pain over 4 months. He rated his pain as 8/10 with pitching, especially at the late cocking phase of throwing. Prior to consult, he had rested 3 months from pitching, progressing to strengthening exercises, with no pain relief. On physical examination, he had 120° of active external rotation, 80° of active internal rotation, mild tenderness to palpation over the capitellum and normal elbow radiography. Magnetic resonance arthrogram of the right elbow revealed subtle, posterolateral joint capsular tear and adjacent synovial hypertrophy. The patient was diagnosed with elbow synovial fold syndrome that was causing impingement at the radiocapitellar joint and was referred to an orthopaedic surgeon. Arthroscopy revealed redundant tissue; scar formation at the radiocapitellar joint was debrided. The patient participated in physical therapy for 2 months and was able to start throwing 3 months later.

The immune system responds to exercise in various ways. Infectious risk is increased in athletes and active individuals because of physical demands, contact with teammates, frequent traveling, and untidy living quarters. Infectious diseases in teams and individual athletes will need to be addressed in the urgent care setting, and challenges may arise in relation to the need to continue competing or to prevent outbreaks. Contacts, relatives, staff, or teammates may need to be treated as well, as the athlete’s infectious condition is diagnosed and addressed. In athletes and active individuals, upper respiratory tract infections generally represent the most common acute illnesses. In terms of seriousness, however, pulmonary and cardiac infections represent perhaps the most important illnesses to address correctly as these may become life threatening. In the urgent care setting, bacterial skin dermatoses should be identified and treated correctly; they are common in athletes and, if left unaddressed, can have serious implications for the individual and the team, especially in wrestling. Methicillin-resistant Staphylococcus aureus (MRSA) infections have been increasing in recent years, and the approach used in urgent care settings to identify such infections may have long-lasting implications. Widespread outbreaks of viral cutaneous infections are common among athletes and can develop quickly if not identified and treated appropriately in the urgent care clinic. Athletes and active individuals can find gastrointestinal (GI) infections troublesome and debilitating. A comprehensive history is crucial when investigating GI tract symptoms. Urgent care clinics can play an important role in recognizing and appropriately treating infectious conditions in athletes and active individuals; the individual’s ability to return to play is clearly affected as well. The management of acute infectious diseases in athletes here may also have implications for the prevention of outbreaks.

Superficial fungal infections grow in dark and moist areas and invade various parts of the body. These infections are easily treatable in immunocompetent individuals. In immunosuppressed individuals, the presentation can be quite severe, requiring use of more potent antifungal agents. The treatment for these conditions consists of topical antifungal agents, creams, and oral systemic medications. The use of prednisone can alter the appearance of superficial fungal infections, making them difficult to diagnose. It is important for primary care providers to become adept at understanding the epidemiology, transmission, clinical presentation, diagnosis techniques, and treatment options available.

Background and objective Family physicians are expected to be comfortable in treating common sports injuries. Evidence shows a limited level of comfort in treating these injuries in pediatric and internal medicine residents. Studies are lacking, however, in family medicine residents. The purpose of this study is to assess the comfort level of family medicine residents in treating common sports injuries in adults and children based on their perceived level of knowledge and attitudes. Methods This is a cross-sectional study of family medicine residents in the United Sates. A written survey of 25 questions related to sports injury knowledge and factors affecting comfort level were collected. A chi-square test was implemented in calculating P-values. Results Five hundred and fifty-seven residents responded to the survey. A higher percentage of doctors of osteopathy (86.6%, 82.5%, 69.6%, and 68.7%) compared to doctors of medicine (78.5%, 71.6%, 53.4%, and 52.8%) respectively identified ankle sprain, concussion, plantar fasciitis, and lateral epicondylitis as common injuries, and felt comfortable in treating them (P-values =0.015, 0.004, 0.0001, and 0.0002, respectively). Residents with high interest in sports medicine correctly identified the injuries as common and felt comfortable treating them as well (knowledge, P=0.027, 0.0029, Video abstract

We present a rare case of severe neck pain in a 45-year-old man with severe hidradenitis suppurativa who was participating in a study involving adalimumab. The neck pain was associated with acute longus colli calcific tendinitis, which is a noninfectious inflammatory response in the longus colli tendons secondary to deposition of calcium hydroxyapatite crystal. The diagnosis was made by computed tomography, which showed calcifications and deposits, and magnetic resonance imaging, which showed a retropharyngeal effusion. Ears, Nose, and Throat Services performed a fiberoptic scope examination, which revealed a patent airway and no drainable abscess. Nonsteroidal anti-inflammatory drugs resulted in a dramatic improvement in the patient's clinical symptoms. In acute longus colli tendinitis, differentiating retropharyngeal aseptic effusion from infection is important. Of note, the confounding factor in this case was that the patient was blinded to whether he was receiving the placebo or adalimumab, so whether the patient was immunosuppressed and at risk for infection was unknown. Clinician familiarity and education concerning acute calcific longus colli tendinitis may lead to decreased costs stemming from incorrect diagnosis and unnecessary treatment.

Uncover literature pertaining to: (1) attention deficit hyperactivity disorder (ADHD) and how it impacts athletes; (2) ADHD medication effects; (3) regulations regarding ADHD medications; (4) approaches to conditions similar to, and occurring with, ADHD; and (5) use of stimulants.MEDLINE, Embase, PsycINFO, Cochrane Database of Systematic Reviews, Ovid interface.ADHD can have many effects on athletes and sports participation. Exercise has positive benefits on ADHD behaviors and players' attitudes. Athletes with ADHD can have worsened ADHD symptoms after concussions. Attention deficit hyperactivity disorder is a modifier of return to play; baseline ADHD symptoms should be used to guide management. Management should include medications, behavioral/psychosocial therapy, and academic accommodations. Behavioral therapy combined with medication is superior to behavioral treatment alone. Sustained exercise as ADHD treatment should be considered mainstay in management. Sports can increase thermogenic effects of stimulants, heat injury, and cardiac arrhythmias. Increased aggressiveness, improved pain tolerance, and decreased sense of fatigue are some attributes of stimulants that are presumed to impart some advantage to athletes, but evidence is uncertain. Attention deficit hyperactivity disorder medications may lead to myocardial infarctions, cerebrovascular accidents, paranoid psychoses, seizures, insomnia, tremors, anxiety, hypertension, and death.Athletes' performance and quality of life can be negatively affected by ADHD. Risks exist for those who take ADHD medications. More research is needed on the implications ADHD may have in specific sports, and on possible advantages of medication use. Potential deleterious effects of these medications should be addressed.

Teaching primary care providers how to perform musculoskeletal procedures has become increasingly important as more and more patients with orthopedic conditions present in primary care clinics. This study aims to evaluate whether targeted simulation model training in residency can increase residents’ comfort level in performing intra-articular knee injections and decrease the pain of the procedure, as reported by patients injected. Residents were randomized into intervention and control groups. The comfort level of the residents as well as the pain levels from the procedures, as reported by patients, was recorded. The mean comfort level for the intervention group was 1.2, compared with that in the control group, which was 2.13; P value was .047. The mean pain level in the intervention group was 1.8, whereas in the control group was 3.63; P value was .156. Simulation training may boost residents’ comfort level, but not necessarily decrease patient discomfort during intra-articular knee injections.

Acne is a common complaint in the primary care clinics. It has not only physical implications but also psychological. This article discusses the epidemiology, pathophysiology, and criteria for making the diagnosis. It also discusses endocrine disorders that may be the cause of acne. Treatment and management are discussed by subtype. Acne mechanica or sports-related acne is also discussed.

Skin and soft tissue infections account for 0.5% of outpatient visits to primary care. Skin and soft tissue infections can usually be managed in an outpatient setting. However, there are certain circumstances as discussed in this article that require more urgent care or inpatient management. Primary care providers should be able to diagnose, manage, and provide appropriate follow-up care for these frequently seen skin infections. This article provides family physicians with a comprehensive review of the assessment and management of common bacterial skin infections.

Running is often recommended by physicians to maintain a healthy lifestyle. As more individuals participate in running-related activities, clinicians must be increasingly aware of common injuries. Training errors leading to overuse are the most common underlying factors in most running-related injuries. Clinicians need to keep in mind that the presenting injury is frequently the result of an inability to compensate for a primary dysfunction at another site. Although imaging may be helpful in differentiating among diagnoses with similar clinical presentations, a detailed history and physical examination are essential in making a correct diagnosis.

Thenar pain can represent a significant morbidity for a baseball player who relies on manual dexterity for gripping a bat and precise and accurate throws. While osseous, ligamentous, and neurovascular pathologies are commonly considered, musculotendinous injuries are often neglected in the differential diagnosis of thenar pain. We present a case of adductor pollicis longus strain as a cause of acute thenar pain in a baseball player. Adductor pollicis longus strains should be considered in any baseball player sustaining a hyperabduction force to the thumb.

Patients with illnesses caused by ticks may present with flulike symptoms. Physicians should learn how to recognize these illnesses by specific aspects in the patients' histories and physical examinations. Prevention of mortality and morbidity may depend on correct early diagnosis and treatment. Illness prevention may result with early removal of the tick, because infection usually requires 24 to 48 hours of attachment to the host. A bite from one tick may transmit several different pathogens leading to concurrent infections. The prevention of tick-borne illnesses can start with advice on how to prevent tick bites, especially during summer time.

The main objective of this pictorial essay is to illustrate the sonographic appearance of the postoperative carpal tunnel and median nerve. Carpal tunnel surgical treatment failures have been shown to occur in up to 19% of a large series requiring re-exploration. Surgical management options for recurrent carpal tunnel syndrome (CTS) include revision release, neurolysis, vein wrapping, and fat grafting procedures. While several descriptions of median nerve entrapment in CTS exist in the ultrasound literature, little is written regarding its postoperative appearance. We report the sonographic changes in the appearance of the median nerve and postoperative carpal tunnel.

A 59-year-old white hunter and archer presented to the sports medicine clinic with bilateral knee and left elbow pain. Various treatments for presumed musculoskeletal diagnoses did not help. When reviewing his medications, the patient concluded that the only new one before the appearance of his symptoms was tadalafil. He stopped taking it, and his pain resolved immediately thereafter. On review, it was noted that the patient was also on pravastatin. There have been a few previous reports of myopathy and rhabdomyolysis with the concomitant use of a phosphodiesterase-5 inhibitor (PDE5I), such as tadalafil and a statin. We report a case where such processes may have been occurring and may have resolved shortly after discontinuing concomitant use, in turn resulting in decreased pain. Clinicians may need to be aware of the possibility of such symptoms and processes occurring in patients taking both a statin and a PDE5I.

Objective We aimed to identify any correlation between long-term proton pump inhibitor use and low bone mineral density in the elderly. Materials and methods This is a retrospective cohort study looking at PPI usage and bone mineral density scores of patients age 65 and above within a period of two years. Lumbar spine, right hip, and left hip bone mineral density t-scores were reviewed in PPI users and non-users. Results A total of 1,016 patients who had bone mineral density scans within that period were identified. Non-adjusted data showed no statistically significant association between PPI users and non-users in lumbar spine (p = 0.903), right hip (p = 0.775) and left hip (p = 0.407) bone mineral density scores. After adjusting for age and gender, PPI use was still not associated with low bone mineral density at the lumbar spine (p = 0.957), right hip (p = 0.440), or left hip (p = 0.691). Thelogistic regression did not show a statistically significant difference in low bone mineral density scores in lumbar spine (p= 0.162), right hip (p = 0.796), and left hip (p = 0.196) when length of use was considered. Conclusion Among adults 65 years and older proton pump inhibitors users; there appears to be no correlation betweenPPI use and low bone mineral density and/or the length of PPI use.