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Ulcerative colitis is a relapsing and remitting inflammatory bowel disease of the large intestine. Risk factors include recent Salmonella or Campylobacter infection and a family history of ulcerative colitis. Diagnosis is suspected based on symptoms of urgency, tenesmus, and hematochezia and is confirmed with endoscopic findings of continuous inflammation from the rectum to more proximal colon, depending on the extent of disease. Fecal calprotectin may be used to assess disease activity and relapse. Medications available to treat the inflammation include 5-aminosalicylic acid, corticosteroids, tumor necrosis factor-alpha antibodies, anti-integrin antibodies, anti-interleukin-12 and -23 antibodies, and Janus kinase inhibitors. Choice of medication and method of delivery depend on the location and severity of mucosal inflammation. Other treatments such as fecal microbiota transplantation are considered experimental, and complementary therapies such as probiotics and curcumin have mixed data. Surgical treatment may be needed for fulminant or refractory disease. Increased risk of colorectal cancer and use of immunosuppressive therapies affect the preventive care needs for these patients. [ABSTRACT FROM AUTHOR]

Sudden infant death syndrome (SIDS) is the sudden unexpected death of a child younger than one year during sleep that cannot be explained after a postmortem evaluation including autopsy, a thorough history, and scene evaluation. The incidence of SIDS has decreased more than 50% in the past 20 years, largely as a result of the Back to Sleep campaign. The most important risk factors relate to the sleep environment. Prone and side sleeping positions are significantly more dangerous than the supine position. Bed sharing with a parent is strongly correlated with an increased risk of SIDS, especially in infants younger than 12 weeks. Apparent life-threatening events are not a risk factor for SIDS. Parents should place infants on their backs to sleep, should not share a bed, and should avoid exposing the infant to tobacco smoke. Other risk-reducing measures include using a firm crib mattress, breastfeeding, keeping vaccinations up to date, avoiding overheating due to overbundling, avoiding soft bedding, and considering the use of a pacifier during sleep once breastfeeding is established. One consequence of the Back to Sleep campaign is a significant increase in the incidence of occipital flattening. Infants who develop a flat spot should be placed with the head facing alternating directions each time he or she is put to bed. Supervised prone positioning while the infant is awake, avoiding excessive use of carriers, and upright positioning while awake are also recommended. [ABSTRACT FROM AUTHOR]

Ulcerative colitis is a chronic inflammatory disease of the colon. The etiology is unknown. Risk factors include a history of recent infection with Salmonella or Campylobacter, living in Western industrialized nations and at higher latitudes, and a family history of the disease. The incidence peaks in early adulthood, but patients can develop the disorder from early childhood through adulthood. Ulcerative colitis often presents with abdominal pain, diarrhea, and hematochezia. It is important to exclude infectious etiologies. Anemia and an elevated erythrocyte sedimentation rate or C-reactive protein level may suggest inflammatory bowel disease, but the absence of laboratory abnormalities does not rule out ulcerative colitis. The diagnosis is suspected clinically and confirmed through endoscopic biopsy. First-line treatment is therapy with 5-aminosalicylic acid. Corticosteroids may be added if 5-aminosalicylic acid therapy is ineffective. Infliximab can be added to induce and sustain remission. Patients with severe or nonresponsive ulcerative colitis should be hospitalized, and intravenous corticosteroids should be given. If medical management has been ineffective, surgical intervention is indicated for severe disease. Patients with ulcerative colitis have an increased risk of colon cancer and should have periodic colonoscopy beginning eight to 10 years after diagnosis. [ABSTRACT FROM AUTHOR]

Urine drug screening can enhance workplace safety, monitor medication compliance, and detect drug abuse. Ordering and interpreting these tests requires an understanding of testing modalities, detection times for specific drugs, and common explanations for false-positive and false-negative results. Employment screening, federal regulations, unusual patient behavior, and risk patterns may prompt urine drug screening. Compliance testing may be necessary for patients taking controlled substances. Standard immunoassay testing is fast, inexpensive, and the preferred initial test for urine drug screening. This method reliably detects morphine, codeine, and heroin; however, it often does not detect other opioids such as hydrocodone, oxycodone, methadone, fentanyl, buprenorphine, and tramadol. Unexpected positive test results should be confirmed with gas chromatography/mass spectrometry or high-performance liquid chromatography. A positive test result reflects use of the drug within the previous one to three days, although marijuana can be detected in the system for a longer period of time. Careful attention to urine collection methods can identify some attempts by patients to produce false-negative test results. [ABSTRACT FROM AUTHOR]

Sudden infant death syndrome is the leading cause of death among healthy infants, affecting 0.57 per 1,000 live births. The most easily modifiable risk factor for sudden infant death syndrome is sleeping position. To reduce the risk of sudden infant death syndrome, parents should be advised to place infants on their backs to sleep and avoid exposing the infant to cigarette smoke. Other recommendations include use of a firm sleeping surface and avoidance of sleeping with soft objects, bed sharing, and overheating the infant. Pacifier use appears to decrease the risk of sudden infant death syndrome, but should be avoided until one month of age in infants who are breastfed. The occurrence of apparent life-threatening events does not increase the risk of sudden infant death syndrome, and home apnea monitoring does not lower the risk of sudden infant death syndrome. Supine sleeping position has increased the incidence of flattening of the occiput (deformational plagiocephaly), but this condition can be prevented and treated by encouraging supervised "tummy time," meaning that when awake, infants should spend as much time as possible on their stomachs. All apparent deaths from sudden infant death syndrome should be carefully investigated to exclude other causes of death, including child abuse. Families who have an infant die from sudden infant death syndrome should be offered emotional support and grief counseling. [ABSTRACT FROM AUTHOR]

Several letters to the editor are presented in response to articles in previous issues including "Update on the Treatment of Tuberculosis" in the August 15, 2008 issue, "Pharmacologic Management of Adult Depression" in the March 15, 2008 issue and "Recommendations for Preconception Care" in the August 1, 2007 issue.

Major depression is a common and treatable disease. Many patients benefit from pharmacologic treatment and, because there is little variation in antidepressant effectiveness, medication choices should be made based on patient characteristics, safety, and anticipated side effects. Most patients respond favorably to treatment, but many do not have complete symptom relief. Changing medications or augmenting with a second medication is helpful for some partial or non-responders. All antidepressants are capable of producing harmful side effects, and some are particularly prone to dangerous drug-drug interactions. The risk of suicide is always a concern in depression and this risk is not necessarily reduced by the use of antidepressants. Some persons may have an increase in suicidal thoughts with antidepressant treatment. Close follow-up is required when initiating therapy and adjusting dosages. [ABSTRACT FROM AUTHOR]

Seizure is a common presentation in tile emergency care setting, and new-onset epilepsy is the most common cause of unprovoked seizures. The patient history and physical examination should direct the type and timing of laboratory and imaging studies. No single sign, symptom, or test clearly differentiates a seizure from a pseudoseizure event (e.g., syncope, pseudoseizure). Electroencephalography is recommended for patients presenting with a first seizure, and neuroimaging is recommended for adults. Neuroimaging also should be performed ill children with risk factors such as head trauma, focal neurologic deficits, or a history of malignancy. Magnetic resonance imaging is preferred over computed tomography except when acute intracranial bleeding is suspected. The most common laboratory findings associated with a seizure are abnormal sodium and glucose levels. Patients with a normal neurologic examination, normal test results, and no structural brain disease do not require hospitalization or antiepileptic medications. Treatment with antiepileptic medications reduces the one- to two-year risk of recurrent seizures but does not reduce the long-term risk of recurrence and does not affect remission rates. Regardless of etiology, a seizure diagnosis severely limits a patient's driving privileges, although laws vary by state. [ABSTRACT FROM AUTHOR]

Several letters to the editor are presented in response to article about fibromyalgia by Doctors Sangita Chakrabarty and Roger Zoorob.

A letter to the editor is presented in response to the articles "Sudden Infant Death Syndrome," by Stephen C. Adams, Matthew W. Good and Gina M. Defranco in the May 15, 2009 issue and "Risks and Benefits of Pacifiers," by Sumi Sexton in the April 15, 2009 issue, along with the responses of the authors.

A letter to the editor is presented in response to the article "Antidepressant Medication Use in Palliative Care," by K. E. Miller and colleagues, published in a previous issue.

A letter to the editor is presented in response to the article "Diverticular Disease: Diagnosis and Treatment" in the October 1, 2005 issue.