Jennifer M. Gierisch, PhD
 https://medicine.duke.edu/faculty/jennifer-m-gierisch-phd A 29-year-old man presents to the clinic complaining of back pain for the past several months pain treatment center fayetteville nc discount 500mg sulfasalazine free shipping. On examination pain treatment center albany ky order sulfasalazine canada, the pertinent finding is decreased range of motion in the lumbar spine on forward flexion pain treatment ulcerative colitis order 500mg sulfasalazine otc. A 94-year-old female nursing home resident is referred for evaluation of anemia of 8 g/dL acute low back pain treatment guidelines purchase 500mg sulfasalazine with visa. She has dementia, and adequate documentation of her past medical history is not available. Examination reveals evidence of cognitive impairment, primitive reflexes, and a well-healed midline abdominal scar. Which of the following surgical procedures is most likely to cause her current anemia An asymptomatic 59-year-old man is treated with oral anticoagulants for chronic atrial fibrillation. When reviewing the benefits of warfarin therapy, he asks about the risks of major bleeding while taking the medication. Which of the following is the best estimate of the major bleeding complication rate with warfarin anticoagulation Questions 96 through 100: Match the appropriate statement about pharmacology with each of the following medications. Questions 101 through 105: For each of the following side effects, select the most likely medication to cause them. Questions 106 through 108: For each of the following situations, select the most likely sleep disturbance. Physical examination reveals crackles in his lungs, some abdominal distension, and bilateral asterixis. A 69-year-old woman is brought to the hospital under an order of medical evaluation after she was found confused in an unkempt apartment with 5 cats. Extensive investigation does not reveal a specific cause of confusion in this woman, and the medical service wonders whether the true diagnosis is dementia. Which of the following cognitive or behavioral impairments is more typical of delirium than dementia A 77-year-old man is brought to the hospital by his granddaughter for evaluation of confusion. Further investigations reveal a urinary tract infection, and the man improves somewhat after treatment, but still exhibits poor judgment and bizarre behavior. Pressing the family for information, the intern unearths a history of 8 years of progressive bizarre behavior. The man has undressed himself, made inappropriate sexual comments, has urinated in hallways, and pushed food into his mouth with alarming speed. A 68-year-old woman with frontotemporal dementia is being cared for at home by a supportive family. Which of the following is the most common reason for considering nursing home placement in this individual A 69-year-old man has developed memory difficulty and is seen for further evaluation. His laboratory investigations and brain imaging are normal, and there does not appear to be any reversible cause for the memory deficits. Which of the following pathologic changes are most likely to be seen in the brain of a patient with Alzheimer disease Alternatives to ceftriaxone include ciprofloxacin, ofloxacin, or cefixime given orally, with 7 days of doxycycline, or a single 1 g dose of azithromycin in case of coinfection with Chlamydia. In Asia and the Pacific (as well as in California), quinolones are not considered first-line therapy because of the high rate of resistant organisms. Decline in most systems starts in the third decade and is gradual and progressive. Decrements in each organ system seem independent of other systems and are influenced by diet, environment, personal habits (eg, exercise), and genetic factors, as well as just chronologic age. At times, it can be difficult to differentiate between age-related physiologic change and age-related diseases. However, the insidious and subtle onset, with few focal signs (except for higher mental functioning) and a slowly progressive course are characteristic. Careful attention to the pattern of cognitive defects also improves diagnostic accuracy. The intensity of investigation will depend on numerous factors, including age, presence of atypical findings, and the timing of presentation. There is as yet no definite consensus on the most appropriate plan of investigation. Cardiac complications are more common in the elderly patient and may dominate the clinical presentation. There is often a wide pulse pressure, systolic murmurs, increased intensity of the first heart sound, and cardiomegaly. A to-and-fro high-pitched sound in the pulmonic area (Means-Lerman scratch) can mimic a pericardial friction rub. Aortic regurgitation, soft heart sounds, and hypotension are not usual findings in hyperthyroidism. A whole host of locally produced hormones and cytokines, as well as ectopically produced hormones, are implicated in local osteoclastic hypercalcemia. Streptococcal toxic shock-like syndrome was so named because of its similarity to staphylococcal toxic shock syndrome. The illness includes fever, hypotension, renal impairment, and the respiratory distress syndrome. It may be associated with localized infection as well; the most common associated infection is a soft-tissue infection such as necrotizing fasciitis. The mortality is high (up to 30%), usually secondary to shock and respiratory failure. The rapid progression of the disease and its high mortality demand early recognition and aggressive treatment. Management includes fluid resuscitation, pressor agents, mechanical ventilation, antibodies, and, if necrotizing fasciitis is present, surgical debridement. Labetalol is also useful since is can be administered in an oral preparation, but has more contraindications. Regardless of which drug is selected, early administration of medications for long-term control is mandatory. Transmural involvement, lymph node involvement, skip lesions, granulomas, and anorectal complications (abscesses, fistulas, fissures) are characteristic of Crohn disease. Findings on physical examination may be deceptively normal, but tachycardia is a consistent finding. Pleuritic chest pain and hemoptysis suggest a peripheral embolism adjacent to the pleura. Myocardial infarction is a rare complication in pregnancy and likely to present with chest pain, and primary pulmonary hypertension while common in young woman would present with the insidious onset of dyspnea on exertion. The eye findings in Wernicke encephalopathy include bilateral (but not necessarily symmetrical) abductor weakness or paralysis, horizontal diplopia, strabismus, and nystagmus. There is no indication to administer phenytoin for this patient, and while diazepam maybe important for prophylaxis against alcohol withdrawal symptoms, the most important immediate treatment is thiamine. The inhibition of osteoclast-mediated bone resorption and the stimulation of renal calcium clearance are mediated by receptors on osteoclasts and renal tubular cells. The diagnosis is made with 2 major, or 1 major and 2 minor criteria, and evidence of group A streptococcal infection (positive throat culture or rapid streptococcal antigen test, or rising antibody titers). In the United States, it is estimated that only 2000 potential donor hearts become available each year for 20,000 potential recipients. The optimal candidates will have a high likelihood of return to a high level of function, to be mentally vigorous and medically compliant. Common reasons for treatment include hemolytic anemia, cytopenias, disfiguring lym-phadenopathy, symptomatic organomegaly, or systemic symptoms. Chlorambucil is easy to administer, but fludarabine is considerably more effective. Patients with cirrhosis and portal hypertension are at risk for variceal bleeding.
The following terminology is used: Ideallythe pulse should be assessed in a number of body locations to check that it does not vary low back pain treatment video discount 500mg sulfasalazine free shipping. Arterial thrombosis midsouth pain treatment center germantown tn purchase generic sulfasalazine, brosis Tachycardia may occur in nervous and stressed ani and local oedema can all reduce the strength of the mals pain treatment center seattle buy 500 mg sulfasalazine visa, and the patient should be allowed time to settle pulse in an affected area pain treatment center houston texas order generic sulfasalazine line. The pulse rate also rises in pyrexic animals and those which have under Colour of mucous membranes gone strenuous exercise or are experiencing pain. Normally salmon pink in colour, the membranes may be cyanotic in cases of terminal Table 6. False anomalies in which red blood cells are destroyed by jugular pulsation may be observed if pulsation of the a turbulence in blood ow. Other causes of discolouration of the lling and emptying of the jugular veins are im the mucous membranes are discussed under the portant indicators of the ef ciency of the cardiovas General Clinical Examination in Chapter 2. Distension of the jugular vein can be a sign pressure on an area of non-pigmented mucosa of of right-sided heart failure and should not be present the lips, dental pad or vulval mucosa causes blanch in normal animals. Distension of the jugular veins may Apex beat of the heart also be observed in animals in which there is a space the apex beat of the heart, caused by the apex or occupying lesion at the thoracic inlet. The apex beat can often be seen and readily pal hydrated animals or those suffering from shock the pated in the new-born calf. Pulsation extending up to disease the angle of the jaw is abnormal and may suggest in Visible cardiac apex beat competence of the tricuspid valve. In such cases com Position of the elbows pression of the vein does not result in a loss of the Brisket and submandibular oedema jugular pulse. This pulsation disappears when the head is Consequences of cardiac failure including renal dysfunction raised and is of no pathological signi cance. The nor and diarrhoea mal jugular vein looks full when the head is lowered 54 Clinical Examination of the Cardiovascular System the stethoscope. In fat, heavily muscled animals the Auscultation of the heart intensity of the heart sounds may be reduced, but in such animals there should be no other signs of heart this is carried out on both sides of the chest between failure. The heart sounds may be very Normal heart sounds loud in cases of acute hypomagnesaemia when they Four heart sounds have been described in cattle: S1, may be audible without a stethoscope through the S2, S3 and S4. The events accompa Cardiac rate and rhythm nying the normal heart sounds are as follows: the pulse of the animal has been taken already. In the living animal they can the bovine heart should be clearly audible through be located within the area bounded by a line drawn Figure 6. The stethoscope is advanced under the triceps muscle to get as close to the valves as possible. Murmurs are mostly caused by leakage of blood through closed but incompetent valves, or through congenital ori ces between the chambers of the heart. Other murmurs are caused by the presence and movement of uid within the peri cardium. It is important to detect, by careful auscul tation over a series of cardiac cycles, the nature and location of any cardiac abnormality which is causing the murmur. Murmurs are most likely to be heard in systole when blood within the heart is under the greatest pressure. It is important to be sure that audible murmurs are arising from the heart and not from the respiratory system. Friction rubs caused by pleural adhesions may be mistaken for abnormal heart sounds. Brief blockage of the nostrils will elim inate respiratory but not cardiac sounds. Such a murmur may be heard in cases where horizontally back from the shoulder joint and a line there is incompetence of an atrioventricular valve. If the pitch falls it is known as a decres Endocarditis Systolic, plateau murmur, grade 2 to cendo murmur. The heart sounds may be muf present in anaemic animals, possibly as a result of ed if a pericardial effusion is present. Pulling the fore leg forward helps expose the area for percussion on Description of some common the chest wall. Cardiac percussion should normally cardiac murmurs be included with general percussion of the chest, Ventricular septal defect Murmurs are present since ndings can be in uenced by the presence of on both sides of the chest: (i) on the right side a sys pulmonary abnormalities. The area may be more obvious on the left than Patent ductus arteriosus Systolic and diastolic on the right. In cattle with pneumonia, ventral consolidation of the lungs can make identi cation of areas of cardiac dullness dif cult. Aseries B-mode scanner can also be used to guide a needle 58 Clinical Examination of the Cardiovascular System Body wall Tricuspid valve Pericardial effusion Wall of left ventricle Figure 6. Access for ultrasonography to the bovine heart may be dif cult since in the lower thorax the Pericardiocentesis ribs are wide and the space between them is very nar row. Quite good visualisation of the cardiac cham this technique is used to collect and assess peri bers can be achieved in calves using a basic linear cardial uid. The needle is inserted through the tect the presence and character of pericardial uid chest wall into the pericardial sac and uid is allowed (Fig. Local anaes as the Doppler ow sector scanner produce more in thetic is injected into the skin and muscle layers of formation, including the direction and pressure of the space between the 5th and 6th ribs. This information is particularly helpful prepared aseptically and the needle with syringe in cases of congenital cardiac abnormality. Fluid, which may be very foul smelling if infection is present, is aspirated for cytology, culture and Radiography drainage purposes. If ultrasonographic equipment is this is of limited value in assessing bovine cardiac available the needle may be directed visually. The size and mass of the bovine heart equipment is not available care must be taken to prevent clear demonstration of the internal divisions avoid penetrating the myocardium with the needle of the heart. Valvular regurgitation occurs and cardiac Blood for culture may be taken aseptically from the failure follows in most cases. This can be useful in cases of endocardi include intermittent pyrexia; later signs are exercise tis, but repeated samples may be needed as bacterial intolerance and thoracic pain. An Radiography ultrasonographic scan may demonstrate clear peri Pericardiocentesis cardial uid and evidence of vegetative growths on Blood culture the affected valve. In advanced cases signs of right sided heart failure, including a distended jugular vein and brisket oedema, are present. Clinical signs of speci c cardiac diseases Pericarditis this often follows the penetration of the reticulum by Endocarditis a sharp foreign body which passes through the dia Endocarditis usually involves the tricuspid valve phragm into the pericardial sac. Less may lose weight, show a reluctance to move and be 60 Clinical Examination of the Cardiovascular System come pyrexic. The animal often stands with its back arched, elbows abducted and grunts in pain if the Diseases of the blood vessels withers are pinched or the chest is percussed.
However alternative pain treatment center tacoma cheap generic sulfasalazine canada, clinicians must also be aware of the paucity of long-term safety data pain treatment with acupuncture generic 500mg sulfasalazine fast delivery, although the scanty evidence that exists is somewhat reassuring allied pain treatment center youngstown oh discount sulfasalazine 500mg line. In addition pain treatment of shingles purchase sulfasalazine, clinicians must appreciate that there is very little information available regarding many important clinical issues, including the optimal dose for producing the best clinical outcomes, as well as clear indicators for initiating therapy or for discontinuing therapy because of a poor response. The major gaps in our knowledge about hydroxyurea, described in this report, should motivate researchers to search for answers. Also, if this drug is shown to have long-term safety, research needs to be directed at testing interventions to overcome barriers to the use of this drug so that patients have the opportunity to enjoy its benefits. This medication is not being evaluated for comparative effectiveness or comparative safety with reference to established therapies. Although it was beyond the scope of this report to describe the funding challenges in sickle cell disease research, we note a recent article that describes the state of funding for such 186 research. The report noted that even though cystic fibrosis affects fewer than half the number of Americans affected by sickle cell disease, there is a dramatic discrepancy in their funding. The implication is that patients from racial minorities, and often a low-socioeconomic stratum, may not have the organizational strength and resources to command research dollars. The cooperative study of oxide-dependent activation of soluble guanylyl sickle cell disease: review of study design and cyclase. Medicine (Baltimore) hydroxyurea on the frequency of painful crises in 2005;84(6):363-76. Impact of clinical trial results on national trends in alpha-blocker prescribing, 1996-2002. Does blinding of readers affect the Multicenter Study of Hydroxyurea in Sickle Cell results of meta-analyses Assessing the of hydroxyurea administration on the body weight, quality of reports of randomized clinical trials: is body composition and exercise performance of blinding necessary Analytical Hydroxyurea and sickle cell anemia: effect on strategies to reduce confounding. Assessing hydroxyurea on mortality and morbidity in adult potential for confounding. Methodological rigour Hydroxyurea: effects on hemoglobin F production within a qualitative framework. Cytotoxic and genotoxic monitoring of sickle cell anaemia patients treated with hydroxyurea. Determining causation from case microalbuminuria and proteinuria in children with reports. J Pediatr Hematol Oncol Strom (Ed) 2005;John Wiley and Sons, West 2007;29(3):140-4. Pediatr Blood treatment in children with sickle cell anemia in Cancer 2006;47(7):894-900. Hydroxyurea children with sickle cell disease: impact on splenic treatment of sickle cell anemia in hospital-based function and compliance with therapy. Arch Pediatr Adolesc Med adverse reactions to hydroxyurea in patients with 2002;156(7):729. French Study Prevention of secondary stroke and resolution of Group on Sickle Cell Disease. Arch Dis Child transfusional iron overload in children with sickle 1999;81(5):437-9. Exp Hematol of hydroxyurea in children with sickle cell anemia: 2007;35(2):179-83. Clinical and hydroxyurea on splenic function in patients with hematological responses to hydroxyurea in Sicilian sickle cell disease. Long-term pilot trial of hydroxyurea in very young children hydroxyurea therapy for infants with sickle cell with sickle-cell anemia. Fetal hemoglobin and F-cell erythrocyte arginase activity in sickle cell disease responses to long-term hydroxyurea treatment in patients during hydroxyurea therapy. Pulmonary bilirubin response to hydroxyurea therapy in sickle hypertension in patients with sickle cell disease: a cell anemia. Hydroxyurea therapy for sickle cell disease in community-based practices: a survey of Florida and 82. Am J Hydroxyurea for sickle cell disease in children and Hematol 2005;79(2):107-13. French prospective studies of hydroxyurea and Randomized comparison of interferon-alpha with pipobroman in polycythemia vera and essential busulfan and hydroxyurea in chronic myelogenous thrombocythemia. Randomized study on hydroxyurea alone versus vera: A prospective analysis of 682 cases. Second cutaneous changes during long-term therapy with malignancies in patients with essential hydroxyurea in chronic myeloid leukaemia. Busulfan versus hydroxyurea in therapy of chronic myelogenous leukemia in 1(st) chronic 132. Treatment of polycythemia disorder treated with hydroxyurea alone or with vera: the use of hydroxyurea and pipobroman in 292 hydroxyurea after busulphan. Acute leukaemia after hydroxyurea therapy in leukemia in polycythemia vera: an analysis of 1638 polycythaemia vera and allied disorders: patients enrolled in a prospective observational prospective study of efficacy and leukaemogenicity study. Safety efficacy to safety: A Polycythemia Vera Study profile of hydroxyurea in the treatment of patients Group report on hydroxyurea in patients with with Philadelphia-negative chronic polycythemia vera. Hydroxyurea in the treatment of polycythemia vera: a prospective study of 100 139. Hydroxyurea for patients with essential thrombocythemia and a high risk of thrombosis. Int J Qual Health Care sickle cell disease: Disease-related risk and 2004;16(3):245-51. J attitudes and practices in sickle cell pain Pediatr Hematol Oncol 2001;23(2):112-6. Caregiver attitude and practices in sickle cell disease pain knowledge and adherence in children with sickle management. J Health Care Poor Underserved physician ratings of pain and medication decisions. Optimism disparity between standard of care and delivery of Predicting Daily Pain Medication Use in care in sickle cell disease, as assessed from sickle Adolescents with Sickle Cell Disease. Pain Parent factors and adolescent sickle cell disease: management in sickle cell disease. A care access for sickle cell patients through the natural history study of adolescents and young discursive regimes of biomedicine. Cult Med adults with sickle cell disease as they transfer to Psychiatry 2004;28(3):369-99. Sickle sickle cell crisis pain as experienced by patients and cell anemia day hospital: an approach for the their carers. Ann Intern Med focus groups for pain and quality of life assessment 1992;116(5):364-8. Int J Qual Health Care sickle cell group: education, task orientation, and 2002;14(1):39-47. Health Care to improve compliance with prophylactic penicillin 2006;35(4):281-296. Perceptions of ethnic and cultural factors in the delivery of services in the treatment of 184. J Health Soc Policy 1994;5(3 telephone-based outreach using nonmedical 4):215-42. Mayo Clin Proc 98;73(10):961-3 leg ulcer succesfully treated with hyperbaric oxygen in a diabetic patient. Hydroxyurea induced foot ulcer successfully treated with a topical basic Beylot-Barry M, Vergier B, Beylot C et al. Br J Dermatol squamous cell carcinomas after prolonged treatment with 2003;148(3):599-600 hydroxyurea. Hydroxyurea as a cause of epitheliomas during long-term treatment with hydroxyurea. Neth J Med J Eur Acad Dermatol Venereol 2001;15(1):89-90 88;32(5-6):240-2 Au W Y, Hung K N, Loong F et al. J Eur disease and glioblastoma multiforme in a renal transplant Acad Dermatol Venereol 98;10(2):187-9 recipient. 500 mg sulfasalazine. Treat Knee Joint Pain with Jiva - Testimonial of Mr. Dinesh Chandra Mishra. Alcohol use leads to hypertension as a causal relation exists between the use of >30-60 g/day and blood pressure elevation in men and women (Grobbee et al pain treatment center pasadena drive lexington ky proven 500mg sulfasalazine. Assuming a linear relationship with no threshold pain swallowing treatment cheap 500mg sulfasalazine otc, an additional drink a day (10 g) would increase both systolic and diastolic blood pressures by 1 2 mmHg (Anderson et al pain treatment and wellness center seattle proven 500 mg sulfasalazine. Though most epidemiological studies suggest that regular light to moderate alcohol intake (16-32 g/day) probably reduces the risk of ischaemic stroke kidney pain treatment 500mg sulfasalazine for sale, regular consumption of more than 40 g of alcohol per day and binge drinking increases the risk of ischaemic and haemorrhagic stroke (due to cerebral or subarachnoid haemorrhage) (Anderson et al. A meta-analysis of 27 studies (follow-up and case-control studies) (Longnecker et al. Later reports showed similar effect sizes, though at higher daily alcohol consumption (Cho et al. They also observed an almost linear dose-response association, but estimated a (confounder-adjusted) slightly lower increased risk of 7. As such, it has been suggested that alcohol may act as co-carcinogen by enhancing the carcinogenic effects of tobacco smoking (Blot et al. Note that an elevated mean corpuscular volume may also result from liver disease in the lipid bilayers that red cells do not form properly. When liver disease is severe, platelets may be destroyed or can isolate an enlarged spleen. Microcytic anaemias are associated with active bleeding or bleeding and the evaluation should ask for a gastrointestinal disorder or injury. With liver disease, spider nevi, telangiectasias, palmar erythema (red palms), spider angiomas, and hepatic porphyria, especially porphyria cutanea tarda (bullous erosions, blistering, crusting lesions and scars heal with hyperpigmentation or depigmentation on the face, side of the neck and the backs of the hands) could be found (Johnson and Marzani-Nissen, 2010). The most important of these and commonly seen in alcoholics is Wernicke-Korsakoff syndrome. Alcohol consumption is related to more mortality in young people than it is in any other age group. In European countries, over 10% of female mortality and 25% of male mortality in those aged 15-29 years is alcohol-related. In Europe, a rise of one litre per capita in alcohol intake was associated with a 1% rise in all causes of morbidity (Her and Rehm, 1998). The intangible costs, related to the value people place on pain, suffering and lost life that occurs to the criminal, social and health harms caused by alcohol, are estimated to be 270 billion or 2. For instance, we recently showed that the consumption of magic mushrooms is relatively safe, but can occasionally lead to fatal accidents when used in combination with alcohol (Van Amsterdam et al. The treatment of alcohol addiction is much higher than that of illegal drugs because the number of alcoholics in Netherlands is 13 times higher than the number of illicit drug addicts, and alcohol and tobacco-related deaths are 15 and 333 times higher respectively than those related to the use of illicit drugs (Council, 1999, Trimbos, 2004). The costs of hospitalisations related to excessive alcohol use amount to 106 million. Smoking a single cigarette decreases the cutaneous blood flow in habitual smoker as well as in non-smoker subjects (Monfrecola et al. About 90,000 people of 35 years and older were admitted to hospital with a smoking related disease (Cruts et al. Mainly airway related cancer, cardiovascular disease and chronic airway obstruction were the most frequent reasons for admission. Tobacco smoke is both prothrombotic and atherogenic (Bullen, 2008b, Rahman and Laher, 2007a) by narrowing the blood vessels (atherosclerosis) (Leone, 2007, Rahman and Laher, 2007c). With increased use of tobacco, patients show higher periodontal probing depths, increased clinical attachment loss, more alveolar bone resorption, a higher prevalence of gingival recessions, and a higher risk for tooth loss (Jacob et al. Cigarette smoking has a negative effect on wound healing and periodontal treatment procedures (Jacob et al. Women who smoke have an increased risk for cataract, hip fractures, low bone density, and peptic ulcer disease when Heliobacter pylori positive (Hatsukami et al. These numbers are surely an underestimate, since the effects of passive smoking, through environmental smoke, have not been included and are difficult to exactly estimate. These number of deaths through passive smoking were estimated to be at least several thousands in 2009. Worldwide, the incidence of death through passive smoking is estimated to be one on every hundred deaths (Oberg et al. Main causes of death include cardiovascular disease, airway infections and lung cancer. The economic health care burden of smoking in the Netherlands were investigated in 2003; it was estimated that around 2 billion were spent on health care attributed to the chronic effects of smoking; 3. This is a higher amount than is spent on health care resulting from overweight/obesity. Surprisingly, in the long run, smokers save on governmental spending in comparison with healthy non smokers, mainly because their lifespan expectancy is shortened (van Baal et al. In this way, it was estimated that smokers save up 60,000 on lifetime health care in comparison with non-smokers. It was shown that health care costs of men who do not smoke are 15% more than those of smokers. Smoking was directly responsible for 12% of disability adjusted life years lost in 2002 (15. Bert Molendijk of the Centre for Special Dentistry of Jellinek for his contribution about the adverse oral health effects in drug users. Our special thanks goes to the experts Roel Kerssemakers, Gabe Sonke, Jan Krul, Irma de Vries, Armand Girbes, Barbara Broers, Ton Nabben, Dirk Korf, Magda Boonstra, Margriet van Laar, Ed Pennings, Raymond Niesink, Evelien Vermeulen en Hein Sigling, who have advised us in the identification of the gaps in knowledge. The search was not confined to the population-based controlled trials or prospective studies in order to retrieve also the information about drug abuse and physical illness from other studies. Because the focus of the search and subsequent review of the literature was on humans, animal studies in connection with illegal substances abuse were not included in the search. A broad search strategy was conducted to ensure retrieval of all data about the physical illnesses of the 19 drugs selected. Finally, the experts engaged were asked to report unpublished data to the authors. Textbooks in addiction medicine and internal medicine do not adequately review the physical morbidity associated with drugs of abuse. Nevertheless, the following seven textbooks were used as a source of physical health problems associated with drugs of abuse. Physical Illness and Drugs of Abuse: A review of the evidence Cambridge University Press. References found in the different retrieved sources have been used as further source of information. Aldington S, M Harwood, B Cox, M Weatherall, L Beckert, A Hansell, A Pritchard, G Robinson, R Beasley: Cannabis use and risk of lung cancer: a case control study. Amin M, G Gabelman, J Karpel, P Buttrick: Acute myocardial infarction and chest pain syndromes after cocaine use. Baan R, K Straif, Y Grosse, B Secretan, F El Ghissassi, V Bouvard, A Altieri, V Cogliano. Balakrishnan R, S Allender, P Scarborough, P Webster, M Rayner: the burden of alcohol-related ill health in the United Kingdom. Bullen C: Impact of tobacco smoking and smoking cessation on cardiovascular risk and disease. Colebunders B, P van Erps: Cystitis due to the use of ketamine as a recreational drug: a case report. Corrao G, V Bagnardi, A Zambon, C La Vecchia: A metaanalysis of alcohol consumption and the risk of 15 diseases.
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