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477 Hypothermia and Peripheral Cold Injuries as necessary. For cases of arterial gas embolism, evidence supports the use of intravenous lidocaine to achieve standard antiarrhythmic plasma levels. Occasionally, very sick divers require intubation, ventilation, ...

478 Heat-Related Illnesses from frostbite. This vesiculation rapidly progresses to ulceration and liquefaction gangrene. Consider administering amitriptyline early for pain. Patients with milder cases report hyperhidrosis, cold sensitivity, and painful ambulat...

479 Principles of Human Genetics Genes, the Environment, and Disease PART 16 J. Larry Jameson, Peter Kopp Principles of Human Genetics IMPACT OF GENETICS AND GENOMICS ON MEDICAL PRACTICE Over the past four decades, novel insights into human genetics and genomi...

481 Mitochondrial DNA and Heritable Traits and Diseases limited to, variable penetrance, which may be significantly impacted by family history (thus, those individuals with germline pathogenic variants detected via population screening in the absence of a clas...

482 Telomere Disease Parikh S et al: Diagnosis of “possible” mitochondrial disease: An exis­ tential crisis. J Med Genet 56:123, 2019. Russell OM et al: Mitochondrial diseases: Hope for the future. Cell 181:168, 2020. Saneto RP et al (eds): Mitochondrial Case ...

483 Gene and Cell-Based Therapy in Clinical Medicine PART 16 Genes, the Environment, and Disease FIGURE 482-5  Pathologic manifestations of telomere diseases. A. In the bone marrow, telomere erosion predisposes to aplastic anemia, characterized by an empty hem...

484 The Human Microbiome in Health and Disease ■ ■COMBINATION APPROACHES: MODIFICATION OF HOST AND TUMOR BY VIROTHERAPY— IMMUNO-ONCOLYTIC VIRUSES These viruses are genetically modified to replicate in malignant but not normal cells. The replicating vectors thu...

485 Global Issues in Medicine Joseph J. Rhatigan, Paul E. Farmer* Global Issues in Medicine WHY GLOBAL HEALTH? Global health has emerged as an important field within medicine. Some scholars have defined global health as the field of study and practice concerne...

486 Emerging and Re-Emerging Infectious Diseases high morbidity and mortality among those who cannot—grow in the absence of an equity plan to deliver the tools to those most at risk. Preventing such a future is among the most important goals of global health. ...

487 Primary Care and Global Health ■ ■FURTHER READING Fauci AS, Morens DM: The perpetual challenge of infectious diseases. N Engl J Med 366:454, 2012. Harper K: Plagues Upon the Earth: Disease and the Course of Human History. Princeton, Princeton University Pr...

488 Biology of Aging Rafael de Cabo, David G. Le Couteur Biology of Aging The increase in older people over the past few decades is one of the most significant changes in human history. For the first time, people over the age of 65 years now exceed children un...

489 Caring for the Geriatric Patient Joseph G. Ouslander, Bernardo Reyes Caring for the Geriatric Patient DEMOGRAPHICS OF AGING AND ITS IMPLICATIONS FOR CARE OF OLDER ADULTS The United States and other countries will continue to experience a rapid increase in ...

490 Approach to Medical Consultation Jeffrey S. Berns, Jack Ende Approach to Medical Consultation Effective health care requires teams of generalists and specialists with complementary expertise. Many clinical conditions require the input of more than one clin...

491 Medical Disorders During Pregnancy often viewed as convenient, efficient, and a common aspect of clinical care, without a comprehensive review of the record or any direct con­ tact with the patient, curbside consults have been found to often be incomplete ...

492 Medical Evaluation of the Patient Undergoing Noncardiac Surgery Parikh NI et al: Adverse pregnancy outcomes and cardiovascular dis­ ease risk: Unique opportunities for cardiovascular disease prevention in women: A scientific statement from the American Hea...

493 Point-of-Care Ultrasound Emerging Topics in Clinical Medicine PART 20 Wilma Chan, Nilam J. Soni, Paul H. Mayo Point-of-Care Ultrasound DEFINITION Point-of-care ultrasound (POCUS) is defined as the acquisition, interpretation, and clinical integration of ul...

495 Complementary and Integrative Therapies and Practices seen as intractable, even the most effective drugs will not work if physi­ cians fail to prescribe them and if patients fail to take them. Although the dominant forms of investigation in medicine seek c...

496 Placebo and Nocebo Effects Kathryn T. Hall, Alia J. Crum Placebo and Nocebo Effects Placebos are sham versions of drugs, devices, or surgeries that lack the active compound, function, or procedure they are designed to simulate (Table 496-1). Administration...