Internal Medicine

P1: RLJ/OZN P2: KUF

0521779407-D-01 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:41

482 Diabetic Retinopathy Diarrhea

■Arxxant (ruboxistaurin; Eli Lilly) – promising new protein kinase C

beta (PKC-ß) inhibitor, taken orally

➣May reduce vision loss; ongoing analysis and studies

■DRCR.net studies (NEI/NIH); ongoing studies

➣Mild grid vs. focal laser

➣Laser vs. triamcinolone

➣Peribulbar triamcinolone vs. laser

■Cand5 (Acuity) – small interfering RNA, injected intravitreally, that

selectively silences the mRNA encoding for VEGF; ongoing analysis

and studies

■Intraocular implants (Posurdex, Retisert) – slow release of steroids;

ongoing analysis and studies

Diarrhea...........................................

JAYSHREE MATADIAL, MD and SUZANNE M. MATSUI, MD

history & physical

History

■Duration of diarrhea:

➣acute – acquired within 2–3 weeks of evaluation

➣chronic – >4 weeks of symptoms

■Character of fecal output: too loose, too frequent, increased volume

■History of exposure to enterotoxins or recent antibiotic use

■History of exposure to poorly absorbed osmotically active agents or

new medications

■History of systemic disease: diabetes, pancreatic insufficiency, small

bowel disease, endocrinopathy, surgical resection, neoplasms, IBD,

AIDS

■History of travel, epidemiological setting in which illness was

acquired, family and social history all important

Signs & Symptoms

■Abdominal pain, cramping, bloating, distention, tenesmus

■Fever, rashes

■Dehydration

■Signs of malnutrition, malabsorption, weight loss

■Hematochezia, anemia, watery diarrhea, passage of mucous

■Manifestations of systemic disease