Volume 97, Issue 6

Onychomycosis is one of the most stubborn superficial mycoses. With few exceptions, oral antifungal therapy is needed to achieve resolution. Before oral itraconazole, fluconazole, and terbinafine hydrochloride became available, physicians had to rely on prolonged therapy with griseofulvin or oral ketoconazole. Of the newer oral agents, itraconazole appears to have the broadest spectrum of action, with therapeutic activity against dermatophytes, yeasts, and some nondermatophyte molds. Tissue pharmacokinetics account for significantly greater efficacy and much shorter treatment courses for fungal infections of the skin and nails. In general, oral itraconazole, fluconazole, and terbinafine are very well tolerated. The newer oral agents offer improved efficacy over griseofulvin and ketoconazole for onychomycosis and dry tinea pedis.

The symptom of chest pain may be a result or manifestation of somatic dysfunction of the musculoskeletal system. Chest pain is a common chief complaint among patients in a family practice office or in the emergency room. Various intrathoracic and extra thoracic factors may be responsible. The authors describe their experience with one patient in whom osteopathic manipulative treatment was used along with accepted medical tests and therapy to diagnose and treat this patient. If chest pain is effectively diagnosed and promptly treated, OMT can provide the most thorough, cost-effective, and satisfying care available.

Neuroleptic malignant syndrome is a rare but potentially fatal disorder that has been associated with the use of antipsychotic medications. Because neuroleptic malignant syndrome is rare, clinicians often have a low index of suspicion for the disorder which may lead to delayed treatment and increased mortality. This article describes a case of neuroleptic malignant syndrome and briefly reviews current diagnostic criteria and treatment options.

The authors used random effect meta-analysis to synthesize eight mean score differences of the Part III/Level3 examinations of the National Board of Osteopathic Medical Examiners (NBOME) between osteopathic medical trainees in DO residency programs and osteopathic medical trainees in MD programs. The analysis involved 6001 trainees and all Part ill or Level 3 examinations since 1992. The average mean score difference was not significantly different from zero; however, the estimates of true effect sizes of each examination varied substantially. The findings indicate that, overall, medical knowledge of osteopathic trainees in MD and DO residency programs is compatible at the time they took the examinations. However, a large variation of effect size suggests the need for further investigation of the factors other than difference between osteopathic and allopathic training programs.