Preface

Current Medical Diagnosis & Treatment 2020 (CMDT 2020) is the 59th edition of this single-source reference for practitioners in both hospital and ambulatory settings. The book emphasizes the practical features of clinical diagnosis and patient management in all fields of internal medicine and in specialties of interest to primary care practitioners and to subspecialists who provide general care.

Our students have inspired us to look at issues of race and justice, which surely impact people’s health. We have therefore reviewed the content of our work to ensure that it contains the dignity and equality that every patient deserves.

House officers, medical students, and all other health professions students will find the descriptions of diagnostic and therapeutic modalities, with citations to the current literature, of everyday usefulness in patient care.

Internists, family physicians, hospitalists, nurse practitioners, physician assistants, and all primary care providers will appreciate CMDT as a ready reference and refresher text. Physicians in other specialties, pharmacists, and dentists will find the book a useful basic medical reference text. Nurses, nurse practitioners, and physician assistants will welcome the format and scope of the book as a means of referencing medical diagnosis and treatment.

Patients and their family members who seek information about the nature of specific diseases and their diagnosis and treatment may also find this book to be a valuable resource.

• Extensive updating of images

• FDA designates esketamine as breakthrough medication for resistant depression

• New FDA-approved medication for multiple sclerosis

• Extensive revision of Viral & Rickettsial Infections chapter, including updates on measles, polio, and acute flaccid paralysis outbreaks; immunizations; as well as preventing and treating Epstein-Barr virus and cytomegalovirus infections in transplant patients

• FDA re-approval of tegaserod for irritable bowel syndrome with constipation

• Treatment options for prevention of opioid overdose and substance abuse disorders

• Clarification of the appropriate role of opioids and buprenorphine formulations in chronic pain management

• Information on new biologic agents for asthma

• Evolving treatment for chronic lymphocytic leukemia

• Differentiation of patients with celiac disease from patients intolerant of short-chain carbohydrates (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols or “FODMAPS”)

• New treatment recommendations for bacterial peritonitis

• Recommendations regarding use of tofacitinib to treat moderate to severe ulcerative colitis

• New model for acetaminophen-induced acute liver failure

• New table summarizing recommended FDA-approved oral direct-acting antiviral treatment regimens for hepatitis C

• New minimally invasive procedures for benign prostatic hyperplasia

• Rewritten Lipid Disorders chapter

• New table summarizing pharmacologic options for treatment of obesity

• Recommendations for treatment of fever during neutropenia following chemotherapy

• Update on biologic markers for breast cancer and their use in staging

• US Preventive Services Task Force screening recommendations for osteoporosis, prostate cancer, ovarian cancer, and cervical cancer

• Targeted therapies in advanced non-small cell lung cancers

• New immunotherapies for esophageal cancer, bladder cancer, and hepatocellular carcinoma

• Inclusion of most recent adult congenital heart disease guideline recommendations

• Detailed recommendations for the treatment of pulmonary stenosis

• Important update on cardiac amyloidosis treatment

• New discussion about management of subclinical atrial fibrillation

• Extensive update of immune modulation therapy and adjuvant treatments in breast cancer

• Approval of transcutaneous supraorbital neurostimulation and use of monoclonal antibodies for migraine

• Recommendations for thrombolysis and endovascular therapies in stroke as well as dual antiplatelet therapy in transient ischemic attack and stroke

• Novel treatments for posttraumatic stress disorder

• Revised table showing how to initiate and subsequently titrate antihypertensive medications

• Addition of angiotensin II in vasodilatory shock that is refractory to catecholamines and vasopressin

• Rewritten section on Health Care for Sexual and Gender Minority Patients

• Medical advances up to time of annual publication

• Detailed presentation of internal medicine disciplines, plus primary care topics including gynecology, obstetrics, dermatology, ophthalmology, otolaryngology, psychiatry, neurology, toxicology, urology, geriatrics, orthopedics, women's health, LGBT health, preventive medicine, and palliative care

• Concise format, facilitating efficient use in any practice setting

• More than 1000 diseases and disorders

• Annual update on HIV/AIDS and other newly emerging infections

• Specific disease prevention information

• Easy access to medication dosages, with trade names indexed and costs updated in each edition

• Recent references, with unique identifiers (PubMed, PMID numbers) for rapid downloading of article abstracts and, in some instances, full-text reference articles

Seven e-chapters mentioned in the Table of Contents can be accessed at www.AccessMedicine.com/CMDT. These online-only chapters (available without need for subscription) include

• Anti-Infective Chemotherapeutic & Antibiotic Agents

• Diagnostic Testing & Medical Decision Making

• Information Technology in Patient Care

• Integrative Medicine

• Podiatric Disorders

• Women's Health Issues

• Appendix: Therapeutic Drug Monitoring, Laboratory Reference Intervals, & Pharmacogenetic Tests

Institutional or individual subscriptions to AccessMedicine also have full electronic access to CMDT 2020.

Subscribers to CMDT Online receive full electronic access to CMDT 2020 as well as

• An expanded, dedicated media gallery

• Quick Medical Diagnosis & Treatment (QMDT)—a concise, bulleted version of CMDT 2020

• Guide to Diagnostic Tests—for quick reference to the selection and interpretation of commonly used diagnostic tests

• CURRENT Practice Guidelines in Primary Care—delivering concise summaries of the most relevant guidelines in primary care

• Diagnosaurus—consisting of 1000+ differential diagnoses

CMDT 2020, QMDT, Guide to Diagnostic Tests, and Diagnosaurus are also available as individual apps for your smartphone or tablet and can be found in the Apple App Store and Google Play.

With this 2020 edition, Dr. Robert Baron will be retiring from CMDT after more than 30 years of contributions. Dr. Baron has authored CMDT's Nutritional Disorders chapter for 31 years (since 1989) and its Lipid Disorders chapter for 22 years (since 1998).

Dr. Baron has had a distinguished career in internal medicine. He received his BA in anthropology and sociology from Princeton University, his MS in nutrition from the University of Wisconsin, Madison, and his MD from the University of California, San Francisco (UCSF). After his residency training in UCSF's Primary Care Internal Medicine Residency Program, he joined the UCSF faculty in 1981. He directed that residency from 1989 until 2006. In 2000, he became Associate Dean for Continuing Medical Education (CME) and continues to lead UCSF's extensive CME program. Since 2006, Dr. Baron has also been serving as Associate Dean for Graduate Medical Education and Designated Institutional Official for UCSF, overseeing its 92 Accreditation Council for Graduate Medical Education (ACGME)-accredited residency and fellowship training programs and 50 non-ACGME programs.

A practicing primary care general internist, Dr. Baron has been recognized as one of America's Top Doctors and as one of its Outstanding Primary Care Physicians. He has received numerous other teaching and service awards. Focusing his scholarship on graduate and continuing medical education and on nutrition, preventive medicine, and chronic disease, he has published 69 peer-reviewed papers and 99 book chapters and reviews.

Dr. Baron lives in San Francisco with his wife, Randie Bencanann. Their daughter, Micki, is a practicing obstetrician-gynecologist and daughter, Haley, recently obtained her master's degree in food studies.

As his editors, we offer our immense gratitude to Dr. Baron for 30 years of work on CMDT. It has been a genuine pleasure to edit his two chapters each year. We will miss working with you, Bobby!

We wish to thank our authors for participating once again in the annual updating of this important book. We are especially grateful to Kevin Barrows, MD, Thomas D. Chi, MD, Pelin Cinar, MD, MS, Dima Dandachi, MD, Maxwell V. Meng, MD, FACS, Ramana K. Naidu, MD, Charles J. Ryan, MD, and Samuel A. Shelburne III, MD, PhD, who are leaving CMDT this year. We have all benefited from their clinical wisdom and commitment.

Many students and physicians also have contributed useful suggestions to this and previous editions, and we are grateful. We continue to welcome comments and recommendations for future editions in writing or via electronic mail. The editors' e-mail addresses are below and author e-mail addresses are included in the Authors section.