Preface

Current Medical Diagnosis & Treatment 2021 (CMDT 2021) is the 60th 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 quickly referencing medical diagnosis and treatment modalities.

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.

• INNOVATIVE TABLE highlighting the “Year in Review: Key Clinical Updates in CMDT 2021,” individually listed with page numbers and reference citations, for easy access to significant changes in this edition

• New section on SARS-CoV-2 virus and COVID-19 infection

• Extensive revision of the Viral & Rickettsial Infections chapter, including new section on acute flaccid myelitis as well as updates on measles, mumps, and Zika virus

• 140 NEW online images in the Heart Disease, Gastrointestinal Disorders, and Cancer chapters

• Addition of the 2019 European guidelines for treating pulmonary embolism

• New table outlining agents to consider for reversing anticoagulant effect during life-threatening bleeding based on the Anticoagulation Forum and American Society of Hematology 2019 guidelines

• Bedaquiline considered first-line medication for multidrug-resistant tuberculosis

• Lefamulin, a new commercially available medication for treating community-acquired bacterial pneumonia

• New information on the combination of emtricitabine/tenofovir alafenamide as antiretroviral treatment for preexposure prophylaxis among men

• A two-drug regimen, dolutegravir plus lamivudine, included in the top recommended HIV antiretroviral regimens

• Recommendation from the Advisory Committee on Immunization Practices for shared clinical decision-making regarding HPV vaccination for adults aged 26–45 years

• Substantial revision of the Sexual & Gender Minority Health chapter

• Bempedoic acid, a new FDA-approved pharmacologic option for lowering LDL cholesterol in patients who cannot tolerate statins

• FDA approval of various closed loop systems that adjust basal insulin delivery for diabetic patients

• Eculizumab, a newly FDA-approved medication for both myasthenia gravis and neuromyelitis optica

• FDA approval of lasmiditan, a new pharmacologic option that can safely be given to migraine sufferers with cardiovascular risk factors

• The sodium-glucose linked transporter (SGLT) inhibitors slow progression of early diabetic nephropathy in addition to their having cardioprotective effects

• The US Preventive Services Task Force recommendation for hepatitis C screening of asymptomatic adults between ages 18 and 79 years

• FDA approval of adjuvant trastuzumab emtansine for patients with HER2-positive breast cancer with residual disease after standard trastuzumab-containing neoadjuvant therapy

• Data from HER2CLIMB, a phase III trial, expected to lead to FDA approval of a new therapy for breast cancer patients with pretreated HER2-positive advanced disease

• Promising results from phase 3 clinical trials of gene therapy for hemophilia A and B

• Information on bremelanotide, a second FDA-approved medication for hypoactive sexual desire disorder in premenopausal women

• Mepolizumab, newly FDA approved for the treatment of eosinophilic granulomatosis with polyangiitis

• Medical advances up to time of annual publication

• Detailed presentation of internal medicine disciplines, plus primary care topics in gynecology, obstetrics, dermatology, ophthalmology, otolaryngology, psychiatry, neurology, toxicology, urology, geriatrics, orthopedics, women’s health, sexual and gender minority 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 listed 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 2021. Subscribers to CMDT Online receive full electronic access to CMDT 2021 as well as

• An expanded, dedicated media gallery

• Quick Medical Diagnosis & Treatment (QMDT)—a concise, bulleted version of CMDT 2021

• 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 2021, 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 2021 edition of CMDT, we thank and say goodbye to Kent R. Olson, MD, our long-time contributor of the Poisoning chapter. Since 2019, Kent has coauthored this wonderful resource with Craig Smollin, MD, who will now assume its sole authorship. When Steve McPhee became an editor of CMDT in 1988 for the 1989 edition, Kent was already the chapter author for Poisoning, meaning that he has now joined the handful of CMDT authors who have edited their chapter annually for more than 30 years.

Kent received his BA in chemistry from Boston University in 1974 and his MD from UC San Francisco in 1978. He then completed his postgraduate training at the Mt. Zion Hospital and the San Francisco General Hospital. Kent has been the lead editor for 7 editions of Poisoning & Drug Overdose, also published by McGraw-Hill, last in 2017. He has authored or coauthored more than 100 articles in the peer-reviewed medical literature, and he has mentored more than 50 postgraduate toxicology fellows, including 14 from countries outside the United States. In 2010, Kent received the Matthew J. Ellenhorn Award from the American College of Medical Toxicology “as an individual who had made extraordinary contributions to the field of medical toxicology.” Kent retired from UC San Francisco in 2017 after serving for more than 30 years as the Medical Director of the San Francisco Division of the California Poison Control System. He continues to consult in medical toxicology at the Zuckerberg San Francisco General Hospital.

Throughout his career, Kent has been committed to preclerkship medical education and he has served on the core faculty of the UC Berkeley-UCSF Joint Medical Program at UC Berkeley, where he was the content expert in pharmacology, a master clinician for its clinical skills course, and a small-group tutor for its problem-based medical curriculum.

As his editors, we are genuinely grateful for his always timely and incisive annual update. He has been a true pleasure to work with for more than 30 years. We wish to say to him, “Kent, you will be greatly missed, but know that you have our very best wishes for the years ahead!”

We wish to thank our authors for participating once again in the annual updating of this important book. We are especially grateful to Naomi B. Anker, MD, Kerry C. Cho, MD, Megan McNamara, MD, MSc, Joseph H. Rapp, MD, and Rachel K. Scott, MD, MPH, FACOG, who are leaving CMDT this year. We have all benefited from their clinical wisdom and commitment.

We also wish to extend our heartfelt gratitude to Eva Clark, MD, PhD, and to Wayne Shandera, MD, for providing ongoing, current, and expert updates to the Severe Acute Respiratory Syndrome—Coronavirus 2019 (SARS-CoV-2) topic in CMDT Online.

Many students and physicians 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.