Preface

Current Medical Diagnosis & Treatment 2023 (CMDT 2023) is the 62nd edition of this single-source reference for practitioners of adult medicine 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.

With a growing recognition of systemic racism and other biases in institutions across our societies, including the institution of medicine (https://www.mdcalc.com/race), the editors of CMDT, with humility, have committed to a thorough examination of our content to remove biased language, research, and recommendations. Since 2020, we have been pursuing an ongoing, formal process of review and revision in an effort to recognize and correct biases and to promote equity in our book and the practice of medicine. While we, the editors, take this on as our responsibility, we also invite readers to share with us any CMDT content that they find problematic or biased.

We have tried to describe populations used in the studies that form the basis of the information in CMDT, use appropriate language where we can (eg, persons of sub-Sahara African descent, rather than African-Americans), and use the gender-neutral term Latinx. We acknowledge that, like others,¹ we find this an imperfect solution. We continue, however, to use terms from original sources when study populations are broad.

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 of adult medicine 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 2023,” individually listed with page numbers and reference citations, for easy access to significant changes in this edition

• Ongoing concerted effort to address and remove unconscious bias

• List of Common Abbreviations used in CMDT can be found on the inside of the front cover

• New section on opioids for pain management

• Overhauled organization of Dermatology chapter to better reflect categorization of conditions and lesions

• Expanded section of interventional therapies to manage chronic pain

• Updated USPSTF lung cancer screening recommendations using low-dose CT

• New prognostic systems for primary myelofibrosis: GIPSS and MIPSSv2

• Discussion of the use of DOACs in patients with morbid obesity who require antithrombotic therapy

• Updated section on osmotic laxatives to treat chronic constipation

• Ozanimod approved for the treatment of moderate to severe ulcerative colitis

• Landmark change in staging female breast carcinoma modifying anatomic stage and adding prognostic stage

• New medications for treating metastatic breast cancer (olaparib, talazoparib, palbociclib, ribociclib, and abemaciclib)

• New recommendations on treating cholestasis of pregnancy

• Updated criteria for diagnosing systemic lupus erythematosus to include antinuclear antibody measurement

• New medications for active lupus nephritis, including voclosporin used with mycophenolate mofetil as well as belimumab

• Anifrolumab is approved for nonrenal lupus when standard therapies fail

• New guidelines for diagnosing polyarteritis nodosa

• New American College of Rheumatology/Vasculitis Foundation recommendations for the treatment of granulomatosis with polyangiitis

• A newly described genetic syndrome, VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) in the differential diagnosis of relapsing polychondritis

• Discussion of the role of left atrial appendage closure in preventing stroke and systemic embolization

• Aducanumab (anti-amyloid therapy) is approved by the US FDA for the treatment of Alzheimer disease

• Extensive revision of the Thyroiditis section in Endocrine Disorders chapter

• Substantial revision of the Nutritional Support section in the Nutritional Disorders & Obesity chapter

• Substantial revision in the HIV Infection & AIDS chapter, including updates in the available therapeutic regimens

• Rewritten SARS-CoV-2 section and inclusion of SARS-CoV-2 information relevant to specific chapters throughout the textbook

• Extensive revision of Sexual & Gender Minority Health chapter, including sections on family planning and health care for transgender and gender diverse persons

• 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

• Specific disease prevention information

• Easy access to medication dosages, with trade names indexed and current costs updated in each annual 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, & Commonly Used Blood Specimen Collection Tubes

Institutional or individual subscriptions to AccessMedicine also have full electronic access to CMDT 2023. Subscribers to CMDT Online receive full electronic access to CMDT 2023 as well as

• An expanded, dedicated media gallery; new to this edition are educational videos and printable protocols in the Orthopedic Disorders & Sports Medicine chapter

• Quick Medical Diagnosis & Treatment—a concise, bulleted version of CMDT 2023

• 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 2023, 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 2023 edition of CMDT, we express our immense gratitude and say goodbye to Mitchell H. Katz, MD as he transitions away from his 30+ years as author of Chapter 31 “HIV Infection & AIDS.”

A graduate of Yale College and Harvard Medical School, Dr. Katz completed his residency in the UCSF Primary Care General Internal Medicine Residency, and then trained as a Robert Wood Johnson Clinical Scholar.

Dr. Katz has spent the bulk of his career in public service. He began his work in 1991 in the San Francisco Department of Public Health, ultimately being appointed Director and Health Officer of the Department of Health. He was probably best known for funding San Francisco’s successful needle exchange program; for creating its “Healthy San Francisco” Program as the first comprehensive municipal health care and financing system in the United States; for outlawing the sale of tobacco at pharmacies; and for winning ballot measures funding the replacement of the City’s 780-bed nursing home, the Laguna Honda Hospital & Rehabilitation Center, and for rebuilding its 386-bed public “safety net” hospital, the Zuckerberg San Francisco General Hospital.

In 2010, Dr. Katz was appointed the Director of the Los Angeles County Department of Health Services (DHS), the second largest public safety net system in the U.S. While in L.A., he created an ambulatory care network that empaneled over 350,000 patients in a primary care home and that transitioned over 4000 medically complex patients from care at hospitals and emergency departments into independent housing, effectively eliminating unnecessary and expensive hospital care and giving these patients the dignity of their own home.

Moving to New York City in 2018, Dr. Katz became President and CEO of NYC Health and Hospitals, the largest municipal health system in the U.S. He is the architect of NYC Care, a health access program that provides comprehensive health care to New Yorkers regardless of income or immigration status. In the spring of 2019, Dr. Katz steered the municipal health system through the worst of the COVID-19 outbreak when NYC was the epicenter of the U.S. pandemic. In a 6-week period, he tripled the number of ICU beds to care for acutely ill patients.

Dr. Katz is an elected member of the National Academy of Sciences and is the Deputy Editor of JAMA Internal Medicine. He has published extensively in the areas of HIV epidemiology and health care access. He practices as a primary care physician at Gouverneur Health in Manhattan. Mitch and his partner, Rabbi Igael Gurin-Malous, have two children, Maxwell and Roxie, who were adopted from an orphanage in Vietnam.

As Mitch’s editors, we are particularly thankful for his expert annual submissions, providing us a precis about the care of patients with HIV infection/AIDS. We are immensely grateful for his friendship and look forward to hearing about the next chapters in his amazing career of service.

We wish to thank our authors for participating once again in the annual updating of this important book. We are especially grateful to N. Franklin Adkinson, Jr., MD, Antoine Azar, MD, Thomas M. Bashore, MD, C. Seth Landefeld, MD, Manesh R. Patel, MD, George R. Schade, MD, Joshua S. Schindler, MD, and Scott Steiger, MD who are leaving CMDT this year. We have all benefited from their clinical wisdom and commitment.

With enormous gratitude and respect, we dedicate this 62nd edition of Current Medical Diagnosis & Treatment to all health care professionals and staff who have cared for patients with COVID-19. We honor their competence, their humanity, and their bravery. We also wish to extend our heartfelt gratitude to Eva Clark, MD, PhD, and to Wayne Shandera, MD, for coauthoring (along with Christine Akamine, MD) the authoritative section on COVID-19 (SARS-CoV-2) in the Viral chapter of the print edition of CMDT and for providing ongoing, current, and expert updates on this 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.