Patients seeking primary care often have upper respiratory symptoms caused by viral infection. Most patients are diagnosed based on medical interviews and physical examinations ; however, such diagnoses are often based on experience, and education for younger physicians regarding such patients is often insufficient. This review addresses evidence related to history and physical findings of cough, sore throat, and nasal discharge. We reviewed differential diagnosis of cough, as well as select diagnosis, including the common cold, acute bacterial sinusitis, Bordetella pertussis infection, and gastroesophageal reflux disease. Sore throat is similarly reviewed through differential diagnosis and select diagnosis, including Streptococcal (group A) infection, infectious mononucleosis, and Mycoplasma and Chlamydia. Nasal discharge is reviewed in terms of differential diagnosis and allergic rhinitis. Many histories or physical findings of upper respiratory symptoms are not supported by evidence, and further study is warranted.

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BACKGROUND : Because of its high incidence, sensitivity to specific antibiotics, and rare but severe complications, campylobacter enteritis needs to be confirmed or excluded accurately and rapidly. We investigated the validity of Gram staining of a stool sample as a quick and useful method of diagnosing campylobacter enteritis in patients with acute diarrhea presenting at primary healthcare centers.
MATERIALS AND METHODS : Stool samples obtained from 64 patients with acute diarrhea were sent to a laboratory for Gram staining and culture. To estimate the usefulness of Gram staining, we calculated the sensitivity, specificity and likelihood ratio (LR) of Gram staining. Subject profiles, symptoms and peripheral white cell counts were also examined to see if they could raise the pre-test probability prior to the Gram staining test.
RESULTS : Of 64 subjects with acute diarrhea, 38 had C. jejuni (n=37) or C. coli (n=1) (campylobacter group), and 26 had other causes (control group). Gram staining revealed campylobacter-like bacteria (Cb-like bacteria) in 22 samples from the campylobacter group and 3 from the control group, yielding a sensitivity and specificity of 0.58 and 0.88, respectively. The positive LR was 5.02 (95%CI : 1.67-15.05), and the negative LR was 0.48 (0.32-0.71). Other factors such as patient age, disease duration, fever, abdominal pain and leucocytosis failed to raise the pre-test probability prior to Gram staining test. Taking a thorough history of food intake can raise the pre-test probability, although this may be difficult and was not evaluated in this study.
CONCLUSION : Gram staining can assist in making the diagnosis of campylobacter enteritis in patients with acute diarrhea, but it cannot be used alone to make or exclude the diagnosis.

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We describe a 38-year-old, severely emaciated female with slowly progressive type 1 diabetes mellitus (SPIDDM), who had hypoglycemia due to fasting and an extremely low energy intake. After being diagnosed with diabetes mellitus (DM), she took in only 300-500 kcal per day and her weight had decreased to 30 kg, with a body mass index (BMI) of 11.4 kg/m². She was admitted with hypoglycemia, and SPIDDM was confirmed by nearly-completely ceased insulin secretion and seropositivity towards anti-GAD antibody. After appropriate dietary therapy and insulin administration, she recovered from a state of emaciation and her glucose metabolism was restored. With this patient it proved very effective for the general physician to coordinate treatment for both diabetes and an eating disorder.

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