HIV AIDS

A 27-year-old primigravida is seen 3 weeks before expected date of confinement, with a 1-week history of vulvovaginal pain and a yellowish white discharge.

A 28-year-old woman presents with milky discharge in both breasts and throbbing occipital headaches of 4 months' duration. The headaches begin gradually, do not radiate, and have no apparent triggers or relieving factors.

A 71-year-old man complains of left elbow pain that increases with movement and has worsened over the past 12 hours. He has also had a cough with sputum production for the past several days.

The practice of academic detailing is gaining interest and momentum in some health care circles. The primary aim of academic detailing is to prevent the overuse and misuse of certain medications. This is done by educating prescribers on the therapies that are clinically appropriate as well as the costs of therapeutically similar choices. It is less an issue of switching to generics than it is of favoring step therapy or moving toward cost-effective therapeutically equivalent options. A well-designed program should maintain prescriber autonomy and quality of care while helping manage drug costs for both health plans and patients.

Last month I wrote about how patients-or rather consumers-were taking on greater responsibility for decisions affecting their own health, largely because of the Internet and the ability to research and form opinions about individual treatments. That was only scratching the surface of how the Internet is revolutionizing health care.

As more high-cost biologic drugs become part of standard care, the FDA has been under pressure to devise a way to allow generic versions of biologics to reach the market. Although competing industry interests have made it difficult for the agency and Congress to agree on such an approach, 2008 may be the year when that changes.

A 57-year-old woman presents for follow-up several months after a series of thrombotic episodes. Four days after she underwent ankle fusion to relieve pain and edema associated with a leg fracture that had occurred 40 years earlier, she sustained a massive myocardial infarction (MI).

Dermclinic

Nephropathy develops in about 30% of patients with diabetes. Screen for albuminuria at the time type 2 diabetes is diagnosed and within 5 years of diagnosis of type 1 diabetes.

The differential diagnosis of generalized weakness is enormous; it includes disorders at all levels of the neur-axis. A variety of electrophysiological, pathological, radiographic, and other laboratory studies may be indicated depending on the specific diagnostic possibilities; costs can be controlled if such investigations are selected judiciously.

Given the dramatic advances in antimicrobials since penicillin was introduced, why has the mortality rate associated with community-acquired pneumonia (CAP) remained essentially unchanged?

The notoriously adaptable and increasingly common pathogen requires a new approach including routine I&D and culturing of infected tissues; the use of more-potent antibiotics, but only when needed; and a focus on hygiene in patients with recurrent infections.

For 6 weeks, a 56-year-old man had worsening dyspnea on exertion and a cough productive of yellow sputum with scant hemoptysis. He reported subjective fever over the past month but no weight loss.

An 81-year-old woman with a history of moderate Alzheimer dementia, depression, coronary artery disease, hypertension, and type 2 diabetes mellitus was accompanied to the office by her son for a routine follow-up appointment.

Fear of bioterrorism persists because of new reports of biological warfare, including the most recent attack that involved a Russian spy who was poisoned with polonium-210. However, vaccination against potential biological weapons, such as anthrax and smallpox, is controversial because of associated adverse effects.

Six months after testing positive for HIV in 10 bands, a 24-year-old homosexual man presented with a macular rash on his palms and soles. He first noticed the lesions 2 weeks earlier; they were not pruritic or painful. He also had a brighter, more inflamed rash in the groin and antecubital fossae that was presumed to be a yeast infection and was treated with fluconazole. He had no other symptoms.

SAN FRANCISCO -- HIV-positive African-Americans have a six-fold higher risk for end-stage renal disease than whites with HIV, investigators here reported.

ATLANTA -- Invasive infections of methicillin-resistant Staphylococcus aureus (MRSA) may be more common than suspected, according to the first nationwide surveillance estimates.

WHITEHOUSE STATION, N.J. -- The FDA has approved raltegravir (Isentress) as part of a combination regiment for treatment for multi-resistant HIV-1 infection in adults, according to an announcement from Merck.

SAN DIEGO -- Rotavirus infection, once considered almost exclusively a pediatric diarrheal disease, affects adults as well, causing substantial morbidity and unnecessary use of procedures and antibiotics, according to results of a study reported here.

PITTSBURGH -- There is strong evidence suggesting -- but not proving -- the existence of a causal link between psychological stress and chronic conditions such as depression, cardiovascular disease, and HIV/AIDS, asserted researchers here.

SAN DIEGO -- Older patients with HIV infection have robust responses to highly active antiretroviral therapy (HAART), with no increased risk of metabolic disorders or other adverse effects, according to two studies.

EDMONTON, Alberta -- Pneumococcal vaccine dose not prevent community-acquired pneumonia but can significantly reduce deaths or ICU admissions from it, researchers here reported.

SAN DIEGO -- Adolescents and teenagers with perinatally acquired HIV infection have high rates of neurologic, psychiatric, and cognitive problems that can confound attempts to treat them, investigators reported here.

BORAS, Sweden -- Keeping HIV at bay with highly active anti-retroviral therapy (HAART) may also forestall AIDS-related neurodegeneration, investigators have found.