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A new study presented at the 48th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy in Washington, DC, suggests that persons infected with HIV should begin antiretroviral treatment sooner than guidelines currently recommend (Marchione M. Associated Press. October 26, 2008). The large study finds that delaying antiretroviral therapy until patients’ T-cell counts fall below 350/µL nearly doubles the risk of death in the next few years of their lives when compared with the risk of death in patients whose treatment was started earlier.

At Consultant, our goal is to provide the practical, authoritative information you need to best serve your patients. That is why we “pre-test” article ideas (before we invite articles on those topics) to be sure they are of real interest to you and your colleagues. It is also why we take great care in checking facts, creating useful tables and figures, and choosing illustrations and photographs to enhance teaching messages.

In September 2008, data from what is purported to be the largest sexual health survey ever conducted in the United States, cataloging more than 1.2 million Internet responses to an “anonymous” questionnaire, were released.1 There were the expected admissions from respondents concerning frequent use of behavioral disinhibitors-alcohol being the most popular-to manage anxiety and “have an excuse” to do what they wanted to do anyway, ie, have sex:

These extensive, smooth, irregular masses of pigmented tissue on the earlobes of a 28-year-old woman are keloids. The patient had her ears pierced at age 6 years; the masses began to develop when she was about 9 to 10 years old. The right earlobe mass arose first and is larger. She had one other keloid of 1 cm on her chest that had developed after a scratch. She denied any other skin lacerations or incisions.

During a new-patient evaluation, a 49-year-old Hispanic man was found to have several nontender, hard nodules protruding from the lingual area. The nodules had evolved slowly over several years. The patient reported no trauma to the area. He was a long-time smoker and took no medications. His medical and family histories were unremarkable.

Patients with HIV infection are at increased risk for several types of malignancy. After Kaposi sarcoma, non-Hodgkin lymphoma (NHL) is the second most common HIV-associated cancer.1

Methicillin-resistant Staphylococcus aureus (MRSA) was once considered a strictly nosocomial pathogen. Over the past decade, however, MRSA has emerged as a prominent cause of community-associated infections in both adults and children. Although community-associated MRSA strains occasionally cause severe invasive infections, they are most frequently isolated from patients with skin and soft tissue infections.

Injection drug use (IDU) has been a route for HIV transmission since the beginning of the epidemic.

As discussed by Mitty and colleagues,1 the proportion of HIV infections associated with injection drug use (IDU) has dropped dramatically across the United States, including the northeastern portion of the country.

Acute gouty arthritis is frequently misdiagnosed or diagnosed late in its clinical course, and therapy is often suboptimal. Because the treatment of gout as a chronic, progressive disease has not been standardized, optimal disease management remains a challenge.

I had prescribed oral iron sulfate, 325 mg tid, for a 35-year-old woman with severe iron deficiency anemia. Soon after the patient started therapy, she complained of dull, aching, continuous bone pain that was localized to the sternal region, both upper arms, and both thighs, without radiation. The pain resolved after her hematocrit had risen above 34% and iron replacement therapy had been discontinued.

Now that the holiday travel season is upon us, more of your patients may be taking to the skies. But some of them may have more serious problems to contend with than long lines, delayed flights, and missing luggage.

The median deductible for employees with individual coverage in PPO employer health plans jumped to $1000 in 2008, up from $500 in 2007 and $250 in 2000, according to the National Survey of Employer-Sponsored Health Plans, an annual report released on November 19 by Mercer (Figure). This significant increase was found among traditional PPOs, the most common type of plan (covering 69% of insured employees). Nearly four-fifths (79%) of employers imposed a deductible for PPO coverage in 2008 compared with about half (52%) of employers in 2000. For the survey, approximately 2900 private and public employers with 10 or more employees were interviewed in August and September.

In January 2006, the American College of Physicians (ACP) warned that primary care, rightly referred to as the backbone of the nation's health care system, was on the verge of collapse. The ACP noted then that few young physicians were going into primary care and that many of those already in practice were leaving.

The use of specialty pharmaceuticals in the United States continues to surge as more drugs enter the market and new indications are found for existing medications. Use of specialty drugs has dramatically improved clinical outcomes. However, while the health benefits of specialty pharmaceuticals are substantive, health care expenditures associated with the drugs can be significant, with some costing as much as $250,000 annually. Specialty medications accounted for 11.4% of pharmacy benefit spending in 2007, up from 5.6% in 2003. With the increasing use and higher costs of specialty medications, employers and health plans need to effectively manage distribution and utilization to ensure the most cost-effective use of these agents as possible. (Drug Benefit Trends. 2008;20:478-484)

Coronary artery disease (CAD), the most common form of cardiovascular disease in the United States, is the most costly type of cardiovascular condition to manage, according to the American Heart Association. Of the estimated $448.5 billion in total costs for cardiovascular diseases and stroke in 2008, CAD accounted for $156.4 billion, more than twice the cost of hypertension ($69.4 billion) and stroke ($65.5 billion) (Figure 1). Direct costs associated with CAD were $87.6 billion in 2008, of which prescription drug costs alone were $9.7 billion (Figure 2). Of the $68.8 billion in indirect costs for CAD in 2008, $58.6 billion were associated with lost productivity caused by increased mortality.

Combining antidepressants and cognitive-behavior therapy (CBT) is the most effective treatment for 8 in 10 children and teenagers with anxiety disorders, according to researchers led by John T. Walkup, MD, associate professor of psychiatry and behavioral sciences, and deputy director, division of child and adolescent psychiatry, Johns Hopkins Medical Institutions, Baltimore. Findings of the study were published in the October 30 issue of the New England Journal of Medicine. The study was funded by the National Institute of Mental Health (NIMH).

Sleep disturbance, especially insomnia, is common, with up to 25% of the population in industrialized countries reporting severe chronic insomnia.1 Medications to improve sleep patterns are plentiful but are not always effective. New research on sleep disturbance focuses on the role of the hypothalamic-pituitary-adrenal (HPA) axis.