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A 50-year-old African American man with HIV infection had a CD4+ T-cell count of 18/μL (1%), CD8+ cell count of 1035/μL (69%), and CD4:CD8 ratio of 0.01 at the time of diagnosis. He had multiple erythematosquamous skin lesions over his forehead, face, chest, back, and extremities

In 2006, the CDC recommended “opt-out” routine HIV testing in all health care encounters for persons 13 to 64 years of age. While this recommendation has garnered some support, concerns about the feasibility of such routine testing in a busy office without disrupting patient care has persisted. We report the results of a pilot study to determine the feasibility of routine testing in a busy urban clinic.

Hear an interview with Ted Rosen, MD, professor of dermatology at Baylor College of Medicine, and chief of Dermatology Service at Veterans Affairs Medical Center, Houston. Dr Rosen has a keen interest in current healthcare reform; he recently attended a summit in Washington with a group of think-tank leaders who are at the forefront of reform efforts.

On January 15, 2010, top congressional Democrats reported that they were “close” to an agreement with the White House on cost and coverage issues and that a draft would soon be sent to the Congressional Budget Office, the official authority on the cost and extent of coverage that any new legislation would provide. However, the outcome of the Massachusetts Senate race has created a significant obstacle to passing a health care reform bill for the Democrats in the Senate.

A 38-year-old man had fever and fatigue for the past 6 days and tenderness in the left upper abdominal quadrant for the past 3 days. He also had a facial butterfly rash that had been present for 10 years and a 1-year history of lupus nephritis, treated with prednisone and mycophenolate. He denied respiratory complaints or recent weight loss.

Lymphocytic Hypophysitis

A 26-year-old woman at 30 weeks’ gestation presented to the emergency department with a throbbing frontal headache of 1 month’s duration. She had also had peripheral blurred vision for the past 2 weeks. Acetaminophen initially decreased her pain but was no longer effective. She had had a previous miscarriage.

Malignant thymoma is an indolent tumor arising from the thymic epithelial cells located in the anterior mediastinum. These tumor cells spread via regional metastasis or invade surrounding structures, including the pleural space.

Beet the Clock

To obtain a general idea of intestinaltransit time when doing a workupfor chronic constipation or shortbowelsyndrome, I use this simpletest:

DiscreetUrine Strain

Patients with kidney stones areoften sent home with a bulky plasticfilter cup and told to use it to straintheir urine.

Recurrent or persistent vaginal itching is a common problem. If antifungals have not been effective, ask the patient, while she is in the stirrups, to point to the pruritic spot or touch it with her finger.