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Huskamp and associates recently reported that in the year following the implementation of Part D, many patients dually eligible for Medicaid and Medicare benefits had difficulty gaining access to psychiatric medications.

The Fifth International AIDS Society Conference on HIV Pathogenesis, Treatment, and Prevention (IAS 2009) was held in Cape Town, South Africa, from July 19 to 22, 2009. More than 5500 delegates from more than 100 countries attended this annual event.

To ensure accurate joint injections, mark the site by firmly pressing the end of a closed ballpoint pen against the patient's skin.

Neurosarcoidosis has not been reported in patients with HIV infection. We present the case of a patient with AIDS in whom spinal cord sarcoidosis developed years after highly active antiretroviral therapy was initiated and her immune system was reconstituted. Treatment with prednisone resulted in resolution of MRI lesions and symptoms. Since patients with HIV-1 infection who are receiving antiretroviral therapy can survive for many years, physicians should be aware of chronic immune restoration disease involving the CNS.

As even the busiest clinician knows, patients are using the Internet for medical information.

Bilateral retrobulbar optic neuritis developed in a 38-year-old woman with advanced HIV infection. This was secondary to varicella-zoster virus (VZV) infection, confirmed by polymerase chain reaction detection of VZV in the patient's cerebrospinal fluid. There was no evidence of retinitis, and the ocular symptoms preceded the rash. This case illustrates that a new onset of unexplained visual loss resulting from optic neuritis in an HIV-positive patient may be caused by VZV infection. Clinicians should be aware of this unusual manifestation of VZV infection. Prompt recognition and early intervention with antivirals are needed, but it is unclear how much vision can be preserved.

We report 4 cases of bladder cancer in an ethnically diverse population of about 2500 HIV-infected patients. These patients were younger than the median age at diagnosis of bladder cancer in the United States.

While avoidance measures are a key component of the treatment of allergic rhinitis, pharmacological therapies are often needed to adequately control symptoms. Intranasal corticosteroids are highly effective and are particularly useful in patients with moderate to severe disease.

While the facts support the claim from the Centers for Medicare & Medicaid Services (CMS) that beneficiaries have “robust” choices in the sign-up period for 2010 Part D drug coverage plans that begins in November, the number of options available have continued to decline. At the peak in 2007, 1875 stand-alone Medicare drug plans were offered; this year, the number had shrunk to 1659, and the total for next year will be 1510.

A 60-year-old woman with a 3-month history of progressively worsening epigastric pain was referred for elective cholecystectomy after ultrasonography showed findings consistent with chronic cholecystitis (A and B). The patient reported having postprandial abdominal discomfort since 4 years of age. She also had occasional nausea and vomiting but denied jaundice, change in bowel habits, or urinary symptoms.

Match the following characteristics with the clinical disorders pictured in the photographs of Cases 1 and 2. Then read the brief descriptions that follow to see how well you did.

A 78-year-old man examined on rehabilitation unit, where he has beenreceiving intensive physical therapy after uneventful total knee arthroplasty.

Astrict definition of “dehydration” is a relative absence of water as manifested by hypernatremia. However, patients who are dehydrated are usually also volume-contracted; I prefer the latter term for a patient who has experienced vomiting, diarrhea, or decreased intake. Volume contraction denotes the need for replacement with saline equivalents, whereas dehydration indicates the need for water-and only possibly saline as well.

The medications currently approved for the treatment of insomnia include 9 benzodiazepine receptor agonist (BZRA) hypnotics and the selective melatonin receptor agonist ramelteon.

A novel H1N1 influenza virus has emerged from swine and is causing a worldwide pandemic. Children and young adults have been most affected, in terms of both numbers of cases and severity of disease. Perhaps the most striking feature of the pandemic so far is that fewer than half of those hospitalized or killed by this virus have had identifiable prior medical conditions or risk factors.

Many health care professionals are practicingwhat they preach daily-exercise forcardiovascular health. And an increasingnumber of patients are taking the exercisemessage to heart.

Despite the recent development of several new therapies, pulmonary arterial hypertension (PAH) remains an incurable disease. Careful monitoring of disease progression is vital to ensuring that patients receive maximal medical therapy before the onset of overt right-sided heart failure. In part 1 of this article, I reviewed the role of the history and physical examination, chest radiography, electrocardiography, echocardiography, and pulmonary artery catheterization. In part 2, I focus on MRI, cardiopulmonary exercise testing (CPET), the 6-minute walk test, and biomarkers.

In a recent editorial in The AIDS Reader, the “burden of responsibility for routine HIV testing” was accurately described as now falling on all clinicians, including those in emergency departments (EDs). Routine HIV testing in the ED seems logical because patients who seek health care in the ED are often underinsured and have low incomes, the very populations with a higher prevalence of undiagnosed HIV.