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Despite meticulous titration of anticoagulation therapy and careful attention to confounding medications, serious bleeding complications occur in some patients who receive warfarin.

Some of my patients who are being treated for hypertension, hyperlipidemia, or both claim that an elevated blood pressure reading or lipid level measurement resulted from a sodium- or fat-laden meal that they had eaten 1 or 2 days before their office visit.

For easier application of eye ointment, have the patient lie down or sit with his head tilted back.

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.

A 50-year-old woman had a 6-month history of severe generalized itchiness and fatigability. There was no associated fever, abdominal pain, or joint pain. A cholecystectomy had been performed 20 years earlier. She had no family history of hypercholesterolemia or liver disease.

Identifying the cause of a persistent, asymptomatic aminotransferase elevation can be challenging. The possible diagnoses are many and varied. To narrow the differential, begin with a detailed history.

Sometimes, despite compliance with prescribed thyroid medication, a patient's thyroid-stimulating hormone (TSH) level remains high.

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.

An epidemic of acute hepatitis C is emerging among HIV-infected men who have sex with men (MSM), with a growing number of cases reported in the MSM population in the United States and Europe.

An independent advisory panel recommended accelerated FDA approval of Merck & Co's drug Isentress (raltegravir) for patients who have drug-resistant strains of HIV (Chong J-R. Los Angeles Times. September 6, 2007). If approved, Isentress would be the first in a new class of AIDS drugs, integrase inhibitors, that aim to prevent HIV from integrating into human DNA during the replication process.

A 28-year-old African American woman (gravida 1, para 1) presented to clinic with breast tenderness. The result of a urine pregnancy test was positive.

A 33-year-old, sexually active homosexual HIV-positive man, with a CD4+ T-lymphocyte count of 258/µL and HIV-1 RNA level of 7079 copies/mL, presented to his primary care physician with left upper quadrant pain, urgency to defecate, and non-bloody watery diarrhea.

In the era of rapid transmittal of health information and frequent educational updates via the Internet, hardcover medical texts still have a place. A worthy newcomer in this regard is Psychiatric Aspects of HIV/AIDS, edited by Fernandez and Ruiz, a comprehensive sourcebook with contributions by a panel of experts.

Pharmacogenomic and pharmacogenetic tests are increasingly being used during drug development.

Almost 2 years ago I reviewed the topic of hepatitis C virus (HCV) infection in the setting of HIV.1 Given the advances–and some setbacks–in our understanding of HCV pathogenesis and treatment in the coinfected population, it's time for an update.

A 46-year-old man is seen by medical personnel with new skin injuries of the upper limbs as shown. States he has not had such injuries before. Denies altercations with knife wielders; also denies self-mutilation or any sexual practice involving bondage or injury.

For 2 weeks, a 43-year-old white female had worsening nausea and multiple episodes of vomiting. Her symptoms began with increased malaise and decreased appetite. The emesis was unrelated to meals and was sometimes accompanied by mild abdominal distention. She had occasional fevers but denied any recent contact with ill persons. She also reported a 12-lb weight loss, decreased energy level, and an increased tan complexion over the past several months.

Primary care practice is filled with patients who have acute coronary disease complicated by multiple comorbid conditions. In this era of percutaneous treatments, contrast-induced nephropathy persists as an unwelcome and debilitating complication.