Change is in the air. By the time this column is published, the nation will know who will next occupy the White House; many appointees of the departing administration will most likely have already moved on to new positions; and potential appointees will be polishing their résumés and pressing the wrinkles out of their good interview suit.
What’s The “Take Home”? Elderly Man With Late-Night Confusion and Hypoglycemia
New research suggests that AIDS among humans occurred at least 3 decades earlier than previously thought. Rapid urbanization in west-central Africa “was the turning point that allowed the pandemic to start,” said Michael Worobey, an evolutionary biologist at the University of Arizona, Tucson, and the study’s lead author (Avasthi A. National Geographic News. October 1, 2008).
One fun thing to do at an International AIDS Conference-aside from the social aspects and the presentations, protests, and theatre found in the Global Village-is to match your wisdom and art in the selection of antiretroviral drug regimens to that of a large audience of HIV-treating physicians and expert panel members. In this sense, the 17th International AIDS Conference, held this year in Mexico City, did not disappoint.
Because the medical literature and direct-to-consumer advertising have focused mainly on the burden of osteoporosis in postmenopausal women, recent screening guidelines for this disease in men may catch some by surprise.
A previously healthy 16-year-old boy presents for evaluation of a slightly pruritic, nontender, generalized rash.
It was not until she went to have an impression made for a broken dental retainer that this 17-year-old girl became aware of a mass on the left side of the palate.
It’s been 10 years since you first started to see our “What’s The ‘Take Home’?” feature every month in CONSULTANT. Our goal then, as it remains today . . . to bring you real-life clinical cases that keep you up-to date on the latest thinking-and that offer a “takehome message” you can put to immediate use in your daily practice.
Pneumonia remains a concern for persons with long-standing HIV infection. We present a case of a 43-year-old HIV-infected woman with bilateral pneumonia whose presentation suggested the cause was a bacterial pathogen.
A 36-year-old man presents to the emergency department (ED) after a single tonic-clonic seizure. He has a history of numerous male sexual contacts. HIV infection was diagnosed 5 months earlier. At that time his CD4+ cell count was 66/μL and his HIV RNA level was 20,000 copies/mL.
A 14-month-old infant was brought by his mother for evaluation of fever (temperature, 39.4ºC [103ºF]) and a tender, indurated, warm area with surrounding edema and a centrally located papule in the left groin.
A 75-year-old man is brought to the emergency department (ED) after awakening in the night very confused and disoriented. His wife had called 911; when the paramedics arrived, they found his blood glucose level to be 36 mg/dL.
Consider including the “bounce test” in your assessment of a febrile toddler: have the parent bounce the child on his or her knee as in the “horsey ride” game.
Mycobacterium goodii infection is uncommon and probablyoccurs via disruption of skin and bone integrity or theintroduction of a foreign body into viscera, namely implantationof a prosthetic device. We describe a case of nosocomial,total knee arthroplasty–associated M goodii infection thatrequired combined antibiotic and surgical therapy for clinicalmanagement. An infection control investigation revealed thatthe source of the organism might have been the water in theoperating room scrub faucets. [Infect Med. 2008;25:522-525]
Posaconazole, indicated for prophylaxis of invasive Aspergillus and Candida infections in immunosuppressed patients aged 13 years or older and for treatment of oropharyngeal candidiasis (Table 1), is like other triazole antifungals in that it blocks ergosterol biosynthesis. 1 Its chemical structure is most similar to that of itraconazole (Figure), which may confer efficacy even against strains resistant to fluconazole and voriconazole.2
A 55-year-old man with no past medical problems presented with headache, difficulty in walking, and loss of balance of 3 days' duration. Physical examination findings and laboratory test results were unremarkable except for lethargy, slurred speech, positive Romberg sign, hyponatremia, and leukocytosis with left shift.
Third-degree perineal lacerations reputedly occur in2.2% to 19% of vaginal deliveries in the UnitedStates.1,2 Breakdown of a third- or fourth-degreeperineal repair can lead to incontinence of stool or flatus,rectovaginal fistula, or sexual dysfunction.3,4 Infection atthe operative site occurs in up to 12% of cases,5 and a keyfactor in successful anal sphincter repair is the absence ofinfection.6
Many advances and challenges have occurred inthe field of pediatric infectious disease medicineduring the past 10 years. Because this is the 10thanniversary of this column, a summarization of what, inmy opinion, are the most clinically significant developmentsis presented here.
A 28-year-old man presented with a 1-year history of nodular, plaque-like, nontender, pruritic lesions on his face, ears, elbows, and feet. He was born in Mexico but had been residing in the United States for the past 6 years. He worked in construction, was an active smoker, and denied use of alcohol or illicit drugs. The patient had not been taking any oral medications and had no recent history of trauma.
Herpes zoster is a painful, blistering rash that typically manifests in a dermatomal distribution and is caused by reactivation of varicella-zoster virus infection. A classic presentation of herpes zoster involving the right T4 dermatome is illustrated in Figure 1. The patient was a 90-year-old man who experienced severe pain on the right side of his neck and chest followed by development of maculopapular lesions. The lesions, which ranged from macular to vesicular, resolved with no scarring or postherpetic neuralgia following 10 days of therapy with oral acyclovir and intramuscular injections of γ-globulin.
