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.
The left lateral decubitus position is both a less awkward and a more productive position for digital rectal examinations than the standard one in which the patient bends over the examining table.
A 21-year-old man presents with a "swelling" in the testicle that he first noticed about 1 month earlier while showering. He does not recall any previous scrotal tenderness; because he has been frequently palpating the lesion, he cannot say for certain whether it is currently tender.
An 81-year-old woman with a history of moderate Alzheimer dementia, depression, coronary artery disease, hypertension, and type 2 diabetes mellitus was accompanied to the office by her son for a routine follow-up appointment.
A 66-year-old woman was hospitalized because of severe anemia secondary to myelodysplastic syndrome. She had had associated fatigue and throbbing pain in both legs for several days.
The Dutch Guillain-Barré Study Group found that intravenous immunoglobulin and therapeutic plasma exchange were equally effective in the treatment of GBS. The Plasma Exchange/Sandoglobulin Guillain-Barré; Syndrome Trial Group demonstrated that therapeutic plasma exchange alone, intravenous immunoglobulin alone, and therapeutic plasma exchange immediately followed by a course of intravenous immunoglobulin were all equally effective.
The development of more sophisticated testing modalities now permits the identification of coronary artery narrowing in asymptomatic adults. The images obtained in these studies provide potential targets for intervention-based therapy.
Worsening painful ulcers on both legs prompted a 62-year-old woman to seek medical attention. She had a history of rheumatoid arthritis (RA), demonstrated by the markedly deformed interphalangeal joints in her thumbs (A), and scleroderma-polymyositis overlap syndrome.
A 74-year-old woman presented with a refractory pruritic eruption. Four months earlier, she had sought evaluation of a thickened, slightly crusted 6 3 8-cm patch on her right ankle of 2 months' duration. Contact dermatitis with secondary impetigo from scratching was suspected, and a topical corticosteroid and an oral antibiotic were prescribed.
I often drive home key points I make to patients by drawing on the paper cover on the examining table. A graph, a key lab value, an anatomical aid--indeed, any kind of visual aid--is likely to help patients "get" the concept I am trying to explain.
The sharply demarcated, smooth red plaques on this 3-year-old's tongue had been present for several months.
Over the past 20 years, the treatment armamentarium for diabetes has greatly expanded: 8 different classes of non-insulin drugs and 8 different types of insulin are now available. The newer classes of agents include disaccharidase inhibitors, thiazolidinediones, meglitinides, glucagonlike peptide analogs, and dipeptidyl peptidase IV inhibitors.
