One of the 2 feature articles this month in The Aids Reader is a review of the literature on the management of dyslipidemia. In this article, Dr Craig E. Metroka of Columbia University and colleagues focus on the use of fish oil to reduce elevated triglyceride levels, an independent risk factor for cardiovascular disease and a hallmark of antiretroviral-related dyslipidemia.
For many of us, the term "prejudice" translates into racism and then into the range of negative, stereotyped assumptions about others based on no more than externally observable features such as skin color or eye shape. We further translate this into discrimination and the full negative history of treating those whom we observe to be racially different.
AIDS Seen as New Threat to African Democracy A new study suggests that HIV/AIDS is hitting elected officials hard in southern Africa, thus posing a new threat to democracy and governance (Felix B. Reuters. June 4, 2007). The report was released in advance of South Africa's biannual AIDS conference in Durban.
In a midsummer issue of the Journal of Infectious Diseases, Dr Anthony Fauci1––who is as close as the United States comes to a tsar of AIDS medicine––describes 7 HIV-infected persons who had received protease inhibitor (PI)-based antiretroviral therapy for an average of 40.4 months (range, 31.1 to 54 months).
abstract: Tuberculous pericarditis, while relatively rare in the United States, is an important cause of pericardial disease in countries where tuberculosis is prevalent. Patients are most likely to present with chronic disease--effusive and/or constrictive. Those with effusive pericarditis often present with tamponade. Patients with constrictive pericarditis exhibit features of systemic and pulmonary venous congestion. An elevated level of adenosine deaminase in pericardial fluid is a good marker for tuberculosis. The presence of granulomas or case-ation necrosis in pericardial tissue confirms the diagnosis. If treatment of effusive tuberculous pericarditis is delayed, constrictive or effusive-constrictive disease usually develops, resulting in a high mortality risk. In addition to a standard antituberculosis regimen, treatment of tuberculous pericarditis may include adjuvant therapy with corticosteroids, pericardiocentesis, and/or pericardiectomy. (J Respir Dis. 2007;28(7):278-282)
The effectiveness of corticosteroids in the prevention of postextubation laryngeal edema is controversial, but a recent study conducted in France indicates that the administration of methylprednisolone before a planned extubation does, in fact, reduce the incidence of laryngeal edema and reintubation.
Acute invasive fungal rhinosinus- itis occurs predominantly in immunocompromised patients, such as those with neutropenia and transplant recipients. The diagnosis requires biopsy, but permanent section can be time-consuming and result in a delay in treatment. Ghadiali and colleagues conducted a study to evaluate the accuracy of frozen-section biopsy in this setting.
The development of an enzyme-linked immunosorbent assay (ELISA) that detects the glycoprotein galactomannan represents an important advance in the diagnosis of invasive aspergillosis. Foy and associates found evidence that the galactomannan ELISA is a highly specific diagnostic tool when used to screen patients who are undergoing hematopoietic stem cell transplantation (HSCT).
At a routine blood pressure check, a 63-year-old woman has 2 readings of 165/100 mm Hg. The patient has had essential hypertension since age 41 years. For more than a decade, it was easily controlled with a b-blocker; however, in recent years, her blood pressure has been more variable, with occasional readings of higher than 150/90 mm Hg.
Heart failure is prevalent in both primary care and cardiology practices. It develops in about 1 in 5 persons during their lifetime and in about 1 in 8 of those who have not sustained a myocardial infarction (MI). Heart failure is also the leading cause of hospitalization in the elderly.
Guest Commentary
Lp(a) is a fascinating variant of low-density lipoprotein (LDL). It is basically an LDL molecule that has been modified by the covalent addition of apoprotein(a). Elevated levels of Lp(a) correlate with increased risk of acute coronary syndromes, cerebrovascular accident, peripheral arterial disease, and coronary mortality. This Q&A session answers some curiosities about Lipoprotein(a).
Young children are prone to scrapes and bruises. I recommend to their parents keeping a tray of miniature party-type ice cubes in the freezer.
Photo quiz
When patients' deep tendon reflexes in the ankle and knee are diminished, have them clasp their hands together and pull outward with both arms.
The next time you need to perform a routine oral examination in a patient with a severe gag reflex, try this: have the patient use the tongue blade to depress his or her own tongue while you shine the light. For some reason, the exam goes more smoothly when the patient is involved.
Clinical Images to Help You Hone Your Diagnoses
This 33-year-old Guatemalan man presented to a medical mission camp with generalized bilateral knee pain and inability to extend his leg without pain. The 4-ft 11-in patient had mild scoliosis, increased elbow carrying angles, and hypoplastic patellae. He had had dysplasia of the nails with triangular lunulae since birth. The fingernails were absent on the first and second digits of both hands. His mother had had similar physical findings. He had not had regular medical care.
An 82-year-old man is seen for annual physical examination in the nursing home. He has resided there for 1 year because of the aggregate impact of multiple medical problems including, most prominently, laryngeal swallowing dysfunction associated with vocal cord paralysis.
ROCKVILLE, Md. -- Veggie Booty snack food, sold in all 50 states and Canada, may be contaminated with Salmonella wandsworth, and consumers should throw away any of the product they have on hand, the FDA advised.
