HIV AIDS

Dermclinic

Nephropathy develops in about 30% of patients with diabetes. Screen for albuminuria at the time type 2 diabetes is diagnosed and within 5 years of diagnosis of type 1 diabetes.

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.

Given the dramatic advances in antimicrobials since penicillin was introduced, why has the mortality rate associated with community-acquired pneumonia (CAP) remained essentially unchanged?

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.

For 6 weeks, a 56-year-old man had worsening dyspnea on exertion and a cough productive of yellow sputum with scant hemoptysis. He reported subjective fever over the past month but no weight loss.

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.

Fear of bioterrorism persists because of new reports of biological warfare, including the most recent attack that involved a Russian spy who was poisoned with polonium-210. However, vaccination against potential biological weapons, such as anthrax and smallpox, is controversial because of associated adverse effects.

Six months after testing positive for HIV in 10 bands, a 24-year-old homosexual man presented with a macular rash on his palms and soles. He first noticed the lesions 2 weeks earlier; they were not pruritic or painful. He also had a brighter, more inflamed rash in the groin and antecubital fossae that was presumed to be a yeast infection and was treated with fluconazole. He had no other symptoms.

SAN FRANCISCO -- HIV-positive African-Americans have a six-fold higher risk for end-stage renal disease than whites with HIV, investigators here reported.

ATLANTA -- Invasive infections of methicillin-resistant Staphylococcus aureus (MRSA) may be more common than suspected, according to the first nationwide surveillance estimates.

WHITEHOUSE STATION, N.J. -- The FDA has approved raltegravir (Isentress) as part of a combination regiment for treatment for multi-resistant HIV-1 infection in adults, according to an announcement from Merck.

SAN DIEGO -- Rotavirus infection, once considered almost exclusively a pediatric diarrheal disease, affects adults as well, causing substantial morbidity and unnecessary use of procedures and antibiotics, according to results of a study reported here.

PITTSBURGH -- There is strong evidence suggesting -- but not proving -- the existence of a causal link between psychological stress and chronic conditions such as depression, cardiovascular disease, and HIV/AIDS, asserted researchers here.

SAN DIEGO -- Older patients with HIV infection have robust responses to highly active antiretroviral therapy (HAART), with no increased risk of metabolic disorders or other adverse effects, according to two studies.

EDMONTON, Alberta -- Pneumococcal vaccine dose not prevent community-acquired pneumonia but can significantly reduce deaths or ICU admissions from it, researchers here reported.

SAN DIEGO -- Adolescents and teenagers with perinatally acquired HIV infection have high rates of neurologic, psychiatric, and cognitive problems that can confound attempts to treat them, investigators reported here.

BORAS, Sweden -- Keeping HIV at bay with highly active anti-retroviral therapy (HAART) may also forestall AIDS-related neurodegeneration, investigators have found.

SAN DIEGO -- Once stereotyped as wasting away, HIV patients have joined the rest of America in fighting the battle of the bulge, according to results of a study reported here.

SALT LAKE CITY -- Forecasts that physician-assisted suicide and euthanasia would be practiced disproportionately on vulnerable groups, such as the poor, the elderly, and women, did not prove accurate, according to researchers here.

DURHAM, N.C. -- Adding nicotine replacement to cognitive behavioral therapy helped pregnant women stop smoking, but didn't prevent relapse after the baby was born, investigators here found.

SAN FRANCISCO -- In another setback to the effort to create a preventive vaccine against HIV, a key trial has been halted because of a lack of efficacy, according to Merck and the HIV Vaccine Trials Network.

NEW YORK -- Inpatients cared for by full-time hospitalists were likely to be discharged almost a day sooner than those in the care of nonhospitalists, but there was no significant difference in readmission rates or mortality, researchers found.

CHICAGO -- As clinical data accumulates, researchers are gaining confidence in a drug that blocks HIV from entering its target cells.

CHICAGO -- The experimental integrase inhibitor elvitegravir induces a swift reduction in HIV levels but needs an optimized background regimen, researchers emphasized.

CHICAGO -- An antibody that blocks HIV entry to its target T-lymphocytes was found to be well tolerated and effective in the first study to test its activity in humans.

AMSTERDAM -- Inflammation in patients with type 2 diabetes is independent of obesity, an observation that may partly explain the increased risk of cardiovascular disease among patients with diabetes.

CHICAGO -- In patients newly diagnosed with HIV, the novel protease inhibitor darunavir (Prezista) has been found to be as effective as the standard lopinavir (Kaletra).

CHICAGO -- The investigative integrase inhibitor raltegravir (Isentress) can suppress the viral load to undetectable levels in at least half of HIV patients with virus resistant to three drug classes, researchers said here.

My patient is a 39-year-old man who has had burning pain and lack of muscle endurance in his bilateral quadriceps and bilateral deltoids for 4 years.