Infectious Disease

NEW YORK -- Men given thrombolysis for acute ischemic stroke were three times more likely than women to have a good functional outcome, despite elevated mortality, researchers here reported.

ROCKVILLE, Md. -- For the second time in two weeks, the FDA has informed physicians of an excess fracture risk in women taking an oral diabetes drug in the thiazolidinedione class. This time the drug is pioglitazone (Actos).

SEATTLE -- Percutaneous vertebroplasty reduces pain of collapsed vertebra without increasing risk of new fractures over the long term, Italian researchers said here.

SEATTLE -- Cardiac MRI used in tandem with echocardiography can enhance the likelihood of finding the cause of cardioembolic stroke, according to a small retrospective study.

ROCKVILLE, Md. -- The FDA has licensed an automated nucleic acid test to screen donor blood for West Nile virus.

SEATTLE -- Radiofrequency ablation eliminates the debilitating bone pain of benign bone tumors without the risks associated with surgery, researchers here said.

GENEVA -- Complications after hip replacement are more common for obese patients, particularly women, researchers here found.

MANCHESTER, England -- Patients with inflammatory polyarthritis, often a precursor to rheumatoid arthritis, are 40% more likely than the general population to die of cancer, according to a prospective cohort study.

LOS ANGELES -- A drug for patients infected with hepatitis B virus, an agent that was thought to be inactive against HIV for those co-infected with that virus, may not be so innocuous with HIV after all, investigators suggested here.

NORWICH, England -- The way that toddlers and teens grow may protect them against high cholesterol levels in adulthood, researchers here found.

IZMIR, Turkey -- Hepatitis B virus testing and immunization should be mandatory for professional or Olympic athletes participating in contact sports, a small Turkish study suggests.

Policy Watch: Using Science, Abusing Science

Editorial: Highlights of a Year in AIDS

Managing Managed Care: Health Literacy, HIV, and Outcomes

Research Focus: Recent Developments in HIV Therapeutics

Antiretroviral Therapy: Darunavir: An Overview of an HIV Protease Inhibitor Developed to Overcome Drug Resistance

Case Report: Cytomegalovirus Encephalitis in an HIV-Seropositive Person

Editorial Comment: Impact of Darunavir for Salvage Therapy

From the Editor's Desk: In This Month's Issue

abstract: The mainstay of therapy for acute severe asthma includes ß2-agonists, anticholinergics, and corticosteroids. Other agents, such as leukotriene modifiers and magnesium sulfate, can be used in patients who have responded poorly to conventional therapy. Noninvasive positive pressure ventilation (NPPV) should be tried before intubation in alert, cooperative patients who have not improved with aggressive medical therapy. However, NPPV should not be attempted in patients who are rapidly deteriorating or in those who are somnolent or confused. Endotracheal intubation is recommended for airway protection or for patients who present with altered mental status or circulatory shock. Patients should be admitted to the ICU if they have difficulty in talking because of breathlessness, altered mental status, a forced expiratory volume in 1 second or peak expiratory flow rate of less than 25% of predicted, or a PaCO2 greater than 40 mm Hg after aggressive treatment in the emergency department. (J Respir Dis. 2007;28(3):113-117)

The influenza vaccine not only reduces the morbidity and mortality of influenza, it also reduces the risk of death in adults hospitalized with community-acquired pneumonia (CAP). Spaude and colleagues found that this protective effect covered in-hospital all-cause mortality, even after adjustment for pneumococcal vaccination status and the presence of comorbidities.

The authors present a case in which the initial manifestation of systemic lupus erythematosus (SLE) was diffuse alveolar hemorrhage (DAH), which is a rare presentation that carries a high risk of death. The patient failed to respond to standard therapy but was successfully treated with plasmapheresis.

a 1-Antitrypsin (AAT) deficiency is a genetic disorder that predisposes patients to early-onset emphysema and chronic liver disease. It is more common than is generally appreciated, occurring in about 1 in 2000 to 5000 persons.1,2 It has been estimated that 1% to 2.5% of persons with chronic obstructive pulmonary disease (COPD) in the United States have AAT deficiency.1,2

A 42-year-old woman returned from a 2-month stay in India with a rash and alow-grade fever. She also complained of fatigue, nausea, anorexia, and weightloss. Despite treatment with amoxicillin for a presumed streptococcal rash,her symptoms worsened. The pruritic rash spread over the patient’s body;only the face was spared.

A painful, indurated, erythematousswelling arose on the left wrist of a62-year-old man who had recentlyvisited Guatemala. Initially, the lesionwas about 2 cm in diameter andhad 2 central openings that drainedserosanguinous fluid on pressure.The patient denied trauma to thearea or insect bites.

This infection is caused by reactivationof varicella-zoster virus (VZV),which may remain latent in thedorsal root and cranial nerve gangliafor decades. Reactivation oftenoccurs for no apparent reason, althoughstress and immunosuppressionmay increase the risk.

A 15-day-old boy is brought for evaluation after his mother noted a "lump" in his left breast that morning. There is no history of illness or trauma. The infant's appetite and activities are normal, and he has no constitutional symptoms. He was delivered vaginally at full term and did not require a prolonged nursery stay or antibiotic therapy. Results of standard maternal screens were negative.

A 34-year-old woman who was coinfected with HIV and hepatitis C virus complained of acute abdominal pain and generalized pruritus of 3 weeks' duration. She was noncompliant with her antiretroviral medications.

A 3-year-old girl is brought to the office because of a1-week history of hematuria and dysuria. Her motherhad noticed bright red blood in the child’s urine anddiaper. The child did not have dysuria initially but latercomplained of a burning sensation.

A linear, severely pruritic rash erupted on the lateral and plantar aspectsof the left foot (A) of a 72-year-old woman who had recently been campingon a Caribbean beach. Antihistamines and locally applied antifungal agentsoffered no relief.