1/50. Suggestions for improving AIDS treatment in hospitals.On July 26, 1994, John William George Swaffer died of AIDS in an Ottawa hospital. His partner shares his experience while caring for John at the hospital. While the hospital did many things well, it seemed that requests for palliative care were poorly communicated among the various physicians involved with John's care. Coordination between hospital doctors and those from a local hiv clinic also seemed poor. The author recommends eight changes to better serve patients with AIDS and other terminal illnesses.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/50. paracoccidioidomycosis and AIDS: report of the first two Colombian cases.The records of the first two Colombian patients with AIDS and paracoccidioidomycosis are presented. Both patients were males and had no known risk factors for hiv although in the past they had worked in the field where they could have been infected with the fungus. They exhibited the juvenile type of disease with multiple organ system involvement and symptoms of short duration. They were deeply immunodepressed as indicated by less than 100 CD4 T lymphocytes per mL; however, serologic tests revealed circulating anti-paracoccidioides brasiliensis antibodies and in one patient the first diagnostic clue came from such tests. In one case, the mycosis preceded the AIDS diagnosis while in the other, both pathologies were discovered simultaneously. Antimycotic therapy with itraconazole was administered for over 10 months, with an initial dose of 200 mg/day followed by 100 mg/day; marked improvement of the mycotic signs and symptoms was soon noticed an there have been no signs of relapse. The patients improvement was also due to the combined retroviral treatment that was instituted. In spite of the rarity of the AIDS-paracoccidioidomycosis association, physicians practicing in endemic areas should consider the presence of the mycosis in immunosuppressed patients, since a prompt diagnosis and institution of combined antimycotic-anti-retroviral treatments would result in patient improvement and survival. It appears possible that the longer survival time of today's AIDS patients would give the quiescent fungus the opportunity to revive, multiply and cause overt disease.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/50. Talking about AIDS.Despite increased public and professional awareness, patients and physicians tend to avoid discussions about hiv. Empiric studies of patient-physician communication point to specific common communication breakdowns. These include lack of a good opening line, inappropriate context, awkward moments, vague language, and a physician-centered rather than a patient-centered interview style. In effective hiv-related discussions, clinicians elicit the patient's beliefs and concerns first, are organized, use empathy, provide a rationale for the discussion, persist through awkward moments, and clarify vague language. In addition to information about sexual behaviors and the number, gender, and hiv status of partners, clinicians should ask about the context and antecedents to risk behaviors, praise prior attempts to reduce risk, and assess the patient's motivation to change. Although studies indicate that experienced practitioners often do not have these skills, they can be learned.- - - - - - - - - - ranking = 3keywords = physician (Clic here for more details about this article) |
4/50. telephone medical care of patients with hiv/AIDS.It has been reported that primary care physicians make 27% of their patient contacts by telephone. With the knowledge that more than 90% of the population has access to a telephone, it is reasonable to propose that the telephone might be employed in a more structured and organized manner for improved, cost-effective medical care. In the current study, two diverse practices (multiphysician and university-affiliated hiv/AIDS clinic, private practice specializing in hiv/AIDS care), both of which used the telephone as having a central role in patient management, were critically observed and reported through three case reports. The results indicate that personnel other than the primary physician provider, such as the triage nurse, may handle a large percentage of calls and successfully manage numerous psychologic and health care issues for the patient, referring, when necessary, appropriate medical inquiries to the physician. It is recommended that physicians take the time to construct sound protocols for clinic personnel to manage patient inquiries by telephone.- - - - - - - - - - ranking = 5keywords = physician (Clic here for more details about this article) |
5/50. Disseminated manifestation of Kaposi's sarcoma in newly diagnosed AIDS in an african female.BACKGROUND: Kaposi's sarcomas are the most frequent malignancies in patients with AIDS and there is increasing evidence of an association with human Herpesvirus 8 (HHV-8). A reconstitution of the immune response due to different regimens of highly active antiretroviral therapy (HAART) is the most important step in treatment of Kaposi's sarcomas. Local treatment options include the topic application of alitretionin (9-cis-retinoic acid) as a gel, cryotherapy with liquid nitrogen and intralesional vinblastine, as well as local laser or low-dose X-ray treatment. A systemic chemotherapy can be taken under consideration in selected cases with clinical significant visceral lesions or aggressive sarcomatous behavior with anthracyclines, taxanes, as well as an immunomodulatory treatment with alpha Interferon. CASE REPORT: The case of an african emigrant is described. Hospitalized due to recurrent fever and diarrhea, the diagnosis of AIDS was quickly established. The physical examination revealed multiple nodular, painless skin lesions suspicious of Kaposi's sarcoma. The diagnosis was confirmed histologically, later on also in bronchial and duodenal biopsies due to the atypical subepithelial vessels with slit-like appearance and prominent endothelia. CONCLUSIONS: Cutaneous lesions in patients with dark skin colour may be unfamiliar to European physicians. In patients with hiv-infection, nodular skin lesions should lead suspicion to Kaposi's sarcoma. If this diagnosis is established, it should be clarified, if other locations (e.g.: intestine, respiratory tract) are involved, too.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/50. Multiple nevoid malignant melanomas in a patient with AIDS: the role of proliferating cell nuclear antigen in the diagnosis.The rapid growth of lesions clinically resembling compound nevi in patients with hiv/AIDS should alert physicians to the possibility of malignant melanomas. immunohistochemistry for proliferating cell nuclear antigen can be helpful in the diagnosis of these tumors. A case of multiple primary nevoid melanomas in a patient with hiv/AIDS is reported.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/50. cytomegalovirus peritonitis in a patient with the acquired immunodeficiency syndrome.peritonitis has been reported infrequently in patients with the acquired immunodeficiency syndrome (AIDS). Intestinal or colonic perforation resulting from cytomegalovirus (CMV) enteritis is the most common cause of peritonitis in these patients. We report a patient with CMV peritonitis occurring in the absence of perforation (primary peritonitis) to alert physicians to this potentially treatable disorder.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/50. Thrombotic microangiopathy: an atypical cause of acute renal failure in patients with acute pancreatitis.OBJECTIVE: To report on the development and treatment of thrombotic microangiopathy, an atypical cause of acute renal failure in patients with acute pancreatitis. DESIGN: case reports. SETTING: A 21-bed medical intensive care unit at an university hospital. patients: Two men with acute pancreatitis presented with acute renal failure, neurological manifestations, haemolytic anaemia and thrombocytopenia. Both patients required intensive care. MEASUREMENTS: Fragmented red cell count; levels of haptoglobin, amylase and lipase; serological testing for escherichia coli o157; computed tomography of the abdomen. MAIN RESULTS: The patients' courses were rapidly favourable after daily plasma exchange. A review of the existing medical literature was also undertaken. CONCLUSION: As thrombotic microangiopathy may be life-threatening without administration of fresh frozen plasma or plasma exchange, physicians should consider this disease as a possible cause of acute renal failure in patients with acute pancreatitis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/50. nevirapine-associated rash in a Jamaican child with hiv/AIDS.nevirapine is one of the first line antiretroviral agents used in the treatment of hiv/AIDS as well as for prophylaxis against mother-to-child transmission of hiv As antiretroviral medication becomes more available it is important for physicians to recognize the major clinical toxicities of these medications. We report a hiv-infected infant who developed a rash with systemic symptoms in association with nevirapine administration.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/50. An appointment with god: AIDS, place, and spirituality.This article describes how an African American gay man living with AIDS used his spiritual, religious, and cultural strengths to resist internalized dislocation because of heterosexism and homophobia. He was able to experience a relocation of God from places that rejected him to places that were conducive to his healing. By using these strengths, he was able to reject his physician's prediction of death and to call on God in response to an end-stage AIDS crisis. The development of spiritual agency is addressed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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