1/18. 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 = 1keywords = physician (Clic here for more details about this article) |
2/18. Differentiating hiv-1 parotid cysts from papillary cystadenoma lymphomatosum.BACKGROUND: patients with parotid cystic lesions may first be seen in the dental office. These conditions most often represent either papillary cystadenoma lymphomatosum, or PCL, or lymphoepithelial cysts associated with human immunodeficiency virus, or HIV, disease. The authors present a case report to illustrate the differential diagnosis. CASE DESCRIPTION: PCL represents a benign, usually unilateral, circumscribed parotid tumor with cystic elements. HIV-associated lymphoepithelial cysts of the parotid gland usually are seen bilaterally, create cosmetic concerns and are hallmarked by an associated cervical lymphadenopathy. Therapy for PCL demands surgical excision, while patients with HIV-associated lymphoepithelial cysts may be treated with antiviral therapy and undergo periodic monitoring by a physician. CLINICAL IMPLICATIONS: As a member of the health care team, the dentist must be familiar with head and neck swellings. Early clinical recognition of parotid swellings leads to successful treatment.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
3/18. Report of a false-positive HIV test result and the potential use of additional tests in establishing HIV serostatus.Considering the lifelong implications of a positive human immunodeficiency virus (HIV) test result, physicians should be aware of the limitations of tests for HIV. A 43-year-old man had a reactive enzyme-linked immunosorbent assay and an indeterminate result on Western blot analysis. The results of subsequent enzyme-linked immunosorbent assay and Western blot tests were interpreted as positive, and the patient was informed that he had HIV infection. Persistently undetectable plasma hiv-1 rna, combined with normal physical examination findings, CD4( ) cell count, and CD4/CD8 ratio, prompted further testing, which revealed that the patient was not infected with HIV. False-positive HIV test results are uncommon, but they can occur. In the appropriate clinical setting, follow-up and the use of other laboratory tests, such as determination of plasma viral load, may help identify such cases.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
4/18. porphyria cutanea tarda and HIV: two cases associated with hepatitis c.hepatitis c virus (HCV) is a probable etiologic factor for the development of porphyria cutanea tarda (PCT), a photosensitive skin disease causing blistering, skin fragility, milia, and scarring. In a review of the literature, the hepatitis c status of patients coinfected with HIV and PCT was not known. Two patients with PCT who were seropositive for HIV and HCV are discussed herein. The appropriateness of performing porphyrin studies in patients diagnosed with HIV and photosensitivity and of prompting physicians to test for HIV and HCV infection in individuals who are diagnosed with PCT is discussed. Because HIV has been isolated from cutaneous blister fluid in patients with PCT and HIV, caregivers should be aware of the infection risk associated with the vesicles and erosions in these patients.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
5/18. Acute human immunodeficiency virus syndrome in an adolescent.Acute human immunodeficiency virus (HIV) seroconversion illness is a difficult diagnosis to make because of its nonspecific and protean manifestations. We present such a case in an adolescent. A 15-year-old boy presented with a 5-day history of fever, sore throat, vomiting, and diarrhea. The patient also reported a nonproductive cough, coryza, and fatigue. The patient's only risk factor for HIV infection was a history of unprotected intercourse with 5 girls. physical examination was significant for fever, exudative tonsillopharyngitis, shotty cervical lymphadenopathy, and palpable purpura on both feet. Laboratory studies demonstrated lymphopenia and mild thrombocytopenia. Hemoglobin, serum creatinine, and urinalysis were normal. The following day, the patient remained febrile. physical examination revealed oral ulcerations, conjunctivitis, and erythematous papules on the thorax; the purpura was unchanged. Serologies for hepatitis b, syphilis, HIV, and Epstein-Barr virus were negative. Bacterial cultures of blood and stool and viral cultures of throat and conjunctiva showed no pathogens. Coagulation profile and liver enzymes were normal. Within 1 week, all symptoms had resolved. The platelet count normalized. Repeat HIV serology was positive, as was HIV dna polymerase chain reaction. Subsequent HIV viral load was 350 000, and the cd4 lymphocyte count was 351/mm3. HIV is the seventh leading cause of death among people aged 15 to 24 in the united states, and up to half of all new infections occur in adolescents. Our patient presented with many of the typical signs and symptoms of acute HIV infection: fever, fatigue, rash, pharyngitis, lymphadenopathy, oral ulcers, emesis, and diarrhea. Other symptoms commonly reported include headache, myalgias, arthralgias, aseptic meningitis, peripheral neuropathy, thrush, weight loss, night sweats, and genital ulcers. Common seroconversion laboratory findings include leukopenia, thrombocytopenia, and elevated transaminases. The suspicion of acute HIV illness should prompt virologic and serologic analysis. Initial serology is usually negative. Diagnosis therefore depends on direct detection of the virus, by assay of viral load (HIV rna), dna polymerase chain reaction, or p24 antigen. Both false-positive and false-negative results for these tests have been reported, further complicating early diagnosis. Pediatricians should play an active role in identifying HIV-infected patients. Our case, the first report of acute HIV illness in an adolescent, emphasizes that clinicians should consider acute HIV seroconversion in the appropriate setting. Recognition of acute HIV syndrome is especially important for improving prognosis and limiting transmission. It is imperative that we maintain a high index of suspicion as primary care physicians for adolescents who present with a viral syndrome and appropriate risk factors.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
6/18. reproduction decision making for couples affected by HIV: a review of the literature.Medical issues faced by HIV-affected couples include transmission risks between partners and between mother and child, as well as the technologies and procedures available to reduce those risks. Assisted reproductive techniques discussed are artificial insemination, in vitro fertilization, intracytoplasmic sperm injection, self-insemination, and timed intercourse. It is important that physicians be aware of reproductive options available to couples affected by HIV and be prepared to engage in nonjudgmental dialogue with patients. This review is the result of a literature search performed to identify useful information to counsel HIV-serodiscordant and HIV-seroconcordant couples facing decisions on reproduction.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
7/18. pyelonephritis and acute renal failure.Bacterial invasion of the renal parenchyma, pyelonephritis, is rarely considered as a primary cause of acute renal failure, particularly in adults. We report two cases of acute renal failure occurring in absence of hypotension, urinary tract obstruction, or nephrotoxic medications that are likely the direct consequence of pyelonephritis. The first case involved a 48-year-old HIV-positive woman who presented with 3 days of nonspecific symptoms and was noted to have acute renal failure. Due to unremitting renal dysfunction, a renal biopsy was performed confirming the diagnosis of bacterial pyelonephritis. The second case, a 33-year-old man with HIV disease, presented with fever and was found to have pyelonephritis by urine culture and ultrasonography. These cases represented initial diagnostic dilemmas for the admitting physicians and demonstrate the varied clinical presentations of acute renal failure as a direct consequence of bacterial infiltration of the renal parenchyma.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
8/18. Multifocal choroiditis in disseminated cryptococcus neoformans infection.PURPOSE: To report an uncommon case of multifocal choroiditis as the result of disseminated cryptococcus neoformans infection in a patient who is HIV-positive. DESIGN: Interventional case report. methods: A 27-year-old HIV-positive woman with fever, headache, and vomiting was examined. Lumbar puncture was performed and revealed C neoformans infection. Her condition evolved with sudden bilateral blindness and deafness. Ophthalmologic examination revealed multiple yellowish choroidal lesions in the posterior pole of both eyes. RESULTS: Postmortem examination showed disseminated C neoformans infection. Histologic examination of the eyes confirmed the presence of C neoformans in the choroiditis. CONCLUSION: Multifocal choroiditis in C neoformans infection is a rare ophthalmic manifestation. The recognition of this condition by ophthalmologists can help physicians to diagnose a disseminated and fatal disease.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
9/18. fever and high lactate dehydrogenase in HIV-positive patients from the Antilles and Surinam: histoplasmosis?We describe four cases of HIV-positive patients, two from Surinam, one from the Dutch Antilles and one from nigeria, who presented with a febrile illness and a high lactate dehydrogenase plasma level. In all four, the diagnosis of disseminated histoplasmosis was made, in three of them by liver biopsy. Two patients had retinal abnormalities compatible with a systemic fungal infection. Three patients were treated successfully with antifungal agents. One patient died. Between 2000 and 2006, only 14 patients with HIV have been found to have histoplasmosis in the netherlands. Although histoplasmosis is not endemic in the netherlands, physicians are more likely to see cases because of a growing number of HIV -positive immigrants from endemic regions.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
10/18. rhodococcus equi causing human pulmonary infection: review of 29 cases.rhodococcus equi is a gram-positive pleomorphic bacillus that has been identified as a life-threatening pulmonary pathogen in the immunocompromised host. infection with R equi may go unrecognized by physicians unacquainted with its presentation and unaware of the organism's ability to mimic diphtheroids and to stain weakly positive with an acid-fast stain.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
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