1/8. Serious adverse events attributed to nevirapine regimens for postexposure prophylaxis after hiv exposures--worldwide, 1997-2000.In September 2000, two instances of life-threatening hepatotoxicity were reported in health-care workers taking nevirapine (NVP) for postexposure prophylaxis (PEP) after occupational human immunodeficiency virus (hiv) exposure. In one case, a 43-year-old female health-care worker required liver transplantation after developing fulminant hepatitis and end-stage hepatic failure while taking NVP, zidovudine, and lamivudine as PEP following a needlestick injury (1). In the second case, a 38-year-old male physician was hospitalized with life-threatening fulminant hepatitis while taking NVP, zidovudine, and lamivudine as PEP following a mucous membrane exposure. To characterize NVP-associated PEP toxicity, CDC and the food and Drug Administration (FDA) reviewed MedWatch reports of serious adverse events in persons taking NVP for PEP received by FDA (Figure 1). This report summarizes the results of that analysis and indicates that healthy persons taking abbreviated 4-week NVP regimens for PEP are at risk for serious adverse events. Clinicians should use recommended PEP guidelines and dosing instructions to reduce the risk for serious adverse events.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/8. Chronic illnesses and the end of life.Great progress has been made in controlling the symptom distress of dying patients. This article reviews some of these methods and examines some triggering events that should cause physicians to re-examine patients' goals and care.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/8. Fetal meconium peritonitis in the infant of a woman with fulminant hepatitis B. A case report.BACKGROUND: Simultaneous fulminant maternal hepatitis B infection and fetal meconium peritonitis has never been reported before in the English-language literature. CASE REPORT: Fetal meconium peritonitis was detected at 32 weeks' gestation in a 21-year-old woman suffering from fulminant hepatitis. Fulminant hepatitis B was confirmed by clinical observation and serologic examination results. The course was also complicated with preterm labor. The fetus was diagnosed with meconium peritonitis prenatally. Because of failed tocolytic treatment, the fetus was delivered vaginally. Both the mother and fetus received intensive care, and the mother recovered. In contrast, the fetus's course worsened due to progressive abdominal distension. Although exploratory laparotomy was attempted, the operation was not successful. The infant died five days after birth. CONCLUSION: Recognition of the predisposing factors in fetal meconium peritonitis and immediate referral to a tertiary medical center, where specialists are available, could help physicians determine an accurate diagnosis and might improve prognosis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/8. Hepatic failure due to fibrosing cholestatic hepatitis in a patient with pre-surface mutant hepatitis b virus and mixed connective tissue disease treated with prednisolone and chloroquine.Fibrosing cholestatic hepatitis (FCH) is a severe variant of hepatitis B infection that has until recently been described almost exclusively in the setting of organ transplantation and hiv infection. This case report describes a patient with pre-surface (pre-S) mutant hepatitis b virus (HBV) infection who developed a fatal form of FCH after high dose prednisolone for mixed connective tissue disease (MCTD). The role of corticosteroids and pre-S viral mutation in the pathogenesis of the disease is discussed, and the importance of early diagnosis is emphasised. This report alerts the physician to the need for close monitoring of LFTs and HBV dna of hepatitis B carriers during immunosuppressive therapy regardless of the indication. As in the transplantation setting, viral dna levels should be kept to undetectable if viral replication or recurrence is to be prevented.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/8. Fatal hepatic failure secondary to acute herpes simplex virus infection.Acute hepatitis with severe hepatic failure is an uncommon manifestation of herpes simplex virus (HSV) infection. It has been described in both immunocompromised and immunocompetent patients and is usually fatal. Due to the better survival after acyclovir treatment in a few reported cases, physicians need to be aware of the characteristic clinical abnormalities so that early diagnosis and treatment can be implemented. The authors describe an adolescent diagnosed with hodgkin disease who developed fatal hepatic failure secondary to acute HSV. Typical signs and symptoms in patients at risk, when there is no other obvious cause of fulminant hepatitis, should lead to early empirical treatment with acyclovir.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/8. Integrating palliative care for liver transplant candidates: "too well for transplant, too sick for life".Chronic liver disease results in more than 1 million physician visits and more than 300,000 hospitalizations per year in the united states. More than 27,000 patients annually progress to end-stage liver disease (ESLD), liver failure, or death. patients with ESLD experience such complications as encephalopathy, malnutrition, muscle wasting, ascites, esophagogastric variceal hemorrhage, spontaneous bacterial peritonitis, fatigue, and depression. Despite significant improvements in palliation, patients' quality of life diminishes and their disease will often inexorably progress. liver transplantation, a valid treatment option, increases life and reduces many symptoms. With the current shortage of organs, up to 10% to 15% of these patients die without receiving an organ. Many patients also are not candidates for transplantation due to comorbid illness. In addition, some patients receive a transplant but succumb to complications of the transplant itself. Such patients and families face the conundrum of a potentially treatable yet often fatal illness. Through the case of a 55-year-old woman with a life-long history of hepatitis b virus infection who is awaiting transplant, we discuss the transplant eligibility process and the struggle with maintaining hope for a cure in the face a life-threatening illness. In all of these circumstances, the health care team must combine elements of palliative care with life-sustaining therapy to maximize the patient's quality and quantity of life.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/8. liver transplantation in hawaii.The first liver transplant performed in hawaii was on May 17, 1993 in a patient with end-stage liver disease caused by autoimmune hepatitis. liver transplantation is a well-accepted treatment for end-stage liver disease with a 1-year patient survival of 80% to 85%. Early recognition of the appropriate candidate by primary care physicians and prompt referral to a liver transplant center are essential for optimal results. The indications, contraindications, organ procurement and allocation, complications, and results of liver transplantation are described. Finally, several controversial areas will be introduced, including liver transplant for alcoholic cirrhosis and hepatitis B, and use of transjugular intrahepatic portosystemic shunts (TIPS).- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/8. Disseminated herpes simplex virus infection in a neonate.The emergency department (ED) evaluation of the neonate with sepsis or symptoms suggesting sepsis usually includes a complete blood count, catheterized urinalysis with culture, blood cultures, cerebrospinal fluid analysis and culture, and possibly a chest radiograph. Admission for observation for neonates at high risk for sepsis is universal. Depending on the patient's presentation and the preference of the admitting physician, intravenous antibiotics are started. Typically, ampicillin and either an aminoglycoside or cefotaxime are chosen because they cover the likely pathogens in this age group, ie, group B streptococci, escherichia coli and other gram-negative enterics, and listeria monocytogenes. Coverage for viral infection, most notably herpes simplex virus (HSV), is only rarely instituted in the ED and is usually considered if the patient has obvious ulcerative lesions or if the mother has known HSV infection. Unfortunately, antiviral therapy with acyclovir or vidaribine has to be started in the early stages of infection to be effective. If antiviral therapy is started after viral entry into cells, morbidity is severe and mortality approaches 80%. Neonates who survive are usually severely disabled. Broadening the indications for initiating antiviral therapy to include the neonate whose mother has any history of a sexually transmitted disease may prevent the sequelae of untreated or inadequately treated HSV infection. A case is reported of an 8-day-old girl who developed disseminated HSV infection and died as a result of hepatic failure.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |