Initial treatment of cryptococcal meningitis in AIDS.

The comparison of initial treatment with amphotericin B (0.7 mg/kg/d) plus rifampin (600 mg/d) with amphotericin B (0.7 mg/kg/d) alone for 2 weeks, both followed by fluconazole (400 mg/ d) for 8 weeks in the acute treatment of cryptococcal meningitis in AIDS by an open- randomized, controlled, prospective clinical trial is reported. Twenty patients were enrolled in each group. There were no significant differences between the groups in regard to a negative CSF culture for Cryptococcus neoformans in the 2nd and 10th weeks of treatment, time until normal body temperature after treatment, number of patients who died, and persistence of high CSF pressure after completion of treatment. Elevated intracranial pressure was an important factor associated with the patients who died. These results indicate that the combination of amphotericin B plus rifampin is not superior to amphotericin B alone.

Do physicians recognise dementia.

Background : Recognition and diagnosis of dementia is frequently overlooked by attending physicians both in the community and hospital settings. Objective : To determine the ability of attending physicians to recognise dementia. Methods : A cross-sectional survey of cognitive impairment in 150 medical inpatients at Siriraj Hospital, Bangkok, Thailand was done from May to November 1999. Inclusion criteria were patients aged over 50 year-old with Glasgow coma score over 12/15, no delirium and no active medical problems. Cognitive assessment was done before the discharge date by means of clinical evaluation, neurological examination and mental state examination. Dementia was diagnosed by DSM-IV criteria. The severity of dementia was classified by using the degree of dependency. Diagnosis of dementia in the medical records was categorised as whether dementia was recognised by the attending physicians. Results : Forty nine patients out of a total of 150 patients (32.67 per cent) were demented of which thirty three patients had mild dementia, thirteen patients had moderate dementia and three patients had severe dementia. The attending physicians recognised two patients out of forty nine dementia patients (4%). However, both of them had previously been diagnosed as having dementia before the admission. Conclusion : Delayed diagnosis of dementia is frequently due to attending physicians not recognising this condition. Early recognition of dementia usually leads to its proper management, thus internists should be more alert for this condition.