ABSTRACT
Acute encephalitis can be life-threatening, especially in the immunocompromised population. Viruses are the main infectious agents, with varicella zoster virus (VZV) a common cause. Neuropsychiatric symptoms are well documented, but it is rare for mania to be the only symptom on presentation. Here, we report a case of hypomania in a 31-year-old white British heterosexual man who following investigation was found to be HIV positive and subsequently diagnosed with VZV encephalitis. To date, we are unaware of any similarly reported cases. It is important to raise awareness of atypical HIV presentations to improve clinical outcomes for patients.
Subject(s)
Encephalitis, Varicella Zoster/complications , HIV Infections/complications , Mania/virology , Adult , Humans , MaleSubject(s)
Anti-HIV Agents/pharmacology , Drug Resistance, Viral , HIV Infections/transmission , HIV Integrase/genetics , HIV Reverse Transcriptase/genetics , HIV/drug effects , Mutation, Missense , Adult , Anti-HIV Agents/therapeutic use , Dideoxynucleosides/pharmacology , Dideoxynucleosides/therapeutic use , Drug Combinations , Female , HIV/genetics , HIV/isolation & purification , HIV Infections/drug therapy , HIV Infections/virology , Heterocyclic Compounds, 3-Ring/pharmacology , Heterocyclic Compounds, 3-Ring/therapeutic use , Humans , Lamivudine/pharmacology , Lamivudine/therapeutic use , Treatment FailureABSTRACT
Adolescence is a time of sexual risk-taking and experimentation but also vulnerability. Young people may present to general physicians with systemic symptoms of sexually transmitted infections (STIs), such as arthritis, hepatitis or rash, but may not necessarily volunteer information about sexual activity. It is important for physicians to ask directly about sexual risks and if appropriate test for STIs and pregnancy. Knowing how to take a sexual history and consent a patient for an HIV test are core medical skills that all physicians should be trained to competently perform. Safeguarding young people is the responsibility of all healthcare professionals who come into contact with them, and young victims of abuse may present with physical symptoms such as abdominal pain or deliberate self-harm. We must all be aware of indicators of both child sexual exploitation and HIV infection and not be afraid to ask potentially awkward questions. If we don't we may miss vital opportunities to prevent or minimise harm to young people.
Subject(s)
Psychology, Adolescent , Sexual Behavior , Adolescent , Adult , Arthritis, Reactive/diagnosis , Child , Child Abuse, Sexual , Chlamydia Infections/diagnosis , Female , Gonorrhea/diagnosis , HIV Infections/diagnosis , Hepatitis/diagnosis , Humans , Lymphogranuloma Venereum/diagnosis , Male , Pelvic Inflammatory Disease/diagnosis , Peritonitis/diagnosis , Proctitis/diagnosis , Risk-Taking , Sexually Transmitted Diseases/diagnosis , Syphilis/diagnosis , Young AdultSubject(s)
Access to Information , Child Abuse, Sexual/prevention & control , Consultants , Guidelines as Topic , Physical Examination/methods , Child , Child Abuse, Sexual/statistics & numerical data , Child, Preschool , Homeless Youth , Humans , Juvenile Delinquency , Mandatory Reporting , Pilot Projects , Poverty , Prevalence , Risk FactorsSubject(s)
Family Health , HIV Infections/diagnosis , HIV Infections/transmission , Adolescent , Adult , Child , Child, Preschool , Female , HIV Infections/drug therapy , Humans , Infant , Infant, Newborn , MaleSubject(s)
HIV Infections/ethnology , Health Services/statistics & numerical data , Warfare , Africa/ethnology , Emigration and Immigration/trends , Female , HIV Infections/epidemiology , HIV Infections/therapy , Humans , London/epidemiology , Male , Patient Acceptance of Health Care/ethnology , Patient Acceptance of Health Care/statistics & numerical data , Retrospective StudiesABSTRACT
BACKGROUND: The objectives of the study were to compare the efficacy and safety of intravaginal misoprostol and intravaginal dinoprostone for induction of labor and to quantify the clinical response to suspicious cardiotocographic (CTG) readings. METHODS: One hundred and ninety-one patients were randomized to receive either 50 micro g misoprostol initially then a further identical dose 6 h later or 2 mg dinoprostone initially followed by 1 mg 6 h later, over a period of 24 h. If not in labor after 24 h, then both arms of the study would thereafter receive dinoprostone alone as per hospital protocol. RESULTS: The induction to delivery interval (1047 vs. 1355 min, p = 0.01), delivery within 12 h (35.4% vs. 18.9%, p = 0.02) and delivery within 24 h (83.3% vs. 63.3%, p = 0.01) were all shorter in the misoprostol arm. There were no differences in rates of oxytocin augmentation (p = 0.47), tachysystole (p = 0.32) and hyperstimulation syndrome (p = 0.82). There was an increase in the median number of times a doctor was called to advise on a suspicious CTG in the misoprostol group (1 vs. 2 occasions, p = 0.052), but there was no difference in neonatal outcome. CONCLUSIONS: Intravaginal misoprostol led to a shorter, more efficient labor, and although there was more anxiety related to the CTG, there was no increase in neonatal adverse effects.
Subject(s)
Dinoprostone/administration & dosage , Labor, Induced/methods , Misoprostol/administration & dosage , Oxytocics/administration & dosage , Administration, Intravaginal , Adolescent , Adult , Cardiotocography/drug effects , Cervical Ripening/drug effects , Dinoprostone/adverse effects , Female , Humans , Labor, Obstetric , Middle Aged , Misoprostol/adverse effects , Oxytocics/adverse effects , Parity , Pregnancy , Pregnancy Outcome , SafetyABSTRACT
BACKGROUND: Multiparous patients have a higher risk of hyperstimulation and uterine rupture than nulliparous patients. The minimum possible dose of uterotonic drug should be used in induction of labor for multiparous patients to avoid excessive uterine activity, which could increase both maternal and fetal risks. METHODS: One hundred and four women were randomized to either a single dose of 50 micro g of intravaginal misoprostol in 24 h, or two consecutive doses of intravaginal 50 micro g misoprostol 6 h apart. RESULTS: The mean induction to delivery interval (789 min [95% CI: 637-941] vs. 576 min [95% CI: 484-667], p = 0.018) and delivery rate within 12 h (63% vs. 83%, p = 0.035) were higher in the two-dose group. The oxytocin augmentation rate (14% vs. 2%, p = 0.03) was higher in the single-dose group. There was a higher rate of clinician input related to suspicious cardiotocographic readings in the single-dose arm (p = 0.04). There was no statistical difference (p > 0.05) between the one- and two-dose regimens with respect to the rates of tachysystole (21% vs. 15%), hyperstimulation (3.9% vs. 0%), and meconium staining at delivery (9.8% vs. 13.2%). CONCLUSIONS: The two-dose regimen was most efficient, but both regimens were well tolerated by the fetuses.
