Prognostic model for nephrotoxicity among HIV-positive Zambian adults receiving tenofovir disoproxil fumarate-based antiretroviral therapy.

Persons living with HIV (PLWH) receiving tenofovir disoproxil fumarate (TDF)-based antiretroviral therapy (ART) risk suffering TDF-associated nephrotoxicity (TDFAN). TDFAN can result in short- and long-term morbidity, including permanent loss of kidney function, chronic kidney disease (CKD), and end-stage kidney disease (ESKD) requiring dialysis. Currently, there is no model to predict this risk or discern which patients to initiate TDF-based therapy. Consequently, some patients suffer TDFAN within the first few months of initiating therapy before switching to another suitable antiretroviral or a lower dose of TDF. In a prospective observational cohort study of adult Zambian PLWH, we modelled the risk for TDFAN before initiating therapy to identify individuals at high risk for experiencing AKI after initiating TDF-based therapy. We enrolled 205 HIV-positive, ART-naïve adults initiating TDF-based therapy followed for a median of 3.4 months for TDFAN at the Adult Infectious Disease Research Centre (AIDC) in Lusaka, Zambia. We defined TDFAN as meeting any of these acute kidney disease (AKD) criteria: 1) An episode of estimated glomerular filtration rate (eGFR)< 60ml/ min/1.73m2 within 3 months, 2) reduced eGFR by> 35% within 3 months or 3) increased serum creatinine by> 50% within 3 months. A total of 45 participants (22%) developed acute kidney disease (AKD) after TDF-based therapy. The development of AKD within the first 3 months of commencing TDF-based therapy was associated with an increase in baseline serum creatinine, age, baseline eGFR and female sex. We concluded that baseline characteristics and baseline renal function biomarkers predicted the risk for AKD within the first 3-months of TDF-based therapy.

Solving crimes with hypnosis.

Following a brief review of the literature on hypnosis and memory, this paper overviews the procedures that are used in conducting forensic hypnosis interviews. Ten forensic hypnosis cases are then described. These real world cases are in stark contrast to research done in an artificial laboratory setting where the information to be recalled lacks personal relevance and was not associated with emotionally arousing situations. These cases illustrate how forensic hypnosis can result in obtaining important additional investigative leads which lead to the solving of crimes.

Problems in the therapy for imported malaria in the United States.

BACKGROUND: Errors in the diagnosis of imported malaria are increasingly recognized. However, there are few data on the treatment of malaria in the United States. METHODS: Medical records were reviewed for 83 patients with microscopically confirmed malaria at Cook County Hospital, Chicago, Ill, between 1991 and 1999. RESULTS: Errors in drug treatment occurred in 25% of patients in this study. The most common error in therapy was the failure to prescribe primaquine to eradicate the liver forms of Plasmodium vivax. Another 5 patients with P vivax received an inappropriate drug regimen. Errors in Plasmodium falciparum therapy occurred in 5 patients. All patients received an inappropriate drug regimen. While the clinical symptoms and signs do not help distinguish the infecting Plasmodium species, the travel history is extremely helpful in guiding drug selection. Non-infectious diseases specialists are more likely to make errors in therapy than are infectious diseases specialists. CONCLUSIONS: Despite widely published guidelines on the treatment of malaria, there are frequent errors in the therapy for malaria. A detailed travel history emphasizing the duration and country of travel should be sought. Primaquine should be included in the primary prescription for the treatment of P vivax infection. Improvements in the therapy for malaria can be made with the aid of an infectious diseases specialist and/or a tropical medicine specialist.