HIV and ID Observations

October 7th, 2015

The Future of Diagnostic Microbiology, in 17 Minutes!

Over at Open Forum Infectious Diseases, I had the pleasure to interview Dr. Angela Caliendo about the latest advances in diagnostic microbiology. She touches on molecular testing in general, rapid pathogen identification (especially with MALDI-TOF, everyone’s favorite acronym), “syndromic” diagnostic testing for respiratory infections and diarrhea, use of Xpert for TB even here in the United States, […]

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September 24th, 2015

Decision to Lower Price of Pyrimethamine a Good One, Especially Given the Weak Defense of the Price Hike

The big ID story the past couple of weeks is that the price of pyrimethamine — a drug that’s been available generically for decades — went from $13.50 to $750 for one pill after the exclusive rights to the drug were purchased by Turing Pharmaceuticals. Now, after a barrage of criticism — all the way from this […]

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September 20th, 2015

EHR and Drug Prescribing Warnings: The Good, the Bad, the Ugly

Part 1. The Good. Recently, an ENT colleague (fictionally named “Clint” below), sent me two emails triggered by drug-drug interaction warnings he received while seeing HIV patients. Here’s #1: Hey Paul, I saw Mark C yesterday for hoarseness, and his exam was negative. Thought we’d try a PPI for reflux, but when I wrote the script, I […]

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September 7th, 2015

Two Drugs with High Prices — One is (Surprise!) Good Value, The Other is Truly a Rip-off

By now, the fact that HCV treatment carries a high price is a fact as well known to the medical and non-medical public as 1) a million dollars doesn’t get you much in Manhattan or Bay-area real estate; 2) a Rolex is an expensive way to know what time it is; and 3) even though […]

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August 30th, 2015

(Not) Doing the Retinal Exam, and the Importance of Acknowledging Limitations

This past week, the New England Journal of Medicine released one of its excellent instructional videos, detailing how to do direct ophthalmoscopy to examine the retina. That’s the use of one of those hand-held gizmos — an ophthalmoscope, see picture on the right — to look at the back of the eye. As usual, the video was […]

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August 23rd, 2015

Post-Exposure Prophylaxis for HCV Can’t Be Cost-Effective — But We Might End Up Recommending It Anyway

An email query from a colleague: Hi Paul, Just got a call from one of our surgeons who got a needlestick from a suture needle, small amount of blood. Patient is HCV +. Any post-exposure prophylaxis recommended? Thanks, Dan The quick answer is no, it’s not recommended. From the guidelines: But it’s a natural question to ask for several reasons — […]

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August 17th, 2015

Dog Days of Summer ID Link-o-Rama

A few ID/HIV items of note to consider as you gather up your sunscreen, flip flops, towels, and sand toys and head off to the beach: Interesting review of the impact of low socioeconomic status in the recent outbreak of Legionnaires’ Disease in the South Bronx. It’s just like (almost) every infection — the combined effects of crowding, poor sanitation, and […]

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August 9th, 2015

The Pain — and Potential Power — of Electronic Health Records in One Little Anecdote

Here’s a scintillating series of events that happened recently on our inpatient consult service: Reason for consult: “Treatment of UTI in a 26-year-old pregnant woman with multiple allergies.” Culture result:  Group B strep, resistant to clindamycin and nitrofurantoin. She’s been on the latter. Patient’s allergies as listed on her chart:  Penicillins, cephalosporins, sulfonamides. Plan per OB service: […]

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August 1st, 2015

Ten Reasons to Attend Our “Infectious Diseases in Primary Care” Course

With an up-front apology for the shameless plug — sorry! — here are 10 great reasons to attend our annual postgraduate course. It’s called Infectious Diseases in Primary Care, and takes place October 14-16 here at the Fairmont Copley Plaza Hotel in Boston. All the topics are clinically relevant to day-to-day practice. Look at these topics! There’s a strict […]

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July 7th, 2015

For HIV in the USA, Not in Care Exceeds the Undiagnosed — Solutions Welcome

In last week’s post, I asked about two of the key components of the HIV care cascade — the “undiagnosed” vs the “diagnosed but not in care,” and which group was larger in the USA. Here are your answers as of now: The people who read this site are a pretty knowledgeable group when it comes to […]

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