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Behind the (bilateral) fungus ball
A 54-year-old man with AIDS and a history of Pneumocystis jirovecii pneumonia presented with chronic cough and weight loss for 1 year. There was no haemoptysis. He had normal vital signs and was afebrile. Lung auscultation was normal. Laboratory evaluation was unremarkable. Chest radiography revealed bilateral upper lobe cavities with internal densities (figure 1). CT of the chest demonstrated these apical cavities to contain material consistent with a mycetoma (fungus ball). Adjacent pleural thickening and areas of consolidation and fibrosis were also present (figure 2). A CT scan performed 2 years previously showed ...
Source: Postgraduate Medical Journal - April 26, 2017 Category: Journals (General) Authors: Epelbaum, O., Rashidfarokhi, M., Patel, G. Tags: Immunology (including allergy), Drugs: infectious diseases, Radiology, Adult intensive care, Pneumonia (respiratory medicine), Dermatology, Clinical diagnostic tests, Radiology (diagnostics) Images in medicine Source Type: research

Diagnostics for pulmonary tuberculosis
Tuberculosis (TB) remains a leading cause of human suffering and mortality despite decades of effective treatment being available. Accurate and timely diagnosis remains an unmet goal. The HIV epidemic has also led to new challenges in the diagnosis of TB. Several new developments in TB diagnostics have the potential to positively influence the global campaign against TB. We aim to review the performance of both established as well as new diagnostics for pulmonary TB in adults, and discuss the ongoing challenges.
Source: Postgraduate Medical Journal - March 21, 2016 Category: Journals (General) Authors: Cudahy, P., Shenoi, S. V. Tags: Sexual transmitted infections (viral), Immunology (including allergy), Drugs: infectious diseases, HIV/AIDS, Tuberculosis, Epidemiology PMJ 90th anniversary review Source Type: research

Cytomegalovirus retinitis
We present a case of CMV retinitis and the full treatment course with fundus pictures. Case report A 32-year-old man visited our department and presented with floaters in the right eye for a week. Ophthalmoscope examination showed retinal whitening and haemorrhages in the right eye and normal fundus in the left eye (figure 1). We checked his HIV antibody, venereal disease research laboratory, rapid plasma regain, IgG and IgM for Toxoplasma gondii, basic blood chemistry and complete blood...
Source: Postgraduate Medical Journal - March 21, 2016 Category: Journals (General) Authors: Kuo, C.-Y., Lin, J.-M. Tags: Journalology, Sexual transmitted infections (viral), Immunology (including allergy), Drugs: infectious diseases, HIV/AIDS, Travel medicine, Tropical medicine (infectious diseases), Ophthalmology, Epidemiology, Ethics Images in medicine Source Type: research

Distant site lipoatrophy: a rare complication of subcutaneous insulin therapy
Introduction Injection site lipodystrophy is not uncommon in insulin-treated patients with diabetes. In this era of human insulin and insulin analogues, lipoatrophy is far less common than lipohypertrophy, and distant site lipoatrophy is even rarer. The underlying pathophysiology of distant site lipoatrophy is largely undefined, and this disease is a diagnostic and therapeutic challenge to the treating physicians. Case history A 60-year-old woman (BMI 32 kg/m2) with a 25-year history of type 2 diabetes mellitus presented with a depression in her interscapular region that had been present for 3 months and was caus...
Source: Postgraduate Medical Journal - December 16, 2015 Category: Journals (General) Authors: Chakraborty, P. P., Biswas, S. N. Tags: Sexual transmitted infections (viral), Immunology (including allergy), Drugs: infectious diseases, HIV/AIDS, Diet, Radiology, Dermatology, Surgical diagnostic tests, General surgery, Diabetes, Metabolic disorders Images in medicine Source Type: research

Pyrexia of unknown origin 90 years on: a paradigm of modern clinical medicine
In 1925, Sir Thomas Horder, a leading physician of his day, gave a lecture, published in this journal, entitled ‘Some cases of pyrexia without physical signs’. The paper highlighted what was already a familiar clinical presentation "which taxes our resources to the utmost". Fast-forward through 90 years of careful clinical description, technological innovation in diagnosis and treatment, emergent infections, novel diagnoses, demographic shifts, and radical changes in the health economy. Sir Thomas would find certain aspects familiar, and others revolutionary, in the differential diagnosis and management of...
Source: Postgraduate Medical Journal - November 25, 2015 Category: Journals (General) Authors: Brown, M. Tags: Sexual transmitted infections (viral), Editor's choice, Immunology (including allergy), Drugs: infectious diseases, HIV/AIDS, Radiology, Clinical diagnostic tests, Radiology (diagnostics) PMJ 90th anniversary review Source Type: research

Puerperal sepsis in the 21st century: progress, new challenges and the situation worldwide
Puerperal sepsis is one of the five leading causes of maternal mortality worldwide, and accounts for 15% of all maternal deaths. The WHO defined puerperal sepsis in 1992 as an infection of the genital tract occurring at any time between the rupture of membranes or labour and the 42nd day post partum; in which, two or more of the following are present: pelvic pain, fever, abnormal vaginal discharge and delay in the reduction of the size of the uterus. At the same time, the WHO introduced the term puerperal infections, which also include non-genital infections in the obstetric population. Recent epidemiological data shows th...
Source: Postgraduate Medical Journal - September 24, 2015 Category: Journals (General) Authors: Buddeberg, B. S., Aveling, W. Tags: Sexual transmitted infections (viral), Immunology (including allergy), Drugs: infectious diseases, HIV/AIDS, Pain (neurology), Pregnancy, Reproductive medicine, Epidemiology PMJ 90th anniversary review Source Type: research

Ebola virus disease: where are we now and where do we go?
Despite its vivid place in the popular imagination, conjuring up images of germ warfare and Hollywood blockbusters, Ebola has previously affected a relatively small number of people. Prior to 2014, approximately 2400 people were infected, with just over 1500 deaths in the four decades since its 1976 discovery in Zaire and Sudan.1 Smaller outbreaks occurred in the late 1970s, with sporadic, larger ones each numbering under 500 cases seen in the Democratic Republic of Congo (Zaire) and Uganda in the 1990s, 2000s and early 2010s. Ebola virus disease (EVD) was therefore largely thought to be an exotic, tropical disease confine...
Source: Postgraduate Medical Journal - October 20, 2014 Category: Journals (General) Authors: Brown, C. S., Cropley, I. M. Tags: Emergency medicine, Sexual transmitted infections (viral), Editor's choice, Immunology (including allergy), Drugs: infectious diseases, HIV/AIDS, Travel medicine, Tropical medicine (infectious diseases), Epidemiology Editorials Source Type: research

Rat bite fever: an unusual cause of a maculopapular rash
Introduction Rat bite fever (RBF) is a rare zoonosis caused worldwide by Streptobacillus monoliformis with Spirillum minus cases restricted to Asia.1 Transmission arises mainly by scratches or bites from colonised rats.1 At-risk groups include veterinarians, sewerage and laboratory workers or rat owners.1 Patients typically present within 7 days of exposure with an acute febrile illness characterised by headache, myalgia, migratory polyarthralgia and a rash.2 In the UK, one–two cases are diagnosed per year3 predominantly caused by S monoliformis.2 It is likely underdiagnosed due to a wide differential diagnosis ...
Source: Postgraduate Medical Journal - March 18, 2014 Category: Journals (General) Authors: Rosser, A., Wiselka, M., Pareek, M. Tags: Sexual transmitted infections (bacterial), Sexual transmitted infections (viral), Immunology (including allergy), Drugs: infectious diseases, HIV/AIDS, Drugs: cardiovascular system, Headache (including migraine), Pain (neurology), Ophthalmology, Valvar di Source Type: research

Republished: Unlocking the potential: longitudinal audit finds multifaceted education for general practice increases HIV testing and diagnosis
Conclusions The training intervention has been found to significantly increase general practice HIV testing rates in the absence of financial incentives. Positivity rates are substantially higher than that found in pilots of screening in London, suggesting that the training nurtured and supplemented complex clinical skills.
Source: Postgraduate Medical Journal - January 21, 2014 Category: Journals (General) Authors: Pillay, T. D., Mullineux, J., Smith, C. J., Matthews, P. Tags: Sexual transmitted infections (viral), Open access, General practice / family medicine, Immunology (including allergy), Drugs: infectious diseases, HIV/AIDS, Reproductive medicine, Epidemiology Original article Source Type: research

Acute febrile neutrophilic dermatosis (Sweet's syndrome) in a patient with biliary sepsis
We present a case of SS in a patient with biliary sepsis. Case history A 54-year-old Caucasian man developed pyrexia, leukocytosis with neutrophilia and raised C-reactive protein one day after transhepatic biliary stent insertion. Intravenous piperacillin/tazobactam (Tazocin, Pfizer, USA) was started for presumed biliary sepsis. He remained pyrexial 2 days later. The antibiotic was changed to meropenem. He remained unwell with swinging pyrexia while his leucocytosis, neutrophilia and C-reactive protein worsened over the following 5 days. Two days after he became unwell, he developed multiple violaceous tender nodules and plaques...
Source: Postgraduate Medical Journal - November 15, 2013 Category: Journals (General) Authors: Yong, A. S. W., Lee, K. Y. C., Murphy, J., Phillips, M., Rushbrook, S., Garioch, J. J. Tags: Inflammatory bowel disease, Liver disease, Pancreas and biliary tract, Sexual transmitted infections (viral), Pancreatitis, Immunology (including allergy), Drugs: infectious diseases, HIV/AIDS, Pregnancy, Reproductive medicine, Interventional cardiology, Source Type: research

Protecting the health of sex workers: will the real agenda please stand up
Interest in the health of women selling sex began in earnest towards the end of the 20th century with the advent of HIV. Although heterosexual transmission of HIV failed to reach the magnitude of problem that industrialised countries initially feared, research funded to assess HIV risk in sex workers revealed the significant risks to health experienced by this group. This set the scene for the now substantial body of research highlighting the extremely poor health and barriers to healthcare access experienced by many sex workers. Increased awareness of these unmet health needs has led to pressure on governments and authori...
Source: Postgraduate Medical Journal - June 18, 2013 Category: Journals (General) Authors: Jeal, N., Salisbury, C. Tags: Sexual transmitted infections (viral), General practice / family medicine, Immunology (including allergy), Drugs: infectious diseases, HIV/AIDS, Pregnancy, Reproductive medicine, Drugs misuse (including addiction) Editorials Source Type: research

Suboptimal access to primary healthcare among street-based sex workers in southwest Switzerland
Conclusions This vulnerable population comprises SSWs who, whether through mobility, insufficient education or language barriers, are unaware of services they are entitled to. With half the participants reporting no HIV testing, there is a need to enhance awareness of available facilities as well as to increase provision and uptake of HIV testing.
Source: Postgraduate Medical Journal - June 18, 2013 Category: Journals (General) Authors: Darling, K. E. A., Gloor, E., Ansermet-Pagot, A., Vaucher, P., Durieux-Paillard, S., Bodenmann, P., Cavassini, M. Tags: Emergency medicine, Sexual transmitted infections (viral), General practice / family medicine, Immunology (including allergy), Drugs: infectious diseases, HIV/AIDS Original article Source Type: research

Republished: Mainstreaming HIV services for men who have sex with men: the role of general practitioners
Mainstreaming HIV services for men who have sex with men: The role of general practitioners General practitioners (GPs) and other primary care doctors around the world have a strong potential for providing quality HIV prevention, testing and treatment for men who have sex with men, as advocated by the recent WHO guideline.1 As the HIV epidemic becomes more focused on chronic disease care in many parts of the world, a number of primary care issues come to the forefront of clinical HIV service delivery. GPs have advantages in providing HIV services because of their position as trusted, community-based, long-term advocates fo...
Source: Postgraduate Medical Journal - March 12, 2013 Category: Journals (General) Authors: Wong, W. C. W., Kidd, M. R., Tucker, J. D. Tags: Liver disease, Sexual transmitted infections (viral), General practice / family medicine, Immunology (including allergy), Drugs: infectious diseases, HIV/AIDS, Stroke, Hypertension, Communication, Ethics, Legal and forensic medicine Republished editoria Source Type: research

Pyomyositis
is a primary bacterial infection of skeletal muscles presenting with minimal clinical symptoms during the early stages and affects immunocompetent and immunocompromised individuals.1 MRI is a sensitive and specific imaging modality for early detection.1 Here we report a young man with a recent history of type 2 diabetes and recovery from hepatitis E presenting with right thigh pain and minimal erythema diagnosed with right thigh pyomyositis with the assistance of an early MRI. A 39-year-old man presented with a 5 day history of non-specific pain over the right thigh and a low grade fever. He was diagnosed with type 2...
Source: Postgraduate Medical Journal - February 15, 2013 Category: Journals (General) Authors: Annamalai, A. K., Gopalakrishnan, C., Jesuraj, M., Sureshkumar, G., Chelian, M., Srinivasan, K. G. Tags: Liver disease, Sexual transmitted infections (viral), Immunology (including allergy), Drugs: infectious diseases, HIV/AIDS, Pain (neurology), Dermatology, Diabetes, Metabolic disorders Images in medicine Source Type: research

Predictors of outcome in routine care for Cryptococcal meningitis in Western Kenya: lessons for HIV outpatient care in resource-limited settings
Conclusions Cryptococcal meningitis diagnosed in routine HIV outpatient settings is largely treated as an outpatient and adherence to treatment guidelines is poor. Body mass index is a critical independent predictor of outcome. Additional research to determine the most effective strategies to reduce premature mortality is urgently needed.
Source: Postgraduate Medical Journal - January 21, 2013 Category: Journals (General) Authors: Kendi, C., Penner, J., Koech, J., Nyonda, M., Cohen, C. R., Bukusi, E. A., Ngugi, E., Meyer, A.-C. L. Tags: Sexual transmitted infections (viral), Immunology (including allergy), Drugs: infectious diseases, HIV/AIDS, Epidemiology, Guidelines Original article Source Type: research