Mercedes Torres

Rapid HIV Screening in the Emergency Department

In 2001 and then again in 2006, the Centers for Disease Control and Prevention (CDC) published guidelines recommending universal HIV screening in acute care settings, including emergency departments (EDs). The value of early identification and treatment of HIV-infected patients is clear, but the most effective method for accomplishing this has yet to be determined. In this article, published experiences by ED-based HIV screening programs are reviewed to learn lessons from their mistakes and accomplishments. The goal of this article is to encourage thought regarding previous experiences with HIV screening and future ideas for improving efforts to this end. By examining the variety of HIV testing kits available, the debate regarding targeted testing versus screening, the consent and patient education requirements, and the staffing models used to implement HIV testing in the ED, this review aims to provide emergency physicians and administrators with options that can be tailored based on the resources available in their specific venue.

Gynecologic and Other Infections in Pregnancy

The treatment of gynecologic and other infections in obstetric patients involves consideration of the physiologic changes of pregnancy, the clinical implications of the infection for the patient as well as the fetus, and the safety of antimicrobials available for therapy. This article highlights the treatment of infections of the vagina, uterus, and urinary tract, with a focus on how therapy changes in obstetric patients. In addition, the emergency department management of other clinically important infections in pregnancy, such as those caused by the human immunodeficiency virus, influenza viruses, methicillin-resistant Staphylococcus aureus, Parvovirus, Listeria, and others is reviewed.

Human Immunodeficiency Virus Infection-Related Heart Disease.

Human immunodeficiency virus (HIV) infection and antiretroviral medications are independent risk factors for cardiovascular disease. In the pre-antiretroviral therapy (ART) era, HIV-infected patients had increased morbidity and mortality from opportunistic infections; in the post-ART era, these patients are at increased risk of chronic diseases such as acute coronary syndrome, coronary artery disease, cardiac arrhythmias, and cardiomyopathy. They may present with vague symptoms such as weakness, dyspnea, or fatigue as the initial presentation of their cardiovascular disease. An overview of the clinical presentation, workup, management, and treatment of different cardiovascular disease is provided in this article.