Mengele's suitcase.

On January 9, 2014, I received a call at my home in the small town of Alfeld (Leine), Central Germany. On the phone was Barbara Riepl, an acquaintance from Munich, and she had a truly exciting story waiting for me.1 The grandfather of her best friend Nicole had been a prominent Hungarian Jew who had been deported to Auschwitz during World War II. There, he became a prisoner doctor forced to assist the notorious Nazi doctor Josef Mengele in his infamous human experiments. Several years after the war, he deposited a slew of documents in a Swiss safe. That safe had remained untouched for decades, but it was to be unsealed soon. Riepl went on to claim that her friend had entrusted her personally with these documents and asked if I, as a historian, would be interested in examining the documents and-if need arose-help to publish them.

Outcomes of Patients with Alcohol Withdrawal Syndrome Treated with High-Dose Sedatives and Deferred Intubation.

RATIONALE: High doses of sedating drugs are often used to manage critically ill patients with alcohol withdrawal syndrome. OBJECTIVES: To describe outcomes and risks for pneumonia and endotracheal intubation in patients with alcohol withdrawal syndrome treated with high-dose intravenous sedatives and deferred endotracheal intubation. METHODS: Observational cohort study of consecutive patients treated in the intensive care unit (ICU) of a university-affiliated, community hospital for alcohol withdrawal syndrome, where patients were not routinely intubated to receive high-dose or continuously infused sedating medications. MEASUREMENTS AND MAIN RESULTS: We studied 188 patients hospitalized with alcohol withdrawal syndrome from 2008 through 2012 at one medical center. The mean age (SD) of the subjects was 50.8 ± 9.0 years and their mean ICU admission APACHE (Acute Physiology and Chronic Health Evaluation) II score was 6.2 ± 3.4. Thirty subjects (16%) developed pneumonia, and 38 (20.2%) required intubation. All of the 188 patients received lorazepam (median total dose, 42.5 mg), and 170 of 188 received midazolam, all but 2 by continuous intravenous infusion (median total dose, 527 mg; all administered in ICU); 19 received propofol (median total dose, 6,000 mg); and 19 received dexmedetomidine (median total dose, 1,075 mg). Intubated patients received substantially more benzodiazepine (median total dose, 761 mg of lorazepam equivalent vs. 229 mg for subjects in the nonintubated group; P < 0.0001). Endotracheal intubation was associated with pneumonia and higher acuity of illness (APACHE II score, >10). Intubated patients had a longer duration of hospital stay (median, 15 d vs. 6 d; P ≤ 0.0001). One patient did not survive hospitalization. CONCLUSIONS: In this single-center, observational study, where endotracheal intubation was deferred until aspiration or cardiopulmonary decompensation, treatment of alcohol withdrawal syndrome with high-dose, continuously infused sedating medications was not associated with excess morbidity or mortality.

Atazanavir: a new protease inhibitor to treat HIV infection.

PURPOSE: The pharmacology, pharmacokinetics, and clinical trials of and drug interactions and formulary considerations associated with atazanavir, the newest protease inhibitor (PI) to treat human immunodeficiency virus (HIV) infection, are evaluated. SUMMARY: Clinical and pharmacokinetic trials were identified through a MEDLINE search. In addition, all available literature citations and meeting abstracts were obtained from the drug's manufacturer. All articles identified from the data sources were evaluated, and all information deemed relevant was included in this review. Data on atazanavir for the treatment of HIV infection are limited to several phase II and III trials, one of which is still ongoing. Atazanavir has shown efficacy comparable with other PIs and the nonnucleoside reverse-transcriptase inhibitor efavirenz in reducing HIV RNA levels, increasing CD4+ lymphocyte counts, and increasing the percentage of patients achieving clinically undetectable HIV RNA levels when given as the sole PI in treatment-naive patients, in combination with saquinavir in treatment-experienced patients, and with ritonavir-boosting regimens in highly treatment-experienced patients. Treatment-naive patients receiving atazanavir commonly develop a protease enzyme mutation on codon 50, which decreases HIV's susceptibility to atazanavir but may increase the susceptibility of the virus to other PIs. When atazanavir is given to patients with preexisting PI-related mutations, the virus's susceptibility to atazanavir is greatly reduced. The occurrence of lipid abnormalities, which has been a major concern with previous PIs, has not been shown to be troublesome in patients receiving atazanavir. CONCLUSION: Atazanavir may be used alone as a first-line PI, with saquinavir in treatment-experienced patients, or in combination with a ritonavir-boosting regimen in highly treatment-experienced patients as part of a salvage regimen.