When a patient's ethnicity is declared, medical students' decision-making processes are affected.

BACKGROUND: Disparity in health status and healthcare outcomes is widespread and well known. This holds true for Indigenous peoples in many settings including Australia and Hawaii. While multi-factorial, there is increasing evidence of health practitioner contribution to this disparity. This research explored senior medical students' clinical decision-making processes. METHODS: A qualitative study was conducted in 2014 with 30 final year medical students from The University of Melbourne, Australia, and The John Burns Medical School, Hawaii, USA. Each student responded to questions about a paper-based case, first in writing and elaborated further in an interview. Half the students were given a case of a patient whose ethnicity was not declared; the other half considered the patient who was Native Hawaiian or Australian Aboriginal. A systematic thematic analysis of the interview transcripts was conducted. RESULTS: The study detected subtle biases in students' ways of talking about the Indigenous person and their anticipation of interacting with her as a patient. Four main themes emerged from the interview transcripts: the patient as a person; constructions of the person as patient; patient-student/doctor interactions; and the value of various education settings. There was a strong commitment to the patient's agenda and to the element of trust in the doctor-patient interaction. CONCLUSION: These findings will help to advance medical curricula so that institutions graduate physicians who are increasingly able to contribute to equitable outcomes for all patients in their care. The study also draws attention to subtle biases based on ethnicity that may be currently at play in physicians' practices.

Profile of patients triply infected with HIV and the hepatitis B and C viruses in the HAART era.

HIV-HCV-HBV-coinfected patients were assessed to characterize the viral interactions in the setting of HIV coinfection and in the HAART era. All positive anti-HCV antibody and HBs antigen-positive HIV-infected patients were identified at five HIV clinics. Antihepatitis delta (HDV) antibody, serum HIV RNA, HCV RNA, and HBV DNA quantification and genotype determinations were performed. Out of 67 patients identified 47 (70%) were receiving anti-HBV therapy. HCV RNA and HBV DNA were detectable in 52.5% and 37% of patients, respectively. All possible patterns were found, regardless of anti-HBV therapy. HDV coinfection was associated with undetectable HCV RNA [RR 9.52 (95% CI 1.85-49.01); p = 0.007]. Independent factors predicting undetectable HBV DNA lacked HBeAg [RR 13.94 (95% CI 3.05-63.72); p = 0.001] and use of anti-HBV therapy [RR 11.42 (95% CI 2.43-53.54); p = 0.002]. Replication and genotypes of HCV or HBV had no impact on the replication of the other virus. In conclusion, in this cohort of triple infection (HBV/HCV/HIV) various viral patterns were identified. Spontaneous HCV clearance was frequent, and it was independently associated with HDV coinfection. In the absence of HBV therapy, HBV most often actively replicates. HBV/HCV replication or genotypes were not related to the replication of the other virus.

Prophylaxis against fungal infections and cytomegalovirus disease after bone marrow transplantation.

Among the serious complications associated with bone marrow transplantation are invasive fungal infections caused by organisms such as Candida and Aspergillus species and end-organ disease caused by cytomegalovirus (CMV). Successful prevention of these complications can have a significant impact on morbidity and mortality. The primary option for prophylaxis against fungal infections is fluconazole (Diflucan). Low doses of intravenous amphotericin B may be useful where there is a higher rate of aspergillosis. Itraconazole (Sporanox) and nasal amphotericin B are other options that have been less well studied. The development of fluconazole-resistant candidiasis may become problematic. Ganciclovir (Cytovene) is useful for the prevention of end-organ disease caused by CMV but carries a significant risk for neutropenia. New techniques for the early detection of CMV infection should allow prophylaxis to be targeted to patients at highest risk of developing CMV disease. It is critical to clearly define the risk factors for fungal and CMV disease in the individual patient in order to minimize adverse effects and provide the optimal prophylactic benefit.

Pneumocystis carinii pneumonia: a clinical review.

Pneumocystis carinii pneumonia (PCP) is an opportunistic infection that occurs in immunosuppressed populations, primarily patients with advanced human immunodeficiency virus infection. The classic presentation of nonproductive cough, shortness of breath, fever, bilateral interstitial infiltrates and hypoxemia does not always appear. Diagnostic methods of choice include sputum induction and bronchoalveolar lavage. The drug of choice for treatment and prophylaxis is trimethoprim-sulfamethoxazole, but alternatives are often needed because of adverse effects or, less commonly, treatment failure. Adjunctive corticosteroid therapy improves survival in moderate to severe cases. Complications such as pneumothorax and respiratory failure portend poorer survival. Prophylaxis dramatically lowers the risk of disease in susceptible populations. Although PCP has declined in incidence in the developed world as a result of prophylaxis and effective antiretroviral therapy, its diagnosis and treatment remain challenging.

Marco integral de la gestión de riesgos de desastres naturales: Proyecto final: Avalancha en Jimani, República Dominicana

Documento de proyecto propuesto por el licenciado Wilken Moreno, con referencia a los alcances del sistema nacional de prevención, mitigación y respuesta, tomando como caso de referencia la avalancha en Jimani en República Dominicana.