Doctor’s blog

HIV/AIDS (Human immunodeficiency virus/acquired immunodeficiency syndrome) is classified by the CDC (Centers for Disease Control and Prevention) into category A (asymptomatic, acute primary HIV or PGL or persistent generalized lymphadenopathy), category B (symptomatic, but not A or C of this classification) & category C (AIDS indicator conditions) based on CD4+ T lymphocyte counts.

Category A:

This category consists of conditions listed below in an adolescent or adult (more than 13 years) with confirmed HIV infection. Conditions listed in categories B and C should not have occurred.

1. Asymptomatic HIV infection.

2. Acute (primary) HIV infection with accompanying illness.

3. Progressive generalized lymphadenopathy (PGL).

Category B:

This category consists of conditions in an HIV-infected individual (adolescent or adult) that are not included among conditions listed in clinical category C below and also it present at least one of the following conditions:

1. Oropharyngeal candidiasis also known as thrush.
2. Candidiasis (vulvovaginal) or candidiasis which is persistent, occurs frequently, or poor response to therapy.
3. Cervical carcinoma in situ or moderate to severe cervical dysplasia.
4. Constitutional symptoms like fever (38.5°C) or diarrhea lasting more than one month.
5. Herpes zoster or shingles that involve at least two distinct dermatomes.
6. Oral hairy leukoplakia.

There are many more examples which can indicate category B HIV/AIDS, although not included here.

Category C:

This category includes the clinical conditions that are included in the AIDS surveillance case definition.

1. Candidiasis of bronchi, trachea, lungs or esophagus.

2. Cervical cancer.

3. Fungal infections like extrapulmonary cryptococcosis, chronic intestinal cryptosporidiosis of more than 1 month’s duration, disseminated or extrapulmonary coccidioidomycosis, disseminated or extrapulmonary histoplasmosis etc. 

4. Loss of vision due to cytomegalovirus retinitis.

5.Kaposi’s sarcoma, Burkitt’s lymphoma, primary lymphoma of brain etc.

6. HIV-related encephalopathy.

7. Disseminated or extrapulmonary Mycobacterium avium complex or M. kansasii.

8. Pneumocystis jiroveci (previously P. carinii) pneumonia.

9.  Wasting syndrome due to HIV.

10. Pulmonary or extrapulmonary Mycobacterium tuberculosis.

There are some other uncommon clinical conditions that are not included here but can be categorized under category C.      

Every doctor has to practice to help the needy and sufferings by use of the knowledge he/she acquired in a medical school. Many a times it may be confusing for a budding doctor freshly passed out from a medical school, as to how to start a medical practice. The medical practice is different in different countries and if you are in United States it is wise to take help of online facilities through books and other publications. There are many websites which helps budding, young, freshly pass out doctors regarding starting a medical practice. If a young, budding doctor tries to find help online, he/she may find it difficult to get right information he/she needs about how to start a medical practice and succeed in future. The phrase of “well begun is half done” is true in medical practice also. So if a young doctor starts medical practice well at the beginning of his/her carrier, it can be said that the success is half accomplished.

Hippocrates publishing is one such good website which is dedicated in serving young doctors who are about to start medical practice and life as doctor. Hippocrates publishing is such a website which can help young doctor to get a head start in medical practice.  About Hippocrates publishing, one can say it is of high standard and quality.

Hippocrates publishing offers a series of guides & books about how to start medical practice marketing from the very beginning of medical practice by a doctor after passing out. These days of high competitiveness in all fields including medical profession, it is wise to market your skills and knowledge and you can get help online from websites like Hippocrates publishing.  

Chemotherapy plays an important role in treatment of breast cancer, unlike other epithelial malignancies, which usually do not respond to chemotherapy. Breast cancer responds better to chemotherapeutic agents, although it is epithelial cancer. Unlike other epithelial cancers, breast cancers respond to multiple chemotherapy agents (anthracyclines, alkylating agents, taxanes, and antimetabolites combinations). Multiple combinations of these agents improve response rates, but unfortunately they have little effect on duration of response or duration of survival.

The choice among multi-drug chemotherapy combinations generally depends on whether adjuvant chemotherapy was administered and, if administered, what type of adjuvant is administered. Some patients treated with adjuvant regimens (cyclophosphamide, methotrexate, and fluorouracil known as CMF regimen) may also subsequently respond to the same combination, when there is metastasis. Most of the oncologists (cancer doctor) use chemotherapeutic agents to which the patients have not been previously exposed.

If patients have progressed after combination chemotherapy, it is most common in practice to treat them with single agent, to prevent toxicity of these agents (chemotherapy agents are highly toxic). The use of a single effective chemotherapy agent can minimize toxicity by sparing the patient exposure to drugs (chemotherapy agents) that would be of little value. The selection of single drug is based on the clinical experience of the treating oncologist, as no method to select the drugs most efficacious for a given patient has been found to be useful. Most oncologists use either an anthracycline or paclitaxel if initial chemotherapy combinations have failed. But, the choice should be balanced with individual needs and doctor’s experience.

N.B.: The use of a humanized antibody to erbB2 gene (trastuzumab) combined with paclitaxel can improve response rate and survival for women whose metastatic tumors overexpress erbB2. But in metastatic disease the survival extension is modest in patients. Similarly, the use of bevacizumab (avastin) has improved the response rate and response duration to paclitaxel. Some positive responses may also be seen with gemcitabine, capecitabine, navelbine, and oral etoposide.

New developments: Autologous bone marrow transplantation combined with high doses of single agents can produce good responses. However, such responses are rarely durable and do not alter the clinical course for most patients with advanced metastatic disease.