Acquired Immunodefiency Syndrome (AIDS) Acquired Immunodefiency Syndrome is defined as the most severe form of continuum ilness associated

with human immunodeficiency virus (HIV) infection. HIV belon gs to a group of viruses known as retroviruses. They carry their genetic materia l in the form of ribonucleic acid (RNA) rather than deoxyribonucleic acid. Inf ection with HIV occurs when it enters the host CD4 (t) cells and causes this to replicate viral RNA and viral proteins; which in turn invade other CD4 cells. Risk Factors: The most common mode of transmission is the transfer of body secretions through sexual contact. This is accomplished through exposure of mucous membranes of the rectum, vagina or mouth to blood, semen or vaginal secretions containing the HI V virus. Blood or blood products can transmit the virus, most often through the sharing of contaminated syringes and needles. HIV can be spread during pregnancy from mother to fetus. Clinical Manifestation: Symptoms are widespread and may affect any organ system. RESPIRATORY: dsypnea and chestpain associated with opportunistic infections incl ude Pneumocytis carinii pneumonia (PCP) the most common infection and Mycobacter ium avium complex (MAC)/ Mycobacterium avium intracellulare (MAI) GASTROINTESTINAL : loss of appetite, nausea and vomiting, oral and esophageal ca ndidiasis, chronic diarrhea, wasting sydrome (cachexia) NEUROLOGIC: encephalopathy (Aids Dementia Complex), neuropathy INTEGUMENTARY: Kaposi Sarcoma, herpes simplex and herpes zoster viruses, dermati tis, folliculitis REPRODUCTIVE: vaginal candidiasis, chancroid, syphilis, herpes, venereal warts Diagnosis Because it can take from six weeks to six months to develop antibodies to the vi rus, follow-up tests may be needed. Your doctor will ask about your symptoms, me dical history and risk factors and perform a physical examination. ELISA Test ELISA, which stands for enzyme-linked immunosorbent assay, is used to detect HIV infection. If an ELISA test is positive, the Western blot test is us ually administered to confirm the diagnosis. If an ELISA test is negative, but y ou think you may have HIV, you should be tested again in one to three months. Western Blot This is a very sensitive blood test used to confirm a positive ELIS A test result. Management Currently there is no cure for HIV or AIDS but there are some medications have b een highly effective in fighting HIV and its complications. 1. Nonnucleoside Reverse Transcriptase Inhibitors (NNRTIs), such as nevirappine (Viramune) and efavirenz (Sustiva), bind to and block the action of reverse tran scriptase, a protein that HIV needs to reproduce. 2. Nucleoside Reverse Transcriptase Inhibitors (NRTIs), such as zidovudine (Retr ovir), tenofovir DF (Viread), and stavudine (Zerit), are faulty versions of buil ding blocks that HIV needs to make more copies of itself. When HIV uses an NRTI instead of a normal building block, reproduction of the virus is stalled. 3. Protease Inhibitors (PIs), such as lopinavir/ritonavir (Kaletra), disable pro tease, a protein that HIV needs reproduce itself. 4. Fusion Inhibitors, such as enfuvirtide (Fuzeon ), are newer treatments that w ork by blocking HIV entry into cells. Prevention Abstain from sex outside of a mutually faithful relationship with a partner whom the person knows is not infected with the AIDS virus. Avoid oral, genital and anal contact with partner's blood, semen, vaginal secret ions, feces or urine of infected person. Don't share toothbrushes, razors or other implements that could become contamina ted with the blood of anyone who is or might be infected with the AIDS virus. Exercise caution regarding procedures, such as acupuncture, tattooing, ear pierc ing, etc., in which needles or other nonsterile instruments may be used repeated ly to pierce the skin and/or mucous membranes.

Do not share needles or syringes

Addisons Disease Addison's disease or Primary Adrenal Insufficiency, is a disorder that occurs wh en your body produces insufficient amounts of certain hormones produced by your adrenal glands. In Addison's disease, your adrenal glands produce too little cor tisol and often insufficient levels of aldosterone as well. It is usually caused by an autoimmune reaction, where the body attacks its own adrenal glands and pr events them from functioning properly. Pathophysiology of Addisons Disease Symptoms Cyanosis, fever and classic sign of shock; pallor, apprehension, rapid and weak pulse, rapid respirations and low blood pressure Headache, nausea, abdominal pain, diarrhea, confusion and restlessness Decrease blood glucose and sodium levels, increased serum potassium(hyperkalemia ) and leukocytosis darkened skin on exposed and unexposed areas of the body (also called hyperpigme ntation) - this is a symptom of primary adrenal insufficiency Assessment and Diagnostic Methods Diagnosis is confirmed by low levels of adrenocortical hormones in blood or urin e and decreased serum cortisol levels. Medical Management Restore blood circulation, administer fluids, monitor vital signs and place pati ent in recumbent position with legs elevated Administer IV hydrocortisone followed by 5% dextrose in Normal Saline Vasopressor amines maybe required if hypotension persists Antibiotics maybe prescribed for infection Aldosterone is replaced by an aldosterone-like synthetic steroid, fludrocortison e (Florinef) tablets given once daily. If adrenal gland does not regain function, lifelong replacement of corticosteroids and mineralcorticosteroids is required. Dietary intake should be supplemented with salt during times of gastrointestinal losses of fluids through vomiting and diarrhea.