A case of panuveitis with hypopyon due to presumed ocular leishmaniasis in a HIV patient.

BACKGROUND: Post-kala-azar dermal leishmaniasis is a well-known immunologic cutaneous reaction. There are few case reports of ocular leishmaniasis. It is a sight-threatening condition that needs to be rapidly recognized and treated to avoid permanent visual loss. Ocular leishmaniasis panuveitis can present with severe inflammation in patients with highly active anti-retroviral therapy (HAART)-induced immune reconstitution syndrome. FINDINGS: A case of a 40-year-old man, human immunodeficiency virus (HIV) positive on HAART, with a presumed diagnosis of ocular leishmaniasis, is presented. He had a past history of visceral leishmaniasis and was referred to the uveitis service with rapidly worsening panuveitis and counting fingers vision in both eyes. On empirical anti-leishmania therapy and systemic steroids, the visual acuity of the left eye improved to 6/9 but remained poor in the right eye. Based on the medical history, improvement with therapy and the exclusion of other common infections, a presumed diagnosis of ocular leishmaniasis-related panuveitis was made. CONCLUSIONS: A major immune reaction against lingering parasites may play a key role in the pathogenesis of this sight-threatening and rapidly progressive condition. Both the infection and the immune reaction should be treated

Family physicians' information seeking behaviors: A survey comparison with other specialties

BACKGROUND: Using technology to access clinical information has become a critical skill for family physicians. The aims of this study were to assess the way family physicians use the Internet to look for clinical information and how their patterns vary from those of specialists. Further, we sought a better understanding of how family physicians used just-in-time information in clinical practice. METHODS: A fax survey was provided with 17 items. The survey instrument, adapted from two previous studies, was sent to community-based physicians. The questions measured frequency of use and importance of the Internet, palm computers, Internet CME, and email for information seeking and CME. Barriers to use were explored. Demographic data was gathered concerning gender, years since medical school graduation, practice location, practice type, and practice specialty. RESULTS: Family physicians found the Internet to be useful and important as an information source. They were more likely to search for patient oriented material than were specialists who more often searched literature, journals and corresponded with colleagues. Hand held computers were used by almost half of family physicians. CONCLUSION: Family physicians consider the Internet important to the practice of medicine, and the majority use it regularly. Their searches differ from colleagues in other specialties with a focus on direct patient care questions. Almost half of family physicians use hand held computers, most often for drug reference