Intracranial opportunistic infections have been widely reported in patients with acquired immune deficiency syndrome (AIDS). We report an unusual presentation of Toxoplasma gondii infection in a patient with AIDS.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

Differences in the use of emergency room and hospitalization in relation to primary care pediatric services.

Two pediatric primary care services in Ofakim, Israel, were compared with respect to their use of hospital emergency room facilities and hospitalizations. The services compared were a community-based university pediatric clinic in which preventive and curative care were merged and a traditional service in which preventive and curative care were provided by different agencies. The university clinic had a considerably lower rate of emergency room visits/1,000 children in the population. The proportion of children who were admitted to hospital, among those referred to the emergency room, was much higher for the university clinic. Consistent differences were not found in the number of hospital admissions/1,000 children in the population, nor in the mean duration of stay of hospitalized children.

Child↗

PubMedDate not supplied

Intranasal lidocaine for treatment of migraine: a randomized, double-blind, controlled trial.

OBJECTIVE: To evaluate the effectiveness of intranasal lidocaine for treatment of acute migraine headache. DESIGN: Prospective, randomized, double-blind, placebo-controlled trial. SETTING: Community urgent care department. PATIENTS: A total of 81 patients (67 women and 14 men; median age, 42 years; range, 19-68 years) with a chief complaint of headache who fulfilled criteria of the International Headache Society for migraine participated. Patients were excluded if headache had lasted more than 3 days or if the frequency of severe headache was more than once per week. INTERVENTION: Patients were randomized in a 2:1 ratio to receive a 4 percent solution of intranasal lidocaine or saline placebo, respectively. MAIN OUTCOME MEASURES: The primary outcome measure was at least 50 percent reduction of headache within 15 minutes after treatment. Secondary measures include reduction in nausea and photophobia, use of rescue medication, relapse of headache, and change in headache disability scores. RESULTS: Of 53 patients who received intranasal lidocaine, 29 (55 percent) had at least a 50 percent reduction of headache compared with 6 (21 percent) of 28 controls (P=.004). Nausea and photophobia were significantly reduced (P=.03 and P=.001, respectively). Rescue medication for headache relief was needed in 15 (28 percent) of 53 patients in the lidocaine group vs 20 (71 percent) of 28 controls (P<.001). Among those with initial relief of headache, relapse of headache occurred in 10 (42 percent) of 24 in the lidocaine group vs 5 (83 percent) of 6 in the control group (P=.17), usually within the first hour after treatment. CONCLUSIONS: Intranasal lidocaine provides rapid relief of headache in approximately 55 percent of ambulatory patients with migraine. Relapse of headache is common and occurs early after treatment.

Acute Disease↗