Nephrotic glomerulonephropathies are not only linked to solid-organ tumors, but also to hematological malignancies. A thorough evaluation, including a physical examination for lymphadenopathy and organomegaly, as well as a hematological evaluation, must be performed in all patients presenting with nephrotic glomerulonephropathies.
The authors identified 1,800,948 patients who made 2,326,701 health care encounters eligible for HIV testing before implementation (1/08-6/12) and 1,362,479 eligible encounters after implementation (1/13-6/15). The sameday HIV testing rate increased from 36.7% to 44.1%, a significant increase. The positive test result rate increased from 0.02% to 0.04% (p < 0.001). During the postimplementation period, fewer HIVinfected patients had a CD4+ cell count below 200 and/or HIV viral load of 10,000 copies/mL or higher at diagnosis.
The Birch Lake photograph By Shenshen Dou, MS Nature not only nurtures us, it eases our pain and heals our soul. This is a work from the artist's "Man in Nature" photography art serial. In this image a girl playfully walks along a flowered trail beside a lake. The blurry reflection of the birch trees in the lake helps to fashion an illusory feel.
This photograph was taken at Ho'omaluhia Botanical Garden in Kaneohe, Oahu, HI. The 400-acre park boasts hiking trails, freshwater lakes and streams, and a campground.Dr Lim is an Otolaryngologist for the Hawaii Permanente Medical Group. He is passionate about exploring and photographing the natural beauty of Hawaii. More of his work can be seen at www.lim-photography.com.
ON THE COVER "Torres del Paine" by David Clarke, MD, was taken on a trip to Patagonia, Chile. The mountains, valleys, glaciers, lakes, and rivers of Torres del Paine National Park, in southern Chile, draw visitors from around the world. The Torres are the peaks of the mountains-seen here in bold and stark relief.
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