Baillière's clinical rheumatology
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In many countries of the world, there is now a dual epidemic of tuberculosis and HIV disease. HIV specifically eliminates the tissue macrophages and CD4 lymphocytes, the very cells that provide immunity against tuberculosis. Tuberculosis is one of the more virulent opportunistic infections and it therefore appears fairly early in HIV disease. ⋯ HIV-positive patients respond poorly to chemotherapy and are subject to drug sensitivity reactions. Major surgery is fraught with infectious complications and should be avoided. Once Pott's paraplegia has developed, the demise of the HIV-positive patient is rapid.
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Systemic lupus erythematosus (SLE) is the most common of the connective tissue disorders and can involve virtually any organ in the body. It is associated with pleuropulmonary manifestations in well over 50% of cases. Pleuritis with or without pleural effusion is the most common manifestation and can be particularly troublesome to manage but is rarely life-threatening. ⋯ Several drugs can produce a clinical syndrome that has many of the clinical and immunological features of SLE. Pleuritis may be seen in up to half of these cases of drug induced SLE. The development of SLE and conditions such as sarcoidosis or asbestosis in the same patient may represent a simple coincidence but there is some evidence for a closer association between these disorders.
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Baillieres Clin Rheumatol · Oct 1992
ReviewPrevention of low back pain: basic ergonomics in the workplace and the clinic.
Redesigning the job is a strategy for preventing low back injuries at work or for accommodating injured employees who return to work. An evaluation of the physical job demands is necessary in either strategy. Several job demands are associated with low back pain and injury--heavy physical work, static or postural effort, dynamic work-load and exposure to wholebody vibration. ⋯ A health care provider should be part of a task force that oversees these interventions. Future effort should be directed to finding a method that health care practitioners could be competent to carry out effectively in a clinical setting. Expert systems offer promising results in disseminating ergonomic knowledge in primary and secondary health care facilities.