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February 10, 2005 Vol. 352 No. 6
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Although some kidney-transplant recipients with severe vascular rejection have antibodies against HLA antigens, others do not. Severe vascular rejection accompanied by accelerated hypertension, and even convulsions, resembles preeclampsia. Activating antibodies targeting the angiotensin II type 1 receptor have been found in preeclampsia, and the authors sought and detected such antibodies in patients with severe vascular rejection. These results suggest that a pathway mediated by a non-HLA, angiotensin II type 1 receptor may be involved in vascular rejection.
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The authors estimate that routine HIV screening in health care settings with a 1 percent prevalence of HIV infection costs about $15,000 per quality-adjusted life-year gained. The cost remains below $50,000 when the prevalence of HIV is above 0.05 percent. When the potential benefits of reduced HIV transmission are excluded, screening populations with a 1 percent prevalence of HIV infection costs about $42,000 per quality-adjusted life-year gained.
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This cost-effectiveness analysis compared routine screening for HIV with current detection of HIV through selective screening and patients who present with opportunistic infections. One-time screening cost $38,000 per quality-adjusted life-year gained when HIV prevalence is 1 percent, and $113,000 for the general population of the United States (0.1 percent prevalence). Screening for HIV has the potential to reduce the transmission of HIV and may be associated with lower cost-effectiveness ratios.
A 35-year-old man who had recently emigrated from Brazil had swelling and pain in his right nostril that had worsened over six months. A physical examination disclosed swelling and erythema of the right nasal vestibule, with tenderness and crusting. The lesion did not respond to antibiotic therapy. A biopsy disclosed necrotizing granulomatous inflammation without evidence of microorganisms. A diagnostic procedure was performed.
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