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The data presented in this issue reflect all cases in the HIV AIDS Reporting System HARS ; reported to the Office of HIV AIDS Surveillance OHAS ; as of June 30, 2005. When interpreting data in this report, keep in mind that the HARS database is continuously being updated to reflect the most current and complete information on people infected with HIV AIDS. 2 ; HIV not AIDS ; data presented in this issue are cases of HIV that have not progressed to AIDS. HIV cases include both laboratory-defined cases as well as HIV cases diagnosed by a physician without laboratory tests. Over time, HIV infection may progress to AIDS and be reported to OHAS. Person with HIV not AIDS ; infection who are later reported as having AIDS are deleted from the HIV not AIDS ; infection tables and added to the AIDS tables. Data on HIV not AIDS ; infection should be interpreted with caution. HIV surveillance reports may not be representative of all persons infected with HIV because not all infected persons have been tested and the completeness of the HIV reporting system is undefined. 3 ; Report delay is defined as the time interval between the date an HIV or AIDS case is diagnosed and the date the case is reported to the health department. Reporting delays are important when interpreting trends in case numbers and rates over time and especially for 2003, the most recent year of diagnosis. Almost 50% of AIDS cases were actually reported within the same calendar year in which they were diagnosed, and roughly 80% of all cases are reported within two calendar years of diagnosis. Additional cases continue to be reported in subsequent years and new cases are identified through laboratory reporting and registry matches.Thus, the number of cases diagnosed for each year - even for remote years - are subject to change as new information is received from any of the reporting sources. 4 ; For surveillance purposes, HIV not AIDS ; or AIDS cases are counted only once in a hierarchy of modes of transmission. Persons with more than one reported mode of transmission are classified in the transmission mode first in the hierarchy. The exception is men who have sex with men and inject drugs, which has its own category. Persons whose transmission mode is classified male-to-male sexual contact MSM ; include men who report sexual contact with other men and men who report sexual contact with both men and women. Persons whose mode of transmission is classified as heterosexual contact are persons who report specific heterosexual contact with a person with, or at increased risk for, HIV infection e.g. and injection drug user ; . Undetermined risk represents persons for whom an expanded investigation either was or is still being followed up by the health department and includes cases in persons whose transmission history is incomplete.
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EDUCATIONAL OBJECTIVE: At the conclusion of this presentation, the participants should be able to understand the utility of topical and nebulized amphotericin B as adjuvants to the standard of care of invasive fungal sinusitis. OBJECTIVES: The objective of this case report is to examine the benefits of topical and high pressure, high concentration nebulized amphotericin B as adjuvants to the standard of care for invasive fungal sinusitis. STUDY DESIGN: This is a two patient case presentation of a treatment protocol for invasive fungal sinusitis introduced by a staff otolaryngologist at the National Institutes of Health. METHODS: The charts of two patients who presented to the otolaryngology service at the NIH were retrospectively reviewed to assemble the current case presentations. Both patients had pathologically confirmed invasive fungal sinusitis. Standard management was instituted and included treatment of underlying metabolic or systemic disturbances, antifungal therapy, and surgical debridement. Both patients were monitored endoscopically following surgical debridement, and they underwent mucosal atomization treatments with high pressure 60 psi ; amphotericin B rinses and daily nebulized amphotericin B at a high concentration 1 mg mL ; . In one case, topical amphotericin B was effectively employed for a recurrent fungal lesion. RESULTS: Both patients were disease free two and a half years following treatment. One patient's eye was at risk due to recurrent disease, but was subsequently spared following high concentration topical amphotericin B. CONCLUSIONS: Topical and long term, high pressure nebulized amphotericin B administered at high concentration appear to be viable additions to the current standard of care in the treatment and prevention of invasive fungal sinusitis. 38. Anhydrous Ammonia Burn: An Acute Inhalational Injury Resulting In Long-Term Impairment Kirby J. Scott, DO, Portsmouth, VA Ronald C. Hamaker, MD * , Indianapolis, IN Darren Kest, DO, Indianapolis, IN and cardura.
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