Testing for HIV infection in the US typically has been a two-step process that requires patients to return for results. This review describes two rapid tests currently FDA-approved, OraQuick and Reveal. It includes a table with the cost and characteristics of each test (result time, device type, equipment needed, etc.).

Three rapid-acting insulin analogs are currently available: insulin lispro, insulin aspart and insulin glulisine. 1-3 All three are approved for use in both type 1 and type 2 diabetes, either by subcutaneous injection, insulin pump or intravenous administration. All three cost more than regular insulin.

Lispro insulin (Humalog - Lilly), a synthetic insulin analog, has been approved for marketing by the US Food and Drug Administration. Prepared by recombinant DNA methods using E. coli, lispro differs from human insulin in having lysine and proline at positions 28 and 29 on the beta-chain, reversed from their natural position. The new drug has biologic effects similar to unmodified insulin, but is absorbed more rapidly after subcutaneous injection.

The FDA has approved three office laboratory tests for diagnosis of influenza. These tests are of special interest now because the FDA recently also approved two new drugs for treatment of influenza that must be started--to be effective--less than 48 hours after the onset of symptoms.

The intramedullary venous plexus of cancellous bone marrow does not collapse in patients who are dehydrated or in shock. Intraosseous (IO) infusion through an intramedullary cannula has effectively replaced central venous catheterization (CVC) as the method of choice for rapid vascular access in both adults and children when peripheral veins are inaccessible. Absorption of fluids into the central circulation with IO infusion is equivalent to absorption from IV sites, and IO access can be achieved more rapidly and with a higher success rate than CVC.

Antibiotic treatment of group A streptococcal pharyngitis can relieve symptoms, limit transmission of infection, and prevent suppurative and nonsuppurative sequelae. Clinical findings may be unreliable, however, in establishing the diagnosis, and conventional throat cultures take overnight or longer to produce results. Rapid office tests for streptococcal pharyngitis can make the diagnosis in about 10 minutes. Since the previous Medical Letter article on this subject (Medical Letter, 27:49, 1985), many new tests have been marketed, including some that use new technologies.

Insulin aspart (Novolog - Novo Nordisk) is the second rapid-acting insulin analog to be approved by the FDA. The first was insulin lispro (Humalog). Insulin aspart differs from human insulin by substitution of aspartic acid for proline in position 28 on the beta-chain.

An orally dissolving, immediate-release tablet formulation of carbidopa/levodopa (Parcopa - Schwarz) that can be taken without water is now available for treatment of Parkinson's disease.

The FDA has approved sugammadex (Bridion – Merck), a selective relaxant binding agent, for reversal of rocuronium- or vecuronium-induced neuromuscular blockade in adult surgical patients. It is the first selective relaxant binding agent to be approved in the US. Sugammadex has been available in the European Union, Japan, and elsewhere for several years. Previous FDA reviews of sugammadex did not result in approval because of concerns about a risk of anaphylaxis and other hypersensitivity reactions with its use.

Insulin glulisine (Apidra - Sanofi Aventis) is the third rapid-acting insulin analog to be marketed in the US, following insulin lispro (Humalog) and insulin aspart (Novolog). All three have a more rapid onset and shorter duration of action than regular human insulin. Rapid-acting insulin analogs are generally taken immediately before meals and are usually combined with a long-acting basal insulin.