Measles vaccines: a review of adverse events

A great deal of controversy has recently been generated over the publication of several articles implicating measles vaccine in the induction of Crohn's disease and autism. The publication of this work has already had a negative impact on measles vaccine acceptance in the UK. These allegations are particularly troubling because they arise in the context of increased use of measles vaccine as global control of measles nears and the international community considers strategies for a drive towards eradication. In 1994, the US Institute of Medicine reviewed the world literature and published a comprehensive review of adverse events associated with measles-containing vaccines. Reviewing the literature published between 1994 and the present day, reveals that there is considerable new data suggesting that modified gelatin rather than egg proteins is responsible for most episodes of anaphylaxis following measles vaccination. New work weakens the possible links between measles vaccine and subacute sclerosing panencephalitis and Guillain-Barré syndrome, but strengthens the rare association of measles-containing vaccines with post infectious encephalomyelitis. The alleged associations between measles vaccination and Crohn's disease and autism are based upon weak science and have largely been refuted by a large volume of stronger work. A review of the data generated in the last 4 years amply demonstrates the continued efforts of the scientific community to monitor and understand true measles vaccine-associated adverse events. The rapidity and clarity of this same community's debunking of the spurious associations with Crohn's disease and autism suggests that those charged with vaccination programmes have learned from past mistakes. During 30 years of worldwide use, measles vaccination has proven to be one of the safest and most successful health interventions in the history of mankind. It is not a 'perfect' vaccine, but the benefits of measles vaccination far outweigh the risks even in countries with low incidence of measles and high rates of measles vaccine coverage.     

Risk of tuberculosis transmission in dentistry. Results of a retrospective chart review

This pilot project was conducted for the purpose of performing a retrospective chart review on selected clients and using the results for evaluating purified protein derivative (PPD) conversion rates among the student population. The occupational risk of exposure to active tuberculosis was assessed in a large dental educational setting. Charts of clients seen in the College's Oral Medicine Clinic, referred out for health care consultation for one of several reasons potentially associated with active tuberculosis disease over a 1 year period, were reviewed. Data sources included the medical consultation log and the tuberculosis log, which were maintained by faculty in the Oral Medicine Clinic. Ninety-six clients met the authors' criteria. However, compiling data was severely hampered for two reasons: missing charts (19 of 96, or 19.8%) and non-returning clients (55, or 57%). Four clients with potentially active cases of tuberculosis were identified. Follow up revealed, however, that none of these four clients was contagious when seen at the Dental Center. The protocol and definition recommended by the Centers for Disease Control and Prevention 1994 Guidelines, and the results of PPD screening and chart audit conducted by the authors, suggest that the employees and students of the College of Dentistry are at low risk for workplace exposure to active tuberculosis.     

Neutropenia and fever in patients receiving chemotherapy in a community teaching hospital: results of a retrospective chart review

A retrospective chart review study of factors that may influence the outcome of cancer patients hospitalized with febrile neutropenia indicates that positive microbial cultures, older age, and hematologic malignancies may be associated with poor outcome (death during the hospitalization). The absolute neutrophil count was statistically significant only in patients with positive cultures. Good outcome was associated with negative microbial cultures and shorter length of hospital stay.     

Benefits of screening mammography: a review for the primary care physician

BACKGROUND: Screening mammography, particularly for women in their 40s, has become a confusing issue for many physicians. Recent scientific and political controversies regarding screening guidelines have added to this confusion. METHODS: Many randomized clinical trials have shown the benefits of mammographic screening for women over the age of 50, and recent studies show a statistically significant benefit for women in their 40s as well. Understanding the screening controversy requires an understanding of the principle of screening for disease, the epidemiology of breast cancer, and the results of the many randomized clinical trials, particularly recent data from the Swedish two-county trials. An appreciation of the improvements in mammographic quality in recent years, and in the education of the radiologists who interpret these studies, will also heighten clinical acceptance of this screening technique. RESULTS: Both the American Cancer Society and American College of Radiology endorse annual mammographic screening for women over age 40, and there is compelling evidence to support these recommendations. CONCLUSION: Radiologists, primary care providers, surgeons, and pathologists should work together to enhance the benefits of and access to screening mammography.     

Adolescents who attempt suicide: A retrospective clinical chart review of hospitalized patients.

In a review of pediatric hospital admissions over 4 years, we identified 173 adolescents who had attempted suicide. Of these individuals, 104 (60.1%) were female and 69 (39.9%) were male. The age range was 10–20 years, with approximately 60% of the population being 17–20 years old. The three characteristics most often exhibited by an adolescent in the year prior to the attempt were alcohol use, drug use, and rebellion toward authority. Only 10% of the attempters were reported to have come from a harmonious family. Depression, impulsivity, and anger were the most predominant personality characteristics reported. The suicide attempts were usually precipitated by conflicts with a significant person, either a parent or a boy- or girlfriend, and were accomplished by drug overdose. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gender in medical encounters: An analysis of physician and patient communication in a primary care setting.

The relation of physician and patient gender to verbal and nonverbal communication was examined in 100 routine medical visits. Female physicians conducted longer visits, made more positive statements, made more partnership statements, asked more questions, made more back-channel responses, and smiled and nodded more. Patients made more partnership statements and gave more medical information to female physicians. The combinations of female physician–female patient and female physician–male patient received special attention in planned contrasts. These combinations showed distinctive patterns of physician and patient behavior, especially in nonverbal communication. The relation of the results to gender differences in nonclinical settings, role strains in medical visits, and current trends in medical education are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Withholding medical care as a physical injury--homicide from the viewpoint of the physician

Limitation and termination of intensive care and in particular life support in patients who do not have a chance to recover from their illness has become a widely accepted approach in intensive care medicine. In well defined situations, life support can be withheld or withdrawn without the risk of becoming a criminal case. Frequently, the physician must base his/her decision on the presumed will of the patient which can be difficult to assess. Existing guidelines of the Society of physicians of Germany, which are partly preliminary, are helpful for the decision process of the physicians as well as of the relatives of the patients.     

Hydrocephalus in Apert syndrome: a retrospective review

We report six cases of Morgagni hernia diagnosed and operated on in our pediatric surgical unit during a 14-year period. Four children were younger than 1 year and two between 1 and 2 years. Predominance in males was found. Associated congenital pathology was present in 3 children (Down's syndrome, diaphragmatic relaxation, criptorquidia and pyelo-ureteral stenosis). Predominant clinical features were respiratory infections and vomiting. In only one patient clinical onset was with respiratory distress. Plain chest x-ray was the most used diagnostic procedure. In all cases barium enema was performed to confirm the clinical diagnosis. Most frequent surgical approach was a midline supra-umbilical laparotomy. Diaphragmatic defect was left sided in 3 children and right-sided in the other 3. Transverse colon and liver were the most frequent herniated viscera. Postoperative follow-up showed no complications or recidives.     

A retrospective chart review of uncontrolled use of metformin as an add-on therapy in type 2 diabetes

Chronic schizophrenic patients often do not suppress the auditory P50 component of the event-related potential to the second of 2 clicks, presented 500 ms apart, suggesting a loss of normal inhibition. This study attempted to replicate the P50 suppression deficit in patients with recent-onset schizophrenia and to examine whether P50 is related to clinical symptoms or is affected by an atypical antipsychotic medication. Data from 22 recent-onset schizophrenia patients and 11 normal controls revealed that disruption in P50 suppression is present during the early stages of illness. In addition, impaired P50 suppression covaried with clinical ratings of anxiety, depression, and anergia; results also suggested that the P50 inhibitory deficit may be related to the degree of patients' attentional impairment. Finally, risperidone, compared with a typical antipsychotic medication, improved inhibition of P50 to the second click. These results support P50 suppression as a measure of disordered neurocognition in schizophrenia.     

Teledermatology and in-person examinations: a comparison of patient and physician perceptions and diagnostic agreement

PURPOSE: The aim of this study was to assess the outcome of reoperation following photorefractive keratectomy related to different techniques. MATERIAL AND METHODS: 265 retreated eyes were divided into 5 groups; low to moderate myopia, high myopia, enlargement, abrasion, and non-compliance. The low to moderate group was further subdivided into 5 categories based on the surgical approach of the reoperation. Outcomes were compared at 12 months after reoperation. RESULTS: There was no statistically significant difference in the median refraction prior to initial PRK, before reoperation, and after reoperation between the 5 categories 66%, of all reoperated patients achieved an uncorrected visual acuity of 0.5 or better after 12 months. 72% had a postoperative refraction between +/- 1 diopter. The other 4 groups were not statistically analyzed due to the wide variety of patients included and non-compliance. CONCLUSION: In low to moderate myopes, approximately 97% achieve uncorrected visual acuity of 0.5 or better following PRK, including one reoperation.     

First degree atrioventricular block caused by a calcified tumor of the atrioventricular septum

First degree atrioventricular block occurred in a 69-year-old patient with a calcified atrioventricular septum tumour. The patient suffered several episodes of syncope and the only abnormality found in the routine clinical work-up was a remarkable first degree atrioventricular block. The echocardiogram, computed tomography (CT) and the magnetic resonance imaging (MRI) procedure showed a calcified tumour in the posterior part of the left ventricle, between the left atrium and left ventricle, just beneath the aortic root spreading to the interventricular septum. It was suggested that the first degree atrioventricular block was caused by the tumour. The symptoms were relieved by implantation of permanent cardiac pacemaker.     

Chorea caused by lithium intoxication: a case report and literature review

We report a patient who developed an acute, reversible, generalized choreiform disorder from lithium (Li) intoxication. This medication was prescribed for manic-depressive disorder, and serum levels became elevated after the addition of a diuretic for the treatment of hypertension. There were no other apparent causes for the movement disorder, and it was associated with other known features of Li intoxication, including ataxia and encephalopathy. There was a delay between the initial symptoms of Li intoxication and the onset of chorea. The chorea improved as serum Li levels diminished, with some lag time. This represents the eleventh case report of Li-induced chorea, but only the sixth in a patient without concomitant neuroleptic therapy, and the first presented with videotape confirmation. A review of these other cases is included, and possible mechanisms are discussed.     

Efficacy and adverse effects of different corticosteroid dose regimens in temporal arteritis: a retrospective study

Human obesity has an inherited component, but in contrast to rodent obesity, precise genetic defects have yet to be defined. A mutation of carboxypeptidase E (CPE), an enzyme active in the processing and sorting of prohormones, causes obesity in the fat/fat mouse. We have previously described a women with extreme childhood obesity (Fig. 1), abnormal glucose homeostasis, hypogonadotrophic hypogonadism, hypocortisolism and elevated plasma proinsulin and pro-opiomelanocortin (POMC) concentrations but a very low insulin level, suggestive of a defective prohormone processing by the endopeptidase, prohormone convertase 1 (PC1; ref. 4). We now report this proband to be a compound heterozygote for mutations in PC1. Gly-->Arg483 prevents processing of proPC1 and leads to its retention in the endoplasmic reticulum (ER). A-->C+4 of the intro-5 donor splice site causes skipping of exon 5 leading to loss of 26 residues, a frameshift and creation of a premature stop codon within the catalytic domain. PC1 acts proximally to CPE in the pathway of post-translational processing of prohormones and neuropeptides. In view of the similarity between the proband and the fat/fat mouse phenotype, we infer that molecular defects in prohormone conversion may represent a generic mechanism for obesity, common to humans and rodents.     

Latex allergies and adverse reactions: a review of the literature

In the last few years, the allergenic potential of latex has been receiving greater attention. While latex allergies have been widely reported in the literature, the prevalence and severity have rapidly increased in the last few years. The role of rubber in the prevention of HIV infection has played a part in recognizing the allergenic potential, as with increased emphasis on infection control in the dental office has come an increase in complaints of adverse reactions to surgical gloves. A review of the literature reveals latex allergy problems to be not confined to gloves, but to articles of clothing, rubber dam material, and other latex-containing materials. Life-threatening cases have been reported. Little information in the literature concerns the extent of the problem among dental personnel. The dental professional may be faced with not only discomfort for the dental staff, but also compromising reactive possibilities in certain patients. There is a need for development of alternative protective products for the dental office, since elimination of barrier protection is not a viable alternative to infection control.     

Identifying patients with depression in the primary care setting: a more efficient method

OBJECTIVE: To determine if there is a core subset of depressive symptoms that could be used to efficiently diagnose depression after administering the 2-item PRIME-MD a screening questionnaire for depression. METHODS: One thousand patients selected randomly and by convenience from 4 primary care clinics were assessed by PRIME-MD and completed a questionnaire measuring the following validation variables: functional status and well-being, disability days, somatic symptoms, depression severity, suicidal thoughts, health care utilization, and the physician-patient relationship. RESULTS: Four symptoms (sleep disturbance, anhedonia, low self-esteem, and decreased appetite) accounted for virtually all the depression symptom-related variance in functional status and well-being, with 8.3% of patients having 2 of these symptoms and 8.2% having 3 or 4 of these symptoms. There was excellent agreement between diagnosis based on core symptoms and major depression (K= 0.77; overall accuracy rate, 94%). There were significant differences (P<.001) among patients with negative depression screen, 0 to 1, 2, and 3 to 4 core symptoms with scores on each of the validation variables getting progressively worse in these 4 groups. A cutoff point of 2 core symptoms identified all but 3 patients with major depression and an additional 5% of the entire sample without major depression who were significantly (P<.05) worse than patients without depression on each of the validation variables. CONCLUSION: A strategy that includes the use of a 2-item depression screener followed by the evaluation of 4 core depressive symptoms is an efficient and effective way of identifying and classifying primary care patients with depression in need of clinical attention.     

Infections caused by Flavobacterium meningosepticum in patients in a neonatal intensive care unit

During a period of three and a half months 7 neonates from a neonatal intensive care unit became infected by F. meningosepticum, serotype B. The pathogens could be isolated from the tracheal secretions and--less frequently--from throat swabs, gastric juice and nose swabs. Environmental sampling led to the isolation of F. meningosepticum from the humidification fluid of the respirator, from vaporizers as well as from the artificial ventilation tubing. F. mengingosepticum was found in the water of humidifiers from 3 children, who developed neither a colonization nor an infection. In a number of cases the patients' environment was contaminated with F. meningosepticum prior to colinization or infection. Nearly identical resistance patterns against the antibiotics tested, could be demonstrated for the isolated strains. The primary source of infection could not be identified, it is supposed however that the index patient had been admitted to the hospital nine months before. A strict hygienic policy, like consequently performed hand hygiene, adequate processing of ventilation equipment and application of sterile tubings led to extinction of the infections. During subsequent environmental controls, F. meningosepticum could not be isolated.