Vaccination rates in adults are lower than those in children, but the consequences of lack of immunization in adults are just as significant. Barriers to adult immunization include patients’ lack of knowledge or misconceptions about vaccines and health care providers’ failure to recommend vaccination.1
The CDC recommends that sexually active adolescent girls be screened for Chlamydia trachomatis infection at least annually and that all sexually active women aged 20 to 25 years and women aged 25 years or older who have risk factors also receive an annual screening.1 How well are these screening practices being observed and what are the implications?
Emphysematous pyelonephritis (EPN) is a rare but life-threatening infection characterized by widespread necrosis and production of gas within the kidney.
A 70-year-old man was admitted with a change in mental status and shortness of breath. He had a history of carcinoma of the colon and status postcolectomy with ileostomy. He was receiving long-term total parenteral nutrition, including lipid emulsion, for short-gut syndrome. Other pertinent findings in the medical history included type 2 diabetes mellitus and enterocutaneous fistula.
Methicillin-resistant Staphylococcus aureus (MRSA) must be recognized now as one of the most common causes of infections acquired in the community. The majority of these infections involve the skin and soft tissue structures and confer significant morbidity on those affected.
With the introduction of immunosuppressive drugs, solid organ transplant (SOT) has progressed such that potential recipients significantly outnumber available organs. In 2007, there were 14,394 donors of 28,353 organs, but 98,645 persons were on a waiting list as of March 2008.1
An 18-year-old woman with a history of allergic rhinitis and moderate persistent asthma presented with right-sided nasal congestion of 6 months’ duration.
Clostridia are anaerobic, spore-forming, gram-positive bacilli that are ubiquitious in nature. They can be isolated from soil and the GI tract of animals and humans.1
Catastrophic antiphospholipid syndrome (CAPS), first described by Asherson and colleagues1 in 1992, refers to a clinical scenario in which multiple vascular occlusive events involving small vessels that supply blood to organs occur over a short period.
Over the past 15 years in the United States, HIV/AIDS has become increasingly common among women. In 1990, women made up only 11% of the newly reported cases of AIDS.1 In 2006, 27% of newly reported AIDS cases were in women.2
After drinking a cup of coffee in the lounge of St Gimmick Hospital, Dr Schmeckman accompanied one of his students, Mollie Jeanette, who was beginning her rotation through the hospital’s infectious diseases service, to the microbiology laboratory.
The recent report of an HIV-positive cardiothoracic surgeon in Israel has offered a contemporary perspective on the risks of transmission of HIV in health care settings, specifically surgical settings.
Many policy watchers are anticipating a golden age of science-led policy in health and environment under the presidential leadership of Barack Obama. After 8 years of frustration at bowdlerized reports, derailed rule making, and policies based on stubbornly held beliefs-despite the facts pointing government policies in another direction-it’s time for clearheaded thinking and the best use of sound information to formulate health and environment policy-even when a policy needs to be based on findings that make us uncomfortable. Of course, it’s this last condition that’s the kicker: none of us want to feel anything other than good when a policy is enacted, and that’s not always going to be the case.
For the first 25 years of the AIDS epidemic, HIV testing was treated differently from all other types of medical diagnostic testing. Formal pretest and posttest counseling was required, and patients had to give written informed consent before being tested. The need for testing was focused primarily on assessment of risk, which required the taking of a detailed sexual and drug use history for which few clinicians had the time, training, or inclination. The rationale for this particular form of “HIV exceptionalism” was mostly historical, dating back to times when concerns about stigma; discrimination; and loss of insurance, jobs, or housing outweighed any modest benefit that might have been derived from early medical care.
Digestive diseases are costly to manage, with annual costs totaling $141.8 billion in 2004 (Figure 1), according to an NIH report. Direct costs associated with digestive diseases jumped from $85 billion in 1998 to nearly $98 billion in 2004. Prescription drug costs alone were $12.3 billion. Indirect costs for digestive diseases more than doubled, from $20 billion in 1998 to $44 billion in 2004, of which $32.8 billion was associated with lost productivity caused by increased mortality.
Genetic studies are slowly leading to a better understanding of certain diseases as well as progress toward individualized drug therapy. Developments in DNA sequencing make it relatively simple to look for allelic (ie, alternative) versions of a gene by examining samples of a specific gene taken from different members of a population (or from a heterozygous individual). Genetic variants that appear in at least 1% of a population are called polymorphisms. With the cutoff at 1%, one does not get sidetracked by spontaneous mutations that may have occurred in-and spread by the descendants of-a single family.
Researchers at Northwestern University, Evanston, Ill, report that insulin, by shielding memory-forming synapses from injury, may slow or prevent the damage and memory loss caused by amyloid b–derived diffusible ligands (ADDLs)-toxic neuroproteins associated with Alzheimer disease (AD). Findings of the study, which provides additional evidence that AD may be caused by a new, third form of diabetes, were published in the February 10 issue of the Proceedings of the National Academy of Sciences of the United States of America.
Financial incentives offered by employers significantly increased rates of smoking cessation, according to results of a study published in the February 12 issue of the New England Journal of Medicine. The study, one of the largest of its kind, was funded by the CDC and the Pennsylvania Department of Health. The CDC reports that smoking costs employers about $3400 per employee annually, or about $7.18 per pack of cigarettes smoked, in health care costs, presenteeism (lost productivity), and absenteeism.
A 37-year-old white woman, previously in excellent health, presented to a local emergency department for evaluation of evolving left-sided weakness and a slight left facial droop.
New guidelines from the Centers for Medicare & Medicaid Services (CMS) that increase the number of compendia health insurers rely on to determine whether a drug use is appropriate will greatly expand the number of off-label uses of chemotherapy agents for which the agency will reimburse.
