Be aware of Drinkaware

In 2006, Drinkaware was established as a charity in the United Kingdom following a memorandum of understanding between the Portman Group and various UK government agencies. This debate piece briefly reviews the international literature on industry social aspects organizations, examines the nature of Drinkaware's activities and considers how the public health community should respond. Although the British addiction field and the wider public health community have distanced themselves from the Portman Group, they have not done so from Drinkaware, even though Drinkaware was devised by the Portman Group to serve industry interests. Both long‐standing and more recent developments indicate very high levels of industry influence on British alcohol policy, and Drinkaware provides one mechanism of influence. We suggest that working with, and for, industry bodies such as Drinkaware helps disguise fundamental conflicts of interest and serves only to legitimize corporate efforts to promote partnership as a means of averting evidence‐based alcohol policies. We invite vigorous debate on these internationally significant issues and propose that similar industry bodies should be carefully studied in other countries.     

Warfarin sensitivity: be aware of genetic influence

BACKGROUND: avoidance of over anticoagulation in response to warfarin therapy would reduce risk of associated bleeding. SUBJECTS: two elderly patients with venous thromboembolism exhibited extreme anticoagulant response to warfarin. Both were noted to have variant CYP2C9 alleles, which reduce the metabolic capacity of cytochrome P450 2C9. DISCUSSION: adverse outcomes with warfarin therapy could be explained and possibly avoided by identifying patients with variant alleles for CYP2C9 before initiation of therapy.     

Antiepileptic hypersensitivity syndrome: Clinicians beware and be aware

Antiepileptic hypersensitivity syndrome is a serious idiosyncratic, non-dose-related adverse reaction reported to occur with phenytoin, phenobarbital, carbamazepine, primidone, and lamotrigine. The reaction usually develops 1 to 12 weeks after initiation of therapy with one of the above agents and is recognized by the classic triad of fever, rash, and internal organ involvement. Immediate discontinuation of the suspected anticonvulsant is essential for good outcome. Patients usually are managed supportively with hydration, antihistamines, H₂-receptor blockers, and topical corticosteroids. In severe cases, the use of systemic corticosteroids may be necessary. The use of intravenous immune globulin should be limited to severe cases where Kawasaki disease or idiopathic thrombocytopenic purpura cannot be ruled out. Education of health care professionals and patients is imperative to improving outcomes and prevention of this reaction in the future.     

提高非经典型21-羟化酶缺陷症的诊治水平

非经典型21-羟化酶缺陷症（210HD）是最常见的常染色体隐性遗传病之一，但临床上可以仅表现为高雄激素血症如多毛、痤疮等皮肤症状，部分患者也可有月经紊乱及不育症等，极易漏诊误诊，而其引起的糖脂代谢紊乱等远期并发症（如代谢综合征、心血管并发症等）危害极大。基础的17-羟孕酮以及快速ACTH兴奋实验是非常好的筛查和辅助诊断手段。非经典型210HD疾病本身治疗的花费极少，提高其诊断的准确性具有临床意义和社会经济学意义。因此，应提高对非经典型210HD的认识，重视该症的诊治。     

Orofacial pain and fibromyalgia pain: Being aware of comorbid conditions

Orofacial pain originating from myofascial pain of temporomandibular disorders is the second most common source of pain, after tooth pain. However, diagnosis of myofascial pain is challenging due to its characteristic referral pattern. Furthermore, pain arising from structures in the orofacial region may be a presentation of fibromyalgia and treatment directed at temporomandibular disorders fails to alleviate the pain. Similarly, patients with fibromyalgia may present with pain in the orofacial region. The physician in this case should be aware of temporomandibular disorders, its characteristic findings and treatment approaches that might be included in the treatment plan.     

AIDS oncology

New diagnostic approaches to primary central nervous system lymphoma have been developed that may make brain biopsy unnecessary in many instances. Reduced-dose chemotherapy for non-Hodgkin's lymphoma has been shown to be advantageous in a randomized controlled trial. New agents for the treatment of Kaposi's sarcoma are available. Adoptive cellular immunotherapy has been shown to be effective in the treatment and prevention of Epstein-Barr virus-associated B-cell lymphomas in bone marrow transplant recipients, and may have promise in AIDS patients.     

AIDS cholangiopathy

Opinion statement AIDS is an advanced disease with systemic and infectious complications that can be fatal. When a patient with AIDS presents with right upper quadrant or midepigastric pain, cholestasis, and symptoms of cholangitis, AIDS cholangiopathy should be suspected and appropriate diagnostic and therapeutic interventions should be initiated. Opportunistic infections such as Cryptosporidium and cytomegalovirus are the most common cause of AIDS cholangiopathy. Four distinct cholangiographic abnormalities have been demonstrated by endoscopic retrograde cholangiopancreatography, the most common being papillary stenosis with sclerosing cholangitis. Antimicrobial therapy is often ineffective. Highly active antiretroviral therapy may enhance immune function and offers the best medical therapy to clear the opportunistic infections. Ursodeoxycholic acid has a limited benefit in patients with sclerosing cholangitis and cholestasis. Endoscopic sphincterotomy has been shown to relieve pain and biliary obstruction in patients with papillary stenosis. Balloon dilation of strictures and stent placement decompress the biliary system and may be helpful. Cholecystectomy is recommended to treat acalculous cholecystitis, and celiac plexus block may be offered to patients with terminal disease and intractable abdominal pain.