Information Channels Associated with Awareness of Human Papillomavirus Infections and Vaccination among Latino Immigrants from Safety Net Clinics

We report on information channels associated with awareness about human papillomavirus (HPV) among immigrant Central and South American Latinos. We conducted a survey of 1,334 Latino ≥ 21 years attending safety-net clinics in 2007–2008. Logistic regression analyses evaluated associations with HPV awareness. Forty-eight percent were aware of HPV infection and 40% were aware of the vaccine. Spanish television (38%) and providers (23%) were the primary HPV information sources. Infection awareness was associated with internet use (OR 1.47; 95% CI 1.10–1.96) and self-efficacy to find health information (OR 1.19; 95% CI 1.08–1.30). Vaccine awareness was associated with media use for health information (OR 1.27; 95% CI 1.09–1.49) and internet use (OR 1.59; 95% CI 1.18–2.13). Although Spanish television has reached this low HPV awareness group, there may be missed opportunities for education by providers. Television and the internet may also be effective channels for future interventions.     

Successful Immunosuppressive Treatment of Erythroid Aplasia Appearing after Thymectomy

S ummary . A unique case of red cell aplasia appearing 2 yr after removal of a thymoma and a transient episode of myasthenic crisis is presented. When the marrow cells of this patient were incubated in vitro a marked increase in haem synthesis occurred, suggesting that the marrow had been freed from an inhibitor of erythroid function. An antibody to erythroblast nuclei was also present. The patient failed to respond to an initial course of immunosuppressive therapy, but after splenectomy he had a second course of immunosuppressive treatment which was followed by a complete haematologic remission. Guidelines for the future therapeutic use of immunosuppressive agents in pure erythroid aplasia are presented.     

Sepsis und Multiorganversagen nach BCG-Instillation bei Blasenkarzinom

Local Bacillus Calmette-Guérin (BCG) immunotherapy is an effective and widely used treatment for superficial bladder carcinoma. Local side effects are frequent, whereas systemic side effects are rare, but more serious. Systemic BCG infection as a life-threatening complication of intravesical BCG instillation should be suspected in any patient who presents with persistent fever after BCG instillation for bladder cancer. A 62-year-old patient had been treated with 6 intravesical BCG instillations for recurrent, multifocal bladder carcinoma. 4 weeks after the last instillation, he presented with fever, malaise and scleral icterus. Laboratory tests revealed abnormal liver function tests, panzytopenia and signs of coagulation disorder. Bone marrow biopsy and liver biopsy showed noncaseating granulomas. Systemic BCG infection was suspected and antituberculous therapy combined with steroids was started. The patient developed severe sepsis and suffered from multiple organ failure. Despite partial improvement, the course was complicated by intracranial sinus thrombosis, and the patient died two month after admission.     

Association between tidal volume size,duration of ventilation,and sedation needs in patients without acute respiratory distress syndrome: an individual patient data meta-analysis

Purpose

Mechanical ventilation with lower tidal volumes (≤6 ml/kg of predicted body weight, PBW) could benefit patients without acute respiratory distress syndrome (ARDS). However, tidal volume reduction could be associated with increased patient discomfort and sedation needs, and consequent longer duration of ventilation. The aim of this individual patient data meta-analysis was to assess the associations between tidal volume size, duration of mechanical ventilation, and sedation needs in patients without ARDS.

Methods

Studies comparing ventilation with different tidal volume sizes in patients without ARDS were screened for inclusion. Corresponding authors were asked to provide individual participant data. Patients were assigned to three groups based on tidal volume size (≤6 ml/kg PBW, 6–10 ml/kg PBW, or ≥10 ml/kg PBW). Ventilator-free days, alive at day 28, and dose and duration of sedation (propofol and midazolam), analgesia (fentanyl and morphine), and neuromuscular blockade (NMB) were compared.

Results

Seven investigations (2,184 patients) were included in the analysis. The number of patients breathing without assistance by day 28 was higher in the group ventilated with tidal volume ≤6 ml/kg PBW compared to those ventilated with tidal volume ≥10 ml/kg PBW (93.1 vs. 88.6 %; p = 0.027, respectively). Only two investigations (187 patients) could be included in the meta-analysis of sedation needs. There were neither differences in the percentage of study days that patients received sedatives, opioids, or NMBA nor in the total dose of benzodiazepines, propofol, opioids, and NMBA.

Conclusions

This meta-analysis suggests that use of lower tidal volumes in patients without ARDS at the onset of mechanical ventilation could be associated with shorter duration of ventilation. Use of lower tidal volumes seems not to affect sedation or analgesia needs, but this must be confirmed in a robust, well-powered randomized controlled trial.     

Widely used track and trigger scores: Are they ready for automation in practice?

Introduction

Early Warning Scores (EWS) are widely used for early recognition of patient deterioration. Automated alarm/alerts have been recommended as a desirable characteristic for detection systems of patient deterioration. We undertook a comparative analysis of performance characteristics of common EWS methods to assess how they would function if automated.

Methods

We evaluated the most widely used EWS systems (MEWS, SEWS, GMEWS, Worthing, ViEWS and NEWS) and the Rapid Response Team (RRT) activation criteria in use in our institution. We compared their ability to predict the composite outcome of Resuscitation call, RRS activation or unplanned transfer to the ICU, in a time-dependent manner (3, 8, 12, 24 and 36 h after the observation) by determining the sensitivity, specificity and positive predictive values (PPV). We used a large vital signs database (6,948,689 unique time points) from 34,898 unique consecutive hospitalized patients.

Results

PPVs ranged from less than 0.01 (Worthing, 3 h) to 0.21 (GMEWS, 36 h). Sensitivity ranged from 0.07 (GMEWS, 3 h) to 0.75 (ViEWS, 36 h). Used in an automated fashion, these would correspond to 1040–215,020 false positive alerts per year.

Conclusions

When the evaluation is performed in a time-sensitive manner, the most widely used weighted track-and-trigger scores do not offer good predictive capabilities for use as criteria for an automated alarm system. For the implementation of an automated alarm system, better criteria need to be developed and validated before implementation.     

EPR study of radiation stability of organic plastic scintillator for cardiovascular brachytherapy Sr90-Y90 beta dosimetry.

Nowadays, more than one million percutaneous transluminal coronary angioplasties are being performed annually throughout the world. Restenosis is a significant problem associated with these angioplasty procedures. Radiation treatment with catheter-based beta-emitter sources is currently under clinical trial to prevent this problem. Due to fast and worldwide introduction of beta-sources for intravascular application, there is a growing interest in the dosimetry aspects. However, accurate dosimetry of beta-radiation is more difficult than that of gamma-radiation. Suitable detectors are not yet available with accuracy down to a tenth of a millimeter. Conventional measuring systems are not capable of such spatial resolution, except radiochromic film. However, film dosimeters have limited sensitivity and their radiation characteristics are different than those of tissue; therefore dose measurements require corrections. An alternative is to use water-equivalent plastic scintillators. In this work, organic plastic scintillator (BCF-10) dosimetry is studied using the Monte Carlo (MC) technique PENELOPE, and its radiation stability, after irradiation, is experimentally studied through electron paramagnetic resonance (EPR). Depth dose and dose profile are measured and compared to film dosimetry results. The EPR technique shows that the recovery time is dose independent in this kind of fiber and shows good stability.     

Possible interaction between warfarin and Lycium barbarum L.

OBJECTIVE: To describe a patient who was stabilized on warfarin and developed an elevated international normalized ratio (INR) after drinking a concentrated Chinese herbal tea. Additionally, to determine the effect of the tea on CYP2C9, the isoenzyme responsible for the metabolism of S-warfarin. CASE SUMMARY: An elevated INR of 4.1 was observed in a 61-year-old Chinese woman, previously stabilized on anticoagulation therapy (INR 2-3). With no changes in her other medications or lifestyle, a review of her dietary habits revealed four days of drinking a concentrated Chinese herbal tea made from Lycium barbarum L. fruits (3-4 glasses daily) prior to her clinic visit Warfarin was withheld for one day and then resumed at a lower weekly dose. She discontinued the tea, while maintaining consistency with medications and dietary habits. A follow-up INR seven days later was 2.4, and seven subsequent INR values were in the 2.0-2.5 range. DISCUSSION: L barbarum L. (family Solanaceae) is a commonly used Chinese herb considered to have a tonic effect on various organs. Any impact of an herbal product on the metabolism of S-warfarin, the enantiomer responsible for most of the anticoagulant activity, could alter the INR values. An herbal-drug interaction was suspected in this case. In vitro evaluation showed inhibition of S-warfarin metabolism by CYP2C9 by the tea of L. barbarum L.; however, the inhibition observed was weak, with a dissociation constant (Ki) value of 3.4 mg/mL, suggesting that the observed interaction may be caused by factors other than the CYP450 system. CONCLUSIONS: There is a potential herbal-drug interaction between warfarin and L. barbarum L., based on an increased INRvalue noted with concurrent use. Thus, combination of L. barbarum L. and warfarin should be avoided. Vigilance is needed with other herbal combinations taken with drugs of narrow therapeutic indices.     

Dienestrol: Another synthetic estrogen of clinical value

Clinical trials of dienestrol for relief of climacteric symptoms in thirteen women indicate that doses of 0.2 to 0.5 mg. daily are adequate, dependable and tolerated without unpleasant side effects.

a.

							Results
Patient	Age	Spontaneous	Surgical	Radiation	Dienestrol mg./day	Excellent	Good
Ac	55	#			0.2		#
An	49		#	#	0.6	#
Er	29			#	0.3		#
Ha	47	#			0.3	#
Ke	36	#			0.5		#
Ko	54		#		0.3		#
Na	53		#		0.2	#
Re	50	#			0.5		#
Sc	56	#			0.1		#
Sm	38	#			0.2	#
Sw	49	#			0.1		#
Va	31	#a			0.1	#
We	39			#	0.3

a

Irregular menses, climacteric symptoms.