“Did I Hear You Correctly? The Organism Identified Was Corynebacterium diphtheriae?”

Diphtheria is a bacterial infection caused by Corynebacterium diphtheriae and is primarily transmitted from person to person through close physical and respiratory contact; disease can involve almost any mucous membrane and is classified depending on the anatomic site of infection. Diphtheria is an acute, toxin-mediated disease whose occurrence is characterized by periodicity and epidemic waves, with a high incidence and mortality. Once one of the leading causes of childhood death, global diphtheria incidence declined approximately 70% through implementation of widespread vaccination programs. However, a major epidemic of diphtheria occurred during the 1990s in the Russian Federation and the newly independent states of the former Soviet Union. Although the epidemic is under control, toxigenic C. diphtheriae strains are still reported in Europe and globally, including North and South America, the Indian subcontinent, Africa, Southeast Asia, and the eastern Mediterranean. Rapid clinical and public health responses are required to control diphtheria outbreaks, with the clinical microbiology laboratory playing an essential role in providing prompt and rapid identification. In light of experience with a recent case of nontoxigenic C. diphtheriae respiratory infection, aspects of this organism and the diseases it causes are reviewed.     

When is it safe to exercise mechanically ventilated patients in the intensive care unit? An evaluation of consensus recommendations in a cardiothoracic setting

Rationale

Consensus recommendations have been developed to guide exercise rehabilitation of mechanically ventilated patients in the intensive care unit.

Using clinical tests of colour vision to predict the ability of colour vision deficient patients to name surface colours

PURPOSE: To determine the predictive power of commonly used tests for abnormal colour vision to identify patients who can or cannot name surface colours without error. METHODS: The colour vision of 99 subjects with colour vision deficiency (CVD) was assessed using the Ishihara, the Richmond HRR (2002), the Farnsworth D15, the Medmont C100 and the Nagel anomaloscope. They named 10 surface colours (red, orange, brown, yellow, green, blue, purple, white, grey and black), which were presented in two shapes (lines and dots) and three sizes. The surface colours were also named by an age-matched group of 20 subjects with normal colour vision. The performance of the clinical tests to predict the CVD subjects who made no colour naming errors and those who made errors is expressed in terms of the predictive value of a pass P((P)) and the predictive value of a fail P((F)). RESULTS: The P((P)) values of the tests were between 0.59 and 0.70 and P((F)) values were between 0.77 and 1.00. CONCLUSIONS: A 'mild' classification with the Richmond HRR test, especially if no more than two errors are made on the HRR diagnostic plates, identifies patients with abnormal colour vision who are able to name surface colour codes without error or only the occasional error. A pass of the Farnsworth D15 test identifies patients who will make no or few (up to 6%) errors with a 10 colour code, but who will be able to name the colours of a seven colour code that does not include orange, brown and purple. If protans are excluded, the predictive value for a pass P((P)) for the Farnsworth D15 is improved from 0.59 to 0.70. The anomaloscope is not an especially good predictor of those who can recognise surface colour codes. However, an anomaloscope range >35 units identifies those who have difficulty in recognising surface colour codes, as does a fail at the Farnsworth D15 test.     

Jan Lovie‐Kitchin

Background: Colour vision deficiency (CVD) has a high prevalence and is often a handicap in everyday life. Those who have CVD will be better able to adapt and make more informed career choices, if they know about their deficiency. The fact that from 20 to 30 per cent of adults with abnormal colour vision do not know they have CVD suggests that colour vision is not tested as often as it should be. This may be because of practitioner uncertainty about which tests to use, how to interpret them and the advice that should be given to patients on the basis of the results. The purpose of this paper is to recommend tests for primary care assessment of colour vision and provide guidance on the advice that can be given to patients with CVD. Methods: The literature on colour vision tests and the relationship between the results of the tests and performance at practical colour tasks was reviewed. Results: The colour vision tests that are most suitable for primary care clinical practice are the Ishihara test, the Richmond HRR 4th edition 2002 test, the Medmont C‐100 test and the Farnsworth D15 test. These tests are quick to administer, give clear results and are easy to interpret. Tables are provided summarising how these tests should be interpreted, the advice that can be given to CVD patients on basis of the test results, and the occupations in which CVD is a handicap. Conclusion: Optometrists should test the colour vision of all new patients with the Ishihara and Richmond HRR (2002) tests. Those shown to have CVD should be assessed with the Medmont C‐100 test and the Farnsworth D15 test and given appropriate advice based on the test results.     

What's new in dermatopathology?

This review emphasizes the important work in dermatopathology reported in the past 3 years. In reviewing the recent contributions in the field, four areas appear to have received particular attention: (1) new information concerning the histogenesis of cutaneous tumors based on the dual functional capacities of cells; (2) the Langerhans cell and its role in inflammatory and neoplastic processes; (3) prognostic factors in stage I malignant melanoma; and (4) the use of new immunofluorescent and immunohistochemical technics as diagnostic tools in cutaneous pathology.     

Use of a feeding procedure in the treatment of a stress-related anxiety disorder

A feeding procedure was used with a Vietnam veteran who became highly anxious when near a springhouse that resembled the site where he had been wounded in Vietnam. After 36-hr of food deprivation, the patient ate his favorite meal while sitting next to the springhouse. Treatment successfully reduced both anxiety and avoidance behavior. Results of a 10-month follow-up showed no relapse.