Thursday, March 26, 2009

Malignant Mesothelioma

Malignant mesothelioma, or is often simply shortened to just mesothelioma, is a cancer of the mesothelium, the tissue that lines our lungs, stomach, heart and other organs. It is fairly rare, especially for people under age 55, however, a serious cancer.
Diagnosing mesothelioma is often difficult, because the symptoms are similar to those of a number of other conditions. Also mesothelioma is very hard to control. Treatment for mesothelioma depends on the location of the cancer, the stage of the disease, and the patient's age and general health. Standard treatment options include surgery, radiation therapy, and chemotherapy. Sometimes, these treatments are combined.
Working with asbestos is the major risk factor for mesothelioma. About 70 percent to 80 percent of all cases have been linked to asbestos exposure in the workplace. There is also some evidence that family members and others living with asbestos workers have an increased risk of developing mesothelioma, and possibly other asbestos-related diseases. This risk may be the result of exposure to asbestos dust brought home on the clothing and hair of asbestos workers.
If you got mesothelioma because of your workplace is "an asbestos environment," you can go to mesothelioma law firm and work together with the mesothelioma lawyer to make a claim. You need an experienced mesothelioma attorney not just an ordinary law firm or lawyer since it could mean the difference between success and failure.

Saturday, February 7, 2009

Hepatitis C and Cardiovascular Risk

Conflicting results have been produced regarding the association between chronic hepatitis C virus (HCV) infection and coronary artery disease, including heart attacks and strokes. It was found in a study about the relationship between HCV infection and risk for incident (newly emerging) coronary artery disease. HCV-positive patients were less likely to have arterial hypertension, dyslipidemias, and diabetes than persons without HCV. HCV-positive patients were more likely to smoke cigarettes and abuse alcohol or drugs. Compared with participants without HCV, patients with HCV had lower mean plasma levels of total cholesterol , low-density lipoprotein (LDL) cholesterol, and triglycerides .
In a multivariate analysis, HCV infection was associated with a 25% higher risk for coronary artery disease. Classic risk factors (older age, hypertension, smoking, diabetes, dyslipidemias) were associated with a higher risk for coronary artery disease. In contrast, nonwhite ethnicity and female sex were associated with a lower risk. It was concluded that people infected with HCV are at increased risk for coronary artery disease despite having fewer other cardiovascular risk factors.
(Butt A, Xiaoqiang W, Budoff M, et al. Hepatitis C virus infection and the risk of coronary disease. Program and abstracts of the 48th ICAAC/46th IDSA; October 25-28, 2008; Washington, DC. Abstract V-4219)

Monday, February 2, 2009

The Pathophysiology of The Premenstrual Syndrome (PMS)

Premenstrual syndrome (PMS) is a recurrent luteal phase condition characterized by physical, psychological, and behavioral changes of sufficient severity to result in deterioration of interpersonal relationships and normal activity. Premenstrual dysphoric disorder (PMDD) is considered a severe form of PMS.
Incorrect older theories about the causes of PMS include an estrogen excess, estrogen withdrawal, progesterone deficiency, pyridoxine (vitamin B-6) deficiency, alteration of glucose metabolism, and fluid-electrolyte imbalances. Current research provides some evidence supporting the following etiologies:
  • Serotonin deficiency is postulated because patients who are most affected by PMS have differences in serotonin levels. The symptoms of PMS can respond to selective serotonin reuptake inhibitors (SSRIs), which are medications that increase the amount of circulating serotonin.
  • Magnesium and calcium deficiencies are postulated as nutritional causes of PMS. Studies evaluating supplementation show improvement in physical and emotional symptoms.
  • Women with PMS often have an exaggerated response to normal hormonal changes. Although their levels of estrogen and progesterone are similar to women without PMS, rapid shifts in levels of these hormones promote pronounced emotional and physical responses.
  • Other theories under investigation include increased endorphins, alterations in the gamma-aminobutyric system (GABA), and hypoprolactinemia.
(Primary Care Companion J Clin Psychiatry. 2003;5:30-9;
Obstet Gynecol. 2005;106(3):492-501;
Pediatric and Adolescent Gynecology. 5th ed. Philadelphia, PA: Lippincott-Raven Inc; 2005:461-7;
J Womens Health. Jan-Feb 1999;8(1):75-85;
J Reprod Med. Feb 1991;36(2):131-6)

Friday, January 30, 2009

Human Papilloma Virus (HPV) Vaccination Recommendations

Human Papilloma Virus (HPV) vaccination is recommended for all females aged 11 through 26 years, regardless of sexual activity or clinical evidence of previous HPV infection, who have not completed the vaccine series. Ideally, vaccination should be given before potential exposure to HPV through sexual activity and may be given as early as age 9 years. The complete series consists of 3 doses, with the second dose given 2 months after the first dose and the third dose 6 months after the first dose.
(Morb Mortal Wkly Rep. 2009;57(53))

Tuesday, January 27, 2009

Sleep Quality Is An Important Predictor Of Immunity And Susceptibility To The Common Cold

Poorer sleep efficiency and shorter sleep duration in the weeks before exposure to a rhinovirus are linked to greater susceptibility to the common cold. Sleep quality is an important predictor of immunity and susceptibility to the common cold. Sleep deprivation has been shown to result in poorer immune function and to attenuate antibody response to virus infections. Shorter sleep duration and lower efficiency were associated with an increased risk for development of a common cold. People who less than 7 hours of sleep were 2.94 times more likely to get a cold than those with 8 hours or more of sleep. Longer sleep duration is associated with a reduced risk for infection with the common cold. People with less than 92% sleep efficiency were 5.50 times more likely to get a cold than those with 98% or more efficiency. Higher sleep efficiency is associated with a reduced risk for infection with the common cold, and sleep efficiency lower than 85% is associated with an increased risk.
So, if you don't want to get cold, please just sleep tight... :)
(Arch Intern Med. 2009;169:62-67)

Saturday, January 24, 2009

Hepatitis Vaccination Recommendations

Hepatitis A vaccination is indicated for persons with chronic liver disease, those who receive clotting factor concentrates, men who have sex with men, illegal drug users, laboratory workers exposed to hepatitis A virus–infected primates, persons traveling to or working in countries with high or intermediate endemicity of hepatitis A, and those seeking protection from hepatitis A virus infection. Single-antigen vaccine formulations should be given in 2 doses either at 0 and 6 to 12 months (Havrix, GlaxoSmithKline) or at 0 and 6 to 18 months (Vaqta, Merck). Combined hepatitis A and hepatitis B vaccine (Twinrix, GlaxoSmithKline) should be given in 3 doses at 0, 1, and 6 months or in 4 doses on days 0, 7, and 21 to 30, followed by a booster dose at month 12.
Hepatitis B vaccination is indicated for persons with end-stage renal disease, HIV infection, or chronic liver disease; for healthcare personnel and public-safety workers exposed to blood or other potentially infectious body fluids; for sexually active persons not in a long-term, mutually monogamous relationship; for persons seeking evaluation or treatment of a sexually transmitted infection; for current or recent injection-drug users; and for men who have sex with men. Other indications and settings are also listed, as well as special formulation indications.
(Morb Mortal Wkly Rep. 2009;57(53))

Friday, January 23, 2009

Influenza Vaccination

Influenza vaccination should be given to those with medical, occupational, or other indications. Medical indications are chronic disorders of the cardiovascular or pulmonary systems, chronic metabolic diseases, immunocompromising conditions, or any condition that compromises respiratory function or that increases risk for aspiration. All healthcare personnel and caregivers of children younger than 5 years should receive influenza vaccination, as should residents of nursing homes and other long-term care and assisted-living facilities, persons likely to transmit influenza to persons at high risk, and others who wish to decrease their risk of getting influenza. Healthy, nonpregnant adults younger than 50 years without high-risk medical conditions who are not contacts of severely immunocompromised persons in special care units can receive either intranasally administered live, attenuated influenza vaccine (FluMist, MedImmune) or inactivated vaccine, but others should receive the inactivated vaccine.
(Morb Mortal Wkly Rep. 2009;57(53))

Thursday, January 22, 2009

The Difficulties of Acute HCV-Infection Diagnosis

Most individuals infected with hepatitis C virus (HCV) fail to clear virus at the acute stage, becoming chronically infected, with consequent significant risks of progressive liver disease, cirrhosis and hepatocellular carcinoma. Treatment of chronic HCV with combination pegylated-interferon (PEG-IFN) and ribavirin achieves sustained virological response (SVR) rates of 42-52% of patients infected with HCV genotype 1 and 76-82% of those with genotype 2/3. In contrast, much higher SVR rates (e.g. >97%) have been reported when treating acute HCV infection with PEG-IFN, irrespective of the infecting genotype. It would thus seem preferable to treat HCV infection at the acute stage rather than waiting for the infection to become chronic.
The problem is the diagnosis of acute HCV infection is not straightforward. Detection of anti-HCV IgM does not distinguish acute from chronic infection. Genome or antigen detection techniques provide information on the current infection status of an individual, but do not indicate when infection may have taken place. One possible laboratory approach to diagnosis of acute infection would be to demonstrate sero- or genoconversion in serial samples, but practically, it is difficult to obtain regular repeat samples in high-risk individuals such as injecting drug users (IDUs). Clinical approaches to diagnosis are also flawed. Only a small minority of acute infections are symptomatic. Even in patients presenting with acute hepatitis C, the majority of whom are already anti-HCV positive, one cannot be certain that illness is due to recent infection with HCV rather than another inter-current cause in a chronically infected patient.
(J Viral Hepat. 2008;15(12):871-877)

Wednesday, January 21, 2009

What is Keloid?

Keloids result from wound healing gone awry. Formation is commonly seen after invasive medical procedures; elective cosmesis (tattoos and piercings); and mundane events, such as insect bites and trauma from scratching. Symptoms can extend beyond cosmesis. One survey reported pruritus in 27% of patients and pain in 19%. Rarely, keloids have also been shown to ulcerate and develop draining sinus tracts. The most common anatomical sites for keloids include the chest, shoulders, earlobes, upper arms, and cheeks. Although keloid formation has been traditionally understood to result from indefinite collagen production, no single accepted hypothesis has been accepted to fully explain the pathological mechanism.
Keloids are more common in dark-skinned persons. Incidence is estimated to be between 4.5% to 16% among blacks and Hispanics. Keloids occur with equal frequency in men and women. Younger patients are affected more often, with an age range of 10 to 30 years. A genetic predisposition to keloids has been described, and it is inherited in an autosomal dominant fashion.

Tuesday, January 20, 2009

HIV and Methicillin-resistant Staphylococcus Aureus (MRSA)

HIV-infected patients could increase the risk for Staphylococcus aureus and methicillin-resistant Staphylococcus aureus (MRSA) colonization and infection, including bloodstream infection. A study reported that the incidence of methicillin resistant Staphylococcus aureus (MRSA) bacteraemia increased significantly in HIV-infected patients from 2000 to 2004. Injection drug use (IDU), end-stage renal disease (ESRD) and CD4 count <200 cells/μL were independent predictors for incident MRSA bacteraemia, while ESRD was more common in patients with MRSA bacteraemia than methicillin-susceptible Staphylococcus aureus (MSSA) bacteraemia. IDU, ESRD and CD4 count <200 cells/μL factors may serve as important clinical markers of MRSA likelihood in decisions regarding initial antimicrobial management.
Initial antimicrobial therapy for presumed sepsis in HIV-infected patients may require agents active against MRSA, including vancomycin, linezolid and, in nonpulmonary infections, daptomycin, particularly in patients with risk factors for MRSA bacteraemia.
(HIV Med. 2008;9(10):858-862)

Monday, January 19, 2009

The Role of Viral Infections in Type 1 Diabetes

A number of epidemiological studies support the hypothesis that viral infections play a causative role in type 1 diabetes. However, systematic review of control studies published between 1966 and 2002 has shown no convincing evidence for or against an association between type 1 diabetes and the prime candidate for infectious cause, Coxsackievirus B (CVB). In animal models for type 1 diabetes, solid evidence supporting an inductive role for viruses is faced with just as solid evidence supporting a protective effect of viral infections. For example, based on mouse studies alone, there is no doubt that association between viruses and type 1 diabetes is extremely complex: while belonging to the same enteroviral group, CVB3 and CVB4 have opposing effects on type 1 diabetes in the same mouse model. Thus, the reason for current failure to associate a particular virus with induction of autoimmune diabetes likely is that such an association might be impossible to make. Certain viruses might be capable of inducing diabetes and others of preventing diabetes, and type 1 diabetes inducers might be capable of preventing disease under certain conditions. This will depend of course on the nature of the considered virus, but also on the state of advancement of autoimmunity at the time of infection. A given viral infection could thus be an essential disease precipitator once required predisposing events have occurred, but could on the other hand disrupt accumulation of these events.
Most important is the indication from animal studies that modulation of autoimmunity during viral infection does not depend merely on inherent properties of the virus, but also significantly on intrinsic factors of the host. The close interplay between the two will dictate whether enhancement or abrogation of autoimmune diabetes occurs. While molecular mimicry might activate autoreactive T-cells, it could also segregate these cells away from the islets and/or induce the activation of protective Tregs. While inflammatory cytokines might promote bystander activation of APCs and autoreactive T-cells, infection could occur at a time where inflammation will induce the relocation or demise of these cells. Whereas β-cell lysis and presentation of islet antigen might promote activation of autoreactive T-cells, it could also suppress the function of these cells by promoting Treg activity. Whereas repeated/sustained infections might lead to the accumulation of autoreactive T-cells within the memory pool, they could also induce suppressor mechanisms that will hinder autoimmunity.
(Diabetes. 2008;57(11):2863-2871)

Sunday, January 18, 2009

Syphilis in Pregnancy

Syphilis in pregnancy could threatening the fetus. T. pallidum could crosses the placenta, resulting in fetal infection. Vertical transmission can occur at any time during pregnancy and at any stage of syphilis. Vertical transmission of syphilis is more common in primary (50%) and secondary syphilis (50%), compared with early latent (40%), late latent (10%), and tertiary syphilis (10%). Seventy to one hundred per cent of infants born to untreated infected mothers are infected. Pregnancies complicated by syphilis may result in intrauterine growth restriction, non-immune hydrops fetalis, stillbirth, preterm delivery, and spontaneous abortion in up to 50% of pregnancies. Women who had documented treatment for syphilis in the past do not need treatment during current or subsequent pregnancies.
Penicillin is the drug of choice for treating all stages of syphilis. Parenteral rather than oral treatment has been the route of choice as the therapy is supervised and bioavailability is guaranteed. Most women treated during pregnancy will deliver before their serological response to treatment can be assessed definitively. Neonates born to such women should be evaluated for congenital syphilis. For the treatment of early syphilis during pregnancy is procaine penicillin 750 mg daily for 10 days. If it is not possible to give daily procaine penicillin on the weekend, then either long-acting procaine penicillin in aluminium stearate, 2 million units (MU) or long-acting benethamine penicillin 1.2 MU should be given IM on the Friday. Patients with penicillin allergy: erythromycin 500 mg four times a day should be given for 14 days. Alternatively, azithromycin 500 mg should be given daily for 10 days. In addition to this, examination, tests, and treatment of all babies at birth should be carried out. Desensitization to penicillin may be considered, followed by the first-line treatment. Mothers treated with erythromycin or azithromycin may be considered for retreatment with doxycycline after delivery and when breast-feeding is stopped.
(Expert Rev Vaccines. 2008;7(10):1465-1473)

Saturday, January 17, 2009

Inappropriate Antibiotic Prescribing Contributes To The Higher Bacterial Resistance

Inappropriate antibiotic prescribing contributes to the problem of higher bacterial resistance. Bacterial resistance to antibiotics is a major public health problem, increasing morbidity and mortality as well as healthcare costs.
Rates of antimicrobial resistance were higher in countries with the highest consumption of antibiotics. In countries with the highest use of antibiotics, prescription rates peaked during cold and flu seasons. The antibiotics were prescribed for sore throat during 73% of visits although the prevalence of sore throat caused by bacterial infection among adults is between 5% and 17%. Moreover, most of these patients received antibiotics that were not recommended for pharyngitis, with a high number of prescriptions being for extended-spectrum antibiotics. More than half of children with sore throats received antibiotics, a rate significantly higher than the regular prevalence of bacterial pharyngitis. Furthermore, more than one quarter of these children received an inappropriate antibiotic.
In a study it was found that the rates of resistance of S. pneumoniae to penicillin, amoxicillin-clavulanate, and cefdinir were 16%, 6.4%, and 19.2%, respectively. The least effective agents against S. pneumoniae were trimethoprim-sulfamethoxazole and azithromycin, with resistance rates of 23.5% and 34%, respectively. In a study of resistance in urinary tract infections in one health maintenance organization in the United States, the prevalence of resistance among isolates of Escherichia coli to ampicillin, cephalothin, and sulfamethoxazole exceeded 20% in each of the study years 1992 to 1996. The overall prevalence of resistance to trimethoprim-sulfamethoxazole doubled between 1992 and 1996.

Friday, January 16, 2009

Rotavirus among Children Worldwide

A hospital-based surveillance reports indicate that during 2001-2008, rotavirus accounted for approximately 40% of hospitalizations for diarrhea among children aged <5>85% of these deaths occurring in low-income countries of Africa and Asia. Two licensed rotavirus vaccines have shown efficacy of 85%-98% against severe rotavirus diarrhea in trials conducted in the Americas and Europe and they have been introduced into routine immunization programs in 11 countries in these regions and in Australia. Although the two licensed rotavirus vaccines differ in strain composition (i.e., one is monovalent, and one is pentavalent), both appear to provide protection against a variety of strains, including some strains not included in either of the licensed vaccines.
(MMWR. 2008;57(46):1255-1257)

Thursday, January 15, 2009

Maternal Vaccination for Influenza is Safe

In pregnant women and young infants Influenza could induce a serious disease. The maternal antibodies can pass transplacentally, therefore, it can protect infants during the first months of life. Currently, it is recommended that pregnant women be immunized with the inactivated trivalent influenza vaccine. However, compliance with this recommendation is low. The vaccine is not licensed for infants less than 6 months of age, and antiviral agents are not licensed for children younger than 1 year of age. Thus prevention of influenza by other means is an important goal. A study performed in Bangladesh provides data indicating that maternal vaccination for influenza is safe and efficacious. The vaccine also reducing illness among both mothers and infants, therefore antenatal immunization should be considered as an important strategy for the prevention of influenza.
(N Engl J Med 359:1555, 2008)