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MedPulse is a weekly index of key news and features on
Medscape's
specialty sites compiled by Medscape's Editors.
_______________________________________________________________________
___________________ NEW FEATURE ARTICLES THIS WEEK
____________________
-- MEDSCAPE ORIGINAL ARTICLES --
HEPATOLOGY FOCUS - LIVER TRANSPLANTATION: AN UPDATE
Christopher R. Shackleton, MD, and Paul Martin, MD,
discuss topical issues
in orthotopic liver transplantation, including the
challenge of recurrent
disease and strategies for expansion of the donor
pool.
Medscape Gastroenterology 3(6), 2001
http://id.medscape.com/44857.rhtml?srcmp=id-110901
-- WEEKLY EPIDEMIOLOGICAL RECORD --
SMALLPOX
A thorough review of the clinical features, treatment,
and response to an
outbreak, from the WHO.
Weekly Epidemiological Record, 2001
http://id.medscape.com/44605.rhtml?srcmp=id-110901
-- MMWR --
UPDATE: INVESTIGATION OF BIOTERRORISM-RELATED ANTHRAX
AND INTERIM
GUIDELINES FOR CLINICAL EVALUATION OF PERSONS WITH
POSSIBLE ANTHRAX
Until the source of these intentional exposures is
eliminated, clinicians
and laboratorians should be alert for clinical
evidence of Bacillus
anthracis infection.
MMWR 50(43):941-948, 2001. Centers for Disease Control
http://www.medscape.com/44759.rhtml
NOTICE TO READERS: UPDATED RECOMMENDATIONS FOR
ANTIMICROBIAL PROPHYLAXIS AMONG ASYMPTOMATIC PREGNANT WOMEN AFTER EXPOSURE TO
BACILLUS ANTHRACIS
The antimicrobial of choice for initial prophylactic
therapy among
asymptomatic pregnant women exposed to Bacillus
anthracis is ciprofloxacin,
500 mg twice a day for 60 days.
MMWR 50(43):960, 2001. Centers for Disease Control
http://www.medscape.com/44763.rhtml
WEEKLY UPDATE: WEST NILE VIRUS ACTIVITY --- UNITED
STATES, OCTOBER 24--30, 2001
No human cases of WNV encephalitis or meningitis were
reported this week.
MMWR 50(43):959, 2001. Centers for Disease Control
http://www.medscape.com/govmt/CDC/MMWR/2001/11.01/mmwr5043.04/mig-pnt-mmwr5043.04.html
-- INFECTIONS in MEDICINE --
METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS IN THE
COMMUNITY
Infection caused by methicillin-resistant
Staphylococcus aureus MRSA has
increased consistently in prevalence since it was
first reported in 1968.
Infect Med 18(10):452, 2001
http://id.medscape.com/44767.rhtml?srcmp=id-110901
A LAWYER FROM HONDURAS WITH FEVER AND HYPOTENSION
A 43-year-old man was transferred to our institution
from Honduras for
evaluation of persistent fever.
Infect Med 18(10):453-460, 2001
http://id.medscape.com/44796.rhtml?srcmp=id-110901
_______________________________________________________________________
___________________________________ NEWS
______________________________
-- ANTHRAX: DIAGNOSIS --
ANTHRAX NEWSBEAT
Read the latest news and useful resources on the
spread, diagnosis, and
treatment of this organism.
http://www.medscape.com/newsbeat/anthrax
ANTHRAX RECOGNITION AND MANAGEMENT REVIEWED FOR
CLINICIANS
With the threat of new anthrax cases still looming,
the New England Journal
of Medicine has released a paper from the November
29th issue, highlighting
the recognition and management of anthrax infection.
http://id.medscape.com/44752.rhtml?srcmp=id-110901
NEW RAPID ANTHRAX TEST AVAILABLE
The Mayo Clinic in Rochester, Minnesota, has developed
a new DNA test to
rapidly identify anthrax in human and environmental
samples in less than 1
hour instead of days.
http://id.medscape.com/44769.rhtml?srcmp=id-110901
SENSOR MADE OF POROUS SILICON MAY REPLACE GRAM STAIN,
IDENTIFY BACTERIA
Using porous silicon and an organic receptor,
scientists at the University
of Rochester in New York can differentiate between
Gram-positive and
Gram-negative bacteria.
http://id.medscape.com/44893.rhtml?srcmp=id-110901
MONITOR SYSTEM OFFERS EARLY WARNING OF BIOATTACK
Stanford University hospital is testing a new system
to monitor the
symptoms of patients brought to emergency rooms in an
effort to gain early
warning of a possible biological attack.
http://id.medscape.com/44635.rhtml?srcmp=id-110901
-- ANTHRAX: TREATMENT & PROPHYLAXIS --
HIGH RATE OF ADVERSE EVENTS REPORTED WITH ANTHRAX
PROPHYLAXIS
Adverse reactions to anthrax antimicrobial
prophylaxis, mostly with
ciprofloxacin, are being reported by about 20% of
those taking it,
according to the CDC.
http://id.medscape.com/44912.rhtml?srcmp=id-110901
NEW ANTHRAX VACCINE FROM INDIA READY FOR TRIALS
A new human anthrax vaccine, developed in India, is
ready for clinical
trials, according to Dr. Rakesh Bhatnagar, chairman of
the Center for
Biotechnology at the Jawaharlal Nehru University in
New Delhi.
http://id.medscape.com/44623.rhtml?srcmp=id-110901
-- ANTHRAX OUTBREAKS: US --
US INVESTIGATES NEW ANTHRAX CONTAMINATIONS
US authorities were investigating two new anthrax
contamination cases on
Monday, as another Capitol Hill office building
received the all-clear to
reopen all but three of its offices.
http://id.medscape.com/44686.rhtml?srcmp=id-110901
ANTHRAX TRACES FOUND AT PENTAGON POST OFFICE
Traces of anthrax have been found at a post office in
the Pentagon, but the
facility was decontaminated over the weekend and no
further signs of the
potentially deadly spores were found, a US defense
official said on Monday.
http://id.medscape.com/44689.rhtml?srcmp=id-110901
CDC SAYS FDA'S MAILROOM FACILITIES ARE NOT
CONTAMINATED
Further testing of the US Food and Drug Administration
mailroom facilities
in Maryland for anthrax has turned out negative,
according to a memo
distributed to FDA employees by Acting Principal
Deputy Commissioner Dr.
Bernard Schwetz.
http://id.medscape.com/44693.rhtml?srcmp=id-110901
-- ANTHRAX OUTBREAKS: INTERNATIONAL --
US CONSULATE IN PAKISTAN TESTS NEGATIVE FOR ANTHRAX
US laboratory tests for suspected anthrax from the
American consulate in
the Pakistani city of Lahore are negative, White House
spokesman Ari
Fleischer said on Wednesday.
http://id.medscape.com/44851.rhtml?srcmp=id-110901
ANTHRAX CONTAMINATION FOUND IN PAKISTAN, FIRST OUTSIDE
US
A Pakistan newspaper editor said on Friday that a
white powder in an
envelope hand-delivered to his paper last week had
tested positive for
anthrax spores, the first confirmed case of its kind
outside the United States.
http://id.medscape.com/44634.rhtml?srcmp=id-110901
ANTHRAX SPOOKS EUROPE THOUGH LITTLE TRACE FOUND
From a German
with an odd taste in birthday pranks to the powdery death
threat mailed to a Romanian soccer referee, anthrax
has Europe on edge --
but it is not yet clear that bioterrorism has spread
beyond the United States.
http://id.medscape.com/44687.rhtml?srcmp=id-110901
US CONSULATE IN RUSSIA RECEIVES ANTHRAX-CONTAMINATED
MAIL
The worldwide anthrax scare extended to the edge of
Siberia Tuesday when
the US consulate in Yekaterinburg, Russia, confirmed
it had received mail
tainted with anthrax.
http://id.medscape.com/44753.rhtml?srcmp=id-110901
-- SMALLPOX --
MEDICAL WORKERS VACCINATED AGAINST SMALLPOX
The United States, fearful of a bioterrorism attack
similar to the anthrax
scare sweeping the country, announced on Sunday that
key frontline medical
workers were being vaccinated against smallpox.
http://id.medscape.com/44688.rhtml?srcmp=id-110901
MASS SMALLPOX VACCINE PRODUCTION RAMPS UP; LOCALITIES
STRUGGLE TO PREPARE
Vaccine makers in the US are 'up to the effort' of
manufacturing 300
million doses of smallpox vaccine by the middle of
next year, an industry
representative told lawmakers on Friday.
http://id.medscape.com/44637.rhtml?srcmp=id-110901
ENFORCEABLE, MANDATORY VACCINATION SEEN NECESSARY IN
EVENT OF SMALLPOX ATTACK
Should smallpox be used as a biological weapon in the
USA, public health
officials must have the authority to quarantine and
forcibly vaccinate the
entire population -- with the help of the military if
needed -- an expert
said on Monday.
http://id.medscape.com/44690.rhtml?srcmp=id-110901
PRE-1970S SMALLPOX VACCINATION MIGHT STILL CONFER SOME
PROTECTION
More than 20 years after the eradication of the
smallpox virus in the wild,
the threat of biological warfare has spurred the US
government to build up
a stockpile of smallpox vaccine.
http://id.medscape.com/44691.rhtml?srcmp=id-110901
US MAY SELECT SMALLPOX VACCINE MAKERS NEXT WEEK
US Health and Human Services Secretary Tommy Thompson
said on Tuesday that
he expected to select by early next week the firm or
firms that will make
smallpox vaccine for the government.
http://id.medscape.com/44850.rhtml?srcmp=id-110901
GERMAN OPPOSITION URGES SMALLPOX VACCINATIONS
Political pressure is growing in Germany for the
government to take prompt
action to prepare for the possibility of terrorists
unleashing a smallpox
attack.
http://id.medscape.com/44849.rhtml?srcmp=id-110901
GERMANY SAYS SMALLPOX VACCINE STOCKPILE IN PLACE
The German government has announced that it now has
stockpiled 6 million
doses of smallpox vaccine that can be used immediately
if the need arises.
http://id.medscape.com/44911.rhtml?srcmp=id-110901
-- BIOTERRORISM PREPAREDNESS --
BIOTERRORISM RESOURCE CENTER: ARE WE PREPARED FOR A
BIO-TERRORIST
ATTACK?
A collection of news, guidelines, and clinical
articles on the recognition
and treatment of potential biowarfare agents.
http://www.medscape.com/mp/rc/bioterrorism
HHS NAMES HOPKINS PROFESSOR TO LEAD BIOTERRORISM
PREPAREDNESS OFFICE
HHS Secretary Tommy Thompson has named Dr. Donald A.
Henderson chairman of
the newly-formed Office of Public Health Preparedness,
which will work to
coordinate HHS' efforts to prepare for and respond to
bioterrorism and
other public health emergencies.
http://id.medscape.com/44636.rhtml?srcmp=id-110901
FDA'S WOODCOCK TO DEVELOP AGENCY'S TERRORISM RESPONSE
PLAN
To better prepare the FDA for a possible terrorist
act, FDA Acting
Commissioner Dr. Bernard Schwetz on Monday assigned
Dr. Jane Woodcock,
director of the agency's Center for Drug Evaluation
and Research (CDER), to
establish a formal, long-term plan.
http://id.medscape.com/44694.rhtml?srcmp=id-110901
ENFORCEMENT OFFICIALS URGE STRONGER PENALTIES FOR
BIOTERROR HOAXES
Officials from the FBI and the Justice Department told
a US Senate
subcommittee Tuesday that they are not as far along as
they hoped to be in
discovering who has been sending anthrax bacteria
through the mail, and
they urged Congress to more severely punish those who
pretend to be
carrying out acts of bioterrorism.
http://id.medscape.com/44746.rhtml?srcmp=id-110901
BIOLOGISTS 'NAIVE' OVER TERROR THREAT
A scientific adviser to United States Secretary of
Defense Donald Rumsfeld
warned biologists on Tuesday that they should be less
naive in order to
prevent their work from being used for terrorist
purposes.
http://id.medscape.com/44754.rhtml?srcmp=id-110901
-- TUBERCULOSIS --
HIV EPIDEMIC IN RUSSIA COULD LEAD TO SURGE IN
TUBERCULOSIS CASES
A rapid rise in the number of people infected with HIV
in Russia could lead
to a tuberculosis epidemic there, scientists warned on
Friday.
http://id.medscape.com/44628.rhtml?srcmp=id-110901
NEW TUBERCULOSIS VACCINE TRIALS SET TO START IN
BRITAIN
Clinical trials of the first vaccine against
tuberculosis since BCG was
developed 80 years ago are about to begin in the UK,
the Wellcome Trust
funding charity has announced.
http://id.medscape.com/44735.rhtml?srcmp=id-110901
-- RESPIRATORY TRACT INFECTIONS --
PREMIER LAUNCHES CARE REGIMEN FOR PNEUMONIA SEASON
About 75 hospitals who subscribe to Premier Inc.'s
Clinical Performance
Initiatives database have agreed to implement a new
screening initiative
aimed at improving care for patients with pneumonia.
http://id.medscape.com/44630.rhtml?srcmp=id-110901
REDUCING ASPIRATION, SEDATION COULD CUT PNEUMONIA RISK
IN LONG-TERM CARE
PATIENTS
The identification of two modifiable risk factors for
pneumonia among
patients in long-term care may help reduce the burden
of pneumonia-related
mortality, based on findings reported in the October
22nd issue of Archives
of Internal Medicine.
http://id.medscape.com/44678.rhtml?srcmp=id-110901
-- HEPATITIS --
UNIVERSAL VACCINATION HAS GREATLY REDUCED HEPATITIS B
CARRIER RATE IN TAIWAN
A paper in the November 6th issue of the Annals of
Internal Medicine
documents the effectiveness of universal hepatitis B
vaccination in a
hyperendemic region.
http://id.medscape.com/44692.rhtml?srcmp=id-110901
INFECTIOUS HEPATITIS B STATUS USUALLY CLEARS WITHIN 10
YEARS
Most patients chronically infected with hepatitis B
virus become negative
for hepatitis B e antigen (HBeAg) within 10 years,
according to the results
of a population-based study among Alaskan Natives.
http://id.medscape.com/44741.rhtml?srcmp=id-110901
-- HIV/AIDS AND OTHER STDs --
PROMPT TREATMENT OF INITIAL HSV EPISODE WITH ACYCLOVIR
CUTS REACTIVATION IN
VIVO
In a murine model, early treatment with high doses of
acyclovir during
primary herpes simplex virus (HSV) infection appears
to reduce the level of
latent infection.
http://id.medscape.com/44698.rhtml?srcmp=id-110901
HHV-6 SUPPRESSES CCR5-TROPIC HIV-1 BY INCREASING
RANTES PRODUCTION
Human herpesvirus 6 (HHV-6) upregulates the production
of the CCR5
chemokine receptor ligand RANTES (regulated upon
activation, normal T-cell
expressed and secreted) in lymphoid tissue and thereby
suppresses
CCR5-tropic HIV-1, according to a report in the
November issue of Nature
Medicine.
http://id.medscape.com/44855.rhtml?srcmp=id-110901
-- SEPSIS --
INCIDENCE OF SEPSIS IN US CONTINUES TO RISE
From 1988 to
1998, the incidence of sepsis in the US increased by 23.3%,
according to study findings presented on Tuesday at
the 67th annual
scientific meeting of the American College of Chest
Physicians in Philadelphia.
http://id.medscape.com/44742.rhtml?srcmp=id-110901
EARLY GOAL-DIRECTED THERAPY, INTENSIVE GLYCEMIC
CONTROL REDUCE SEPSIS MORTALITY
Mortality among patients presenting to an emergency
department with severe
sepsis, septic shock or the sepsis syndrome is reduced
when therapy aimed
at preventing global tissue hypoxia is begun before
admission to an ICU,
according to investigators at Case Western Reserve
University in Detroit.
http://id.medscape.com/44825.rhtml?srcmp=id-110901
-- GI INFECTIONS --
NEW TEST SPEEDS SALMONELLA DETECTION
Scientists in California have developed a test that
drastically reduces the
time it takes to identify Salmonella enteritidis, a
common source of food
poisoning.
http://id.medscape.com/44619.rhtml?srcmp=id-110901
DINNER PARTIES ARE A MAJOR SOURCE OF FOOD POISONING IN
THE HOME
Social functions such as barbecues and dinner parties
are the most common
source of food poisoning in the home, according to UK
investigators.
http://id.medscape.com/44898.rhtml?srcmp=id-110901
-- VACCINES --
ACELLULAR PERTUSSIS VACCINATIONS IN INFANCY PROVIDE
PROTECTION UP TO AGE 6
The protection against pertussis afforded by three
doses of
diphtheria-tetanus-acellular pertussis vaccine (DTaP)
administered at 2, 4
and 6 months of age persists through 6 years of age,
Italian investigators
report.
http://id.medscape.com/44823.rhtml?srcmp=id-110901
-- EUROPEAN TAINTED BLOOD CASE --
CONTAMINATED BLOOD TRIAL IN ITALY MAY IMPLICATE HEALTH
MINISTER
Italian Health Minister Girolamo Sirchia might face
charges in a trial over
HIV and hepatitis infections caused by transfusion of
contaminated blood
that began on Tuesday in Trento.
http://id.medscape.com/44845.rhtml?srcmp=id-110901
ITALIAN STATE MAY JOIN TAINTED BLOOD TRIAL AS INJURED
PARTY
The Italian State is considering seeking compensation
as a injured party in
a trial about HIV and hepatitis-contaminated blood
that reopened on
Tuesday, the Health Ministry said in a official
statement on Thursday.
http://id.medscape.com/44903.rhtml?srcmp=id-110901
IRELAND TO INVESTIGATE COMPANIES IMPLICATED IN TAINTED
BLOOD SUPPLY
The Republic of Ireland's Minister for Health and
Children, Micheal Martin,
and the Irish Haemophilia Society will send lawyers to
the United States to
prepare a case for an enquiry into the supply of
HIV-infected blood
products by multinational companies.
http://id.medscape.com/44906.rhtml?srcmp=id-110901
-- VARICELLA --
DEATHS FROM CHICKENPOX AMONG ADULTS INCREASING IN UK
The number of adult deaths from chickenpox is
increasing in England and
Wales, according to the results of a study published
on Friday.
http://id.medscape.com/44897.rhtml?srcmp=id-110901
S. PYOGENES A FREQUENT CAUSE OF COMPLICATIONS IN
CHILDREN WITH VARICELLA
Although infectious complications represent about a
third of severe
complications experienced by previously healthy
children with varicella,
Streptococcus pyogenes involvement represents
approximately half of cases
with chronic sequelae, German investigators report.
http://id.medscape.com/44899.rhtml?srcmp=id-110901
-- OTHER ID NEWS --
ZITHROMAX ENDORSED AS SINGLE-DOSE TREATMENT OF ACUTE
OTITIS
Expert advisors to the FDA recommended on Wednesday
that the agency grant
pharmaceutical maker Pfizer Inc. a supplemental
indication for its
antibiotic Zithromax (azithromycin), which in effect
would allow doctors to
prescribe a single dose for the treatment of acute
otitis media.
http://id.medscape.com/44854.rhtml?srcmp=id-110901
ANTIBIOTIC PEPTIDE IDENTIFIED IN SWEAT
In a report published in the November 5th online
edition of Nature
Immunology, researchers describe a new antibiotic
peptide that is secreted
by sweat glands.
http://id.medscape.com/44695.rhtml?srcmp=id-110901
AMA RECOMMENDS NONHORMONAL CONTRACEPTION DURING
RIFAMPIN USE
The American Medical Association has adopted new
recommendations regarding
the increased risk of oral contraceptive failure when
they are used
concomitantly with antibiotics.
http://id.medscape.com/44891.rhtml?srcmp=id-110901
PATIENTS OFTEN PRESSURE PHYSICIANS FOR UNNEEDED
ANTIBIOTICS
Overprescription and subsequent overuse of antibiotics
is an increasing
concern, contributing to higher drug costs and the
increasing prevalence of
antibiotic-resistant bacteria.
http://id.medscape.com/44908.rhtml?srcmp=id-110901
______________________________________________________________________
_______________________________ MEMBER NEWS
__________________________
BIOTERRORISM RESOURCE CENTER: ARE WE PREPARED FOR A
BIO-TERRORIST
ATTACK?
http://www.medscape.com/mp/rc/bioterrorism
ANTHRAX: WHAT EVERY CLINICIAN SHOULD KNOW
This recording of the live webcast from the CDC
presents clinical
guidelines and procedures for the early recognition,
diagnosis, treatment,
and reporting of anthrax exposure. A panel of experts
from the CDC provide
an overview of clinical, laboratory and public health
preparedness for
potential Bacillus anthracis incidence. Sponsored by
the American Hospital
Assn., American Medical Assn., Public Health Training
Network, CDC, and the
University of North Carolina School of Public Health.
http://www.medscape.com/webcast/anthrax
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