SUMMARY A patient is described with definite rheumatoid arthritis (RA) who developed life threatening acute pneumonitis after receiving a total dose of only 12-5 mg methotrexate (MTX). This complication has been previously described, but this is probably the lowest reported dose before development of pneumonitis in a patient with RA. The possible significance of this case is discussed in the light of recent reports suggesting an increased susceptibility of patients with RA to the pulmonary toxicity of MTX.
The effectiveness of Reality Orientation (RO) as treatment for disorientation and behavioral deficits in institutionalized elderly adults was assessed over a one-year period, with evaluations at 6-month intervals. Residents of a home for the aged with varying degrees of disorientation and disability were treated with a 24-hour RO program and were compared with a control group. A subsample of disoriented residents also attended RO classes and was compared with controls. Treatment effects were assessed with a Mental Status Questionnaire (MSQ) and ratings of Activities of Daily Living (ADL) and interpersonal behaviors. Compared with controls, who showed deterioration, the subsample attending RO classes showed slight, statistically significant improvement on the MSQ after 6 months. There was no favorable effect on ADL or other measures. Comparisons with other studies suggest that advanced age, severity of disorientation and disability limit the effectiveness of RO.
Recommendations for routine vaccination of adolescents and adults are continually evolving; new vaccines are licensed, and ongoing studies lead to updated recommendations for existing vaccines. Although vaccination is important for both sexes, some recent developments are particularly relevant for women and girls. Human papillomavirus (HPV) vaccine, licensed in 2006, is the first vaccine administered exclusively to women. Another recently licensed vaccine, adult and adolescent tetanus-diphtheria-acellular pertussis (Tdap), is especially important for women who plan to become pregnant and for new mothers to help prevent pertussis disease in infants who are too young to be vaccinated themselves. Other vaccines, such as influenza and rubella, are also important for pregnant women. Several vaccine safety issues are of particular relevance to women, namely, the theoretical risk of administering live vaccines during pregnancy and data suggesting that adolescent females might be at higher risk for syncope following vaccination. Obstetrician-gynecologists are the primary, and sometimes only, contact with the healthcare system for many adolescent and adult women and, as such, are uniquely positioned to provide vaccination services to the country's female population. Vaccine costs, storage and handling requirements, lack of access to immunization information systems (also known as vaccine registries), and unfamiliarity with current recommendations are potential obstacles to ensuring that all adolescent females and women are appropriately vaccinated. Obstetrician-gynecologists can help reduce some of these obstacles by availing themselves of existing vaccination resources.
The aims in management of an arthropathy are to relieve symptoms, preserve function, and control the disease process. Drugs are an important, although not the only, part of any therapeutic regimen enabling us to achieve these aims. Although each individual requires a unique strategy, there is a logical progression from first-line agents to second-line agents. Third-line agents and experimental methods are reserved for aggressive or life-threatening disease. The choice of agent in each group is personal preference, but many agents have high adverse effect profiles, and close monitoring is essential.
BackgroundThe Centers for Disease Control and Prevention (CDC) educates providers and the public about vaccine-preventable diseases and vaccines. Educational tools should be targeted to appropriate audiences and topic areas relevant to them. One important CDC educational tool is its long-standing email question and answer service, NIPINFO@cdc.gov. Two CDC public health professionals (one physician and one non-physician) are assigned daily to answer questions.We describe: 1) the distribution of queries by topic type, query source and level of difficulty; 2) analyses of questions involving safety, particularly safety of HPV vaccine; and 3) the impact of CDC introducing a new vaccine recommendation on the volume and type of queries related to that vaccine.MethodsQueries were summarized from August 2013 through March 2016. Queries were coded by topic (disease/vaccine), subtopic (e.g., safety), source (private provider, public provider, general public) and level of difficulty. Frequencies and strength of associations were generated by SAS 9.3. We also studied the trend of volume of queries relative to the timing of new CDC vaccine recommendations.ResultsDuring the study period, 23,783 queries were answered. The top three query topics were “multiple” (meaning one or more questions about more than one vaccine) (20%), influenza (14%), and miscellaneous (8%). HPV, miscellaneous, and multiple vaccine questions were most frequently rated the most difficult. The percentage of most difficult questions was similar among the public (10%) and providers (11%). HPV queries were more likely than non-HPV queries to be about safety (19% and 10% respectively P <.0001). HPV questions were more likely to come from the general public (31%) compared with other types of questions (20%). The timing of CDC vaccine policy publications did not affect the volume of questions received on that topic after the policy was published.ConclusionThe most common primary query topics were multiple vaccines, influenza, and miscellaneous. Safety of HPV vaccine is a topic that stimulates challenging questions. Publication of CDC vaccine recommendations did not affect timing or volume of queries in this evaluation.Disclosures All authors: No reported disclosures.
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