Severe adverse events, including eczema vaccinatum (EV), can result after smallpox vaccination. Persons at risk for EV include those with underlying dermatologic conditions, such as atopic dermatitis. We investigated a case of vaccinia infection, possibly acquired during sexual contact with a recently vaccinated military service member, in a female Maryland resident with atopic dermatitis. The U.S. Department of Defense's Vaccine Healthcare Centers Network (VHCN) and the Centers for Disease Control and Prevention (CDC) worked in conjunction with the patient's physician and the Maryland Department of Health and Mental Hygiene (DHMH) to confirm the diagnosis, ensure treatment, and prevent further transmission. Specimens collected from the patient were tested at the DHMH laboratories and were positive by real-time polymerase chain reaction for nonvariola orthopoxvirus. Testing at the CDC verified the presence of vaccinia-specific DNA signatures. Continuing spread of the patient's lesions led to the administration of vaccinia immune globulin and strict infection control measures to prevent tertiary transmission to vulnerable family members, also with atopic dermatitis. VHCN contacted the service member to reinforce vaccination site care and hygiene. This case underscores the importance of prevaccination education for those receiving the smallpox vaccine to protect contacts at risk for developing severe adverse reactions.
Purpose. In this study, we examined whether the decrease in endothelial function associated with short-term exposure to elevated retrograde shear rate (SR), could be prevented when combined with a concurrent drop in transmural pressure in humans.Methods. Twenty-five healthy individuals reported to our laboratory on 3 occasions to complete 30-min experimental conditions, preceded and followed by assessment of endothelial function using flow-mediated dilation (FMD). We used cuff inflation for 30min to manipulate retrograde SR and transmural pressure in the brachial artery. Subjects underwent, in randomised order: 1. forearm cuff inflation to 60 mmHg (Distal cuff; causing increase in retrograde SR), 2. Upper arm cuff inflation to 60 mmHg (Proximal cuff; causing increase in retrograde SR + decrease in transmural pressure), and 3. No cuff inflation (Control).Results. The Distal and Proximal cuff conditions both increased brachial artery retrograde SR (p<0.001) and oscillatory shear index (p<0.001). The Control intervention did not alter SR patterns or FMD (p>0.05). A significant interaction-effect was found for FMD (p<0.05), with the decrease during Distal cuff
Aims We wished to determine the incidence of pulmonary hypertension and complications due to Respiratory syncitial virus (RSV) infection in children undergoing cardiopulmonary bypass in a multi-centre randomised trial. Patients and methods Children with haemodynamically significant congenital heart disease (CHD) were matched and randomised to receive palivizumab or placebo during the period 2003–2005 in a multi-centre randomised clinical trial of 1287 children. All those who also underwent cardiac surgery were included in the present study, comparing outcomes for those who acquired RSV infection with those who did not (controls), matched for demographics (age and weight at operation), and physiology of cardiac morphology; left to right shunt (L-R), right to left shunt (R-L) and single ventricle physiology (SV). Cardiac surgery was delayed for more than 6 weeks after the RSV infection. Results 183 children were included in this study of whom 20 suffered from RSV infection during the study period. There were six undergoing correction of L-R, 4 with tetralogy of Fallot or complex transposition (R-L), seven undergoing Glenn shunt (SV), and three others, all at 1 month to 10 months in age. There was no difference in intensive care stay between RSV infected children and controls, or in days of mechanical ventilation, or hospital stay, but supplemental oxygen requirement was increased in L-R by 17% compared to only 3% in controls (p<0.05). In SV 13% had increased oxygen requirement compared to controls (2%) (p<0.05). There was no difference in the R-L group. Duration of heart failure medication tended to be longer in all three groups (L-R more than 6 months in 67% p<0.01, R-L 50% and SV group 63%, both p=NS). Noticeably only 17% of R-L required medication for less than 1 month, versus 48% of controls. Conclusion We have shown that RSV infection more than 6 weeks before cardiopulmonary bypass causes significant morbidity, although we found no indirect evidence of pulmonary hypertension after RSV infection. All three RSV groups demonstrated longer duration of medication, possibly representing respiratory dysfunction several months after RSV infection. A prospective study is needed to determine the longer term effects of RSV in CHD.
This article provides an overview of myeloproliferative neoplasms for nurses who do not specialise in haematology. Diagnosis, management and treatment of patients with these conditions is discussed, as well as long-term nursing implications.
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