REVIEW – Human papillomavirus in 2019: An update on cervical cancer prevention and screening guidelines

Cleveland Clinic Journal of Medicine December 2019 V.86 N.12 P.173-178

ABSTRACT

The human papillomavirus (HPV) causes most cases of cervical cancer. Healthcare providers can help prevent this cancer by recommending HPV vaccination when appropriate, regularly screening women for cervical cancer, and following up on abnormal test results.

KEY POINTS

-Immunization against HPV can prevent up to 70% of HPV-related cervical cancer cases.

-Gardasil 9 is the only HPV vaccine currently available in the United States and is now approved for use in males and females between the ages of 9 and 45.

-In girls and boys younger than 15, a 2-dose schedule is recommended; patients ages 15 through 45 require 3 doses.

-Vaccine acceptance rates are highest when primary care providers announce that the vaccine is due rather than invite open-ended discussions.

-Regular cervical cancer screening is an important preventive tool and should be performed using the Papanicolaou (Pap) test, the high-risk HPV-only test, or the Pap-HPV cotest.

FULL TEXT

https://www.ccjm.org/content/86/3/173

PDF

https://www.ccjm.org/sites/default/files/additional-assets/PDFs/86_3_173.pdf

January 20, 2020 at 10:54 am

EDITORIAL – The return of measles—an unnecessary sequel

Cleveland Clinic Journal of Medicine December 2019 V.86 N.12 P.365-366

Concerns over fake news and alternative facts have permeated the fabric of our daily life. Trust in entrenched establishments seems to be at an all-time low. I grew up in the 1960s; I grew up with “don’t trust the man.” I grew up with the Vietnam War, Watergate, and the military-industrial complex, and I have read and heard enough since then to know that a good amount of our distrust was well founded. More recently, there has been increased public scrutiny of the “pharmaceutical-medical complex,” with concerns being raised in the media and by legislators regarding drug pricing, seemingly inappropriate physician prescribing of medications encouraged by drug manufacturers, and the overall costs of medical care. And yes, there is …

FULL TEXT

https://www.ccjm.org/content/86/6/365

PDF

https://www.ccjm.org/content/ccjom/86/6/365.full.pdf

January 20, 2020 at 10:52 am

Review – Measles: A dangerous vaccine-preventable disease returns

Cleveland Clinic Journal of Medicine December 2019 V.86 N.12 P.393-398

ABSTRACT

Although a safe and effective vaccine has been available for over 6 decades, vaccine hesitancy in the United States and social and political unrest globally have led to under-vaccination. As a result, in recent months, vaccine control of measles has been threatened with an alarming upswing in measles cases nationally and internationally. Here, we review the disease and its management in view of recent outbreaks.

KEY POINTS

-Measles is highly contagious and can have serious complications, including death.

-Measles vaccine is given in a 2-dose series. People who have received only 1 dose should receive either 1 or 2 more doses, depending on the situation, so that they are protected.

-The diagnosis of measles is straightforward when classic signs and symptoms are present—fever, cough, conjunctivitis, runny nose, and rash—especially after a known exposure or in the setting of outbreak. On the other hand, in partially vaccinated or immunosuppressed people, the illness presents atypically, and confirmation of diagnosis requires laboratory testing.

-Management is mostly supportive. Children—and probably also adults—should receive vitamin A.

-Since disease can be severe in the unvaccinated, immune globulin and vaccine are given to the normal host with an exposure and no history of vaccine or immunity.

FULL TEXT

https://www.ccjm.org/content/86/6/393

PDF

https://www.ccjm.org/sites/default/files/additional-assets/PDFs/86_6_393.pdf

January 20, 2020 at 10:50 am

How to respond to flu vaccine doubters

Cleveland Clinic Journal of Medicine December 2019 V.86 N.12 P.782-788

The benefits of influenza vaccination are clear to those in the medical community. Yet misinformation and unfounded fears continue to discourage some people from getting a flu shot. During the 2018–2019 influenza season, only 45% of US adults and 63% of children were vaccinated.

What should we tell patients who say no to the flu shot?

Here are 12 reasons people give for not wanting to receive the inactivated influenza vaccine, along with some potential responses and comments about the nasal live-attenuated vaccine

FULL TEXT

https://www.ccjm.org/content/86/12/782

PDF

https://www.ccjm.org/content/ccjom/86/12/782.full.pdf

January 20, 2020 at 10:48 am

From contamination to infective endocarditis—a population-based retrospective study of Corynebacterium isolated from blood cultures.

European Journal of Clinical Microbiology & Infectious Diseases January 2020 V.39 N.1 P.113-119   

Corynebacterium is a genus that can contaminate blood cultures and also cause severe infections like infective endocarditis (IE).

Our purpose was to investigate microbiological and clinical features associated with contamination and true infection.

A retrospective population-based study of Corynebacterium bacteremia 2012–2017 in southern Sweden was performed.

Corynebacterium isolates were species determined using a matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry (MALDI-TOF MS).

Patient were, from the medical records, classified as having true infection or contamination caused by Corynebacterium through a scheme considering both bacteriological and clinical features and the groups were compared.

Three hundred thirty-nine episodes of bacteremia with Corynebacterium were identified in 335 patients of which 30 (8.8%) episodes were classified as true infection.

Thirteen patients with true bacteremia had only one positive blood culture. Infections were typically community acquired and affected mostly older males with comorbidities.

The focus of infection was most often unknown, and in-hospital mortality was around 10% in both the groups with true infection and contamination.

Corynebacterium jeikeium and Corynebacterium striatum were significantly overrepresented in the group with true infection, whereas Corynebacterium afermentans was significantly more common in the contamination group. Eight episodes of IE were identified, all of which in patients with heart valve prosthesis.

Six of the IE cases affected the aortic valve and six of seven patients were male. The species of Corynebacterium in blood cultures can help to determine if a finding represent true infection or contamination.

The finding of a single blood culture with Corynebacterium does not exclude true infection such as IE.

abstract

https://link.springer.com/article/10.1007/s10096-019-03698-6?wt_mc=alerts.TOCjournals&utm_source=toc&utm_medium=email&utm_campaign=toc_10096_39_1

PDF

https://link.springer.com/content/pdf/10.1007%2Fs10096-019-03698-6.pdf

January 19, 2020 at 8:08 pm

Candida auris Isolates Resistant to Three Classes of Antifungal Medications — New York, 2019

MMWR. January 10, 2020 V.69 N.1 P.6-9.

Summary

What is already known about this topic?

Candida auris is an emerging yeast that is often drug-resistant.

What is added by this report?

Three chronically ill patients in New York were identified as having pan-resistant C. auris after receipt of antifungal medications. No transmission of the pan-resistant isolates was found in patient contacts or the facility environments.

What are the implications for public health practice?

Three years after the first identification of C. auris in New York, pan-resistant isolates remain rare. Continued surveillance for C. auris, prudent antifungal use, and susceptibility testing for all C. auris clinical isolates (especially after patients have been treated with antifungal drugs) are needed.

FULL TEXT

https://www.cdc.gov/mmwr/volumes/69/wr/mm6901a2.htm

PDF

https://www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6901a2-H.pdf

January 18, 2020 at 6:13 pm

2018 recommendations for the management of community acquired pneumonia.

J Bras Pneumol. September-October 2018 V.;44 N.5 P.405-423.   

Corrêa RA1, Costa AN2, Lundgren F3, Michelin L4, Figueiredo MR5, Holanda M6, Gomes M7, Teixeira PJZ8, Martins R9, Silva R10, Athanazio RA2, Silva RMD11, Pereira MC12.

Abstract

Community-acquired pneumonia (CAP) is the leading cause of death worldwide. Despite the vast diversity of respiratory microbiota, Streptococcus pneumoniae remains the most prevalent pathogen among etiologic agents. Despite the significant decrease in the mortality rates for lower respiratory tract infections in recent decades, CAP ranks third as a cause of death in Brazil. Since the latest Guidelines on CAP from the Sociedade Brasileira de Pneumologia e Tisiologia (SBPT, Brazilian Thoracic Association) were published (2009), there have been major advances in the application of imaging tests, in etiologic investigation, in risk stratification at admission and prognostic score stratification, in the use of biomarkers, and in the recommendations for antibiotic therapy (and its duration) and prevention through vaccination. To review these topics, the SBPT Committee on Respiratory Infections summoned 13 members with recognized experience in CAP in Brazil who identified issues relevant to clinical practice that require updates given the publication of new epidemiological and scientific evidence. Twelve topics concerning diagnostic, prognostic, therapeutic, and preventive issues were developed. The topics were divided among the authors, who conducted a nonsystematic review of the literature, but giving priority to major publications in the specific areas, including original articles, review articles, and systematic reviews. All authors had the opportunity to review and comment on all questions, producing a single final document that was approved by consensus

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6467584/pdf/1806-3713-jbpneu-44-05-00405.pdf

January 18, 2020 at 12:22 pm

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