Archive for May, 2012

Recommended Adult Immunization Schedule: United States, 2012*

Ann Intern Med   February 7, 2012  V.156 N.3 P.211-217

Clinical Guidelines

Advisory Committee on Immunization Practices†

From the Centers for Disease Control and Prevention, Atlanta, Georgia.

The Advisory Committee on Immunization Practices (ACIP) annually reviews the recommended Adult Immunization Schedule (Figures 1 and 2) to ensure that the schedule reflects current recommendations for licensed vaccines. In October 2011, ACIP approved the Adult Immunization Schedule for 2012, which includes several changes from2011. Afootnote directing readers to links for the full ACIP vaccine recommendations and where to find additional information on specific vaccine recommendations for travelers is now included. In addition, a table summarizing precautions and contraindications was added (Table). This table is based on the corresponding table in the 12th edition of Epidemiology and Prevention of Vaccine-Preventable Diseases (1) and is included to provide ready access to key safety information for adult vaccine providers.

PDF

http://www.annals.org/content/156/3/211.full.pdf+html

 

EDITORIAL

Adult Immunization 2012: Politics, Process, and Progress

Sandra Adamson Fryhofer, MD

From Emory University, Atlanta, GA 30309.

This issue of Annals marks the sixth consecutive publication of the annual update of the Advisory Committee on Immunization Practices (ACIP) Adult Immunization Schedule (1). For the first time, the adult schedule and the schedule for children and adolescents (2) are designed to be combined. This editorial highlights the rationale behind key changes.

Economics and the Politics of Vaccination Policy

Recommendations by the committee do not become policy of the Centers for Disease Control and Prevention (CDC) until they are signed by the CDC Director and accepted by the Secretary of the U.S. Department of Health and Human Services. This allows for discretionary oversight (3). These recommendations are considered provisional until published in …

PDF

http://www.annals.org/content/156/3/243.full.pdf+html

 

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May 29, 2012 at 2:52 pm

When to initiate combined antiretroviral therapy to reduce mortality and AIDS-defining illness in HIV-infected persons in developed countries: an observational study.

Ann Intern Med. Apr.19, 2011  V.154 N.8 P.509-15.

HIV-CAUSAL Collaboration, Cain LE, Logan R, Robins JM, Sterne JA, Sabin C, Bansi L, Justice A, Goulet J, van Sighem A, de Wolf F, Bucher HC, von Wyl V, Esteve A, Casabona J, del Amo J, Moreno S, Seng R, Meyer L, Perez-Hoyos S, Muga R, Lodi S, Lanoy E, Costagliola D, Hernan MA.

Collaborators (1153)

Harvard School of Public Health, Boston, MA, USA.

Abstract

BACKGROUND:

Most clinical guidelines recommend that AIDS-free, HIV-infected persons with CD4 cell counts below 0.350 × 10(9) cells/L initiate combined antiretroviral therapy (cART), but the optimal CD4 cell count at which cART should be initiated remains a matter of debate.

OBJECTIVE:

To identify the optimal CD4 cell count at which cART should be initiated.

DESIGN:

Prospective observational data from the HIV-CAUSAL Collaboration and dynamic marginal structural models were used to compare cART initiation strategies for CD4 thresholds between 0.200 and 0.500 × 10(9) cells/L.

SETTING:

HIV clinics in Europe and the Veterans Health Administration system in theUnited States.

PATIENTS:

20, 971 HIV-infected, therapy-naive persons with baseline CD4 cell counts at or above 0.500 × 10(9) cells/L and no previous AIDS-defining illnesses, of whom 8392 had a CD4 cell count that decreased into the range of 0.200 to 0.499 × 10(9) cells/L and were included in the analysis.

MEASUREMENTS:

Hazard ratios and survival proportions for all-cause mortality and a combined end point of AIDS-defining illness or death.

RESULTS:

Compared with initiating cART at the CD4 cell count threshold of 0.500 × 10(9) cells/L, the mortality hazard ratio was 1.01 (95% CI, 0.84 to 1.22) for the 0.350 threshold and 1.20 (CI, 0.97 to 1.48) for the 0.200 threshold. The corresponding hazard ratios were 1.38 (CI, 1.23 to 1.56) and 1.90 (CI, 1.67 to 2.15), respectively, for the combined end point of AIDS-defining illness or death. Limitations: CD4 cell count at cART initiation was not randomized. Residual confounding may exist.

CONCLUSION:

Initiation of cART at a threshold CD4 count of 0.500 × 10(9) cells/L increases AIDS-free survival. However, mortality did not vary substantially with the use of CD4 thresholds between 0.300 and 0.500 × 10(9) cells/L.

PDF

http://www.annals.org/content/154/8/509.full.pdf+html

May 27, 2012 at 6:49 pm

2011 1er CONSENSO de DIAGNOSTICO, TRATAMIENTO y PREVENCION de las INF. de TRANSMISION SEXUAL (ITS)

ORGANIZADO por la COMISION de SIDA e ITS de la SADI

Con la participación de las siguientes sociedades:

SOCIEDAD ARGENTINA de DERMATOLOGIA

ASOCIACION ARGENTINA de DERMATOLOGIA

SOCIEDAD ARGENTINA de UROLOGIA

ASOCIACION ARGENTINA para el ESTUDIO de las  ENFERMEDADES DEL HIGADO

ASOCIACION ARGENTINA de MICROBIOLOGIA

SOCIEDAD de OBSTETRICIA y GINECOLOGIA de la PROV. de BUENOS AIRES

SOCIEDAD ARGENTINA de PATOLOGIA del TRACTO GENITAL INFERIOR y COLPOSCOPIA

SOCIEDAD ARGENTINA de PEDIATRIA

ASOCIACION ARGENTINA para el estudio de las INFECCIONES EN GINECOLOGIA Y OBSTETRICIA

MIEMBROS de la COMISION de VACUNAS y de la COMISION de USO APROPIADO de RECURSOS de la SADI

INDICE:

CHANCRO BLANDO p.6

HERPES GENITAL pag. 9

GRANULOMA INGUINAL  pag. 16

LINFOGRANULOMA VENEREO pag. 19

SIFILIS ADQUIRIDA  pag. 22

Características clínicas, diagnósticas y tratamientos de:

Chancro Blando, Granuloma inguinal y Linfogranuloma venéreo pag.29

Uretritis, proctitis y proctocolitis  pag.31

ENFERMEDADES CARACTERIZADAS por FLUJO VAGINAL pag.39

ENFERMEDAD INFLAMATORIA PELVIANA (EPI) pag.58

HEPATITIS  A  pag.64

HEPATITIS  B  pag.65

HEPATITIS  C  pag.67

VIRUS PAPILOMA HUMANO (HPV)   pag.75

ETS  EN EL CONTEXTO DE EMBARAZO  pag.82

SIFILIS CONGENITA pag.85

Oftalmía del recién nacido  pag.92

VIRUS HERPES SIMPLE (VHS)  pag.94

VIRUS HEPATITIS B (VHB)  pag.96

VIRUS PAPILOMA HUMANO (HPV)   pag.98

Abuso Sexual o Violación en Adultos  pag.99

Abuso sexual en niños.  pag.103

PDF

http://www.sadi.org.ar/files/Consenso_ETS_SADI(1).pdf

 

————————————————————————–

 

2011 – RECOMENDACIONES para Seguimiento y Tratamiento de las ITS – SADI

 

INDICE:

 

I. INTRODUCCIÓN  pag.10

II. SIFILIS  pag.12

III. SIFILIS CONGENITA  pag.22

IV. HERPES SIMPLE VIRUS  pag. 36

V. LINFOGRANULOMA VENEREO  pag.47

VI. CHANCRO BLANDO  pag.50

VII. GRANULOMA INGUINAL  pag. 53

VIII. URETRITIS Y CERVICITIS GONOCÓCICAS y NO GONOCÓCICAS  pag. 56

IX. EPIDIDIMITIS Y ORQUITIS  pag. 69

X. PROCTITIS, PROCTOCOLITIS Y ENTERITIS  pag. 76

XI. ETS ASOCIADAS CON FLUJO VAGINAL  pag. 86

XII. ENFERMEDAD INFLAMATORIA PELVIANA  pag. 100

XIII. HPV  pag. 108

XIV. HEPATITIS B, C y A  pag. 121

XV. ABUSO SEXUAL EN NIÑOS  pag. 134

XVI. ABUSO SEXUAL EN ADULTOS  pag. 138

PDF

http://www.sadi.org.ar/files/Recomendaciones_ETS-SADI_2010.pdf

 

May 27, 2012 at 4:08 pm

The Anthrax Attacks 10 Years Later

Annals of Internal Medicine 3 Oct 2011

Larry M. Bush, MD; and Maria T. Perez, MD

From Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, and JFK Medical Center, Atlantis, Florida.

Abstract

Ten years ago, just weeks after the September 11 attacks, theUnited Statesexperienced a deliberate act of bioterrorism. Through use of the U.S.postal service, anthrax spores were widely disseminated, including to homes, the Senate, and major newsrooms, resulting in morbidity and mortality and effectively disrupting our way of life and revealing our vulnerability. Even though such attacks had been the subject of much writing and had been planned for, detection of and the appropriate response to an attack with an agent from the so-called “Category ‘A’ List” had only been considered in theoretical terms. What transpired during the following difficult weeks, including how public health and federal government agencies performed, has been both praised and criticized. An intertwined epidemiologic and criminal investigation of such magnitude was unprecedented inU.S.history. To address the question of whether we as a nation are now better prepared for future threats involving biologic agents, it is important to learn from the lessons of the 2001 anthrax attacks, including the critical role of clinicians in surveillance. As physicians involved in diagnosing anthrax in the index case and alerting authorities, we offer our perspective on these events a decade after their occurrence.

FULL TEXT

http://www.annals.org/content/early/2011/09/30/0003-4819-155-12-201112200-00373.full

 

 

May 27, 2012 at 2:01 pm

Telaprevir for Previously Untreated Chronic Hepatitis C Virus Infection

N Engl J Med 2011 Jun 23 V.364 P.2405.

Ira M. Jacobson, M.D., John G. McHutchison, M.D., Geoffrey Dusheiko, M.D., Adrian M. Di Bisceglie, M.D., K. Rajender Reddy, M.D., Natalie H. Bzowej, M.D., Patrick Marcellin, M.D., Andrew J. Muir, M.D., Peter Ferenci, M.D., Robert Flisiak, M.D., Jacob George, M.D., Mario Rizzetto, M.D., Daniel Shouval, M.D., Ricard Sola, M.D., Ruben A. Terg, M.D., Eric M. Yoshida, M.D., Nathalie Adda, M.D., Leif Bengtsson, B.Sc., Abdul J. Sankoh, Ph.D., Tara L. Kieffer, Ph.D., Shelley George, M.D., Robert S. Kauffman, M.D., Ph.D., and Stefan Zeuzem M.D. for the ADVANCE Study Team

Background

In phase 2 trials, telaprevir, a hepatitis C virus (HCV) genotype 1 protease inhibitor, in combination with peginterferon–ribavirin, as compared with peginterferon–ribavirin alone, has shown improved efficacy, with potential for shortening the duration of treatment in a majority of patients.

Methods

In this international, phase 3, randomized, double-blind, placebo-controlled trial, we assigned 1088 patients with HCV genotype 1 infection who had not received previous treatment for the infection to one of three groups: a group receiving telaprevir combined with peginterferon alfa-2a and ribavirin for 12 weeks (T12PR group), followed by peginterferon–ribavirin alone for 12 weeks if HCV RNA was undetectable at weeks 4 and 12 or for 36 weeks if HCV RNA was detectable at either time point; a group receiving telaprevir with peginterferon–ribavirin for 8 weeks and placebo with peginterferon–ribavirin for 4 weeks (T8PR group), followed by 12 or 36 weeks of peginterferon–ribavirin on the basis of the same HCV RNA criteria; or a group receiving placebo with peginterferon–ribavirin for 12 weeks, followed by 36 weeks of peginterferon–ribavirin (PR group). The primary end point was the proportion of patients who had undetectable plasma HCV RNA 24 weeks after the last planned dose of study treatment (sustained virologic response).

Results

Significantly more patients in the T12PR or T8PR group than in the PR group had a sustained virologic response (75% and 69%, respectively, vs. 44%; P<0.001 for the comparison of the T12PR or T8PR group with the PR group). A total of 58% of the patients treated with telaprevir were eligible to receive 24 weeks of total treatment. Anemia, gastrointestinal side effects, and skin rashes occurred at a higher incidence among patients receiving telaprevir than among those receiving peginterferon–ribavirin alone. The overall rate of discontinuation of the treatment regimen owing to adverse events was 10% in the T12PR and T8PR groups and 7% in the PR group.

Conclusions

Telaprevir with peginterferon–ribavirin, as compared with peginterferon–ribavirin alone, was associated with significantly improved rates of sustained virologic response in patients with HCV genotype 1 infection who had not received previous treatment, with only 24 weeks of therapy administered in the majority of patients. (Funded by Vertex Pharmaceuticals and Tibotec; ADVANCE ClinicalTrials.gov number, NCT00627926.)

PDF

http://www.nejm.org/doi/pdf/10.1056/NEJMoa1012912

May 27, 2012 at 1:58 pm

Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 Update by the Infectious Diseases Society of America.

Clin Infect Dis. Fe.15, 2011  V.52 N.4 P.427-31.

Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, Mullen CA, Raad II, Rolston KV, Young JA, Wingard JR, Infectious Diseases Society of Americaa.

Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA. afreifeld@unmc.edu

Abstract

This document updates and expands the initial Infectious Diseases Society of America (IDSA) Fever and Neutropenia Guideline that was published in 1997 and first updated in 2002. It is intended as a guide for the use of antimicrobial agents in managing patients with cancer who experience chemotherapy-induced fever and neutropenia. Recent advances in antimicrobial drug development and technology, clinical trial results, and extensive clinical experience have informed the approaches and recommendations herein. Because the previous iteration of this guideline in 2002, we have a developed a clearer definition of which populations of patients with cancer may benefit most from antibiotic, antifungal, and antiviral prophylaxis. Furthermore, categorizing neutropenic patients as being at high risk or low risk for infection according to presenting signs and symptoms, underlying cancer, type of therapy, and medical comorbidities has become essential to the treatment algorithm. Risk stratification is a recommended starting point for managing patients with fever and neutropenia. In addition, earlier detection of invasive fungal infections has led to debate regarding optimal use of empirical or preemptive antifungal therapy, although algorithms are still evolving. What has not changed is the indication for immediate empirical antibiotic therapy. It remains true that all patients who present with fever and neutropenia should be treated swiftly and broadly with antibiotics to treat both gram-positive and gram-negative pathogens. Finally, we note that all Panel members are from institutions in theUnited StatesorCanada; thus, these guidelines were developed in the context of North American practices. Some recommendations may not be as applicable outside ofNorth America, in areas where differences in available antibiotics, in the predominant pathogens, and/or in health care-associated economic conditions exist. Regardless of venue, clinical vigilance and immediate treatment are the universal keys to managing neutropenic patients with fever and/or infection.

PDF

http://cid.oxfordjournals.org/content/52/4/427.full.pdf+html

 

 

May 27, 2012 at 1:56 pm

Outcomes of patients hospitalized with community-acquired, health care-associated, and hospital-acquired pneumonia.

Ann Intern Med. Jan 6, 2009  V.150 N.1 P.19-26.

Venditti M, Falcone M, Corrao S, Licata G, Serra P; Study Group of the Italian Society of Internal Medicine.

Collaborators (99)

University of Rome, Rome, Italy. mario.venditti@uniroma1.it

Abstract

BACKGROUND:

Traditionally, pneumonia has been classified as either community- or hospital-acquired. Although only limited data are available, health care-associated pneumonia has been recently proposed as a new category of respiratory infection. “Health care-associated pneumonia” refers to pneumonia in patients who have recently been hospitalized, had hemodialysis, or received intravenous chemotherapy or reside in a nursing home or long-term care facility.

OBJECTIVE:

To ascertain the epidemiology and outcome of community-acquired, health care-associated, and hospital-acquired pneumonia in adults hospitalized in internal medicine wards.

DESIGN:

Multicenter, prospective observational study.

SETTING:

55 hospitals inItalycomprising 1941 beds.

PATIENTS:

362 patients hospitalized with pneumonia during two 1-week surveillance periods.

MEASUREMENTS:

Cases of radiologically and clinically assessed pneumonia were classified as community-acquired, health care-associated, or hospital-acquired and rates were compared.

RESULTS:

Of the 362 patients, 61.6% had community-acquired pneumonia, 24.9% had health care-associated pneumonia, and 13.5% had hospital-acquired pneumonia. Patients with health care-associated pneumonia had higher mean Sequential Organ Failure Assessment scores than did those with community-acquired pneumonia (3.0 vs. 2.0), were more frequently malnourished (11.1% vs. 4.5%, and had more frequent bilateral (34.4% vs. 19.7%) and multilobar (27.8% vs. 21.5%) involvement on a chest radiograph. Patients with health care-associated pneumonia also had higher fatality rates (17.8% [CI, 10.6% to 24.9%] vs. 6.7% [CI, 2.9% to 10.5%]) and longer mean hospital stay (18.7 days [CI, 15.9 to 21.5 days] vs. 14.7 days [CI, 13.4 to 15.9 days]). Logistic regression analysis revealed that depression of consciousness (odds ratio [OR], 3.2 [CI, 1.06 to 9.8]), leukopenia (OR, 6.2 [CI, 1.01 to 37.6]), and receipt of empirical antibiotic therapy not recommended by international guidelines (OR, 6.4 [CI, 2.3 to 17.6]) were independently associated with increased intrahospital mortality. Limitations: The number of patients with health care-associated pneumonia was relatively small. Microbiological investigations were not always homogeneous. The study included only patients with pneumonia that required hospitalization; results may not apply to patients treated as outpatients.

CONCLUSION:

Health care-associated pneumonia should be considered a distinct subset of pneumonia associated with more severe disease, longer hospital stay, and higher mortality rates. Physicians should differentiate between patients with health care-associated pneumonia and those with community-acquired pneumonia and provide more appropriate initial antibiotic therapy.

PDF

http://www.annals.org/content/150/1/19.full.pdf+html

May 25, 2012 at 3:01 pm

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