by Paul Rega, MD — published on June 27th, 2009
Q: If a cowboy rides into town on Friday, and three days later, he leaves on Friday, how does he do it?
A: The horse’s name is Friday.
But I digress…..
By the way, attached is the document that has been recently published by the Feds with regard to air ambulance, safety factors, crashes, and recommendations.
This is a statement from ACIP (Advisory Committee on Immunization Practices ). It’s their recommendation to drop the 5th dose of rabies post-exposure prophylaxis. There have been no cases of rabies in studies where the 5th dose was not administered. In fact, one study of human postexposure prophylaxis concluded that about 13% of people did not complete the full schedule with no subsequent treatment failures. Remember, this is a recommendation not policy yet. Kinda like, “Michael, I wouldn’t advise doing another world tour. It might be bad for your health.”
http://omniphysicians.com/2009/06/27/acip-recommends-reducing-rabies-pep-from-five-doses-to-four/
Here’s a kid who has had a rash on his eyelid for months and now his Mom brings him in at 4AM.
http://omniphysicians.com/2009/06/27/eyelid-dermatitis-in-a-kid/
H1N1 is still with us and CDC is stating that there’s been a bump in cases emanating from summer camps. Sure. Why not? Close quarters. Kids not very hygienic.
http://omniphysicians.com/2009/06/27/not-going-away-anytme-soon/
This is a graphic showing the state of healthcare in Ohio (AHRQ). As you can see, it’s average. However, the estimate of acute care is quite a bit better.
http://omniphysicians.com/2009/06/27/ahrqs-annual-release-of-state-by-state-quality-data/
Meanwhile, up in MIchigan, the state of healthcare is much better. And it’s very strong with regard to acute care. Click on the state and you can see all the parameters.
http://omniphysicians.com/2009/06/27/ahrqs-annual-release-of-state-by-state-quality-data-michigan/
by Paul Rega, MD — published on June 27th, 2009
Dashboard on Health Care Quality Compared to All States
Overall Health Care Quality
Blue marker: Most recent data; dark marker: baseline data
by Paul Rega, MD — published on June 27th, 2009
Dashboard on Health Care Quality Compared to All States
Overall Health Care Quality
Blue marker: Most recent year; dark marker: baseline
by Paul Rega, MD — published on June 27th, 2009
CIDRAP News, 6/26/09 (http://www.cidrap.umn.edu/cidrap/content/influenza/swineflu/news/jun2609influenza-jw.html): “An official from the US Centers for Disease Control and Prevention (CDC) said today that the nation just saw its largest weekly increase in cases since the beginning of the novel flu outbreak and that the virus has so far been detected at 34 summer camps in 16 states.
Anne Schuchat, MD, interim deputy director for the CDC’s science and public health program, told reporters, “The key point is that this new infectious disease is not going away.” Of the nearly 28,000 cases that have been confirmed in the United States, more than 6,000 were reported over the past week, according to the weekly update the CDC issued today….”
Link: http://www.cdc.gov/flu/weekly/
2008-2009 Influenza Season Week 24 ending June 20, 2009
All data are preliminary and may change as more reports are received.
On June 11, the World Health Organization raised the pandemic alert level from Phase 5 to Phase 6 indicating that an influenza pandemic is underway. The novel influenza A (H1N1) virus now will be referred to as “pandemic H1N1 influenza virus.”
Synopsis:
During week 24 (June 14-20, 2009), influenza activity decreased in the United States, however, there were still higher levels of influenza-like illness than is normal for this time of year.
- Three thousand two hundred eighty-six (41.9%) specimens tested by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories and reported to CDC/Influenza Division were positive for influenza.
- Over 99% of all subtyped influenza A viruses being reported to CDC were pandemic influenza A (H1N1) viruses.
- The proportion of deaths attributed to pneumonia and influenza (P&I) was below the epidemic threshold.
- Five influenza-associated pediatric deaths were reported and four of the five deaths were associated with pandemic influenza A (H1N1) virus infection.
- The proportion of outpatient visits for influenza-like illness (ILI) was below the national baseline. Two of the 10 surveillance regions reported ILI above their region-specific baseline.
- Twelve states reported geographically widespread influenza activity, seven states reported regional influenza activity, the District of Columbia and 11 states reported local influenza activity, and Puerto Rico and 20 states reported sporadic influenza activity.
by Paul Rega, MD — published on June 27th, 2009
Link: http://www.pediatricsupersite.com/view.aspx?rid=36225 (by Patricia A. Treadwell, MD)
This 7-year-old had eyelid dermatitis intermittently for several months. He will occasionally complain that his eyes are itching. His skin is clear with the exception of an erythematous plaque of the groin area that his mother had not seen until today. He has a negative past medical history and is not on any medications.
This child has psoriasis.
Psoriasis is a chronic skin condition that affects approximately 2% of the population. Approximately 25% of adults with a diagnosis of psoriasis report that they initially had some skin findings of psoriasis prior to age 18. Psoriasis is inherited in an autosomal dominant manner.
The clinical findings of psoriasis are discrete lesions that are erythematous plaques with thick silvery scale (aka psoriatic plaques). The lesions are preferentially located on the elbows, knees, scalp and genital area. In a patient prone to developing psoriasis, trauma can induce new lesions or cause other lesions to form in the pattern of the trauma (Koebner phenomenon). Guttate psoriasis is a variant in which numerous small (guttate from “Gutta,” which is Latin for “tear drop”) plaques erupt on the trunk, extremities and face. This variant occurs more frequently in children than adults and may be triggered by a strep infection or other acute infection. Nail dystrophy is a common finding in psoriasis, particularly pitting of the nails.
Differential diagnoses include contact dermatitis, seborrheic dermatitis, molluscum dermatitis, pityriasis rosea, eczema, and second- ary syphilis.
Treatment options include liberal use of moisturizers (to minimize itching), and avoidance of trauma. Traditional topical treatments in mild psoriasis include: corticosteroids, calcipotriene, tar, and topical retinoids. Secondary bacterial or fungal infections should be treated since the infections themselves can cause a flare of the psoriasis. Anti-pruritics can be useful inselect patients.
Ultraviolet light B and UVA phototherapy (both natural and artificial) can be effective therapeutic options. Systemic therapies for more severe psoriasis include: methotrexate, oral retinoids, cyclosporine, and biologics.
For more information:
- Guilhou JJ, et al: New hypotheses in the genetics of psoriasis and other ‘complex’ diseases. Dermatology 2008;216:87-92.
- Huerta C, et al: Incidence and risk factors for psoriasis in the general population. Arch Dermatol. 2007;143:1559-1565.
- Paller AS, et al: Etanercept treatment for children and adolescents with plaque psoriasis. N Engl J Med. 2008;358:241-251.
by Paul Rega, MD — published on June 27th, 2009
Link: http://www.pediatricsupersite.com/view.aspx?rid=41131
The Advisory Committee on Immunization Practices has recommended reducing the rabies postexposure prophyhlaxis schedule from five doses to four, following a lengthy discussion at the CDC in Atlanta this morning.
Charles Rupprecht, VMD, MS, PhD, chief of the CDC’s rabies program, presented epidemiologic surveillance data from 1980 to the present, which showed no cases of rabies due to absence of the administration of a fifth dose. Other studies in animals have shown similar results, with many studies demonstrating a full protective effect after only three doses. Rupprecht said his office began looking at the data after some shortages in the vaccine supply were reported in late 2007.
“Compliance has not been 100% with rabies vaccine,” Rupprecht said. “One study of human postexposure prophylaxis concluded that about 13% of people did not complete the full schedule,” with no subsequent treatment failures.
One committee member, H. Cody Meissner, MD, who is a professor of pediatrics at Tufts University School of Medicine in Boston, Massachusetts, expressed concern about the revised recommendations conflicting with the package insert for both the approved Novartis and Sanofi products and the AAP’s recently-issued 2009 Red Book.
“This may cause a great deal of confusion for pediatricians,” Meissner said. However, other committee members noted that other ACIP recommendations conflict with package inserts, and that a strong guidance from the committee disseminated to public health providers would likely ease confusion.
Representatives from the manufacturers in attendance at the meeting stressed that the ACIP’s recommendations would conflict with the package insert, and if they are consulted by physicians on vaccine use, they would continue to recommend the five-dose schedule as directed by the package. – by Colleen Zacharyczuk
For more information:
- Rupprecht C. Reduced rabies vaccine schedule (post-exposure prophylaxis). Presented at: ACIP. June 24, 2009. Atlanta.
