Consultantlive Staff

Making headlines recently was the revelation that HIV infection can be transmitted from men to women through the healthy squamous epithelium of the vaginal tract.

Syphilis took Europe by storm at the end of the 15th century in what was to become a sweeping epidemic. Before 1495, it was unknown or perhaps was attributed to other disease processes, such as leprosy.

Microbes collect on fabric, objects, and surfaces in the hospital environment, but what role do they play in disease transmission, and how can a more sterile environment be maintained? The current findings sometimes leave us with more questions than answers. Food for thought was presented at a poster session that focused on nosocomial infections and environmental contamination at the joint 48th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy and the Infectious Diseases Society of America 46th Annual Meeting, which convened October 25-28, 2008, in Washington, DC.

Delusional parasitosis and factitious disorder are psychiatric illnesses that are often encountered by clinicians. The differential diagnosis can be tricky, but treatment, which may include referral to a mental health specialist, may be trickier.

Asthma affects approximately 22 million adults and children in the United States and poses a significant economic burden on the health care system and on employers. According to the National Heart, Lung, and Blood Institute, direct and indirect costs for all forms of asthma totaled $19.7 billion in 2007. Prescription drugs represented the largest single direct cost at $6.2 billion.

At Consultant, our goal is to provide the practical, authoritative information you need to best serve your patients. That is why we “pre-test” article ideas (before we invite articles on those topics) to be sure they are of real interest to you and your colleagues. It is also why we take great care in checking facts, creating useful tables and figures, and choosing illustrations and photographs to enhance teaching messages.

For 25 years, a 74-year-old man had an intermittent, painful, and pruritic rash that caused cracking and erosions in the axillae and groin. It worsened with sweating and in the summer and also when clothing or skin rubbed against the eruption. The patient’s father, a paternal uncle, and all 3 of the patient’s daughters had a similar rash. Cetirizine and a combination of xipamide, bacitracin ointment, clotrimazole, and triamcinolone cream were prescribed to treat the rash.

A 16-year-old boy with a history of leukemia at age 12 years complains of right hip pain of several months' duration. A 34-year-old woman who had Hodgkin lymphoma at age 14 years comes in for a routine physical.

Many traditional PBMs have revenue streams that are not disclosed or shared with plan sponsors. These revenue streams include pharmaceutical manufacturer rebates, pharmacy network discounts and spread, and data sales. Such arrangements can result in a misalignment of incentives, making it difficult for plan sponsors to achieve the lowest costs possible. Partially transparent or "translucent" PBMs may disclose some but not all rebate revenues. Fully transparent PBMs identify and share all revenue streams with their plan sponsors. (Drug Benefit Trends. 2008;20:98-100)

Heart failure (HF) is a complex clinical syndrome in whichthe heart is unable to deliver adequate cardiac output at normal fillingpressures. There are proven pharmacological and clinical management strategiesthat can improve care and reduce associated health care costs, but these areunderutilized. The Advanced Heart Failure Program (AHFP) was developed at theDorn Veterans Administration Medical Center to provide a comprehensivemultidisciplinary management approach to persons with advanced HF. Beforeenrollment in the AHFP, the average annual all-cause hospital admission rate was3.2 for the 217 HF patients. After enrollment in the AHFP and stabilization, themean all-cause hospital admission rate was 1.2. HF patients had an averageannual hospitalization cost of $28,936.32 before enrollment in the AHFP. Afterenrollment, average hospitalization cost dropped to $10,851.12 per patient.Taking into account the 50-week cost of $3036.14 for a patient enrolled in theclinic, participation in the AHFP was associated with a significant decrease inthe number of HF-related admissions, saving an average of $15,049.06 perpatient. (Drug Benefit Trends. 2008;20:54-59)

ROCKVILLE, Md. -- Eleven deaths and nearly 200 reports of serious cardiopulmonary events have been linked to microbubble contrast agents (Definity and Optison) used in echocardiography, according to the FDA.

SEOUL, South Korea -- Therapies that target several cancer pathways at once, such as multi-kinase inhibitors, might have an emerging role in non-small-cell lung cancer.

SEOUL, South Korea -- Erlotinib (Tarceva) is a viable candidate across the board for second-line treatment of non-small-cell lung cancer (NSCLC), oncologists said here.

A 52-year-old man presented with asymptomatic papules on his scrotum. The lesions had first appeared 1 year earlier. He had not sustained local trauma to the scrotum, and his medical history was unremarkable. There was no family history of similar skin lesions.

CHICAGO -- Second-line agents for hormone-refractory prostate cancer are emerging to fill an unmet need, researchers said here.

SAN DIEGO -- Psychiatrists need to do more objective measurement of the physical and mental health of their schizophrenic patients, researchers said here.

SEATTLE -- Few geriatricians appear willing to try newer medications to treat chronic constipation in older adults, an informal survey here showed.

An 8-year-old boy from southern Ohio was outside playing when he saw a snake lying in the driveway. The boy picked up the snake to show his father and then dropped it. He picked it up again and was bitten. He sustained a tiny puncture wound to the palmar aspect of his distal left ring finger and a scratch to the distal long finger.

SAN FRANCISCO -- Dysphoric mania and other mixed mania states of bipolar disorder will become easier to diagnose with better definitions, a researcher said here.

SAN FRANCISCO -- While the behavioral symptoms of autism have been treated with a wide spectrum of medications, atypical antipsychotics may be the most effective drug class.

SAN FRANCISCO -- Remission rates remain low for major depression even with multiple antidepressant drug classes available, but the recently approved selegiline patch (Emsam) aims to bring the rates up.

SAN FRANCISCO -- Atypical antipsychotic medications have improved adverse-event profiles compared with the older generation of antipsychotics, but careful attention to major side effects is still required.

SAN FRANCISCO -- Given the high prevalence of substance abuse in patients with attention deficit hyperactivity disorder (ADHD), psychiatrists need to consider comorbidity in assessment of both conditions.

Two months after undergoing bilateral transconjunctival blepharoplasty, a 48-year-old man presented with dryness and pruritus of the left eye of 1 week's duration. He denied any discharge, change in vision, or fever.

WASHINTON -- Doctors discovered a blood clot in Vice- President Dick Cheney's left calf today and started him on first-line therapy for deep vein thrombosis, his office said.

ABSTRACT: In patients with jaundice and normal liver function, the cause of hyperbilirubinemia is an isolated disorder of bilirubin metabolism. In patients with hyperbilirubinemia who have abnormal liver enzyme levels, hepatocellular disease must be differentiated from cholestatic liver injury. In general, if the cause of jaundice is global hepatocellular dysfunction, the serum alanine aminotransferase and aspartate aminotransferase levels will be predominantly elevated. If the cause is cholestasis, the serum alkaline phosphatase and gγ-glutamyl peptidase levels will be elevated. In most patients, imaging studies will be needed. The initial workup should include abdominal ultrasonography, which can identify dilated intrahepatic and extrahepatic biliary ducts as well as findings that may suggest cirrhosis or signs of portal hypertension, including splenomegaly and ascites.

ATLANTA -- A more comprehensive vaccination schedule for children and adolescents has been issued by the CDC for 2007.

US researchers recently reported initial phase 1 results from 2 vaccine candidates that successfully produced immune responses in healthy uninfected adults (Gibian JJ. United Press International. November 16, 2006). Eventually, the approach may be used to protect against HIV infection. Barney Graham of the NIH Vaccine Research Center and colleagues performed the tests (Graham BS, Koup RA, Roderer M, et al. J Infect Dis. 2006;194:1650-1660; Catanzaro AT, Koup RA, Roderer M, et al. J Infect Dis. 2006;194:1638-1649).

At Consultant, our goal is to provide the practical, authoritative information youneed to best serve your patients. That is why we “pre-test” article ideas (beforewe invite articles on those topics) to be sure they are of high interest to you andyour colleagues. It is also why we take great care in checking facts, creating usefultables and figures, and choosing illustrations and photographs to enhanceteaching messages.

Laser in situ keratomileusis, orLASIK, was first described in 1990 1;since then, it has surpassed cataractsurgery as the most common eye operationperformed in the world. 2 Asmany as 1.5 million corneal refractivelaser surgeries are done annually inthe United States. 3,4