RESUMO
Most of the world's haemophilia population lives in countries with few medical or financial resources. As such, they cannot easily obtain viral-inactivated clotting product. Many patients are treated with cryoprecipitate made from locally supplied blood. The reasoning for using cryoprecipitate, instead of viral-inactivated products, is based on an unspoken belief that because blood banks can provide reasonably safe products by using modern testing procedures, transmission of HIV and other blood-borne viruses is rare. However, the risk of acquiring a blood-borne infection increases with every exposure, and haemophilia patients treated with cryoprecipitate or fresh-frozen plasma are exposed to hundreds or thousands of donors during their lifetime. The risk that a person infected with HIV will donate blood during the 'window period' is directly related to the incidence of HIV in the country where the donation occurs. To demonstrate the extent of this problem, we devised a model for estimating the risk that a person with haemophilia will encounter HIV-contaminated cryoprecipitate based on the years of treatment and the underlying incidence rate of HIV among blood donors. We applied the model to two countries with different incidence rates of HIV: Venezuela and the United States. We found that a person with haemophilia who receives monthly infusions of cryoprecipitate prepared from plasma of 15 donors over a lifetime of treatment (60 years) is at significant risk of being exposed to HIV. In the United States there is a 2% risk of being exposed to HIV-contaminated blood product, and in Venezuela, the percentage of risk is 40%. Given this degree of risk, medical care providers should carefully evaluate the use of cryoprecipitate except in emergencies or when no viral-inactivated products are available.
Assuntos
Fator VIII/uso terapêutico , Fibrinogênio/uso terapêutico , Infecções por HIV/transmissão , Hemofilia A/virologia , Doadores de Sangue , Contaminação de Medicamentos , Fibronectinas/uso terapêutico , Infecções por HIV/epidemiologia , Infecções por HIV/etiologia , Hemofilia A/complicações , Hemofilia A/terapia , Humanos , Incidência , Modelos Teóricos , Fatores de Risco , Reação Transfusional , Estados Unidos/epidemiologia , Venezuela/epidemiologiaRESUMO
We present a case of a patient admitted to a psychiatric hospital with psychotic symptoms and cognitive impairment but who was subsequently found to have an anterior interhemispheric falx meningioma. There must be a high index of suspicion for organic brain disease in patients over age 45 years presenting with psychotic symptoms and seizures for the first time.
Assuntos
Erros de Diagnóstico , Neoplasias Meníngeas/diagnóstico , Meningioma/diagnóstico , Esquizofrenia/diagnóstico , Demência/diagnóstico , Diagnóstico Diferencial , Eletroencefalografia , Feminino , Lobo Frontal , Humanos , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Tomografia Computadorizada por Raios XRESUMO
We present a case of a patient admitted to a psychiatric hospital with psychotic symptoms and cognitive impairment but who was subsequently found to have an anterior interhemispheric falx meningioma. There must be a high index of suspicion for organic brain disease in patients over age 45 years presenting with psychotic symptoms and seizures for the first time.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Erros de Diagnóstico , Esquizofrenia/diagnóstico , Meningioma/diagnóstico , Neoplasias Meníngeas/diagnóstico , Demência/diagnóstico , Diagnóstico Diferencial , Eletroencefalografia , Escalas de Graduação Psiquiátrica , Lobo Frontal , Tomografia Computadorizada por Raios XRESUMO
We present a case of a patient admitted to a psychiatric hospital with psychotic symptoms and cognitive impairment but who was subsequently found to have an anterior interhemispheric falx meningioma. There must be a high index of suspicion for organic brain disease in patients over age 45 years presenting with psychotic symptoms and seizures for the first time.(AU)
Assuntos
Pessoa de Meia-Idade , Relatos de Casos , Feminino , Humanos , Meningioma/diagnósticoRESUMO
A principle structural component of helicopters is 2024-T3 aluminum alloy. This alloy has been designed for use in areas requiring high strength-to-weight ratios, but it is susceptible to corrosion damage. The air medical helicopter is frequently exposed to bloodborne pathogens, dirt, intravenous solutions and a variety of other contaminants. The amount of damage to the helicopter that can be caused by the use of cleaners and disinfectants has been raised as an area of concern for the safety of the helicopter, crew and patients. In a controlled study, 2024-T3 alclad aluminum strips were placed in 120-ml glass jars that were filled with 60 ml of solution and then sealed. The solutions used were disinfectants, cleaners and water (both tap and distilled). The strips in solution were placed in a controlled oven at 140 F for 100 hours to simulate long-term damage from immersion, vapors and heat. On examination, many strips were discolored and corroded. Only one solution caused no apparent damage, and only one caused slight vapor damage. As a result of the study, one of the solutions has been designated for use. The results have been used as examples for flight team members on the costly damage that can result from inappropriate use of these substances. A cleaning policy and procedure has been developed to ensure adequate protection from chemical exposure while protecting all team members from the dangers of bloodborne pathogens.
Assuntos
Aeronaves/normas , Alumínio , Ambulâncias/normas , Desinfetantes/efeitos adversos , Segurança de Equipamentos/normas , Ligas/normas , Corrosão , Serviço Hospitalar de Emergência/organização & administração , Estudos de Avaliação como Assunto , PennsylvaniaRESUMO
This retrospective study of 84 patients with pain under the heel, with or without a spur (the calcaneal heel spur syndrome) seen from October, 1989 in Barbados. The purpose was to assess the short and long-term results of conservative treatment. Follow-up ranged from 6 months to 8 years (mean = 4 years), and information was obtained by questionnaire (64/84 patients) and telephone. Most patients were middle-aged females, and duration of symptoms ranged from 2 weeks to 5 years. Calcaneal spurs were seen on X-rays in 64 (76 per cent) patients. Treatment was by infiltration of synthetic hydrocortisone preparation and local anaesthetic, surgery was not performed on any patient. Of 64 patients on whom follow-up data were availabe, 57 (89 per cent) were cured of their symptoms, and 7 admitted to having pain of varying severity. It is concluded that this syndrome is a self-limiting condition which usually responds to conservative treatment. Cases of chronic, persistent pain not responding to conservative treatment should be investigated for other causes (AU)