Evaluation of Intussusception after Monovalent Rotavirus Vaccination in Africa.

Postlicensure evaluations have identified an association between rotavirus vaccination and intussusception in several high- and middle-income countries. We assessed the association between monovalent human rotavirus vaccine and intussusception in lower-income sub-Saharan African countries.Using active surveillance, we enrolled patients from seven countries (Ethiopia, Ghana, Kenya, Malawi, Tanzania, Zambia, and Zimbabwe) who had intussusception that met international (Brighton Collaboration level 1) criteria. Rotavirus vaccination status was confirmed by review of the vaccine card or clinic records. The risk of intussusception within 1 to 7 days and 8 to 21 days after vaccination among infants 28 to 245 days of age was assessed by means of the self-controlled case-series method.Data on 717 infants who had intussusception and confirmed vaccination status were analyzed. One case occurred in the 1 to 7 days after dose 1, and 6 cases occurred in the 8 to 21 days after dose 1. Five cases and 16 cases occurred in the 1 to 7 days and 8 to 21 days, respectively, after dose 2. The risk of intussusception in the 1 to 7 days after dose 1 was not higher than the background risk of intussusception (relative incidence [i.e., the incidence during the risk window vs. all other times], 0.25; 95% confidence interval [CI], <0.001 to 1.16); findings were similar for the 1 to 7 days after dose 2 (relative incidence, 0.76; 95% CI, 0.16 to 1.87). In addition, the risk of intussusception in the 8 to 21 days or 1 to 21 days after either dose was not found to be higher than the background risk.The risk of intussusception after administration of monovalent human rotavirus vaccine was not higher than the background risk of intussusception in seven lower-income sub-Saharan African countries. (Funded by the GAVI Alliance through the CDC Foundation.)

Clinical Effects and Antivenom Use for Snake Bite Victims Treated at Three US Hospitals in Afghanistan

Objective—Annually, more than 100,000 US and international military and civilian personnel work in Afghanistan with in terrain harboring venomous snakes. Current literature insufficiently supports Afghan anti-venom treatment and stocking guidelines. We report the clinical course and treatments for snakebite victims presenting to US military hospitals in Afghanistan. Methods.—All snakebite victims presenting to 3 US military emergency departments between July 2010 and August 2011 in northern and southern Afghanistan were examined via chart review. Case information included patient demographics, snake description, bite details and complications, laboratory results, anti-venom use and adverse effects, procedures performed, and hospital course. Results.—Of 17 cases, median patient age was 20 years (interquartile range [IQR],12–30), 16 were male, and 82% were Afghans. All bites were to an extremity, and median time to care was 2.8 hours (IQR, 2–5.8). On arrival, 8 had tachycardia and none had hypotension or hypoxia. A viper was implicated in 5 cases. Ten cases received at least 1 dose of polyvalent anti-venom, most commonly for coagulopathy, without adverse effects. Six received additional anti-venom, 6 had an international normalized ratio (INR) \u3e 10, and none developed delayed coagulopathy. Three received blood transfusions. Hospital stay ranged from 1 to 4 days. None required vasopressors, fasciotomy, or other surgery, and none died. All had resolution of marked coagulopathies and improved swelling and pain on discharge. Conclusions.—We report the largest series of snake envenomation’s treated by US physicians in Afghanistan. Anti-venom was tolerated well with improvement of coagulopathy and symptoms. All patients survived with minimal advanced interventions other than blood transfusion

Applications of Bismuth(III) Compounds in Organic Synthesis

This review article summarizes the applications of bismuth(III) compounds in organic synthesis since 2002. Although there are an increasing number of reports on applications of bismuth(III) salts in polymerization reactions, and their importance is acknowledged, they are not included in this review. This review is largely organized by the reaction type although some reactions can clearly be placed in multiple sections. While every effort has been made to include all relevant reports in this field, any omission is inadvertent and we apologize in advance for the same (358 references)

52 Procedures in 52 Weeks: An innovative curriculum for emergency medicine residents

The specialty of Emergency Medicine (EM) requires that providers are as competent in rare procedures as they are in common ones. This creates a challenge for EM educators, who are charged with graduating competent physicians who have the mental and technical expertise to perform such a breadth of procedures. To facilitate this instruction, we have created a weekly procedure curriculum that utilizes videos coupled with hands on instruction to teach 52 EM procedures. We have found this curriculum to be very effective and easy to implement into our residency training schedule

52 Procedures in 52 Weeks: An innovative curriculum for emergency medicine residents

The specialty of Emergency Medicine (EM) requires that providers are as competent in rare procedures as they are in common ones.  This creates a challenge for EM educators, who are charged with graduating competent physicians who have the mental and technical expertise to perform such a breadth of procedures.  To facilitate this instruction, we have created a weekly procedure curriculum that utilizes videos coupled with hands on instruction to teach 52 EM procedures.  We have found this curriculum to be very effective and easy to implement into our residency training schedule

52 Procedures in 52 Weeks: An Innovative Curriculum for Emergency Medicine Residents

The specialty of Emergency Medicine (EM) requires that providers are as competent in rare procedures as they are in common ones. This creates a challenge for EM educators, who are charged with graduating competent physicians who have the mental and technical expertise to perform such a breadth of procedures. To facilitate this instruction, we have created a weekly procedure curriculum that utilizes videos coupled with hands on instruction to teach 52 EM procedures. We have found this curriculum to be very effective and easy to implement into our residency training schedule

A mild and chemoselective method for the deprotection of tert-butyldimethylsilyl (TBDMS) ethers using iron(III) tosylate as a catalyst

The most common method for the deprotection ofTBDMS ethers utilizes stoichiometric amounts of tetrabutylammonium fluoride, n-Bu4N+F(TBAF), which is highly corrosive and toxic. We have developed a mild and chemoselective method for the deprotection ofTBDMS, TES, and TIPS ethers using iron(III) tosylate as a catalyst. Phenolic TBDMS ethers, TBDPS ethers and the BOC group are not affected under these conditions. Iron(III) tosylate is an inexpensive, commercially available, and non-corrosive reagent