Clinical Usefulness of Measuring Red Blood Cell Distribution Width in Patients with Hepatitis B

BACKGROUND: Red blood cell distribution width (RDW), an automated measure of red blood cell size heterogeneity (e.g., anisocytosis) that is largely overlooked, is a newly recognized risk marker in patients with cardiovascular diseases, but its role in persistent viral infection has not been well-defined. The present study was designed to investigate the association between RDW values and different disease states in hepatitis B virus (HBV)-infected patients. In addition, we analyzed whether RDW is associated with mortality in the HBV-infected patients. METHODOLOGY/PRINCIPAL FINDINGS: One hundred and twenty-three patients, including 16 with acute hepatitis B (AHB), 61 with chronic hepatitis B (CHB), and 46 with chronic severe hepatitis B (CSHB), and 48 healthy controls were enrolled. In all subjects, a blood sample was collected at admission to examine liver function, renal function, international normalized ratio and routine hematological testing. All patients were followed up for at least 4 months. A total of 10 clinical chemistry, hematology, and biochemical variables were analyzed for possible association with outcomes by using Cox proportional hazards and multiple regression models. RDW values at admission in patients with CSHB (18.30±3.11%, P<0.001), CHB (16.37±2.43%, P<0.001) and AHB (14.38±1.72%, P<0.05) were significantly higher than those in healthy controls (13.03±1.33%). Increased RDW values were clinically associated with severe liver disease and increased 3-month mortality rate. Multivariate analysis demonstrated that RDW values and the model for end-stage liver disease score were independent predictors for mortality (both P<0.001). CONCLUSION: RDW values are significantly increased in patients with hepatitis B and associated with its severity. Moreover, RDW values are an independent predicting factor for the 3-month mortality rate in patients with hepatitis B

Factors Affecting Intention to Receive and Self-Reported Receipt of 2009 Pandemic (H1N1) Vaccine in Hong Kong: A Longitudinal Study

Background: Vaccination was a core component for mitigating the 2009 influenza pandemic (pH1N1). However, a vaccination program's efficacy largely depends on population compliance. We examined general population decision-making for pH1N1 vaccination using a modified Theory of Planned Behaviour (TBP). Methodology: We conducted a longitudinal study, collecting data before and after the introduction of pH1N1 vaccine in Hong Kong. Structural equation modeling (SEM) tested if a modified TPB had explanatory utility for vaccine uptake among adults. Principal Findings: Among 896 subjects who completed both the baseline and the follow-up surveys, 7% (67/896) reported being "likely/very likely/certain" to be vaccinated (intent) but two months later only 0.8% (7/896) reported having received pH1N1 vaccination. Perception of low risk from pH1N1 (60%) and concerns regarding adverse effects of the vaccine (37%) were primary justifications for avoiding pH1N1 vaccination. Greater perceived vaccine benefits (β = 0.15), less concerns regarding vaccine side-effects (β = -0.20), greater adherence to social norms of vaccination (β = 0.39), anticipated higher regret if not vaccinated (β = 0.47), perceived higher self-efficacy for vaccination (β = 0.12) and history of seasonal influenza vaccination (β = 0.12) were associated with higher intention to receive the pH1N1 vaccine, which in turn predicted self-reported vaccination uptake (β = 0.30). Social norm (β = 0.70), anticipated regret (β = 0.19) and vaccination intention (β = 0.31) were positively associated with, and accounted for 70% of variance in vaccination planning, which, in turn subsequently predicted self-reported vaccination uptake (β = 0.36) accounting for 36% of variance in reported vaccination behaviour. Conclusions/Significance: Perceived low risk from pH1N1 and perceived high risk from pH1N1 vaccine inhibited pH1N1 vaccine uptake. Both the TPB and the additional components contributed to intended vaccination uptake but social norms and anticipated regret predominantly associated with vaccination intention and planning. Vaccination planning is a more significant proximal determinant of uptake of pH1N1 vaccine than is intention. Intention alone is an unreliable predictor of future vaccine uptake. © 2011 Liao et al.published_or_final_versio

Laser e luz pulsada de alta energia: indução e tratamento de reações alérgicas relacionadas a tatuagens Laser and intense pulsed light: induction and treatment of allergic reactions related to tattoos

Os autores apresentam dois casos de reações alérgicas relacionadas a tatuagens, em que o laser e a luz pulsada de alta energia tiveram papel fundamental na indução e no tratamento dessas reações. No primeiro, houve surgimento de lesão eczematosa no local do pigmento vermelho utilizado na tatuagem. Após várias tentativas terapêuticas, a luz pulsada de alta energia foi utilizada com sucesso na remoção do pigmento e desaparecimento dos sintomas. No segundo, os autores demonstram um caso de reação anafilática induzida pelo laser Nd:YAG de pulso longo.<br>The authors describe two cases of allergic reactions related to tattoos, in which laser and intense pulsed light had an important role in inducing and treating these allergic reactions. In the first case, the patient developed eczematous lesions at the site of the red pigment used in tattooing. After several unsuccessful therapeutic attempts, intense pulsed light was used. It successfully removed the red pigment and treated the allergy symptoms. In the second case, the authors describe a case of anaphylactic reaction precipitated by the long pulse Nd:YAD laser

Medical school selection: screening for dysfunctional tendencies

Aim: One of the aims of medical selection is to deselect students who have personal characteristics that would impact negatively on their ability to interact with patients, supervisors and peers and impede their ability to cope with the stress of medical training. The arduous requirements of the formal curriculum, the customs and rituals of the socialisation process and the mistreatment and abuse reportedly experienced by students all contribute to stress, mental illness, suicide, lowered self-confidence in clinical ability, decreased ability to learn and alcohol and substance abuse. There has been little research on the effectiveness of the selection interview in deselecting students with negative personal characteristics. Our research profiles the dysfunctional interpersonal tendencies of students already selected into a medical programme through the process of academic merit, application and interview.\ud \ud Methods: During 2001 and 2002, 159 students enrolled in an Australian undergraduate medical programme completed the Hogan Development Survey (HDS), which is a self-report measure of dysfunctional personality characteristics that inhibit the development of working relationships with others.\ud \ud Results: The HDS identified negative personality characteristics in medical students that were not detected in the selection interview.\ud \ud Conclusions: The presence of patterns of dysfunctional behaviour in medical training has implications for the selection, teaching and pastoral care of medical students. The HDS has the potential to identify negative personal characteristics that are hard to detect during a selection interview, and may be a valuable adjunct to the interview

Comparison of the effects of xylazine bolus versus medetomidine constant rate infusion on cardiopulmonary function and depth of anesthesia in horses anesthetized with isoflurane

Objective—To compare the effects of xylazine bolus versus medetomidine constant rate infusion (MCRI) on cardiopulmonary function and depth of anesthesia in dorsally recumbent, spontaneously breathing, isoflurane-anesthetized horses. Design—Prospective, randomized crossover study. Animals—10 healthy adult Standardbreds. Procedures—Horses were premedicated with xylazine or medetomidine IV. Anesthesia was induced with diazepam and ketamine and maintained with isoflurane for 150 minutes. For the xylazine treatment, end-tidal isoflurane concentration was maintained at 1.7%, and xylazine (0.2 mg/kg [0.09 mg/lb], IV) was administered as a bolus at the end of anesthesia. For the MCRI treatment, end-tidal isoflurane concentration was maintained at 1.4%, and medetomidine (0.005 mg/kg/h [0.0023 mg/lb/h], IV) was infused throughout anesthesia. Physiologic data (ie, heart rate, respiratory rate, rectal temperature, bispectral index, and electromyographic values) were compared between treatments with xylazine bolus versus MCRI. Results—Heart rate was lower, but mean arterial blood pressure was higher from 20 to 40 minutes with MCRI treatment, compared with conventional treatment with xylazine. Respiratory rate and rectal temperature were greater with MCRI treatment. Bispectral index was lower with MCRI treatment from 80 to 150 minutes, and electromyographic values were lower with MCRI treatment from 30 to 150 minutes. Conclusions and Clinical Relevance—In isoflurane-anesthetized horses, premedication with medetomidine followed by administration of medetomidine as a constant rate infusion resulted in decreased heart rate, higher arterial blood pressure from 20 through 40 minutes after induction of anesthesia, and better preserved body temperature, compared with conventional treatment with xylazine. Greater depth of anesthesia and muscle relaxation were seen with MCRI treatment, despite the lower isoflurane concentration.Catherine M. Creighton, Kip A. Lemke, Leigh A. Lamont, Barbara S. Horney, Christopher B. Rile