ABSTRACT
Acute disseminated encephalomyelitis (ADEM) is an acute demyelinating disorder of the central nervous system, mostly seen in children after viral or bacterial infection and vaccinations. Cases of ADEM, albeit rare, have been reported in renal transplant recipients. The pathophysiology of posttransplant ADEM remains unclear but has been hypothesized to be due to aberrant T-cell reactivity to myelin basic protein triggered by a bacterial or viral infection. We report an unusual case of a 34-year-old white female with ADEM developing 5 years after a living related renal transplant.
Subject(s)
Encephalomyelitis, Acute Disseminated/diagnosis , Glomerulonephritis/complications , Kidney Failure, Chronic/surgery , Kidney Transplantation/adverse effects , Adult , Anti-Bacterial Agents/therapeutic use , Bronchitis/diagnosis , Bronchitis/drug therapy , Cilastatin/therapeutic use , Encephalomyelitis, Acute Disseminated/physiopathology , Fatal Outcome , Female , Gliosis/diagnosis , Humans , Imipenem/therapeutic use , Kidney Failure, Chronic/etiology , Postoperative Complications/diagnosis , Postoperative Complications/physiopathologyABSTRACT
This article describes the assessment of physicians' attitudes and practices regarding prescribing syringes to injection drug users (IDUs). A brief, anonymous, self-administered questionnaire was sent to all Infectious Disease and Addiction Medicine specialists in Rhode Island. Of 49 eligible physicians, 39 responded (response rate 80%). Most (95%) indicated that there is a legitimate medical reason for IDUs to obtain sterile syringes. Many (71%) agreed that they would prescribe syringes to prevent disease in IDUs if it were clearly legal to do so. We can conclude that physician syringe prescription to IDUs may be an acceptable supplement to existing HIV prevention strategies.