An unusual case of hypokalemic paralysis associated with primary Sjogren's syndrome.

43-year-old Caucasian female presented with progressive weakness and dyspnea. She was diagnosed with hypokalemic paralysis from a severe distal renal tubular acidosis (RTA). Immunologic work-up showed a strongly positive ANA of 1:640 and positive antibodies to SSA and SSB. Schirmer's test was normal. Renal involvement in Sjogren's syndrome (SS) is not uncommon and may precede sicca complaints. The pathology in most cases is a tubulointerstitial nephritis causing among other things, distal RTA, and, rarely, hypokalemic paralysis. Treatment consists of potassium repletion, alkali therapy and corticosteroids. Primary SS should be a differential in premenopausal women with acute weakness and hypokalemia.

Influenza immunization of medical residents: knowledge, attitudes, and behaviors.

BACKGROUND: There have been few studies of barriers to acceptance of influenza immunization among medical residents. EXPERIMENTAL DESIGN: We conducted a cross-sectional survey of residents at the Western Pennsylvania Hospital during the 2003-2004 influenza season. An anonymous questionnaire designed specifically for this study was used to collect demographic, health beliefs and attitudes, and medical knowledge data related to the influenza vaccine. RESULTS: 43 residents were surveyed from January to February 2004. 58% of the respondents reported receiving the vaccine. Immunization rates were significantly associated with postgraduate level, prior vaccination, media influence, whether they knew co-residents who were vaccinated, medical knowledge scores, and plan to be vaccinated next year. Immunization rates by age, sex, type of medical school, department, whether they had children younger than 16, whether they would recommend the vaccine to patients, and the respondents' health status did not differ significantly. Residents who had higher medical knowledge scores were significantly more likely to be immunized and recommend the vaccine to patients. CONCLUSIONS: Resident influenza immunization rate in this sample was higher than the national average for healthcare workers. The rate of immunization was associated with demographic, knowledge, and behavioral factors.