The effect of semipermeable dressings on smallpox vaccine site evolution.

BACKGROUND: Many hospital systems in the United States are contemplating the implementation of a smallpox vaccination program. The Centers for Disease Control and Prevention and other organizations recommend use of occlusive dressings over the vaccination site of health care workers in contact with patients. Minimal data are available on the impact of an occlusive dressing on the evolution of the vaccinia inoculation site. METHODS: We conducted a prospective observational study in which subjects were instructed to cover their vaccination site with either a semipermeable dressing over gauze or gauze alone. We recorded the duration of semipermeable dressing use and parameters pertaining to vaccination site evolution, to include time until scab separation. RESULTS: The increased use of a semipermeable dressing is associated with increased time until scab separation (n = 41, r =.48, P =.001 by regression analysis). This analysis predicts a 9-day difference in time until scab separation between patients that wore semipermeable dressings 100% of the time versus not at all. No significant correlation was observed between semipermeable dressing use and size of maximum erythema, time until maximum erythema, size of erythema on day 6 or 8, nor time until pustule formation. CONCLUSION: Semipermeable dressing use appears to prolong the time until scab separation and possibly the duration of infectivity and risk of secondary transmission. Health care organizations may wish to consider this information when instituting a smallpox vaccination program.

The presence of psychiatric disorders reduces the likelihood of neurologic disease among referrals to a neurology clinic.

OBJECTIVES: This study aims to explore the prevalence and impact of psychiatric disorders on the likelihood of an organic, neurological explanation for symptoms among neurology referrals. METHODS: Consecutive new adult neurology referrals were screened for psychiatric disorders (PRIME-MD) prior to evaluation by neurologists, blinded to these results. Diagnoses were stratified into three categories: no neurological diagnosis, neurological-headache, and neurological-nonheadache. RESULTS: Of 235 patients enrolled, 79 (34%) received no neurological diagnosis, 54 (23%) headache and 102 (43%) a neurological diagnosis. Overall, 39% had an underlying psychiatric disorder. Patients with psychiatric disorders were less likely to have a neurological diagnosis (RR: 0.66, 95% CI: 0.48-0.90): 25% of patients with a neurological diagnosis had an underlying psychiatric disorder, compared to 43% among those with no diagnosis and 57% among those with headaches. CONCLUSION: Psychiatric disorders are common among neurology referrals, particularly those with headaches and are associated with a decreased likelihood of an underlying neurological process.

Post-transplant interleukin-2 in patients with low-grade lymphoid neoplasms previously treated with fludarabine is limited by hematologic toxicity.

Given the favorable immunologic effects of IL-2 post transplant, we conducted a feasibility study examining rIL-2 1.0x106 IU/m2/day (SQ) beginning on D+14 post-transplant and continuing for 90 days in 12 patients with low-grade lymphoproliferative disorders. Prior to high-dose chemotherapy and autologous peripheral blood stem cell transplantation (HDCT), 11 patients underwent cytoreduction with fludarabine and cyclophosphamide (Flu/Cy); 11 were in complete remission (CR) and one was in partial remission at the time of HDCT. All 12 patients were in CR 90 days post-HDCT. At a median follow-up of 30 (range 3-44) months, seven patients (58%) remain in remission, four are alive with disease, and one has died of disease progression, resulting in an overall survival of 92%. Kaplan-Meier estimates of progression-free survival (PFS) for the group demonstrate a median of 31 (range 3-43) months. Five patients required rIL-2 cessation at 8-58 days after starting the therapy due to hematologic toxicity. These results are comparable to those achieved in other published bone marrow and peripheral blood stem cell transplantion (PBSCT) series without the addition of rIL-2. Furthermore, rIL-2 using this schedule following fludarabine-based cytoreduction was associated with excessive hematologic toxicity.