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This year we will be featuring affordable camping and outdoor activities in the Northwest. Starting with Sequim, Washington State Park. Our crew will be camping at Sequim Washington State Park on May 9th and 10th. This year we have stored the [...]
An Unusual Cause of Gastrointestinal Bleeding and Severe Anemia in a Child: Leech Infestation
A 1-year-old boy with epistaxis, gastrointestinal bleeding and severe anemia that caused cardiorespiratory distress presented to our unit. The results of coagulation tests were normal. An erythrocyte suspension transfusion was given to the patient. On the second day of his hospitalization, a leech was removed from his nose. In developing countries, leech infestation should be considered in cases where epistaxis, hematemesis, gastrointestinal bleeding and severe anemia are of unknown origin.
Optimization Strategy to Minimize Wastage of Palivizumab during the 2008 RSV Season in Sao Paulo, Brazil
Palivizumab is currently recommended to high-risk children as a prophylaxis for respiratory syncytial virus (RSV) infection. However, it is still very expensive for developing countries like Brazil. Herein, we describe our strategy to minimize wastage of Palivizumab during the 2008 RSV season. Appointments were fixed for 304 children on 2 days of the week, so that a mean of 19.9 children received Palivizumab per day. That allowed remaining volumes of Palivizumab vials to be pooled and used for other children on the same day within the 6 h period after opening a vial. That strategy saved 26.3% of vials, which represents USD749 143.75.
Parvovirus B19-induced Thrombocytopenia and Anemia in a Child with Fatal Fulminant Hepatic Failure Coinfected with Hepatitis A and E Viruses
A 5-year-old male, drowsy, jaundiced child presented with fulminant hepatitis and had HAV and HEV infection. He had hepatic encephalopathy grade 1, fever, pallor, hypotension, crepitations in his right lung base and hepatosplenomegaly with dyspnoea. He had highly raised liver enzymes and hypoalbuminemia (2.8 g/dl) but anemia (hemoglobin of 7.7 g/dl and 5.7 g/dl 2 days later), reticulocytopenia and severe thrombocytopenia (44 x 109/l) were unexplained. Parvovirus B19-specific IgM antibodies and B19 DNA were found in the serum of the child. Chest X-ray showed pleural effusion and bronchopneumonia, while blood culture isolated coagulase-negative staphylococci (BACTEC 9120) and he had low oxygen saturation. Hence, he was treated with IV amoxicillin+ clavulinic acid and oxygen inhalation. He had seizures and cardiac arrest but was revived. On the third day his condition worsened and the child died despite intensive care. Hence it is concluded that his anemia and thrombocytopenia were B19 induced and this might have aggravated or caused fulminant hepatitis.
Proposal For The New Competitive Acquisition Program For Part B Drugs And Biologicals
Section 303 (d) of the MMA (adobe pdf 26Kb) requires the implementation of a competitive acquisition program (CAP) for medicare Part B drugs and biologicals not paid on a cost or prospective payment system basis. Beginning with drugs administered on or after January 1, 2006, physicians will be given a choice between buying and billing [...]
