Path: utzoo!utgpu!jarvis.csri.toronto.edu!mailrus!uwm.edu!zaphod.mps.ohio-state.edu!brutus.cs.uiuc.edu!psuvax1!psuvm!auvm!ASUACAD!ATW1H From: ATW1H@ASUACAD.BITNET (Dr David Dodell) Newsgroups: bit.listserv.mednews Subject: HICN305 News Part 1/3 Message-ID: Date: 10 Feb 90 22:50:18 GMT Sender: MEDNEWS - Health Info-Com Network Newsletter Lines: 643 Approved: NETNEWS@AUVM Gateway --- begin part 1 of 3 cut here --- Volume 3, Number 5 February 10, 1990 +------------------------------------------------+ ! ! ! Health Info-Com Network ! ! Newsletter ! +------------------------------------------------+ Editor: David Dodell, D.M.D. St. Joseph's Hospital and Medical Center 10250 North 92nd Street, Suite 210, Scottsdale, Arizona 85258-4599 USA Telephone +1 (602) 860-1121 FAX +1 (602) 285-3670 [Attn: David Dodell] Copyright 1990 - Distribution on Commercial/Pay Systems Prohibited without Prior Authorization International Distribution Coordinator: Robert Klotz Nova Research Institute 217 South Flood Street, Norman, Oklahoma 73069-5462 USA Telephone +1 (405) 366-3898 The Health Info-Com Network Newsletter is distributed weekly. Articles on a medical nature are welcomed. If you have an article, please contact the editor for information on how to submit it. If you are intrested in joining the distribution system please contact the distribution coordinator. E-Mail Address: Editor: FidoNet = 1:114/15 Bitnet = ATW1H @ ASUACAD Internet = ddodell@stjhmc.fidonet.org LISTSERV = MEDNEWS @ ASUACAD anonymous ftp = vm1.nodak.edu (Notification List/ftp = hicn-notify-request@stjhmc.fidonet.org) Distribution: North America Australia/Far East Europe FidoNet = 1:19/9 David More George Cordner Usenet = krobt@mom.uucp FidoNet = 3:711/413 Fidonet Internet = krobt%mom@uokmax.ecn.uoknor.edu 2:23/105 ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: T A B L E O F C O N T E N T S 1. Comments & News from the Editor Notes from the Editor ................................................. 1 2. Medical News Medical News for Week Ending Feb. 1, 1990 ............................. 2 3. Center for Disease Control Reports [MMWR 1-25-90] Tetanus -- United States, 1987 & 1988 .................. 7 Surveillance of Shelters after Hurricane Hugo ......................... 10 Aspergillus Endophthalmitis in Intravenous-Drug Users ................. 12 Corneal Infection Related to Mascara Applicator Trauma ................ 13 Update: Influenza Activity ............................................ 15 4. Food & Drug Administration News FDA News Releases ..................................................... 17 5. Columns Diabetes Highlights ................................................... 23 6. Articles AIDS and Personnel Management - Bibliography .......................... 26 Health InfoCom Network News Page i Volume 3, Number 5 February 10, 1990 ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: Comments & News from the Editor ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: Notes from the Editor by David Dodell, D.M.D. Well, it appears that my "cry" for help with the newsletter the second time around raised some help. I received several responses from individuals asking what they could do, and several have volunteered to write columns on a semi- regular basis. Two that start appearing this issue are from Pat Watkins, who is based with the University of North Carolina/Chapel Hill Health Science Library. The other is from Dr. J. Martin Wehlou whose interest is in diabetes. Pat has been so kind to send us several columns that are bibliographies of the AIDS literature in several specific areas. Dr. Wehlou's is writing summaries of the current medical literature in diabetes. He is doing this in a short paragraph form, providing the articles/journal as a resource for those of you desiring additional information. I would publically like to thank Pat and Martin for their contributions. I also would like to thank the rest of you who wrote and will be contributing in future issues. I also hope more of you will consider occasionally sending in an article in your area of interest. This is the only way we can spread the contents of the newsletter. Also, announcements of conferences, fellowships, etc are always welcomed. Regards, David Health InfoCom Network News Page 1 Volume 3, Number 5 February 10, 1990 ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: Medical News ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: Medical News for Week Ending Feb. 1, 1990 Copyright 1990: USA TODAY/Gannett National Information Network Reproduced with Permission --- Jan. 29, 1990 --- SHY GUYS MORE DRAWN TO DRUGS: Shy teen-age boys are more likely than gregarious ones to take drugs, says a University of Idaho study. Findings: 8.8 percent of shy boys surveyed used cocaine, compared to 2.3 percent among non-shy ones. Researchers say drugs may be a coping mechanism for shy males who want to participate in social activities but lack the confidence. (From the USA TODAY Life section.) GROUP CRITICIZES HEART PROGRAM: The National-American Wholesale Grocers' Association supports the Food and Drug Administration's stand against the American Heart Association HeartGuide program, saying the plan may confuse people and be unfair the food industry. The FDA last week threatened action if the program labeling some items with heart-healthy seals of approval proceeds Monday. The AHA stands by the program. FOOD INDUSTRY BLASTS AHA PLAN: The American Heart Association's HeartGuide program is deceptive, says the Association of Food Industries. The group says the project, to begin Monday with AHA seal-approved products hitting grocery shelves, deceives consumers into thinking brands with the seals are better than those without. The AHA says the labels are meant to help shoppers with often misleading claims. MAYO LAUNCHES DIET PLAN LETTER: The Mayo Clinic is starting a Diet Plan that will be published in six consecutive issues of "The Mayo Clinic Nutrition Letter," a monthly newsletter beginning in February. The weight-loss program, based on healthy eating and moderate exercise, will offer a weekly slim-down menu, a tested recipe, workout tips and advice on making the diet work. For information call: 1-507- 284-4577. MAYO GIVES DIET PLAN TIPS: The new Mayo Clinic Diet Plan says creative seasoning, daily water intake and regular walking are good ways to keep healthy and trim. Spices provide taste without fat, eight ounces of water daily helps fill up and slow down eating. Also, brisk walking is an aerobic activity that is easy and effective for burning calories. Health InfoCom Network News Page 2 Volume 3, Number 5 February 10, 1990 HIB INFECTION STRIKES KIDS: The most frequent cause of bacterial meningitis in kids under age 5 is Haemophilus influenzae type b infection, says Merck Sharp & Dohme of Pennsylvania. Hib strikes 20,000 annually, resulting in 12,000 cases of bacterial meningitis. The Food and Drug Administration has approved the vaccine PedvaxHib. It provided anti-Hib protection in 97 percent of 18- to 23- month-olds tested. --- Jan. 30, 1990 --- AZT MAY HELP AIDS CARRIERS: Carriers of the AIDS virus who have not developed the disease may get more prolonged benefits from the drug AZT than patients with full-blown AIDS, said AZT maker Burroughs Wellcome. Research shows asymptomatic patients develop fewer drug-resistant strains of the virus while under AZT treatment. (From the USA TODAY Life section.) ANTI-DEPRESSION COMPUTERS USED: A new computer program has been developed to teach patients ways to overcome depression, say psychotherapists in Mesa, Ariz. Findings: Over six weeks, the hour-a-week therapy helped 12 mildly to moderately depressed patients improve as much as a similar group who had seen a therapist weekly. Creators say the high-tech therapy will not replace therapists. (From the USA TODAY Life section.) CHILD CARE AFFECTS WELL-BEING: There is no magic age to put a child in preschool, but most kids seem ready to be enrolled by age 3, say child care experts. By that age, children generally are ready to share and play with other kids. Experts also say that quality of the care program is more important than the child's age - a good caregiver-to-child ratio like 1 to 4 is important. (From the USA TODAY Life section.) SPOTTING GOOD CHILD CARE: Experts advise parents seeking a child care program for their kids to shop around since standards vary greatly. Things to look for: children should be happy and engaged in activities; kids should be involved in activities that look more like play than school; there should be a variety of toys, books and other materials in the environment. (From the USA TODAY Life section.) FDA OK'S DRUG FOR AIDS FUNGUS: The Food and Drug Administration has approved fluconazole for alternative treatment of two AIDS-related fungal infections. The drug was ok'd for cryptococcal meningitis, inflammation of the brain and nervous systems often affecting people with AIDS; and for candidiasis, a fungal infection often causing mouth and throat sores in 80 to 90 percent of advanced AIDS infection. Health InfoCom Network News Page 3 Volume 3, Number 5 February 10, 1990 --- Jan. 31, 1990 --- NECK CAUSES ANGINA-LIKE PAIN: Angina-like chest pains are often caused by neck injuries and can be treated without surgery, says a New York State Journal of Medicine report. Findings: Of 164 patients with cervical angina (also called pseudoangina), 145 had suffered whiplash in car accidents, 10 had been injured at work. The symptoms of neck and arm pain and headache can be relieved by traction. ATHLETE ALCOHOL USE A PROBLEM: High school coaches nationwide cite alcohol abuse by their athletes as a bigger problem than drug abuse, a USA TODAY poll shows. Findings: 88 percent of 798 coaches called liquor the greatest threat to their players, 6 percent cited cocaine and/or crack, 1 percent identified illegal steroids. (From the USA TODAY Sports section.) SUBSTANCE ABUSE POLICIES OFFERED: Most of the 798 high school coaches surveyed said their schools have substance abuse policies, a USA TODAY survey says. Peabody High School in Kansas gives suspension for a first offense, a rehabilitation program for a second. Coaches say the programs stress awareness about the dangers of drugs and alcohol, and how to say no. (From the USA TODAY Sports section.) STANDING CAN BRING EARLY BIRTH: Pregnant women who stand a lot have an increased chance of early delivery, reports the American Journal of Public Health's January issue. But a Yale University study says standing does not affect fetus weight. Scientists think the position may boost the mother's pulse rate, lowering her blood pressure but boosting the unborn baby's pulse. SUPPORT EASES DEPRESSION: Interacting with family and friends can help prevent depression in people stricken with a serious illness, report Purdue University researchers. Study: Of 70 cancer patients, one-third got depressed due to lack of communication with family and friends. The study also showed married couples were less likely to get depressed than singles. BALLOONS USED FOR INFERTILITY: A form of balloon angioplasty, `tuboplasty,' is being tested to help infertile women open blocked fallopian tubes, reports a Mount Sinai Hospital study. Of 89 women tested, tuboplasty was 92 percent successful in initially opening the tubes; 22 have become pregnant. Early cost estimates run about $2,000. AIDS RESEARCH LOOKING HOPEFUL: The anti-AIDS drug AZT is the only one approved for use by the Food and Health InfoCom Network News Page 4 Volume 3, Number 5 February 10, 1990 Drug Administration, but researchers are making slow, steady progress in finding weaknesses in the AIDS virus, which helps scientists design drugs to combat the disease. That's how AZT was found: By chance, among hundreds of compounds first tested against the virus. (From the USA TODAY Life section.) ANTI-AIDS DRUGS ON THE HORIZON: Research is gradually progressing in the fight against AIDS, with at least three therapies with promise to join AZT as approved treatment. They are: protease inhibitors, reverse transcriptase inhibitors and soluble CD4. Immunity-boosting drugs and infection-fighting drugs are also being studied. (From the USA TODAY Life section.) CORNEAL MASK STUDY GETS GRANT: The National Institute of Health has awarded Summit Technology with a grant for research on an erodible corneal mask. The device will be used in the photo-refractive, keratectomy or `corneal sculpting' to treat near- sightedness, far-sightedness and astigmatism. The mask is hoped to optimize healing and provide the surgeon with more control. --- Feb. 1, 1990 --- DRUG TO COMBAT AIDS PNEUMONIA: A new drug, 566C80, has been shown to successfully treat and prevent pneumocystis pneumonia that attacks three out of four AIDS patients, say researchers at St. Jude Children's Hospital. In tests, all rats treated with the drug recovered from the pneumonia while the illness progressed in all the rats that were not treated. FLUORIDATION DEBATE RESPARKED: A National Toxicology Program study has linked fluoridated water to a rare bone cancer in rats. Research: Four of 80 rats drinking 79 parts per million fluoridated water developed the bone cancer, osteosarcoma; one rat drinking water fluoridated to 45 ppm developed the disease. But no rats drinking fluoride-free water developed cancer. (From the USA TODAY Life section.) FAT AFFECTS BREAST CANCER RISK: Women with male-like body fat patterns, such as a pot belly, are at higher breast cancer risk than women with traditional body fat distribution, reports Wednesday's Annals of Internal Medicine. Researchers found that women with body fat over the stomach and abdominal area have a six-fold risk over those with fat deposits on hips and thighs. TEST IDS CYSTIC FIBROSIS RISK: A new test for detecting a majority of those at risk to having children with cystic fibrosis has been developed, reports Thursday's New England Journal of Medicine. Scientists last summer discovered a chromosome mutation that causes the disease; screening for the defect can detect 76 percent of Health InfoCom Network News Page 5 Volume 3, Number 5 February 10, 1990 gene carriers. (From the USA TODAY Life section.) NEW AIDS DRUG SHOWS PROMISE: Test-tube studies have shown that a man-made compound appears to be the strongest substance yet for stopping the AIDS virus from reproduction, reports Thursday's issue of Nature. The TIBO derivatives inhibited reproduction at concentrations 10,000 to 100,000 times lower than what would kill cells. (From the USA TODAY Life section.) HYPERTENSION DRUG HELPS BONES: The elderly over age 65 who take thiazides to treat high blood pressure can cut their risk to hip fractures by one third, reports Thursday's New England Journal of Medicine. Reason: Thiazides, a form of diuretics, can prevent calcium loss. But the drug can cause side effects like high cholesterol and potassium deficiency. (From the USA TODAY Life section.) Health InfoCom Network News Page 6 Volume 3, Number 5 February 10, 1990 ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: Center for Disease Control Reports ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: Morbidity and Mortality Weekly Report Thursday January 25, 1990 Current Trends Tetanus -- United States, 1987 and 1988 During 1987 and 1988, state health departments reported 101 cases of tetanus to the MMWR (48 in 1987 and 53 in 1988). The average annual incidence rate for 1987-1988 was 0.02 per 100,000 U.S. population, compared with 0.39 per 100,000 in 1947, when national reporting began. Thirty-five states reported at least one case of tetanus, and 13 states reported cases in both years. Five of the 15 states reporting no cases were in the Rocky Mountain region, a geographic distribution previously noted (1,2). Case report forms on 99 patients provided demographic data and information on immunization history, injury or other medical conditions, tetanus prophylaxis used in wound management, and outcome. Of the 99 patients, 50 were male. Based on patients with known race, the estimated average annual incidence rate for whites (64 cases) was 0.15 per million; for blacks (21 cases), 0.34 per million; and for all other races combined (12 cases), 0.85 per million. Sixty-seven of the 99 patients were greater than or equal to 50 years of age, and six were less than 20 years of age (Figure 1); incidence increased with age. No cases of neonatal tetanus were reported. Overall, the case- fatality rate was 21%. Five patients reportedly received at least a primary series* of tetanus toxoid before disease onset (Table 1). Of these, two had received the last dose of tetanus toxoid 5-9 years before onset, and one person had received the last dose greater than 20 years earlier; for two patients, the interval since the last dose was unknown. Of the six patients less than 20 years of age, two had not received any doses of tetanus toxoid, one had received one dose, and three had completed the primary series. Of the 93 patients greater than or equal to 20 years of age, two were reported to have received at least three doses of tetanus toxoid, nine had received one or two doses, and 29 reported no prior doses of vaccine; for 53 patients, vaccination status was unknown. Tetanus occurred after an identified acute injury in 74 persons. The most frequently reported acute injuries were puncture wounds (29%), lacerations (18%), and abrasions (13%). Most puncture wounds occurred after persons stepped on sharp objects such as nails and wood splinters. The injury site was a lower extremity in 41 (55%) cases, an upper extremity in 23 (31%) cases, the head or trunk in seven (9%) cases, and an unspecified site in three (4%) cases. Of the 61 patients whose circumstances of injury were known, 33% were injured indoors (three cases were associated with recent surgery), 41% during farming or gardening activities, and 26% in other outdoor settings. The youngest tetanus patient reported was a 2-year-old unvaccinated child whose hand had been injured by broken glass. The median incubation period for the 60 tetanus patients for whom a wound date and tetanus onset date were specified was 7 days. For five (8%) patients, the incubation period was greater than 14 days; for 11 (18%), less than or equal to 3 days. Of the 73 patients who developed tetanus following an acute wound, 31 (42%) had sought medical care for the injury. Tetanus toxoid was given as prophylaxis in wound management to 16 patients (52%); 13 (81%) of these Health InfoCom Network News Page 7 Volume 3, Number 5 February 10, 1990 received toxoid within 4 days of the injury. Based on the current recommendations of the Immunization Practices Advisory Committee (ACIP) for the use of tetanus and diphtheria toxoids (Td) and Tetanus Immune Globulin (TIG) (3) in wound management (Table 2), 14 of the 15 patients who sought medical care for an acute injury but were not given Td should have received it. Fourteen patients with acute wounds severe enough to have required prophylactic wound debridement were candidates for both Td and TIG (Table 2); eight (57%) received Td in the course of wound management, and none received TIG. Fourteen cases were associated with chronic wounds or underlying medical conditions such as skin ulcers, abscesses, or gangrene. Ten of these occurred in patients with diabetes. A history of parenteral drug abuse was the only associated medical condition for six patients. No known acute injury, chronic wound, or other pre-existing medical condition was reported for four patients. The median total TIG dosage used therapeutically after disease onset was 3500 international units (IU). Total TIG dosage ranged from 125 to 10,000 IU. Of the 85 patients who received TIG, 15 (18%) died. Of the 14 patients who did not receive TIG, five (36%) died. For 78 patients, the type of tetanus was reported: 63 (81%) cases were generalized, nine (12%) were localized, and six (8%) were cephalic. Length of hospitalization was reported for 60 patients; the median duration was 15 days (range: 1-73 days). Of the 74 patients for whom the use or nonuse of assisted ventilation was reported, 48 (65%) required ventilation. Reported by: State and territorial epidemiologists. Div of Immunization, Center for Prevention Svcs, CDC. Editorial Note: The reported incidence rate of tetanus declined steadily between 1947 and 1976 (Figure 2). Since 1977, the incidence has continued to decline but at a slower rate. The decline has resulted from the widespread use of tetanus toxoid and improved wound management, including use of tetanus prophylaxis in emergency rooms. The 1990 Health Objectives for the Nation included a goal of less than 50 tetanus cases annually (4), a target achieved for the first time in 1987. The nationwide tetanus surveillance system is a passive reporting system. However, because the clinical presentation of tetanus is distinct, it can be readily diagnosed and is hence more likely than many other diseases to be reported. Completeness of reporting of tetanus deaths to CDC was recently estimated at 40% (5), suggesting that the reported number of total tetanus cases is even further underreported. Although tetanus case report forms were completed on 98% of the cases reported to MMWR during 1987 and 1988, accuracy may have varied; for example, reports on immunization status were usually based on verbal history. The epidemiology of reported tetanus in the United States during 1987 and 1988 was similar to that described previously for 1985 and 1986 (2). Tetanus remains a severe disease with a high case-fatality rate primarily among unimmunized and inadequately immunized adults. Vaccination with a primary series of three doses of tetanus toxoid and booster doses every 10 years is highly effective in the prevention of tetanus (6). Acute wound-associated tetanus can be prevented by appropriate wound management, including active and/or passive immunization. Fifty-eight percent of tetanus patients with acute injuries did not seek medical care for their injuries; of those who did, 81% did not receive prophylaxis as recommended by ACIP guidelines. Of persons with injuries that can lead to tetanus, 1%-6% Health InfoCom Network News Page 8 Volume 3, Number 5 February 10, 1990 reportedly receive less than recommended prophylaxis (7,8). The only means of preventing tetanus not associated with acute wounds or tetanus in persons who do not seek medical care for their wounds is to ensure routine primary immunization and maintenance of immunization status. In the United States, tetanus is primarily a disease of older adults. Thus, tetanus immunization efforts should be especially emphasized for persons aged greater than or equal to 50 years. Health-care practitioners who provide services to adolescents and adults should take every opportunity to review the immunization status of patients and provide, when indicated, Td and other vaccines such as hepatitis B, influenza, pneumococcal polysaccharide, and measles-mumps-rubella (9,10). Maintenance of protection against tetanus (and diphtheria) after the primary series can be achieved by routinely scheduling booster doses of Td at mid-decade ages, e.g., 15 years, 25 years, and 35 years. References 1. CDC. Tetanus--United States, 1982-1984. MMWR 1985;34:602,607-11. 2. CDC. Tetanus--United States, 1985-1986. MMWR 1987;36:477-81. 3. ACIP. Diphtheria, tetanus, and pertussis: guidelines for vaccine prophylaxis and other preventive measures. MMWR 1985;34:405-14,419-26. 4. Public Health Service. Promoting health/preventing disease: objectives for the nation. Washington, DC: US Department of Health and Human Services, Public Health Service, 1980:22. 5. Sutter RW, Cochi SL, Brink EW, et al. Assessment of vital statistics and surveillance data for monitoring tetanus mortality, United States, 1979-1984. Am J Epidemiol 1990;131:132-42. 6. Edsall G. Specific prophylaxis of tetanus. JAMA 1959;171:417-27. 7. Giangrosso J, Smith RK. Misuse of tetanus immunoprophylaxis in wound care. Ann Emerg Med 1985;14:573-9. 8. Brand DA, Acampora D, Gotlieb LD, et al. Adequacy of antitetanus prophylaxis in six hospital emergency rooms. N Engl J Med 1983;309:636-40. 9. ACIP. Adult immunization: recommendations of the Immunization Practices Advisory Com mittee (ACIP). MMWR 1984;33(no. 1S). 10. Committee on Immunization, American College of Physicians. Guide for adult immunization. Philadelphia: American College of Physicians, 1985. *Primary immunization against tetanus consists of three doses of tetanus toxoid, assuming at least 1 month between the first and second doses and at least 6 months between the second and third doses (3). Health InfoCom Network News Page 9 Volume 3, Number 5 February 10, 1990 Epidemiologic Notes and Reports Surveillance of Shelters after Hurricane Hugo -- Puerto Rico On September 18, 1989, Hurricane Hugo struck the northeastern coast of Puerto Rico and left greater than 75% of the island without electricity or water (1). An estimated 10,300 persons were displaced from their residences to temporary shelters. Because of the potential for outbreaks of infectious diseases (such as gastroenteritis) among shelter residents, the Puerto Rico Department of Health (PRDH) conducted active public health surveillance of the shelters from September 25 through October 3. The surveillance system was designed to 1) obtain information about the occurrence of infectious diseases; 2) determine the availability of shelter facilities such as water, toilets, electricity, and medical care; 3) monitor sanitation; 4) identify health- related topics about which to educate shelter residents; and 5) assist in resource allocation. The PRDH divides Puerto Rico into eight administrative regions, six of which were affected by the hurricane. For this surveillance system, each region was assigned teams of public health professionals who reported daily to a supervisory regional epidemiologist, a regional medical director, and the PRDH Division of Epidemiology (DOE). Each team inspected eight shelters daily to provide health education and to assess overcrowding, the occurrence of infectious diseases, and the availability of water and toilet facilities. Potential infectious disease outbreaks were investigated by the regional epidemiologist, with assistance from the PRDH DOE. An infectious disease outbreak was defined as three or more cases of any disease reported on any day in one shelter or an attack rate greater than 10% of a shelter's average population during a 5-day period. The director of DOE reviewed the teams' reports and reported to the Secretary of Health daily. An estimated 10,300 persons were housed in 161 temporary shelters; 113 --- end part 1 of 3 cut here ---