1.

1.                   Eisen D, Carrozzo M, Bagan Sebastian JV, Thongprasom K. Number V Oral lichen planus: clinical features and management. Oral Dis. 2005 Nov;11(6):338-49.

Dermatology Research Associates, Cincinnati, OH 45230, USA. drore@eos.net

Oral lichen planus (OLP) is a relatively common chronic inflammatory disorder affecting stratified squamous epithelia. Whereas in the majority of instances, cutaneous lesions of lichen planus (LP) are self-limiting and cause itching, oral lesions in OLP are chronic, rarely undergo spontaneous remission, are potentially premalignant and are often a source of morbidity. Current data suggest that OLP is a T cell-mediated autoimmune disease in which auto-cytotoxic CD8+ T cells trigger apoptosis of oral epithelial cells. The characteristic clinical aspects of OLP may be sufficient to make a correct diagnosis if there are classic skin lesions present. An oral biopsy with histopathologic study is recommended to confirm the clinical diagnosis and mainly to exclude dysplasia and malignancy. The most commonly employed and useful agents for the treatment of lichen planus (LP) are topical corticosteroids but other newer agents are available.

2.

1.                   Fontana RJ, Shakil AO, Greenson JK, Boyd I, Lee WM. Acute liver failure due to amoxicillin and amoxicillin/clavulanate. Dig Dis Sci. 2005 Oct;50(10):1785-90.

Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, Michigan 48109-0362, USA. rfontana@umich.edu

The aim of our study is to report upon the presentation of two patients with life-threatening acute liver failure (ALF) due to amoxicillin and amoxicillin/clavulanate. A 59-year-old, Caucasian male presented with ALF 34 days after receiving amoxicillin/clavulanate. Despite aggressive supportive care, he died on hospital day 10. A 42-year-old, Caucasian female presented with ALF 21 days after receiving amoxicillin. She underwent successful liver transplantation on hospital day 19. In both cases, all competing causes of ALF had been excluded, liver pathology was consistent with drug-induced hepatitis, and cases were deemed "definite/ highly probable" using causality assessment. Amongst 14 prior ALF/death cases due to amoxicillin / clavulanate, the mean age (62 years), male predominance (57%), and mean delay from drug cessation to presentation (17 days) is similar to what has been reported in patients with self-limited cholestatic hepatitis. Acute liver failure is a rare manifestation of amoxicillin and amoxicillin/clavulanate hepatotoxicity with no obvious clinical features at presentation portending a poor prognosis. Early transfer of patients with severe drug-induced hepatotoxicity (i.e., encephalopathy or coagulopathy) to a transplant center is recommended due to their poor likelihood of recovery.

3.

1.                   Omenaca F, Garcia-Sicilia J, Garcia-Corbeira P, Boceta R, Romero A, Lopez G, Dal-Re R. Response of preterm newborns to immunization with a hexavalent diphtheria-tetanus-acellular pertussis-hepatitis B virus-inactivated polio and Haemophilus influenzae type b vaccine: first experiences and solutions to a serious and sensitive issue. Pediatrics. 2005 Dec;116(6):1292-8.

Department of Neonatology, La Paz Hospital, Madrid, Spain.

OBJECTIVE: Preterm infants are at increased risk from infections and should be vaccinated at the usual chronological age. The aim of the study was to evaluate the immunogenicity and reactogenicity of a hexavalent diphtheria-tetanus-acellular pertussis-hepatitis B virus-inactivated polio and Haemophilus influenzae type b (DTPa-HBV-IPV/Hib) vaccine in preterm infants. METHODS: In a comparative trial, 94 preterm infants between 24 and 36 weeks (mean +/- SD gestational age: 31.05 +/- 3.45 weeks; mean birth weight: 1420 +/- 600 g) and a control group of 92 full-term infants were enrolled to receive 3 doses of a DTPa-HBV-IPV/Hib vaccine at 2, 4, and 6 months. Immunogenicity was assessed in serum samples that were taken before and 4 weeks after primary vaccination. Evaluation of reactogenicity was based on diary cards. RESULTS: All preterm (n = 93) and full-term (n = 89) infants who were included in the immunogenicity analysis had seroprotective titers to diphtheria; tetanus; and polio virus types 1, 2, and 3. The immune response to the Hib and hepatitis B components was lower in preterm than in full-term infants: 92.5% versus 97.8% and 93.4% versus 95.2%, respectively. Vaccine response rates for pertussis antigens were >98.9% in both study groups. Although most geometric mean titers were lower in preterm infants, titers were similar for pertussis, a major threat for premature infants. The vaccine was well tolerated, and there were no differences in reactogenicity between groups. Some extremely immature infants experienced transient cardiorespiratory events within the 72 hours after the first vaccination with no clinical repercussion. CONCLUSIONS: Preterm infants who were immunized with the hexavalent DTPa-HBV-IPV/Hib vaccine at 2, 4, and 6 months displayed good immune response to all antigens. The availability of this vaccine greatly facilitates the vaccination of premature infants.

4.

1.                   Slavin DE, Schlichting CL, Freston JW. Rating the severity of the medical consequences of drug-induced liver injury. Regul Toxicol Pharmacol. 2005 Nov;43(2):134-40.

Pfizer Global Research and Development, Pfizer Inc., Sandwich, CT13 9NJ, England, UK.

Risk analysis in drug development aims to allow for clear decisions showing whether or not the benefit of an intervention outweighs the risk. One of the difficulties in doing this in a repeatable and clear way is the problem of comparing different adverse events, as seriousness is often subjective. Using drug-induced liver injury as our model, we show that clinical, laboratory, and histological manifestations of liver reactions can be ranked by experienced hepatologists and these rankings can be used to rank the consequences of drug-induced side effects as a continuum. This risk ranked information could be transformed to standardized scores (z score) and the risks displayed by standard techniques; adverse events can then be compared with effects from other drugs and possibly with the consequences due to untreated disease or natural occurrences. As a risk is a function of both the seriousness of the event and the probability of its occurrence, risk can therefore be displayed in terms of probability and hazard to further ease communication. We propose that risk management of drugs in development would be improved, especially in terms of risk communication, if the hazard were ranked by means of a common scale and displayed in graphic form against the likelihood of occurrence.

5.

  3         Ward JI, Cherry JD, Chang SJ, Partridge S, Lee H, Treanor J, Greenberg DP, Keitel W, Barenkamp S, Bernstein DI, Edelman R, Edwards K; APERT Study Group. Efficacy of an acellular pertussis vaccine among adolescents and adults. N Engl J Med. 2005 Oct 13;353(15):1555-63.

UCLA Center for Vaccine Research, Research and Education Institute, Harbor-UCLA Medical Center, David Geffen School of Medicine, UCLA, Torrance, Calif 90502, USA.

BACKGROUND: Pertussis immunization of adults may be necessary to improve the control of a rising burden of disease and infection. This trial of an acellular pertussis vaccine among adolescents and adults evaluated the incidence of pertussis, vaccine safety, immunogenicity, and protective efficacy. METHODS: Bordetella pertussis infections and illnesses were prospectively assessed in 2781 healthy subjects between the ages of 15 and 65 years who were enrolled in a national multicenter, randomized, double-blind trial of an acellular pertussis vaccine. Subjects received either a dose of a tricomponent acellular pertussis vaccine or a hepatitis A vaccine (control) and were monitored for 2.5 years for illnesses with cough that lasted for more than 5 days. Each illness was evaluated with use of a nasopharyngeal aspirate for culture and polymerase -chain-reaction assay, and serum samples from patients in both acute and convalescent stages of illness were analyzed for changes in antibodies to nine B. pertussis antigens. RESULTS: Of the 2781 subjects, 1391 received the acellular pertussis vaccine and 1390 received the control vaccine. The groups had similar ages and demographic characteristics, and the median duration of follow-up was 22 months. The acellular pertussis vaccine was safe and immunogenic. There were 2672 prolonged illnesses with cough, but the incidence of this nonspecific outcome did not vary between the groups, even when stratified according to age, season, and duration of cough. On the basis of the primary pertussis case definition, vaccine protection was 92 percent (95 percent confidence interval, 32 to 99 percent). Among unimmunized controls with illness, 0.7 percent to 5.7 percent had B. pertussis infection, and the percentage increased with the duration of cough. On the basis of other case definitions, the incidence of pertussis in the controls ranged from 370 to 450 cases per 100,000 person-years. CONCLUSIONS: The acellular pertussis vaccine was protective among adolescents and adults, and its routine use might reduce the overall disease burden and transmission to children. Copyright 2005 Massachusetts Medical Society.

6.

1.                   Yeo MS, Bond LM, Sawyer SM. Health risk screening in adolescents: room for improvement in a tertiary inpatient setting. Med J Aust. 2005 Oct 17;183(8):427-9.

Centre for Adolescent Health, Royal Children's Hospital, 2 Gatehouse St, Melbourne, VIC 3052. Michele.Yeo@mcri.edu.au

OBJECTIVE: To determine the extent to which comprehensive health screening of adolescents was undertaken in a tertiary inpatient setting. DESIGN AND SETTING: Retrospective review of 100 consecutive medical records of 13-18-year-old adolescents admitted to The Royal Children's Hospital, Melbourne (first 20 consecutive admissions in 2001 to each of five units--general medicine, adolescent medicine, specialty medicine, general surgery, and specialty surgery). MAIN OUTCOME MEASURES: Documentation of screening for biomedical (height, weight, pubertal staging, and hepatitis B vaccination) and psychosocial concerns (HEADSS framework categorised into four screening levels--none, incomplete, adequate, thorough). Risks identified and actions taken. RESULTS: Weight was recorded for 98 patients, height for 17, pubertal staging for 12, and hepatitis B vaccination status for nine. Documentation of psychosocial screening was absent from 62 charts, inadequate in 29, thorough in three, and complete in seven charts. Adolescent medicine inpatients were more likely than patients in other units to have any screening of psychosocial risk recorded and more likely to be thoroughly screened (P < 0.005). Screening was more often documented for less sensitive issues (eg, home, tobacco) than higher risk behaviours (eg, illicit drug use) (P = 0.013). When screening identified risks, appropriate action was undertaken in most cases. CONCLUSIONS: This study highlights deficiencies in comprehensive health screening in adolescents admitted to a tertiary children's hospital. These results support the development of more consistent approaches to screening adolescent inpatients.

Diagnosis, Diagnostics, Immunodiagnosis & Immunodiagnostics:  

13850.   Bae SH, Yoon SK, Choi JY, Jang JW, Cho SH, Yang JM, Han NI, Ahn BM,  hung KW, Sun HS. Timing of lamivudine administration according to Child class in patients with decompensated cirrhosis. J Gastroenterol Hepatol. 2005 Oct;20(10):1527-32.

13851.  Balasubramanian S, Prosser CC, Ransibrahmanakul K, Rossaro L, Bourgeois JA.   Treatment of hepatitis B and C co-infection in schizoaffective disorder. QJM. 2005 Oct;98(10):774-5.

13852.  Barnett ED. Immunizations and infectious disease screening for internationally adopted children. Pediatr Clin North Am. 2005 Oct;52(5):1287-309, vi. Review.

13853.  Coban S, Ceydilek B, Ekiz F, Erden E, Soykan I. Levofloxacin-induced acute fulminant hepatic failure in a patient with chronic hepatitis B infection. Ann Pharmacother. 2005 Oct;39(10):1737-40. 

13854.   Forrest EH.   Prognostic evaluation of alcoholic hepatitis. J Hepatol. 2005 Oct;43(4):738-9.

13855.  Guntupalli SR, Steingrub J. Hepatic disease and pregnancy: an overview of diagnosis and management. Crit Care Med. 2005 Oct;33(10 Suppl):S332-9. Review.

13856.   Iguchi Y, Ohmoto K, Wada H, Yamamoto S. Drug-induced megaloblastic anemia. Dig Dis Sci. 2005 Oct;50(10):1778-9.

13857.   Karnad DR, Guntupalli KK. Neurologic disorders in pregnancy. Crit Care Med. 2005 Oct;33(10 Suppl):S362-71. Review.

13858.   Keeffe EB. Chronic hepatitis C: management of treatment failures. Clin Gastroenterol Hepatol. 2005 Oct;3(10 Suppl 2):S102-5. Review.

13859.   Li XM, Ma L, Yang YB, Shi ZJ, Zhou SS. [Prognostic factors of fulminant hepatitis in pregnancy.]. Chin Med J (Engl). 2005 Oct 20;118(20):1754-7.

13860.   Lindsey N, Reif JS, Bachand A, Seys SA. Behavior modification following a diagnosis of hepatitis C infection. Am J Health Behav. 2005 Nov-Dec;29(6):  512-9.

13861.   Lopez-Medrano F, Lizasoain M, Aguado JM. A fractured diagnosis. N Engl J Med. 2005 Oct 20;353(16):1747; author reply 1747.

13862.   Miyake Y, Sakaguchi K, Iwasaki Y, Ikeda H, Makino Y, Kobashi H, Araki Y, Ando M, Kita K, Shiratori Y. New prognostic scoring model for liver transplantation in patients with non-acetaminophen-related fulminant hepatic failure. Transplantation. 2005 Oct 15;80(7):930-6.

13863.   Mohanty SR. Extrahepatic manifestations of hepatitis C. South Med J. 2005 Oct;98(10):967-9.

13864.   Sherman M.  Predicting survival in hepatitis B. Gut. 2005 Nov;54(11):1521-3. Review.

13865.   Slowik MK, Jhaveri R. Hepatitis B and C viruses in infants and young children. Semin Pediatr Infect Dis. 2005 Oct;16(4):296-305. Review.

13866.   Weyer P, Cummings OW, Knox KS. A 49-year-old woman with hepatitis, confusion, and abnormal chest radiograph findings. Chest. 2005 Oct;128(4):3076-7, 3078-9.

13867.   Zalavras CG, Gupta N, Patzakis MJ, Holtom PD. Microbiology of osteomyelitis in patients infected with the human immunodeficiency virus. Clin Orthop Relat Res. 2005 Oct;439:97-100. 

Pathogenesis:

13868.     Erdem I, Cicekler N, Mert D, Yucesoy-Dede B, Ozyurek S, Goktas P. A case report of acute hepatitis due to brucellosis. Int J Infect Dis. 2005 Nov;9(6):349-50.  .

13869.   Griffith R, Tengnah C. Public health 2: Criminal liability for spreading disease. Br J Community Nurs. 2005 Oct;10(10):475-8. Review.

13870.   Kopka A. Anesthetist to patient transmission of hepatitis C virus associated with non exposure-prone procedures. J Med Virol. 2005 Dec;77(4):500; discussion 501.

13871.   Milazzo L. Hepatitis A associated with green onions. N Engl J Med. 2005 Nov 24;353(21):2300-1.

13872.  Yang PM, Chen DS. Images in clinical medicine. Caput medusae. N Engl J Med. 2005 Nov 24;353(21):e19.

Vaccines:

13873.     Charatan F. US panel recommends young children receive hepatitis A vaccination. BMJ. 2005 Nov 12;331(7525):1102.

13874.   Connor BA. Hepatitis A vaccine in the last-minute traveler. Am J Med. 2005 Oct;118 Suppl 10A:58S-62S. Review.

13875.   Davis JP.  Experience with hepatitis A and B vaccines. Am J Med. 2005 Oct;118 Suppl 10A:7S-15S. Review. 

13876.  Gall SA. Expanding the use of hepatitis vaccines in obstetrics and gynecology. Am J Med. 2005 Oct;118 Suppl 10A:96S-99S. Review.

13877.   Peterson DC, Palevsky SL. Office-based approach to the implementation of a hepatitis immunization program. Am J Med. 2005 Oct;118 Suppl 10A:90S-9S5. Review.

13878.   Woo EJ, Ball R, Braun MM. Fatal syncope-related fall after immunization. Arch Pediatr Adolesc Med. 2005 Nov;159(11):1083.

13879.   Zanetti AR, Mariano A, Romano L, D'Amelio R, Chironna M, Coppola RC,  uccia M, Mangione R, Marrone F, Negrone FS, Parlato A, Zamparo E, Zotti C, Stroffolini T, Mele A; Study Group. Long-term immunogenicity of hepatitis B vaccination and policy for booster: an Italian multicentre study. Lancet. 2005 Oct 15-21;366(9494):1379-84.

13880 .     Dhiman RK, Chawla YK. Herbal medicines for liver diseases. Dig Dis Sci. 2005 Oct;50(10):1807-12. Review.

13881.   Hardie J. Harsh advice? Br Dent J. 2005 Oct 22;199(8):483-4.

13882.   Larkin M. In hurricanes' aftermath, keeping infection under control. Lancet Infect Dis. 2005 Nov;5(11):673.

13883.  Peterson GM, Naunton M. Valproate: a simple chemical with so much to offer. J Clin Pharm Ther. 2005 Oct;30(5):417-21. Review.

13884.  Seed CR, Kiely P, Keller AJ. Residual risk of transfusion transmitted human immunodeficiency virus, hepatitis B virus, hepatitis C virus and human T lymphotrophic virus. Intern Med J. 2005 Oct;35(10):592-8.