1/7. Molecular evolutionary analysis of the complete nucleotide sequence of hepatitis B virus (HBV) in a case of HBV infection acquired through a needlestick accident.To elucidate needlestick transmission of hepatitis b virus (HBV), strains isolated from 1 physician who acquired HBV infection through a needlestick accident and 3 patients with chronic hepatitis B (donor patients A, B, and C) were tested using molecular evolutionary analysis based on full-length HBV genomic sequences. Nucleotide sequences of these isolates were aligned with 55 previously reported full-length genomic sequences. Genetic distances were estimated using the 6-parameter method, and phylogenetic trees were constructed using the neighbor-joining method. Strains isolated from patient A and the recipient pair were clustered within a closer range of evolutionary distances than were strains recovered from the recipient pair and patients B and C. Furthermore, strains from patient A and the recipient were also clustered on the S gene sequences of HBV. These results demonstrated that patient A alone was the source of direct transmission to the recipient. This approach can be used to investigate the transmission route of HBV.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/7. A physician with a positive hepatitis c virus rna test after a needlestick injury.Needlestick accidents continue to be a hazard for healthcare workers. We report the development of acute hepatitis c infection in a physician after needlestick injury. hepatitis c virus (HCV)-rna, seroconversion and a raised plasma alanine aminotransferase (ALAT) level were found in plasma three months after the accident. Treatment with interferon alfa and ribavirin was started. While the physician was on treatment, HCV-rna test results from plasma taken the day treatment was started became available. HCV-rna was undetectable by quantitative bDNA assay, undetectable by qualitative polymerase chain reaction (PCR) and undetectable by transcription mediated amplification (TMA). A dilemma arose at this point: should the patient stop the treatment or continue the planned therapy? The physician decided to continue a 24-week course of treatment. Six months after the end of treatment, the physician was still HCV-rna-negative and with a normal plasma ALAT level. The rationale of the decision to continue therapy is discussed. This information may be useful for clinicians confronted with a similar dilemma.- - - - - - - - - - ranking = 8keywords = physician (Clic here for more details about this article) |
3/7. Freon injection injury to the hand. A report of four cases.During a 6-month period, the poison center was consulted on three occasions for advice regarding accidental injection of hexafluorethane (Freon) used in the manufacturing process of athletic shoes. A fourth case was later identified after consulting physicians near the manufacturing facility. Little information exists in the medical literature concerning injection of freon or other volatile substances. In each of these cases, workers inadvertently injected concentrated hexafluorethane into a finger while holding the shoe component and attempting to inject hexafluorethane. Each case presented with edema, limitation of motion, and crepitation. hand roentgenogram revealed subcutaneous gas. Treatment was nonsurgical, consisting of splinting, tetanus immunization, and antibiotics. Rapid resolution of symptoms occurred in all four cases. Hexafluorethane is relatively inert when injected and has low toxicity. However, potential rapid expansion warrants observation for pressure injury.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/7. Accidental epinephrine auto-injector-induced digital ischemia reversed by phentolamine digital block.The use of epinephrine-containing auto-injectors as a prescription medication for treating routine to severe anaphylactic reactions is now widely accepted. Associated with this trend is an increasing number of accidental injections of epinephrine into digits, causing severe vasoconstriction and the risk of ischemic necrosis. When epinephrine is accidentally discharged into a digit, ischemic skin necrosis resulting from the alpha-adrenergic blocking effects of this agent can lead to the need for multiple operations, wound infection, and even loss of the digit. The alpha-adrenergic blocking characteristics of phentolamine administered by a variety of methods have proved effective in reversing the effects of epinephrine in these cases. The authors urge that the described treatment protocol become more widely disseminated among primary care and emergency physicians.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/7. Laboratory animal allergy: anaphylaxis from a needle injury.A 32 year old male research physician accidentally received a minor wound from a needle which had been previously used on rabbit tissue. Within 15 minutes serious anaphylactic reactions started and he was taken to hospital where his condition stabilised within five hours. serum immunoglobulin e antibodies to rabbit epithelium were high (16.2 U/ml), although other antibody titres were low. Allergy tests were not carried out before employment, so this alarming scenario could not have been predicted. People with confirmed laboratory animal allergy should be warned of the dangers of continued unprotected exposure and avoidance of the allergen should be encouraged by good laboratory practice and respiratory protective equipment.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/7. Operator safety during injection vaccination of fish.Reports of adverse health effects to vaccinators after self-injection of fish vaccine motivated the present study which aimed at identifying risk factors and improving risk management. Information was collected through interviews with members of professional vaccinator teams, and with physicians who had treated injured vaccinators. In addition, a questionnaire was distributed among salmon farmers. Professional vaccinators reported from one to more than 50 stabs or self-injections during the vaccination season. Two cases of hospitalization due to anaphylactic reactions are described. Self-injections occurred exclusively on fingers and hands. The clinical picture is classified into four categories according to the type and severity of the reaction. The overall risk of self-injection leading to serious health effects was low, although the data do not allow a precise estimate. The collected information suggests that allergic hypersensitivity reactions occurred in two vaccinators, whereas increasing tolerance was reported from others. No information indicating infectious reactions was obtained, suggesting that non-steroid anti-inflammatory drugs constitutes an appropriate therapy for self-injection events. The use of a safety bow attached to the syringe and improved training and awareness of personnel apparently have reduced the incidence of self-injection since this study was conducted. health risks for vaccinators have further been reduced by equipping vaccinators with adrenaline and the improved knowledge of local doctors regarding recommended treatment.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/7. Complete response to twice-a-day interferon-beta with standard interferon-alpha therapy in acute hepatitis c after a needle-stick.A 25-year-old male physician with acute hepatitis c after needle-stick injury was treated with combination therapy including twice-a-day interferon-beta (IFN-beta) and standard interferon-alpha (IFN-alpha). The infecting strain was of genotype 1b. Pretreatment hepatitis c virus (HCV) rna levels were high. Because severe paresthesias occurred with initial daily administration of 5 million units (MU) of lymphoblastoid IFN-alpha, the dose was reduced to 3 to 6 MU of IFN-alpha2b three times a week. However, HCV rna was not cleared from serum after 20 weeks of standard IFN-alpha2b treatment. A 4-week course with IFN-beta, at the dosage of 3 MU twice daily i.v. drip, was then started and followed by an 18-week course with IFN-alpha2b, 6 MU thrice weekly. After IFN-beta treatment, HCV rna was cleared from serum without severe adverse effects, including paresthesias. Total amounts of IFN administered were 20 MU of lymphoblastoid IFN-alpha, 648 MU of IFN-alpha2b, and 252 MU of IFN-beta. Complete response and avoidance of chronic HCV infection were achieved. Thus, combination therapy with twice-a-day IFN-beta and standard IFN-alpha was effective in treating an acute hepatitis c patient with a high viral load and sensitivity to adverse effects of high-dose IFN-alpha.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |