Medscape from WebMD Critical Care MedPulse

MedPulse is a weekly index of key news and features on Medscape's specialty sites compiled by Medscape's Editors.


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We have just posted an article from Emerging Infectious Diseases entitled: An Ounce of Prevention Is a Ton of Work: Mass Antibiotic Prophylaxis for Anthrax, New York City, 2001. We also have an item from MMWR entitled: Update: Severe Acute Respiratory Syndrome - United States, June 11, 2003.

We have just posted a couple of new Ask the Experts items. One item is on Atypical Parkinsonism and the other one covers Acute Respiratory Distress Syndrome in Elderly Patient.

As part of our CME news series, we have posted a news item on First Guidelines for Treatment of Pediatric Traumatic Brain Injury. Read the news item, take the post-test, and get CME.

Remember, if you are a physician and have a case study that you would like to share with your colleagues, send it to me at: If you have forgotten or misplaced your Medscape user name and password, we have an easy solution. Click on the registration link, fill in the brief information, and we will email that information back to you. For technical problems, contact customer support at

Alfred J. Saint Jacques
Editor, Medscape Critical Care





From the Editor: July 2003: What's On Medscape Critical Care
Coverage of the latest conferences, reports, articles, and much more
Medscape Critical Care 4(1) 2003

Effect of a Catabolic State With Involuntary Weight Loss on Acute and Chronic Respiratory Disease
How does the catabolic state affect respiratory diseases and how do we treat it?

First Guidelines for Treatment of Pediatric Traumatic Brain Injury
In most areas, the panel found insufficient evidence to establish standards of care, but wherever possible they offered guidelines and options for providers to consider.
Medscape Medical News2003

Update: Severe Acute Respiratory Syndrome - United States, June 11, 2003
CDC continues to work with state and local health departments, the World Health Organization (WHO), and other partners to investigate cases of severe acute respiratory syndrome (SARS).
MMWR 52(23) 2003

Update: Severe Acute Respiratory Syndrome - Toronto, Canada, 2003
Severe acute respiratory syndrome (SARS) was first recognized in Toronto in a woman who returned from Hong Kong on February 23, 2003.
MMWR 52(23) 2003

Medscape Select, our Friendly Clinical MEDLINE
Medscape has developed a tool to narrow your MEDLINE searches.
Medscape General Medicine 5(2) 2003

An Ounce of Prevention Is a Ton of Work: Mass Antibiotic Prophylaxis for Anthrax, New York City, 2001
Protocols for mass antibiotic prophylaxis against anthrax were under development in New York City beginning in early 1999. This groundwork allowed the city's Department of Health to rapidly respond in 2001 to six situations in which cases were identified or anthrax spores were found.
Emerg Infect Dis 9(6) 2003

Sepsis From Pseudomonas aeruginosa Pneumonia Decreases Intestinal Proliferation and Induces Gut Epithelial Cell Cycle Arrest
Sepsis is the leading cause of intensive care unit mortality nationwide, accounting for >210,000 deaths in the United States annually.
Crit Care Med 31(6) 2003

Ventilator-Associated Pneumonia: Current Management Strategies
Patients who are intubated and require mechanical ventilation have a 6- to 21-fold increased risk of pneumonia.
Infect Med 20(5) 2003

Cost and Effectiveness of Glycoprotein IIb/IIIa-Receptor Inhibitors in Patients With Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention
Outcomes in patients with acute myocardial infarction who received adjunctive therapy with glycoprotein IIb/IIIa-receptor inhibitors during percutaneous coronary intervention were studied.
Am J Health-Syst Pharm 60(12) 2003

MEDLINE Abstracts: Insect Bites and Stings
What's new concerning insect bites and stings? What is the current treatment?
Medscape Allergy & Clinical Immunology 3(1) 2003

Endemic Gastrointestinal Anthrax in 1960s Lebanon: Clinical Manifestations and Surgical Findings
Several reports and reviews have recently shed light on anthrax and its cutaneous and pulmonary manifestations, focusing on its threat as a biologic weapon.
Emerg Infect Dis 9(5) 2003


The seriousness of sepsis, both in terms of cost and loss of quality
of life, presents a challenge. Data show that the annual incidence of
severe sepsis is on the order of over 18 million cases worldwide each
year. Keep pace with the most current information on this devastating
condition on Medscape's Sepsis Resource Center.



New SARS Case Casts Doubt on All Clear for Taiwan
Taiwan posted its 20th straight day without a new SARS infection Thursday, meeting a WHO benchmark for being declared technically free of the disease, but a case in Japan cast a cloud over the island's clean bill of health.
Reuters Health Information 2003

Taiwan Says It's Close to Being Declared SARS-Free
Taiwan posted its 19th straight day without new SARS infections Wednesday, just one day away from meeting a World Health Organization target date to be declared free of the respiratory disease.
Reuters Health Information 2003

WHO Lifts Beijing SARS Travel Warning
The World Health Organization declared the Chinese capital free of the spread of SARS on Tuesday and lifted its warning against travel to the city, prompting small but ecstatic bursts of celebration.
Reuters Health Information 2003

Facemasks Ripped off as Hong Kong Dropped From SARS List
The World Health Organization declared Hong Kong effectively free of SARS on Monday after nearly 4 months in which the disease killed nearly 300 people in the city and ravaged its economy.
Reuters Health Information 2003

Changes Suggested for WHO's Definition of Suspected SARS
Current guidelines from the World Health Organization (WHO) may be insensitive when screening patients for early stages of severe acute respiratory syndrome (SARS), Hong Kong researchers suggest in the June 21st issue of the British Medical Journal.
Reuters Health Information 2003

Hong Kong, China Discuss SARS Warning System
Hong Kong health officials met on Friday with their counterparts in China's southern Guangdong province, the origin of the SARS epidemic, to hammer out ways to help prevent future outbreaks.
Reuters Health Information 2003

Medication Errors Common Among Hospitalized Cardiac Patients
In a study of hospitalized patients on a cardiology floor, approximately 24 medication errors occurred for every 100 admissions, according to a report published in the June 23rd issue of the Archives of Internal Medicine.
Reuters Health Information 2003

Quality Watchdog Warns on OR Fires
The Joint Commission on Accreditation of Healthcare Organizations this week issued a special alert urging hospitals and ambulatory surgery centers to report any fire occurring in the surgical suite.
Reuters Health Information 2003

FDG-PET Accurately Diagnoses Infection, Inflammation
The first meta-analysis shows high sensitivity and specificity; experts say that PET should be ordered earlier in the evaluation process.
Medscape Medical News 2003

Level of Income Influences Outcome in Patients With Acute Coronary Syndromes
Lower income patients who are treated in the hospital for acute coronary syndromes are more likely to die or have a myocardial infarction (MI) after discharge than those with higher incomes, despite equal in-hospital care.
Reuters Health Information 2003

Residents Not Well Informed About Premature Infant Survival Chances: Survey
Results of a survey of Quebec pediatric and obstetric residents suggests that a substantial number are not well informed about the outcomes of extremely premature infants (< 28 weeks' gestation). Many would not resuscitate these infants, despite the fact that these infants have a very good chance of a good outcome.
Reuters Health Information 2003

AMA Will Hammer out Aggressive Membership Recruitment Plan at Summit
The American Medical Association, which rejected a plan to replace individual memberships with organizational membership, will now concentrate its efforts on rebuilding individual membership, according to an announcement at the annual meeting of its House of Delegates here this week.
Reuters Health Information 2003

Physician Involvement in Hastening Death Varies in Europe
Switzerland has the highest rate of 'euthanasia', in its widest sense, according to a survey of six European countries carried out from the University of Zurich in 2001 and 2002.
Reuters Health Information 2003

Outpatient Prednisone Reduces Relapses in COPD
In patients with chronic obstructive pulmonary disease treated and discharged from the emergency room, a 10-day course offered a modest benefit, but there are potential risks.
Medscape Medical News 2003

Triple Drug Therapy Beneficial in Emergency Asthma Treatment
In adults with acute severe asthma, triple drug therapy with ipratropium bromide, flunisolide, and albuterol therapy produces a greater improvement in pulmonary function than treatment with albuterol plus flunisolide or albuterol plus ipratropium, according to a new report.
Reuters Health Information 2003

Diluted Smallpox Vaccine Safe and Effective After Previous Immunization
When revaccinated with a 1:10 dilution of smallpox vaccine, previously immunized persons exhibit fewer side effects and a similar immune response to that seen in vaccinia-naive subjects, investigators report in the June 25th issue of the Journal of the American Medical Association.
Reuters Health Information 2003

Good Long-term Outcomes for Rapid Out-of-Hospital Defibrillation
This resuscitative technique, using an automated external defibrillator, was associated with long-term survival and quality of life similar to those of the general population.
Medscape Medical News 2003



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