Clinical Briefs



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Am Fam Physician. 1998 Jan 1;57(1):160-165.

CDC Update on HIV Infection

In response to the recent cluster of cases of human immunodeficiency virus (HIV) infection in Chautauqua County, New York, the Centers for Disease Control and Prevention (CDC) has issued a statement focusing on the implications of this situation for HIV prevention in young persons. According to the CDC, all of the cases of heterosexual HIV transmission in the Chautauqua County situation could have been prevented. These cases, the CDC points out, demonstrate that HIV prevention is as important today as it was in 1981 and that each generation of young persons must be educated about the threat of HIV and other sexually transmitted diseases. The focus should be on sustaining, improving and increasing efforts to provide young persons with the information they need to protect themselves.

Young persons should be informed that measures to prevent infection with HIV and other sexually transmitted diseases include abstaining from sexual intercourse, having sex with an uninfected partner in a monogamous relationship, or using condoms consistently and correctly every time they have sex. They should also be told that persons who use drugs and have other sexually transmitted diseases are at increased risk of HIV infection.

ACC Statement on Weight-Loss Drugs

The American College of Cardiology (ACC) and the American Heart Association (AHA) are currently working on a guideline for the diagnosis and treatment of valvular heart disease, which is expected to be published in the summer of 1998. However, because of widespread concern among patients and health care professionals about the reported association of valvular heart disease with the use of fenfluramine and dexfenfluramine, the ACC has published an interim statement to provide recommendations for the management of patients who have taken these drugs.

According to the ACC, any patient who has taken these weight-loss drugs should undergo a cardiovascular physical examination. Patients with cardiac murmurs or symptoms should be evaluated with an echocardiogram. Patients whose body habitus prevents adequate cardiac auscultation may also undergo echocardiography. The ACC recommends that patients with clinical and echocardiographic evidence of valvular heart disease undergo treatment and/or further testing. The ACC does not recommend that all patients with a history of fenfluramine or dexfenfluramine use undergo echocardiographic screening. However, patients without murmurs should undergo repeat physical examinations in six to eight months.

To receive a copy of the ACC statement, call 800-253-4636, ext. 694. The statement also appears on the ACC Web site (http://www.acc.org). The AHA also has released a statement advising patients to talk to their physicians and be examined. The AHA statement is available on the AHA home page at http://www.amhrt.org.

Immunization Hotline

The Centers for Disease Control and Prevention has upgraded its immunization hotline services. The hotline serves both health care professionals and consumers. Information is now available about vaccinations, vaccine-preventable diseases and vaccines. The number is 800-232-2522. The hotline for Spanish-speaking persons is 800-232-0233. The hotline is available from 8 a.m. to 11 p.m., Monday through Fri-day, with a voice-mail system available during other hours.

Report on the Nation's Health

In 1995, 6 percent of all deaths, 8 percent of all hospital discharges and 37 percent of all emergency department visits were injury-related. These statistics were cited in the most recent federal government report on the nation's health, which reveals that injuries continue to have a significant impact on the overall health of Americans.

The report, “Health, United States, 1996–97 and Injury Chartbook,” prepared by the National Center for Health Statistics, is a comprehensive profile of the nation's health. The report contains a special section on injuries.

Motor vehicle traffic injuries, firearm injuries and poisonings were the three leading causes of injury death in 1995, accounting for nearly two thirds of all injury deaths. One positive note is that age-adjusted firearm mortality decreased 11 percent between 1993 and 1995 after having increased 22 percent between 1985 and 1993. However, motor vehicle fatality rates increased 2 percent from 1993 to 1995, after having decreased 15 percent from 1985 to 1993.

The report also documents trends in such factors as health status, fertility and natality, mortality, health resources and insurance coverage. The average life expectancy at birth continued to increase, reaching 75.8 years in 1995.

Copies of the report are available from the NCHS at 6525 Belcrest Road, Hyattsville, MD 20782. They can also be obtained from the NCHS Web site (http://www.cdc.gov/nch-swww/nchshome.htm).

Statement on Sickle Cell Trait and Exercise

The American College of Sports Medicine (ACSM) has published a statement on the medical factors that should be considered in active individuals with sickle cell trait. According to the ACSM, sickle cell trait is not a disease but a descriptive term for a hereditary condition in which an individual has one normal and one abnormal gene for hemoglobin, giving the genetic type AS. The ACSM states that this condition should not keep an individual from exercising or participating in sports.

However, although the problem is rare, the ACSM notes that sickle cell trait has been associated with splenic infarction, usually during strenuous physical exercise after a recent arrival at a high altitude. Sickle cell trait may also be linked to exercise-related rhabdomyolysis and exercise-associated sudden death. Because of these associations, the ACSM recommends the following points be considered by health care professionals:

  • Team physicians and athletic trainers should be knowledgeable about sickle cell trait.

  • Unwarranted limitations on activity should not be imposed on athletes with sickle cell trait.

  • Screening for sickle cell trait should be voluntary. Individuals who test positive should receive genetic counseling. They should also be told about the health risks that may occur because of this condition.

  • All active individuals, including those with sickle cell trait, should be counseled about dehydration, about acclimating slowly to heat and humidity, about careful and gradual conditioning, about acclimating to altitude over time, and about avoiding extreme exercise during acute illness.

The address of the ACSM is 401 W. Michigan St., Indianapolis, IN 46202. The telephone number is 317-637-9200; fax: 317-634-7817. More information about ACSM can be found on the ACSM Web site (http://www.acsm.org/).

A New Registry for Primary Immune Deficiency Diseases

The National Institute of Allergy and Infectious Diseases (NIAID) has selected the Immune Deficiency Foundation of Towson, Md., to establish and manage a clinical registry for residents of the United States who have one of several different primary immune deficiency diseases. More than 70 such diseases, most of which are inherited, affect approximately 500,000 persons. The new registry is an outgrowth of an NIAID-supported pilot project begun in 1992 to establish a similar registry for U.S. residents with chronic granulomatous disease. In addition to chronic granulomatous disease, the diseases that will be included in the new registry are hyper-IgM syndrome, severe combined immunodeficiency disease, X-linked agammaglobulinemia, Wiskott-Aldrich syndrome, common variable immunodeficiency, leukocyte adhesion deficiency and DiGeorge syndrome. Information from the registry will be available to researchers for basic and clinical studies, to genetic counselors and to persons with the disease and their physicians. Physicians who would like more information may call the Immune Deficiency Foundation at 800-296-4433.

ACOG Opinion on Advanced Paternal Age

In a committee opinion that addresses risks to the fetus of advanced paternal age, the American College of Obstetricians and Gynecologists (ACOG) recommends genetic counseling on an individual basis for couples to address their specific concerns if advancing paternal age is an issue (ACOG Committee Opinion No. 189). There is, however, no specific advanced paternal age when genetic counseling should be offered.

According to ACOG, there is general agreement that advancing paternal age predisposes the fetus to mutations in autosomal dominant diseases such as neurofibromatosis, achondroplasia, Apert syndrome and Marfan syndrome, although the risk is quite low. The risk rises exponentially, rather than linearly.

ACOG also notes that increased paternal age may be associated with spontaneous germline mutations in X-linked genes. These genes are transmitted through carrier daughters to affected grandsons; disorders include hemophilia A and Duchenne muscular dystrophy.

More information on ACOG committee opinions, technical bulletins and practice patterns can be obtained by calling ACOG at 800-762-2264. The ACOG address is 409 12th St., S.W., Washington, D.C. 20090.



Copyright © 1998 by the American Academy of Family Physicians.
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