+------------------------------------------------+ ! ! ! Health Info-Com Network ! ! Medical Newsletter ! +------------------------------------------------+ Editor: David Dodell, D.M.D. 10250 North 92nd Street, Suite 210, Scottsdale, Arizona 85258-4599 USA Telephone +1 (602) 860-1121 FAX +1 (602) 451-1165 Compilation Copyright 1994 by David Dodell, D.M.D. All rights Reserved. License is hereby granted to republish on electronic media for which no fees are charged, so long as the text of this copyright notice and license are attached intact to any and all republished portion or portions. The Health Info-Com Network Newsletter is distributed biweekly. 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 interested in joining the automated distribution system, please contact the editor. E-Mail Address: Editor: Internet: david@stat.com FidoNet = 1:114/15 Bitnet = ATW1H@ASUACAD LISTSERV = MEDNEWS@ASUACAD.BITNET (or internet: mednews@asuvm.inre.asu.edu) anonymous ftp = vm1.nodak.edu Notification List = hicn-notify-request@stat.com FAX Delivery = Contact Editor for information ---------------------------------------------------------------------- Date: Fri, 15 Apr 94 21:52:26 MST From: mednews (HICNet Medical News) To: hicnews Subject: [MMWR 1 Apr 94] E. coli Outbreak Linked to Home-Cooked Hamburger Message-ID: <4DZukc2w165w@stat.com> Emerging Infectious Diseases Escherichia coli O157:H7 Outbreak Linked to Home-Cooked Hamburger - California, July 1993 - Although outbreaks of Escherichia coli O157:H7 have been linked to consumption of contaminated ground beef, the organism is rarely isolated from the implicated meat. In addition, most epidemiologic investigations of illness associated with E. coli O157:H7 infections have been directed at restaurant-associated outbreaks, and the sources of infection for sporadic cases rarely have been identified. In July 1993, three cases of culture-confirmed E. coli O157:H7 infection among persons residing in a small community in California were traced to consumption of hamburger purchased from a local grocery store; E. coli O157:H7 was isolated from that meat. This report summarizes the investigation of these cases by local and state public health officials. On July 12, 1993, a hospital laboratory in Fort Bragg, California, reported a case of E. coli O157:H7 infection in a 13-year-old girl to the Mendocino County Public Health Department (MCPHD). The patient had had onset of bloody diarrhea on July 7 and recovered. Members of her family reported having eaten home-cooked hamburgers on July 5 made from meat purchased from a local market (market A) on July 3; the hamburgers had been cooked "medium rare." All five family members who ate the hamburgers reported diarrhea; the index patient and her mother had bloody diarrhea. E. coli O157:H7 was isolated from leftover ground beef from the same package used to make the hamburgers. Two additional cases of culture-confirmed E. coli O157:H7 infection occurred in persons residing in the same community: an 18-year-old man who had onset of bloody diarrhea on July 18 and an 84-year-old woman with diabetes mellitus and chronic uremia who developed nonbloody diarrhea on July 10. Both persons reported having eaten hamburger purchased at market A on July 3. Two family members of the man and one family member of the woman also developed nonbloody diarrhea after eating the hamburger. Although no patients developed hemolytic uremic syndrome (HUS), the elderly woman died 3 weeks after hospitalization; her death was attributed to her chronic renal disease. Media announcements from MCPHD requested persons who had experienced bloody diarrhea during July to contact the department. Of five persons who reported having had bloody diarrhea, four submitted stool for culture. Although all were negative, the cultures had been obtained 11-26 days after onset of diarrhea. Reviews of the emergency department log of the district hospital for July 1-22 did not identify additional cases of bloody diarrhea. Environmental health staff from MCPHD and staff from the U.S. Department of Agriculture (USDA) inspected market A and the other two markets in the community that sold ground meat (markets B and C) but did not identify violations in meat storage or grinding procedures. Shelf samples of ground beef from all three markets were obtained for testing. The owner of market A also initiated a voluntary recall of all ground beef purchased at that market during June 25-July 19; as a result, 91 packages of ground beef were returned. Of the 15 samples of ground beef obtained from market A and tested, four were positive for E. coli O157:H7. All positive samples had been placed on the shelves on July 3. Of 16 samples from market B, one was positive for E. coli O157:H7. None of seven samples obtained from market C were positive. The packages placed on the shelf of market A on July 3 were obtained from "chubs," which are large tubes of ground beef purchased from an outside supplier. The market often reground the meat in its own grinder and sometimes added "trim meat" from other sources. A traceback of the meat was not performed. Because the isolates produced an uninterpretable pattern by pulsed-field gel electrophoresis, selected isolates were further characterized by phage typing at the National Laboratory for Enteric Pathogens, Laboratory Center for Disease Control, in Ottawa. Phage type 31 was identified in the three patient isolates, the leftover ground beef obtained from the freezer of the index patient's family, and the two isolates selected for testing from market A. The sample from market B (which was not implicated in the outbreak) was phage type 4. Following the investigation, MCPHD provided information to all county meat markets about optimal meat-grinding procedures and issued a press release advising consumers to cook ground beef thoroughly. Reported by: C Turney, M Green-Smith, Microbiology Dept, Mendocino Coast District Hospital; M Shipp, MD, C Mordhorst, C Whittingslow, MPH, L Brawley, MPH, D Koppel, E Bridges, G Davis, J Voss, R Lee, MS, Mendocino County Public Health Dept, Fort Bragg; M Jay, DVM, S Abbott, MS, R Bryant, MS, K Reilly, DVM, SB Werner, MD, L Barrett, DVM, RJ Jackson, MD, GW Rutherford, III, MD, State Epidemiologist, California Dept of Health Svcs. H Lior, MSc, National Laboratory for Enteric Pathogens, Laboratory Center for Disease Control, Health and Welfare Canada, Ottawa. Foodborne and Diarrheal Diseases Br, Div of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, CDC. Editorial Note: E. coli O157:H7 was first described as a pathogen in humans in 1982 following the investigation of two outbreaks of illness that were associated with consumption of hamburger from a fast-food restaurant chain (1). Since then, more than 12 outbreaks have been reported in the United States (2). Although other investigations have implicated consumption of undercooked ground beef, less commonly identified sources of E. coli O157:H7 infection have included roast beef, unpasteurized milk, apple cider, and municipal water (2,3). Person-to-person transmission in child day care centers also has been documented (4). E. coli O157:H7 infection causes diarrhea (often bloody) and abdominal cramps; fever is infrequent. Infection with E. coli O157:H7 is a relatively common cause of sporadic diarrheal illness: in prospective studies of patients with diarrhea, E. coli O157:H7 has been isolated more frequently than Shigella (2). Children and the elderly are at highest risk for clinical manifestations and complications. Although illness usually resolves within 1 week, 5%- 10% of patients develop HUS, which is characterized by hemolytic anemia, thrombocytopenia, and renal failure. HUS is a common cause of acute renal failure in children, and the case-fatality rate is 3%-5%. Sporadic cases and small outbreaks of E. coli O157:H7 infection similar to the cluster described in this report probably occur throughout the United States but are not recognized. Many clinical health-care providers do not routinely order stool cultures for patients with diarrhea. Even when stool cultures are ordered, clinicians may not be aware that most laboratories do not culture stools for E. coli O157:H7 using sorbitol-MacConkey medium unless specifically requested (5). The findings in this report illustrate the usefulness of subtyping in distinguishing outbreak strains of E. coli O157:H7 from those present in the community but unassociated with an outbreak. There are at least 62 known phage types of E. coli O157:H7. In Canada, where phage typing is the predominant subtyping method used, phage type 31 accounts for 9% of isolates tested (6). E. coli O157:H7 may be present in the intestines of healthy cattle and may contaminate meat during slaughter. The process of grinding beef may then transfer pathogens from the surface of the meat to the interior. Because of the publicity generated by large restaurant-associated outbreaks, many persons associate infections caused by E. coli O157:H7 with restaurant-served ground beef. However, the outbreak in Mendocino County emphasizes that home-cooked hamburgers can be a source of infection and underscores the need to cook ground beef until the interior is no longer pink and juices run clear; thorough cooking kills E. coli O157:H7. On March 28, 1994, the USDA Food Safety and Inspection Service published regulations mandating that safe handling instructions be included on all raw meat and poultry product labeling.* These regulations include instructions to cook meat thoroughly. In June 1993, the Council of State and Territorial Epidemiologists (CSTE) passed a resolution that reporting of E. coli O157:H7 infections should be required in all states. As of October 1, 1993, however, only 17 states required E. coli O157:H7 infection to be reported to state health departments (G.S. Birkhead, M.D., CSTE, personal communication, 1994). CDC is working with state health departments to establish national surveillance for E. coli O157:H7 infections. National surveillance and increased laboratory testing for E. coli O157:H7 will assist in defining the public health impact of this emerging pathogen. References 1. Riley LW, Remis RS, Helgerson SD, et al. Hemorrhagic colitis associated with a rare Escherichia coli serotype. N Engl J Med 1983;308:681-5. 2. Griffin PM, Tauxe RV. The epidemiology of infections caused by Escherichia coli O157:H7, other enterhemorrhagic E. coli, and the associated hemolytic uremic syndrome. Epidemiol Rev 1991;13:60-98. 3. Besser RE, Lett SM, Weber JT, et al. An outbreak of diarrhea and hemolytic uremic syndrome from Escherichia coli O157:H7 in fresh-pressed apple cider. JAMA 1993;269:2217-20. 4. Belongia EA, Osterholm MT, Soler JT, Ammend DA, Braun JE, MacDonald KL. Transmission of Escherichia coli O157:H7 infection in Minnesota child day-care facilities. JAMA 1993; 269:883-8. 5. CDC. Laboratory screening for Escherichia coli O157:H7-- Connecticut, 1993. MMWR 1994; 43:192-4. 6. Khakhria R, Duck D, Lior H. Extended phage-typing scheme for Escherichia coli O157:H7. Epidemiol Infect 1990;105:511-20. * 59 CFR 14528-40. ------------------------------ Date: Fri, 15 Apr 94 21:53:33 MST From: mednews (HICNet Medical News) To: hicnews Subject: [MMWR] Prevalence of Penicillin-Resistant Streptococcus pneumoniae Message-ID: Emerging Infectious Diseases Prevalence of Penicillin-Resistant Streptococcus pneumoniae Connecticut, 1992-1993 Streptococcus pneumoniae is an important cause of community-acquired bacterial pneumonia, meningitis, acute otitis media, and other infections (1). Infants, young children, and the elderly are most severely affected by pneumococcal disease (2). Although S. pneumoniae was once considered to be routinely susceptible to penicillin, since the mid-1980s the incidence of resistance of this organism to penicillin and other antimicrobial agents has been increasing in the United States (1-4). National surveillance for drug-resistant S. pneumoniae (DRSP) is limited to testing invasive isolates from sentinel hospitals in 13 states. To determine the extent of antimicrobial susceptibility testing of S. pneumoniae and the prevalence of penicillin resistance among pneumococcal isolates from July 1992 through June 1993, in August 1993 the Connecticut Department of Public Health and Addiction Services (DPHAS) surveyed all 44 hospitals with clinical microbiology laboratories in Connecticut. This report summarizes the results of that survey. Hospital laboratories were asked whether pneumococcal isolates were tested for resistance to penicillin, which isolates were tested, which tests were used, the number of isolates tested from different body sites from July 1992 through June 1993, and the minimal inhibitory concentrations (MICs) for any resistant isolates. Forty-three (98%) of 44 hospital laboratories responded. Of the 43 hospital laboratories, 33 reported performing antimicrobial susceptibility tests on pneumococcal isolates, nine sent pneumococcal isolates to other laboratories for testing, and one neither performed such tests on pneumococcal isolates nor sent isolates to other laboratories for testing. In 15 of the 33 laboratories, penicillin susceptibility testing was limited to qualitative disk diffusion (using an oxacillin disk). Nine laboratories screened pneumococcal isolates by disk diffusion, then confirmed penicillin resistance by determination of a quantitative MIC. Nine laboratories determined the penicillin MIC for all pneumococcal isolates. MIC data were provided by 14 of the 18 laboratories that performed such tests for pneumococcal isolates. MICs were reported for 846 isolates collected during July 1992-June 1993. Penicillin resistance was defined as MIC greater than or equal to 0.1 ug/mL, and high-level resistance was defined as MIC greater than or equal to 2.0 ug/mL (5). Penicillin-resistant isolates were reported from four of 14 hospitals. Eighteen isolates (2.1%) from any body site were penicillin resistant, including five (1.3%) of 400 isolates from usually sterile sites. Overall, three isolates (one each from blood, sputum, and nasal fluid) were highly resistant. Two of these isolates had penicillin MICs greater than or equal to 4.0 ug/mL. Reported by: EH Simpson, ML Cartter, MD, JL Hadler, MD, State Epidemiologist, Connecticut Dept of Public Health and Addiction Svcs. Child and Adult Immunization Br, National Immunization Program; Nosocomial Pathogens and Laboratories Br, Hospital Infections Program, Childhood and Respiratory Diseases Br, Div of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, CDC. Editorial Note: The spread of DRSP strains may increase the public health impact of S. pneumoniae infections because of increased morbidity and reductions in the effectiveness of antimicrobial treatment for pneumococcal disease. Of special concern is resistance to extended-spectrum cephalosporins, which are often used as empiric therapy for meningitis (3). During 1979-1987, only one (0.02%) of 4585 pneumococcal sterile-site isolates submitted to CDC's sentinel hospital surveillance system were highly resistant to penicillin; in comparison, during 1992, seven (1.3%) of 544 such isolates were highly resistant (4,6). In some pediatric populations, up to 30% of pneumococcal isolates are penicillin resistant at some level, with a substantial proportion of strains resistant to multiple drugs (3). Although information regarding resistance to other antimicrobial drugs was unavailable in the Connecticut survey, the overall prevalence of penicillin-resistant strains in Connecticut was low through June 1993. However, resistant pneumococcal strains can spread rapidly in communities (7,8), and DPHAS is conducting surveillance for antimicrobial resistance. Because penicillin susceptibility cannot be assumed, pneumococcal isolates associated with disease should be screened routinely for penicillin resistance by disk diffusion using a 1-ug oxacillin disk (9), which is highly sensitive--although not 100% specific--for penicillin resistance. Screening cannot reliably quantify the degree of penicillin resistance; therefore, pneumococcal isolates with oxacillin zone sizes less than or equal to 19 mm should be further tested by determination of MICs for penicillin (9), as well as for other drugs likely to be used in treatment. Some pneumococci with either intermediate or high-level penicillin resistance also may be resistant to extended-spectrum cephalosporins; therefore, penicillin-resistant isolates should be tested by MIC for susceptibility to either ceftriaxone or cefotaxime (3,5). To optimize empiric regimens and initial therapy for pneumococcal infections, clinical health-care providers must be informed about the prevalence and patterns of drug resistance among isolates in their communities. Statewide surveillance for DRSP as a notifiable condition has been initiated in Colorado, Connecticut, and New Jersey. CDC, in collaboration with the Council of State and Territorial Epidemiologists and the Association of State and Territorial Public Health Laboratory Directors, is developing strategies for collecting information on pneumococcal drug resistance in other states and for preventing morbidity and death associated with infection with resistant strains (3). Because antimicrobial susceptibility testing should be conducted routinely on invasive pneumococcal isolates, emphasis must be placed on developing methods to compile and analyze results, alerting health-care providers in communities in which resistant pneumococcal strains are prevalent, and identifying areas requiring more intensive epidemiologic assessment. In areas where pneumococci resistant to extended-spectrum cephalosporins are prevalent, empiric therapy with vancomycin and an extended-spectrum cephalosporin should be considered for cases of life-threatening infection (e.g., meningitis) potentially caused by S. pneumoniae until results of culture and susceptibility testing are known. The emergence of drug-resistant pneumococcal infections underscores the need for adherence to recommendations of the Advisory Committee on Immunization Practices that persons aged greater than or equal to 2 years with medical conditions placing them at increased risk for serious pneumococcal infection and all persons aged greater than or equal to 65 years should receive 23-valent pneumococcal capsular polysaccharide vaccine (10); no pneumococcal vaccine is licensed for children aged less than 2 years. References 1. Lederberg J, Shope RE, Oaks SC Jr, eds. Emerging infections: microbial threats to health in the United States. Washington, DC: National Academy Press, 1992. 2. Chesney PJ. The escalating problem of antimicrobial resistance in Streptococcus pneumoniae. Am J Dis Child 1992;146:912-6. 3. CDC. Drug-resistant Streptococcus pneumoniae--Kentucky and Tennessee, 1993. MMWR 1994;43:23-5,31. 4. Butler JC, Breiman RF, Facklam RR, the Pneumococcal Working Group. Emergence of drug- resistant pneumococci in the United States [Abstract no. 1182]. In: Program and abstracts of the 33rd Interscience Conference on Antimicrobial Agents and Chemotherapy. Washington, DC: American Society for Microbiology, 1993:336. 5. National Committee for Clinical Laboratory Standards. Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically--third edition; approved standard. Villanova, Pennsylvania: National Committee for Clinical Laboratory Standards, 1993; NCCLS document no. M7-A3 (vol 13, no. 25). 6. Spika JS, Facklam RR, Plikaytis BD, Oxtoby MJ, the Pneumococcal Surveillance Working Group. Antimicrobial resistance of Streptococcus pneumoniae in the United States, 1979-1987. J Infect Dis 1991;163:1273-8. 7. Kristinsson KG, Hjalmarsdottir MA, Axelsson A, Gudnason Th. Invasion and spread of penicillin resistant pneumococci in Iceland [Abstract no. 1180]. In: Program and abstracts of the 33rd Interscience Conference on Antimicrobial Agents and Chemotherapy. Washington, DC: American Society for Microbiology, 1993:335. 8. Dagan R, Yagupsky P, Wasas A, Klugman K. Penicillin-resistant Streptococcus pneumoniae (PenRSP): an increasing problem in pediatric invasive infections and otitis media in southern Israel [Abstract no. 1181]. In: Program and abstracts of the 33rd Interscience Conference on Antimicrobial Agents and Chemotherapy. Washington, DC: American Society for Microbiology, 1993:336. 9. National Committee for Clinical Laboratory Standards. Performance standards for antimicrobial disk susceptibility tests-- fifth edition; approved standard. Villanova, Pennsylvania: National Committee for Clinical Laboratory Standards, 1993; NCCLS document no. M2-A4 (vol 13, no. 24). 10. ACIP. Pneumococcal polysaccharide vaccine. MMWR 1989;38:64- 8,73-6. ------------------------------ Date: Fri, 15 Apr 94 21:54:33 MST From: mednews (HICNet Medical News) To: hicnews Subject: [MMWR] Progress Toward Poliomyelitis Eradication Message-ID: International Notes Progress Toward Poliomyelitis Eradication -- Egypt, 1993 Since 1990, the Ministry of Health in Egypt has directed efforts toward achieving poliomyelitis eradication by the end of 1994. To achieve this goal, the Egyptian Expanded Program on Immunization (EPI) has progressively implemented each of four World Health Organization (WHO)-recommended strategies: 1) increasing and sustaining routine coverage with oral poliovirus vaccine (OPV); 2) conducting National Immunization Days (NIDs); 3) developing surveillance for acute flaccid paralysis (AFP), including laboratory confirmation of cases; and 4) instituting "mopping-up" vaccination (i.e., house-to-house administration of two doses of OPV at an interval of 4-6 weeks to all children aged less than 3 years who reside in areas where risk for wild poliovirus transmission is highest). This report summarizes the poliomyelitis eradication effort in Egypt based on a program review conducted during November 20-30, 1993, by the Egyptian Ministry of Health; Cairo University; the High Institute for Public Health in Alexandria, Egypt; WHO; Rotary International; and CDC. Routine vaccination coverage with all EPI target disease vaccines (bacille Calmette-Guerin [BCG], diphtheria and tetanus toxoids and pertussis vaccine [DTP], measles, and OPV) increased substantially following the acceleration of activities in 1984, and coverage has remained high. The routine OPV vaccination schedule consists of doses at ages 2, 4, 6, 9, and 18 months. Reported vaccination coverage with three doses of OPV in children aged less than 1 year increased from 67% in 1984 to 90% in 1989 and has ranged from 87% to 89% during 1990-1993 (Figure 1). From 1984 to 1990, routine vaccination coverage with the other EPI target disease vaccines also increased (BCG: 53% to 89%; three doses of DTP: 57% to 87%; and measles vaccine: 41% to 87%), and since 1990, coverage with these vaccines has remained high. In addition to the routine vaccination program, supplemental vaccination activities have been used to achieve poliomyelitis eradication goals. NIDs have been conducted intermittently since 1976, and the level of activity increased from 1990-1991, when a single dose of OPV was administered annually to approximately 8.5- 8.7 million children aged less than 5 years, to January-February 1993, when 17 million doses were administered in two separate rounds to approximately 8.4-8.6 million children (Figure 1). Mopping-up vaccination activities also have been used since 1991 (Figure 1). High-risk districts are designated on the basis of low vaccination coverage and confirmed poliomyelitis cases during the preceding 5 years. During 1991-1992, 6 million doses of OPV were administered during more than 100 districtwide mopping-up operations. AFP surveillance was initiated in August 1990, and a policy of regular zero reporting (i.e., reporting even if no cases occurred) from all reporting sites was instituted in January 1992. In April 1992, AFP case investigation was intensified with emphasis on proper collection of two stool specimens for virus isolation. Despite increased surveillance, the reported number of cases of confirmed poliomyelitis decreased from 619 cases in 1991 to 115 cases in 1993 (Figures 1 and 2). In 1993, the seasonal variation in AFP incidence, which reflects the occurrence of poliomyelitis and usually peaks in Egypt during August-October, decreased substantially (Figure 2). The geographic distribution of confirmed poliomyelitis cases remained widespread in 1992, with cases reported from 24 of 26 governorates. However, during 1993, poliomyelitis was focally distributed and reported in 17 of 26 governorates. Reported by: Expanded Program on Immunization, Ministry of Health, Cairo. Eastern Mediterranean Regional Office, World Health Organization, Alexandria, Egypt; Expanded Program on Immunization, World Health Organization, Geneva. International Health Program Office; Div of Viral and Rickettsial Diseases, National Center for Infectious Diseases; Polio Eradication Activity, National Immunization Program, CDC. Editorial Note: Because of its location between the emerging poliomyelitis-free zones of the Mahgreb Union and Arab states of the Persian Gulf, Egypt is particularly important to the goal of global eradication of poliomyelitis by the year 2000 (1). As a result of the implementation of large-scale supplementary vaccination activities and efforts to strengthen the poliomyelitis disease surveillance system, Egypt has made substantial progress toward eradicating poliomyelitis by the end of 1994. The incidence of poliomyelitis has decreased despite improvements in the poliomyelitis surveillance system. In addition, supplemental vaccination activities with OPV have not adversely affected the routine vaccination program or coverage levels with vaccines for the other EPI target diseases (i.e., diphtheria, measles, pertussis, tetanus, and tuberculosis). Since 1991, the epidemiologic pattern of poliomyelitis in Egypt has changed from widespread endemic disease to a problem of more limited focal distribution. This change may be attributed to the combination of NIDs and focused mopping-up vaccination in high-risk districts. The Ministry of Health in Egypt plans to continue two rounds of NIDs each in 1994 and 1995 to ensure interruption of transmission of wild poliovirus. Decisions to conduct additional NIDs will be made following reassessment of the epidemiologic situation during 1995. Reference 1. World Health Assembly. Global eradication of poliomyelitis by the year 2000. Geneva: World Health Organization, 1988. (Resolution WHA41.28). ------------------------------ Date: Fri, 15 Apr 94 21:56:15 MST From: mednews (HICNet Medical News) To: hicnews Subject: Drexel Univ Journal of Undergraduate Biological Research Message-ID: =============================== CALL FOR UNDERGRADUATE PAPERS ---------- [] [] [] THE DREXEL UNIVERSITY JOURNAL OF UNDERGRADUATE [] [] [] [] [] [] [] [] [] BIOLOGICAL RESEARCH [] [] [] [] [] [] Requirements: [] Papers are limited to topics in biology. [] You must be an undergraduate at least assisting with the research on which you plan to write. [] You must use the American Psychological Association (APA) format of citing literature. [see American Scientist for guide]. Due: All papers are due by May 5. If possible, submit papers in MacWrite II compatible format. 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For additional information or clairification you may write: AFIP?ARP, Educ. Div.(I), Washington, DC 20306-6000; Telephone 301/427-5231; Fax 301/427-5001; or INTERNET: LOWTHER@email.afip.osd.mil ------------------------------ Date: Fri, 15 Apr 94 21:57:58 MST From: mednews (HICNet Medical News) To: hicnews Subject: CancerNet Update Message-ID: ************************************************* * NATIONAL INSTITUTE * * C A N C E R * * INTERNATIONAL INFORMATION * * C E N T E R * ************************************************* * Cancernet@icicb.nci.nih.gov * ********************************** The National Cancer Institute has a new Information Associates Program which provides one-stop, easy access to all of NCI's scientific information resources, including online access to the PDQ database via the Internet or by dialing toll-free to NCI using just a modem and personal computer. Request news article cn-400035 (U.S. Residents) or cn-400036 ( International) for details. 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Changed CancerNet News and PDQ database information: The following news items were added: AHCPR Clinical Practice Guidelines on Management of Cancer Pain Overview cn-400015 NCI Statement on Falsified Data in NSABP Trials cn-400018 Breast Cancer BMT Trials Encourage Accrual cn-400019 NCI Update on Falsified Data in NSABP Trials (3/29/94) cn-400026 The following news items were changed: Information About PDQ cn-400001 PDQ Distributors cn-400003 CANCERLIT Distributors cn-400006 NCI High Priority Clinical Trials cn-400007 The following News Articles were deleted: Referral Information for the BCPT ( complete list) cn-400020 BCPT Referral (partial list)-Alabama to Georgia cn-400021 BCPT Referral (partial list)-Hawaii to Michigan cn-400022 BCPT Referral (partial list)-Minn to North Carolina cn-400023 BCPT Referral (partial list)-North Dakota to Texas cn-400024 BCPT Referral (patial list)-Utah to Wisc. plus Canada cn-400025 NCI Fact Sheets: ---------------- The following new fact sheets were added: NCI-Funded Study Evaluates Risk of Uterine Cancer from Tamoxifen cn-600333 Q & A: Fecal Occult Blood Test cn-600515 The following fact sheets were changed: Community Clinical Oncology Program cn-600013 NCI's Clinical Trials Cooperative Group Program cn-600014 The following fact sheets were deleted: Updating the Guidelines for Breast Cancer Screening cn-600055 Fecal Occult Blood Test Reduces Colorectal Cancer Mortality cn-600058 Q & A: Breast Cancer Prevention Trial cn-600041 Breast Cancer Prevention Trial ( in spanish) cn-600044 CANCERLIT Citations and Abstracts: ---------------------------------- Citations and Abstracts from CANCERLIT were added for the following new topics: Acute lymphocytic leukemia -- Diagnosis, histopathology, pathogenesis cn-7__290 Acute lymphocytic leukemia -- Therapy cn-7__291 Acute myeloid leukemia -- Diagnosis, histopathology, pathogenesis cn-7__300 Acute myeloid leukemia -- Therapy cn-7__301 Cervical cancer -- Diagnosis, histopathology, and pathogensis cn-7__180 Cervical cancer -- Therapy cn-7__181 Endometrial cancer cn-7__190 Gestational trophoblastic tumor cn-7__200 Non-Hodgkin's lymphoma -- Therapy cn-7__371 Ovarian cancer -- Diagnosis, histopathology, and pathogensis cn-7__210 Ovarian cancer -- Therapy cn-7__211 Vaginal/Vulvar cancer cn-7__225 Thyroid cancer cn-7__165 Search output is available for the months of October - December 1993 and for January - March 1994. Selected Citations and Abstracts added to CANCERLIT in April will be available in CancerNet on April 7, 1994. Request the Monthly PDQ Statement Changes ( cn-405001) for a description of the changes in the statements listed above. Request Changes to CancerNet (cn-400000) for a complete listing of changes to CancerNet content for the current month. Instructions: To request the CancerNet Instructions and Contents List, send a mail message, and in the body of the message, enter HELP. Address the mail message to: cancernet@icicb.nci.nih.gov To request the modified statements, follow the above directions, and in the body of the mail message, enter the statement code. When requesting more than one statement, enter each code on a separate line. CancerNet statements are available in Spanish. To request the Instructions and Contents List in Spanish, enter SPANISH in the body of the mail message. If you would like to request the statements in Spanish, substitute the prefix "cs-" in front of the number e.g., cs-100022 to receive the statement on anal cancer in Spanish. . All of the physician and patient statements are available in Spanish. Supportive care statements are now available in Spanish. News items that are available in Spanish have a # next to the statement title. Although both the English and Spanish are updated at the same time each month, the Spanish statements do not reflect the changes made in the English statements until the following month to allow time for translation. If you are interested in requesting CancerNet statements or news articles in Spanish, it is suggested that you request an updated Contents List. If you are redistributing the PDQ information you retrieve from CancerNet to others at your location, or are interested in redistributing the information from CancerNet, request the news article, Redistribution of Cancernet (cn-400030), to find out about conditions that apply when redistributing the information. This article also has information on other sites providing access to CancerNet information. Please send comments or questions to: Cheryl Burg NCI International Cancer Information Center Internet: cheryl@icicb.nci.nih.gov ------------------------------ Date: Fri, 15 Apr 94 21:58:47 MST From: mednews (HICNet Medical News) To: hicnews Subject: Univ of Pennsylvania Online Multimedia Oncology Resource Message-ID: OncoLink - The University of Pennsylvania Multimedia Oncology Resource. We would like to announce "OncoLink", a Wide World Web-server and gopher server oriented to CANCER. This resource is directed to physicians, health care personnel, social workers, patients and their supporters. THIS RESOURCE CAN BE REACHED AT: cancer.med.upenn.edu This cancer information server is currently under development, with changes made daily. Gopher can reach this resource using Port 80. With a WWW-client (e.g. Mosaic), use: http://cancer.med.upenn.edu/ With a gopher client (e.g. gopher) use: gopher cancer.upenn.edu 80 The current subject headings are: pediatric oncology radiation oncology medical oncology surgical oncology medical physics psychosocial support for oncology patients & families **** links to other oncology centers in the world In the pediatric oncology section, there is a "Case of the Month" paper, as well as a manuscript entitled: "Primitive Neuroectodermal Tumors of the Pineal Gland (Pineoblastomas): Patterns of Presentation and Relapse, Survival and Treatment Recommendations", by J.W. Goldwein, P.C. Phillips, L.N. Sutton, L.B. Rorke, R.J. Pakcer and G.J.D'Angio of the University of Pennsylvania Medical Center and The Children's Hospital of Philadelphia. In addition to the surveys in the pediatric oncology section, there are also surveys in the psychosocial section addressing cancer survivor's issues. We shall be exploring interactive BBS and other means of disseminating cancer information throughout the world on the Internet. The maintainer of this resource can be contacted at: BUHLE@XRT.UPENN.EDU -- Dr. E. Loren Buhle, Jr. INTERNET: BUHLE@XRT.UPENN.EDU University of Pennsylvania School of Medicine Phone: 215-662-3084 Rm 440A, 3401 Walnut St., Philadelphia, PA 19104-6228 FAX: 215-349-5978 -- Dr. E. Loren Buhle, Jr. INTERNET: BUHLE@XRT.UPENN.EDU University of Pennsylvania School of Medicine Phone: 215-662-3084 Rm 440A, 3401 Walnut St., Philadelphia, PA 19104-6228 FAX: 215-349-5978 ------------------------------ Date: Fri, 15 Apr 94 21:59:37 MST From: mednews (HICNet Medical News) To: hicnews Subject: Post-Traumatic Stress Disorder Electronic Conference Message-ID: <3PZukc10w165w@stat.com> ********************************************************************** ANNOUNCING A NEW UNMODERATED DISCUSSION FORUM DEALING WITH ALL ASPECTS OF POST-TRAUMATIC STRESS DISORDER ********************************************************************** To join send the message: join traumatic-stress firstname lastname to: mailbase@mailbase.ac.uk 'Traumatic-stress' has been established to promote the investigation, assessment, and treatment of the immediate and long-term psychosocial, biophysiological, and existential consequences of highly stressful (traumatic) events. Of special interest are efforts to identify a "cure" of PTSD (Post-traumatic Stress Disorder). ********************************************************************** Comments and suggestions should be addressed to: Prof. Charles Figley or ********************************************************************** ------------------------------ Date: Fri, 15 Apr 94 22:00:28 MST From: mednews (HICNet Medical News) To: hicnews Subject: World Health Organization Worldwide AIDS Statistics Message-ID: *The World Health Organization, Global Programme on AIDS granted permission to CDC to post the following AIDS Global Statistics to LPIES. The statistics were taken from the Weekly Epidemiological Record, Vol. 69, No. 2, p. 5-6 (January 14, 1994). 1994, Vol. 69, Pages 5-6 No. 2 World Health Organization, Geneva Organisation mondiale de la Sante, Geneve WEEKLY EPIDEMIOLOGICAL RECORD RELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE 14 January 1994 - 69th Year 69 Annee - 14 Janvier 1994 ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS) DATA AS AT 31 December 1993 SYNDROME D'IMMUNODEFICIENCE ACQUISE (SIDA) DONNEES AU 31 Decembre 1993 NUMBER DATE OF OF CASES REPORT COUNTRY/AREA - NOMBRE DATE PAYS/TERRITOIRE DE CAS DE NOTIFI- CATION AFRICA - AFRIQUE Algeria - Algerie 138 08.08.93 Angola 608 26.05.93 Benin - Benin 566 10.12.93 Botswana 1,151 30.08.93 Burkina Faso 2,886 31.12.92 Burundi 7,225 10.12.93 Cameroon - Cameroun 2,870 10.12.93 Cape Verde - Cap-Vert 143 10.12.93 Central African Republic - Republique centrafricaine 3,730 30.11.92 Chad - Tchad 1,523 08.12.93 Comoros - Comores 3 31.05.93 Congo 5,267 31.12.92 Cote d'Ivoire 14,655 05.07.93 Djibouti 419 08.11.93 Egypt - Egypte 88 14.11.93 Equatorial Guinea - Guinee equatoriale 31 31.05.93 Eritrea - Erythree 372 31.12.92 Ethiopia - Ethiopie 8,376 30.09.93 Gabon 472 10.12.93 Gambia - Gambie 240 10.06.93 Ghana 11,044 30.04.93 Guinea - Guinee 655 10.12.93 Guinea-Bissau - Guinee-Bissau 380 11.06.93 Kenya 38,220 09.07.93 Lesotho 479 10.12.93 Liberia - Liberia 191 10.12.93 Libyan Arab Jamahiriya - Jamahiriya arabe libyenne 10 01.02.93 Madagascar 4 31.05.93 Malawi 29,194 20.08.93 Mali 1,874 25.11.93 Mauritania - Mauritanie 40 25.07.93 Mauritius - Maurice 17 30.06.93 Morocco - Maroc 156 15.07.93 Mozambique 826 27.07.93 Namibia - Namibie 311 31.03.90 Niger 921 15.06.93 Nigeria - Nigeria 722 02.06.93 Reunion - Reunion 65 20.03.92 Rwanda 10,138 10.12.93 Sao Tome and Principe - Sao Tome-et-Principe 24 10.12.93 Senegal - Senegal 911 31.05.93 Seychelles 2 10.12.93 Sierra Leone 95 07.07.93 Somalia - Somalie 13 01.01.91 South Africa - Afrique du Sud 1,803 01.02.93 Sudan - Soudan 834 03.11.93 Swaziland 248 19.01.93 Togo 2,381 10.12.93 Tunisia - Tunisie 136 21.05.93 Uganda - Ouganda 34,611 01.11.92 United Republic of Tanzania - Republique-Unie de Tanzanie 38,719 07.01.93 Zaire - Zaire 21,008 10.06.93 Zambia - Zambie 2 9,734 20.10.93 Zimbabwe 25,332 30.09.93 TOTAL 301,861 AMERICAS - AMERIQUES Anguilla 5 30.09.93 Antigua and Barbuda - Antigua-et-Barbuda 36 30.09.93 Argentina - Argentine 2,767 30.06.93 Bahamas 1,329 30.09.93 Barbados - Barbade 397 30.09.93 Belize 53 30.09.92 Bermuda - Bermudes 223 30.06.93 Bolivia - Bolivie 60 31.03.93 Brazil - Bresil 43,455 02.10.93 British Virgin Islands - Iles Vierges britanniques 6 30.09.93 Canada 8,640 30.09.93 Cayman Islands - Iles Caimanes 15 30.09.93 Chile - Chili 805 30.09.93 Colombia - Colombie 3,870 30.09.93 Costa Rica 525 30.09.93 Cuba 204 30.06.93 Dominica - Dominique 12 30.06.90 Dominican Republic - Republique dominicaine 2,179 30.09.93 Ecuador - Equateur 265 30.06.93 El Salvador 514 30.06.93 French Guiana - Guyane francaise 232 30.09.90 Grenada - Grenade 51 30.09.93 Guadeloupe 353 31.03.93 Guatemala 520 30.09.93 Guyana 359 31.03.93 Haiti - Haiti 3,086 31.12.90 Honduras 2,865 30.06.93 Jamaica - Jamaique 576 30.09.93 Martinique 266 30.09.93 Mexico - Mexique 16,091 30.09.93 Montserrat 1 30.09.93 Netherlands Antilles and Aruba - Antilles neerlandaises et Aruba 110 30.06.92 Nicaragua 51 30.09.93 Panama 582 30.09.93 Paraguay 62 30.09.93 Peru - Perou 883 30.06.93 Saint Kitts and Nevis - Saint-Kitts-et-Nevis 39 30.09.93 Saint Lucia - Sainte-Lucie 59 30.09.93 Saint Vincent and the Grenadines - Saint- Vincent-et-Grenadines 54 30.09.93 Suriname 146 30.06.93 Trinidad and Tobago - Trinite-et-Tobago 1,404 30.09.93 Turks and Caicos Islands - Iles Turques et Caiques 39 30.09.93 United States of America - Etats-Unis d'Amerique 339,250 30.09.93 Uruguay 389 30.06.93 Venezuela 3,150 30.09.93 TOTAL 435,978 ASIA - ASIE Afghanistan --- 15.02.92 Armenia - Armenie 2 30.04.93 Azerbaijan - Azerbaidjan --- 30.09.93 Bahrain - Bahrein 11 04.05.93 Bangladesh 1 30.11.93 Bhutan - Bhoutan --- 30.11.93 Brunei Darussalam - Brunei Darussalam 3 17.05.93 Cambodia - Cambodge --- 06.09.93 China(a) - Chine(a) 14 07.08.93 Cyprus - Chypre 28 03.11.93 Democratic People's Republic of Korea - Republique populaire democratique de Coree --- 30.11.93 Georgia - Georgie 2 30.04.93 Hong Kong 89 21.09.93 India - Inde 494 30.11.93 Indonesia - Indonesie 42 30.11.93 Iran (Islamic Republic of) - Iran (Republique islamique d') 73 28.08.93 Iraq 18 09.10.93 Israel - Israel 253 30.09.93 Japan - Japon 621 31.10.93 Jordan - Jordanie 29 01.11.93 Kazakhstan --- 30.09.93 Kuwait - Koweit 10 10.08.93 Kyrgyzstan - Kirghizistan --- 30.04.93 Lao People's Democratic Republic - Republique democratique populaire lao 3 10.09.93 Lebanon - Liban 55 19.08.93 Macao 5 01.09.93 Malaysia - Malaisie 90 05.10.93 Maldives --- 30.11.93 Mongolia - Mongolie --- 30.11.93 Myanmar 133 30.11.93 Nepal - Nepal 24 30.11.93 Oman 31 05.11.93 Pakistan 37 01.11.93 Philippines 107 15.11.93 Qatar 34 31.01.93 Republic of Korea - Republique de Coree 13 30.04.93 Saudi Arabia - Arabie saoudite 55 30.08.93 Singapore - Singapour 60 26.08.93 Sri Lanka 33 30.11.93 Syrian Arab Republic - Republique arabe syrienne 23 22.08.93 Tajikistan - Tadjikistan --- 30.04.93 Thailand - Thailande 3,001 30.11.93 Turkey - Turquie 118 31.10.93 Turkmenistan - Turkmenistan 1 30.04.93 United Arab Emirates - Emirats arabes unis 8 12.02.93 Uzbekistan - Ouzbekistan 2 30.06.93 Viet Nam 28 23.09.93 Yemen - Yemen 8 07.11.93 TOTAL 5,559 EUROPE Albania - Albanie --- 30.09.93 Austria - Autriche 1,087 30.11.93 Belarus - Belarus 10 30.09.93 Belgium - Belgique 1,486 30.09.93 Bulgaria - Bulgarie 20 30.06.93 Croatia - Croatie 53 30.06.93 Czech Republic(b) - Republique tcheque(b) 46 30.09.93 Denmark - Danemark 1,296 30.09.93 Estonia - Estonie 2 30.06.93 Finland - Finlande 141 30.09.93 France 26,970 30.09.93 Germany - Allemagne 10,447 30.09.93 Greece - Grece 845 30.09.93 Hungary - Hongrie 139 30.09.93 Iceland - Islande 29 30.09.93 Ireland - Irlande 362 30.09.93 Italy - Italie 18,832 30.09.93 Latvia - Lettonie 4 30.06.93 Lithuania - Lituanie 4 30.09.93 Luxembourg 70 30.09.93 Malta - Malte 29 30.09.93 Monaco 24 30.09.93 Netherlands - Pays-Bas 2,783 30.09.93 Norway - Norvege 349 30.11.93 Poland - Pologne 156 30.11.93 Portugal 1,575 30.11.93 Republic of Moldova - Republique de Moldova 4 30.09.93 Romania - Roumanie 2,545 30.09.93 Russian Federation - Federation de Russie 128 30.09.93 San Marino - Saint-Marin 1 30.09.92 Slovak Republic(b) - Republique slovaque(b) 6 30.09.93 Slovenia - Slovenie 30 30.09.93 Spain - Espagne 21,205 30.09.93 Sweden - Suede 904 30.09.93 Switzerland - Suisse 3,415 30.09.93 Ukraine 22 30.09.93 United Kingdom - Royaume-Uni 8,115 30.09.93 Yugoslavia(c) - Yougoslavie(c) 268 31.12.92 TOTAL 103,402 OCEANIA - OCEANIE American Samoa - Samoa americaines --- 31.08.93 Australia - Australie 4,258 09.11.93 Cook Islands - Iles Cook --- 27.09.93 Fiji - Fidji 6 01.10.93 French Polynesia - Polynesie francaise 33 13.10.93 Guam 18 03.09.93 Kiribati --- 02.07.93 Mariana Islands - Iles Mariannes 4 10.09.93 Marshall Islands - Iles Marshall 2 30.09.93 Micronesia (Federated States of) - Micronesie (Etats federes de) 2 09.09.93 Nauru --- 26.08.93 New Caledonia and Dependencies - Nouvelle-Caledonie et Dependances 31 29.09.93 New Zealand - Nouvelle-Zelande 413 30.09.93 Niue --- 14.05.93 Palau 1 19.07.93 Papua New Guinea - Papouasie- Nouvelle-Guinee 55 29.10.93 Samoa 1 23.04.93 Solomon Islands - Iles Salomon --- 15.05.93 Tokelau --- 20.09.93 Tonga 4 15.03.93 Tuvalu --- 26.07.93 Vanuatu --- 31.07.93 Wallis and Futuna Islands - Iles Wallis et Futuna --- 24.05.93 TOTAL 4,828 WORLD TOTAL - TOTAL MONDIAL 851,628 (a) Does not include the Province of Taiwan which has reported 48 cases. -- A l'exclusion de la Province de Taiwan qui a notifie 48 cas. (b) Previously reported under Czechoslovakia. -- Notifies anterieurement sous Tchecoslovaquie. (c) Refers to states/areas of the former Socialist Federal Republic of Yugoslavia not otherwise listed separately. -- Concerne les Etats/territoires de l'ancienne Republique federale socialiste de Yougoslavie qui ne sont pas cites separement. ------------------------------ End of HICNet Medical News Digest V07 Issue #11 *********************************************** --- Editor, HICNet Medical Newsletter Internet: david@stat.com FAX: +1 (602) 451-1165 Bitnet : ATW1H@ASUACAD -------------------------------------------------------------------------------