Review Comparative Study
The recognition that smallpox is a potential threat agent of bioterrorism has engendered renewed interest in the development of improved vaccines against this pathogen. The purpose of this paper is to review current data regarding novel approaches to smallpox vaccines in comparison with traditional vaccine strategies. The method used is a literature search using overlapping search terms and citations from the relevant, published literature. ⋯ The incidence of other serious, albeit uncommon, adverse events of smallpox vaccines cannot be determined for newer vaccine approaches because these agents have not yet been deployed on a scale large enough to discern rare events. Since 2001, progress towards improved smallpox vaccines has been accelerated, spurred on by the threat of bioterrorism. Among newer vaccine candidates, replication-competent, highly attenuated vaccinia and tissue culture-derived live vaccinia appear to offer the greatest potential for efficacy, although it is unclear whether these products offer a safer alternative to existing first generation vaccines.
Review Case Reports
The entities responsible for isolated vaginal bleeding are a broad spectrum of diseases. Vaginal bleeding in a prepubertal child is always treated as an alarming symptom both by parents and professionals. ⋯ We report the case of a 6 years-old Caucasian girl referred to our Service for a mild vaginal bleeding and with the suspicion of sexual abuse, excluded after the confirmation of the presence of urethral prolapse. The clinical picture and workup are described and compared with a review of the international literature on the issue.
In melanoma, morphology-based classification systems have not been able to provide relevant information for selecting treatments for patients whose tumors have metastasized. The recent identification of causative genetic alterations has revealed mutations in signaling pathways that offer targets for therapy. Identifying morphologic surrogates that can identify patients whose tumors express such alterations (or functionally equivalent alterations) would be clinically useful for therapy stratification and for retrospective analysis of clinical trial data. ⋯ Refined morphological classification of primary melanomas can be used to improve existing melanoma classifications by forming subgroups that are genetically more homogeneous and likely to differ in important clinical variables such as outcome and pattern of metastasis. We expect this information to improve classification and facilitate stratification for therapy as well as retrospective analysis of existing trial data.
Hydroxyurea improves hematologic values and decreases vaso-occlusive complications in adults and children with sickle cell anemia (SCA), but has not been tested in infants before the onset of chronic organ dysfunction. We conducted a collaborative pilot trial of hydroxyurea in infants with SCA to assess its (1) feasibility of administration, (2) toxicity, (3) hematologic effects, and (4) effect on spleen function. ⋯ Hydroxyurea therapy for infants with SCA is feasible and well tolerated, has hematologic efficacy, and may delay functional asplenia. The potential for hydroxyurea to preserve organ function in SCA should be further evaluated.