DOCSLIB.ORG

Incidence of Reactive Arthritis & Other Musculoskeletal Sequelae of Enteric Bacterial Infection in Oregon: a Population-Base

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Incidence of Reactive Arthritis & Other Musculoskeletal Sequelae of Enteric Bacterial Infection in Oregon: a Population-Base 10/29/2013 Oregon Health & Science University Wins the Knowledge Bowl ACR 2013: Go Portlandumabs!! REACTIVE ARTHRITIS IN 2013: WHAT HAVE WE LEARNT? Atul Deodhar MD Professor of Medicine Division of Arthritis & Rheumatic Diseases Oregon Health & Science University Portland, OR Disclosures Evidence-Based Medicine 1. Townes JM, Deodhar AA, Smith K, et al. Rheumatologic • Honoraria, Advisory Boards: Abbvie, MSD, Novartis, Sequelae of Enteric Bacterial Infection in Minnesota and Pfizer, UCB Oregon: A Population-based Study. Ann Rheum Dis. 2008;67:1689-96. • Research Grants: Abbvie, Amgen, Novartis, Pfizer, UCB 2. On the difficulties of establishing a consensus on the definition of and diagnostic investigations for reactive arthritis. Results and discussion of a questionnaire prepared for the 4th International Workshop on Reactive Arthritis, Berlin, Germany, July 3-6, 1999.Braun J. et al. J Rheumatol. 2000 Sep;27(9):2185-92. 3. Comparison of sulfasalazine and placebo in the treatment of reactive arthritis (Reiter's syndrome). A Department of Veterans Affairs Cooperative Study. Clegg DO. et al. Arthritis Rheum. 1996 Dec;39(12):2021- 7. What is Reactive Arthritis? Reactive Arthritis • “Arthritis associated with demonstrable infection at a distant site without traditional evidence of sepsis at the affected joint(s)” Andrew Keat, Adv Exp Med Biol 1999;455:201-6 • Classical Pathogens : Chlamydia trachomatis, Yersinia, Salmonella, Shigella & Campylobacter (perhaps Clostridium difficile, Chlamydia pneumoniae & BCG instillation in bladder) • Interval between preceding infection and onset of arthritis — Urethritis Oligoarthritis Chlamydia Minimum of several days & maximum of several weeks Enthesopathies Dysentery • Typical arthritis pattern — asymmetrical mono- or oligo- Rash: Keratoderma Blenorrhagica, nail changes, Campylobacter arthritis, predominantly of the lower extremities Salmonella Psoriasis, Circinate Balanitis Yersinia Eye: uveitis, conjunctivitis • Reactive arthritis of more than six months duration is Shigella Mucosal: oral ulcers, urethritis, cervicitis regarded as being “chronic” instead of “acute” ReA is part of Spondyloarthritis 1 10/29/2013 ReA is part of Peripheral Spondyloarthritis (ASAS Classification Criteria) Spectrum of Spondyloarthritis (SpA) Axial Peripheral spondyloarthritis Sensitivity 78% spondyloarthritis Specificity 82% PsA AS ReA A of Non-radiographic IBD axSpA What % of ‘undifferentiated’ peripheral SpA actually have Reactive Arthritis? RudwaleitRudwaleit M M et et al. al. Ann Ann Rheum Rheum Dis Dis 2011;70:25 2011;70:25-31-31 Uncertainties in Reactive Arthritis The Tainted Legacy of Hans Reiter • Several classification criteria with no • Supporter of Adolf Hitler & the Nazi regime agreement on their use • Wrote a book on the theory of “Racial Hygiene” • Confusion in use of terms: • Proposed killing mentally or physically handicapped, • Reiter’s syndrome ~ Reactive arthritis sterilizing carriers of hereditary defects to ‘purify the race’ • Incomplete Reiter’s syndrome • No rationale to preserve professional memory of • Post-infectious arthritis Reiter • Role of lab tests in the diagnosis: serology? • Reiter’s syndrome is part of Reactive Arthritis PCR? stool culture? • However, ICD-10-CM M02.30 is still “Reiter's disease, • Is arthritis essential for the diagnosis of ReA? unspecified site” (.33 is wrist, .34 is hand etc) Panush RS. Sem Arthritis Rheum 2003;32:231-36 Reactive Arthritis Vs Post-infectious Arthritis Consensus on ReA 4th International Workshop on ReA, Berlin, July 1999 • Several bacteria are known to cause post-infectious arthritis: acute rheumatic fever, Meningococcus, • ReA: Only if clinical picture & microbes are HLA- Mycoplasma genitalium, Ureaplasma urealyticum, B27 & SpA related Chlamydia pneumoniae, Neisseria gonorrhea, some live • vaccines, beta-hemolytic Streptococci, and Yersinia, Campy, Salmonella, Shigella, Chlamydia Propionibacterium acnes • H/O preceding infection is most relevant for • But these should not be described as ReA since the diagnosis clinical pattern is not like a spondyloarthritis • Minimal interval between infection & arthritis: 1-7 • “Reactive Arthritis” term should be restricted to an acute days, maximum: 4 weeks spondyloarthritis that is linked to acute genitourinary or gastrointestinal infection • Asymmetric, LL>UL, other SpA symptoms • Infection related arthritis: All arthritides associated with infections except septic arthritis Braun J. et al. J Rheumatol. 2000 Sep;27(9):2185-92. 2 10/29/2013 (Lack of) Consensus on ReA Uncertainties in Reactive Arthritis 4th International Workshop on ReA, Berlin, July 1999 Inflammatory musculoskeletal disease (joint, spine or entheseal) is essential for the diagnosis of ReA • No consensus reached on: • Is arthritis essential for the diagnosis of ReA? . Spectrum of ReA: • Is it oligoarthritis or any arthritis? . Asymmetric, oligoarticular arthritis . Enthesitis/tendonitis/bursitis • What is the role and value of serology or PCR investigation? . Dactylitis . Uveitis/conjunctivitis • Is the diagnostic sensitivity of microbiological tests for ReA increased by HLA-B27 . Inflammatory back pain/sacroiliitis determination? . Erythema nodosum . Circinate balanitis . Keratoderma blenorrhagica Braun J. et al. J Rheumatol. 2000 Sep;27(9):2185-92. ReA Has Two Presentations Epidemic ReA • June 2nd 1962: USS Enterprise visited a port to celebrate ship’s anniversary • An Epidemic Form • Food prepared with ‘elaborate sanitary • In a Sporadic Form (in the community) precautions’ since the area was endemic for Shigella • An Acute form • Two cooks had contracted • A Chronic form dysentery but concealed it • 602/1276 developed Shigellosis over the next week • 257 were admitted, 174 in the ‘intensive care ward’ Noer HR. JAMA 1966;198:693-98 Epidemic ReA How common is Reactive Arthritis? • Prevalence 30-40/100,000 & annual incidence 5- 28/100,000 adults in Scandinavia • By one month, there # Signs/symptoms B27 were 10 cases of • Most cases occur sporadically and in outbreaks 1 Symptom free - ReA (9 with urethritis, following single source infections 0-21% develop ReA 2 Poly/spondy, balanitis, 8 conjunctivitis) + • Spanish national registry of spondyloarthropathies uveitis, urethritis • 2/10 became (REGISPONSER): 1-year recruitment period disabled: ‘invalidated’ 3 Oligoarthritis, urethritis, + uveitis, conjunctivitis Diagnosis # of Patients (1385, 68% men) % of Patients out of Navy AS 842 61% 4 Blind in one eye uveitis, • 10 years later, 5 were + PsA 290 21% poly/urethritis/balanitis traced, re-interviewed USpA 205 15% & re-examined 5 Oligo/spondy, balanitis, + ReA 16 1.2% urethritis, uveitis IBD arthritis 13 0.9% Calin A. Ann Int Med 1976;84:564-66 Colantes E. et al. Rheumatology (Oxford). 2007 Aug;46(8):1309-15. 3 10/29/2013 How common is Reactive Arthritis? The Oregon Study on Reactive Arthritis • Population-based study in OR & MN (2002-04) • ReA after culture-proven bacterial infection (Shigella • HLA B27 prevalence was not different between Salmonella, Campylobacter &Yersinia) of the GI tract cases and controls • All patients with new onset of joint/tendon/back • This may indicate that the “Community acquired” discomfort > 3 days within 8 weeks of culture included ReA may be different from the “epidemic” type ReA • 13% (575) of 6379 culture-confirmed infections where presence of HLA B27 leads to increased risk developed ‘possible’ ReA for development of ReA • Only 82 could be examined and 66% (56) were • Use of antibiotics during acute diarrheal illness did confirmed ReA not affect development of, or severity of ReA • The estimated incidence of ReA in Oregon is 0.6-3.1 per 100,000 population Townes JM, Deodhar AA, Laine ES et al. Ann Rheum Dis. 2008 Dec;67(12):1689-96 Townes JM, Deodhar AA, Laine ES et al. Ann Rheum Dis. 2008 Dec;67(12):1689-96 Is Reactive Arthritis Under Reported? Pathogenesis of ReA • Chlamydia tr (Ct) is the most common trigger of ReA • ReA: Genetically predisposed host, known • CDC estimates new Ct genital infections to be 3 million/yr bacterial infections, relatively short period of with 4-6 million active cases at any given time time • 5% get ReA after Ct infection in prospective studies • Despite this, the pathophysiology is unclear • 150,000 cases of acute Chlamydia-induced ReA would occur in the US each year compared to 125,000 new cases • Several uncertainties exist: of RA per year (incidence of RA: 44.6/100,000) • What is the role of HLA-B27? • The above figure does not include ‘GI induced ReA’ • What is the role of bacteria in the pathogenesis of • Is ReA more common than RA?? Reactive Arthritis? • (However, only 4%–19% of patients go on to develop a • Is the arthritis Septic or Aseptic? protracted course of ReA lasting more than 1 year*) • Should long-term antibiotics be used? *Leirisalo-Ripo M. Rheum Dis Clin N Am 1998;24:737-51 Pathogenesis of ReA What is the role of HLA-B27* in pathogenesis? What is the role of genetic factors? Homodimer 2 Protein misfolding, formation due to • In rats & mice transgenic for resulting in pro- Cys67 residue on α-1 human HLA-B27 + 2 inflammatory chain (unique to HLA- Unfolded Protein B27)resulting in microglobulin, spontaneous Response recognition by NK arthritis develops only when 3 cells receptors the animals are outside a germ-free zone 1 HLA B27 may Altered intracellular 5 4 killing in certain Binding of a unique • Arthritogenic peptide theory: influence the human infections, antigenic (self) suggesting that HLA-B27 groove binds peptide microbiome. ‘special’ peptides infection
Load more

Recommended publications
  • EPONYMS in DERMATOLOGY LITERATURE LINKED to GENITAL SKIN DISORDERS Khalid Al Aboud1, Ahmad Al Aboud2
    Historical Article DOI: 10.7241/ourd.20132.60 EPONYMS IN DERMATOLOGY LITERATURE LINKED TO GENITAL SKIN DISORDERS Khalid Al Aboud1, Ahmad Al Aboud2 1Department of Public Health, King Faisal Hospital, Makkah, Saudi Arabia Source of Support: 2Dermatology Department, King Abdullah Medical City, Makkah, Saudi Arabia Nil Competing Interests: None Corresponding author: Dr. Khalid Al Aboud [email protected] Our Dermatol Online. 2013; 4(2): 243-246 Date of submission: 24.09.2012 / acceptance: 04.11.2012 Cite this article: Khalid Al Aboud, Ahmad Al Aboud: Eponyms in dermatology literature linked to genital skin disorders. Our Dermatol Online. 2013; 4(2): 243-246. There are numerous eponymous systemic diseases which of Nazi party membership, forced human experimentation may affect genital skin or sexual organs in both genders. For in the Buchenwald concentration camp, and subsequent example Behçet disease which is characterized by relapsing prosecution in Nuremberg as a war criminal, have come to oral aphthae, genital ulcers and iritis. light. This disease is named after Hulusi Behçet [1] (1889–1948), One more example is syphilis. In 1530, the name „syphilis” (Fig. 1), the Turkish dermatologist and scientist who was first used by the Italian physician and poet Girolamo first recognized the syndrome. This disease also called Fracastoro [4] (1478-1553), as the title of his Latin poem „Adamantiades’ syndrome” or „Adamandiades-Behçet in dactylic hexameter describing the ravages of the disease syndrome”, for the work done by Benediktos Adamantiades. in Italy. In his well-known poem „Syphilidis sive de morbo Benediktos Adamantiades (1875-1962), (Fig. 2) was a Greek gallico libri tres” (Three books on syphilis or the French ophthalmologist [2].
    [Show full text]
  • The Function of Selection in Nazi Policy Towards University Students 1933- 1945
    THE FUNCTION OF SELECTION IN NAZI POLICY TOWARDS UNIVERSITY STUDENTS 1933- 1945 A thesis submitted to the Faculty of Graduate Studies in partial hlfillment of the requirernents for the degree of Doctor of Philosophy Graduate Program in History York University North York, Ontario December 1997 National Library Bibliothèque nationale 1*1 of Canada du Canada Acquisitions and Acquisitions et Bibliogaphic Services se~cesbibliographiques 395 Wellington Street 395, rue Wellington Ottawa ON K1A ON4 Ottawa ON KIA ON4 Canada Canada Your tlk Votre refénmce Our fi& Notre refdrence The author has granted a non- L'auteur a accordé une licence non exclusive licence allowing the exclusive permettant à la National Library of Canada to Bibliothèque nationale du Canada de reproduce, loan, distribute or sell reproduire, prêter, distribuer ou copies of ths thesis in microform, vendre des copies de cette thèse sous paper or elecîronic formats. la forme de microfiche/tilm, de reproduction sur papier ou sur format électronique. The author retains ownership of the L'auteur conserve la propriété du copyright in ths thesis. Neither the droit d'auteur qui protège cette thèse. thesis nor substantial extracts from it Ni la thèse ni des extraits substantiels may be p~tedor othewise de celle-ci ne doivent être imprimés reproduced without the author' s ou autrement reproduits sans son permission. autorisation. Towards a New Genus of Students: The Function of Selection in Nazi Policy Towards University Students 1933-1945 by Béla Bodo a dissertation submitted to the Faculty of Graduate Studies of York University in partial fulfillment of the requirernents for the degree of DOCTOR OF PHILOSOPHY Permission has been granted to the LIBRARY OF YORK UNlVERSlrY to lend or seIl copies of this dissertation, to the NATIONAL LIBRARY OF CANADA to microfilm this dissertation and to lend or sel1 copies of the film.
    [Show full text]
  • Reiter's Disease*
    Br J Vener Dis: first published as 10.1136/sti.35.2.101 on 1 June 1959. Downloaded from Brit. J. vener. Dis. (1959), 35, 101. REITER'S DISEASE* BY HAMILTON BAILEY AND W. J. BISHOP Reiter's disease is characterized by non-gonococcal purulent urethritis followed in 2 to 14 days by arthritis and conjunctivitis. The arthritis is very painful, and is punctuated by remissions and exacer- bations. The knees, the great toe joints, and the interphalangeal joints are affected most often, but other joints are frequently involved. The con- junctivitis is severe and long-lasting. Complications such as iritis are not uncommon. Intermittent pyrexia, night sweats, and secondary anaemia are the rule. The disease often continues for months or years, and in spite of intensive research, neither the cause nor any effective treatment has yet been found. Hans Reiter was born in 1881 in Leipzig, the son of a manufacturer and owner of a factory. After FIG. 1.-Hans Reiter, b. 1881. Reiter had matriculated from the Thomas Gym- nasium at the age of 20, he commenced his medical Western Front, and in September, while stationed at http://sti.bmj.com/ studies in the University of Leipzig, and continued Chauny, France, he was called upon to care for a them in Breslau and Tubingen. In 1906 he graduated number of soldiers suffering from Weil's disease. It M.D. Leipzig, and then undertook post-graduate was here that he made his first great discovery-he training in bacteriology and hygiene. This prolonged found the causative organism of Weil'st disease, the study was exceptionally thorough and highly cos- Leptospira icterohaemorrhagiae, by inoculating in- mopolitan.
    [Show full text]
  • Reiter's Syndrome
    ARCHIWUM HISTORII I FILOZOFII MEDYCYNY 2011, 74, 91-93 GEORGE M. WEISZ “Reiter’s Syndrome” — Ignorance or Plagiarism „Syndrom Reitera” — brak wiedzy czy plagiat School of History (Program in History of Medicine), University of New South Wales, Sydney, and School of Humanities, University of New England, Armidale, NSW, Australia Streszczenie Summary Reaktywne zapalenie stawów to najnowsza nazwa okreś­ Reactive arthritis is the latest and the final name accorded lająca zapalną, surowiczo-ujemną chorobę stawów, będą­ to an inflammatory, sero-negative joint disease, a reac­ cą reakcją na różnego rodzaju choroby żołądkowo-jelito- tion to various gastrointestinal diseases. Introduced by we. Wspomniany syndrom, przedstawiony początkowo Hans Reiter in 1916 and parallel by Fiessinger and Leroy, przez Hansa Reitera w 1916 roku i równocześnie przez the syndrome was adopted in the medical literature as Fiessingera i Leroya, przyjął się w literaturze medycznej “Reiters disease”. Reviewing the past however, it shows jako „choroba Reitera”. W rzeczywistości syndrom zo­ that the syndrome was in detailed published by B. Brodie stał już szczegółowo opisany przez B. Brodiego sto lat a century before. Reiter s name was compromised by his wcześniej. Sam Reiter skompromitował się, popełniając medical crimes during the Nazi and he was convicted zbrodnie medyczne w okresie nazistowskim, za które in Nuremberg. Was this plagiarism or ignorance? In any został skazany w procesie norymberskim. Czy był to event, Reiter s name ought to be removed both for prob­ plagiat, czy też brak wiedzy? Tak czy inaczej nazwisko able plagiarism and for medical crimes and credit should Reitera powinno zostać usunięte z nazewnictwa me­ be accorded to the first describer.
    [Show full text]
  • Smoking and Death. Public Health Measures Were Taken More Than 40
    LETTERS and death indicated strong risks-similar in magnitude to 1 Peto R. Smoking and death: the past 40 years and the next 40. Smoking those found by later studies-whatever control BMJ 1994;309:937-9. (8 October.) 2 Proctor RN. Racial hygiene. Medicne under the Nazis. Cam- Public health measures were taken more group was used (table); these risks were not bridge MA: Harvard University Press, 1988. than 40 years ago explicable in terms of changes in smoking 3 Reiter H. Ansprache bei der Er6ffnung des 1. Wissenschaft- behaviour induced by illness. Schoninger's study lichen Instituts zur Erforschung der Tabakgefahren an EDrroR,-Richard Peto discusses the failure of cost 173.30 of the 100000 Reichsmark given by der Friedrich-Schiller-Universitit Jena am 5 April 1941. public health with regard to smoking over the past Adolf Hitler from his personal funds to the Jena ManchenerMedizinische Wochenschnift 1941;88:697-9. 4 Berlin: stimulants endanger public health. JAMA 1939;12: 40 years,' but his account could have extended Institute. 2339-40. back further. He considers that the Medical 5 Lickint F. Tabak und Organismus. Stuttgart: Hippokrates- Research Council was, in 1957, "the first national Verlag, 1939. institution in the world to accept formally the 6 Davey Smith G, Strobele SA, Egger M. Smoking and health promotion in Nazi Germany. I Epidemiol Community Health evidence that tobacco is a major cause of death." 1994;48:220-3. The formal recognition of this fact, however, was 7 Schairer E, Schoniger E. Lungenkrebs und Tabakverbrauch. explicitly made by many important national insti- ZeitschriftftilrKrebsforschung 1943;54:261-9.
    [Show full text]
  • Medical Ethics in the 70 Years After the Nuremberg Code, 1947 to the Present
    wiener klinische wochenschrift The Central European Journal of Medicine 130. Jahrgang 2018, Supplement 3 Wien Klin Wochenschr (2018) 130 :S159–S253 https://​doi.org/​10.1007/​s00508-​018-​1343-y Online publiziert: 8 June 2018 © The Author(s) 2018 Medical Ethics in the 70 Years after the Nuremberg Code, 1947 to the Present International Conference at the Medical University of Vienna, 2nd and 3rd March 2017 Editors: Herwig Czech, Christiane Druml, Paul Weindling With contributions from: Markus Müller, Paul Weindling, Herwig Czech, Aleksandra Loewenau, Miriam Offer, Arianne M. Lachapelle-Henry, Priyanka D. Jethwani, Michael Grodin, Volker Roelcke, Rakefet Zalashik, William E. Seidelman, Edith Raim, Gerrit Hohendorf, Christian Bonah, Florian Schmaltz, Kamila Uzarczyk, Etienne Lepicard, Elmar Doppelfeld, Stefano Semplici, Christiane Druml, Claire Whitaker, Michelle Singh, Nuraan Fakier, Michelle Nderu, Michael Makanga, Renzong Qiu, Sabine Hildebrandt, Andrew Weinstein, Rabbi Joseph A. Polak history of medicine Table of contents Editorial: Medical ethics in the 70 years after the Nuremberg Code, 1947 to the present S161 Markus Müller Post-war prosecutions of ‘medical war crimes’ S162 Paul Weindling: From the Nuremberg “Doctors Trial” to the “Nuremberg Code” S165 Herwig Czech: Post-war trials against perpetrators of Nazi medical crimes – the Austrian case S169 Aleksandra Loewenau: The failure of the West German judicial system in serving justice: the case of Dr. Horst Schumann Miriam Offer: Jewish medical ethics during the Holocaust: the unwritten ethical code From prosecutions to medical ethics S172 Arianne M. Lachapelle-Henry, Priyanka D. Jethwani, Michael Grodin: The complicated legacy of the Nuremberg Code in the United States S180 Volker Roelcke: Medical ethics in Post-War Germany: reconsidering some basic assumptions S183 Rakefet Zalashik: The shadow of the Holocaust and the emergence of bioethics in Israel S186 William E.
    [Show full text]
  • The Antd-Tobacco Campaign Ofthe Nazis: a Little Known Aspect of Public Health in Germany, 1933-45
    The antd-tobacco campaign ofthe Nazis: a little known aspect of public health in Germany, 1933-45 Robert N Proctor Historians and epidemiologists have only recently propaganda. In a pattern that would become familiar in begun to explore the Nazi anti-tobacco movement. the United States and elsewhere after the second world Germany had the world's strongest antismoking war, several of these journals tried to dismiss the movement in the 1930s and early 1940s, encom- anti-tobacco movement as "fanatic" and "unscientific." passing bans on smoking in public spaces, bans on One such journal featured the German word for science advertising, restrictions on tobacco rations for twice in its title (Der Tabak: Wissenschaftliche Zeitschrift women, and the world's most refined tobacco epi- der Internationalen Tabakwissenschaftlichen Gesellschaft, demiology, linking tobacco use with the already founded in 1940). evident epidemic oflung cancer. The anti-tobacco We should also realise that tobacco provided an campaign must be understood against the back- important source ofrevenue for the national treasury. In drop ofthe Nazi quest for racial and bodily purity, 1937-8 German national income from tobacco taxes which also motivated many other public health and tariffs exceeded 1 billion Reichsmarks.'2 By 1941, efforts ofthe era. as a result of new taxes and the annexation of Austria and Bohemia, Germans were paying nearly twice that. Medical historians in recent years have done a great According to Germany's national accounting office, by deal to enlarge our understanding ofmedicine and pub- 1941 tobacco taxes constituted about one twelfth ofthe lic health in Nazi Germany.
    [Show full text]
  • Assessing Educational Needs for Breast Cancer Diagnosis in Pakistan
    The Anti-tobacco Movement of Nazi Germany Aboul-Enein The Anti-tobacco Movement of Nazi Germany: A Historiographical Re-Examination Basil Aboul-Enein, MSc, MPH, MA1 Author1 is affiliated with San Jacinto College, Department of Dietetic Technology. Contact author: Basil Aboul- Enein, San Jacinto College, Department of Dietetic Technology, 8060 Spencer Hwy, Pasadena, TX 77501; Phone: 832-894-4294; Email: [email protected] Submitted May 31, 2012; Revised and Accepted October 24, 2012 Abstract Introduction: The infamy of Nazi medical research conjures up images of horrific experiments in the concentration camps and SS (Schutzstaffel) doctors like Josef Mengele. However, the anti-smoking campaign of Nazi Germany is perhaps one of the least examined aspects of public health history and state sponsored anti-tobacco advocacy. Nazi public health activism was involved in work that may provide insight relevant to current public health issues. Purpose: This article examined the current literature that discusses the anti-smoking campaigns of Nazi Germany, explored the phenomenon of quality medical research under the banner of National Socialism, and shed light into a forgotten aspect of Nazi medical history. Findings: Previous authors have suggested that the Nazi war on cancer and the contributions made by Nazi public health activists were one of the most aggressive public health movements in the world. Marked with a certain level of ambivalence, these aggressive campaigns against smoking were less concerned with the universal dimensions of public health practices and ethics than they were towards a pursuit of a lifestyle that was worthy of a ‘master race.’ Keywords: Public health, Nazi Germany, smoking, cancer, tobacco International Electronic Journal of Health Education, 2012; 15:166-172 The Anti-tobacco Movement of Nazi Germany Aboul-Enein a core of principles for the Nazi platform including Introduction 8 support for public health efforts.
    [Show full text]
  • | Joint Session
    Send to printer Close window BROBSON LUTZ M.D. JEFFERY JOHNSTON PHOTOGRAPH My right ankle was huge. It happened all of a sudden. I didn’t realize it was swollen until I took off my boot,” says Christopher Oster, a 30-year-old industrial painter and Holy Cross High School graduate. “It didn’t bother me that much at first, but later that evening it was hurting so much I could hardly get off the sofa.” His wife Wendy drove him to the emergency room at Ochsner Baptist Medical Center on a Friday night last May. As Oster hobbled into the emergency room, the physician on duty took one look and called for a syringe to drain the hot, swollen joint. In went the needle and out came a syringe of pus, a ticket for admission and an orthopedic consult. Normal joint fluid is the WD-40 of the skeletal system. It is clear and slightly viscous. Infections and certain inflammatory conditions cause white blood cells, the foot soldiers of the immune system, to stream into the joint. The abnormal accumulation of these cells causes pain, swelling and a change in the cloudy joint fluid. Sticking a needle into a swollen joint can reduce abnormal pressure and pain. It also gives the physician a specimen to send to the laboratory to culture for bacteria. But just like a high white blood cell count doesn’t always indicate infection, pus in a joint doesn’t always equate to an infection. Day 2 “For a week or so before my ankle started hurting, my eyes turned bloodshot and were glued shut with crusts each morning.
    [Show full text]
  • The Many Types of Arthritis That Affect Our Patients!”
    Radiographic Evaluation of Arthritis “The Many Types of Arthritis that affect our Patients!” DANIEL P. EVANS, DPM, FACFAOM Professor, Department of Podiatric Medicine and Radiology Dr. Wm. Scholl College of Podiatric Medicine CONFLICT OF INTEREST I have no conflicts of interest pertaining to the material presented in this lecture. OUTLINE Incidence of Arthritis of the Foot and Ankle Various Arthritides of the foot and ankle How Radiographic Evaluation assists in the diagnosis of Arthritis HOW MANY DIFFERENT TYPES OF ARTHRITIS CAN YOU NAME? Which of the Arthritides is the MOST common? Classification of Arthritides Non-Inflammatory . Metabolic – Degenerative Joint Disease Gout CPPD Disease Inflammatory . Neuropathic – Seropositive Arthritide: Neuropathic Joint Disease Rheumatoid Arthritis – Erosive Osteoarthritis . Miscellaneous DISH (Diffuse Idiopathic Skeletal Hyperostosis) PHO (Pulmonary Hypertrophic Osteoarthropathy) – Seronegative Arthritides: PVNS (Pigmented Villonodular Synovitis) Psoriatic Arthritis Reactive Arthritis (Reiter’s Disease) . Collagen Vascular Disorders Ankylosing Spondylitis SLE Enteropathic Scleroderma Degenerative Joint Disease Degenerative Joint Disease AKA: Osteoarthritis Local disorder of individual joints, independent of infection and systemic disease, brought out by abnormal mechanical conditions in conjunction with age, trauma or other degrading change in the articular cartilage Degenerative Joint Disease Asymmetric/Unilateral Joint Involvement with Asymmetric Joint Space Narrowing So…. What joints
    [Show full text]
  • Reiter's Syndrome Versus Reactive Arthritis
    Editorials Reiter’s Syndrome Versus Reactive Arthritis: Nazi-phobia or Professional Concerns? Itzhak Rosner MD Rheumatology Unit, Bnai Zion Medical Center and Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel Key words: eponym, Reiter’s syndrome, reactive arthritis, ethics IMAJ 2008;10:296–297 When I ask the students on the rheumatology rotation in my a Nazi sympathizer, played on concentration camp loudspeak- unit why we no longer refer to reactive arthritis as Reiter’s ers as people were murdered there, may be a matter of social syndrome, I am usually answered “because Reiter was a Nazi.” sensitivity. But this is not the issue at hand. I guess I should be pleased that they know this fact – but It is the essence of medical practice that it exists solely for I’m not. Somehow conjuring up the Nazi monster once again the benefit and health of the patient; and if no such benefit is some 60 to 70 years after it wreaked havoc in the world seems to be derived it should be withheld. Primum non nocerer – first do tiresome to most people. So, I point out to the students that, no harm – is the fundamental principle taught to all physicians sadly enough, there were millions of Nazis – many of them for centuries. Indeed, for millennia, physicians have instituted physicians. And while, in my opinion, all of the Nazis, especially the Hippocratic Oath, or accepted the Maimonides Code, as physicians, deserve punishment, the case of Reiter is something part of the formal proceedings of becoming physicians. Indeed, else.
    [Show full text]
  • Wüster's View of Terminology
    Slovenski jezik – Slovene Linguistic Studies 11 (2017): 55–85 Mitja Trojar Inštitut za slovenski jezik Frana Ramovša ZRC SAZU, Ljubljana Wüster’s View of Terminology The article presents some aspects of the General Theory of Terminology, whose author, Eugen Wüster (1898–1977), is considered the father of modern terminology. The article first presents his life and work and then also the principal aspects of Wüster’s approach to terminology through citations from his articles and monographs: his utilitarian view of special languages, the emphasis laid on the onomasiological approach to terminology, the notion of concept as the pivotal notion of Wüster’s theory, his attitude towards the polysemy, homonymy and syn- onymy as well as some other important aspects that shaped his view of terminology. Prispevek prikazuje nekatere vidike splošne teorije terminologije Eugena Wüsterja (1898– 1977), ki velja za očeta moderne terminologije. Najprej je prikazano njegovo življenje in delo, nato pa preko citatov iz člankov in monografij tudi bistveni vidiki Wüsterjevega pristopa k terminologiji: njegov utilitaristični pogled na strokovne jezike, poudarjanje onomaziološkega pristopa k terminologiji, koncept pojem kot osrednji koncept Wüsterjeve terminologije, njegov odnos do polisemije, homonimije in sinonimije ter nekateri drugi pomembni vidiki, ki so izob- likovali njegov pogled na terminologijo. 1 Wüster’s Life and Work1 Eugen Wüster was born in 1898 in Wieselburg (Austria) as a son of an indus- trialist.2 He studied electrical engineering at the Technical University in Berlin- Charlottenburg and completed his studies in 1927. In 1931 he defended his PhD entitled International Standardization in Engineering, especially in Electrical Engineering (Internationale Sprachnormung in der Technik besonders in der Elektrotechnik) at the Technical University in Stuttgart.
    [Show full text]