DOCSLIB.ORG

Diagnosis of Venereal Syphilis in the African

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Diagnosis of Venereal Syphilis in the African OF MEDICINE No. 5 SEPTEMBER, 1955 ORIGINAL ARTICLES The Art of Diagnosis D. H u n te r.....................................207 Tetanus Neonatorum Treated with Chlorpromazine A/. G elfand.....................................216 Volvulus of the Stomach W. Shepherd Wilson - - - 218 Blackwater Fever in an African Child //. f . T heron................................220 Africa, But Not So Dark jf. Robertson................................ 221 Chemotherapy in Pulmonary Tuberculosis A. I. L. Turnbull - - - - 228 Pulmonary Haemosiderosis J. R. Harries................................235 Impending Coronary Thrombosis A. D iv aris......................................239 The Right Base 7’. Fane Tierney........................... 243 African Vital Statistics J. R. H. Shard ...........................246 The Management of Syphilis R. R. W i l l c o x ...........................250 The Nganga M. G e lf a n d ................................255 EDITORIALS Rugby Football Injuries 259 The Age of Retirement 261 The Quack 262 Correspondence - ------- 2 6 3 Banquet in Honour of Lord Malvern and Professor Drennan - - - 266 Annual Congress of the Medical The Journal Library 264 Association of S. Rhodesia - - 267 PUBLISHED BI-MONTHLY. ANNUAL SUBSCRIPTION £2 2s. Od. Septembeb, 1955 The Central African Journal of Medicine Truly positive sera usually give a constant pat­ Management of Syphilis in the tern with increasing positivity, while false­ European and African positive results tend to be weaker in litre giving BY inconstant results varying not only with each R. R. WILLCOX, m .d., test, but also with successive specimens. St. Mary’s Hospital, London. To-day, new tests, depending not on the reagin antibody of the Wassermann lest, but on other Management of Syphilis in the European antibodies more specific, are coming into use in As in gonorrhoea, the diagnosis of syphilis many parts of the world. These include the should always be confirmed pathologically, Treponemal pallidum immobilisation (TPI) test and various agglutination tests which are under Diagnosis trial. These new tests, or their future succes­ Primary Syphilis.—All genital sores, whatever sors, depend on specific antibodies and will one their nature, should be examined for T. palli­ day be most useful in the exclusion of false- dum, no antiseptics being placed on the sore or positive results in Africa. antibiotics administered until the tests have been taken. Treatment of Syphilis in the European Chancroid is common in Africa and may con­ Early Syphilis (Primary, Secondary and Early fuse the picture. Persons suffering from chan­ Latent Syphilis) croid, if handled properly, can he finally Penicillin is now the drug of choice for the discharged from observation after a period of treatment of syphilis and for early syphilis, at only three months if syphilis is excluded instead any rate, no adjuvant measures are required. of the years required if syphilis is diagnosed. Neoarsphenamine and bismuth may be entirely If penicillin is given for genital sores without discarded. In-patient treatment is not neces­ diagnostic tests, cases of genital sore have to sary, the patient being virtually non-infectious be observed for the full time as for syphilis. after 24 hours. When penicillin was first introduced, British The correct regime is to perform a dark-field clinics wen' loth to abandon completely the old examination of mutter from the sore daily for proved long-term arsenic and bismuth schedules three days and serum tests monthly for three and for some time gave, following the intensive months. If these all prove negative, syphilis course of penicillin, one ten-week course of neo­ can then be excluded. During the time that arsphenamine and bismuth in an attempt at the dark-field examinations are being made the “ consolidation." As the toxic effects of arsenic, sores should be bathed only with normal saline, sometimes serious, occasionally fatal, were still but sulphonamides (e.g.. sulphadiazine in doses encountered, the arsenical course was gradually of 4-5 g. daily for 4-5 days) may be given by dropped, although the bismuth course was re­ mouth. Sulphonamides have no effect upon T. tained. This too was not without its side-effects, pallidum and will heal most other non-syphilitic and, with cases of stomatitis still occurring, it sores, including chancroid. also came to be omitted. In the belief that Secondary Syphilis.—Patients with secondary there was nothing that bismuth could do that penicillin could not do better, many British syphilis can have their diagnosis confirmed both clinics then employed a method of consolidation by dark-field and serum test. with ten bi-weekly injections of procaine peni­ Latent Syphilis. -I n cases of suspected latent cillin with aluminium monoslearate in lieu of syphilis, in whom the only sign is a positive bismuth. A recent WHO survey, however, indi­ serum test, caution is required. Apart from a cates that this practice is mainly confined to greater likelihood of technical difficulties in the Europe, largely in the British Isles, and that over performance of serum tests in the tropics, false 65 per cent, of 277 world clinics now use an positive results may be encountered during or intensive course of penicillin alone without other following malaria, glandular fever, relapsing measures IWillcox. 1954). fever, leprosy, the collagen diseases and small­ Experimentally it has been shown that a pox vaccination. continuous penicillin serum level for at least 96 When false-positive results are suspected, as hours is the minimum required for the eradica­ many tests, quantitated if possible, as are avail­ tion of syphilis, but, for such a serious disease, able should be performed on each specimen and we must allow for a considerable margin of the tests should be repeated a number of times. safety. Page Two Hundred and Fifty September, l95i> T h e Central, A frican TREATMENT Of SYPHILIS Iocrnal or M ed ic in e The earlier penicillin courses, consisting oi positive. The cerebrospinal fluid should be eight daily intramuscular injections of 600,000 examined as to cell count, protein and globulin units of penicillin in oil-beeswax, gave satisfac­ content, Lange curve and \\ assermann reaction. tory results and a similar dosage has since been Even if available, the new treponemal immo­ employed using oily injection of procaine benzy- bilisation and agglutination tests are not indi­ penicillin, viz., procaine penicillin with alu­ cated at the present time for the routine minium monostearate (PAM), although, with surveillance of treated syphilis, but rather for the this preparation, the interval between injections refutation or otherwise of suspected false-positive can be longer without loss of the continuous reactions. serum level. Late Syphilis It is usual now to recommend an initial load­ Similar courses of penicillin are the standby ing dose of 2.4 mega units of PAM 1.4 mi. in of treatment in all cases of late and latent syphi­ each buttock)—-a so-called "epidemiological lis. An X-ray examination of the heart and an dose”-—so that should the patient then detault examination of the cerebrospinal fluid, in addi­ he already has enough penicillin to give a de­ tion to the serum test, should be made on all tectable serum level for a week, with a good cases prior to treatment. possibility of a cure even if nothing else is given. This may be followed by 6-8 injections An initial intensive PAM course of 600,000- of 600,000 units daily or of 600,000-900,000 900,000 units daily should be given for 10-14 units every 2-3 days. It is considered by the days and, as no immediate serological response WHO Expert Committee on Venereal Infections may he expected, there is perhaps something and Treponematoses (1954) that at least 2.4 to he said for the British regime of giving a mega units of PAM should be given for primary further 900.00(1 units bi-weekly for five weeks. syphilis and 4.8 mega units for secondary There is a possible danger in the penicillin syphilis. treatment of late syphilis of a Jarisch-Herx- Recently the new diamine penicillins (dibenzy- heinier reaction, especially in neurosyphilis lethylenediamine dipenicillin C iDBED) and when epilepsy, mental changes and focal reac­ Benethamine penicillin) have been shown dose tions have occasionally been reported. Similarly, for dose to gi\e even more prolonged penicillin in syphilitic aortitis, the possibility that angina serum levels than PAM. With these prepara­ pectoris or coronary occlusion might be preci­ tions the initial loading dose of 2.4 mega units pitated by local oedema at the site of the lesions should still be employed, but the subsequent during the first 24-48 hours of therapy cannot injections may be fewer and more widely spaced be dismissed from the mind, even if the total and 0.9-1.2 mega units given weekly for three number of reported cases is few and not all are more weeks may well be amply sufficient. These convincing. penicillins are still on trial, however; moreover, At one time a preliminary course of bismuth they are somewhat more painful than PAM. and iodides was given prior to the penicillin which is well tolerated. High cure rates, as course in an attempt to minimise this risk. To­ good as those obtained with PAM, have already day it is believed that the Herxheimer reaction been reported in the U.S.A. following; only a is an “all or none” phenomenon and that it single injection of 2.3-2.5 mega units (Smith may occur even with bismuth and iodides, in et al, 1954). which case it is not: to be expected later with Surveillance.--following the treatment of penicillin; if it does not do so, it may then be early syphilis, serum tests should be performed provoked by penicillin even after such pre­ monthly for six months, quarterly for one year medication. Thus it seems that, in fact, there and six-monthly for a further year, with a is little that can be done to avoid it.
Load more

Recommended publications
  • Known Infectious Causes of Vasculitis in Man
    PATHOGENESIS Known infectious causes of vasculitis in man STANLEY J. NAIDES, MD n array of pathogens is known to cause vasculi- and our ability to intervene in disease processes, have ren- tis in man.1,2 For several of these agents, vas- dered some causes of vasculitis far less common. culitis is the major manifestation of disease. The Amajority, however, typically present as infec- ■ VIRAL CAUSES OF VASCULITIS tious processes in which vasculitis is an occasional mani- Our knowledge of viral pathogenesis has exploded in the festation of disease. For many, vasculitis may be a compo- last quarter of the twentieth century, accelerated in large nent of disease pathogenesis but is not a prominent feature part by epidemics of “emerging” viral diseases. Hepatitis C of the clinical presentation. The various agents—viruses, virus, discovered in 1989, has worldwide prevalence.3 The bacteria, and fungi—share a common target, blood vessels. 10- to 20-year latent period before hepatic or rheumatic The involvement of vessels may be direct, with vascular manifestations of disease explains the increasing number structures serving as targets. Many infectious pathogens of cases of hepatitis C virus–mediated vasculitis currently have tissue tropism that includes endothelium. Other being seen in the United States following the epidemic of agents may bind to the vessel wall because the vascular en- new infections in the 1980s.4 Prior to the discovery and dothelium expresses specific receptors for the pathogen or characterization of hepatitis C virus in the late 1980s, the another moiety with which the pathogen travels. Even triad of arthritis, palpable purpura, and type II cryoglobu- when the agent does not enter the endothelial cell, the im- linemia was given the sobriquet “essential mixed cryo- mune response to the agent may be focused at the vessel globulinemia” and considered an idiopathic vasculitis.
    [Show full text]
  • Identification of Microorganisms Using Nucleic Acid Probes
    Identification of Microorganisms Using Page 1 of 45 Nucleic Acid Probes Medical Policy An Independent Licensee of the Blue Cross and Blue Shield Association Title: Identification of Microorganisms Using Nucleic Acid Probes See Also: Influenza Virus Diagnostic Testing and Treatment in the Outpatient Setting Professional Institutional Original Effective Date: July 8, 2008 Original Effective Date: July 16, 2009 Revision Date(s): June 16, 2009; Revision Date(s): March 1, 2012; March 1, 2012; June 5, 2012; June 5, 2012; November 19, 2012; November 19, 2012; January 15, 2013; January 15, 2013; November 12, 2013 November 12, 2013 Current Effective Date: November 12, 2013 Current Effective Date: November 12, 2013 State and Federal mandates and health plan member contract language, including specific provisions/exclusions, take precedence over Medical Policy and must be considered first in determining eligibility for coverage. To verify a member's benefits, contact Blue Cross and Blue Shield of Kansas Customer Service. The BCBSKS Medical Policies contained herein are for informational purposes and apply only to members who have health insurance through BCBSKS or who are covered by a self-insured group plan administered by BCBSKS. Medical Policy for FEP members is subject to FEP medical policy which may differ from BCBSKS Medical Policy. The medical policies do not constitute medical advice or medical care. Treating health care providers are independent contractors and are neither employees nor agents of Blue Cross and Blue Shield of Kansas and are solely responsible for diagnosis, treatment and medical advice. If your patient is covered under a different Blue Cross and Blue Shield plan, please refer to the Medical Policies of that plan.
    [Show full text]
  • Syphilis As Seen by a Hospital Physician
    284 Prof. Monro?Syphilis as seen by a Hospital Physician. SYPHILIS AS SEEN BY A HOSPITAL PHYSICIAN* By T. K. MONRO, M.A., M.D., Professor of Medicine, University of Glasgow. \ " / Mr. President and Gentlemen,?I thank you heartily for the honour you have done me in inviting me to be Honorary President of this Faculty for the session which is now opening. I was duly informed by Dr. Wardlaw that my principal duty as incumbent of this honourable office was to deliver an address to the Faculty, and as his invitation reached me while I was on holiday, with other objects in view, I had time to contemplate the responsibility I had undertaken, and to consider how I was to face it. In getting over the usual initial difficulty as to the choice of a subject, some assistance was afforded me by the President's instruction that the address ought to be one for the general practitioner. Quite a number of subjects would be appropriate from this point of view. I should have been glad to say some- thing on oral sepsis, a condition often spoken of, and no doubt often wrongly blamed, but also apt to be overlooked. Dentists do not always realise how completely one may be misled by the absence of subjective and objective evidence; so that even an experienced man may pass as innocuous a tooth which subse- quent extraction shows to have disease at its root. Medical men sometimes make a mistake in the opposite direction, by insisting, without sufficient justification, on the removal of teeth, e.g., in epileptiform neuralgia.
    [Show full text]
  • A Review of Primary Vasculitis Mimickers Based on the Chapel Hill Consensus Classification
    Hindawi International Journal of Rheumatology Volume 2020, Article ID 8392542, 11 pages https://doi.org/10.1155/2020/8392542 Review Article A Review of Primary Vasculitis Mimickers Based on the Chapel Hill Consensus Classification Farah Zarka ,1 Charles Veillette ,1 and Jean-Paul Makhzoum 2 1Hôpital du Sacré-Cœur de Montreal, University of Montreal, Canada 2Vasculitis Clinic, Department of Internal Medicine, Hôpital du Sacré-Coeur de Montreal, University of Montreal, Canada Correspondence should be addressed to Jean-Paul Makhzoum; [email protected] Received 10 July 2019; Accepted 7 January 2020; Published 18 February 2020 Academic Editor: Charles J. Malemud Copyright © 2020 Farah Zarka et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Primary systemic vasculitides are rare diseases that may manifest similarly to more commonly encountered conditions. Depending on the size of the vessel affected (large vessel, medium vessel, or small vessel), different vasculitis mimics must be considered. Establishing the right diagnosis of a vasculitis mimic will prevent unnecessary immunosuppressive therapy. 1. Introduction 2. Large-Vessel Vasculitis Mimics Vasculitides are rare heterogenous diseases that affect vessel Large-vessel vasculitis (LVV) is an inflammatory vascu- walls as the main site of inflammation. Organs affected vary lopathy affecting large arteries; giant cell arteritis (GCA) depending on the type and size of blood vessels involved and Takayasu’s arteritis (TAK) are the two main docu- [1]. Autoimmune vasculitis can be primary (idiopathic) or mented variants, each with their own characteristic fea- secondary to an underlying disease.
    [Show full text]
  • List of Codes Used to Identify Measures Reported in the QDFC
    List of Codes Used to Identify Measures Reported in the Quarterly Dialysis Facility Compare Reports July 2018 List of Codes Used to Identify Measures Reported in the Quarterly Dialysis Facility Compare Reports Table of Contents Table 1a: Transfusion Summary for Medicare Dialysis Patients, Codes Used for Exclusions 3 CARCINOMA 3 COAGULATION 5 HEAD/NECK CANCER 5 HEMOLYTIC OR APLASTIC ANEMIA 9 LEUKEMIA 11 LYMPHOMA 15 METASTATIC 27 MYELOMA, ETC. 29 OTHER CANCER 30 SICKLE CELL 34 SOLID ORGAN CANCER 34 Table 1b: Transfusion Summary for Medicare Dialysis Patients, Codes Used to Identify Transfusion Events .................................................................................................................. 45 REVENUE CENTER CODES 45 PROCEDURE CODES 45 VALUE CODES 46 HCPCS CODE 46 Table 2a: Vascular Access Measures (SFR and Long-Term Catheter) for Medicare Dialysis Patients Based on Medicare Claims, Codes Used for Exclusions ........................................... 46 Produced by The University of Michigan Kidney Epidemiology and Cost Center Page 1 of 135 List of Codes Used to Identify Measures Reported in the Quarterly Dialysis Facility Compare Reports July 2018 COMA 46 END STAGE LIVER DISEASE 48 METASTATIC CANCER 48 Table 2b: Standardized Fistulae Rate (SFR) for Medicare Dialysis Patients Based on Medicare Claims, Codes Used for Prevalent Comorbidities Adjusted in Model .................................... 50 ANEMIA 50 CORONARY ARTERY DISEASE 52 CONGESTIVE HEART FAILURE 55 CEREBROVASCULAR DISEASE 56 CHRONIC OBSTRUCTIVE PULMONARY DISEASE 68 DIABETES 69 DRUG DEPENDENCE 79 INFECTIONS (NON-VASCULAR ACCESS-RELATED): 93 PERIPHERAL VASCULAR DISEASE (INCLUDES ARTERIAL, VENOUS AND NONSPECIFIC DISEASES) 124 Table 3: Dialysis Adequacy ...................................................................................................
    [Show full text]
  • Lecture 1 ― INTRODUCTION INTO MICROBIOLOGY
    МИНИСТЕРСТВО ЗДРАВООХРАНЕНИЯ РЕСПУБЛИКИ БЕЛАРУСЬ УЧРЕЖДЕНИЕ ОБРАЗОВАНИЯ «ГОМЕЛЬСКИЙ ГОСУДАРСТВЕННЫЙ МЕДИЦИНСКИЙ УНИВЕРСИТЕТ» Кафедра микробиологии, вирусологии и иммунологии А. И. КОЗЛОВА, Д. В. ТАПАЛЬСКИЙ МИКРОБИОЛОГИЯ, ВИРУСОЛОГИЯ И ИММУНОЛОГИЯ Учебно-методическое пособие для студентов 2 и 3 курсов факультета по подготовке специалистов для зарубежных стран медицинских вузов MICROBIOLOGY, VIROLOGY AND IMMUNOLOGY Teaching workbook for 2 and 3 year students of the Faculty on preparation of experts for foreign countries of medical higher educational institutions Гомель ГомГМУ 2015 УДК 579+578+612.017.1(072)=111 ББК 28.4+28.3+28.073(2Англ)я73 К 59 Рецензенты: доктор медицинских наук, профессор, заведующий кафедрой клинической микробиологии Витебского государственного ордена Дружбы народов медицинского университета И. И. Генералов; кандидат медицинских наук, доцент, доцент кафедры эпидемиологии и микробиологии Белорусской медицинской академии последипломного образования О. В. Тонко Козлова, А. И. К 59 Микробиология, вирусология и иммунология: учеб.-метод. пособие для студентов 2 и 3 курсов факультета по подготовке специалистов для зарубежных стран медицинских вузов = Microbiology, virology and immunology: teaching workbook for 2 and 3 year students of the Faculty on preparation of experts for foreign countries of medical higher educa- tional institutions / А. И. Козлова, Д. В. Тапальский. — Гомель: Гом- ГМУ, 2015. — 240 с. ISBN 978-985-506-698-0 В учебно-методическом пособии представлены тезисы лекций по микробиоло- гии, вирусологии и иммунологии, рассмотрены вопросы морфологии, физиологии и генетики микроорганизмов, приведены сведения об общих механизмах функциони- рования системы иммунитета и современных иммунологических методах диагности- ки инфекционных и неинфекционных заболеваний. Приведены сведения об этиоло- гии, патогенезе, микробиологической диагностике и профилактике основных бакте- риальных и вирусных инфекционных заболеваний человека. Может быть использовано для закрепления материала, изученного в курсе микро- биологии, вирусологии, иммунологии.
    [Show full text]
  • Tabes Dorsalis and Perforated Duodenal Ulcer J
    i6o Postgrad Med J: first published as 10.1136/pgmj.37.425.160 on 1 March 1961. Downloaded from POSTGRAD. MED. J. (1961), 37, i60 TABES DORSALIS AND PERFORATED DUODENAL ULCER J. P. LAWSON, M.B., Ch.B. Late Senior House Officer in Medicine, Crumpsall Hospital, Manchester Senior House Oficer in Radiology, David Lewis Northern Hospital, Liverpool 3 IT is well recorded that tabes dorsalis can mask between the shoulder blades whilst standing in a bus serious visceral disease. Wilson mentions queue. This was shortly followed by a bout of vomiting (1954) and sweating. There was no dyspncea, pain in the chest that tabes can disrupt nervous pathways so as to or abdominal pain. The patient was able to make his produce a visceral analgesia capable of masking own way home on foot. serious abdominal disease. At home he took a Sedlitz powder, which was followed by three further attacks of vomiting and four Connor (I91o) published a case of a brakeman, loose bowel actions. There was no blood in either aged 42, who died in hospital following an acute vomitus or faeces. The pain spread to both shoulder febrile attack and vomiting. There had been no tips, where it persisted and was the cause of his attend- abdominal tenderness or to ance at the casualty department. pain, rigidity explain Four years previously he had developed a similar the condition but autopsy revealed a perforated attack of sweating and stated that he had also vomited appendix abscess and peritonitis. blood. At this time he was apparently found to be from and was trans- Hanser (I9I9) recorded the case of a tabetic suffering pulmonary tuberculosis, by copyright.
    [Show full text]
  • Diagnosis One To
    Diagnosis One-to-One I9cm I9 Long Desc I10cm I10 Long Desc 0010 Cholera due to vibrio cholerae A000 Cholera due to Vibrio cholerae 01, biovar cholerae 0011 Cholera due to vibrio cholerae el tor A001 Cholera due to Vibrio cholerae 01, biovar eltor 0019 Cholera, unspecified A009 Cholera, unspecified 0021 Paratyphoid fever A A011 Paratyphoid fever A 0022 Paratyphoid fever B A012 Paratyphoid fever B 0023 Paratyphoid fever C A013 Paratyphoid fever C 0029 Paratyphoid fever, unspecified A014 Paratyphoid fever, unspecified 0030 Salmonella gastroenteritis A020 Salmonella enteritis 0031 Salmonella septicemia A021 Salmonella sepsis 00320 Localized salmonella infection, unspecified A0220 Localized salmonella infection, unspecified 00321 Salmonella meningitis A0221 Salmonella meningitis 00322 Salmonella pneumonia A0222 Salmonella pneumonia 00323 Salmonella arthritis A0223 Salmonella arthritis 00324 Salmonella osteomyelitis A0224 Salmonella osteomyelitis 0038 Other specified salmonella infections A028 Other specified salmonella infections 0039 Salmonella infection, unspecified A029 Salmonella infection, unspecified 0040 Shigella dysenteriae A030 Shigellosis due to Shigella dysenteriae 0041 Shigella flexneri A031 Shigellosis due to Shigella flexneri 0042 Shigella boydii A032 Shigellosis due to Shigella boydii 0043 Shigella sonnei A033 Shigellosis due to Shigella sonnei 0048 Other specified shigella infections A038 Other shigellosis 0049 Shigellosis, unspecified A039 Shigellosis, unspecified 0050 Staphylococcal food poisoning A050 Foodborne staphylococcal
    [Show full text]
  • BQI Icare HIV/AIDS
    RESOURCE AND PATIENT MANAGEMENT SYSTEM iCare Population Management GUI (BQI) HIV/AIDS Management User Manual Version 2.6 July 2017 Office of Information Technology (OIT) Division of Information Technology iCare Population Management GUI (BQI) Version 2.6 Table of Contents 1.0 Introduction ......................................................................................................... 1 1.1 Key Functional Features .......................................................................... 1 1.2 Sensitive Patient Data ............................................................................. 2 2.0 Patient Management ........................................................................................... 3 2.1 Data Specifically Related to HIV/AIDS ..................................................... 3 2.2 Search for and View a Patient Record ..................................................... 6 2.2.1 Using a Panel ........................................................................................ 6 2.2.2 Using Quick Search ............................................................................... 7 2.3 Displaying Care Management as Default Tab ......................................... 8 2.4 Add/Edit Care Management Data ............................................................ 8 2.4.1 Entering Data on the General Area ....................................................... 9 2.4.2 Entering Data on the Partner Notification Area .................................... 11 2.4.3 Entering Data on the Antiretroviral
    [Show full text]
  • United States Patent (10) Patent No.: US 9,464,124 B2 Bancel Et Al
    USOO9464124B2 (12) United States Patent (10) Patent No.: US 9,464,124 B2 Bancel et al. (45) Date of Patent: Oct. 11, 2016 (54) ENGINEERED NUCLEIC ACIDS AND 4,500,707 A 2f1985 Caruthers et al. METHODS OF USE THEREOF 4,579,849 A 4, 1986 MacCoSS et al. 4,588,585 A 5/1986 Mark et al. 4,668,777 A 5, 1987 Caruthers et al. (71) Applicant: Moderna Therapeutics, Inc., 4,737.462 A 4, 1988 Mark et al. Cambridge, MA (US) 4,816,567 A 3/1989 Cabilly et al. 4,879, 111 A 11/1989 Chong (72) Inventors: Stephane Bancel, Cambridge, MA 4,957,735 A 9/1990 Huang (US); Jason P. Schrum, Philadelphia, 4.959,314 A 9, 1990 Mark et al. 4,973,679 A 11/1990 Caruthers et al. PA (US); Alexander Aristarkhov, 5.012.818 A 5/1991 Joishy Chestnut Hill, MA (US) 5,017,691 A 5/1991 Lee et al. 5,021,335 A 6, 1991 Tecott et al. (73) Assignee: Moderna Therapeutics, Inc., 5,036,006 A 7, 1991 Sanford et al. Cambridge, MA (US) 9. A 228 at al. J. J. W. OS a 5,130,238 A 7, 1992 Malek et al. (*) Notice: Subject to any disclaimer, the term of this 5,132,418 A 7, 1992 °N, al. patent is extended or adjusted under 35 5,153,319 A 10, 1992 Caruthers et al. U.S.C. 154(b) by 0 days. 5,168,038 A 12/1992 Tecott et al. 5,169,766 A 12/1992 Schuster et al.
    [Show full text]
  • Tomonidan Ithutuotte
    TOMONIDANUS010022425B2 ITHUTUOTTE (12 ) United States Patent (10 ) Patent No. : US 10 ,022 , 425 B2 Bancel et al. ( 45) Date of Patent : Jul. 17 , 2018 ( 54 ) ENGINEERED NUCLEIC ACIDS AND 4 , 399 ,216 A 8 / 1983 Axel et al. METHODS OF USE THEREOF 4 ,401 , 796 A 8 / 1983 Itakura 4 ,411 ,657 A 10 / 1983 Galindo 4 ,415 , 732 A 11/ 1983 Caruthers et al . @(71 ) Applicant : Moderna TX , Inc ., Cambridge , MA 4 ,458 , 066 A 7 / 1984 Caruthers et al. (US ) 4 , 474 , 569 A 10 / 1984 Newkirk 4 ,500 ,707 A 2 / 1985 Caruthers et al . @(72 ) Inventors : Stephane Bancel, Cambridge , MA 4 , 579 , 849 A 4 / 1986 MacCoss et al. 4 ,588 , 585 A 5 / 1986 Mark et al. (US ) ; Jason P . Schrum , Philadelphia , 4 ,668 , 777 A 5 / 1987 Caruthers et al . PA (US ) ; Alexander Aristarkhov , 4 , 737 ,462 A 4 / 1988 Mark et al . Chestnut Hill, MA (US ) 4 ,816 , 567 A 3 / 1989 Cabilly et al . 4 ,879 , 111 A 11 /1989 Chong ( 73 ) Assignee : ModernaTX , Inc. , Cambridge, MA 4 , 957 , 735 A 9 / 1990 Huang 4 , 959 , 314 A 9 / 1990 Mark et al. (US ) 4 ,973 ,679 A 11/ 1990 Caruthers et al. 5 ,012 ,818 A 5 / 1991 Joishy @( * ) Notice: Subject to any disclaimer, the term of this 5 ,017 ,691 A 5 / 1991 Lee et al. patent is extended or adjusted under 35 5 ,021 , 335 A 6 / 1991 Tecott et al. U . S . C . 154 (b ) by 0 days . 5 , 036 , 006 A 7 / 1991 Sanford et al . 5 , 047 ,524 A 9 / 1991 Andrus et al .
    [Show full text]
  • Report for the Hemodialysis Vascular Access: Standardized Fistula Rate
    ESRD Quality Measure Development, Maintenance, and Support Contract Number HHSM-500-2013-13017I Report for the Hemodialysis Vascular Access: Standardized Fistula Rate (SFR) NQF #2977 Submitted to CMS by the University of Michigan Kidney Epidemiology and Cost Center June 21, 2017 Produced by UM-KECC Submitted: 6.21.2017 1 ESRD Quality Measure Development, Maintenance, and Support Contract Number HHSM-500-2013-13017I Table of Contents Introduction .................................................................................................................................................. 3 Methods ........................................................................................................................................................ 3 Overview ................................................................................................................................................... 3 Data Sources ............................................................................................................................................. 4 Outcome Definition .................................................................................................................................. 4 Denominator Definition ............................................................................................................................ 5 Risk Adjustment ........................................................................................................................................ 5 Choosing Adjustment Factors
    [Show full text]