1. Orbit. 2010 Aug;29(4):207-8.

A simplified marking technique for eyebrow reconstruction using composite grafts.

Nieto J, Gladstone GJ.

Consultores en Cirugía Oculoplástica. Barcelona, Spain.

Eyebrows can be damaged in facial burns, trauma, skin cancer, herpes zoster and
other conditions. Some of these patients will demand eyebrow reconstruction
surgery. This can be done using free composite grafts from the scalp or flaps
from the temporal area. Both techniques require time-consuming planning, marking 
and shaping of the graft or flap in order to achieve a good cosmetic result. In
an attempt to make free graft reconstructions faster and easier, we modified the 
technique. We describe an easy way of obtaining a template that simplifies the
procedure and enhances symmetry.


PMID: 20812838 [PubMed - in process]


2. Eur J Pediatr. 2010 Aug 28. [Epub ahead of print]

A boy with a one-sided red rash.

Möhrenschlager M, Ring J, Lauener R.

Department of Dermatology and Allergology, Allergieklinik, Hochgebirgsklinik,
Davos, Switzerland, matthias.moehrenschlager@hgk.ch.

We report on a boy with a sudden onset of unilateral skin lesions following
tonsillar infection with fever 2 weeks before. The lesions consisted of
erythematous macules with scaling affecting trunk, axillar, as well as inguinal
region. CRP, blood differential, serum IgG and IgM antibodies (coxsackievirus,
cytomegalovirus, parvovirus, herpes virus, varicella zoster virus, human
herpesvirus-6/-7), and lesional swabs (bacteria, dermatophytes, yeasts) were
uneventful.


PMID: 20803032 [PubMed - as supplied by publisher]


3. JAMA. 2010 Aug 25;304(8):859-66.

Use of acyclovir, valacyclovir, and famciclovir in the first trimester of
pregnancy and the risk of birth defects.

Pasternak B, Hviid A.

Department of Epidemiology Research, Statens Serum Institut, Artillerivej 5, 2300
Copenhagen S, Denmark. bjp@ssi.dk

Comment in:
    JAMA. 2010 Aug 25;304(8):905-6.

CONTEXT: Herpes simplex and herpes zoster infections are common and often treated
with antiviral drugs including acyclovir, valacyclovir, and famciclovir. Safety
of these antivirals when used in the first trimester of pregnancy is
insufficiently documented. OBJECTIVE: To investigate associations between
exposure to acyclovir, valacyclovir, and famciclovir in the first trimester of
pregnancy and risk of major birth defects. DESIGN, SETTING, AND PARTICIPANTS:
Population-based historical cohort study of 837,795 live-born infants in Denmark 
from January 1, 1996, to September 30, 2008. Participants had no diagnoses of
chromosomal aberrations, genetic syndromes, birth defect syndromes with known
causes, or congenital viral infections. Nationwide registries were used to
ascertain individual-level information on dispensed antiviral drugs, birth defect
diagnoses (categorized according to a standardized classification scheme), and
potential confounders. MAIN OUTCOME MEASURE: Prevalence odds ratios (PORs) of any
major birth defect diagnosed within the first year of life by exposure to
antiviral drugs. RESULTS: Among 1804 pregnancies exposed to acyclovir,
valacyclovir, or famciclovir in the first trimester, 40 infants (2.2%) were
diagnosed with a major birth defect compared with 19,920 (2.4%) among the
unexposed (adjusted POR, 0.89; 95% confidence interval [CI], 0.65-1.22). For
individual antivirals, a major birth defect was diagnosed in 32 of 1561 infants
(2.0%) with first-trimester exposure to acyclovir (adjusted POR, 0.82; 95% CI,
0.57-1.17) and in 7 of 229 infants (3.1%) with first-trimester exposure to
valacyclovir (adjusted POR, 1.21; 95% CI, 0.56-2.62). Famciclovir exposure was
uncommon (n = 26), with 1 infant (3.8%) diagnosed with a birth defect.
Exploratory analyses revealed no associations between antiviral drug exposure and
13 different subgroups of birth defects, but the number of exposed cases in each 
subgroup was small. CONCLUSION: In this large nationwide cohort, exposure to
acyclovir or valacyclovir in the first trimester of pregnancy was not associated 
with an increased risk of major birth defects.


PMID: 20736469 [PubMed - indexed for MEDLINE]


4. Lupus. 2010 Aug 20. [Epub ahead of print]

Irreversible blindness in juvenile systemic lupus erythematosus.

Almeida RT, Aikawa NE, Sallum AM, Jesus AA, Sa LC, Silva CA.

Pediatric Rheumatology Unit, Children's Hospital, Hospital das Clínicas da
Faculdade de Medicina da Universidade São Paulo, São Paulo, Brazil.

Blindness caused by severe vasculitis or uveitis is rare in juvenile systemic
lupus erythematosus (JSLE) patients. In a 27-year period, 5367 patients were
followed at our Paediatric Rheumatology Division and 263 (4.9%) patients had JSLE
(American College of Rheumatology criteria). Of note, two (0.8%) of them had
irreversible blindness. One of them presented with cutaneous vasculitis and malar
rash, associated with pain and redness in both eyes, impairment of visual acuity 
due to iridocyclitis and severe retinal vasculitis with haemorrhage. Another
patient had peripheral polyneuropathy of the four limbs and received
immunosuppressive drugs. Three weeks later, she developed diffuse herpes zoster
associated with acute blindness due to bilateral retinal necrotizing vasculitis
compatible with varicella zoster virus ocular infection. Despite prompt
treatment, both patients suffered rapid irreversible blindness. In conclusion,
irreversible blindness due to retinal vasculitis and/or uveitis is a rare and
severe lupus manifestation, particularly associated with disease activity and
viral infection.


PMID: 20729261 [PubMed - as supplied by publisher]


5. Epidemiol Infect. 2010 Aug 23:1-8. [Epub ahead of print]

Herpes zoster in Australia: evidence of increase in incidence in adults
attributable to varicella immunization?

Jardine A, Conaty SJ, Vally H.

Public Health Unit, Sydney South West Area Health Service, Camperdown, New South 
Wales.

SUMMARYRates of herpes zoster (HZ) hospitalizations, antiviral prescriptions, and
New South Wales emergency-department presentations for age groups <20, 20-39,
40-59 and 60 years were investigated. Trends were analysed using Poisson
regression to determine if rates increased following funding of varicella
immunization in Australia in November 2005. The regression analysis revealed
significantly increasing trends of between 2% and 6% per year in both antiviral
prescriptions and emergency-department presentations in all except the <20 years 
age group. When considered together, the differential changes in rates observed
by age group provides preliminary evidence to indicate that HZ incidence is
increasing in adults aged >20 years. However, it is not possible to attribute the
increasing trends in HZ observed directly to the varicella immunization
programme, and continued monitoring and analyses of data for a longer duration,
both pre- and post-vaccine introduction, is required.


PMID: 20727248 [PubMed - as supplied by publisher]


6. J Neuroophthalmol. 2010 Sep;30(3):252-4.

Cancer-associated retinopathy in neuroendocrine carcinoma of the fallopian tube.

Raghunath A, Adamus G, Bodurka DC, Liu J, Schiffman JS.

Departments of Ophthalmology (AR, JSS), Gynecologic Oncology (DCB), and Pathology
(JL), The University of Texas M. D. Anderson Cancer Center, Houston, Texas;
Department of Ophthalmology and Visual Sciences (AR), University of Texas Medical
Branch, Galveston, Texas; and Ocular Immunology Laboratory, Department of
Ophthalmology (GA), Casey Eye Institute, Oregon Health & Science University,
Portland, Oregon.

A 70-year-old woman developed progressive visual loss with compromised visual
acuity and visual fields, cells in the anterior chamber and vitreous, attenuated 
retinal arterioles, and macular edema. She had undergone right oophorectomy and
partial salpingectomy nearly 50 years earlier. Full-field and multifocal
electroretinography showed waveforms of markedly attenuated amplitudes, findings 
consistent with cancer-associated retinopathy (CAR). Positron emission tomography
revealed a nodule in the anterior wall of a right hydrosalpinx. Total
laparoscopic hysterectomy yielded a neuroendocrine fallopian tube malignancy. She
underwent partial treatment with paclitaxel and carboplatin that was aborted
because of the development of herpes zoster infection. At 15 months following
diagnosis, her ophthalmic status was stable. This is the first report of CAR in
neuroendocrine carcinoma of the fallopian tube.


PMID: 20724944 [PubMed - in process]


7. Otolaryngol Head Neck Surg. 2010 Sep;143(3):413-7.

Benign paroxysmal positional vertigo secondary to inner ear disease.

Lee NH, Ban JH, Lee KC, Kim SM.

Department of Otorhinolaryngology-Head and Neck Surgery, Hongik Medical Center,
Seoul, Korea.

OBJECTIVES: To contrast clinical characteristics of secondary benign paroxysmal
positional vertigo (s-BPPV) with idiopathic BPPV (i-BPPV). STUDY DESIGN: Case
series with chart review. SETTING: University hospital. SUBJECTS AND METHODS: A
total of 718 patients whose medical records were reviewed had BPPV. Sixty-nine
patients had existing inner ear diseases and thus were considered to have s-BPPV.
We reviewed demographics, concurrent causative disorders, involved area, and
response to particle repositioning maneuvers for these s-BPPV patients in
comparison with i-BPPV subjects. RESULTS: Female subjects with i-BPPV outnumbered
male subjects by a ratio of 1.9:1, but there was no significant sex difference
for s-BPPV patients. The diseases associated with s-BPPV were idiopathic sudden
sensory hearing loss (ISSHL, 50.7%), Ménière's disease (MD, 28.9%) and unilateral
vestibulopathy such as acute vestibular neuronitis and herpes zoster oticus
(20.2%). The posterior canal was most commonly involved in both i-BPPV and
s-BPPV. The horizontal canal was the second most common, followed by multi-canal 
involvement. However, MD-associated BPPV most commonly involved the lateral
canal. The mean durations of treatment for i-BPPV and s-BPPV were 2.28 and 4.87
days, respectively. The mean duration of treatment was 6.28 days for ISSHL with
BPPV, 5.07 days for BPPV with unilateral vestibulopathy, and 2.28 days for BPPV
with MD. CONCLUSION: The mean duration of treatment for BPPV with ISSHL or
unilateral vestibulopathy was longer than for other groups. The different
pathophysiologies of s-BPPV associated with different inner ear diseases may
explain its diverse clinical features and courses.


PMID: 20723780 [PubMed - in process]


8. BMC Health Serv Res. 2010 Aug 13;10:237.

Assessing the potential effects and cost-effectiveness of programmatic herpes
zoster vaccination of elderly in the Netherlands.

van Lier A, van Hoek AJ, Opstelten W, Boot HJ, de Melker HE.

Department of Epidemiology and Surveillance, Centre for Infectious Disease
Control, National Institute for Public Health and the Environment, Bilthoven, The
Netherlands. alies.van.lier@rivm.nl

BACKGROUND: Herpes zoster (HZ) is a painful disease affecting a considerable part
of the elderly. Programmatic HZ vaccination of elderly people may considerably
reduce HZ morbidity and its related costs, but the extent of these effects is
unknown. In this article, the potential effects and cost-effectiveness of
programmatic HZ vaccination of elderly in the Netherlands have been assessed
according to a framework that was developed to support evidence-based decision
making regarding inclusion of new vaccines in the Dutch National Immunization
Program. METHODS: An analytical framework was used combining a checklist, which
structured relevant data on the vaccine, pathogen and disease, and a
cost-effectiveness analysis. The cost-effectiveness analysis was performed from a
societal perspective, using a Markov-cohort-model. Simultaneous vaccination with 
influenza was assumed. RESULTS: Due to the combination of waning immunity after
vaccination and a reduced efficacy of vaccination at high ages, the most optimal 
cost-effectiveness ratio (21716 euro per QALY) for HZ vaccination in the
Netherlands was found for 70-year olds. This estimated ratio is just above the
socially accepted threshold in the Netherlands of 20000 euro per QALY. If
additional reduction of postherpetic neuralgia was included, the
cost-effectiveness ratio improved (approximately 10000 euro per QALY) but
uncertainty for this scenario is high. CONCLUSIONS: Vaccination against HZ at the
age of 70 years seems marginally cost-effective in the Netherlands. Due to
limited vaccine efficacy a considerable part of the disease burden caused by HZ
will remain, even with optimal acceptance of programmatic vaccination.


PMCID: PMC2928772
PMID: 20707884 [PubMed - in process]


9. J Med Econ. 2010 Aug 16. [Epub ahead of print]

Health economic evaluation of a vaccine for the prevention of herpes zoster
(shingles) and post-herpetic neuralgia in adults in Belgium.

Annemans L, Bresse X, Gobbo C, Papageorgiou M.

Ghent University, Ghent, Belgium and Brussels University, Brussels, Belgium.

Abstract Objective: To determine the cost-effectiveness of vaccination against
herpes zoster (HZ) and post-herpetic neuralgia (PHN) in individuals aged 60 years
and older in Belgium. Methods: A Markov model was developed to compare the
cost-effectiveness of vaccination with that of a policy of no vaccination. The
model estimated the lifetime incidence and consequences of HZ and PHN using
inputs derived from Belgian data, literature sources, and expert opinion.
Cost-effectiveness was measured by the incremental cost-effectiveness ratio
(ICER), expressed as cost per quality-adjusted life-year (QALY) gained. Results: 
Vaccination in individuals aged 60 years and older resulted in ICERs of euro6,799
(third party payer perspective), euro7,168 (healthcare perspective), and
euro7,137 (societal perspective). The number needed to vaccinate to prevent one
case was 12 for HZ, and 35 or 36 for PHN depending on the definition used.
Univariate sensitivity analyses produced ICERs of euro4,959-19,052/QALY; duration
of vaccine efficacy had the greatest impact on cost-effectiveness. Probabilistic 
sensitivity analysis showed at least a 94% probability of ICERs remaining below
the unofficial euro30,000 threshold. Discussion: Key strengths of the model are
the combination of efficacy data from a pivotal clinical trial with
country-specific epidemiological data and complete sensitivity analysis
performed. Main limitations are the use of non country-specific PHN proportion
and non Belgian disease-specific utilities. Results are comparable with those
recently published. Conclusions: HZ vaccination in individuals aged 60 years and 
older would represent a cost-effective strategy in Belgium.


PMID: 20707768 [PubMed - as supplied by publisher]


10. Vojnosanit Pregl. 2010 Jul;67(7):523-9.

[Varicella complications: is it time to consider a routine varicella
vaccination?]

[Article in Serbian]

Dulović O, Gvozdenović E, Nikolić J, Spurnić AR, Katanić N, Kovarević-Pavićević
D.

Klinicki centar Srbije, Klinika za infektivne i tropske bolesti Dr. Kosta
Todorović, Beograd, Srbija. odulovic@sbb.rs

BACKGROUND/AIM: Varicella is a common and benign disease of childhood.
Complications are rare, but in some patients, even without risk factors, severe, 
life treathening complications could be seen. The aim of this study was to
establish the type and frequency of varicella complications among hospitalised
patients over an 8-year period. METHODS: This retrospective analysis included
medical charts of the patients hospitalised in the Infectious Disease Clinic,
Belgrade, Serbia, from 2001-2008 (4.85% of all registered patients with varicella
in Belgrade, 2001-2008). Among hospitalised patients dermografic characteristics 
were analysed: hospitalisation lenght, presence and type of complications,
presence of immunocompromising conditions and outcome of the disease. The
diagnosis of varicella was made on clinical grounds, and in persons >40 years,
with negative epidemiological data of contacts, serological confirmation (ELISA
VZV IgM/IgG BioRad) and avidity of IgG antibodies were done to exclude the
possibility of disseminated herpes zoster. RESULTS: A total of 474 patient were
hospitalised over an 8-year period. The age of patients was from 5 months to 75
years (mean 22.4 +/- 16.1, median 23.5 years). The majority of patients were
adults (n=279; 58.9%) and 195 (41.1%) patients were < or =15 years old.
Complications were found in 321/474 (67.7%) patients. The registered
complications were: varicella pneumonia (n=198; 41.38%), bacterial skin
infections (n=40; 8.4%), cerebelitis (n=28; 5.9%), bacterial respiratory
infection (n=21; 4.4%), viral meningitis (n=10; 2.31%), encephalitis (n=9; 1.9%),
thrombocytopenia (n=2; 0.4%); 11 (2.3%) patients had more than one complication, 
among them were sepsis, myopericarditis and retinal hemorrhages. When
complications were analysed according to the age, there were no statistical
significance, but when type of complication was analysed statistical significance
was found (p < 0.05). In adults, pneumonia was the most common complication:
173/279 (62%), followed by skin infections (2.9%), bacterial respiratory
infections (2.2%), and more than one complication (2.3%). Pneumonia was more
common in adults than in children (7:1). In children skin infections were the
most common complications (16.4%), followed by cerebelitis (13.3%), viral
pneumonia (12.8%), bacterial respiratory infections (7.7%), encephalitis (3.6%), 
and more than one complication (4.1%). Neuroinfections were more common in
children than in adults (6:1), as well as bacterial skin infections (4:1). Two
patients died (0.4%). CONCLUSION: There was no difference in the incidence of
varicella complication in children and adults, but the type of complication
differed. In children the most common complications were skin and neurological
infections, while in adults it was varicella pneumonia. These data provide a
baseline for estimating the burden of varicella in Belgrade and support the
inclusion of varicella vaccine in childhood immunisation program in Serbia.


PMID: 20707045 [PubMed - indexed for MEDLINE]


11. Infect Disord Drug Targets. 2010 Aug 10. [Epub ahead of print]

Epidemiology and Prevention of Viral Infections in Patients with Hematologic
Malignancies.

Angarone M.

Northwestern University Feinberg School of Medicine, Division of Infectious
Diseases, 645 N. Michigan Ave, Suite 900, Chicago, Illinois 60611, USA.
m-angarone@northwestern.edu.

Viral infections are some of the most frequent complications in patients with
hematologic malignancies are viral infections. Infections caused by
cytomegalovirus, herpes simplex virus, varicella zoster virus, hepatitis B virus 
and influenza virus are associated with high morbidity and mortality in this
vulnerable population. Fortunately, a growing number of antiviral medications and
vaccines are allowing for more effective prophylaxis against these pathogens.
This article reviews the epidemiology and prophylactic strategies available for
these opportunistic viral pathogens.


PMID: 20701581 [PubMed - as supplied by publisher]


12. Arch Ophthalmol. 2010 Aug;128(8):1079-80.

Exacerbation of zoster interstitial keratitis after zoster vaccination in an
adult.

Khalifa YM, Jacoby RM, Margolis TP.

PMID: 20697015 [PubMed - indexed for MEDLINE]


13. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010 Aug 5. [Epub ahead of
print]

Unusual oral complications of herpes zoster infection: Report of a case and
review of literature.

Jain MK, Manjunath KS, Jagadish SN.

Assistant Professor, Department of Oral and Maxillofacial Surgery, Vidyanagar,
Karnataka, India.

A case of herpes zoster infection with unusual oral complications involving the
mandibular division of the trigeminal nerve is presented. The post-herpetic
complications of osteonecrosis, spontaneous exfoliation of teeth, and subsequent 
pathologic fracture of mandible in the absence of concurrent predisposing factors
in a 65-year-old man are demonstrated. Forty-one cases with osteonecrosis and
spontaneous exfoliation of teeth previously presented in the literature are
reviewed. This is the first report of pathologic fracture after herpes zoster
infection.


PMID: 20692192 [PubMed - as supplied by publisher]


14. Am J Ophthalmol. 2010 Aug 4. [Epub ahead of print]

Identification of New Pathogens in the Intraocular Fluid of Patients With
Uveitis.

de Groot-Mijnes JD, de Visser L, Zuurveen S, Martinus RA, Völker R, Ten Dam-Van
Loon NH, de Boer JH, Postma G, de Groot RJ, Van Loon AM, Rothova A.

Department of Virology, University Medical Center Utrecht, Utrecht, The
Netherlands; Department of Ophthalmology, University Medical Center Utrecht,
Utrecht, The Netherlands.

PURPOSE: To determine infectious causes in patients with uveitis of unknown
origin by intraocular fluids analysis. DESIGN: Case-control study. METHODS:
Ocular fluids from 139 patients suspected of infectious uveitis, but negative for
herpes simplex virus, varicella-zoster virus, cytomegalovirus, and Toxoplasma
gondii by polymerase chain reaction and/or antibody analysis in intraocular
fluids, were assessed for the presence of 18 viruses and 3 bacteria by real-time 
polymerase chain reaction (PCR). The ocular fluids from 48 patients with uveitis 
of known etiology or with cataract were included as controls. RESULTS: Positive
PCR results were found for Epstein-Barr virus, for rubella virus, and for human
herpesvirus 6 each in 1 patient and for human parechovirus in 4 patients. Of the 
human parechovirus-positive patients, 1 was immunocompromised and had panuveitis.
The other 3 patients were immunocompetent and had anterior uveitis, all with
corneal involvement. CONCLUSIONS: Human parechovirus might be associated with
infectious (kerato)uveitis.


PMID: 20691420 [PubMed - as supplied by publisher]


15. Przegl Lek. 2010;67(3):149-50.

[Neurological complications among patients with zoster hospitalized in Department
of Infectious Diseases in Cracow in 2001-2006]

[Article in Polish]

Biesiada G, Czepiel J, Sobczyk-Krupiarz I, Mach T, Garlicki A.

Klinika Chorób Zakaźnych, Katedry Gastroenterologii, Hepatologii i Chorób
Zakaźnych, Collegium Medicum, Uniwersytetu Jagiellońskiego w Krakowie.
gbiesiada@op.pl

BACKGROUND: Herpes zoster is an infectious disease caused by varicella zoster
virus (VZV). After replication at the place of entry, VZV spreads via the blood
into the skin and mucosa, causing the varicella. From these regions VZV migrates 
into the sensory ganglia where it establishes a latent infection. The aim of our 
study was to analyze the localization of the skin changes and correlations of
neurological complications among patient with zoster. MATERIAL AND METHODS: We
have reviewed medical documentation of the 67 patients with herpes zoster,
hospitalized in our Department during the years 2001-2006. We have studied
localization of the herpes zoster changes and frequency of neurological
complications among these patients. RESULTS: Neuralgia was less intensive and
last shorter time, when antiviral treatment had been started earlier. Neuralgia, 
meningitis, encephalitis and complications of the eye zoster were present more
often among patients over 65 years old.


PMID: 20687373 [PubMed - in process]


16. J Med Econ. 2010 Aug 4. [Epub ahead of print]

Descriptive analysis of Medicaid patients with postherpetic neuralgia treated
with lidocaine patch 5%

Kirson NY, Ivanova JI, Birnbaum HG, Wei R, Kantor E, Amy Puenpatom R, Ben-Joseph 
RH, Summers KH.

Analysis Group, Inc., Boston, MA, USA.

Abstract Objectives: To compare demographic and comorbidity profiles and
healthcare costs of Medicaid patients with postherpetic neuralgia (PHN) treated
with lidocaine patch 5% (lidocaine patch) versus patients not treated with the
lidocaine patch. Repeat comparison for the subset of patients treated in
long-term care (LTC) settings. Methods: Patients, age >/=18 years, with PHN
diagnosis, or PHN-likely patients with herpes zoster diagnosis and >/=30 days of 
PHN-recommended treatment, were identified in Medicaid claims from Florida, Iowa,
Missouri, and New Jersey (1999-2007). Patients had continuous eligibility 6
months before (baseline) and 12 months after (study period) the PHN index date.
Patients with >/=1 claim for a lidocaine patch during the study period (n = 872) 
were compared to patients without a lidocaine patch claim (comparison group).
Baseline characteristics, study period treatment and healthcare costs
(reimbursements by Medicaid for medical services and prescription drugs) were
compared between groups using univariate analyses. Results: PHN patients in the
lidocaine patch group were older (64.5 vs. 62.2 years; p = 0.002) and had higher 
rates of pain-related comorbidities (e.g., back/neck pain, osteoarthritis) than
comparison patients. Average PHN-related drug costs per patient were higher
($1994 vs. 1137; p < 0.0001) among lidocaine patch patients, with lidocaine patch
accounting for $505 of the difference. PHN-related medical costs appeared lower
in the lidocaine patch group, although not statistically significant ($983 vs.
1294; p = 0.1348). No significant differences were found in total healthcare
costs ($20,175 vs. 19,124; p = 0.3720) across groups, despite higher total
prescription drug costs among lidocaine patch patients. A similar pattern was
observed among LTC patients. Conclusions: Despite higher rates of comorbidities
and prescription drug costs, lidocaine patch patients had similar study period
healthcare costs as comparison patients. The cost of the lidocaine patch
represented a small fraction of overall costs incurred over the study period.
Limitations: Findings are based on a Medicaid sample and may not be generalizable
to all PHN patients.


PMID: 20684670 [PubMed - as supplied by publisher]


17. J Med Econ. 2010 Aug 4. [Epub ahead of print]

Comparing healthcare costs of Medicaid patients with postherpetic neuralgia (PHN)
treated with lidocaine patch 5% versus gabapentin or pregabalin.

Kirson NY, Ivanova JI, Birnbaum HG, Wei R, Kantor E, Puenpatom RA, Ben-Joseph RH,
Summers KH.

Analysis Group, Inc., Boston, MA, USA.

Abstract Objective: To compare healthcare resource utilization and costs of
postherpetic neuralgia (PHN) patients initiating lidocaine patch 5% (lidocaine
patch) or oral gabapentin/pregabalin. Methods: Patients with PHN diagnosis, or
herpes zoster diagnosis and >/=30 days PHN-recommended treatment were selected
from de-identified Medicaid claims data from Florida, Iowa, Missouri, and New
Jersey, 1999-2007. Patients initiated monotherapy with lidocaine patch or
gabapentin/pregabalin after PHN diagnosis, had continuous eligibility 6 months
before (baseline) and 6 months after (study period) medication index date, and
were >/=18 years old. Lidocaine patch patients were matched to
gabapentin/pregabalin patients based on their propensity to initiate treatment.
Study period resource utilization and costs from a Medicaid perspective were
compared between treatment groups using univariate analysis. Results: Matched
patients were on average 61.3 years old, approximately 73% were women, and 55%
had other painful conditions during the baseline period. 6-month per patient
PHN-related prescription drug costs were similar for matched lidocaine patch (n =
312) and gabapentin/pregabalin (n = 312) patients ($854 vs. 820, p = 0.75), while
PHN-related medical costs appeared lower in the lidocaine patch group ($145 vs.
353, p = 0.12). Furthermore, there were no statistically significant differences 
between treatment groups during the observation period in overall resource
utilization, total prescription drug costs, and total medical costs per patient. 
Conclusions: In spite of higher list prices, PHN patients treated with lidocaine 
patch cost no more than patients treated with gabapentin or pregabalin in terms
of overall healthcare costs over the 6-month study period. The study suggests
that PHN-related medical costs may be lower among lidocaine patch patients.
Limitations: Findings are based on a Medicaid sample and may not be generalizable
to all PHN patients.


PMID: 20684669 [PubMed - as supplied by publisher]


18. Ophthalmology. 2010 Aug;117(8):1659, 1659.e1; author reply 1660-1.

Acute retinal necrosis.

Carifi G, Onyema L.

Comment on:
    Ophthalmology. 2009 Oct;116(10):1971-5.e2.

PMID: 20682386 [PubMed - indexed for MEDLINE]


19. BMC Infect Dis. 2010 Aug 3;10:230.

Epidemiology and economic burden of herpes zoster and post-herpetic neuralgia in 
Italy: a retrospective, population-based study.

Gialloreti LE, Merito M, Pezzotti P, Naldi L, Gatti A, Beillat M, Serradell L, di
Marzo R, Volpi A.

Dipartimento di Sanità Pubblica, Università di Roma Tor Vergata, Via Montpellier 
1, 00133 Roma, Italy. leonardo.emberti.gialloreti@uniroma2.it

BACKGROUND: Data on the epidemiology and cost of herpes zoster (HZ) and
post-herpetic neuralgia (PHN) in Italy are limited. This retrospective,
population-based study was designed to determine the incidence of HZ and the
proportion developing PHN in Italy and the associated medical resource
utilisation and costs. It focused primarily on immunocompetent patients aged > or
= 50 years who would be eligible for preventive vaccination. METHOD: Data were
extracted from a primary-care database and national hospital-discharge records
covering four major regions in Italy for 2003-2005. Cases of HZ and PHN (1 and 3 
months' duration; PHN1 and PHN3) were identified by ICD9-CM codes and,
additionally for PHN, prescription of neuropathic pain medication. RESULTS: Over 
3 years, 5675 incident cases of HZ were documented in adults, of which 3620
occurred in immunocompetent patients aged > or = 50 years (incidence of 6.31 per 
1000 person-years [95% CI: 6.01-6.62]). Of the immunocompetent patients aged > or
= 50 years with HZ, 9.4% (95% CI: 8.2-10.7) and 7.2% (95% CI: 6.2-8.2) developed 
PHN1 and PHN3, respectively. Increasing age, female sex, and being
immunologically compromised conferred increased risk for both HZ and PHN.
Overall, about 1.3% of HZ and almost 2% of PHN cases required inpatient care,
with 16.9% of all HZ-related hospitalisations due specifically to PHN. In
patients aged > or = 50 years, mean stay was 7.8 +/- 5.4 days for HZ and 10.2 +/-
8.6 days for PHN, and direct costs associated with inpatient care were more than 
20 times outpatient costs per HZ case (mean +/- SD: euro2592 +/- euro1313 vs.
euro122.68 +/- euro97.51) and over 5 times more per episode of PHN (mean +/- SD: 
euro2806 +/- euro2641 vs. euro446.10 +/- euro442.97). Total annual costs were
euro41.2 million, of which euro28.2 million were direct costs and euro13.0
million indirect costs. CONCLUSIONS: This study, the largest to date on the
epidemiology and economic impact of HZ and PHN in Italy, confirms the
considerable disease and economic burden posed by HZ. As HZ and PHN
disproportionately affect the elderly, without intervention this problem is
likely to grow as the proportion of elderly in the Italian population continues
to increase.


PMCID: PMC2921387
PMID: 20682044 [PubMed - in process]


20. Ann Intern Med. 2010 Aug 3;153(3):210-1; author reply 211-2.

Herpes zoster vaccine in nursing facility residents: safety questions remain.

Nace DA, Drinka PJ, Crnich CJ.

Comment on:
    Ann Intern Med. 2010 May 4;152(9):545-54.

PMID: 20679571 [PubMed - indexed for MEDLINE]