ABSTRACT
Azathioprine hypersensitivity syndrome is a rare but potentially severe side effect of azathioprine use. It has a variable and non-specific presentation making it difficult to distinguish from sepsis or disease relapse. High clinical suspicion is therefore required for recognition and prompt cessation of azathioprine for symptom resolution. Herewith two cases of severe azathioprine hypersensitivity syndrome are described, one in association with Sweet syndrome. Both presented with vague symptoms 2 weeks after commencing azathioprine for antineutrophil cytoplasmic antibody vasculitis. The differentials of sepsis and disease relapse were considered prior to cessation of azathioprine which resulted in a dramatic improvement in both cases. These cases highlight the diagnostic challenge azathioprine hypersensitivity syndrome presents. It should be suspected when there is a temporal relationship to drug initiation, with absence of infection or serological evidence of disease relapse.
Subject(s)
Drug Hypersensitivity Syndrome , Drug Hypersensitivity , Sweet Syndrome , Antibodies, Antineutrophil Cytoplasmic , Azathioprine/adverse effects , Drug Hypersensitivity/diagnosis , Drug Hypersensitivity/etiology , Humans , Immunosuppressive Agents/adverse effects , Sweet Syndrome/chemically induced , Sweet Syndrome/diagnosis , Sweet Syndrome/drug therapyABSTRACT
Living near landfills is a known health hazard prompting recognition of environmental injustice. The study aim was to compare self-reported symptoms of ill health among residents of four neighborhoods, living in haphazardly constructed settlements surrounded by illegal dumpsites in Tijuana, Mexico. One adult from each of 388 households located in Los Laureles Canyon were interviewed about demographics, health status, and symptoms. Distance from each residence to both the nearest dumpsite and the canyon bottom was assessed. The neighborhoods were selected from locations within the canyon, and varied with respect to proximity to dump sites. Residents of San Bernardo reported significantly higher frequencies of ill-health symptoms than the other neighborhoods, including extreme fatigue (OR 3.01 (95% CI 1.6-5.5)), skin problems/irritations (OR 2.73 (95% CI 1.3-5.9)), stomach discomfort (OR 2.47 (1.3-4.8)), eye irritation/tears (OR 2.02 (1.2-3.6)), and confusion/difficulty concentrating (OR 2.39 (1.2-4.8)). Proximity to dumpsites did not explain these results, that varied only slightly when adjusted for distance to nearest dumpsite or distance to the canyon bottom. Because San Bernardo has no paved roads, we hypothesize that dust and the toxicants it carries is a possible explanation for this difference. Studies are needed to further document this association and sources of toxicants.
Subject(s)
Environmental Exposure , Environmental Pollutants/analysis , Health Status , Waste Disposal Facilities , Adult , Cross-Sectional Studies , Demography , Female , Humans , Male , Mexico , Middle Aged , Needs Assessment , Residence Characteristics , Risk Factors , Self Report , Young AdultABSTRACT
PURPOSE: To develop and demonstrate the usefulness of quantitative methods for assessing retention and academic success of junior faculty in academic medicine. METHOD: The authors created matched sets of participants and nonparticipants in a junior faculty development program based on hire date and academic series for newly hired assistant professors at the University of California, San Diego (UCSD), School of Medicine between 1988 and 2005. They used Kaplan-Meier and Cox proportional hazards survival analyses to characterize the influence of covariates, including gender, ethnicity, and program participation, on retention. They also developed a new method for quantifying academic success based on several measures including (1) leadership and professional activities, (2) honors and awards, (3) research grants, (4) teaching and mentoring/advising activities, and (5) publications. The authors then used these measures to compare matched pairs of participating and nonparticipating faculty who were subsequently promoted and remained at UCSD. RESULTS: Compared with matched nonparticipants, the retention of junior faculty who participated in the faculty development program was significantly higher. Among those who were promoted and remained at UCSD, the academic success of faculty development participants was consistently greater than that of matched nonparticipants. This difference reached statistical significance for leadership and professional activities. CONCLUSIONS: Using better quantitative methods for evaluating retention and academic success will improve understanding and research in these areas. In this study, use of such methods indicated that organized junior faculty development programs have positive effects on faculty retention and may facilitate success in academic medicine.
