Medicine and health, Rhode Island 

About: Medicine and health, Rhode Island is an academic journal. The journal publishes majorly in the area(s): MEDLINE & Health care. It has an ISSN identifier of 1086-5462. Over the lifetime, 1068 publications have been published receiving 5527 citations.

Smallpox: clinical and epidemiologic features.

Abstract: Clinical and Epidemiologic Characteristics of Smallpox Smallpox is a viral disease unique to humans. To sustain itself, the virus must pass from person to person in a continuing chain of infection and is spread by inhalation of air droplets or aerosols. Twelve to 14 days after infection, the patient typically becomes febrile and has severe aching pains and prostration. Some 2 to 3 days later, a papular rash develops over the face and spreads to the extremities (Figure 1). The rash soon becomes vesicular and later, pustular (Figure 2). The patient remains febrile throughout the evolution of the rash and customarily experiences considerable pain as the pustules grow and expand. Gradually, scabs form, which eventually separate, leaving pitted scars. Death usually occurs during the second week. The disease most commonly confused with smallpox is chickenpox, and during the first 2 to 3 days of rash, it may be all but impossible to distinguish between the two. However, all smallpox lesions develop at the same pace and, on any part of the body, appear identical. Chickenpox lesions are much more superficial and develop in crops. With chickenpox, scabs, vesicles, and pustules may be seen simultaneously on adjacent areas of skin. Moreover, the rash in chickenpox is more dense over the trunk (the reverse of smallpox), and chickenpox lesions are almost never found on the palms or soles. In 5% to 10% of smallpox patients, more rapidly progressive, malignant disease develops, which is almost always fatal within 5 to 7 days. In such patients, the lesions are so densely confluent that the skin looks like crepe rubber; Smallpox: Clinical and Epidemiologic Features

Gait in the elderly.

Abstract: falls in the elderly are routinely cited in review articles. ,2 Interestingly, none of them are recent.1,2 My guess is that as the population ages, these numbers will worsen. In addition, abandonment of the "chemical straitjacket" routinely used for the demented twenty years ago which rendered poor walkers into non-walkers may have increased fall frequency. For example, data from 1988, still cited in recent articles, 1,2 state thar one third of people over age 65 fall each year, and for half of them this is an ongoing prob­ lem.J ,4 Ten percent of these falls results in significant morbidity (data from early 1990s).5 Presumably these numbers in­ crease with age. Falls are the fifth most com­ mon cause of death in the elderly. Only 25% of patients who suffer hip fractures regain their former level of function. And falls frequently induce a fear of falling, which itself contributes to the problem. Impairment in mobility affects 14% ofthose between 65 and 74 but halfofthose over 85.(' This impairment occurs for a number of reasons, including brain changes, both normal and pathological, as well as changes in muscles and the sensoty organs (eyes, vestibular apparatus, periph­ eral nerves). Normal aging produces physi­ cal changes that overlap with the signs of Parkinson's disease, except for tremor. The clinical importance of gait can­ not be overestimated. In a nursing home evaluation, every single patient seen by this author had a significant gait abnor­ mality. Ofcourse, in many cases, that was why they were not living at home. It is my hypothesis that gait abnormali­ ties are often not identified by doctors because it has not been pan of their training. In the outpatient setting, doctors, for efficiency, tend ro see patients in examining rooms, partially undressed, seated on the examining table. In the hospital, it is difficult to get patients out of bed or off their stretchers, and a lot more dif­ ficult ro get them back on them, especially in the emergency department where the stretch­ ers are quite high. The basic problem is the lack of a language for describing and classifying gait problems.