Management of the severely anemic patient who refuses transfusion: lessons learned during the care of a Jehovah's witness
Article Abstract:
Treatment of Jehovah's witnesses suffering from severe anemia may be difficult because of their religious beliefs. Jehovah's witnesses are forbidden by their religion from receiving blood transfusions, but they may receive other types of treatment to increase the delivery of oxygen to the tissues. Refusal of blood transfusions by Jehovah's witnesses is based on passages in the Bible that forbid the eating of blood. Refusal of blood transfusions by members of this sect often give rise to a complex set of legal and ethical issues. Some of these patients may request alternative treatments that are expensive and relatively ineffective. Treatment with genetically engineered erythropoietin, a hormone that increases red blood cell production, may be an effective alternative for these patients. Other strategies include minimizing blood loss, increasing cardiac output, increasing the oxygen content of their blood and reducing their metabolic rate.
Publication Name: Annals of Internal Medicine
Subject: Health
ISSN: 0003-4819
Year: 1992
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Epidemic visceral leishmaniasis in Southern Sudan: treatment of severely debilitated patients under wartime conditions and with limited resources
Article Abstract:
Visceral leishmaniasis may be treatable with few resources and during the crisis of war even in very ill patients. The disease is spread to humans by the sand fly and is fatal unless treated. Doctors in southern Sudan treated 3,076 patients with visceral leishmaniasis from 1990 to 1991. The country was experiencing a civil war during this time. A total of 336 patients (10.9%) died during hospitalization. Children younger than five years and adults 45 years and older had a greater risk of death after less than five doses of medicine. Other risk factors for death were severe anemia, malnourishment, enlarged spleen, high parasite density, and vomiting at least once during treatment. Antimonial therapy with sodium stibogluconate may treat leishmaniasis without producing drug resistance.
Publication Name: Annals of Internal Medicine
Subject: Health
ISSN: 0003-4819
Year: 1996
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The Return of Cyclospora in 1997: Another Outbreak of Cyclosporiasis in North America Associated with Imported Raspberries
Article Abstract:
Consumption of contaminated raspberries imported from Guatemala likely caused 41 outbreaks of cryptosporidiosis in the US and Canada in 1996 and 1997. Infection with cryptosporidia caused 762 cases of disease associated with events in which raspberries were served. Outbreaks of disease ended when the exportation of the fruit from Guatemala was halted. Researchers do not know how the berries became contaminated.
Publication Name: Annals of Internal Medicine
Subject: Health
ISSN: 0003-4819
Year: 1999
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