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Angiotensin-Converting Enzyme Inhibitors for Secondary Erythrocytosis

Fadi Fakhouri, MD; Jean-Pierre Grünfeld, MD; Olivier Hermine, MD, PhD; and Richard Delarue, MD
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Ann Intern Med. 2004;140(6):492-493. doi:10.7326/0003-4819-140-6-200403160-00032
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Computed tomography scan and evolution of hematocrit.

TOp. Renal computed tomography showed a nonfunctioning cystic left kidney in patient 2. Bottom. Change in hematocrit after the introduction of an angiotensin-converting enzyme (ACE) inhibitor. *The initial decrease in hematocrit in patient 2 resulted from blood loss caused by gastrointestinal bleeding and 2 phlebotomy sessions. † Patient 1 reported cough during treatment with the ACE inhibitor and was switched to an angiotensin II receptor antagonist.

Grahic Jump Location




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Occupational exposure and worker's rights.
Posted on September 13, 2004
Nicola Magnavita
Institute of Occupational Medicine
Conflict of Interest: None Declared

To the Editor

The Behrman and Allan's commentary1 of Dr. Seibert's body fluid exposure2 points out that only a part of health care workers (HCWs) depend on efficient surveillance programs at the workplace. The failure of some hospitals to put on effective infection control procedures and training of staff is hardly justified. Moreover, work organization in hospital is often the root-cause of occupational injuries. It is well known that sleep deprivation and shift work have deleterious effect on level of alertness and performance, and increase the frequency of occupational injuries. However, current regulations allow hospital scheduling that can result in too much time on task, no concessions for time-of-day effect related to work and sleep times, and no concessions for schedules that result in increasing sleep debt. It is worth of note that, once infected by bloodborne pathogens, HCWs are not entitled to the same level of civil rights of people. Federal laws, State statutes, and court decisions, in the intention of attain best protection of the public, often encourage violation of confidence when impaired HCWs are at issue. A recent Opinion of the Council on Ethical and Judicial Affairs (CEJA)3 states that each physician has an ethical duty to investigate on colleague's health, even if the first report of colleague's illness had been submitted anonymously. According to current recommendations4, expert panels decide if infected HCWs may continue to perform their practice. In the absence of precise guidelines, such judgement might me vulnerable to the particular biases and experiences of the members of the panel, as well as to conflict of interest of colleagues sitting on such a committee. While the first ethical duty is unquestionably to protect the patient, compromising HCWs' rights could deter them from reporting injuries or undergo serological testing. An intense lobbing action is requested, to balance society's and patient's interests and HCWs rights.

Nicola Magnavita, M.D. Italian Study Group on Hazardous Workers Institute of Occupational Medicine Catholic University School of Medicine, Rome, Italy nmagnavita@rm.unicatt.it


1. Behrman AJ, Allan DA. Occupational exposure to bloodborne pathogens. Ann Intern Med 2004; 140: 492 2. Seibert C. Stuck. Ann Intern Med 2003; 138: 765-6 3. Council of Ethical and Judicial Affairs (CEJA): Reporting impaired, incompetent, or unethical colleagues, Amendment. CEJA Opinion 5-A-04. Available at: http://www.ama- assn.org/ama1/pub/upload/mm/369/rprtcolleag_ceja_a04.pdf 4. Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposure to HBV, HCV, and HIV and Recommendation for Postexposure Prophylaxis. Centers for Disease Control and Prevention. 29 June 2001. Available at www.cdc.gov/mmwr/preview/mmwrhtml/rr5011a1.htm

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