Volume 94, Issue 1

Chlamydia pneumoniae has recently been shown to be a cause of pharyngitis. Because the impact of this pathogen on United States Air Force basic trainees is unknown, the authors undertook a prospective study to evaluate the prevalence of C pneumoniae. Of 118 asymptomatic basic trainees, 43% had preexisting antibodies to C pneumoniae and 0.9% had serologic evidence of C pneumoniae infection. Of 226 symptomatic basic trainees, only four (1.8%) met the criteria for serologic evidence of acute C pneumoniae infection. No other cause of pharyngitis was found in three of four of these basic trainees. Three of the trainees with C pneumoniae infection had hoarseness and all had a dry cough. All symptoms resolved without specific antichlamydial therapy. Chlamydia pneumoniae was an uncommon cause of pharyngitis in basic trainees, appearing as a mild, self-limiting illness.

An uncontrolled, retrospective study of 58 consecutive patients admitted to a hospital substance abuse unit assessed the effects of alcohol consumption on cholesterol levels. From the dietary histories completed by 54 of the patients, it was found that the alcoholics consumed a high-calorie diet containing a high percentage of foods with a high cholesterol content, but in small quantities. Most of their caloric intake was derived from the alcohoL Abusers of substances other than alcohol had a low-calorie intake of the same quality as alcoholics. It appears that low consumption of alcohol rather than something intrinsic in alcohol or other drugs is related to low levels of total cholesterol in persons consuming a high cholesterol-containing diet. The author also suggests that an unexplained relationship between low cholesterol levels and some gastrointestinal malignancies may be due to the effects of alcohol on the gastrointestinal tract.

In traumatically \injured or medically unstable pediatric patients requiring resuscitation, gaining intravenous access often is frustrating for the physician and agonizing for the patient. Even when cardiopulmonary resuscitation is performed by trained professionals, cardiac arrests in children in the prehospital setting have a mortality of 79% to 100%. Immediate vascular access such as that obtained by intraosseous infusion improves survival. The intraosseous infusion technique uses the medullary cavity in the tibia as a ''noncollapsible vein" for parenteral infusion. It is indicated in a child in shock or cardiac arrest when two attempts to access peripheral vasculature have failed or when more than 2 minutes have elapsed in the attempt to gain access. Epinephrine, bicarbonate, calcium, lidocaine, and volume expanders can be infused via the intraosseous route. Complications rarely occur. The technique described here is gaining acceptance in both prehospital and emergency department settings.

Primary care will play a central role in the new national healthcare program. Our osteopathic medical education programs must change if osteopathic physicians are to remain dominant in primary care and thereby play a large role in the revamped healthcare system. This article outlines a pilot program currently in development at the Michigan State University College of Osteopathic Medicine (MSU-COM). H successful, the MSU-COM program could be used as a blueprint for a similar nationwide program in osteopathic medical education.