Time for my yearly check up…or is it?

Interesting editorial from The New York Times yesterday by Dr. Ezekiel J. Emanuel, oncologist and vice provost at University of Pennsylvania, calling into question the utility of an annual physical exam. Dr. Emanuel discusses whether the annual exam has any meaningful impact on health outcomes of patients. He refers to a 2012 study from The Cochrane Library that looked at the benefits and harms of general health checks in asymptomatic adults. This study analyzed 14 randomized controlled trials and the authors concluded that general health checks did not reduce morbidity or mortality. Because no mortality/morbidity benefit has been shown, should we disregard the annual physical exam? With physician-patient communication gaining recent attention, are there other outcomes that haven’t been measured from annual health exams that benefit the patient’s general health? Check out the editorial and Cochrane study below!

“Skip Your Annual Physical Exam”

“General health checks in adults for reducing morbidity and mortality from disease”

The Epstein Barr Virus – A Primer

  • General Information
    • peak incidence: 15 to 24-year age range
    • UK Data: cases may be occurring later in life with increasing severity, requiring hospitalization
  • Transmission
    • Person-to-person — salivary secretions
    • Breastfeeding
    • Sexual transmission
  • Manifestations
    • Classic Infectious Mononucleosis — fever, pharyngitis, adenopathy, fatigue, and atypical lymphocytosis
    • Clinical variants —
      • Mild disease — pharyngitis and tonsillitis in the absence of a full-blown IM syndrome
      • Typhoidal form — fever and lymphadenopathy without pharyngitis . Heterophile antibody-negative.
  • Other clinical manifestations
    • Splenomegaly and splenic rupture — 50 to 60 percent of patients
    • Rash — generalized maculopapular, urticarial, or petechial rash; a maculopapular rash almost always occurs following the administration of ampicillin or amoxicillin.
    • Neurologic syndromes — GBS, aseptic meningitis, transverse myelitis, peripheral neuritis, optic neuritis, and encephalomyelitis.
  • Diagnosis
    • Heterophile antibodies — vast majority of patients are heterophile positive
    • EBV-specific antibodies — IgM and IgG antibodies directed against viral capsid antigen have high sensitivity and specificity for the diagnosis of IM
    • Viral capsid antigen — IgM VCA antibody is highly suggestive of acute EBV infection
    • Nuclear antigen — IgG antibodies to EBV nuclear antigen
    • Early antigen — IgG antibodies to early antigen (EA) are present at the onset of clinical illness.
    • Detection of EBV virus — those with detectable virus are more likely to have lymphadenopathy, higher atypical lymphocytes counts
  • EBV-associated Disorders
    • Infectious mononucleosis
    • Burkitt’s Lymphoma
    • Hodgkin’s Lymphoma
    • Post-transplant lymphoproliferative disorders
    • HIV-associated lymphoproliferative disorders
      • Primary CNS lymphoma
      • Diffuse large B-cell lymphoma
      • HHV-8 (+) primary effusion lymphoma
      • Plasmablastic lymphoma
    • Nasopharyngeal carcinoma
    • Hemophagocytic lymphohistiocytosis
    • Multiple Sclerosis
    • and many more…
  • Treament
    • Supportive care: NSAIDs, fluids, rest, and relaxation
    • Antiviral therapy: acyclovir – may reduce viral shedding, but otherwise has no effect in symptomatic relief; no significant clinical benefit
    • Steroids: some studies suggest that acyclovir + prednisolone may reduce viral shedding, but this practice is not recommended
    • Anecdotal experience: IL-2, IFN-a, IVIG