Milwaukee Rabies Protocol

The latest ProMed reports a case of a Brazilian boy who survived rabies.  Like all previous survivors except one, he received vaccine as prophylaxis, but prophylaxis was incompletely administered (no immunoglobulin.)  Apparently unlike the previous survivors, the virus was isolated from the patient.  He was treated with the Milwaukee protocol first tried on the non-vaccinated girl in Wisconsin who survived.  To what extent this is a result of the protocol is unclear - rabies after failed prophylaxis appears to have a higher survival rate, especially for bat rabies.
The ProMed report [22 Nov 2008] - Rabies, human survival, bat - Brazil (02)
Milwaukee Protocol 2.1 with its checklist can be obtained at the Children's Hospital of Milwaukee Rabies Registry page.

A few articles referenced in the protocol or the ProMed article or discussing the protocol:
Jackson AC. Rabies: new insights into pathogenesis and treatment. Curr Opin Neurol 2006;19:267-70.
PubMed link | Journal link

Wilde H. Failures of post-exposure rabies prophylaxis. Vaccine 2007;25:7605-9. Epub 2007 Sep 14.
PubMed link | Journal link

Jackson AC, Warrell MJ, Rupprecht CE, et al. Management of rabies in humans. Clin Infect Dis 2003;36:60-3. Epub 2002 Dec 11.
PubMed link | Journal link

Willoughby RE Jr, Tieves KS, Hoffman GM, et al. Survival after treatment of rabies with induction of coma. N Engl J Med 2005;352:2508-14.
PubMed link | Journal link

Hemachudha T, Wilde H. Survival after treatment of rabies. N Engl J Med 2005;353:1068-9.
PubMed link | Journal link

Jackson AC. Recovery from rabies. N Engl J Med 2005;352:2549-50.
PubMed link | Journal link

Hu WT, Willoughby RE Jr, Dhonau H, Mack KJ. Long-term follow-up after treatment of rabies by induction of coma. N Engl J Med 2007;357:945-6.
PubMed link | Journal link

Wilde H, Hemachudha T, Jackson AC. Viewpoint: Management of human rabies. Trans R Soc Trop Med Hyg 2008;102:979-82. Epub 2008 May 16.
PubMed link | Journal link

Human rabies--Indiana and California, 2006. MMWR Morb Mortal Wkly Rep 2007;56:361-5.
PubMed link | Journal link

cave canem? cave etiam vespertilionem!

Bullshit Bingo

These are a few of the crapspeak words/phrases that irritate me the most:

Learners - they are really pupils
Strategic - my arse (for Americans who don't speak English, "ass" refers to a donkey)
Value-added - like a tax
Quality - is a "quality item" of good or bad quality???
Service delivery - an excuse for bad service
Niche market - a market in a corner
Drill down - for oil???
Comprehensive - full of it
Project manager - he manages projects
Fixed-dose - I have never prescribed a variable-dose tablet!
Grass roots - where we find garbage, snails, and other crap
Culture - the culture of crapspeak is a niche market that adds value to strategic learners

Useful items to include in a game of Bullshit Bingo in your next meeting.

For those who don't know what Bullshit Bingo is, it's a form of Bingo where you have a card with words or phrases instead of numbers, and then wait for those words/phrases to be used in meetings or speeches.  When you hear them, you cross them off.  Once you have a full line (across, down, or diagonal) crossed off, you shout "Bullshit!" and you've won.

Here's an example of a Bullshit Bingo card:

You can make such cards (each person should get a slightly different card, so not everyone has the exact same words in the same positions) and distribute them at your next meeting.

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