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OBJECTIVE -To assess whether the influenza vaccination of community-dwelling, diabetic, elderly individuals is associated with reduced rates of hospitalization and death.RESEARCH DESIGN AND METHODS -In this outcome-research study, we compared mortality and hospitalization rates of 15,556 patients aged Ն65 years followed using a diabetes registry in a large health maintenance organization to that of 69,097 members not suffering from chronic disease who were considered as a reference group. The study outcomes included all-cause death and hospitalization in internal medicine or geriatric wards for any reason over winter and summer (control) periods.RESULTS -Vaccination rates were 48.8 and 42.0% among patients with diabetes and the reference population, respectively. Influenza vaccination was associated with a 12.3% reduction in hospitalization rates for patients with diabetes compared with 23.0% in the reference group (P ϭ 0.08). The reduction in hospitalization rates was similar in both sexes among patients with diabetes. In addition, there was a significant reduction in mortality for the vaccinated group of patients with diabetes when compared with the nonvaccinated group except for female patients aged Ն85 years.CONCLUSIONS -The study results support the use of influenza vaccine among an elderly population. However, there does not appear to be an additional benefit for patients with diabetes. Diabetes Care 27:2581-2584, 2004S erious complications of influenza among the elderly include pneumonia and exacerbations of coexisting conditions that can result in hospitalization and death (1). Vaccination against influenza has consistently been associated with reductions in hospitalizations for pneumonia and death from all causes in the elderly (2,3). It has been shown that vaccination of high-risk groups (e.g., patients with diabetes, renal disease, rheumatological disease, dementia, and stroke) reduced hospitalizations for respiratory conditions by 39% (4). In addition, the effectiveness of the influenza vaccine in reducing hospitalization due to cardiovascular and cerebrovascular causes and death from any reason has also been demonstrated (5).The few observational studies of diabetic subjects demonstrated up to 79% reduction in hospitalization rates (6,7).Although these studies were based on a small sample, they were sufficient for the Centers for Disease Control and Prevention to recommend inoculation with influenza vaccine for diabetic patients (8). Studies of the immunological responses have shown that influenza vaccine elicits comparable antibody responses in people with diabetes and control subjects (9,10) The aims of the current study were to assess whether the influenza vaccination of community-dwelling, diabetic, elderly individuals is associated with reduced rates of hospitalization and death. RESEARCH DESIGN AND METHODS -Maccabi HealthcareServices (MHS) is the second largest preferred provider organization in Israel, insuring 1.6 million members nationwide. According to the Israeli National Health Insurance...

A 9‐year‐old black girl presented with papules and nodules in a linear distribution on her right inner arm, right axilla, and right chest ( ). The lesions were hyperpigmented, indurated, and had been present for 3 years. She was otherwise healthy. A biopsy of one of the lesions revealed a sparse superficial and deep perivascular infiltrate of lymphocytes, compactly arranged collagen bundles in the upper part of the dermis, and abundant mucin throughout the reticular dermis, which was consistent with morphea with dermal mucinosis ( ). Biopsy of another lesion revealed classic histologic features of morphea: thickened bundles of collagen crowded in the reticular dermis aligned parallel to the skin surface. 1 Discrete nodules in a linear distribution on the right arm 2 Biopsy of a lesion

Clopidogrel, a new antiplatelet agent that irreversibly inhibits platelet aggregation, is widely used today. This prospective work was conducted to evaluate the safety of performing skin surgery on patients taking clopidogrel. Patients undergoing surgery for excision of skin or subcutaneous lesions under local anesthesia taking clopidogrel were the study group. The control group comprised 2073 historical patients who had undergone a similar procedure. Data collected included: age, sex, past medical history, medications, and late complications. Follow-up was done at 1 to 2 weeks and 3 to 6 months. There were 32 patients on clopidogrel, having 38 lesions removed. Of these, seven patients were on aspirin and clopidogrel combined. The groups taking clopidogrel, aspirin, and warfarin had significantly more males, were older, and had significantly more comorbid medical conditions. There was no significant difference in the incidence of any of the complications in any of the groups. This study shows that patients taking clopidogrel before skin surgery, though older and with more associated medical conditions, do not experience a greater rate of complications. We conclude that patients undergoing minor excisional cutaneous surgery should continue taking clopidogrel because there is no apparent risk for increased complications when good meticulous surgical techniques are used.