Comparison of the effect of topical triamcinolone 0.1% cream with sulfur 2.0% cream in the treatment of patients with hand eczema: A randomized controlled trial

BACKGROUND

Hand eczema (HE) is a common and heterogeneous condition. It has a wide range of etiologies and clinical manifestations. In this study the efficacy of triamcinolone 0.1% cream and sulfur 2% creams was compared in treating patients with HE.

METHODS

This randomized, triple-blind clinical trial was performed on 70 patients with HE (including 70 right and 70 left hands). In this study, two creams were used including triamcinolone 0.1% and sulfur 2.0%. Patients were treated with these creams twice a day (once in every 12 h) for 4 weeks. Follow-up was 4 weeks after treatment. Hand Eczema Severity Index (HECSI), itching, dryness, burning sensation, and erythema scores were collected three times during the study and compared between treatment regimens.

RESULTS

Findings showed that both triamcinolone (0.1%) and sulfur (2.0%) creams could significantly reduce the scores of HECSI, itching, dryness, burning sensation, and erythema, and the therapeutic effects lasted for at least 4 weeks after cessation of topical treatment.

CONCLUSION

Topical sulfur cream (2.0%) is as effective as triamcinolone (0.1%) cream in treatment of HE without any prominent adverse reactions.

Comparison of sulfur ointment and permethrin treatments in scabies

Scabies is a contagious, parasitic skin disease that adversely affects the quality of life and, can cause systemic complications if it is not properly treated. Sulfur ointment and permethrin cream are among the most used topical agents in the treatment of scabies. In this study, we aimed to compare the efficacy of sulfur ointment and permethrin cream in the treatment of scabies. In this single-center study, patients who were diagnosed with scabies in the dermatology outpatient clinics of Karabuk University Training and Research Hospital between April, 2021 and September, 2021 were investigated retrospectively. Age, gender, date of diagnosis, topical agent used for scabies treatment, and response to the treatment at the control examination in the second week were recorded. The patients were divided into two groups those receiving 5% permethrin cream or 10% sulfur ointment, and the treatment efficacy of both agents was compared. This study showed that 10% sulfur ointment was significantly more effective in treating scabies than 5% permethrin cream (p < 0.001). Moreover, younger patients with scabies responded better to both treatments. 10% Sulfur ointment can be considered a safe and effective topical option in the treatment of scabies. The resistance to 5% permethrin cream, which is the most commonly used agent for scabies, can be a concern as an unexpected low success rate was obtained in this study.

Associations of Spatial Disparities of Alzheimer's Disease Mortality Rates with Soil Selenium and Sulfur Concentrations and Four Common Risk Factors in the United States

BACKGROUND

Associations between environmental factors and spatial disparity of mortality rates of Alzheimer's disease (AD) in the US are not well understood.

OBJECTIVE

To find associations between 41 trace elements, four common risk factors, and AD mortality rates in the48 contiguous states.

METHODS

Isopleth maps of AD mortality rates of the 48 states and associated factors were examined. Correlations between state average AD mortality rates and concentrations of 41 soil elements, wine consumption, percentage of current smokers, obesity, and diagnosed diabetes of the 48 states between 1999 and 2014 were analyzed.

RESULTS

Among 41 elements, soil selenium concentrations have the most significant inverse correlations with AD mortality rates. Rate ratio (RR) of the 6 states with the lowest product of soil selenium and sulfur concentrations is 53% higher than the 6 states with the highest soil selenium sulfur product in the 48 states (RR = 1.53, CI95% 1.51-1.54). Soil tin concentrations have the most significant inverse correlation with AD mortality growth rates between 1999 and 2014, followed by soil sulfur concentrations. Percentages of obesity, diagnosed diabetes, smoking, and wine consumption per capita also correlate significantly with AD mortality growth rates.

CONCLUSIONS

High soil selenium and sulfur concentrations and wine consumption are associated with low AD mortality rates. Given that average soil selenium and sulfur concentrations are indicators of their intakes from food, water, and air by people in a region, long-term exposure to high soil selenium and sulfur concentrations might be beneficial to AD mortality rate reduction in a region.

Sulfur spring dermatitis

Thermal sulfur baths are a form of balneotherapy promoted in many cultures for improvement of skin conditions; however, certain uncommon skin problems may occur after bathing in hot sulfur springs. We report the case of a 65-year-old man who presented with multiple confluent, punched-out, round ulcers with peripheral erythema on the thighs and shins after bathing in a hot sulfur spring. Histopathologic examination revealed homogeneous coagulation necrosis of the epidermis and papillary dermis. Tissue cultures showed no evidence of a microbial infection. The histopathologic findings and clinical course were consistent with a superficial second-degree burn. When patients present with these findings, sulfur spring dermatitis should be considered in the differential diagnosis. Moreover, the patient's clinical history is crucial for correct diagnosis.

Novel insights into the function of Arabidopsis R2R3-MYB transcription factors regulating aliphatic glucosinolate biosynthesis

Arabidopsis transcription factors, MYB28, MYB29 and MYB76, positively regulate aliphatic glucosinolate (AGSL) biosynthesis. Mutual transcriptional regulation among these MYB genes makes it difficult to elucidate their individual function simply by analyzing knock-out mutants or ectopically overexpressing lines of these genes. In this study, we constructed transgenic lines expressing each MYB gene driven by its own promoter in the myb28myb29 background, where the expression of the endogenous MYB28, MYB29 and MYB76 was repressed with no AGSL accumulation. In leaves, transgenic MYB28 expression activated AGSL biosynthetic genes and restored accumulation of AGSLs with short side chains. Transgenic MYB29 expression activated the same biosynthetic pathway, but induction of the genes involved in side chain elongation was weaker than that by MYB28, resulting in a weaker recovery of AGSLs. Neither MYB28 nor MYB29 recovered long-chain AGSL accumulation. MYB76 was considered to require both MYB28 and MYB29 for its normal level of expression in leaves, and could not activate AGSL biosynthesis on its own. Interestingly, the accumulation in seeds of long- and short-chain AGSLs was restored by transgenic expression of MYB28 and MYB76, respectively. A sulfur stress experiment indicated that MYB28 expression was induced by sulfur deficiency, while the expression levels of MYB29 and MYB76 were positively correlated with sulfur concentration. This study illustrated how the individual MYBs work in regulating AGSL biosynthesis when expressed alone under normal transcriptional regulation.

Study on the destructive effect to inherent quality of Fritillaria thunbergii Miq. (Zhebeimu) by sulfur-fumigated process using chromatographic fingerprinting analysis

The after-harvesting sun-dried processing of Fritillariae thunbergii bulbus (Zhebeimu) was the traditional treatment for commodity. Over recent decades the natural drying process for bulbus of Fritillariae has been replaced by sulfur-fumigation for reducing the drying duration and pest control. We used ultra-performance liquid chromatography coupled with evaporative light scattering detection (UPLC-ELSD) fingerprinting analysis and major alkaloids determination to investigate the potential damaging effect of the sulfur-fumigating process. The experimental conditions were as follows: Chromatography was proceeded on Waters Acquity UPLC BEH C(18) column; the linear gradient elution was conducted with mobile phase prepared from acetonitrile-0.02% triethylamine; the drift tube temperature was set at 40°C with a nitrogen flow-rate of 30psi, and the spray parameter was set 40%. All calibration curves showed good linear regression (R>0.9991) within the tested range. The method was validated for precision, accuracy, limit of detection and quantification. The study also has shown that sulfur-fumigated samples had significant loss of the main active compounds and a more destructive fingerprint profile when compared to the sun-dried samples.

Treatment of scabies using 8% and 10% topical sulfur ointment in different regimens of application

BACKGROUND

Many therapeutic modalities for scabies were available, topical sulfur ointment is a cost-effective and safe therapeutic agent. It is often applied for the whole body for three successive days.

OBJECTIVE

To evaluate their therapeutic regimen of 8% and 10% topical precipitated sulfur in petrolatum ointment for single day, three successive nights or three successive days in management of scabies.

PATIENTS AND METHODS

This single-blinded, comparative study was conducted in the Department of Dermatology-Baghdad Teaching Hospital from April 2008 through October 2009. A total of 97 patients with scabies were enrolled in this study. The diagnosis was established on clinical basis. The patients treated with 8% and 10% topical sulfur in petrolatum ointment were divided randomly into three groups: Group A: 33 patients treated for single day (24 hours); Group B: 32 patients treated for three successive nights (from 6 p.m. to 8 p.m. to 6 a.m. to 8 a.m. and bathing every day); and Group C: 32 patients treated for three successive days (bathing every 24 hours). The patients were seen regularly every two weeks for the duration of four weeks.

RESULTS

Study included 58 (59.8%) males and 39 (40.2%) females, with a male to female ratio 1.4:1. The age range of males at presentation from 3 to 64 (26.74±15.98) years, while the females age ranged at presentation from 3 to 60 (24.05±14.53) years of age. At the end of the study, the response to treatment was: Group A, response in 14 (42.4%) patients and no response in 19 (57.6%); Group B, response in 29 (90.6%) patients and no response in 3 (9.4%); and Group C, response in 31 (96.9%) patients and no response in 1 (3.1%). There is significant statistical difference among the response of 3 groups with (P=0.00000011), but no statistically significant difference between the response of Group C and Group B, (P=0.6055). Mild burning sensation and irritating (sulfur) dermatitis were the only side effects of 8% and 10% sulfur. Pruritic rash occurred in Group C mainly, in 11 (34.4%) patients, 8 (25%) in Group B and 4 (12.1%) in Group A, with no significance (P=0.1058). Recurrence or relapse occurred in Group A mainly, with 4 (12.1%) patients, and in Group B, 1 patient, (3.1%), with no recurrence in group C, with significance (P=0.0060).

CONCLUSION

Three successive days and three successive nights of 8% and 10% sulfur ointment were effective regimens with no statistical difference in favor of three successive days, while single-day application was much less effective but with fewer side effects.

[Evaluation of the status of experimental animals after chronic sulfur steam inhalation]

Bronchoalveolar lavage (BAL) and the hepatorenal system were studied on albino rats in one-month regeneration period after 4-month chronic sulfur vapor in a dose of 1.76 and 12.68 microg/m3. Cytomorphological studies were used to detect the cumulative properties of sulfur: there were pathological processes in the hepatocytes; the light hepatocytes showed small-canalicular adipose degeneration, reduced dark cells, and increased degenerated light cells. There was a rise in the count of neutrophilic leukocytes, suggesting the progression of an inflammatory process in the regeneration period. The secretory function of the renal tubules exhibited destructive changes in the small and large light tubular cells; protein dystrophy was to a greater extent encountered in small tubular cells in the regeneration period.

Classification of benzoyl peroxide as safe and effective and revision of labeling to drug facts format; topical acne drug products for over-the-counter human use; final rule

We, the Food and Drug Administration (FDA), are issuing this final rule to include benzoyl peroxide as a generally recognized as safe and effective (GRASE) active ingredient in over-the-counter (OTC) topical acne drug products. In addition, this final rule includes new warnings and directions required for OTC acne drug products containing benzoyl peroxide. We are also revising labeling for OTC topical acne drug products containing resorcinol, resorcinol monoacetate, salicylic acid and/or sulfur to meet OTC drug labeling content and format requirements in a certain FDA regulation. This final rule is part of our ongoing review of OTC drug products and represents our conclusions on benzoyl peroxide in OTC acne drug products.

Studies of a naturally occurring sulfur-induced copper deficiency in Przewalski's gazelles

The Przewalski's gazelles in the Hudong area of the Qinghai Lake area in China were affected by an ailment characterized by pica, emaciation, dyskinesia, loss of appetite, and anemia. Concentrations of copper (Cu) in soil and forage from affected and unaffected areas were similar and within the normal range, but concentrations of sulfur (S) in soil and forage were significantly higher (P < 0.01) in affected than in unaffected areas. Concentrations of Cu in blood, hair, and liver from the affected Przewalski's gazelles were significantly lower (P < 0.01) than those in healthy animals. Affected Przewalski's gazelles showed a hypochromic microcytic anemia and a low level of ceruloplasmin. Oral administration of copper sulphate (CuSO(4)) prevented and cured the disease. We conclude that the disorder of Przewalski's gazelles was caused by secondary Cu deficiency, mainly due to high S content in forage.

Steroid acne and rebound phenomenon

BACKGROUND

There have been many reports of topical steroids treatment for the face causing perioral dermatitis, steroid acne, and steroid rebound phenomenon.

OBJECTIVE

To assess patient reported outcomes in patients receiving compounded topical (hydrocortisone 0.75% and precipitated sulfur 0.5%) lotion for up to 15 years for common dermatological conditions of the face.

METHODS

In a retrospective study, 300 patients were randomly sampled from the dermatology clinic who had used, or were continuing to use, a lotion based, pharmacy-compounded topical preparation for the face. The topical compound was used in therapies for seborrheic dermatitis and combination with prescription topical therapy for patients with acne and rosacea with tolerability problems.

RESULTS

None of the 300 patients experienced steroid acne, rebound phenomenon, or perioral dermatitis associated with use of hydrocortisone 0.75% and precipitated sulfur 0.5% on the face.

CONCLUSION

There was no evidence found that perioral dermatitis, steroid acne, or rebound phenomenon occurs when sulfur is compounded with topical hydrocortisone 0.75%.

Symptoms and immunologic markers among vulcanization workers in rubber industries in southern Sweden

OBJECTIVES

The aim of this study was to estimate the risk of symptoms and the possible derangement of levels of immunologic markers for contemporary Swedish rubber workers. Furthermore, the relation between exposure and these biomarkers of response was examined using urinary levels of 2-thiothiazolidine-4-carboxylic acid (TTCA), which reflect the exposure.

METHODS

Included in the study were 166 exposed workers and 117 controls. Medical and occupational histories were obtained in structured interviews. Symptoms were recorded, and immunologic markers were analyzed in blood. Urinary levels of TTCA were determined by liquid chromatography tandem mass spectrometry.

RESULTS

Compared with the controls, the exposed workers had increased risks of eye symptoms [odds ratio (OR) 3.0], nose bleeds (OR 4.0), burning and dry throat (OR 3.0), hoarseness (OR 2.4), severe dry cough (OR 3.8), nausea (OR 4.3), and headache (OR 2.5). When the exposed workers were divided into three groups according to the TTCA levels, the highest risks were observed among the exposed workers with intermediate TTCA levels. Furthermore, the exposed workers in all of the TTCA subgroups had elevated concentrations of total immunoglobulin G when compared with the controls. Elevated concentrations of leukocytes, neutrophils, and eosinophils were observed in the group with high TTCA levels.

CONCLUSIONS

This work shows an increased risk of several symptoms and elevated levels of some immunologic markers among exposed workers in Swedish rubber industries. In addition, relationships between urinary levels of TTCA and some biomarkers of response were reported.

Radiosynoviorthesis of medium-sized joints with rhenium-186-sulphide colloid: a review of the literature

Hypertrophy and inflammation of the synovium with various underlying pathologies - such as rheumatoid arthritis, osteoarthritis, haemophilia and spondyloarthropathy - can be treated successfully by radiosynoviorthesis (RSO). For medium-sized joints (shoulder, elbow, wrist, hip and ankle), the radionuclide of choice is rhenium-186. We review the evidence for the efficacy of this local, relatively non-invasive therapy and evaluate its benefits and risks. We conclude good evidence of rhenium-186 RSO in rheumatoid arthritis and haemophilic arthropathy. In the remaining pathologies, up to now, the therapeutic efficacy has not been confirmed by today's most stringent criteria for clinical studies. The available data support rhenium-186 RSO as a suitable second-line treatment for patients in whom other therapies (including locally injected corticoids) have failed, as long as proper attention is paid to correct administration - including post-treatment immobilization and the co-administration of corticoids.

Absence of respiratory inflammatory reaction of elemental sulfur using the California Pesticide Illness Database and a mouse model

Elemental sulfur, a natural substance, is used as a fungicide. Elemental sulfur is the most heavily used agricultural chemical in California. In 2003, annual sulfur usage in California was about 34% of the total weight of pesticide active ingredient used in production agriculture. Even though sulfur is mostly used in dust form, the respiratory health effects of elemental sulfur are not well documented. The purpose of this paper is to address the possible respiratory effect of elemental sulfur using the California Pesticide Illness Database and laboratory experiments with mice. We analyzed the California Pesticide Illness Database between 1991 and 2001. Among 127 reports of definite, probable, and possible illness involving sulfur, 21 cases (16%) were identified as respiratory related. A mouse model was used to examine whether there was an inflammatory or fibrotic response to elemental sulfur. Dust solutions were injected intratracheally into ovalbumin sensitized mice and lung damage was evaluated. Lung inflammatory response was analyzed via total lavage cell counts and differentials, and airway collagen content was analyzed histologically and biochemically. No significant differences from controls were seen in animals exposed to sulfur particles. The findings suggest that acute exposure of elemental sulfur itself may not cause an inflammatory reaction. However, further studies are needed to understand the possible health effects of chronic sulfur exposure and environmental weathering of sulfur dust.

Polioencephalomalacia in Cattle: A Consequence of Prolonged Feeding Barley Malt Sprouts

Polioencephalomalacia (PEM) in ruminants has been recognized as a consequence of excess sulphur intake. The present study describes clinical, gross and histopathological findings of PEM following an abrupt change of diet in two ranches housing 2750 dairy and 2300 beef cattle. As a result of severe PEM, 256 cattle died or were slaughtered. Clinical findings included circling, hypersensitivity, excessive salivation, hypermetria, incoordination, blindness and death. The first clinical signs occurred in beef calves (6-8 months old) at a holding facility. Clinical signs of the disorder continued intermittently during the 5-month period in both ranches and were more evident in calves and lactating dairy cows. The affected cattle did not respond to thiamine injections. Clinical signs disappeared gradually following removal of barley malt sprouts from the diet. Although macroscopic lesions were not apparent in the brain tissues of some animals, histopathology typical of PEM was found in most cases: spongiosis in the neuropil and neuronal necrosis, haemorrhage, capillary hyperplasia, fibrinoid degeneration in arterioles, multifocal liquefaction necroses in the grey matter and abundance of gitter cells with vacuolar large cytoplasm. Sulphide in rumen fluid of a clinically affected animal was measured as 1.55 mg/dl, which is considerably higher than that collected from two control cows (mean 0.21 mg/dl). The total sulphur content of the diet containing barley malt sprouts was estimated to be 0.45%, which is also higher than the National Research Council (NRC) maximum tolerable levels. In conclusion, PEM can result from excess barley malt sprout intake because of its higher sulphur content. Clinical signs may occur shortly after the intake of barley malt sprout as outbreaks with a higher number of deaths or as an ongoing periodic condition.

Associations between ambient, personal, and indoor exposure to fine particulate matter constituents in Dutch and Finnish panels of cardiovascular patients

AIMS

To assess the relation between ambient, indoor, and personal levels of PM2.5 and its elemental composition for elderly subjects with cardiovascular disease.

METHODS

In the framework of a European Union funded study, panel studies were conducted in Amsterdam, the Netherlands and Helsinki, Finland. Outdoor PM2.5 concentrations were measured at a fixed site. Each subject's indoor and personal PM2.5 exposure was measured biweekly for six months, during the 24 hour period preceding intensive health measurements. The absorbance of PM2.5 filters was measured as a marker for diesel exhaust. The elemental content of more than 50% of the personal and indoor samples and all corresponding outdoor samples was measured using energy dispersive x ray fluorescence.

RESULTS

For Amsterdam and Helsinki respectively, a total of 225 and 238 personal, and 220 and 233 indoor measurements, were analysed from 36 and 46 subjects. For most elements, personal and indoor concentrations were lower than and highly correlated with outdoor concentrations. The highest correlations (median r>0.9) were found for sulfur and particle absorbance, which both represent fine mode particles from outdoor origin. Low correlations were observed for elements that represent the coarser part of the PM2.5 particles (Ca, Cu, Si, Cl).

CONCLUSIONS

The findings of this study provide support for using fixed site measurements as a measure of exposure to particulate matter in time series studies linking the day to day variation in particulate matter to the day to day variation in health endpoints, especially for components of particulate matter that are generally associated with fine particles and have few indoor sources. The high correlation for absorbance of PM2.5 documents that this applies to particulate matter from combustion sources, such as diesel vehicles, as well.

Indirect latex glove contamination and its inhibitory effect on vinyl polysiloxane polymerization

STATEMENT OF PROBLEM

The inhibitory effect of indirect latex contamination on the polymerization of vinyl polysiloxane (VPS) impression material has been previously reported. However, the transfer of specific elements that cause inhibition has not been confirmed, nor has the removal of such contaminants been reported.

PURPOSE

This study examined the surfaces of materials commonly used in restorative procedures that were contaminated by indirect latex glove contact and then evaluated for inhibition of polymerization of VPS. The effect of selected cleansing procedures was then studied.

MATERIAL AND METHODS

Four experimental groups (n = 8) were prepared: (1) clean vinyl gloves (control), (2) clean gingival retraction cords (control), (3) contaminated vinyl gloves, and (4) contaminated gingival retraction cord. Microscopic evaluation of the appearance and the characterization of surface particulate contamination were performed for each. Three cleansing protocols were then evaluated for efficacy in cleaning vinyl glove surfaces contaminated by latex contact (n = 10): (1) brushing with water, (2) brushing with soap/rinsing with water, (3) cleansing with rubbing alcohol. The subsequent degree of VPS polymerization inhibition was evaluated subjectively. A chi-square test was used for data analysis (alpha=.05).

RESULTS

Particulate sulfur elements and sulfur-chloride compounds were present on the contaminated substrates. None of the 3 cleansing procedures eliminated polymerization inhibition (P =.33). Residual elemental sulfur remained on all tested surfaces.

CONCLUSION

Particulate sulfur and sulfur-chloride compounds were identified as the particulate contamination that resulted in polymerization inhibition of the tested VPS dental impression material. Removal of these contaminants from the tested vinyl gloves and gingival retraction cord was not possible with the 3 cleansing protocols tested in this study.

Ambient hydrogen sulfide, total reduced sulfur, and hospital visits for respiratory diseases in northeast Nebraska, 1998-2000

This analysis examined associations between total reduced sulfur (TRS) and hydrogen sulfide (H(2)S) levels, and hospital visits for respiratory disease among residents of Dakota City and South Sioux City, Nebraska, from January 1998 to May 2000. For reference, the association between TRS, H(2)S, and digestive diseases was also examined. Time-series analyses of daily hospital visits in the selected outcome categories and measures of TRS and H(2)S were performed using generalized additive models with a Poisson link. TRS and H(2)S levels were categorized as high if at least one of the daily 30-min rolling averages was > or =30 ppb and as low if every rolling average was <30 ppb. Loess smoothers allowed for flexible modeling of the time effect and the effect of temperature and relative humidity. The measure of association used was the mean percent change in the average number of hospital visits recorded following a day with a high exposure versus a day with a low exposure. For children less than 18 years of age, a positive association was found between asthma hospital visits and 1-day lagged TRS levels. For adults, a positive association was found between asthma hospital visits and H(2)S levels on the previous day. A positive association also was found between hospital visits for all respiratory diseases, and H(2)S and TRS levels on the previous day for children but not for adults. No association was found between contaminant levels and hospital visits for all digestive diseases. These findings suggest that TRS or H(2)S levels may be associated with exacerbations of asthma or other respiratory diseases among the residents of Dakota City and South Sioux City.

New international long-term ecological research on air pollution effects on the Carpathian Mountain forests, Central Europe

An international cooperative project on distribution of ozone in the Carpathian Mountains, Central Europe was conducted from 1997 to 1999. Results of that project indicated that in large parts of the Carpathian Mountains, concentrations of ozone were elevated and potentially phytotoxic to forest vegetation. That study led to the establishment of new long-term studies on ecological changes in forests and other ecosystems caused by air pollution in the Retezat Mountains, Southern Carpathians, Romania and in the Tatra Mountains, Western Carpathians on the Polish-Slovak border. Both of these important mountain ranges have the status of national parks and are Man & the Biosphere Reserves. In the Retezat Mountains, the primary research objective was to evaluate how air pollution may affect forest health and biodiversity. The main research objective in the Tatra Mountains was to evaluate responses of natural and managed Norway spruce forests to air pollution and other stresses. Ambient concentrations of ozone (O(3)), sulfur dioxide (SO(2)), nitrogen oxides (NO(x)) as well as forest health and biodiversity changes were monitored on densely distributed research sites. Initial monitoring of pollutants indicated low levels of O(3), SO(2), and NO(x) in the Retezat Mountains, while elevated levels of O(3) and high deposition of atmospheric sulfur (S) and nitrogen (N) have characterized the Tatra Mountains. In the Retezat Mountains, air pollution seems to have little effect on forest health; however, there was concern that over a long time, even low levels of pollution may affect biodiversity of this important ecosystem. In contrast, severe decline of Norway spruce has been observed in the Tatra Mountains. Although bark beetle seems to be the immediate cause of that decline, long-term elevated levels of atmospheric N and S depositions and elevated O(3) could predispose trees to insect attacks and other stresses. European and US scientists studied pollution deposition, soil and plant chemistry, O(3)-sensitive plant species, forest insects, and genetic changes in the Retezat and Tatra Mountains. Results of these investigations are presented in a GIS format to allow for a better understanding of the changes and the recommendations for effective management in these two areas.

Potentially hazardous sulfur conditions on beef cattle ranches in the United States

OBJECTIVE

To analyze the sulfur content of water and forage samples from a geographically diverse sample of beef cow-calf operations in the United States and to estimate frequency and distribution of premises where forage and water resources could result in consumption of hazardous amounts of sulfur by cattle.

DESIGN

Cross-sectional study.

SAMPLE POPULATION

709 forage samples from 678 beef cow-calf operations and individual water samples from 498 operations in 23 states.

PROCEDURE

Sulfur content of forage samples and sulfate concentration of water samples were measured. Total sulfur intake was estimated for pairs of forage and water samples.

RESULTS

Total sulfur intake was estimated for 454 pairs of forage and water samples. In general, highest forage sulfur contents did not coincide with highest water sulfate concentrations. Overall, 52 of the 454 (11.5%) sample pairs were estimated to yield total sulfur intake (as a percentage of dry matter) > or = 0.4%, assuming water intake during conditions of high ambient temperature. Most of these premises were in north-central (n = 19) or western (19) states.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggest that on numerous beef cow-calf operations throughout the United States, consumption of forage and water could result in excessively high sulfur intake. All water sources and dietary components should be evaluated when assessing total sulfur intake. Knowledge of total sulfur intake may be useful in reducing the risk of sulfur-associated health and performance problems in beef cattle.

Effects of dietary sulfur concentrations on the incidence and pathology of polioencephalomalicia in weaned beef calves

Fourteen heifer calves weighing 174.5+/-17.7 kg were used to evaluate the effects of 3 levels of dietary sulfur. Sodium sulfate added to basal diet made treatments designated moderate (3860 ppm sulfur), moderatey high (5540 ppm sulfur) and high (7010 ppm sulfur). Clinical polioencephalomalacia occurred in all calves assigned to the moderately high and high treatments. The calves did not acclimate to the dietary sulfur as polioencephalomalacia occurred in 4 animals on d 35 and in 1 calf on d 37. Microscopic lesions confirmed polioencephalomalacia in the calves on moderately high and high diets. Microscopic lesions also were present in 4 moderate diet calves although clinical signs were not seen. High dietary sulfur did not limit feed intake. Diets containing sulfur levels >4000 ppm sulfur produced polioencephalomalacia in 10 calves and sub-clinical brain lesions occurred in 4 calves consuming <4000 ppm sulfur.

Biological responses to the reversal of acidification in surface waters of the English Lake District

Declining sulphur deposition since the late 1970s has led to increases in pH in lakes and streams of the English Lake District (Cumbria, UK). To determine whether there have been biological responses to the chemical changes, we carried out surveys of stream macroinvertebrates and lake surface sediment diatoms, and compared the results with those from earlier surveys. Macroinvertebrate taxa in five streams (current average pH range 5.1-7.0) sampled in 1999 showed clear changes from those found during 1965/1966 and 1972. For three of the streams, more taxa were present in 1999 than recorded using comparable sampling methods in the 1960s and 1970s, despite lower numbers of individuals being recovered in 1999. Values of the Margalef diversity index could be calculated for both 1965-1972 and 1999 for four of the streams; the index was significantly greater in 1999 (P < 0.001) in three streams, and unchanged in one stream (the most acid). The 1999 survey revealed the presence of acid-sensitive taxa that had been absent in the earlier surveys, notably the three stoneflies Leuctra fusca, L. moselyi and Chloroperla tripunctata. Some taxa that had been present during 1965-1972 were absent in 1999, but few of these were acid-sensitive. Diatoms from the surface sediments of six lakes were classified according to their acid sensitivities. In three of the lakes sampled in 1999 there were more diatoms characteristic of circumneutral waters, and less acidophilic species than had been found in 1983-1985. In the remaining three lakes, no noticeable changes had occurred. Overall, the observed biological changes are qualitatively as expected for the observed increases in pH, and there have been no instances of biological change in the opposite direction. The results support the expectation that changes in freshwater ecological status can be reversed by decreasing the remote emissions of acidifying pollutants.

Dispersion models and longitudinal data analysis

Dispersion models provide a flexible class of non-normal distributions with many potential applications in biostatistics, accommodating a wide range of continuous, discrete and mixed data. Starting with Liang and Zeger's generalized estimating equation method, we review some recent applications of dispersion models in longitudinal data analysis, including state space models based on the Tweedie class of exponential dispersion models. In medical applications the latent process of a state space model may often be interpreted as an unobserved potential morbidity process, which is modelled as a function of time varying covariates. By allowing a multivariate response vector of 'symptoms', the model integrates several response variables of mixed types into a single model. For growth curve models, the latent process reflects the 'true' growth.

The influence of dietary sulphur loading on metabolism and health in young sheep fed low fibre and high starch diet

The purpose of the experiment was to evaluate the long-term effect of a low roughage diet (7-8% CF) with or without sulphur (S) supplementation (elemental and sodium sulphate 1:1) on basal dietary components, Zn, Cu and S availability, rumen metabolism and health in growing sheep. The control diet contained 0.2% and the supplemented diet 0.8% of S on a DM basis. The experiment lasted 12 weeks. The intake of the diet with 0.8% of S resulted in an increase in rumen acetic acid concentration. Rumen lactic acid concentrations in S-supplemented versus control sheep were higher in the first and lower in the third month, and decreased at the end of the third month of the experiment in both groups. Blood plasma pyruvate was lower at the end of the experiment in S-supplemented sheep than in control sheep. In the 5th week of the experiment, the high S diet depressed basal nutritional components as well as Zn and Cu availability. After 12 weeks of feeding of this diet, polioencephalomalacia had developed in all sheep.

A randomized equivalence trial comparing the efficacy and safety of Luffa comp.-Heel nasal spray with cromolyn sodium spray in the treatment of seasonal allergic rhinitis

BACKGROUND

The objective of the clinical study was to investigate the efficacy and tolerance of a homeopathic nasal spray in cases of hay fever (seasonal allergic rhinitis) in comparison with the conventional intranasal cromolyn sodium therapy.

PATIENTS AND METHODS

In total, 146 outpatients with symptoms of hay fever were enrolled into the clinical study (randomized, double-blind, equivalence trial) (time of treatment: 42 days). The homeopathic remedy (Luffa comp.-Heel trade mark Nasal Spray, dosage: 0.14 ml per application, 4 times per a day / naris) consisted of a fixed combination made up of Luffa operculata, Galphimia glauca, histamine, and sulfur. The main outcome measure of the efficacy was the quality of life as measured by means of the Rhinoconjunctivitis Quality of Life-Questionnaire (RQLQ). The tolerance of the trial medication was registered by means of global assessment, rhinoscopy, recording of adverse events and with the aid of vital and laboratory parameters.

RESULTS

The results of the study demonstrate a quick and lasting effect of the treatment. This effect was independent from the medication applied and produced a nearly complete remission of the hay fever symptoms. The RQLQ global score changed significantly in the course of the treatment, indicating therapeutic equivalence between the two forms of treatment. Adverse systemic effects did not occur. Local adverse events appeared in 3 patients.

CONCLUSIONS

The study proved that, for the treatment of hay fever, the homeopathic nasal spray is as efficient and well tolerable as the conventional therapy with cromolyn sodium.

Association of excess sulfur intake and an increase in hydrogen sulfide concentrations in the ruminal gas cap of recently weaned beef calves with polioencephalomalacia

During a 2-week period, 16 of 150 recently weaned calves developed signs of polioencephalomalacia (PEM). One calf was examined and treated at our veterinary teaching hospital and a necropsy was performed on a calf that died. During the peak of the outbreak, clinicians visited the ranch. Ruminal hydrogen sulfide (H2S) and blood thiamine concentrations were measured in 10 clinically normal penmates of PEM-affected calves. Ruminal H2S concentrations were high (> 0.695 mg/L [> 500 ppm]) in all cattle (mean, 12.19 mg/L [8,770 ppm]). All blood thiamine values were within the reference range. Within 12 hours after measurement of blood thiamine concentrations, 2 of the calves from which samples were obtained developed clinical signs of PEM. Dietary analysis revealed an estimated sulfur intake of 0.9% per calf on a dry-matter basis. Hay contributed most of this sulfur. In the investigation reported here, an outbreak of PEM was associated with high ruminal H2S concentrations and excess sulfur intake without evidence of thiamine deficiency.

Mortality studies of machining fluid exposure in the automobile industry. IV: A case-control study of lung cancer

Machining fluids are diverse products that contain numerous additives and contaminants, including polycyclic aromatic hydrocarbons. Studies treating machining fluids as an aggregate exposure have found both positive and negative associations with lung cancer. In this nested case-control study of automotive workers (667 cases and 3,041 matched controls), individual estimates of exposure quantity and duration for specific classes of machining fluids were derived. An inverse dose-response relationship was found between synthetic machining fluids and lung cancer mortality, with an odds ratio of 0.6 (95% CI = 0.4, 0.8) for the highest level of lifetime exposure. The relationship was strongest for recent exposures. There was little evidence of an association with soluble or straight oil machining fluids. Risks were inconsistently elevated in workers exposed to aluminum. Results from this study provide strong evidence that exposure to machining fluids is not associated with an increased risk of lung cancer mortality in automotive workers.

Oils and cancer

Epidemiologic evidence on the relationship between mineral oil exposure and cancer is reviewed. The review is restricted to occupations involving substantial dermal and inhalational exposure and for which an epidemiologic literature exists: metal machining, print press operating, and cotton and jute spinning. Mineral oils are complex mixtures of aliphatic hydrocarbons, naphthenics, and aromatics, the relative distribution of which depends on the source of the oil and the method of refinement. End-use products contain a variety of additives, and contamination by other agents generally occurs during use. Suspect agents include polycyclic aromatic hydrocarbons (PAH) (particularly benz[a]pyrene), nitrosamines, chlorinated paraffins, long-chain aliphatics, sulfur, N-phenyl-2-naphthylamine, and formaldehyde. The heterogeneity of this exposure makes epidemiologic study difficult and meta-analysis inappropriate. Nonetheless, several associations emerge from the literature with varying degrees of support. There is clear evidence that early formulations of mineral oils used in cotton and jute spinning and in metal machining were carcinogenic to the skin. Associations of mineral oil exposure with laryngeal and rectal cancer have received some support in the literature, particularly with respect to straight oils. Evidence is suggestive that grinding operations (which can entail either mineral oil-based or ethanolamine-based fluids) are associated with excess risk of cancer of the esophagus, stomach, and pancreas. A number of bladder cancer case-control studies have noted an association with work as a machinist. There is limited evidence of an association with cancer of the colon, prostate, and sinonasal region. Several studies of printers have yielded positive findings for lung cancer, whereas studies in metal machinists have been generally negative. The PAH and nitrosamine content of current formulations is lower than in the past and the implications of these changes in composition to the carcinogenicity of the formulations are not yet known.

The South Karelia Air Pollution Study: effects of low-level exposure to malodorous sulfur compounds on symptoms

Exposure to very low levels of ambient-air malodorous sulfur compounds and their effect on eye irritation, respiratory-tract symptoms, and central nervous system symptoms in adults were assessed. A cross-sectional self-administered questionnaire (response rate = 77%) was distributed during March and April 1992 to adults (n = 336) who lived in a neighborhood that contained a pulp mill and in a nonpolluted reference community (n = 380). In the exposed community, the measured annual mean concentrations of total reduced sulfur compounds and sulfur dioxide measured in two stations were 2 to 3 micrograms/m3 and 1 micrograms/m3, respectively. In the reference community, the annual mean concentration of sulfur dioxide was 1 micrograms/m3. The residents of the community near the pulp mill reported an excess of cough, respiratory infections, and headache during the previous 4 wk, as well as during the preceding 12 mo. The relative risk for headache was increased significantly in the exposed community, compared with the reference area: the adjusted odds ratio (aOR) was 1.83 (95% confidence interval [95% CI] = 1.06-3.15] during the previous 4 wk and 1.70 (95% CI = 1.05-2.73) during the preceding 12 mo. The relative risk for cough was also increased during the preceding 12 mo (aOR = 1.64, 95% CI = 1.01-2.64). These results indicated that adverse health effects of malodorous sulfur compounds occur at lower concentrations than reported previously.

Sulphur-induced polioencephalomalacia in lambs

An outbreak of polioencephalomalacia affected 16 of 46 Swaledale lambs and five of 25 Scottish blackface lambs 15 to 32 days after they were introduced to an ad libitum concentrate ration containing 0.43 per cent sulphur. The clinical signs were acute and included depression central blindness and head-pressing, but no hyperaesthesia, nystagmus, dorsiflexion of the neck or opisthotonos were observed. Treatment of the affected lambs with vitamin B1, dexamethasone and antibiotics was associated with a prolonged recovery period, though no further cases were identified after vitamin B1 had been given parenterally to all the lambs at risk.

Characteristics of lethal substances and the removal effect of molecular sulfur in the Salmonella mutagenicity test for river sediments

The lethal action and the effect from the removal of molecular sulfur by copper treatment were investigated in the Salmonella mutagenicity test for river sediments. Survival ratios of Ames Salmonella strains for five different sediment extracts were tested, and it was found that many of the river sediments showed the lethal action on TA98 and TA100, and the lethal action was stronger in the sample from which larger amount of extracts per unit weight were obtained. It was also found that the lethal action was reduced with the addition of the metabolizer S9 mix, and TA98 was more resistant than TA100 against the lethal substances in sediment extracts. Further, removal of molecular sulfur, one of the lethal substances, by copper treatment raised survival ratios of the tester strains. On high-pressure liquid chromatographic fractionation, the lethal substances, including molecular sulfur distributed in non-polar and slightly polar fractions, and medium or high polar fractions did not reveal lethal action. Consequently, the removal procedure of molecular sulfur was proper for applying on the fraction contained non-polar and slightly polar compounds.

South Karelia Air Pollution Study: daily symptom intensity in relation to exposure levels of malodorous sulfur compounds from pulp mills

In a longitudinal study, we assessed the relation between daily exposure to ambient air malodorous sulfur compounds from pulp production and experience of symptoms in a small population living in the vicinity of a pulp mill. Special emphasis was laid on exposure-response pattern, where the intensity of the symptoms of interest was assessed in six consecutive questionnaires after three predefined levels of exposure to malodorous sulfur compounds [total reduced sulfur (TRS)] (reference: daily mean < 10 micrograms/m3, medium exposure: 10-30 micrograms/m3 high exposure: > 30 micrograms/m3). The study population included 81 adults, who responded to the baseline questionnaire (response rate 81%). The outcomes of interest were eye, respiratory, and central nervous symptoms. The mean daily intensity of the outcome symptoms, but not of control symptoms, was significantly higher on days of medium and high exposure compared with the reference days (paired t test). The probability ratios between experiencing more or fever symptoms during the medium and high exposure compared with reference days were increased for all the symptoms of interest with a consistent exposure response pattern. The probability ratios were for eye symptoms 3.17, 95% confidence intervals (CI) 1.21 to 7.47 (medium exposure), and 5.0, 95% CI 1.66 to 12.65 (high exposure); for nasal symptoms 3.13, 1.25 to 7.25 (medium), and 8.50, 3.19 to 18.64 (high); and for pharyngeal symptoms 2.0, 0.92 to 4.14 (medium) and 5.20, 1.95 to 11.99 (high). The results suggest that relatively low daily levels of malodorous sulfur compounds (TRS > 10 micrograms/m3) cause exposure-related short-term adverse effects.

Hydrogen sulfide and reduced-sulfur gases adversely affect neurophysiological functions

Hydrogen sulfide (H2S) above 50 parts per million (ppm) causes unconsciousness and death. Lower doses of H2S and related gases have been regarded as innocuous, but the effects of prolonged exposure have not been studied. This study was designed to determine whether people exposed to sulfide gases as a result of working at or living downwind from the processing of "sour" crude oil demonstrate persistent neurobehavioral dysfunction. Thirteen former workers and 22 neighbors of a refinery complained of headaches, nausea, vomiting, depression, personality changes, nosebleeds, and breathing difficulties. Their neurobehavioral functions and a profile of mood states (POMS) were compared to 32 controls, matched for age and educational level. The exposed subjects' mean values were statistically significantly abnormal compared to controls for two-choice reaction time, balance (as speed of sway), color discrimination, digit symbol, trail-making A and B, and immediate recall of a story. Their POMS scores were much higher than those of controls. Visual recall was significantly impaired in neighbors, but not in exworkers. It was concluded that neurophysiological abnormalities were associated with exposure to reduced sulfur gases, including H2S from crude oil desulfurization.

Identical HLA class II alleles predispose to drug-triggered and idiopathic pemphigus vulgaris

In pemphigus vulgaris, a dermatological autoimmune disease, specific human leukocyte antigen (HLA) class II alleles, DR4 (DRB1*0402) and DRw14 (DRB1*1401, in linkage disequilibrium with DQB1*0503), are thought to be susceptibility genes involved in the onset of the disease. We studied the HLA class II alleles (DQA1, DQB1, DRB1 and DPB1) of 6 patients with pemphigus, in whom the disease was "triggered" by drugs containing sulphydryl or another sulphur-containing group. All patients carried the DRB1*0402 susceptibility allele, and one patient also carried the second susceptibility allele, namely DQB1*0503 (in linkage with DRB1*1401). Bacterial, viral or environmental agents are suspected to trigger the onset of autoimmune diseases. Our study demonstrated the presence in patients with drug-triggered pemphigus vulgaris of the same HLA alleles thought to predispose to idiopathic pemphigus vulgaris. This finding strengthens the notion that these HLA alleles may be true disease susceptibility genes.

Sulfur spring dermatitis

44 cases of an unusual condition, designated hot spring dermatitis, have been studied. Patients usually presented during the winter months with a history of having taken green sulfur spring baths within the previous 2-20 days. Skin lesions developed about 24 h after bathing and were distributed generally over the trunk and limbs, especially in the skin folds. No micro-organisms were found in either hot spring water specimens or skin lesions. Patch tests showed no positive reactions. Investigations were undertaken to determine the physicochemical characteristics of the hot spring. In its extreme acidity and high content of soluble sulfur and chloride, it differed from other nearby hot springs.

The South Karelia Air Pollution Study: the effects of malodorous sulfur compounds from pulp mills on respiratory and other symptoms in children

We assessed the role of long-term exposure to ambient air malodorous sulfur compounds released from pulp mills as a determinant of eye and respiratory symptoms and headache in children. Adverse health effects of environmental exposure to these compounds in children have not been reported previously. The parents of 134 children living in a severely polluted (n = 42), moderately polluted (n = 62) and rural nonpolluted (n = 30) community responded to a cross-sectional questionnaire. The response rate was 83%. The adjusted odds ratios (OR) for symptoms experienced during the previous 4 weeks and 12 months in the severely versus nonpolluted community were estimated in logistic regression analysis controlling for age and gender. The risk of nasal symptoms (4 weeks OR 1.40, 95% CI 0.59-3.31; 12 months OR 2.47, 95% CI 0.93-6.53), cough (4 weeks OR 1.83, 95% CI 0.75-4.45; 12 months OR 2.28, 95% CI 0.95-5.47), eye symptoms (12 months OR 1.15, 95% CI 0.43-3.05), and headache (12 months OR 1.77, 95% CI 0.69-4.54) was considerably increased in the severely polluted community, although not quite reaching statistical significance. The results suggest that exposure to malodorous sulfur compounds may affect the health of children.

Role of thiamine status in sulphur induced polioencephalomalacia in sheep

The effects of excess dietary sulphur were studied in sheep supplemented and unsupplemented with thiamine. The diets contained either 0.19 per cent sulphur (LS) or 0.63 per cent sulphur (HS) in combinations with 14 mg kg-1 thiamine (LB1) or 243 mg kg-1 thiamine (HB1). A total of 56 two-month-old lambs were used. Groups consisting of nine, nine, 22 and 16 lambs were fed LS-LB1, LS-HB1, HS-LB1 and HS-HB1 diets, respectively for 14 weeks. Out of 22 lambs fed the HS-LB1 diet, seven lambs developed neurological signs between the third and eighth week of the trial. Two of these lambs died, three that were in extremis were euthanased, and two recovered completely. All clinically affected animals had extensive malacic lesions in the cerebral cortex, midbrain and brainstem. None of the lambs from the LS groups or HS-HB1 group developed clinical signs. Several clinically normal lambs from the HS-LB1 group had necrotic lesions in their brains at gross and microscopic examination. Supplementation with dietary thiamine prevented development of clinical signs, but did not totally prevent development of microscopic brain lesions. Brain thiamine concentration, transketolase activity and thiamine pyrophosphate (TPP) effect were not different (P greater than 0.05) among groups. There was a strong effect (P less than 0.0001) of dietary thiamine supplementation on blood thiamine concentration and TPP effect. Blood thiamine concentration was higher whereas TPP effect was lower in the thiamine supplemented sheep. Blood and tissue thiamine concentrations in sheep exposed to high dietary sulphur did not indicate either systemic or local thiamine deficiency per se. Increased TPP effect in sheep fed the HS-LB1 diet indicated mild to moderate metabolic thiamine deficiency. Thiamine inadequacy may be an effect of an increased requirement for thiamine in animals exposed to excess dietary sulphur.