Demographic patterns in Lyme borreliosis seasonality over 25 years

Lyme borreliosis, the most common vector-borne disease in Europe and North America, is attracting growing concern due to its expanding geographic range. The growth in incidence and geographic spread is largely attributed to climate and land-use changes that support the tick vector and thereby increase disease risk. Despite a wide range of symptoms displayed by Lyme borreliosis patients, the demographic patterns in clinical manifestations and seasonal case timing have not been thoroughly investigated and may result from differences in exposure, immunity and pathogenesis. We analysed 25 years of surveillance data from Norway, supplemented by population demography data, using a Bayesian modelling framework. The analyses aimed to detect differences in case seasonality and clinical manifestations of Lyme borreliosis across age and sex differentiated patient groups. The results showed a bimodal pattern of incidence over age, where children (0-9 years) had the highest incidence, young adults (20-29 years) had low incidence and older adults had a second incidence peak in the ages 70-79 years. Youth (0-19 years) presented with a higher proportion of neuroborreliosis cases and a lower proportion of arthritic manifestations compared to adults (20+ years). Adult males had a higher overall incidence than adult females and a higher proportion of arthritis cases. The seasonal timing of Lyme borreliosis consistently occurred around 4.4 weeks earlier in youth compared to adults, regardless of clinical manifestation. All demographic groups exhibited a shift towards an earlier seasonal timing over the 25-year study period, which appeared unrelated to changes in population demographics. However, the disproportionate incidence of Lyme borreliosis in seniors requires increased public awareness and knowledge about this high-risk group as the population continues to age concurrently with disease emergence. Our findings highlight the importance of considering patient demographics when analysing the emergence and seasonal patterns of vector-borne diseases using long-term surveillance data.

The emergence and shift in seasonality of Lyme borreliosis in Northern Europe

Climate change has had a major impact on seasonal weather patterns, resulting in marked phenological changes in a wide range of taxa. However, empirical studies of how changes in seasonality impact the emergence and seasonal dynamics of vector-borne diseases have been limited. Lyme borreliosis, a bacterial infection spread by hard-bodied ticks, is the most common vector-borne disease in the northern hemisphere and has been rapidly increasing in both incidence and geographical distribution in many regions of Europe and North America. By analysis of long-term surveillance data (1995-2019) from across Norway (latitude 57°58'-71°08' N), we demonstrate a marked change in the within-year timing of Lyme borreliosis cases accompanying an increase in the annual number of cases. The seasonal peak in cases is now six weeks earlier than 25 years ago, exceeding seasonal shifts in plant phenology and previous model predictions. The seasonal shift occurred predominantly in the first 10 years of the study period. The concurrent upsurgence in case number and shift in case timing indicate a major change in the Lyme borreliosis disease system over recent decades. This study highlights the potential for climate change to shape the seasonal dynamics of vector-borne disease systems.

Early COVID-19 therapy with azithromycin plus nitazoxanide, ivermectin or hydroxychloroquine in outpatient settings significantly improved COVID-19 outcomes compared to known outcomes in untreated patients

In a prospective observational study (pre-AndroCoV Trial), the use of nitazoxanide, ivermectin and hydroxychloroquine demonstrated unexpected improvements in COVID-19 outcomes when compared to untreated patients. The apparent yet likely positive results raised ethical concerns on the employment of further full placebo controlled studies in early-stage COVID-19. The present analysis aimed to elucidate, through a comparative analysis with two control groups, whether full placebo-control randomized clinical trials (RCTs) on early-stage COVID-19 are still ethically acceptable. The Active group (AG) consisted of patients enrolled in the Pre-AndroCoV-Trial (n = 585). Control Group 1 (CG1) consisted of a retrospectively obtained group of untreated patients of the same population (n = 137), and Control Group 2 (CG2) resulted from a precise prediction of clinical outcomes based on a thorough and structured review of indexed articles and official statements. Patients were matched for sex, age, comorbidities and disease severity at baseline. Compared to CG1 and CG2, AG showed reduction of 31.5-36.5% in viral shedding (p < 0.0001), 70-85% in disease duration (p < 0.0001), and 100% in respiratory complications, hospitalization, mechanical ventilation, deaths and post-COVID manifestations (p < 0.0001 for all). For every 1000 confirmed cases for COVID-19, at least 70 hospitalizations, 50 mechanical ventilations and five deaths were prevented. Benefits from the combination of early COVID-19 detection and early pharmacological approaches were consistent and overwhelming when compared to untreated groups, which, together with the well-established safety profile of the drug combinations tested in the Pre-AndroCoV Trial, precluded our study from continuing employing full placebo in early COVID-19.

Erosive pustular dermatosis of the scalp: a multicentre study

BACKGROUND

Erosive pustular dermatosis of the scalp (EPDS) is characterized by crusted erosions or superficial ulcerations that lead to scarring alopecia.

OBJECTIVES AND METHODS

We performed a multicentre retrospective clinical study including 56 patients (29 females and 27 males, mean age 62.7) with a confirmed EPDS in order to describe epidemiology, clinical findings and therapeutic choices of this disease.

RESULTS

Mechanical/chemical trauma was reported in 28.6%, a previous infection in 10.7%, a previous cryotherapy in 5.4% androgenetic alopecia in 48.2% and severe actinic damage in 25%. Trichoscopy showed absence of follicular ostia, tufted and broken hair, crusts, serous exudate, dilated vessels, pustules and hyperkeratosis. Histopathology revealed three different features, depending on the disease duration. The most prescribed therapy was topical steroids (62.5%), followed by the combination of topical steroids and topical tacrolimus (8.9%), systemic steroids (7.1%) and topical tacrolimus (5.4%). A reduction of inflammatory signs was observed in 28 patients (50%) treated with topical steroids and in all three patients treated with topical tacrolimus.

CONCLUSION

The relatively high number of patients collected allowed us to identify a better diagnostic approach, using trichoscopy and a more effective therapeutic strategy, with high-potency steroids or tacrolimus, which should be considered as first-line treatment.

Identification of the sulfotransferase iso-enzyme primarily responsible for the bio-activation of topical minoxidil

Pattern hair loss (i.e., androgenetic alopecia) is a common condition afflicting approximately fifty percent of men and women by the age of fifty. Currently, topical minoxidil is the only US FDA approved drug for the treatment of pattern hair loss in men and women.

Starch formation inside plastids of higher plants

Starch is a water-insoluble polyglucan synthesized inside the plastid stroma within plant cells, serving a crucial role in the carbon budget of the whole plant by acting as a short-term and long-term store of energy. The highly complex, hierarchical structure of the starch granule arises from the actions of a large suite of enzyme activities, in addition to physicochemical self-assembly mechanisms. This review outlines current knowledge of the starch biosynthetic pathway operating in plant cells in relation to the micro- and macro-structures of the starch granule. We highlight the gaps in our knowledge, in particular, the relationship between enzyme function and operation at the molecular level and the formation of the final, macroscopic architecture of the granule.

Low-dose daily aspirin reduces topical minoxidil efficacy in androgenetic alopecia patients

Topical minoxidil is the only US FDA approved OTC drug for the treatment of androgenetic alopecia (AGA). Minoxidil is a pro-drug converted into its active form, minoxidil sulfate, by the sulfotransferase enzymes in the outer root sheath of hair follicles. Previously, we demonstrated that sulfotransferase activity in hair follicles predicts response to topical minoxidil in the treatment of AGA. In the human liver, sulfotransferase activity is significantly inhibited by salicylic acid. Low-dose OTC aspirin (75-81 mg), a derivative of salicylic acid, is used by millions of people daily for the prevention of coronary heart disease and cancer. It is not known whether oral aspirin inhibits sulfotransferase activity in hair follicles, potentially affecting minoxidil response in AGA patients. In the present study, we determined the follicular sulfotransferase enzymatic activity following 14 days of oral aspirin administration. In our cohort of 24 subjects, 50% were initially predicted to be responders to minoxidil. However, following 14 days of aspirin administration, only 27% of the subjects were predicted to respond to topical minoxidil. To the best of our knowledge, this is the first study to report the effect of low-dose daily aspirin use on the efficacy of topical minoxidil.

The effect of topical minoxidil treatment on follicular sulfotransferase enzymatic activity

Minoxidil is the only US FDA-approved topical drug for the treatment of female and male pattern hair loss. Previously, it was demonstrated that topical minoxidil is metabolized to its active metabolite, minoxidil sulfate, by sulfotransferase enzymes located in the outer root sheath of hair follicles. The expression of sulfotransferase in the scalp varies greatly between individuals, and this difference in expression explains the varied response to minoxidil treatment. Previously, we have demonstrated the clinical utility of detecting sulfotransferase in plucked hair follicles to predict minoxidil response in pattern hair loss patients. Typically, exogenous exposure to substrates affects the expression of the enzymatic system responsible for their metabolism. For example, Phase I metabolizing enzymes, such as the cytochrome P450 family of enzymes, are known to be up-regulated in the presence of xenobiotic substrates. However, it is not known if Phase II metabolizing enzymes, such as the sulfotransferase family of enzymes, are similarly affected by the presence of substrates. In this study, we recruited 120 subjects and analyzed their sulfotransferase enzymatic activity before and after treatment with topical minoxidil. Adjusting the results for biologic (within subject) variability, we discovered that the sulfotransferase enzymatic system expression is stable over the course of minoxidil treatment. To the best of our knowledge, this is the first study to demonstrate the stability of sulfotransferase, a Phase II metabolizing enzyme, over the course of minoxidil treatment.

Social selection favours offspring prone to the development of androgenetic alopecia

In recent years, dermatologists have observed an increase in the incidence of male androgenetic alopecia (AGA). In a survey of 41 dermatologists, 88% reported an increase in incidence of AGA in men younger than 30 years. This phenomenon has no apparent explanation. However, due to the strong genetic inheritance component of AGA, a social or environmental factor which favours the inheritance of genes that increase the risk of developing AGA is suspected. To date, the strongest predictor of AGA in men has been the length of the CAG repeat located in the androgen receptor gene (AR gene) on the X chromosome. The same genetic variant in women is associated with ovulation at a later age, higher antral follicle count, and lower risk for premature ovarian failure. This led us to theorize that, due to social pressure to conceive later in life, women carriers of the short CAG repeat in the AR gene would have a selective advantage to conceive later in life and would thus favour male offspring exhibiting AGA.

Mechanism of action of minoxidil in the treatment of androgenetic alopecia is likely mediated by mitochondrial adenosine triphosphate synthase-induced stem cell differentiation

Topical minoxidil is the only topical drug approved by the US Food and Drug Administration (FDA) for the treatment of androgenetic alopecia. However, the exact mechanism by which minoxidil stimulates anagen phase and promotes hair growth is not fully understood. In the late telegen phase of the hair follicle growth cycle, stem cells located in the bulge region differentiate and re-enter anagen phase, a period of growth lasting 2-6 years. In androgenetic alopecia, the anagen phase is shortened and a progressive miniaturization of hair follicles occurs, eventually leading to hair loss. Several studies have demonstrated that minoxidil increases the amount of intracellular Ca2+, which has been shown to up-regulate the enzyme adenosine triphosphate (ATP) synthase. A recent study demonstrated that ATP synthase, independent of its role in ATP synthesis, promotes stem cell differentiation. As such, we propose that minoxidil induced Ca2+ influx can increase stem cell differentiation and may be a key factor in the mechanism by which minoxidil facilitates hair growth. Based on our theory, we provide a roadmap for the development of a new class of drugs for the treatment of androgenetic alopecia.

Potential risk of developing herpes simplex encephalitis in patients treated with sildenafil following primary exposure to genital herpes

Herpes simplex encephalitis (HSE) is associated with significant mortality and morbidity. As a consequence of HSE, up to 75% of infected individuals die or experience irreversible neurological damage. While the pathogenesis of the disease is unknown, it is traditionally hypothesized that the viral infection occurs by neuronal transmission directly from peripheral sites. Non-neuronal modes of infection have generally been overlooked as the brain is protected by the blood-brain-barrier (BBB). The BBB poses an effective barrier to pathogens as well as to drugs such as chemotherapies. In the pursuit to deliver chemotherapeutic agents to the brain, several studies demonstrated that phosphodiesterase type 5 (PDE5) inhibitors, such as sildenafil, may increase the permeability of the BBB enabling successful delivery of chemotherapeutic agents to the brain. In this communication, we report a case of HSE infection in a 62-year-old man, which we suspect was facilitated by the use of sildenafil during a primary genital herpes simple virus (HSV) infection. Due to large number of patients treated with PDE5 inhibitors for erectile dysfunction and the high incidence of genital HSV infection in the general population, a larger study should examine the potential risk of developing HSE in patients treated with PDE5 inhibitors.

Melanin of the nipple areola complex

Biological pigments or biochromes are ubiquitous in animals, plants, and simpler organisms such as fungi and bacteria. They serve a wide spectrum of functions from photosynthesis, camouflage, mimicry, photo protection from the environment to attracting mates. The human female nipple areola complex (NAC) is a highly-pigmented area. Currently, the prevailing theory as to the evolution of the pigmented human NAC is based on infant recognition of breast feeding latching zone; however, due to the protruding shape of the nipple and surrounding breast, the authors of this letter believe that the evolutionary advantage of the pigmented NAC has a direct physiological function, namely the initiation of involution at the end of the infant lactation period.

Minoxidil dose response study in female pattern hair loss patients determined to be non-responders to 5% topical minoxidil

Topical minoxidil is the only US FDA approved drug for the treatment of female pattern hair loss (FPHL). 5% minoxidil foam is only effective at re-growing hair in a minority of women (approximately 40%). Thus, the majority of FPHL patients remain untreated. Previously, we demonstrated that nonresponders to 5% minoxidil have low metabolism of minoxidil in hair follicles. As such, we hypothesized that increasing the dosage of topical minoxidil to low metabolizers would increase the number of responders without increasing the incidence of adverse events. In this study, we recruited FPHL subjects that were identified as non-responders to 5% topical minoxidil utilizing the previously validated assay for minoxidil response. Subjects were treated for 12 weeks with a novel 15% topical minoxidil solution. At 12 weeks, 60% of subjects achieved a clinically significant response based on target area hair counts (>13.7% from baseline), as well as significant improvement in global photographic assessment. None of the subjects experienced significant hemodynamic changes or any other adverse events. To the best of our knowledge, this is the first study to demonstrate the potentially beneficial effect of a higher dosage of minoxidil in FPHL subjects who fail to respond to 5% minoxidil.

Potential benefits of diagnosis and treatment on health outcomes among elderly people with symptoms of overactive bladder

OBJECTIVES

This study examined potential benefits of diagnosing and treating elderly adults with overactive bladder (OAB) symptoms.

METHODS

Data were analysed from the OAB Re-Contact Study (N = 2750), a cross-sectional, self-reported Internet survey. Elderly respondents (65+ years old) with OAB were identified according to current medication use to control OAB symptoms or by scores > 14 (men) or > 16 (women) on the OAB Awareness Tool. Treated were those currently using prescription medication and never treated were those who never used prescription medication for OAB. Outcome measures included health-related quality of life, activity impairment, OAB-related severity and symptoms, and healthcare resource use (e.g. hospitalisations). Generalised linear models predicted health outcomes as a function of diagnosis or treatment, adjusting for covariates.

RESULTS

Diagnosed vs. not diagnosed elderly respondents had higher mental component summary (MCS) scores and SF-6D health utilities, and less activity impairment. Treated vs. never treated elderly respondents had higher MCS and SF-6D health utilities, less activity impairment, fewer OAB symptoms, lower OAB Awareness Tool scores, and lower odds of having bladder problems or incontinence. There were no significant differences in healthcare resource use. Further analysis by age group (middle-aged vs. elderly respondents) revealed significantly greater diagnosis- and treatment-related benefits on MCS (2.93 and 4.49 points more, respectively) and activity impairment (1.24 and 1.37 times as much, respectively) among elderly respondents.

CONCLUSIONS

Diagnosis and treatment were each associated with a lower health burden for elderly adults with OAB symptoms. These findings highlighted the importance of diagnosis and treatment in alleviating OAB symptoms and their impact on health outcomes.

Doppler laser imaging predicts response to topical minoxidil in the treatment of female pattern hair loss

Topical minoxidil is the only drug approved by the US FDA for the treatment of female pattern hair loss. Unfortunately, following 16 weeks of daily application, less than 40% of patients regrow hair. Several studies have demonstrated that sulfotransferase enzyme activity in plucked hair follicles predicts topical minoxidil response in female pattern hair loss patients. However, due to patients’ discomfort with the procedure, and the time required to perform the enzymatic assay it would be ideal to develop a rapid, non-invasive test for sulfotransferase enzyme activity. Minoxidil is a pro-drug converted to its active form, minoxidil sulfate, by sulfotransferase enzymes in the outer root sheath of hair. Minoxidil sulfate is the active form required for both the promotion of hair regrowth and the vasodilatory effects of minoxidil. We thus hypothesized that laser Doppler velocimetry measurement of scalp blood perfusion subsequent to the application of topical minoxidil would correlate with sulfotransferase enzyme activity in plucked hair follicles. In this study, plucked hair follicles from female pattern hair loss patients were analyzed for sulfotransferase enzyme activity. Additionally, laser Doppler velocimetry was used to measure the change in scalp perfusion at 15, 30, 45, and 60 minutes, after the application of minoxidil. In agreement with our hypothesis, we discovered a correlation (r=1.0) between the change in scalp perfusion within 60 minutes after topical minoxidil application and sulfotransferase enzyme activity in plucked hairs. To our knowledge, this is the first study demonstrating the feasibility of using laser Doppler imaging as a rapid, non-invasive diagnostic test to predict topical minoxidil response in the treatment of female pattern hair loss.

Burden of smoking among adults with COPD, chronic bronchitis, and emphysema in urban China

OBJECTIVE

Tobacco, widely used in China, poses a major risk for chronic obstructive pulmonary disease (COPD). This study assessed health outcomes of COPD-diagnosed smokers vs. never smokers and examined treatment patterns of patients attempting to quit smoking in urban China.

METHODS

National Health and Wellness Survey (NHWS) 2010 and 2012 China data were analysed. Respondents self-reporting diagnosis with COPD, chronic bronchitis, or emphysema were categorised: quit attempters (current smokers 'trying to quit' or non-smokers 'in the process of quitting'), smokers (including quit attempters) and those who never smoked. Respondents reported smoking cessation treatment utilisation; health status: SF-36v2-based scores and SF-6D health utilities; Work Productivity and Activity Impairment questionnaire-based metrics; and resource utilisation. Regression modelling assessed health outcomes, controlling for covariates.

RESULTS

Among 1421 (3.6%) diagnosed respondents, 51.6% never smoked and 35.5% smoked (of whom, 43.8% were attempting to quit). After adjustments, smokers vs. never smokers had significantly lower health utilities, lower mental/physical health status and greater absenteeism, presenteeism, overall work impairment, activity impairment, emergency room visits, hospitalisations and provider visits. Quit attempters were diagnosed an average 6.9 years (SD = 7.7) previously, with 25.3% reporting moderate/severe COPD. Most-reported main causes of COPD were: smoking (57.5%), illnesses/conditions (53.8%) and pollutants (44.3%). Among quit attempters, 82.8% smoked currently. Use of prescription cessation treatments was reported by 12.7%.

CONCLUSIONS

Smokers experienced poorer health outcomes, reinforcing importance of prevention in mitigating disease burden. Among quit attempters, few reported using prescription cessation treatments. Given the high burden imposed by smoking in China, effective interventions may be beneficial.

Direct and indirect cost of urge urinary incontinence with and without pharmacotherapy

OBJECTIVE

To evaluate the impact of treating urge urinary incontinence (UUI), including mixed urinary incontinence (MUI), on healthcare resource utilisation, productivity, activity impairment and associated costs.

METHODS

The study used data from the 2011 U.S. National Health and Wellness Survey, an Internet-based questionnaire of a nationwide sample of adults. UUI or MUI respondents were identified via three Incontinence Questions. Respondents with stress urinary incontinence only, prostate cancer or (medication for) benign prostatic hyperplasia were excluded. UUI/MUI respondents were categorised as Rx users for overactive bladder (OAB) and non-Rx users (who never used Rx and whose condition reportedly interfered with life activities or was difficult to manage). Outcome measures included healthcare utilisation and Work Productivity and Activity Impairment questionnaire-based scores. Direct and indirect costs were estimated using 2010 labour and 2008 medical expenditure data sources. Generalised linear models predicted resource use and productivity as a function of treatment status, adjusting for covariates (e.g. sociodemographics, OAB severity, comorbid status) that may also predict impairment.

RESULTS

Rx (vs. non-Rx) users were more likely to be female (80.7% vs. 70.0%), older (mean = 62.7 vs. 53.1) and reporting more moderate-to-severe OAB (70.9% vs. 52.6%; all p < 0.05). Adjusting for covariates, Rx (vs. non-Rx) users had significantly lower activity impairment (41.1% vs. 46.8%), more provider visits (7.42 vs. 5.60) and costs ($18,175 vs. $13,679), and higher total direct costs ($27,291 vs. $21,493), all p < 0.01.

CONCLUSIONS

Urge urinary incontinence patients using, vs. never using, prescription medication reported lower activity impairment but higher direct costs. These findings may inform the degree to which UUI pharmacotherapy affects health outcomes.

Short-term effects of ambient particles on mortality in the elderly: results from 28 cities in the APHEA2 project

Within the framework of the APHEA2 (Air Pollution on Health: a European Approach) project, the effects of ambient particles on mortality among persons > or = 65 yrs were investigated. Daily measurements for particles with a 50% cut-off aerodynamic diameter of 10 microm (PM10) and black smoke (BS), as well as the daily number of deaths among persons > or = 65 yrs of age, from 29 European cities, have been collected. Data on other pollutants and meteorological variables, to adjust for confounding effects and data on city characteristics, to investigate potential effect modification, were also recorded. For individual city analysis, generalised additive models extending Poisson regression, using a locally weighted regression (LOESS) smoother to control for seasonal effects, were applied. To combine individual city results and explore effect modification, second stage regression models were applied. The per cent increase (95% confidence intervals), associated with a 10 microg x m(-3) increase in PM10, in the elderly daily number of deaths was 0.8%, (0.7-0.9%) and the corresponding number for BS was 0.6%, (0.5-0.8%). The effect size was modified by the long-term average levels of nitrogen dioxide (higher levels were associated with larger effects), temperature (larger effects were observed in warmer countries), and by the proportion of the elderly in each city (a larger proportion was associated with higher effects). These results indicate that ambient particles have effects on mortality among the elderly, with relative risks comparable or slightly higher than those observed for total mortality and similar effect modification patterns. The effects among the older persons are of particular importance, since the attributable number of events will be much larger, compared to the number of deaths among the younger population.

Application of mixed-effects models for exposure assessment

The benefits of using linear mixed-effects models for occupational exposure assessment were studied by re-analysing three data sets from two published surveys with repeated exposure measurements. The relative contributions of particular characteristics affecting exposure levels were assessed as in a multiple regression model, while controlling for the correlation between repeated measurements. While one-way ANOVA allows one only to estimate unconditioned variance components, a mixed model enables estimation of between- and within-worker variance components of exposure levels while accounting for the fixed effects of work characteristics. Consequently, we can identify the work characteristics affecting each variance component. Mixed models were applied to the data sets with repeated measurements and auxil iary information on work characteristics. The between-worker variance components were reduced by 35, 66 and 80%, respectively, in the three data sets when work characteristics were taken into account. The within-worker (day-to-day) variability was reduced only in the pig farmer data set, by 25%, when accounting for work activities. In addition, coefficients of work characteristics from the mixed model were compared with coefficients resulting from originally published multiple linear regression models. In the rubber manufacturing data, the coefficients of the mixed model showed similar relative importance, but were generally smaller than the coefficients from regression models. However, in the pig farm data, only the coefficients of work activities were somewhat reduced. The mixed model is a helpful tool for estimating factors affecting exposure and suitable variance components. Identifying the factors in the working environment that affect the between-worker variability facilitates a posteriori grouping of workers into more uniformly exposed groups. Identifying the factors that affect the within-worker variance is helpful for hazard control and in designing efficient sampling schemes with reference to time schedule.

Adjustment to illness of cancer patients treated by complementary therapy along with conventional therapy

This pilot study compares the adjustment to illness, i.e. psychosocial and psychological distress, of 29 cancer patients being treated by complementary therapy along with conventional therapy, with a control group of 29 patients being treated by conventional therapy only. The findings indicate statistical differences in the brief symptom inventory scale (BSI), namely, the psychological distress of patients who received conventional therapy only was more severe than those being treated by complementary therapy with conventional therapy. No statistical differences, however, were found between the two groups in terms of psychosocial adjustment to the illness (PAIS). The findings lead to a recommendation that complementary therapy should be offered by public medical facilities as part of the standard treatment for cancer patients in order to ease psychological distress.

Transillumination of the palm for venipuncture in infants

AIM

To assess the efficacy of transillumination of the palm of the hand in establishing venous access in small infants.

METHODS

One hundred infants aged 2 to 36 months were considered for venipuncture under transillumination following failure to find an accessible vein or a failed venipuncture attempt.

RESULTS

In 40 of the 100 infants, a vein was visible with transillumination. In 22 of these children, previous attempts to achieve a venous line failed (mean number of failed venipunctures 2.11 +/- 0.6) and in 18 infants, no vein could be identified. Using transillumination, venous access was established with just one venipuncture in 39 of the 40 patients.

CONCLUSIONS

Transillumination of the palm can aid in establishing venous access in infants. This can be easily carried out using a common otoscope.

Exposure to benzene in fuel distribution installations: monitoring and prevention

The authors used a mixed-effects model on a cohort of 258 randomly chosen workers in 7 fuel-distribution facilities to examine the association between airborne benzene exposure and task and timing factors. During an 8-y period, 692 repeated personal measurements were performed. Filler task, warm month, Tuesday, credit day, and time period (1992-1996) were associated significantly with higher exposures to benzene. The authors controlled for the time period, and task type strongly affected the between-worker variance; therefore, two exposure groups (i.e., fillers and nonfillers) were adequate for purposes of exposure grouping strategy. Timing factors (after controlling for task and period effects) strongly affected the high within-worker variance (> 2 than between-worker variance). Long-term exposure would be better represented if the sample was stratified by warm/nonwarm months and if measurement days were selected randomly.

[Recurrent anaphylactic reactions during hospitalization--an unusual etiology]

The prevalence of hypersensitivity and untoward reactions to natural rubber latex (NRL) products is increasing, particularly among specific risk groups. A young man aged 23 years who experienced several episodes of allergic reactions, 2 of which included anaphylactic shock during hospital admission, is presented. These episodes were initially attributed to intravenous medication, but were most probably caused by inadvertent exposure to latex. Medical facilities may contain large amounts of latex, and therefore present a hazardous environment for sensitive people. Increasing awareness of latex sensitivity among patients-at-risk and medical personnel, and implementing simple prophylactic measures, may reduce morbidity and mortality. We propose simple and practical guidelines for diagnosis and treatment.

Respiratory problems associated with exposure to airborne particles in the community

During the spring of 1995, schoolchildren aged 7-13 y who lived in a rural area in Israel were studied. These children lived in two communities: in one community, the population was exposed to pollution from a cement factory and quarries; the population of the second community was not exposed to pollution from these sources. The children from participating schools performed forced vital capacity, forced expiratory volume in 1 s, peak expiratory flow, forced expiratory flow at 50%, and forced expiratory flow at 25%. Parents completed an American Thoracic Society-National Heart and Lung Institute health questionnaire, which included information about respiratory symptoms and diseases of the children and information about background variables. A trend of higher prevalence of most respiratory symptoms occurred in 638 children who were growing up in the community that bordered the industrial zone, compared with 338 children from the unexposed community. Cough without cold, sputum without cold, and cough accompanied by sputum were the most prevalent symptoms. Asthma diagnosed by a physician was reported more frequently for children who lived near the polluting sources. No consistent trend of reduced pulmonary function tests was observed among children who lived in the polluted community; however, peak expiratory flow was significantly lower among these children. Odds ratio values, calculated from logistic regressions in which we controlled for respiratory problems among parents, mothers who smoked, crowding index, education of mothers, and residential heating, were 3.6 (p value for model = .244) for cough without cold, 4.0 (p value for model = .333) for asthma, and 2.2 (p value for model = .753) for asthma and/or bronchitis in the polluted area, compared with 1.0 in the low-pollution community. Total suspended particulate matter and levels of airborne particles less than 10 microns, measured in the community bordering the industrial zone, very often violated the relevant 24-h Israeli standards of 200 microg/m3 and 150 microg/m3, respectively.

Alteration of computer dental radiography images

This study was designed to determine if digital images stored on the hard drive of a Schick computer dental radiography system could be exported, altered, and then restored to the drive without any visible signs of alteration. Digital images were downloaded from the computer dental radiography system using an I-Omega Zip Drive, 100-MB capacity, and then opened in Corel Photo Paint where images were altered and manufacturer export symbols were edited. The resulting images were printed to a default printer (Fargo Foto Fun). The ease of manipulation of the exported digital images reflects the need for the manufacturer to implement safeguards so that the integrity of digital imaging cannot be compromised. Computer dental radiography has many advantages: conservation of time (instant radiographs), less radiation (50 to 60%), no chemical waste, and many viewing options. However, questions that might be raised regarding the ability of persons with minimal computer expertise, using a commercially available program to alter images should be addressed.

The variability of exposure over time: a prospective longitudinal study

Four hundred and forty personal air measurements were carried out on 54 workers, employed in the main processes in six different factories (6-13 in each). Potential exposure was to lead, benzene and dust. Ten randomly repeated hygiene surveys were carried out over 1 year. In order to estimate the magnitude of the variability in workers' exposure over time, its sources, the variance between workers and the variance within a worker, a nested unbalanced analysis-of-variance model was fitted to the log-transformed data. Of the total exposure variance, the within variance of a worker's exposure over time was 51% (geometrical standard deviation, GSD = 3.1) and the between workers, factories and air contaminants variance was 49%. The exposure variance between all the workers was due mainly to variance between workers within the same factory (67%). Outdoor locations, mobility of the worker and mobility of the sources of exposure result in a positive influence on both the variance between (26%, ANOVA) and the variance of a worker over time (39%, regression). These variables are therefore important in the sampling strategy of workers' exposure. For valid compliance testing and assessment of workers' exposure the mean and the within- and between-variance of the workers' exposure over time should be considered. The exposure should be measured several times a year randomly in order to prevent workers misclassification. To assess yearly exposure, a GSD = 3.1 can be used to calculate confidence limits for the arithmetic mean of worker's exposure measurements, in circumstances similar to those in this study.