[Priapism associated to zuclopentixol and the choice for an alternative]

A 29-year-old man developed priapism following the (re)administration of zuclopentixol. In the previous days, a significant amount of alcohol was consumed, presumably in combination with amphetamine and cannabis. Priapism is a rare but serious side effect of various psychoactive medications and recreational drugs, leading to permanent loss of erectile function if not treated in time. In this case the side effect was discovered in a late stage, at which curative treatment was no longer viable. A clear guideline for choosing an alternative antipsychotic agent is currently lacking, but an antipsychotic with low alfa-adrenergic affinity seems preferable. To prevent erectile disfunction following priapism, awareness of its severity is essential, for both doctor and patient.

Oral cholera vaccination promotes homing of IgA+ memory B cells to the large intestine and the respiratory tract

Oral cholera vaccination is used to induce immune responses in the intestines to protect against cholera infection. However, oral vaccination may also affect immune responses in other mucosal tissues. To study this, tissue-specific homing potential and kinetics of B-cell responses were characterized after oral cholera vaccination. Healthy adult volunteers received two doses of Dukoral® and blood, saliva, nasal wash, and fecal samples were collected over time to detect vaccine-specific antibodies. Additionally, homing potential of lymphocytes to small intestine, colon, airways, skin, and periphery was measured by expression of Integrin β1 and β7, CCR9, CCR10, CCR7, and CLA. After vaccination, antibody responses to cholera toxin B (CTB) and Dukoral® were detected in serum and nasal wash. CTB-specific memory B cells in peripheral blood and tissue homing profiles of memory B cells peaked at day 18. IgA⁺ memory B cells expressed markers that enable homing to the airways and colon, while IgA^- memory B cells primarily expressed small-intestine-homing markers. These data show that oral cholera vaccination has a differential effect on immune responses in various mucosal sites, including the respiratory tract.

The diagnostic accuracy of serological tests for Lyme borreliosis in Europe: a systematic review and meta-analysis

Background

Interpretation of serological assays in Lyme borreliosis requires an understanding of the clinical indications and the limitations of the currently available tests. We therefore systematically reviewed the accuracy of serological tests for the diagnosis of Lyme borreliosis in Europe.

Methods

We searched EMBASE en MEDLINE and contacted experts. Studies evaluating the diagnostic accuracy of serological assays for Lyme borreliosis in Europe were eligible. Study selection and data-extraction were done by two authors independently. We assessed study quality using the QUADAS-2 checklist. We used a hierarchical summary ROC meta-regression method for the meta-analyses. Potential sources of heterogeneity were test-type, commercial or in-house, Ig-type, antigen type and study quality. These were added as covariates to the model, to assess their effect on test accuracy.

Results

Seventy-eight studies evaluating an Enzyme-Linked ImmunoSorbent assay (ELISA) or an immunoblot assay against a reference standard of clinical criteria were included. None of the studies had low risk of bias for all QUADAS-2 domains. Sensitivity was highly heterogeneous, with summary estimates: erythema migrans 50 % (95 % CI 40 % to 61 %); neuroborreliosis 77 % (95 % CI 67 % to 85 %); acrodermatitis chronica atrophicans 97 % (95 % CI 94 % to 99 %); unspecified Lyme borreliosis 73 % (95 % CI 53 % to 87 %). Specificity was around 95 % in studies with healthy controls, but around 80 % in cross-sectional studies. Two-tiered algorithms or antibody indices did not outperform single test approaches.

Conclusions

The observed heterogeneity and risk of bias complicate the extrapolation of our results to clinical practice. The usefulness of the serological tests for Lyme disease depends on the pre-test probability and subsequent predictive values in the setting where the tests are being used. Future diagnostic accuracy studies should be prospectively planned cross-sectional studies, done in settings where the test will be used in practice.

Granulocyte transfusions for pediatric patients and the establishment of national treatment guidelines and donor registry

G-CSF/dexamethasone stimulated donor derived granulocyte transfusion (GTX) has been shown in non-randomized studies to be a useful co-therapy in immune-compromised patients unresponsive to conventional antimicrobial treatments. Reports of GTX are however usually single institution adult experiences. Substantiated pediatric data, other than in neonates, is less common.

Ethnic differences in cigarette smoking among adolescents: a comparison of Jews and Arabs in Jerusalem

BACKGROUND

Prevention of cigarette smoking is an important issue in public health policy. Since most adult smokers began smoking in childhood, understanding behavorial factors associated with smoking initiation would contribute to smoking initiation programs. Health-related behavior may vary between different ethnic groups.

OBJECTIVES

To determine the prevalence of smoking among Jewish and Arab adolescents in Jerusalem, and whether there are differences in smoking initiation between the two ethnic groups.

METHODS

We carried out a cross-sectional survey of all students in the 6th to 11th grades (age range 11-17 years) of a Jewish school and an Arab school in the Jerusalem area, using an anonymous self-completion questionnaire. A total of 791 questionnaires was analyzed, 479 from the Jewish students and 312 from the Arab students.

RESULTS

The lowest prevalence of smoking was found among Arab female students and the highest among Jewish female students (9% vs. 41%, P < 0.001). The prevalence of smoking among Jewish and Arab males was similar. More Arab female students smoked than their mothers. Peer pressure seemed to be a more important factor among Jewish students.

CONCLUSIONS

This study demonstrated the presence of ethnic differences in smoking prevalence and the reasons for smoking among adolescents in Israel. These results suggest the need for specific smoking prevention policies for different ethnic groups.

[Circumcision from a historical perspective]

Male circumcision has been practiced by many tribes in different continents. The oldest image of a circumcision dates from 2300 BC and was found in Egypt. In the Jewish religion circumcision symbolizes the covenant between God and Abraham. Despite the fact that Jesus of Nazareth was circumcised, circumcision has never been part of Christianity. Circumcision is not mentioned in the Koran; the practice of circumcision in Islam is attributed to Abraham, who is considered by muslims to be one of the prophets. From the middle of the nineteenth century circumcision was performed for medical reasons. Throughout the centuries, from the time of the Bible, many methods for performing circumcision have been described, and a few to undo it by restoring the prepuce.

Extensive neuronal cell death following intracranial transection of the facial nerve in the adult rat

The aim of the present study is to examine the neuronal degeneration and the glial response following intracranial transection of the facial nerve close to the brainstem and furthermore to compare the results with a distal nerve injury. The facial nerve was cut either intracranially in the posterior cranial fossa or further distally, where it passes the parotid gland, in adult rats. Intracranial axotomy caused a massive loss of neuronal profiles. Only 26.8+/-11.3% of facial motor neuronal profiles were found ipsilateral to the nerve injury when compared to the contralateral side, following intracranial axotomy. This was statistically significant in comparison to the distal injury (72.4+/-9.5%), 4 weeks post-lesion. Reactive microglial cells expressed ED1 immunoreactivity following the intracranial axotomy but not following the distal nerve injury. In conclusion, there was a large discrepancy in neuronal degeneration as well as presence of phagocytic (ED1 positive) microglia between the two lesions. The intracranial lesion model used in the present study generates a massive neuronal cell death and should therefore be a useful tool for studies on proximal cranial nerve injuries and in particular mechanisms causing cell death, which may occur following, for example, head trauma.

Adhesion properties, intermediate filaments and malignant behaviour of head and neck squamous cell carcinoma cells in vitro

This study compared phenotype and behaviour of seven head and neck squamous cell carcinoma (HNSCC) cell lines and normal epithelial cells. Indications were found that in HNSCC cells: 1) loss of the cell-cell adhesion molecule E-cadherin was correlated with loss of epithelioid cell morphology but not with loss of cell-cell cohesion; 2) reduced expression of the cell-cell adhesion molecule desmoglein was unrelated to cell shape or motility; 3) high expression of the cell-substrate adhesion molecule alpha 6 beta 4, a receptor for laminin, corresponded with epithelioid colony formation while, in our adhesion assay, low expression of alpha 6 beta 4 paradoxically coincided with an increased adhesion to laminin; 4) presence of vimentin intermediate filaments coincided with loss of anchorage dependency. We propose that by simultaneous downregulation of E-cadherin, replacement of alpha 6 beta 4 by an aberrant laminin receptor and co-expression of vimentin a malignant phenotype arises of spindle-shaped, motile, anchorage-independent HNSCC cells with enhanced laminin-binding capacity.

Cigarette smoking habits among schoolchildren

STUDY OBJECTIVE

Cigarette smoking is a major preventable cause of morbidity and mortality worldwide. Most adult smokers start smoking regularly some time before 18 years of age. The aim of this study was to determine the age at which children begin cigarette smoking, to study the environmental factors that influence children to smoke, and to understand the reasons why children smoke. The results of this study may help lead to the development of more effective smoking prevention programs.

METHODS

We carried out a cross-sectional survey of all students in grades 6 to 11 (ages: 11 to 17 years) in two high schools in the Jerusalem area, using an anonymous self-completion questionnaire. The students were asked questions regarding the age at which they began smoking, initiation, their smoking habits, their reasons for smoking, and their views on children who smoke. In addition, they were asked about the smoking status of their parents, siblings, and friends. Finally they were asked about the health hazards of smoking.

RESULTS

Of the 847 students who answered the questionnaire, 35% stated that they had smoked at least once and 14% stated that they were currently smoking. The percentage of students who were currently smoking increased gradually with age to 36%. There was a sharp increase in experimental smoking after seventh grade (ages 12 to 13 years). Having a friend who smoked substantially increased the likelihood of smoking, whereas parental smoking or having a sibling who smoked did not increase the likelihood of smoking. The most common reason for starting to smoke was "to try something new" (55%). There was a significant difference between the views of students with different smoking statuses regarding children who smoke: nonsmoking children associated more negative characteristics to smoking. All of the children studied were well aware of the health hazards of cigarette smoking.

CONCLUSIONS

Smoking is highly prevalent among schoolchildren in Jerusalem. The increase in the rate of smoking at the age of 12 years indicates that smoking prevention programs need to be started at an earlier age. Peer pressure is a very strong stimulus for smoking in children. Since children are aware of the health hazards of smoking, prevention policy should be aimed more at associating smoking with negative images and addressing peer pressure.