Diabetes-related lower extremity amputations in Ontario: 1987-88 experience.

Lower extremity amputee rates were estimated for diabetic persons living in Ontario. The rates were specified for age, sex and six Health Regions. The 1987-88 Hospital Records Institute database supplied the information regarding the amputations and the prevalence of diabetes in Ontario was estimated from age/sex specific diabetic rates of the U.S. The crude amputee rate for Ontario is 40 amputees/year/10,000 diabetics and the amputation rate is 44 amputations/year/10,000. These rates are lower than the 101 amputees/year/10,000 reported in the U.K. and are reasonably close to those of the U.S. (59.7 amputations/year/10,000). Age and sex Standardized Morbidity Ratios indicated that Region 1 and 6 have significantly higher and Region 2 significantly lower amputee rates than the Province. There is an almost two-fold difference between the highest and the lowest DRLEA rates of the six regions. (Range: 60-30). These results should be interpreted with caution, since actual prevalence rates of diabetes are not available.

Randomized, double-blind, placebo-controlled, clinic-initiated, Canadian multicenter trial of topical edoxudine 3.0% cream in the treatment of recurrent genital herpes. Canadian Cooperative Study Group.

Treatment for recurrent genital herpes using edoxudine 3% cream for 5 days was evaluated in 200 patients in a randomized, multicenter, double-blind, placebo-controlled, clinic-initiated trial. Lesion tenderness was predictive of and more sensitive and longer-lasting than the symptom of pain. Among patients receiving placebo, times to crusting (P = .043), cessation of investigator-observed signs (P = .005), lesion-associated signs (P = .02), and groin signs (P = .05) were longer in women. Edoxudine reduced viral shedding in men (mean 2.7 vs. 3.4 days, P = .009) and women (2.0 days vs. 3.5 days, P = .0001). Loss of investigator-observed signs (4.4 vs. 6.2 days, P = .002), investigator-observed lesion tenderness (P = .01), lesion signs (P = .02), groin adenopathy (P = .01), and tenderness (P = .01) occurred earlier in women taking edoxudine. Edoxudine was well-tolerated and reduced several signs of herpes in women. Its clinical role in recurrent genital herpes remains to be fully determined.

Malaria prophylaxis.

The authors of this paper provide an overview of the relative risk of malaria in various areas of the world. On the basis of the geographic information available, they discuss both chemoprophylaxis and treatment for this disease, and make recommendations for their use.

Illness in returned travellers.

Intercontinental travel is more common now than it has ever been before, and so are travel-related diseases. A thorough history and physical examination provide many clues to possible pathogens, particularly when combined with knowledge of the geographic distribution of specific diseases. Prompt diagnosis and proper treatment are imperative.

Efficacy and safety of foscarnet for recurrent orolabial herpes: a multicentre randomized double-blind study.

Foscarnet sodium (trisodium phosphonoformate hexahydrate) has been shown to inhibit herpes simplex virus (HSV) in vitro and to be efficacious for topical treatment of experimental HSV infection in animals. To assess its clinical efficacy in the treatment of recurrent orolabial herpes a multicentre collaborative, double-blind, placebo-controlled trial was conducted. The study patients were randomly assigned to receive either 3% foscarnet cream (78 patients) or placebo (cream vehicle) (75 patients) and were asked to start treatment at the earliest indication of a recurrence. Efficacy was evaluated in 143 patients (74 in the foscarnet group and 69 in the placebo group). There was no significant difference in time to healing or duration of virus shedding between the two groups. However, in the subgroup of patients who started treatment before vesicles appeared, the duration of virus shedding was shorter in the foscarnet group than in the placebo group (p = 0.04), and the proportion of lesions that evolved to the vesicular stage was smaller (p = 0.03). No significant difference in the incidence of local or systemic adverse effects was noted between the two groups. We conclude that the beneficial effect of foscarnet was limited to a subgroup of patients who started treatment in the prevesicular stage.

Clinical course of recurrent genital herpes and treatment with foscarnet cream: results of a Canadian multicenter trial.

Clinic-initiated topical treatment of recurrent genital herpes with foscarnet cream (concentration, 0.3% in men and 1% in women) was compared with a placebo in a Canadian multicenter trial involving 309 patients. Culture-positive episodes of herpes took significantly longer to heal than did the others. Lesions in men were larger and lasted longer but were less symptomatic than those in women. Foscarnet did not statistically improve the times to healing or the loss of symptoms overall but did result in a higher proportion of symptom-free individuals after one day of treatment. Foscarnet-treated patients had a reduced duration of shedding of virus, and this was significant for men. These clinical benefits do not, however, warrant general use of this agent for established lesions. Earlier, prodromal treatment might have been more effective, but patient-initiated studies include a greater proportion of culture-negative (shorter) episodes that often make results difficult to interpret.

Hospitals' response to the buckle-up baby legislation in Ontario.

Drivers in Ontario are legally responsible to ensure that infants and toddlers are restrained in a child safety seat or by a lap belt. In 1982 the minister of health sent a memorandum to all medical officers of health and the administrators and medical directors of all public hospitals in Ontario, urging them to encourage and assist parents in protecting their newborn children with safety seats. In 1983 the Toronto General Hospital established the Cooperative Hospital Infant Restraint Program (CHIRP) to study the feasibility of a "loaner" program for hospitals in metropolitan Toronto. The authors describe CHIRP and its objectives. They also report the results of a questionnaire they sent in 1984 to all Ontario hospitals that had a newborn or pediatric service to assess their response to the minister's memorandum.

Advice for travellers to tropical and subtropical countries.

Travellers to areas where political instability, poverty or inadequate public health measures render them at risk of exposure to infections and diseases they are unlikely to meet at home should seek prophylaxis and protection before departure. Inoculation is the best form of protection for certain diseases; since protocols change frequently, a reliable local source of current information should be found. Prophylaxis against malaria involves both mechanical protection against mosquito bites, and appropriate chemoprophylaxis. Water safety must be considered where chlorinated water is not available; a protocol for decontamination is presented, and guidelines for avoiding gastrointestinal disorders are listed.

Rosoxacin in the therapy of uncomplicated gonorrhea.

In this randomized, multicentered study, 157 males and 130 females with laboratory-confirmed, uncomplicated anogenital Neisseria gonorrhoeae infections were evaluated to determine the efficacy and safety of a single 300-mg oral dose of rosoxacin versus 3.5 g of ampicillin plus 1 g of probenecid. A total of 130 males and 101 females were evaluated. Rosoxacin cured 90.3% (P = 0.053) and 94.1% (P = 0.62), respectively, whereas ampicillin was effective in 98.5 and 98% of males and females, respectively. All 39 patients with anorectal infections were cured. One penicillinase-producing N. gonorrhoeae strain was isolated and was eradicated with rosoxacin. Of 212 pretreatment isolates tested, 201 were inhibited by 0.06 micrograms or less of rosoxacin per ml. The MICs of rosoxacin for the remaining 11 isolates ranged up to 0.5 micrograms/ml. The incidence of adverse effects was relatively high (29% for the rosoxacin group versus 18% for the ampicillin group), but none of the reactions required medical intervention nor did they result in serious sequelae.

Solitary penile ulcer associated with infections mononucleosis.

Determining the cause of genital ulcers requires extensive laboratory investigation, particularly if there is no history of sexually transmitted disease. In a patient with a solitary penile erosion who was tired, weak, sweaty and febrile, hematologic and serologic tests suggested infectious mononucleosis, and bacteriologic and serologic studies, along with attempts at virus culture, ruled out syphilis and herpes simplex. The erosion healed soon after the other signs and symptoms resolved. It therefore appears that solitary penile erosions may be a presenting feature of infectious mononucleosis.

Herpes genitalis in patients attending a clinic for sexually transmitted diseases.

In a prospective study of 210 patients attending a hospital-based sexually transmitted disease clinic, we documented the prevalence of genital herpes infection (GHI) and its association with gonococcal infection (GI). Herpes simplex virus type 2 was cultured from 58% of symptomatic patients and 0.5% of asymptomatic patients.The ratio of GI to GHI was 41:31 by clinical criteria. The laboratory-confirmed ratio was 41:18. These ratios are much higher than those normally used to estimate the caseload of GHI.

Genital herpetic infection: a family practice perspective.

Several major breakthroughs have occurred in our understanding of the epidemiology, immunology and biological behavior of the human herpes virus I and II. The family physician, however, is still confronted with four basic clinical situations: patients who present with a genital erosion or ulcer, affected patients in the reproductive age group, patients who ask if herpes causes cervical cancer, and patients who are very troubled by endless recurrences. As syphilitic chancre is becoming rare, the family physician has to recognize the increasing importance of herpes viruses in the etiology of the genital erosion-ulcer syndrome to acquire the clinical and laboratory skills to make that distinction. The prevention of neonatal disease is now possible in the majority of cases provided that pregnancies at risk are identified. Adequate virological surveillance should make it possible to virtually eliminate the disease. The evidence for the oncogenecity is circumstantial. Potential intra- and interpersonal effects of the disease are outlined.

Efficacy of Influenza Inoculation: Intradermal versus Subcutaneous Route.

Intradermal injection of antigen can theoretically produce the same antibody response as 10-20% of the volume required for subcutaneous injection. This paper demonstrates equal efficacy of intradermal injection of Fluviral vaccine as compared to subcutaneous injection in an ambulatory geriatric population. There was no difference in adverse reactions between the two groups. A significant portion of both groups did not develop protective HAI antibody level to or more than 1/40.

Clinical application of serological tests for syphilis.

This article differentiates and describes the serological tests for syphilis- antitreponemal antibody tests (TPI, FTA-ABS, TPHA), non-treponemal antigen test (VDRL)-their clinical and serological correlation, the responses to therapy and the biologically false positive syndrome.