Malaria Fever Therapy for General Paralysis of the Insane: A Historical Cohort Study.

BACKGROUND/AIMS: This year marks the 100th anniversary of the first malaria fever treatment (MFT) given to patients with general paralysis of the insane (GPI) by the Austrian psychiatrist and later Nobel laureate, Julius Wagner-Jauregg. In 1921 Wagner-Jauregg reported an impressive therapeutic success of MFT and it became the standard treatment for GPI worldwide. In this study, MFT practice in the Dutch Vincent van Gogh psychiatric hospital in GPI patients who had been admitted in the period 1924-1954 is explored. METHODS: To identify patients with GPI, cause-of-death statistics was used. Data on MFT were retrieved from annual hospital reports and individual patient records. RESULTS: Data on MFT were mentioned in the records of 43 out of 105 GPI patients. MFT was practiced in a wide range of patients with GPI, including those with disease duration of more than 1 year, up to 70 years of age, and those with a broad array of symptoms and comorbidities, such as (syphilitic) cardiac disease. Inoculation with malaria was done by patient-to-patient transmission of infected blood. CONCLUSIONS: MFT practice and mortality rates in MFT-treated patients correspond to similar findings worldwide. MFT was well tolerated and MFT-treated patients had a significantly longer survival.

Antimicrobial activity of Butyl acetate, Ethyl acetate and Isopropyl alcohol on undesirable microorganisms in cosmetic products.

OBJECTIVE: The microbiological contamination risk of a cosmetic product has to be assessed by the manufacturer, according to the composition, to determine whether microbiological testing is required. Certain ingredients in cosmetic formulations help to create an environment hostile towards microbial growth. In this study, the influence on microbial survival of some solvents used in nail varnishes was evaluated. The purpose of this study was two-fold. The first was to define the thresholds to be considered for the exemption of products from microbiological testing. The second was to assess the cross-contamination risk linked to the use on successive consumers of solvent-based products in beauty salons. METHODS: Strains of Pseudomonas aeruginosa, Staphylococcus aureus, Escherichia coli, Candida albicans and Trichophyton rubrum were exposed to various concentrations of ethyl acetate, butyl acetate and isopropyl alcohol in culture medium to estimate their MIC (minimum inhibitory concentration). These strains are relevant to cosmetic products as they are associated with skin and nail infections. Mixtures of the three solvents, which are characteristic of nail varnish compositions, were also tested for their cidal activity. RESULTS: Ethyl and butyl acetates had a stronger impact than isopropyl alcohol: the MIC of ethyl and butyl acetate is ≤5% for all of the tested strains, whereas that of isopropyl alcohol is ≤10%. Various combinations of the three solvents tested showed a significant effect on both fungal and bacterial strains (greater than 3 log reduction in 15 min for the bacterial test strains and in 30 min for T. rubrum). CONCLUSION: Products containing more than 5% ethyl or butyl acetate or more than 10% isopropyl alcohol are hostile towards microbial growth. These products can therefore be considered as microbiologically low risk during both production and use, and so do not require microbiological testing (challenge test and end-product testing). Moreover, the nine tested mixtures of these three solvents - which are characteristic of nail varnish compositions - all have a high cidal activity on the tested strains within a short time. The risk of cross-contamination can therefore be considered as controlled when the nail varnishes are applied on successive clients in beauty salons.

Clinical Presentation of General Paralysis of the Insane in a Dutch Psychiatric Hospital, 1924-1954.

General paralysis of the insane (GPI) or dementia paralytica was once a fatal complication of syphilitic infection and a major reason for psychiatric hospitalization. Nowadays, physicians consider GPI to be exceptional. It should be noted, however, that syphilis re-emerged worldwide at the turn of the 20th to 21st century and a revival of GPI can, therefore, be expected. Advanced diagnosis is crucial in that treatment in the early, inflammatory phase is warranted before irreversible tissue damage occurs. Therefore, a renewed clinical awareness of the broad spectrum of psychiatric and neurologic signs and symptoms of GPI is needed. In this historical cohort study, comprising 105 patients with GPI admitted to the Dutch Vincent van Gogh Psychiatric Hospital in the period 1924-1954, the clinical presentation of this invalidating disorder is investigated and described in detail.

Method for evaluation of the efficacy of antimicrobial preservatives in cosmetic wet wipes.

Many cosmetic formulations are now available in the form of wet wipes packaged in sealed sachets or packets. Like the majority of cosmetic products having an aqueous phase, wipes are susceptible to microbial contamination and require the addition of preservatives. The efficacy of such preservatives can be evaluated using a standard challenge test performed on the wetting liquid but this test cannot be regarded as representative for this new type of formulation. The method presented here evaluates the efficacy of preservatives used in wet wipes kept in their original packaging. Dried inoculums were prepared by membrane filtration followed by drying in an incubator. The method is applicable to bacteria (Pseudomonas aeruginosa, Escherichia coli, Staphylococcus aureus and Enterococcus faecalis), Bacillus cereus spores and fungi (Candida albicans and Aspergillus niger). These inoculated carriers were inserted between two wipes in the original package, which was then re-sealed immediately. The test requires one dry inoculum per packet and one packet for each control or test. After incubation at 22.5 degrees C for 1, 2, 7, 14 or 28 days and, for the control, immediately after insertion of the membrane (time 0), microorganism counts were performed on the germ-carrier membranes as well as on adjacent wipes, after transfer into a suitable neutralizing agent. The membranes were shaken in the presence of glass beads and microorganisms were dissociated from the wipes by means of a Stomacher. The supernatants recovered after being left to stand for 20 min are counted by pour plate method or membrane filtration. The feasibility of the method was demonstrated for each of the seven above-mentioned strains. The repeatability and reproducibility of the results obtained is similar to that obtained for preservative efficacy tests in the Pharmacopoeias. The lethal rate of microorganisms during the preparation of dry inoculums ranges from 50 to 90% depending on the strain and the test (generally, a spontaneous reduction of about 1 log up to a maximum of 2 log). The recovery rate for microorganisms from dry inoculums (on membranes) at time 0 (control = T(0)) is around 90%, regardless of the strain or the test. The number of microorganisms recovered from the wipes (W(0)) is between 2 and 10% of the number recovered from membranes (T(0)) and may be considered negligible. Application of this method to different types of wipes demonstrates that the efficacy of preservatives, expressed as the logarithmic reduction in the number of microorganisms at each time point, depends on the type of wipe and on the strain tested. The results obtained are considerably different from those found with the standard challenge tests applied to wetting liquids for wipes. The differences found confirm the need for a specific method applicable to wipes.