Tungiasis, a rare case of plantar inflammatory disease, a review of travelers skin lesions for emergency providers.

Parasitic infections while common in underdeveloped nations are rarely seen in developed urban centers. We report a case of a thirty-three-year-old male with no past medical history who presented to the emergency department with a chief complaint of "eggs coming out of my foot" after returning home from Brazil. Based on clinical presentation, travel history, and appearance of the lesion, diagnosis was most consistent with tungiasis infection which was confirmed by the pathology examination. It is important to make the appropriate diagnosis when skin lesions are found in returning travelers and emergency providers should take broad differential diagnosis into consideration.

Peripheral i.v. analysis (PIVA) of venous waveforms for volume assessment in patients undergoing haemodialysis.

Background: The assessment of intravascular volume status remains a challenge for clinicians. Peripheral i.v. analysis (PIVA) is a method for analysing the peripheral venous waveform that has been used to monitor volume status. We present a proof-of-concept study for evaluating the efficacy of PIVA in detecting changes in fluid volume. Methods: We enrolled 37 hospitalized patients undergoing haemodialysis (HD) as a controlled model for intravascular volume loss. Respiratory rate (F0) and pulse rate (F1) frequencies were measured. PIVA signal was obtained by fast Fourier analysis of the venous waveform followed by weighing the magnitude of the amplitude of the pulse rate frequency. PIVA was compared with peripheral venous pressure and standard monitoring of vital signs. Results: Regression analysis showed a linear correlation between volume loss and change in the PIVA signal (R2=0.77). Receiver operator curves demonstrated that the PIVA signal showed an area under the curve of 0.89 for detection of 20 ml kg-1 change in volume. There was no correlation between volume loss and peripheral venous pressure, blood pressure or pulse rate. PIVA-derived pulse rate and respiratory rate were consistent with similar numbers derived from the bio-impedance and electrical signals from the electrocardiogram. Conclusions: PIVA is a minimally invasive, novel modality for detecting changes in fluid volume status, respiratory rate and pulse rate in spontaneously breathing patients with peripheral i.v. cannulas.

Polyethylene glycol-fused allografts produce rapid behavioral recovery after ablation of sciatic nerve segments.

Restoration of neuronal functions by outgrowths regenerating at ∼1 mm/day from the proximal stumps of severed peripheral nerves takes many weeks or months, if it occurs at all, especially after ablation of nerve segments. Distal segments of severed axons typically degenerate in 1-3 days. This study shows that Wallerian degeneration can be prevented or retarded, and lost behavioral function can be restored, following ablation of 0.5-1-cm segments of rat sciatic nerves in host animals. This is achieved by using 0.8-1.1-cm microsutured donor allografts treated with bioengineered solutions varying in ionic and polyethylene glycol (PEG) concentrations (modified PEG-fusion procedure), being careful not to stretch any portion of donor or host sciatic nerves. The data show that PEG fusion permanently restores axonal continuity within minutes, as initially assessed by action potential conduction and intracellular diffusion of dye. Behavioral functions mediated by the sciatic nerve are largely restored within 2-4 weeks, as measured by the sciatic functional index. Increased restoration of sciatic behavioral functions after ablating 0.5-1-cm segments is associated with greater numbers of viable myelinated axons within and distal to PEG-fused allografts. Many such viable myelinated axons are almost certainly spared from Wallerian degeneration by PEG fusion. PEG fusion of donor allografts may produce a paradigm shift in the treatment of peripheral nerve injuries.

One-year outcome after a first clinically possible epileptic seizure: predictive value of clinical classification and early EEG.

OBJECTIVE: To assess the one-year outcome of patients referred to the emergency room for a first paroxysmal event of clinically certain or uncertain epileptic origin. METHODS: This prospective observational cohort study included 175 adult patients who were consecutively referred for a first paroxysmal event and excluding clinically certain syncope faints. Simple descriptive clinical criteria were used by emergency room physicians for epileptic assessment. Follow-up and final diagnosis were made by neurologists specialized in epilepsy. The risk of recurrence and epilepsy over time was described using Kaplan-Meier estimates. The effect of risk factors (including EEG results) was assessed using univariate log-rank tests and a Cox regression multivariate model. Negative and positive predictive values (NPV and PPV) at 1 year of significant factors were calculated. RESULTS: Clinical criteria were positive in 67 patients and negative in 108. At 1 year, the rate of recurrence was respectively 8% in the negative clinical criteria group (NCC) and 30% in the positive clinical criteria group (PCC) (RR=9.3; 95% CI=[1.22; 71.4]). The risk of subsequent epilepsy was respectively 16% in the NCC group and 57% in PCC group (RR=5.6; 95% CI=[2.0; 15.6]). Positive predictive value (PPV) of clinical criteria was 28.8% for recurrence and 57.6% for definite epilepsy. Negative predictive value (NPV) of clinical criteria was 93.2% for recurrence and 83.5% for definite epilepsy. The presence of significant abnormalities on early EEG (paroxysms or focal abnormalities) supported an epileptic origin in 17% of clinically uncertain seizures. It was associated with a higher risk of subsequent epilepsy (RR=2.50; 95% CI [1.37; 4.41]; P=0.007), but did not significantly improve the PPV of clinical criteria alone. CONCLUSION: These results may help provide a prognosis at 1 year after a first paroxysmal event of certain or uncertain epileptic origin. Future studies focusing on the outcome after a first epileptic seizure should take into consideration the degree of certainty of the clinical diagnosis and integrate the group of patients with uncertain epileptic seizure.

Vedic principles of therapy.

This paper introduces Vedic principles of therapy as a holistic integration of healing and human development. The most integrative aspect is a "consciousness-based" approach in which the bottom line of the mind is consciousness itself, accessed by transcending mental activity to its simplest ground state. This directly contrasts with "unconscious-based" approaches that hold the basis of conscious mind is the unconscious, such as analytic, humanistic, and cognitive-behavioral approaches. Although not presented as a specific therapeutic approach, interventions associated with this Vedic approach have extensive support in the applied research literature. A brief review of experimental research toward a general model of mind-and cutting-edge developments in quantum physics toward nonlocal mind-shows a convergence on the ancient Vedic model of mind. Comparisons with contemporary therapies further show that the simplicity, subtlety, and holistic nature of the Vedic approach represent a significant advance over approaches which have overlooked the fundamental ground state of the mind.

Changes in spinach phylloepiphytic bacteria communities following minimal processing and refrigerated storage described using pyrosequencing of 16S rRNA amplicons.

AIMS: To investigate the changes in bacterial diversity on fresh spinach phyllosphere associated with storage at refrigeration temperatures. METHODS AND RESULTS: Community structure and population dynamics of spinach phylloepiphytic bacteria associated with packaging and refrigeration of ready-to-eat fresh produce were evaluated using pyrosequencing of 16S rRNA gene amplicons. A diverse community responsive to storage at refrigerated temperatures was detected belonging to over 1000 operational taxonomic units, including many diverse members not previously described on the phyllosphere. Of the approx. 8800 unique sequences examined from fresh spinach leaves, 75% were from previously undescribed taxa. The classified sequences from the fresh spinach phyllosphere were assigned to 11 different phyla with the largest number of reads belonging to Proteobacteria and Firmicutes. Packaging and storage of spinach under refrigerated conditions decreased the richness, diversity and evenness of the bacterial community. Refrigeration at 4 and 10°C and storage resulted in a decrease in number of taxa represented from 11 phyla in fresh spinach to only 5 phyla after 1 day of storage. Sequences belonging to γ-Proteobacteria, particularly Pseudomonas spp. and members of the Enterobacteriaceae, were the most numerous after 15 days of storage at both temperatures. Growth inhibition of the genera Escherichia was achieved at 4°C but not at 10°C storage, thus highlighting the importance of temperature in fresh packaged spinach. CONCLUSIONS: The application of pyrosequencing to describe composition and diversity of the phyllosphere on spinach leaves provided a broader outlook of the bacterial composition of this community complementing other phyllosphere studies that have used culture- and nonculture-dependent approaches. SIGNIFICANCE AND IMPACT OF THE STUDY: Pyrosequencing allowed a broader description of the bacterial composition and diversity of the spinach leaf surface than previously obtained using culture-based detection and will be a powerful tool to help ensure the future safety and quality of packaged spinach.

Survival of Listeria monocytogenes, Listeria innocua, and lactic acid bacteria in chill brines.

Listeria monocytogenes is the pathogen of concern in ready-to-eat (RTE) meat products. Salt brines are used to chill processed meats. L. monocytogenes and lactic acid bacteria (LAB) can grow under saline conditions, and may compete with each other for nutrients. The objective of this study was to determine the effect of lactic acid bacteria (Enterococcus faecalis, Carnobacterium gallinarum, and Lactobacillus plantarum) on the survival of L. monocytogenes and Listeria innocua in brines stored under low temperatures for 10 d. Sterile tap water (STW) and 2 brine solutions (7.9% and 13.2% NaCl) were inoculated with 1 of 5 cocktails (L. monocytogenes, L. innocua, LAB, L. monocytogenes+ LAB, or L. innocua+ LAB) at initial concentrations of 7 log CFU/mL. Brines were stored for 10 d at 4 or 12 degrees C. Three replications of each brine concentration/cocktail/temperature combination were completed. No significant reductions of L. monocytogenes occurred in 7.9%[w/v] or 13.2%[w/v] brines when LAB were present; however, there were significant reductions after 10 d of L. monocytogenes in the STW solution when LAB were present (1.43 log CFU/mL at 4 degrees C and 3.02 log CFU/mL at 12 degrees C). L. innocua was significantly less resilient to environmental stresses of the brines than L. monocytogenes, both with and without LAB present (P< or = 0.05). These strains of lactic acid bacteria are not effective at reducing L. monocytogenes in brines at low temperatures. Furthermore, use of L. innocua as a model for L. monocytogenes is not appropriate under these environmental conditions.

Use of UV light for the inactivation of Listeria monocytogenes and lactic acid bacteria species in recirculated chill brines.

Ready-to-eat meat products have been implicated in several foodborne listeriosis outbreaks. Microbial contamination of these products can occur after thermal processing when products are chilled in salt brines. The objective of this study was to evaluate UV radiation on the inactivation of Listeria monocytogenes and lactic acid bacteria in a model brine chiller system. Two concentrations of brine (7.9% [wt/wt] or 13.2% [wt/wt]) were inoculated with a approximately 6.0 log CFU/ml cocktail of L. monocytogenes or lactic acid bacteria and passed through a UV treatment system for 60 min. Three replications of each bacteria-and-brine combination were performed and resulted in at least a 4.5-log reduction in microbial numbers in all treated brines after exposure to UV light. Bacterial populations were significantly reduced after 5 min of exposure to UV light in the model brine chiller compared with the control, which received no UV light exposure (P < 0.05). The maximum rate of inactivation for both microorganisms in treated brines occurred between minutes 1 and 15 of UV exposure. Results indicate that in-line treatment of chill brines with UV light reduces the number of L. monocytogenes and lactic acid bacteria.

Detection of depression and anxiety disorders by home care nurses.

Several studies have reported that psychiatric disorders, mainly depression and anxiety disorders, were masked and undiagnosed among older adults, particularly frail elderly. This phenomenon could have a significant impact on elderly quality of life. In this study, we assessed the utility of three measures for detecting mental health disorders among frail elderly receiving home care services: (1) the PRIME-MD; (2) a standard psychological distress measure (PDI-29), and (3) the health care case manager'sa priori judgment on the subject's mental health status. Results obtained by home care nurses were compared to those obtained by clinical psychologists using a structured diagnostic interview (SCID for DSM-IV). The study was conducted in two community health service centres. During the study's period, all patients in the health care workers' caseload without cognitive impairment and not reporting significant stressful life events during the six-week period preceding the interview (n = 315) were asked to participate in the study. Results showed that 42.9% of the volunteers that agreed to meet a psychologist at home (n = 177) had a current SCID-IV diagnosis. The specificity of the PRIME-MD test performed by nurses was 83.8% and its sensitivity was 41.7%. The correct classification rate was 66.7%. Results indicated that the PDI-29 items showed better performance characteristics than the PRIME-MD in identifying current cases. The specificity of the PDI-29 was 59.0% and its sensitivity was 73.6%. These results lead us to the conclusion that the PRIME-MD, previously proposed by Spitzer, R.L., Williams, J.B., Kroenke, K., Linzer, M., DeGruy, F.V. 3rd, Hahn, S.R., et al. (1994, Utility of a new procedure for diagnosing mental disorders in primary care. The PRIME-MD 1000 study. Journal of the American Medical Association, 272 (22), 1749-1756.) to help physicians in primary care clinics, could be less appropriate than the PDI-29 when used by home care nurses in identifying undiagnosed mental health disorders in frail older adults living at home. Moreover, this study showed that the health care case manager'sa priori judgment on the care receiver's mental health status is not sufficient in identifying frail elderly mental health services needs. A two-stage screening procedure is proposed to help home care nurses.

Correlates of psychotropic drug use in the elderly compared to adults aged 18-64: results from the Quebec Health Survey.

This study documents correlates of psychotropic drug use among older adults and compares the results observed in this group to those observed in individuals aged 18-64. A multivariate logistic regression analysis using data from the Quebec Health Survey (1992-1993) was employed to study predisposing and facilitating factors of this behavior. Results showed that 22% of the elderly reported having used anxiolytics, sedatives or hypnotics during the two days preceding the survey, compared to 4.9% of the respondents aged 18-64. Combining both samples, perceived health status, physical functional status, and health services utilization for psychological distress symptoms were the main health factors associated with psychotropic drug use. A significant difference was observed between the two age groups with regard to the association between the respondents' health status and the use of anxiolytics, sedatives or hypnotics. When the effect of other explanatory factors was controlled, older adults in poor health used anxiolytics, sedatives or hypnotics 2.21 times more than individuals aged 18-64 with a similar health condition, whereas older adults in good health used these drugs 7.49 times more than healthy individuals aged 18-64. Furthermore, after controlling for the effect of the respondents' physical and psychological health status, our results showed that more women than men used psychotropic drugs (OR = 1.57; 99% CI = 1.26-1.94). Low-income respondents were also more likely to report using these medications (OR = 1.53; 99% CI = 1.22-1.90). These results were interpreted as supporting the socio-cultural hypothesis of psychotropic drug use, which suggests that the prescribing and utilization of psychotropic drugs is influenced not only by symptoms but also by the social characteristics of individuals. It is suggested that future research may contribute to a better understanding of psychotropic drug utilization in the older adult community-dwelling population by examining consumers' attitudes and health care providers' social values concerning the appropriateness of this behavior.

N-acyloxymethyl carbamate linked prodrugs of pseudomycins are novel antifungal agents.

We describe herein the synthesis, bioconversion, antifungal activity, and preliminary toxicology evaluation of a series of N-acyloxymethyl carbamate linked triprodrugs of pseudomycins. The syntheses of these prodrugs (3-6) were achieved via simple N-acylation of PSB (1) or PSC' (2) with various prodrug linkers (7-9). As expected, upon incubation with mouse and/or human plasma, many of these prodrugs (3, 5, and 6) were converted to the parent compound within a few hours. Of particular significance, two pseudomycin triprodrugs (5 and 6) showed excellent in vivo efficacy against systemic Candidiasis without tail vein irritation being observed.

Synthesis and evaluation of oxodioxolenylmethyl carbamate prodrugs of pseudomycins.

With the aim of increasing therapeutic indexes of novel cyclic depsinonapeptide pseudomycins, we synthesized and evaluated a series of mono-, di-, and trioxodioxolenylmethyl carbamate prodrugs (2 and 4) of pseudomycin B 1 and pseudomycin C' 3. It is rather encouraging to note that several members of the newly synthesized prodrugs described herein (e.g., 2a, 2e, and 4e) exhibited comparable in vivo efficacy to that achieved by the parent compounds, yet free of tail vein irritation and histamine induced toxicity in vivo.

Relationship between soil lead and airborne lead concentrations at Springfield, Missouri, USA.

This study tests whether lead deposited to soil from automobiles during past years in a medium-sized US city (population 150,000) may present a current health risk. It examines the relationship between current soil lead concentrations at nine locations within the city of Springfield, Missouri, and airborne lead levels measured at the same locations during years (1975-1981) when lead emissions from automobiles were much greater than at present. A strong, significant correlation is found between soil and airborne lead levels at eight of the sites (r = 0.91, P < 0.005 for soil lead vs. 1979 airborne lead), in low-traffic areas as well as in areas adjacent to heavy traffic flow. Residual lead concentrations in these soils are relatively low, even for the high-traffic sites, as expected for a medium sized city.

Loneliness in relation to suicide ideation and parasuicide: a population-wide study.

Some links between loneliness and different manifestations of suicidal conduct have been reported in variety of subgroups (e.g., college students, the elderly, psychiatric patients). We tested this hypothesis by using the results of a population-wide survey. Strong associations among suicide ideation, parasuicide and different ways of being lonely and alone, defined either subjectively (i.e., the feeling), or objectively (i.e., living alone or being without friends), were observed. Moreover, prevalence of suicide ideation and parasuicide increased with the degree of loneliness. Only minimal differences between men and women were found.

Posttraumatic stress disorder, trauma exposure, and the current health of Canadian bus drivers.

OBJECTIVE: Previous studies of veterans have linked posttraumatic stress disorder (PTSD) after combat-related trauma to increased reports of health problems. It is unclear whether this association between PTSD and increased health problems generalizes to civilians who are exposed to a broader array of traumatic events. We also do not know whether trauma exposure is associated with increased health problems in individuals who do not develop PTSD. Using a non-treatment-seeking civilian sample, we examined whether lifetime PTSD or trauma exposure by itself was associated with current health problems. METHODS: Using a cross-sectional design and self-report measures, we evaluated urban Canadian bus drivers (n = 342) on trauma exposure, lifetime PTSD, and current health problems. Based on their responses, we divided our sample into individuals who had never experienced trauma (n = 91), trauma-exposed individuals who had never developed PTSD (n = 218), and persons who developed PTSD at some point after trauma (n = 33). We compared these groups on health problems, treatment service use, and health assessment measures. RESULTS: The PTSD group reported increased health complaints, more frequent use of health treatments, and poorer health self-ratings compared with the exposed non-PTSD and nonexposed groups. Trauma-exposed drivers without PTSD did not differ from unexposed drivers on any health measure. Controlling for sex and trauma frequency did not alter our findings. CONCLUSIONS: Trauma exposure that leads to PTSD is associated with increased health problems, while trauma exposure alone is not. Our results extend previous findings to a broader civilian context and clarify associations between trauma exposure and health.

[Psychological well-being and related concepts: a conceptual comparative analysis.]. / Le bien-être psychologique et ses concepts cousins, une analyse conceptuelle comparative.

The concept of psychological well-being acquired more importance in the field of health over the last decade. Ever since research paid more attention to "quality of life", psychological well-being became popular. The increasing interest in this concept entailed the development of many scales of measure. However, less importance has been given to the conceptual development of its construct, thus creating confusion between terms which at first appear similar: psychological well-being, subjective well-being, quality of life, spirit, satisfaction in life, happiness and mental health. The objective of this literature review (n:57) was to conduct a conceptual and comparative analysis (Morse et al., 1996) of psychological well-being with competitive concepts according to a comtemporary approach of analysis. Results show that these concepts are distinct and should not be used in an interchangeable way. They are distinct on various levels: type of measure (objective/subjective), type of evaluation (cognitive and affective), attributes, antecedents, consequences and influence of time (temporary/stable). Results of this review brings new light at the conceptual level for several terms. Graphic 1 illustrates its various positions thus favoring a better use of these terms in research.

Emotional distress among couples involved in first-trimester induced abortions.

OBJECTIVE: To establish the prevalence of clinically significant psychological distress in women and men involved in first-trimester abortions and to identify related risk factors. DESIGN: Prospective cohort study. SETTING: A downtown Montreal public abortion clinic and the Montreal metropolitan area. PARTICIPANTS: We recruited 197 women and 113 men involved in first-trimester abortions and compared them with control groups composed of 728 women and 630 men 15 to 35 years old who had taken part in a previous public health survey (Enquête Santé Québec 1987). One hundred twenty-seven women and 69 men completed the follow-up questionnaire. MAIN OUTCOME MEASURES: Level of distress as measured by the Ilfeld Psychological Symptom Index. RESULTS: Before the abortion, 56.9% of women and 39.6% of men were much more distressed than their respective controls. Three weeks after the abortion, 41.7% of women and 30.9% of men were still highly distressed. Predictors of distress for women were fear of negative effects on the relationship, unsatisfactory relationships, relationships of less than 1 year, ambivalence about the decision to abort, not having a previous child, and suicidal ideation (this association was weaker than in controls). Predictors for men were fear of negative effects on the relationship, relationships of less than 1 year, preoccupation with the abortion and anxiety about its accompanying pain, negative perceptions of their own health, suicidal gestures in the past, and suicidal ideation in the past year (only the association with suicidal gestures was marginally stronger than in controls). CONCLUSION: Being involved in a first-trimester abortion can be highly distressing for both women and men.

Syntheses and biological evaluation of novel pseudomycin side-chain analogues. Part 2.

A series of aliphatic side-chain analogues of pseudomycin was synthesized and evaluated during the course of our side-chain SAR effort. We found that several of the pseudomycin side-chain analogues (e.g., 10) exhibited good in vitro activity against all three major fungi responsible for systemic fungal infections.