Are we seeing the effects of public awareness campaigns? A 10-year analysis of Breslow thickness at presentation of malignant melanoma in the South West of England.

INTRODUCTION: The last 20 years has seen a marked improvement in skin cancer awareness campaigns. We sought to establish whether this has affected the presenting Breslow thickness of malignant melanoma in the South West. METHOD: This is a retrospective study looking at the first presentation of melanomas from 2003 to 2011. Data was accessed using the local online melanoma database. RESULTS: A total of 2001 new melanomas presented from 2003 to 2012 (Male:Female = 1:1.062). The average yearly number of melanomas was 200.1 (range = 138-312). The mean age was 62.5 years (range 12-99). Data was analysed using a Chi² test. For 0-1 mm melanomas, there is a significant difference in the observed versus expected values over the 10 years (p = 0.0018). There is an increasing proportion of 0-1 mm (thin) melanomas presenting year on year, with a positive linear trend. This is very statistically significant (p < 0.0001). The 1-2 mm melanomas are decreasing in proportion with a negative linear trend (p = 0.0013). The 2-4 mm are also decreasing in proportion (p = 0.0253). There is no significant change in the thick >4 mm melanomas (p = 0.1456). CONCLUSION: The proportion of thin 0-1 mm melanomas presenting in South West England has significantly increased from 2003 to 2012. There is no significant change in the thick >4 mm melanomas. This may be a result of increased public awareness due to effective public health campaigns which has significant prognostic and financial implications.

Epidemiological profile and clinical associations of human bocavirus and other human parvoviruses.

BACKGROUND: Human bocavirus (HBoV) and PARV4 are newly discovered human parvoviruses. HBoV, which was first detected in respiratory samples, has a potential role in the development of human respiratory disease. The present study compared the frequencies, epidemiological profiles, and clinical backgrounds of HBoV and PARV4 infections with those of other respiratory virus infections, by evaluating diagnostic samples referred to the Specialist Virology Laboratory (SVL) at the Royal Infirmary of Edinburgh (Edinburgh, United Kingdom). METHODS: Anonymized samples and study subject information were obtained from the respiratory sample archive of the SVL. Samples were screened for HBoV, PARV4, B19, respiratory syncytial virus (RSV), adenoviruses, influenza viruses, and parainfluenza viruses by use of nested polymerase chain reaction. RESULTS: HBoV infection was detected in 47 (8.2%) of 574 study subjects, ranking third in prevalence behind RSV infection (15.7%) and adenovirus infection (10.3%). Peak incidences of HBoV were noted among infants and young children (age, 6-24 months) during the midwinter months (December and January) and were specifically associated with lower respiratory tract infections. HBoV infections were frequently accompanied by other respiratory viruses (frequency, 43%), and they were more prevalent among individuals infected with other respiratory viruses (17%), frequently adenovirus or RSV. All respiratory samples were negative for PARV4. CONCLUSIONS: In the present study, HBoV was a frequently detected, potential respiratory pathogen, with a prevalence and an epidemiological profile comparable to those of RSV. Identification of HBoV infections may be clinically important in the future.

Benign acute childhood myositis in an accident and emergency setting.

Four children presented to the Accident and Emergency department of the Royal Hospital for Sick Children in Edinburgh during seven days in February 2003. They shared a strikingly similar clinical picture with debilitating muscle pain in their calves. This paper discusses their clinical course and presents a literature review of the problem.

The decay of chlorine associated with the pipe wall in water distribution systems.

Free chlorine decay rates in water distribution systems for bulk and wall demands should be modelled separately as they have different functional dependencies. Few good quality determinations of in situ wall demand have been made due to the difficulty of monitoring live systems and due to their complexity. Wall demands have been calculated from field measurements at 11 locations in a distribution system fed from a single source. A methodology for the laboratory determination has been evolved and shown to give results that are similar to the in situ results. Pipe materials were classified as either having high reactivity (unlined iron mains) or low reactivity (PVC, MDPE and cement-lined ductile iron). The results indicate that wall decay rates for the former are limited by chlorine transport and for the latter by pipe material characteristics. The wall decay rate is inversely related to initial chlorine concentration for low reactivity pipes. In general, water velocity increases wall decay rates though the statistical confidence is low for low reactivity pipes. A moderate biofilm coating did not influence the wall decay rate for low reactivity pipes.

The potential for biofilm growth in water distribution systems.

Biofilms on pipe walls in water distribution systems are composed of bacteria in a polymeric matrix, which can lead to chlorine demand, coliform growth, pipe corrosion and water taste and odour problems. The majority of previous studies have been laboratory or pilot plant based and few results are available for field conditions. In this study, field observations of biofilm were made using biofilm potential monitors. The monitor results were compared with pipe samples taken from the distribution system and with laboratory pipe reactors. An empirical equation quantified the inhibitory effects of free chlorine and decrease of temperature on biofilm growth. With water having total organic carbon concentrations in the range 1.5-3.9mg/1 a free chlorine residual of 0.2 mg/l was needed to reduce biofilm concentration to below 50 pg ATP cm2. Pipe material influenced biofilm activity far less than chlorine with mean biofilm activity being ranked in the order glass (136 pg ATP/cm2) < cement (212 pg ATP/cm2) < MDPE (302 pg ATP/ cm2) < PVC (509 pg ATP/cm2).

The protective effect of immunisation against diphtheria, pertussis and tetanus (DPT) in relation to sudden infant death syndrome.

Epidemiological evidence indicates infants immunised against diphtheria, pertussis and tetanus (DPT) are at decreased risk of sudden infant death syndrome (SIDS). Asymptomatic whooping cough and pyrogenic toxins of Staphylococcus aureus have been implicated in the aetiology of SIDS. The objectives of the present study were: (1) to determine if the DPT vaccine induced antibodies cross-reactive with the staphylococcal toxins; (2) to determine if antibodies to the pertussis toxin (PT) and the staphylococcal toxins were present in the sera of women during late pregnancy; (3) to examine the effects of infant immunisation on levels of antibodies to PT and the staphylococcal toxins; (4) to assess the effects of changes in immunisation schedules in the UK on the incidence and age distribution of SIDS. Enzyme-linked immunosorbent assays (ELISA) were used to measure binding of rabbit or human IgG to the DPT vaccine, PT, toxic shock syndrome toxin-1 (TSST-1) and staphylococcal enterotoxins A (SEA), B (SEB) and C (SEC). Neutralisation activity of anti-DPT serum was assessed by a bioassay for induction of nitric oxide from human monocytes by the staphylococcal toxins. Anti-DPT serum bound to the DPT vaccine, PT and each of the staphylococcal toxins. It also reduced the ability of the four toxins to induce nitric oxide from monocytes. In pregnant women, levels of IgG to PT, SEC and TSST-1 decreased significantly in relation to increasing weeks of gestation while antibodies to SEA and SEB increased. In infants' sera there were significant correlations between levels of IgG bound to DPT and IgG bound to PT, TSST-1 and SEC but not SEA or SEB. Antibody levels to the toxins in infants declined with age; sera from infants < or = 2 months of age had higher levels of IgG bound to the toxins than those older than 2 months. This pattern was observed for infants whose immunisation schedules began at 2 months of age or 3 months of age. The decrease in IgG bound to the toxins was, however, less for those immunised at 2 months. The decrease in SIDS deaths after the change in immunisation schedules was greatest in the 4-6-month age range. While DPT immunisation might prevent some unexplained infant deaths due to asymptomatic whooping cough, these data indicate that immunisation with DPT also induces antibodies cross-reactive with pyrogenic staphylococcal toxins implicated in many cases of SIDS. Passive immunisation of infants who have low levels of these antibodies might reduce further the numbers of these infant deaths.

Mannan binding lectin and the sudden infant death syndrome.

Mannan binding lectin (MBL) may be important for innate immunity and some cases of sudden infant death syndrome (SIDS) may be preceded by bacterial infection. Therefore, relative MBL deficiency might be associated with susceptibility to SIDS. We measured MBL concentrations in 46 SIDS infants and 26 controls. The proportion of subjects with low MBL values was similar in the two groups. However, the mean for the SIDS group (3 micrograms/ml) was higher than that of the controls (2.2 micrograms/ml; P < 0.05). We interpret this difference as due to acute phase responses and suggest these findings are consistent with the view that some cot deaths are preceded by bacterial infections.

Respiratory viruses in a hospitalized paediatric population in Edinburgh 1985-1994.

We describe the incidence of respiratory viruses identified in children admitted to an Edinburgh hospital between October 1985 and July 1994. Respiratory syncytial (RS) virus, influenza viruses and parainfluenza viruses showed seasonal activity whereas adenoviruses and rhinoviruses did not. Parainfluenza viruses were the most changeable in their epidemiological behaviour and RS virus the least.

Does large loop excision of the transformation zone of the cervix predispose to the development of antisperm antibodies in women?

OBJECTIVE: To determine whether large loop excision of the transformation zone of the uterine cervix for cervical intraepithelial neoplasia predisposes to the development of female isoimmunity to human spermatozoa. DESIGN: A prospective, controlled study. SETTING: Colposcopy and Andrology units at the John Radclife and Churchill Hospitals, Oxford, United Kingdom. INTERVENTIONS: Serum samples were collected from 33 women before large loop excision of the transformation zone of the cervix and repeated at a minimum time interval of 4 months after the procedure. Women were questioned regarding the procedure and subsequent reproductive function. A control population of 30 women not undergoing cervical surgery also underwent serial serum screening for antisperm antibodies. MAIN OUTCOME MEASURE(S): The detection of serum antisperm antibodies by flow cytometry. RESULTS: None of the serum samples before large loop excision of the cervical transformation zone had clinically significant levels of antisperm antibodies. There was, however, a significant rise in antisperm antibody levels in women following large loop excision of the transformation zone. Apparent risk factors for the development of antisperm antibodies included a short duration of sexual abstinence and the use of nonbarrier contraception after surgery. There was no rise in antisperm antibody levels in the control population. CONCLUSION: Large loop excision of the transformation zone of the cervix is a risk factor for the development of antisperm antibodies in women. Women should be advised to use barrier contraception or avoid sexual intercourse until complete healing of the cervix has occurred.

Vertical transmission of hepatitis C virus infection.

Since the virus responsible for non-A, non-B hepatitis was cloned in 1989, much has been learnt about the epidemiology, diagnosis and clinical spectrum of hepatitis C virus (HCV) infection. As the routes of transmission are elucidated, specific groups of children as well as adults are known to be at particular risk of infection. The women most at risk of HCV infection are those with a history of injecting drug use. Mother-to-child transmission has been documented, although the exact risk has not been quantified, and the factors influencing the risk remain to be evaluated. This article reviews current knowledge on vertical transmission of HCV, and provides some guidelines on the management of infants born to women infected with the virus.

Emotional reactions in women attending a UK colposcopy clinic.

STUDY OBJECTIVE: To assess the emotional responses of women attending a colposcopy clinic for investigation of an abnormal cervical smear, and to elicit the women's views on the screening service and colposcopy clinic. DESIGN: Over 12 months all new attenders at a colposcopy clinic were invited to join the study. They were assessed psychiatrically four weeks before their first clinic appointment, and four weeks and 32 weeks after their first clinic appointment. SETTING: Colposcopy clinic, John Radcliffe Hospital, Oxford. PATIENTS: Of 114 women attending the colposcopy clinic for investigation of an abnormal cervical smear, 102 agreed to enter the study. MEASUREMENTS: Psychiatric symptoms were assessed with a standardised psychiatric interview, the present state examination; and with four self rated mood scales:--the general health questionnaire, the Beck depression inventory, the Leeds depression scale, and the Leeds anxiety scale. MAIN RESULTS: On all these measures, in the whole patient group, psychiatric morbidity was found to be transient and relatively minor. Thus ratings on the present state examination were not significantly higher than the rate found in a community sample of 520 women in Oxford, while on the four self rated mood scales, mean total scores were lower than the cut off value used to distinguished cases. Patient satisfaction with the colposcopy services was generally high but there was some dissatisfaction with delays. CONCLUSIONS: After an abnormal cervical smear, further investigation by colposcopy is generally associated with low levels of anxiety and depression.

Human papillomavirus status in the prediction of high-grade cervical intraepithelial neoplasia in patients with persistent low-grade cervical cytological abnormalities.

The role of human papillomavirus (HPV) detection in the management of patients with persistent low-grade (mild dyskaryosis or less) cervical cytological abnormalities is unclear. We have analysed cytological material from 167 such patients both cytologically and by non-isotopic in situ hybridisation (NISH) for HPV 16, 18, 31 and 33 and consensus primer polymerase chain reaction (PCR) amplification followed by both generic and specific typing for these HPV types. Cervical intraepithelial neoplasia (CIN) 2 or 3 was present in 40 of 167 patients (23.9%), and the positive predictive values (PPVs) for the presence of CIN 2 or 3, of moderate or severe dyskaryosis at repeat cytology and an HPV-positive NISH and generic PCR signal were 100%, 66% and 42% respectively. The corresponding sensitivities were 48%, 68% and 87%. Addition of cytology to molecular analysis improved both PPV and sensitivity, the best combination being NISH and cytopathology (PPV 71%, sensitivity 87%). These data demonstrate that the presence of CIN 2 or 3 in patients with mild cytological abnormalities can be predicted by molecular detection of HPV in some cases, particularly when combined with cytological analysis. However, the magnitude of this prediction is dependent on the population of patients studied, and the clinical role of this approach therefore remains to be defined.