[Dermophytes and guinea pigs : An underestimated danger?] / Dermatophyten und Meerschweinchen : Eine unterschätzte Gefahr?

BACKGROUND: For several years, an increasing number of human infections, mainly affecting children, with the zoophilic dermatophyte Trichophyton benhamiae has been observed. It is predominantly transmitted by pet guinea pigs. The prevalence of the dermatophyte on guinea pigs which are for sale in pet shops is unknown. OBJECTIVE: Therefore, the aim of this study was to analyze the frequency of T. benhamiae on symptomatic and asymptomatic guinea pigs from pet shops in Berlin. METHODS: We sampled 59 guinea pigs from 15 pet shops using toothbrushes (MacKenzie brush technique) and FLOQswabs™ and analyzed the material for the presence of T. benhamiae with polymerase chain reaction (PCR) and culture. RESULTS: We detected T. benhamiae on more than 90% of the guinea pigs; 9% of which showed visible tinea symptoms. The majority was identified as asymptomatic carriers of the dermatophyte. CONCLUSION: Pet shop guinea pigs have a high risk of being carriers of T. benhamiae, which can be transmitted to humans via physical contact, even though there is no visible infection in most cases. It is therefore recommended to have newly purchased animals examined by a veterinarian.

Pregnancy outcome following maternal exposure to statins: a multicentre prospective study.

OBJECTIVE: This contribution addresses the risk associated with exposure to statins during pregnancy. DESIGN: Multicentre observational prospective controlled study. SETTING: European Network of Teratology Information Services. POPULATION: Pregnant women who contacted one of 11 participating centres, seeking advice about exposure to statins during pregnancy, or to agents known to be nonteratogenic. METHODS: Pregnancies exposed during first trimester to statins were followed up prospectively, and their outcomes were compared with a matched control group. MAIN OUTCOME MEASURES: Rates of major birth defects, live births, miscarriages, elective terminations, preterm deliveries and gestational age and birthweight at delivery. RESULTS: We collected observations from 249 exposed pregnancies and 249 controls. The difference in the rate of major birth defects between the statin-exposed and the control groups was small and statistically nonsignificant (4.1% versus 2.7% odds ratio [OR] 1.5; 95% confidence interval [95% CI] 0.5-4.5, P = 0.43). In an adjusted Cox model, the difference between miscarriage rates was also small and not significant (hazard ratio 1.36, 95% CI 0.63-2.93, P = 0.43). Premature birth was more frequent in exposed pregnancies (16.1% versus 8.5%; OR 2.1, 95% CI 1.1-3.8, P = 0.019). Nonetheless, median gestational age at birth (39 weeks, interquartile range [IQR] 37-40 versus 39 weeks, IQR 38-40, P = 0.27) and birth weight (3280 g, IQR 2835-3590 versus 3250 g, IQR 2880-3630, P = 0.95) did not differ between exposed and non-exposed pregnancies. CONCLUSIONS: This study did not detect a teratogenic effect of statins. Its statistical power remains insufficient to challenge current recommendations of treatment discontinuation during pregnancy.

Safety of negative-pressure wound therapy over ocular structures.

This is a report of the use, efficacy, and theoretic safety of negative-pressure wound therapy over ocular structures as a part of surgical treatment for necrotizing fasciitis. We treated a 65-year-old man with facial necrotizing fasciitis requiring serial debridement and closure of extensive periorbital and nasal wounds with skin grafts. Negative-pressure wound therapy was first used as a bridge to allow temporary closure and to encourage granulation tissue development. It was then used as a bolster dressing to stabilize skin grafts in the complex wound, not amenable to tie-over dressings. Excellent functional and cosmetic reconstruction of the periorbital and nasal regions was achieved. After treatment, the patient's corrected vision was 20/20. To our knowledge, the use of negative-pressure wound therapy directly over ocular structures has not been previously documented. In this case, it was safely used over the eyes with no sequelae to the patient's vision.

HIV-infected health care professionals. Public opinion about testing, disclosing, and switching.

BACKGROUND: We wanted to know what the public believes about the risks of human immunodeficiency virus (HIV) transmission in health care settings, and what opinions the public holds regarding HIV-infected health care professionals. We also wanted to uncover the correlates and predictors of those opinions. METHODS: A telephone survey of a nationwide random probability sample of adults was conducted in summer 1991. Thirteen hundred fifty adults completed the survey. The response rate was approximately 63%. We assessed (1) public opinion about whether HIV-infected physicians, surgeons, and dentists should quit working, and (2) the public's self-reported intention to remain in the care of an HIV-infected professional or to switch to another provider. RESULTS: Public concern about HIV transmission in health care settings has increased from 19% in 1988 to 38% in 1991. More of the public now believes that transmission from HIV-infected physicians is likely (up from 33% in 1988 to 46% in 1991). Yet, fewer respondents believe that HIV-infected physicians should not be allowed to work (45% vs 39%). Only 5% would deprive HIV-infected physicians of their livelihood as physicians. Fewer would switch from HIV-infected physicians now than in 1988 (56% vs 37%). Knowing someone with HIV infection was related to less concern and to less belief in likelihood of transmission as well as to increased support of HIV-infected health professionals' right to work. CONCLUSIONS: Although the public is more concerned about HIV transmission in health care settings since 1988, fewer would not allow HIV-infected health care professionals to work now than in 1988. Personalizing the epidemic, by using personal physicians and people with acquired immunodeficiency syndrome as educators, might help continue the trend toward improved attitudes toward HIV-infected health care professionals.

Glucocorticoids and Sarcoidosis: A Longitudinal Study on the Effects on Cortical and Trabecular Bone.

BACKGROUND: Glucocorticoid induced osteoporosis is a well-known side effect of glucocorticoid treatment. In sarcoidosis the impact on bone by glucocorticoid treatment is complex due to hormonal disturbances of calcium and vitamin-D, which by itself may cause bone loss. In this study we aimed to investigate the longitudinal impact of glucocorticoids on cortical and trabecular bone in patients with mild, recently diagnosed sarcoidosis. METHODS: Ten patients (8 females; mean age 44 (±13)) were studied during one year of glucocorticoid treatment. The assessment of mainly cortical to purely trabecular bone was made by dual X-ray absorptiometry (DXA) of the spine and hip, quantitative ultrasound of the calcaneus, and magnetic resonance relaxometry of the spine and calcaneus. Bone and hormonal measurements were performed at baseline, after 3, 6, and 12 months, and baseline, 3 weeks and 3 months, respectively. RESULTS: DXA of the spine, decreased from baseline at 6 months (P=0.01). R2' of the calcaneus decreased with time (B: -3.6;P=0.03). In the females (n=8) there was a significant decrease in DXA of the spine when comparing 3 months and 6 months (P=0.03), and 3 months and 12 months (P=0.02) and a decrease in R2'of the calcaneus from baseline to 12 months (P=0.01). There was no change in hormonal levels. CONCLUSION: Treatment of initial mild sarcoidosis with dose tapered glucocorticoid therapy only mildly affects the final trabecular and cortical bone and hormone levels. Dose tapering is an important part in glucocorticoid therapy, likely contributing to the mild effects on bone observed in this study.

Interaction between selenium and inorganic mercury.

Data on mercury and selenium interaction in the mammalian body are reviewed. Experimental data from studies on rats show that selenium interacts with mercury metabolism and toxicity after exposure to mercuric mercury. Autopsy data from workers exposed to mercury vapor indicate an association between mercury and selenium retention in the central nervous system, suggesting the formation of a mercury-selenium complex. In animal experiments, mercuric mercury interferes with selenium metabolism and toxicity. Available data do not, at present, permit deduction as to whether additional selenium intake in man, exposed to mercury vapor or mercuric mercury, will have any effect, beneficial or adverse.

Formation of 9,10-unsaturation in the mitomycins: facile fragmentation of beta-alkyl-beta-aryl-alpha-oxo-gamma-butyrolactones.

A facile fragmentation of beta-alkyl-beta-aryl-alpha-oxo-gamma-butyrolactones is reported. A study to assist in the elucidation of the mechanism of the reaction is also revealed.

Efficacy of oral beta-agonist maintenance therapy in preterm labor: a meta-analysis.

OBJECTIVE: To analyze the available data on the efficacy of oral beta-agonist maintenance therapy in delaying delivery and in decreasing the incidence of preterm birth and its complications. DATA SOURCES: A computer search of English-language abstracts using MEDLINE (medical subject heading terms: labor, premature and beta-adrenergic receptor agonist, therapeutic use) was supplemented with a review of the bibliographies of obstetric texts to identify randomized trials of oral beta-agonist maintenance therapy. METHODS OF STUDY SELECTION: Six trials were identified, of which four met our inclusion criteria for the meta-analysis. DATA EXTRACTION AND SYNTHESIS: Trials to be included in this meta-analysis underwent trial quality evaluation and data abstraction independently by two blinded investigators. An estimate of the odds ratio (OR) and risk difference was calculated for the dichotomous outcomes using both a random effects model and a fixed effects model. Continuous outcomes were pooled using a simple weighted average of the within-study difference in means. The pooled OR for preventing preterm delivery was 1.09 (95% confidence interval [CI] 0.60-1.99) and the OR for preventing recurrent preterm labor was 1.05 (95% CI 0.53-2.05). The pooled difference in the mean interval to delivery was -0.22 days (95% CI -2.5 to +1.99). CONCLUSIONS: The available data do not support a role for beta-agonist maintenance therapy after resolution of an acute episode of preterm labor in reducing the incidence of preterm delivery, increasing the interval to delivery, or reducing the incidence of recurrent preterm labor.

Racial differences in survival from gynecologic cancer.

OBJECTIVE: To determine whether survival from gynecologic cancer is different between African-American and white patients at an inner-city hospital with both a large clinic and a private service. METHODS: We studied 538 patients (89 African American, 449 white) diagnosed with cervical, uterine, or ovarian cancer at a single institution from January 1, 1989 through December 31, 1993. Information was obtained on age, stage, site of disease, histology, and type of health insurance (public or commercial). Insurance coverage was used as a proxy for socioeconomic status. Overall survival was estimated by the method of Kaplan and Meier and compared by the log-rank test. Cox proportional hazard modeling was used to evaluate the effects of multiple factors on survival. RESULTS: African-American patients were significantly older and were more likely to have cervical cancer and public insurance than white patients. Overall survival was worse for African-American patients than for white patients (P < .05). However, stage for stage, there was no significant difference in survival between the groups. There was also no difference when patients were grouped by insurance status. African Americans had a significantly worse survival for cervical cancer than whites, and African-American patients older than 65 years had a worse survival than whites of similar age. On multivariate analysis, only stage and insurance coverage were significant predictors of survival. CONCLUSIONS: African-American patients with gynecologic cancer at our institution have worse overall survival than white patients. The survival difference seems to be due predominantly to differences in socioeconomic status and stage at diagnosis.

Barriers to influenza immunization in a low-income urban population.

BACKGROUND: Although influenza immunization significantly reduces mortality from influenza, over one third of elderly Americans are not immunized each year. Low rates of immunization are particularly concerning among African-American low-income populations. Preliminary interviews suggested that fear of undisclosed ingredients in the influenza vaccine may impede vaccine acceptance in this vulnerable population. OBJECTIVES: To assess the role of concern about vaccine contents and other factors in the use of influenza immunization among a predominantly African-American low-income urban population. METHODS: Cross-sectional, health-system-population-based, telephone survey of a random sample of West Philadelphia residents aged > or =65 years. RESULTS: Of 659 eligible individuals, 486 (73.8%) were successfully interviewed. Concern about undisclosed shot contents was reported by 132 (20%) respondents and was inversely associated with vaccine receipt (OR 0. 49, 95% CI 0.26-0.91). This association was similar among African Americans and Caucasians. In addition, receipt of influenza vaccine was inversely associated with belief that immunization is inconvenient (OR 0.14, 95% CI 0.05-0.36), belief that immunization is painful (OR 0.21, 95% CI 0.08-0.54), and history of previous side effects (OR 0.33, 95% CI 0.18-0.60), and positively associated with physician recommendation (OR 3.22, 95% CI 1.76-5.93). CONCLUSIONS: In a low-income urban population, concern about undisclosed vaccine contents appears to impede acceptance of influenza immunization among both African Americans and Caucasians. Directly addressing this concern offers a new approach to increasing immunization in this vulnerable population.

Keratoconus detected by videokeratography in candidates for photorefractive keratectomy.

BACKGROUND: Patients with corneal shape abnormalities should be identified prior to photorefractive keratectomy (PRK). We used videokeratography screening to detect subclinical corneal abnormalities, including keratoconus, which might have been missed by conventional clinical evaluation. METHODS: One hundred forty-six apparently normal myopic eyes (-1.00 to -7.00 diopters [D] with less than 1.50 D of cylinder) of 91 consecutive patients who were candidates for PRK were screened by videokeratography. RESULTS: In 6 of 91 patients (7 of 146 eyes), unsuspected corneal shape abnormalities were detected by videokeratography. Two patients had definite keratoconus and three were classified as keratoconus suspects by inferior corneal steepening (Rabinowitz I-S index ranging from 1.62 to 6.20 D). One patient had early pellucid marginal degeneration. CONCLUSIONS: Keratoconus suspects and contact lens-induced changes resembling keratoconus are present in the "normal" myopic population that presents for refractive surgery. Videokeratographic screening is the only effective means of identifying these and other corneal shape abnormalities.

Sarcoidosis and regional enteritis in two patients.

Both sarcoidosis and Crohn's disease (regional enteritis) are characterized by granuloma formation and they also have an unknown etiology. Only a few subjects with co-existing sarcoidosis and Crohn's disease have been reported in the literature. We report two cases who suffered from both disorders. In the two subjects Crohn's disease began first and the symptoms of sarcoidosis came later; four and sixteen years, respectively.

Pathological changes in the Brown Norway rat cerebellum after mercury vapour exposure.

Our previous studies have demonstrated that mercury vapour exposure of Brown Norway rats induced an autoimmune response with development of glomerulonephritis and resulted in mercury deposition in the central nervous system, particularly in the neurons. The aim of this study was to investigate the effect on the central nervous system. A loss of Purkinje cells accompanied by Bergmann glial cell proliferation was found at a brain mercury level of 0.71 micrograms/g and became even more pronounced as the exposure dose increased. At a brain mercury level of 5.0 micrograms/g, a heavy gliosis was present in the brain stem, particularly around the pontine nuclei. In comparison with our previous study, the pathological changes in the brain appeared at the same mercury exposure dose as the glomerulonephritis. However, the location of pathological changes at the mercury level of 0.71 micrograms/g was not completely in accordance with the mercury distribution in the brain, which might be due to the sequence of mercury deposition, its amount or the vulnerability of the various cells classes.

Autoimmune glomerulonephritis induced by mercury vapour exposure in the Brown Norway rat.

Subcutaneous injections of mercuric chloride induce an autoimmune glomerulonephritis with both granular and linear IgG deposits along the glomerular capillary wall and proteinuria. This disease is due to a T cell dependent polyclonal B cell activation responsible for production of antibodies against self (glomerular basement membrane, immunoglobulins, DNA, myeloperoxydase) and non self (sheep red blood cells, trinitrophenol (TNP)) components. Increase in serum IgE concentration is the hallmark of this disease. To determine if mercury vapours have pathogenic effects is an important problem of public health. The aim of this study was, first to compare the effects of mercury vapour exposure to those of mercury injections and, second, to compare the effects of high doses to those of low doses of mercury. Two exposure levels were studied corresponding to a mercury absorption of 13.1 mumol/week per kg body wt. and 1.7 mumol/week per kg body wt. during a 5-week period. It will be shown that, whereas the mercury concentration in the kidneys was similar in injected--and vapour exposed--rats, the mercury concentration in blood at the end of the exposure was about twice as high in the injected animals. Blood concentration of mercury was related to dose level but kidney content of mercury was similar in all groups, in spite of a dose difference by a factor of seven between low and high exposure. Mercury vapour and HgCl2 injections both trigger autoimmunity to the same extent and, in both cases the extent of autoimmune manifestations was dose-dependent.

Excimer laser ablation of the human lens at 308 nm with a fiber delivery system.

A 308 nm excimer laser has been used with a fiber delivery system to perform ablation of the human lens. Preliminary results demonstrate the system's ability to ablate lens nucleus and cortex selectively, preserving the anterior and posterior capsules. The total delivered energy necessary to ablate a human lens ranged from 35 to 63 joules. Laser tissue interaction and ablation rates were computed for the different components of the human lens (capsule, cortex, nucleus) for the operatively useful energy densities (fluences). Operative experience suggests that cortex and nucleus can be ablated while preserving the capsule if an adequate irrigation and aspiration system is developed. These results also suggest that this modality may be adequate for performing endocapsular cataract extraction. Laser tissue interactions were also computed at variable distances between the fiber tip and tissue. As this distance increased, the spread of the beam increased and a significant increase in energy was necessary to induce tissue ablation. This was due to the decrease in fluence with increasing distance to the target tissue and/or the absorption and scattering of the delivered energy within a short distance from the fiber tip by the ablated material. Evidence of a sonic effect was also present.

The biological monitoring of mercury in the Seychelles study.

The concentration of total mercury in maternal hair during pregnancy was used as a measure of fetal exposure to methylmercury in a study of a fish-eating population in the Seychelles islands. A segment of scalp hair approximately 10 centimeters in length, that grew during pregnancy, was selected for measurement. Total and inorganic mercury were measured by cold vapor atomic absorption (CVAA) using the Magos reagents (Magos, 1971). For comparative purposes, total mercury was measured by X-ray Fluorescent Spectrometry (XRF) and methylmercury by gas chromatography/atomic fluorescence detection (GC/AFD) in a subset of hair samples. A limited number of fish samples were also analyzed. Extensive interlaboratory testing was conducted to ensure accuracy of the mercury measurements. Concentrations of organic mercury calculated as the difference between total and inorganic mercury as measured by CVAA agreed with those of methylmercury measured on the same samples of hair by GC/AFD. Methylmercury measured by GC/AFD and organic mercury measured by CVAA accounted for over 80% of the total mercury in hair and over 90% of the total mercury in fish muscle. To test the accuracy of recapitulation by hair sampling, hair samples were collected from mothers at the time of delivery and 6 months later. The segment corresponding to the pregnancy term was selected for measurement assuming a hair growth rate of 1.1 cm/month. Results from both samples were in close agreement. As part of both a pilot investigation followed by the main study, maternal hair samples were collected each year from 1986 to 1989 for a total of 1604 samples. The median and mean values for each year's collection fell in the range of 5.9 to 8.2 ppm and exhibited no statistically significant trend with time. The highest recorded concentration was 36 ppm. In hair samples from 654 mothers, the mean concentration of total mercury was compared with the mean concentrations in segments corresponding to each trimester, approximately 3.3 centimeters in length. A high degree of correlation was found between mean levels in each trimester versus the entire pregnancy segment.

Neurodevelopmental test selection, administration, and performance in the main Seychelles child development study.

The Seychelles Child Development Study was designed to provide data on normal neurodevelopment of Seychellois children and to examine the relationship of their neurodevelopmental outcomes to in utero fetal exposure to low concentrations of methylmercury from a maternal diet high in fish. This paper outlines the strategies used to select, modify, and field test evaluation tools used in the main longitudinal prospective study of 740 children (95% of the cohort of 779 initially enrolled in 1989). It also gives population statistics and quality assurance data for the tests administered and the evaluation of the home environments.

Longitudinal neurodevelopmental study of Seychellois children following in utero exposure to methylmercury from maternal fish ingestion: outcomes at 19 and 29 months.

UNLABELLED: Despite the importance of defining developmental consequences for humans of in utero exposure to low levels of methylmercury, it is not yet clear if there are postnatal effects in fish-eating populations. The Seychelles Child Development Study (SCDS), now underway in the Republic of Seychelles, is following children to test the hypothesis that prenatal exposure to low concentrations of MeHg through maternal ingestion of fish is related to child development outcomes. In this study, children were evaluated with the Bayley Scales of Infant Development (BSID) at 19 mos. of age (N = 738). The cohort was evaluated again at 29 mos. (N = 736) with the BSID and the Bayley Infant Behavior Record. Mercury exposure determined by cold vapor atomic absorption analysis of maternal hair segments corresponding to pregnancy revealed a median exposure of 5.9 ppm (Range 0.5 - 26.7 ppm). The association between maternal hair mercury concentrations and neurodevelopmental outcomes at 19 and 29 mo. of age was examined by multiple regression analysis with adjustment for confounding variables. RESULTS: BSID Intertester reliability was ascertained by the Kappa statistic and was high. The mean BSID Mental Scale Indexes at both 19 and 29 mo. were comparable to the mean performance of US children. The mean BSID Psychomotor Scale Indexes at 19 and 29 mo. were 2 SD units above US norms, but consistent with previous findings of motoric precocity in children reared in African countries. No effect of mercury was detected on BSID scores at either age. On the Bayley Infant Behavior Record, activity level in boys, but not girls, decreased with increasing mercury exposure. Only one subjective endpoint was correlated with prenatal exposure to mercury. This study may have implications for environmental health policies concerning mercury in fish or fish consumption during pregnancy. Follow-up data are needed to determine if adverse effects occur at older ages and if such effects are determined to be related to mercury.

Monitoring methylmercury during pregnancy: maternal hair predicts fetal brain exposure.

Autopsy brains were obtained from infants dying from a variety of causes within a few days of birth in a population exposed to methylmercury in fish. Infant and maternal blood and hair samples were also obtained. The concentration of total mercury in 6 major brain regions were highly correlated with maternal hair levels. This correlation was confirmed by a sequence of comparisons of maternal hair to maternal blood to infant blood and finally to infant brain. The results lend support to the use of maternal hair in assessing fetal exposure to methylmercury in fish-eating populations.