A Shigella sonnei outbreak traced to imported basil--the importance of good typing tools and produce traceability systems, Norway, 2011.

On 9 October 2011, the University Hospital of North Norway alerted the Norwegian Institute of Public Health (NIPH) about an increase in Shigella sonnei infections in Tromsø. The isolates had an identical 'multilocus variable-number tandem repeat analysis' (MLVA) profile. Most cases had consumed food provided by delicatessen X. On 14 October, new S. sonnei cases with the same MLVA-profile were reported from Sarpsborg, south-eastern Norway. An outbreak investigation was started to identify the source and prevent further cases. All laboratory-confirmed cases from both clusters were attempted to be interviewed. In addition, a cohort study was performed among the attendees of a banquet in Tromsø where food from delicatessen X had been served and where some people had reported being ill. A trace-back investigation was initiated. In total, 46 cases were confirmed (Tromsø= 42; Sarpsborg= 4). Having eaten basil pesto sauce or fish soup at the banquet in Tromsø were independent risk factors for disease. Basil pesto was the only common food item that had been consumed by confirmed cases occurring in Tromsø and Sarpsborg. The basil had been imported and delivered to both municipalities by the same supplier. No basil from the specific batch was left on the Norwegian market when it was identified as the likely source. As a result of the multidisciplinary investigation, which helped to identify the source, the Norwegian Food Safety Authority, together with NIPH, planned to develop recommendations for food providers on how to handle fresh plant produce prior to consumption.

A rapid chemokine response of macrophage inflammatory protein (MIP)-1α, MIP-1ß and the regulated on activation, normal T expressed and secreted chemokine is associated with a sustained virological response in the treatment of chronic hepatitis C.

The role of chemokines in chronic hepatitis C virus (HCV) infection is not fully understood. The present study aimed to characterize the baseline serum concentrations and the initial ß-chemokine response to treatment with interferon-α and ribavirin with respect to the final clinical outcome of virological response to treatment. Serum concentrations of alanine aminotransferase (ALT) and of the CC subfamily chemokines [macrophage inflammatory protein (MIP)-1α, MIP-1ß, monocyte chemoattractant protein (MCP)-1 and the regulated on activation, normal T expressed and secreted (RANTES) chemokine] were measured in patients with chronic HCV infection and in healthy individuals. Necroinflammation and fibrosis were scored in liver biopsies. Treatment outcomes were classified as with or without a sustained virological response after a full-course treatment according to the genotypes. The main treatment group consisted of 72 patients with chronic hepatitis C, whereas 24-h blood samples were available for 42 patients. Increased baseline levels of all CC chemokines were found in the two responder groups compared to the healthy controls, although significant levels were reached only for MIP-1α and MCP-1. No correlation was observed between chemokine levels and serum ALT levels, any histological necroinflammatory parameters, or the fibrosis grade. After 24 h of treatment, increases in MIP-1α, MIP-1ß and RANTES levels were exclusively observed in the group with sustained virological response. MCP-1 was also significantly increased after 24 h in both responder groups, although no differences were observed between the two responder groups. In conclusion, an early MIP-1α, MIP-1ß, and RANTES response may predict a sustained response to virological treatment.

Pilomatrix carcinoma with multiple metastases: report of a case and review of the literature.

Pilomatrix carcinoma, the malignant counterpart of pilomatrixoma, is rare, with only 55 cases reported, and only four cases with visceral metastases described in the literature. Here we present a case report and a literature review on this rare tumour. A 74-year-old male with a pilomatrix carcinoma from the left temporal region presented in July 1996 and the tumour was excised. One month after diagnosis, metastases to both lungs and to a regional lymph node were found and histologically verified. The patient also developed metastases in the abdomen, back and thoracic spine. The latter resulted in spinal cord compression and paraplegia. Despite systemic chemotherapy with intravenous cisplatin and 5-fluorouracil and localised radiotherapy to the thoracic spine, progression and deterioration led to death within 3 months from time of diagnosis. Pilomatrix carcinomas are usually indolent. In our patient, however, the malignant disease progressed rapidly and it appeared to be resistant to both chemotherapy and irradiation.

Do pregnant women who report a reduction in cigarette consumption consume less tobacco?

OBJECTIVE: To investigate the relationship between changes in self-reported cigarette consumption and changes in serum thiocyanate among pregnant and non-pregnant women who participated in a smoking cessation trial. DESIGN: Intervention study. SETTING: General practitioners in western Norway. SUBJECTS: 146 pregnant and 102 non-pregnant women who were daily smokers at inclusion. Self-reported cigarette consumption and serum thiocyanate were recorded at inclusion and after 12 months. RESULTS: Women who smoked in the first trimester of pregnancy reported 21% less cigarette consumption than non-pregnant women. This was in accordance with the serum thiocyanate values. Twelve months later the mean values of serum thiocyanate had increased irrespective of whether the postpartum women reported that they had reduced, increased, or not changed their cigarette consumption. However, among those who reported that they had stopped smoking, analyses of serum thiocyanate confirmed their statements, with very few exceptions. Among nonpregnant women, the serum thiocyanate changed in accordance with the reported changes in cigarette consumption in all groups. CONCLUSION: Women smoking daily in the first trimester of pregnancy had a lower exposure to tobacco than daily smoking non-pregnant women. Twelve months later (six months after delivery) analyses of serum thiocyanate indicated that postpartum women underestimated their tobacco consumption.

[Education of medical students in substance abuse]. / Rusmiddelundervisning for medisinstudenter.

A substantial amount of resources available to the health services in Norway are spent on alcohol- and drug-related disorders. Physicians play an important role in preventing, diagnosing and treating these disorders. We have reviewed the curricula used at our four Norwegian medical schools for education in this field. The curricula are characterized by lack of specified educational goals and are somewhat limited, seen in relation to the extent of the alcohol- and drug-related problems. With reference to a structured educational programme at Karolinska Sjukhuset, Stockholm, we propose a new Norwegian model for alcohol- and drug related medical education. This model focuses especially on early identification of problems and intervention in harmful alcohol consumption.