The significant health threat from sunbed use as a self treatment in patients with acne.

Patients with acne are increasingly using sunbeds as a self treatment despite the harmful effects. Little is known about sunbed use in adult patients with acne under dermatology care. This questionnaire study explored prevalence and behaviours surrounding sunbed use in patients with acne at a UK dermatology centre. Over a quarter (26%) of respondents used sunbeds and of these, 72% used them at least weekly. Respondents using sunbeds were more likely to be older, to be female, to have a longer duration of acne diagnosis and to have previously been offered blue-light therapy by their doctor (P < 0.05 for all) Reasons for use included recommendations from external sources (including the Internet), the perceived greater efficacy compared with physician-prescribed treatments and that light therapy was not offered by their doctor. Nearly half (49%) of respondents were taking isotretinoin at the time of sunbed use, which carries an increased risk for photosensitivity and sunburn in this cohort. Dermatologists have a responsibility to address this gap in public awareness by directly counselling patients at risk of sunbed use, particularly for those concomitantly prescribed oral retinoid therapy.

Laser-driven formation of transient local ferromagnetism in FeRh thin films.

The antiferromagnetic to ferromagnetic phase transition in FeRh can be induced globally by either heating the material above its phase transition temperature or applying a combination of external stimuli (such as mechanical strain, electric/magnetic fields) on the material preheated close to its transition temperature. On the other hand, to locally induce this phase transition is more desirable for applications and requires a confined source of energy such as a focused laser beam. Here we combine laser excitation with X-ray magnetic imaging to determine the effect of laser heating on the local and transient magnetization of FeRh using time-resolved photoelectron emission microscopy. Excitation by an ultrashort laser pulse generates a local ferromagnetic state within 0.6ns which recovers its initial antiferromagnetic state after a further 2ns. The form of the domains during the growth and diminution of ferromagnetic ordering suggests an intrinsic speed limit for magnetic and structural changes.

Incremental increase in percentage mouth opening after coronoidectomy in temporomandibular joint ankylosis.

The aim of this study was to evaluate the incremental improvement in mouth opening following coronoidectomy. Twenty-three patients with unilateral temporomandibular joint (TMJ) ankylosis (Sawhney types I-III) were assessed preoperatively; physical and radiological examinations were done (panoramic radiography and computed tomography). Data including demographic and clinical parameters were recorded. Patients with bilateral ankylosis, recurrent cases, and those with Sawhney type IV TMJ ankylosis were not included. The improvement in mouth opening was measured after ostectomy, after ipsilateral coronoidectomy, and after contralateral coronoidectomy. The improvements in mouth opening at each stage were analysed using the Student's t-test and Pearson's correlation coefficient. There was a marked improvement in maximal incisal opening (MIO) from 5.7 ± 4.2mm to 23.7 ± 5.9 mm after removal of the ankylotic bony mass. MIO was significantly increased after ipsilateral coronoidectomy (31.6 ± 7.4mm), and after contralateral coronoidectomy, a mean MIO of 39.4 ± 11.2mm was achieved. At more than 1 year of follow-up, all patients showed improved mouth opening. In conclusion, coronoidectomy plays an important role in improving mouth opening in the treatment of TMJ ankylosis.

Oral submucous fibrosis: a review article on etiopathogenesis.

Areca quid chewing related oral mucosal lesions are potential hazard to a large population worldwide. Commercially freeze dried products such as pan masala, guthka and mawa have high concentration of areca nut per chew and appear to cause OSMF more rapidly than by self prepared conventional betel quid that contain smaller amounts of areca nut. The basic constituent of areca nut is either raw or dried or boiled or baked. Diverse agents including lime, tobacco, catechu, cloves, saffron and leaf of piper betel leaves may form a part of formulation. Many of the undesirable aspects of areca nut have been attributed to arecoline. These chemical appear to interfere with the molecular processes of deposition and or degradation of extracellular matrix molecules such as collagen, causing imbalance in the normal process. The most likely events that take place with regards to the above imbalance may be reduced phagocytosis of collagen by fibroblasts, up or down regulation of copper dependent enzyme lysyl oxidase, matrix metalloproteinases and tissue inhibitors of matrix metalloproteinases . It has been postulated that areca nut may also induce the development of the disease by increased levels of cytokines in the lamina propria. Current evidence implicates collagen related genes in susceptibility and pathogenesis of OSMF. The individual mechanisms operating at various stages of the disease--initial, intermediate and advanced--need further study in order to propose appropriate therapeutic interventions.

Linezolid: an effective, safe and cheap drug for patients failing multidrug-resistant tuberculosis treatment in India.

Linezolid is identified as an effective drug with which to treat patients failing multidrug-resistant (MDR)-tuberculosis (TB) treatment. However, cost and safety are the concerns. In India, the average price of a 600-mg pill of linezolid is less than one US dollar, much cheaper than most of the third-line drugs. A prospective study of 29 MDR-TB treatment failure patients (16 with laboratory-proven extensively drug-resistant (XDR)-TB and the remaining 13 with MDR-TB with resistance to any quinolone but sensitive to injectables) was carried out in Delhi, India. All patients received daily unsupervised therapy with linezolid, one injectable agent, one fluoroquinolone and two or more other drugs. Patients received a median of six anti-mycobacterial agents. Besides linezolid, capreomycin, moxifloxacin, levofloxacin and amoxycillin-clavulanic acid were used in 41.4%, 58.6%, 41.4%, and 79.3% of patients. Out of a total of 29 patients, 89.7% patients achieved sputum smear and culture conversion; 72.4% showed interim favourable outcome; 10.3% died, 6.8% failed and 10.3% patients defaulted. Linezolid had to be stopped in three (10.3%) patients due to adverse reactions. The outcome of treatment of 16 XDR-TB patients was comparable to the other 13 MDR-TB patients. Linezolid is an effective, cheap and relatively safe drug for patients failing MDR-TB treatment, including those with confirmed XDR-TB.

An analysis of the healthcare informatics and systems in Southeast Asia: a current perspective from seven countries.

This paper presents an overview of the healthcare systems in Southeast Asia, with a focus on the healthcare informatics development and deployment in seven countries, namely, Singapore, Cambodia, Malaysia, Thailand, Laos, the Philippines and Vietnam. Brief geographic and demographic information is provided for each country, followed by a historical review of the national strategies for healthcare informatics development. An analysis of the state-of-the-art healthcare infrastructure is also given, along with a critical appraisal of national healthcare provisions.

Critical success factors for achieving superior m-health success.

Recent healthcare trends clearly show significant investment by healthcare institutions into various types of wired and wireless technologies to facilitate and support superior healthcare delivery. This trend has been spurred by the shift in the concept and growing importance of the role of health information and the influence of fields such as bio-informatics, biomedical and genetic engineering. The demand is currently for integrated healthcare information systems; however for such initiatives to be successful it is necessary to adopt a macro model and appropriate methodology with respect to wireless initiatives. The key contribution of this paper is the presentation of one such integrative model for mobile health (m-health) known as the Wi-INET Business Model, along with a detailed Adaptive Mapping to Realisation (AMR) methodology. The AMR methodology details how the Wi-INET Business Model can be implemented. Further validation on the concepts detailed in the Wi-INET Business Model and the AMR methodology is offered via a short vignette on a toolkit based on a leading UK-based healthcare information technology solution.

How workflow management systems enable the achievement of value driven healthcare delivery.

Healthcare institutions globally are currently having major problems accessing and maintaining the large amounts of data that are continuously being generated. Examination of the clinical procedures relating to patient management reveals that many of these activities are repetitive. Workflow Management Systems (WFMS) can automate these repeated activities. Moreover, the introduction of WFMS would enable healthcare institutions to face this challenge of transforming large amounts of medical data into contextually relevant clinical information and knowledge. In order to emphasise the dynamic connection between healthcare, workflow and internet technologies, the intelligence continuum is introduced.

Implications for healthcare knowledge management systems: a case study.

The notion of incorporating knowledge management (KM) in the healthcare sector has recently witnessed a lot of interest, both from healthcare practitioners and scholars. Because KM for healthcare has just started to appear on the radar of healthcare stakeholders, there exists very limited research (particularly empirical data) to guide healthcare stakeholders, both from an academic and organizational perspective. This paper attempts to contribute to the adoption of KM in the clinical and healthcare sectors by collecting and analyzing data on technological, organizational and managerial perspectives on KM in these sectors. This paper provides an analysis of a case study which looks at current practices towards healthcare information management.

Meanaging Knowledge for the emergency care of heart attack patients: Paramedics and thrombolytic treatment.

The objective of this paper is to examine the Knowledge Management(KM) paradigm in the context of UK paramedics' assessment and treatment of patients with suspected acute myocardial infarction (MI) or ;heart attack' We outline the role of thrombolytic therapy and other aspects of emergency cardiac care and discuss how contemporary KM tools and techniques can be used to support the development and retention of key clinical skills and knowledge in this emerging field of parcice.

Towards a web-based knowledge management system for cardiovascular disease.

The objective of this paper is to examine the efficacy of the Knowledge Management (KM) paradigm for a web-based patient administration system (PAS) for cardiovascular disease (CVD). We discuss the role of contemporary information and communication technologies (ICTs) for the management of electrocardiographic information and how this can act as a foundation for a KM-based system.

Towards total knowledge management for healthcare: clinical and organizational considerations.

Knowledge Management (KM) has made a significant impact on the global healthcare sector. However, it is important to address the link between knowledge, information and engineering. Knowledge Engineering (KE) is often only a small part of a KM-based project, yet some KM practitioners favour wholly KE-biased Knowledge Management projects, disregarding a more necessary holistic stance. This paper analyses some current achievements in the KM field and provides a benchmark from which academics and practitioners can attempt to attain "Total Knowledge Management for Healthcare" (TKMh).

The knowledge management landscape: implications for clinical knowledge management and practice.

The objective of this paper is to determine the future for Knowledge Management (KM) applications that focus on healthcare processes. This is achieved by tracing the evolution of KM by examining how different sectors have formulated industry-specific KM applications, then discussing the key constraints that these sectors have faced whilst formulating industry specific KM applications. It then details how these constraints can impede the coming of age of KM applications for healthcare. The results of several case studies on the future of healthcare KM applications are presented. This paper thus attempts to contribute to the adoption of KM in healthcare by looking at how practitioners can overcome stumbling blocks in KM healthcare applications.

Incidence of foreign-body-induced ileus in dogs.

While playing or simply because of avidity, dogs may ingest a variety of foreign bodies. Ingested foreign bodies, which are not stopped in the mouth or oesophagus, enter into the stomach. Once a foreign body has passed through the pylorus, jejunum and ileum appear to be the most common sites of the small intestine obstruction. The records of 103 cases, treated at the Clinic for Surgery, Orthopaedics and Ophthalmology of the Veterinarian Faculty, University of Zagreb from January 1981 till December 1998 were analysed. The analysis included the incidence of ileus caused by foreign bodies and the distribution of patients by sex, age, breed, duration of illness, site of obstruction, types of foreign bodies and the interrelation between these parameters. The results of our research show that the number of patients with foreign body induced ileus is increasing. Males ingested foreign bodies more often than females. Foreign body induced ileus was more frequently found in animals below 2 years of age. Foreign bodies were mostly ingested by mongrels, but also by popular dog breeds such as Dobermanns, Poodles, Cocker Spaniels and Rottweiler. Most of these ileus cases were found in March and October and the predominant clinical signs included anorexia, dehydration, abdominal tenderness and absence of defecation. The most common site of small intestine obstruction by foreign bodies was the jejunum, and the most effective treatment was enterotomy. Dogs mostly ingested stones, plastic and rubber objects. The treatment was more successful in dogs below 2 years of age. Patients that died post-surgically, died mostly the first day after surgery.

In vitro susceptibility of nosocomial isolates against a new aminoglycoside isepamicin.

BACKGROUND AND OBJECTIVES: isepamicin is a new aminoglycoside with a spectrum of activity similar to amikacin with an advantage of possessing a high level of stability against different aminoglycoside modifying enzymes. the in vitro susceptibility of nosocomial isolates obtained from patients admitted to the All India Institute of Medical Sciences, New Delhi during October-December, 1999 was tested against isepamicin and compared with other aminoglycosides. METHODS: a total of 251 clinical isolates were studied which included Escherichia coli 87, Klebsiella pneumoniae 54, Pseudonomas aeruginosa 38, Staphylococcus aureus 27 (methicillin resistant S. aureus 15, methicillin sensitive S. aureus 12), Acinetobacter species 26, Enterobacter aerogenes 9, Proteus mirabilis 5, Proteus vulgaris 2, and Citrobacter species 3. The minimum inhibitory concentration (MIC) against isepamicin and other aminoglycosides including amikacin, gentamicin, netilmicin and tobramycin was done using NCCLS guidelines. The cut-off values of isepamicin were used as that of amikacin. RESULTS: we found that overall 153 nosocomial isolates were sensitive to isepamicin as compared to 95 for amikacin in this hospital. Isepamicin showed a superior in vitro activity compared to the other aminoglycosides tested. INTERPRETATION AND CONCLUSIONS: isepamicin can be a good alternative in multidrug resistant nosocomial isolates in hospitals where amikacin resistance is emerging.

Effect of topical interferon-beta on recurrence rates in genital herpes: a double-blind, placebo-controlled, randomized study.

The aim of this randomized, double-blind placebo-controlled trial was to evaluate the effect of IFN-beta cream applied at the time of recurrent eruptions of genital herpes during 6 months on the overall rate of recurrence. Therapy was initiated at the clinic for the first treated recurrence, and thereafter by the patient for early treatment of eventual subsequent eruptions. Each recurrence was ascertained at the clinic in all 35 evaluable patients. The mean recurrence rate was significantly lower in the group using IFN-beta cream than in the placebo group (p = 0.03). Complete responders without recurrence for the duration of the trial were 36.4% of all patients and 46% among women versus 15.4 and 16.6% in the placebo groups, respectively. A total of 77.3% of all patients were defined as complete or partial responders, their average recurrences/year decreasing from 11 to 2.2 (p < 0.0001). The topical episodic IFN-beta treatment was well tolerated by patients and without side effects. It is concluded that IFN-beta cream application reduces the overall rate of recurrence of genital herpes.

Palmar flexion creases and dermatoglyphics in leprosy patients.

Palmar configurations of 115 male and 48 female leprosy patients were compared with 536 males and 426 female normal individuals of the same population. The data was derived from Nekararu (weavers) castes of Karnataka State, India. Among flexion creases, the single radial base crease (SRBC) especially showed more association with leprosy in both male and female patients than their respective controls. Among dermatoglyphics, only C-line types are significantly different in male leprosy patients as compared to their controls. The female patients also showed more C-absent lines than the control group. The susceptibility to bacterial infection may be due to some biologic deficiency which warrants continued investigation on a broader and more intensive basis.

Palmar flexion creases and dermatoglyphics among diabetic patients.

Palmar dermatoglyphics and flexion creases of 108 male and 65 female patients diagnosed as having diabetes mellitus have been analysed. The control population consists of 536 males and 234 females from the same population. Palmar flexion creases were analysed according to the method suggested by Bali and Chaube ('71). The flexion creases of diabetic patients and the control population are significantly different. The differences between main line formulae in diabetes and controls are significant among males. The differences between C-line types of patients and controls are significant among both sexes. Axial triradii are significant among female patients and controls. The patterns in the interdigital areas IV and II are significantly lower among male and female patients respectively from their controls.