What is the demand for out-of-hours dermatology? A UK-based region-wide survey of dermatology demand and provision during the evenings and at weekends.

BACKGROUND: Little is known about the demand for out-of-hours (OOH) dermatology in the UK, and this can make commissioning of acute services difficult. The East Midlands region has a population of 4.5 million people, with variable access to OOH dermatology services. AIM: We sought to investigate the provision of, and demand for, OOH dermatology services across the region with a view to informing commissioning decisions for the future. METHODS: We contacted all dermatology departments in the East Midlands region to establish what level of service was commissioned at evenings and weekends. At the sites providing any form of OOH service, we recorded all requests for advice received after 17.00 h on weekdays, or at any time during weekends and bank holidays over a 3-month period from October to December 2019. RESULTS: The OOH services provided ranged from 24 h/day cover 7 days/week at one site, to no formal provision across much of the rest of the region. In total, 125 calls were received during the study period, averaging 1 call per day on weekday evenings, and 2 calls per day at weekends and on bank holidays. Of these 125 calls, 11 patients (9%) were prioritized and seen by the on-call dermatologist on the day of referral, and 9 of these had potentially life-threatening skin conditions. A further 39 (31%) were deemed to need review within 24 h and 22 (18%) within 48 h. The remaining 42% were given appointments within 7 days or dealt with by telephone advice. CONCLUSION: The demand for OOH dermatology across the East Midlands is low, but access to timely dermatology advice is essential in some situations. Commissioning of a regional dermatology OOH service incorporating digital technology may help to improve the equity of access for all patients across the region.

Toxic epidermal necrolysis-like lupus.

Toxic epidermal necrosis (TEN)-like lupus is a rare condition characterized by epidermal loss and mucosal ulceration occurring in patients with acute severe flares of systemic lupus erythematosus. The clinical picture may mimic drug-induced Stevens-Johnson syndrome/TEN; however, the absence of a suitable culprit drug, and the context of acute lupus point to the correct diagnosis. In a case series of three patients, further discriminating features included a slower onset of epidermal loss, more limited mucosal ulceration and a lack of ocular involvement when compared with drug-induced TEN. Histology may show similar features, including basal layer vacuolation, apoptosis and full-thickness epidermal necrosis. Patients with TEN-like lupus may have additional features of lupus, and a lupus band on direct immunofluorescence. It is important to identify this condition correctly, so that these patients can be appropriately managed with early input from Rheumatologists and prompt treatment with high-dose combined immunosuppressant therapy.

Hemolytic activity in crude polysaccharide extracted from grain sorghum [Sorghum bicolor (L.) Moench].

A crude polysaccharide that hemolyzed human red blood cells of the ABO types was isolated from the condensed tannin fraction of Sorghum bicolor. It contained primarily 2-hydroxybenzoic acid and glucose and had a molecular weight of greater than 6000. Limit hemolytic activity for each of four blood group cells corresponded to a range of 110-27 micrograms of carbohydrate per assay.

Follow-up study of schizophrenic patients initially treated with home care.

A follow-up enquiry was carried out after two years on 54 patients who had earlier participated in a controlled experiment on home-care through a community nurse in Bangalore. Thirty seven of these patients could be contacted, of whom 21 had undergone the experimental care (home care) and 16 were from the control group, which had been treated by hospital admission. It was found that the experimental subjects had maintained a significantly better clinical status than the controls, and had been readmitted less often.

Parent-child communication about sexuality.

PIP: The Project on Human Sexual Development carried out a study of more than 1400 parents of 3-11 year-old children. The study was designed to determine the process of sexual learning in the home environment. It was seen that most children, both boys and girls, took their questions regarding sexual matters to their mothers. A very small percentage of either mother or fathers had ever discussed premarital sex, venereal disease, or contraception with their children, although they nearly universally wanted their children to be familiar with these matters before adolescence. In fact, most parents said that they waited for the children to broach the subject of sexuality. Despite their desires to communicate wth their children regarding sexual matters, they were generally unable to move beyond the traditional manner in which they themselves had been taught sexuality in their childhoods. Beneath the traditional surface, there is a movement away from the status quo. Some of the parent respondents were dissatisfied with traditional gender roles, especially in relation to childrearing. To correct this situation, sexuality must be recognized as broad-based, not genital-related. "Sexual learning is social learning, from birth throughout life."^ieng

Characterization of potato yellow mosaic virus as a geminivirus with a bipartite genome.

A whitefly-transmitted virus from Venezuela, potato yellow mosaic virus, has been propagated, isolated and characterized as a member of the Geminivirus group. The virus was transmitted to several species of Nicotiana and to Petunia hybrida by mechanical inoculation, and to potato and tomato plants by grafting. Purified virus possessed typical geminate particle morphology and encapsidated both genomic and subgenomic species consisting of single-stranded DNA. The genome of the virus was cloned into both bacteriophage and plasmid vectors following restriction of supercoiled double-stranded DNA species isolated from infected plant extracts. Two distinct classes of cloned DNA were generated, both about 2,500-2,600 base pairs in length and designated A and B, which when inoculated in combination to Nicotiana benthamiana were infectious after excision from the recombinant clones. The subgenomic DNA was shown to be related to DNA B.

The nucleotide sequence of the infectious cloned DNA components of potato yellow mosaic virus.

The complete nucleotide sequence of a Venezuelan isolate of potato yellow mosaic virus (PYMV) has been determined, showing it to be typical of subgroup I geminiviruses in that it is whitefly-transmitted, has a circular, bipartite ssDNA genome and possesses bidirectionally orientated open reading frames (ORFs). The two genomic components have little sequence similarity apart from a common region of 268 nucleotides (nt) which is almost identical. Analysis of ORFs revealed six potential coding regions encoding proteins of Mr greater than 10K, four in PYMV A (2593 nt) and two in PYMV B (2547 nt), which are preceded by regulatory transcription elements and have polyadenylation signals present at the ends. Amino acid sequence alignments of PYMV DNA ORF-encoded proteins with those encoded by other previously sequenced geminivirus ORFs show that PYMV is closely related to those geminiviruses isolated from the New World, especially in the putative coat protein gene regions.

Premature chain termination is a unifying mechanism for COL1A1 null alleles in osteogenesis imperfecta type I cell strains.

Nonsense and frameshift mutations, which predict premature termination of translation, often cause a dramatic reduction in the amount of transcript from the mutant allele (nonsense-mediated mRNA decay). In some genes, these mutations also influence RNA splicing and induce skipping of the exon that contains the nonsense codon. To begin to dissect how premature termination alters the metabolism of RNA from the COL1A1 gene, we studied nonsense and frameshift mutations distributed over exons 11-49 of the gene. These mutations were originally identified in 10 unrelated families with osteogenesis imperfecta (OI) type 1. We observed marked reduction in steady-state amounts of mRNA from the mutant allele in both total cellular and nuclear RNA extracts of cells from affected individuals, suggesting that nonsense-mediated decay of COL1A1 RNA is a nuclear phenomenon. Position of the mutation within the gene did not influence this observation. None of the mutations induced skipping of either the exon containing the mutation or, for the frameshifts, the downstream exons with the new termination sites. Our data suggest that nonsense and frameshift mutations throughout most of the COL1A1 gene result in a null allele, which is associated with the predictable mild clinical phenotype, OI type 1.

Acetylator phenotype and the effect of dapsone in rheumatoid arthritis.

Acetylator phenotype was determined in 54 patients with rheumatoid arthritis (RA) taking dapsone in the course of 2 comparative clinical studies. No significant differences were demonstrated in the assessments, either of efficacy or adverse effects. There appears to be no clinical advantage in assessing acetylator phenotype in patients with RA being treated with dapsone.

Osteogenesis imperfecta type I: molecular heterogeneity for COL1A1 null alleles of type I collagen.

Osteogenesis imperfecta (OI) type I is the mildest form of inherited brittle-bone disease. Dermal fibroblasts from most affected individuals produce about half the usual amount of type I procollagen, as a result of a COL1A1 "null" allele. Using PCR amplification of genomic DNA from affected individuals, followed by denaturing gradient gel electrophoresis (DGGE) and SSCP, we identified seven different COL1A1 gene mutations in eight unrelated families with OI type I. Three families have single nucleotide substitutions that alter 5' donor splice sites; two of these unrelated families have the same mutation. One family has a point mutation, in an exon, that creates a premature termination codon, and four have small deletions or insertions, within exons, that create translational frameshifts and new termination codons downstream of the mutation sites. Each mutation leads to both marked reduction in steady-state levels of mRNA from the mutant allele and a quantitative decrease in type I procollagen production. Our data demonstrate that different molecular mechanisms that have the same effect on type I collagen production result in the same clinical phenotype.