Perforation Rates for Nonsterile Examination Gloves in Routine Dermatologic Procedures

BACKGROUND: Low cost, nonsterile examination gloves are used routinely to perform various dermatologic procedures. OBJECTIVE: To evaluate the perforation rate of nonsterile examination gloves in routine dermatologic procedures. METHODS: Three hundred fifty nonsterile latex examination gloves used to perform shave biopsies were evaluated for perforations using an air inflation/water submersion method. Ninety gloves, which were intentionally perforated with a 30-gauge needle, were used as controls to assess our evaluation method. RESULTS: Eight of the 350 gloves were found to have a perforation, which corresponds to a 2.3% perforation rate. Seven of the eight perforations were found in the web space between the second and third finger sleeves, with one being an obvious manufacturing error. All 90 perforations of the control group were correctly identified. CONCLUSION: There appears to be a very low risk of glove perforation when nonsterile examination gloves are used in routine dermatologic procedures.     

Serum Aminotransferases in Thai Children With Dengue Infection

Background:

Hepatic manifestations are one of the unusual manifestations of dengue infection.

Objectives:

We conducted this study in order to study the pattern of serum aminotransferases and sequential changes before and after shock in Thai children with dengue infection.

Patients and Methods:

Children who were clinically and serologically diagnosed as dengue infection and were admitted to King Chulalongkorn Memorial Hospital during a peroid of one year were enrolled. They were clinically classified into a non-shock group and a shock group. The majority of serum aminotransferases including aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were obtained within a week after the onset of fever and until 3 days after shock in the shock group. Student t-test and median in boxplot form were used for statistical analysis.

Results:

We enrolled 127 children with a mean age of 7.6 ± 3.6 years. The incidence of abnormal AST and ALT levels was 97.4% and 50.0% in the shock group, and 91.8% and 44.9% in the non-shock group respectively. 29% and 15.4% of the patients in shock group and only 10.2% and 4.1% in non-shock group had the respective AST and ALT levels > 200 U/L. Serum aminotransferase levels were significantly higher in the shock group when compared to the non-shock group. AST tended to increase starting from one day before shock and continued to increase within a few days whereas ALT was less likely to be affected.

Conclusions:

Elevated serum aminotransferases are a common finding in children with dengue infection and the levels of AST are higher than those of ALT. Patients with shock have significantly higher aminotransferase levels that increase up to 3 days after shock.     

Clinical definitions of pertussis: Summary of a Global Pertussis Initiative roundtable meeting, February 2011

Existing clinical case definitions of pertussis are decades old and based largely on clinical presentation in infants and children, yet an increasing burden is borne by adolescents and adults who may manifest distinct signs/symptoms. Therefore, a "one-size-fits-all" clinical case definition is no longer appropriate. Seeking to improve pertussis diagnosis, the Global Pertussis Initiative (GPI) developed an algorithm that delineates the signs/symptoms of pertussis most common to 3 age groups: 0-3 months, 4 months to 9 years, and ≥10 years. These case definitions are based on clinical presentation alone, but do include recommendations on laboratory diagnostics. Until pertussis can be accurately diagnosed, its burden will remain underestimated, making the introduction of epidemiologically appropriate preventive strategies difficult. The proposed definitions are intended to be widely applicable and to encourage the expanded use of laboratory diagnostics. Determination of their utility and their sensitivity and/or specificity versus existing case definitions is required.     

Etidronate inhibits human osteoblast apoptosis by inhibition of pro-apoptotic factor(s) produced by activated T cells

Humoral factors produced by activated T cells are thought to be important in the development of bone loss in patients with rheumatoid arthritis (RA). We investigated the inhibitory effect of etidronate disodium (EHDP) on apoptosis of human osteoblasts induced by supernatants from in vitro activated T cell cultures. Human osteoblastic cell line MG63 cells and human primary osteoblast-like cells were used in the present study as human osteoblasts. T cells were incubated with interleukin-2 and further activated with 1 2-o-tetradecanoyl-phorbol 13-acetate and ionomycin, either in the presence or absence of EHDP. After we carried out the cultivation, we examined the cytotoxicity of cultured T cell supernatants toward MG63 cells and human primary osteoblast-like cells. Supernatants from activated but not resting T cell cultures efficiently induced apoptosis of MG63 cells and primary osteoblast-like cells. Supernatants from activated T cell cultures, incubated with EHDP, exhibited significantly less cytotoxicity than did supernatants incubated in the absence of EHDP. In contrast, the cytotoxicity of activated T cell culture supernatants was not affected by direct treatment of human osteoblasts with EHDP. The concentration of soluble Fas ligand in activated T cell culture supernatants was actually increased by EHDP. However, EHDP did not influence soluble Fas and tumor necrosis factor-alpha concentrations in the supernatant. Furthermore, treatment of human osteoblasts with EHDP did not alter their expression of Bcl-2/Bcl-xL or their sensitivity to anti-Fas immunoglobulin M-induced apoptosis. Our results suggest that EHDP inhibits the production of soluble factor that induces apoptosis of human osteoblasts and thus exhibits a protective action toward human osteoblast apoptosis induced by activated T cell culture supernatants. Although the exact EHDP-regulated molecule that induces apoptosis of human osteoblasts is unknown at present, our study may explain part of the therapeutic action of bisphosphonates in RA complicated by bone loss.     

Skeletal muscle glucose transporter gene expression is not affected by injecting growth-hormone-secreting cells in young rats

Summary To elucidate the diabetogenic effect of growth hormone on glucose metabolism the regulation of glucose transporter (GLUT) gene expression was examined in rat skeletal muscles. Female Wistar-Furth rats were implanted subcutaneously with growth-hormone-producing pituitary tumour (GH₃) cells. Animals were killed 4 or 9 weeks after GH₃ cell injection. Although body weight, serum growth hormone and insulin-like growth factor I levels were remarkably elevated during the 4–9 week period, serum blood glucose levels were within normal range. Muscles were obtained from the quadriceps muscle, diaphragm and heart, respectively. Northern blot analysis and Western blot analysis were performed using specific cDNA probes and antibodies. During the 4–9 week period, the levels of muscle GLUT 1 and 4 mRNA (corrected by β-actin mRNA level) in each muscle from the rats injected with tumour cells were not significantly different from those of control rats. Chronic elevation of growth hormone in these rats did not cause any change in GLUT1 and 4 expression compared to the controls during the euglycaemic period. These results provide the first evidence that chronic growth hormone elevation itself does not affect a key gene of in vivo glucose metabolism.     

Metabolic cardiovascular disease risk factors and their clustering in subclinical hypothyroidism

Objective A possible association between subclinical hypothyroidism and cardiovascular disease (CVD) has been reported. Monitoring of atomic‐bomb survivors for late effects of radiation exposure at the Radiation Effects Research Foundation has provided the opportunity to examine associations between subclinical hypothyroidism and metabolic CVD risk factors. The objective of the study was to evaluate associations between subclinical hypothyroidism and metabolic CVD risk factors, and a cluster of these factors. Design and participants This was a cross‐sectional study of 3549 subjects (mean age 70 years; 1221 men and 2328 women) between 2000 and 2003 comprising 306 subjects with subclinical hypothyroidism and 3243 control euthyroid subjects in Japan. Measurements We investigated associations between subclinical hypothyroidism and metabolic CVD risk factors such as hypertension, diabetes mellitus, dyslipidaemia and hyperuricaemia, and a cluster of these factors. Results Subclinical hypothyroidism was not significantly associated with either hypertension, diabetes mellitus or hyperuricaemia defined by taking into account the use of medications in both men and women, but in men it was associated with dyslipidaemia (P = 0·02). We observed a significantly increased odds ratio (OR) for the presence of three or more metabolic CVD risk factors in men with subclinical hypothyroidism after adjusting for age, body mass index (BMI), and smoking status [OR: 1·83, 95% confidence interval (CI): 1·13–2·94, P = 0·01]. The significant associations remained after an additional adjustment for atomic‐bomb radiation dose. Conclusions There appears to be a significant increase in a cluster of metabolic CVD risk factors among people with subclinical hypothyroidism.     

Novel ellipsoid spatial analysis for determining malaria risk at the village level

The distribution patterns of malaria incidence at a village level in Thailand were demonstrated with the use of a geographical information system (GIS), and provided the study of the malaria situation at a household level. Mosaic imageries from aerial photographs were used to create maps that contained X and Y coordinates. These digitized base maps were kept as computerized files. Standard Distance Ellipse (SDE) was used to measure the prevalence of dispersion around the mean center of malaria cases and points. Households in the SDE were at greater risk of malaria infection than those located outside the SDE. The spatial pattern of malaria incidence was investigated using spatial autocorrelation using Geary's ratio and Moran's index. Five of seven villages had a clustered spatial distribution of malaria incidence, the vector point of which had a 2-3 km range from the patient's houses. Only one village had a significant clustered spatial distribution of malaria incidence (p < 0.05). Control efforts should be focused on high-risk areas, especially those households with the heaviest caseloads. This approach would probably be more cost effective than the conventional malaria control methods. This SDE analytical technique would be a novel and useful epidemiological control method for use by public health administrators. The ellipsoidal areas required malaria control intervention.     

Mucocutaneous findings in pediatric AIDS related to degree of immunosuppression

The normal value of the absolute CD4-positive T-lymphocyte count is relatively high in normal infants and declines steadily until 6 years of age, whereas the CD4 percentage of the total lymphocyte count is constant. The immunologic categories according to the 1994 revised pediatric human immunodeficiency virus (HIV) classification, based on CD4-positive percentage of the total lymphocyte count, is classified into three categories: no evidence of suppression (> or =25%), moderate suppression (15-24%), and severe suppression (1-14%). Our objective was to determine the prevalence of mucocutaneous findings in pediatric acquired immunodeficiency syndrome (AIDS) related to the degree of immunosuppression. We prospectively examined 120 children less than 13 years of age who were born to HIV-seropositive women and developed definite HIV infection. The prevalence of mucocutaneous findings in those children who had severe, moderate, and no evidence of immunosuppression were 62%, 43%, and 20%, respectively. The mucocutaneous findings in patients in the moderate and severe suppression groups were significantly more common than in patients without evidence of immunosuppression (p < 0.001). In the moderate immunosuppression group, 11% had two mucocutaneous findings while 21% in the severe immunosuppression group had two or more mucocutaneous findings. The most common mucocutaneous finding was oral candidiasis (33%), which had a mean corresponding CD4 percentage of the total lymphocyte count of 11.3%. Herpes zoster was found in 6% of the patients (mean CD4 percentage of the total lymphocyte count = 13.5%). Chronic herpes simplex virus (HSV) stomatitis was found in 3% of the patients (mean CD4 percentage of the total lymphocyte count = 3%). Mucocutaneous manifestations are common in pediatric AIDS. The majority of these findings have an infectious etiology. The prevalence increases as the CD4-positive percentage of the total lymphocyte count decreases. More than one mucocutaneous finding can be found at the same time in patients with moderate or severe immunosuppression.     

Serum and urine sodium levels in dengue patients

We evaluated serum and urine sodium levels in children with dengue infections. Children with acute febrile illness admitted to Bhumibol Adulyadej Hospital in Bangkok from January 1999 to January 2000 were enrolled. Serum and urine sodium levels were measured before initiating intravenous fluid therapy. Two milliliters of blood were obtained on admission and before discharge to test for anti-dengue virus antibody using the enzyme-linked immunosorbent assay technique. Hyponatremia was defined as a serum sodium level <130 mEq/l and depletion of circulatory volume was defined as a urine sodium level < 20 mEq/l. Out of 93 enrolled patients, 49 were categorized as dengue patients and 44 were as non-dengue patients. Six dengue patients developed shock whereas 43 patients did not. The mean serum sodium level was significantly lower in dengue patients compared to non-dengue patients (p-value < 0.0001). Hyponatremia was 9.7 times more common in dengue patients. Among dengue patients, the mean serum sodium level was significantly lower in shock patients compared to non-shock patients (p-value = 0.003). However, the prevalence of hyponatremia was not different between the two groups. The mean urine sodium level was significantly lower in dengue patients compared to non-dengue patients (p-value < 0.0001). A urine sodium level < or = 20 mEq/l was 8.1 times more common in dengue patients. Among dengue patients, the mean urine sodium level was not significantly different between shock and non-shock patients. In shock patients, a urine sodium level < or = 20 mEq/l was 7.6 times more common.     

Childhood shigellosis at King Chulalongkorn Memorial Hospital, Bangkok, Thailand: a 5-year review (1996-2000)

The objective of this study was to evaluate the demographic data and clinical presentation of childhood shigellosis, and to study the microbiological data and antimicrobial susceptibilities of Shigella spp. Nine thousand nine hundred fourteen stool culture specimens from children aged 0-15 years who were treated at King Chulalongkorn Memorial Hospital, Bangkok, Thailand, between 1996 and 2000 were retrospectively reviewed. Data were collected from microbiological records and medical charts of childhood shigellosis in terms of demographic data, symptoms, signs, and complications of the patients, and the species and antimicrobial susceptibilities of the organisms. The data were analyzed in terms of means, ranges, and percentages. Of 1,523 children whose stool cultures were positive for pathogenic bacteria, 80 (5.3%) were infected with Shigella spp; 34 females and 46 males. The age distribution ranged from 1 day to 13 years with a mean age of 3.6 years. Common clinical presentations included diarrhea (96.6%), fever (77.6%) and vomiting (44.8%); seizures were the most common complication found (27.6%). Watery and mucous were the most common characteristics of stools. The major Shigella spp found was S. sonnei (62.8%), which was susceptible to co-trimoxazole, ampicillin, cefazolin and ciprofloxacin in 2.3, 84.1, 100 and 100%, respectively. A short course of quinolones or oral cephalosporins should be recommended for the treatment of childhood shigellosis in areas with low susceptibility rates to co-trimoxazole and ampicillin.