Latex glove allergy among hospital employees: a study in the north-west of England

The frequency of use and duration of wearing latex gloves among hospital employees has increased due to concerns about AIDS and hepatitis. In many countries there is increased consciousness about latex sensitization. In the UK, the Medical Device Agency has been monitoring latex allergy for a number of years but has not found any conclusive evidence of any significant problem. We report following a detailed questionnaire study in two hospitals in the north-west of England. A total of 1,827 members of staff were questioned about latex allergy at work. One hundred and twenty-four (7%) of these hospital employees had experienced symptoms strongly suggestive of latex allergy. Of this group, 56 had a-RAST test (IgE specific to latex), which was positive in seven (12.5%). There was a history of atopy in 31%, and a family history of atopy in 17% of the individuals. As a result of the study it was found that 17% (21 of the affected individuals) had already changed their working practice by using latex-free gloves. We were able to increase awareness of latex allergy within the hospitals. Both individuals and health care organizations need to be aware of the problem and hospital organizations should encourage staff to seek guidance to address the problem and, if necessary, to take appropriate measures to improve working practices. Practical guidelines are given with regard to identifying the problem and glove use for hospital staff.

Primers of glycosaminoglycan biosynthesis from Peruvian rain forest plants

We have developed a rapid, high throughput screening assay for compounds that alter the assembly of glycosaminoglycan chains in Chinese hamster ovary cells. The assay uses autoradiography to measure the binding of newly synthesized [35S]proteoglycans and [35S]glycosaminoglycans to a positively charged membrane. Screening over 1000 extracts from a random plant collection obtained from the Amazon rain forest yielded five plants that stimulated glycosaminoglycan assembly in both wild-type cells and a mutant cell line defective in xylosyltransferase (the first committed enzyme involved in glycosaminoglycan biosynthesis). Fractionation of an extract of Maieta guianensis by silica gel and reverse-phase chromatography yielded two pure compounds with stimulatory activity. Spectroscopic analysis by NMR and mass spectrometry revealed that the active principles were xylosides of dimethylated ellagic acid. One of the compounds also contained a galloyl group at C-3 of the xylose moiety. These findings suggest that plants and other natural products may be a source of agents that can potentially alter glycosaminoglycan and proteoglycan formation in animal cells.

Subphrenic abscess following laparoscopic cholecystectomy and spilled gallstones

The natural biology of spilled intraperitoneal gallstones is not known. We report a patient with subphrenic abscess following spilled gallstones at laparoscopic cholecystectomy.

Sclerosing aspergilloma mimiking sphenoid ridge meningioma in an immunologically competent patient

A 30 year old man presented with history suggestive of a parasellar tumour. Computerised tomography of brain revealed a hyperdense lesion on either side of sphenoid ridge having extension to floor of middle cranial fossa on the left side, enhancing homogenously with contrast and suggestive of a meningioma. Paranasal sinuses and orbit were free of tumour. He did not have any predisposing factor to harbour oppurtunistic infection. Craniotomy and total excision of the lesion was done. Histopathology was reported as aspergilloma.

Zinc supplementation reduces the incidence of acute lower respiratory infections in infants and preschool children: a double-blind, controlled trial

BACKGROUND

Increased acute lower respiratory infection incidence, severity, and mortality are associated with malnutrition, and reduced immunological competence may be a mechanism for this association. Because zinc deficiency results in impaired immunocompetence and zinc supplementation improves immune status, we hypothesized that zinc deficiency is associated with increased incidence and severity of acute lower respiratory infection.

METHODS

We evaluated the effect of daily supplementation with 10 mg of elemental zinc on the incidence and prevalence of acute lower respiratory infection in a double-blind, randomized, controlled trial in 609 children (zinc, n = 298; control, n = 311) 6 to 35 months of age. Supplementation and morbidity surveillance were done for 6 months.

RESULTS

After 120 days of supplementation, the percentage of children with plasma zinc concentrations <60 microg/dL decreased from 35.6% to 11.6% in the zinc group, whereas in the control group it increased from 36.8% to 43.6%. Zinc-supplemented children had 0.19 acute lower respiratory infection episodes/child/year compared with 0.35 episodes/child/year in the control children. After correction for correlation of data using generalized estimating equation regression methods, there was a reduction of 45% (95% confidence interval, 10% to 67%) in the incidence of acute lower respiratory infections in zinc-supplemented children.

CONCLUSIONS

A dietary zinc supplement resulted in a significant reduction in respiratory morbidity in preschool children. These findings suggest that interventions to improve zinc intake will improve the health and survival of children in developing countries.

Knowledge acquired and decisions made: triadic interactions during allogrooming in wild bonnet macaques, Macaca radiata

The pressures of developing and maintaining intricate social relationships may have led to the evolution of enhanced cognitive abilities in many nonhuman primates. Knowledge of the dominance ranks and social relationships of other individuals, in particular, is important in evaluating one's position in the rank hierarchy and affiliative networks. Triadic interactions offer an excellent opportunity to examine whether decisions are taken by individuals on the basis of such knowledge. Allogrooming supplants among wild female bonnet macaques (macaca radiata) usually involved the subordinate female of a grooming dyad retreating at the approach of a female dominant to both members of the dyad. In a few exceptional cases, however, the dominant member of the dyad retreated; simple non-cognitive hypotheses involving dyadic rank differences and agonistic relationships failed to explain this phenomenon. Instead, retreat by the dominant individual was positively correlated with the social attractiveness of her subordinate companion (as measured by the duration of grooming received by the latter from other females in the troop). This suggests that not only does an individual evaluate relationships among other females, but does so on the basis of the amount of grooming received by them. Similarly, the frequency of approaches received by any female was correlated with her social attractiveness when she was the dominant member of the dyad, but not when she was the subordinate. This indicated that approaching females might be aware of the relative dominance ranks of the two allogrooming individuals. In logistic regression analyses, the probability of any individual retreating was found to be influenced more by her knowledge of her rank difference with both the other interactants, rather than by their absolute ranks. Moreover, information about social attractiveness appeared to be used in terms of correlated dominance ranks. The nature of knowledge acquired by bonnet macaque females may thus be egotistical in that other individuals are evaluated relative to oneself, integrative in that information about all other interactants is used simultaneously, and hierarchical in the ability to preferentially use certain categories of knowledge for the storage of related information from other domains.

Mutation of the sialyltransferase S-sialylmotif alters the kinetics of the donor and acceptor substrates

Protein sequence analysis of the cloned sialyltransferase gene family has revealed the presence of two conserved protein motifs in the middle of the lumenal catalytic domain, termed L-sialylmotif and S-sialylmotif. In our previous study (Datta, A. K., and Paulson, J. C. (1995) J. Biol. Chem. 270, 1497-1500) the larger L-sialylmotif of ST6Gal I was analyzed by site-directed mutagenesis, which provided evidence that it participates in the binding of the CMP-NeuAc, a common donor substrate for all the sialyltransferases. However, none of the mutants tested in this motif had any significant effect on their binding affinities toward the acceptor substrate asialo alpha1-acid glycoprotein. In this study, we have investigated the role of the S-sialylmotif of the same enzyme ST6Gal I. In total, nine mutants have been constructed by changing the conserved amino acids of this motif to mostly alanine by site-directed mutagenesis. Kinetic analysis for the mutants which retained sialyltransferase activity showed that the mutations in the S-sialylmotif caused a change of Km values for both the donor and the acceptor substrates. Our results indicated that this motif participates in the binding of both the substrates. A sequence homology search also supported this finding, which showed that the downstream amino acid sequence of the S-sialylmotif is conserved for each subgroup of this enzyme family, indicating its association with the acceptor substrate.

Study of aeroball injuries

OBJECTIVE

To present the risks of aeroball, a new sport played by either two or four players on a trampoline court surrounded by specially constructed fabric walls, and to propose ways to increase awareness and reduce the incidence of injury, in particular, ankle injury.

METHOD

A study was carried out to document the nature of aeroball related incidents, between 1991 and 1995, at Lancaster University Sports Centre. Lace-up ankle supports were introduced in April 1992, and their effect on the incidence of ankle injury was recorded.

RESULTS

The lower limb received most injuries (90%), followed by the upper limb (6%), then the face (3%) and cervical spine (1%). The most common category of injuries was sprains (83%), followed by fractures (8%), contusions (5%), and dislocations (4%). The most common site of injury was the ankle (73%). It is during doubles play that injury is most likely to occur. Since the introduction of ankle supports, there has been a gradual decline in the incidence of ankle injury, 31 in 1991 to nine in 1995.

CONCLUSION

Aeroball has become a popular sport, but it is not without risks. Leaflets have been produced to promote the objectives, rules, and safety of the game. Trained full-time staff should be present to explain the nature of the game. The use of prophylactic ankle stabilisers in aeroball is strongly recommended.

Efficacy of zinc supplementation in reducing the incidence and prevalence of acute diarrhea--a community-based, double-blind, controlled trial

A community-based, double-blind, randomized trial was conducted in a population of low socioeconomic status in urban India to determine whether daily zinc supplementation reduces the incidence and prevalence of acute diarrhea, especially in those with zinc deficiency. Children 6-35 mo of age were randomly assigned to zinc (n = 286) and control (n = 293) groups and received a supplement daily for 6 mo. Zinc gluconate (10 mg elemental Zn) was given, with both zinc and control groups also receiving multivitamins. The primary outcome measures determined by home visits every fifth day and physician examinations were the number of acute diarrheal episodes (incidence) and total diarrheal days (prevalence). Zinc supplementation had no effect in children 6-11 mo old. In children aged > 11 mo there was significantly less diarrhea in the zinc group. In boys > 11 mo old, supplementation resulted in a 26% (95% CI: 13%, 38%) lower diarrheal incidence and a 35% (95% CI: 20%, 50%) lower prevalence. In zinc-supplemented girls > 11 mo of age, the incidence was 17% (95% CI: 2%, 30%) lower and the prevalence was 19% (95% CI: 4%, 47%) lower. Overall, zinc supplementation resulted in a 17% (95% CI: 1%, 30%) lower diarrheal incidence in children with plasma zinc concentrations < 9.18 mumol/L at enrollment and a 33% (95% CI: 6%, 52%) lower incidence in children with concentrations < 50 mumol/L. In conclusion, zinc supplementation had a significant effect on acute diarrheal morbidity in children > 11 mo old and in children with low plasma zinc concentrations.

Effect of zinc supplementation on cell-mediated immunity and lymphocyte subsets in preschool children

OBJECTIVE

In a zinc supplementation trial (with a significant impact on diarrheal morbidity), to evaluate effect of zinc supplementation on cellular immune status before and after 120 days of supplementation.

DESIGN

A double blind, randomized controlled trial with immune assessment at baseline and after 120 days on supplement.

SETTING

Community based study in an urban slum population.

SUBJECTS

Randomly selected children (zinc 38, control 48), had a Multitest CMI skin test at both times. In 66 children (zinc 22, control 34), proportions of CD3, CD4, CD8, CD16, CD20 cells and the CD/CD8 ratio were also estimated using a whole blood lysis method and flowcytometry.

INTERVENTION

Zinc gluconate to provide elemental zinc 10 mg daily and 20 mg during diarrhea.

MAIN OUTCOME RESULTS

Regarding CMI, the percentage of anergic or hypoergic children (using induration score) decreased from 67% to 47% in the zinc group, while in the control group it remained unchanged (73% vs 71%) (p = 0.05). The percentage of children deteriorating between first and second tests was significantly lower in the zinc group (13% vs 33%, p = 0.03). Regarding lymphocyte subsets, the zinc group had a significantly higher rise in the geometric means of CD3 (25%, p = 0.02), CD4 (64% p = 0.001), and CD4/CD8 ratio (73% p = 0.004) with no difference in CD8 and CD20. The rise in CD4 was significantly higher in the zinc as compared to the control group; the ratio of geometric means was 1.45 (95% CI, 1.03-2.01).

CONCLUSION

Zinc supplementation improves cellular immune status, which may have been one of the mechanisms for observed impact of zinc supplementation on diarrheal morbidity.

Dupuytren's disease may extend beyond the wrist crease in continuity

Debate continues about the origin of Dupuytren's disease, which is usually in the palm but is seen elsewhere as ectopic lesions. We describe a young patient with Dupuytren's disease extending proximal to the wrist crease in continuity with the palmar lesion. Our findings support the view that the condition starts within the palmar connective tissue, but there is no palmar aponeurosis in the forearm and the proximal extension probably started in the deep layer of the superficial fascia.

DUPUYTREN’S DISEASE MAY EXTEND BEYOND THE WRIST CREASE IN CONTINUITY

Debate continues about the origin of Dupuytren’s disease, which is usually in the palm but is seen elsewhere as ectopic lesions. We describe a young patient with Dupuytren’s disease extending proximal to the wrist crease in continuity with the palmar lesion.

Our findings support the view that the condition starts within the palmar connective tissue, but there is no palmar aponeurosis in the forearm and the proximal extension probably started in the deep layer of the superficial fascia.

Benign necrotizing osteitis of the external auditory meatus

Benign necrotizing osteitis of the external auditory meatus is a rare condition which occurs in non-diabetic healthy people. The aetiology of the necrotic process with the formation of sequestrum in the bony external meatus is unknown. It is important to differentiate this benign process from malignant otitis externa and radionecrosis of the temporal bone as the management of these conditions differs. We present two cases, one managed surgically and the other medically, and review the literature. Immediate surgical excision of the sequestrum is advocated instead of long-term medical therapy and waiting for it to separate spontaneously.

Isoflurane hepatotoxicity: a case report and review of the literature

Isoflurane, hailed as the anesthetic of the 1980s, is less hepatotoxic than its predecessors, halothane and enflurane. Since its release by the Food and Drug Administration in 1979, controversy has existed about the extent to which isoflurane is capable of producing hepatotoxic effects. In this report, we provide direct evidence that isoflurane can induce liver injury and should therefore be considered as a potential cause of serum transaminase elevations in any patient who is exposed to this anesthetic.

An unusual foreign body migrating from pharynx to mediastinum

A case of a swallowed foreign body migrating from the pharynx into the soft tissues of the neck is presented, whose management was complicated by its undetected migration to the superior mediastinum occurring between radiological localization in the neck three days prior to exploration and its attempted removal. A median sternotomy was then required to retrieve the object. Radiological guidance with regard to the localization of a foreign body in the neck can only be relied on when performed immediately prior to surgical removal.

Field trial of billings ovulation method of natural family planning

There are couples with unmet family planning needs and couples who do not use any modern method, yet they desire to space or avoid pregnancies. Many of them look for safe and effective options like the natural family planning methods. The Billings Ovulation Method based on single index cervical mucus parameter is one such option. The present multicentre trial conducted in India has shown an encouraging use-effectiveness of the method, indicating method failure as low as 1.5 +/- 0.3 and use-failure 15.9 +/- 0.8 per 100 users at 21 months. The method continuation rates have also been as high as 88.3/100 users at 6 months and 52.0/100 users at 21 months.

Zinc supplementation reduces the incidence of persistent diarrhea and dysentery among low socioeconomic children in India

Persistent diarrhea (PD) and dysentery (DD) account for most diarrhea-associated deaths among children in developing countries. Zinc deficiency can cause stunting and impaired immune function, both of which are risk factors for these diarrheal illnesses. We investigated the effect of zinc supplementation on the incidence of PD and DD in a community-based, double-blind randomized trial in children 6-35 mo of age. Increase over baseline in plasma zinc concentrations in the supplemented group compared with a control group (3.61 vs. 0.009 mumol.L-1), indicated successful supplementation. The overall reductions in the zinc supplemented group of 21% in the incidence of PD (95% CI -6 to 42%) and 14% in the incidence of dysentery (95% CI -15 to 36%) were not significant. There was a significant interaction of treatment effect with baseline plasma zinc concentration and age for PD and with gender for DD. In the zinc-supplemented group compared with the control group, the incidence of PD was reduced by 73% (P < 0.05; 95% CI 34 to 91%) in children with a baseline zinc < 7.65 mumol.L-1 and by 49% (P < 0.05; 95%CI 24 to 66%) in children > 11 mo of age. Zinc supplementation resulted in a 38% (P < 0.05 95%CI 8 to 59%) reduction in the incidence of DD in boys. There was no effect on PD among children 6-11 mo old or on DD in girls. In conclusion, zinc supplementation had a significant impact on the incidence of persistent diarrhea in children > 1 y old and in children with low plasma zinc, as well as on dysentery in boys. These findings may have important implications for reducing diarrhea-related morbidity and mortality.

Effects of insulin on body composition in patients with insulin-dependent and non-insulin-dependent diabetes

Insulin is used to control blood glucose but may have an adverse effect on the amount and distribution of fat mass and other cardiovascular risk factors. To test this hypothesis the effect of insulin therapy on blood glucose, body composition, and lipid levels was measured during 6 months in 9 patients with newly diagnosed insulin-dependent (Type 1) diabetes mellitus (IDDM) and 15 patients with non-insulin dependent (Type 2) diabetes (NIDDM) and secondary failure of therapy with oral hypoglycaemic agents. Both groups received similar daily doses of insulin (approximately 0.6 units kg-1 day-1). Glycaemic control improved during 6 months treatment in both groups, although the reduction in HbA1c was greater in IDDM (5.2 +/- 0.7%) than in NIDDM (2.0 +/- 0.4%, p < 0.001). All parameters of the lipid profile improved in IDDM but not in NIDDM. Body weight, lean mass, and fat mass, measured by dual energy x-ray absorptiometry, increased at 1 month in IDDM but not in NIDDM. By 6 months, body weight had increased more in IDDM than NIDDM (9.1 +/- 1.2 vs 3.77 +/- 0.5 kg, p < 0.01). The increase in weight was predominantly lean mass in IDDM (60.4 +/- 9.3%) and fat mass in NIDDM (59.9 +/- 8.4%). The increase in lean mass was greater in IDDM than NIDDM (5.6 +/- 1.1 vs 1.4 +/- 0.3 kg, p < 0.001). Fat mass increased by similar increments in IDDM and NIDDM (3.4 +/- 0.8 vs 2.4 +/- 0.5 kg, p = ns) and was predominantly an increase in trunk fat (IDDM: 2.3 +/- 0.6 kg, NIDDM: 2.0 +/- 0.4 kg, p = ns). The central/peripheral fat mass ratio prior to treatment was lower in IDDM than NIDDM (0.64 +/- 0.05 vs 1.09 +/- 0.09, p < 0.01) and then increased in IDDM by 0.32 +/- 0.15 (p = 0.07) and in NIDDM by 0.22 +/- 0.06 (p < 0.001). In conclusion, insulin therapy is associated with weight gain in both IDDM and NIDDM. In the former, weight gain reflects increases in lean mass whereas in NIDDM it reflects an increase in trunk fat mass. It remains to be determined whether this trend to central obesity partly offsets other benefits of insulin therapy in NIDDM.

Neural-network-based classification of Space Acceleration Measurement Systems (SAMS) data via supervised learning

This paper illustrates the applicability of neural networks in classifying events using Space Acceleration Measurement System (SAMS) data. Computer programs have been written in the MATLAB environment for the following purposes: automatic retrieval of SAMS data from NASA CDROM disks, computation of power spectral densities for SAMS data and construction of input patterns for the training of a multi-layer neural network (MNN). The MNN has been trained using the backpropagation learning algorithm and the SAMS data collected on the STS-50 Space Shuttle mission for three crew exercise events. It is found that the trained MNN is highly successful in classifying events. In addition, the performance of MNN is found to be better than that of the nearest neighbor classifier.

Zinc supplementation in young children with acute diarrhea in India

BACKGROUND

In developing countries the duration and severity of diarrheal illnesses are greatest among infants and young children with malnutrition and impaired immune status, both factors that may be associated with zinc deficiency. In children with severe zinc deficiency, diarrhea is common and responds quickly to zinc supplementation.

METHODS

To evaluate the effects of daily supplementation with 20 mg of elemental zinc on the duration and severity of acute diarrhea, we conducted a double-blind, randomized, controlled trial involving 937 children, 6 to 35 months of age, in New Delhi, India. All the children also received oral rehydration therapy and vitamin supplements.

RESULTS

Among the children who received zinc supplementation, there was a 23 percent reduction (95 percent confidence interval, 12 percent to 32 percent) in the risk of continued diarrhea. Estimates of the likelihood of recovery according to the day of zinc supplementation revealed a reduction of 7 percent (95 percent confidence interval, -9 percent to +22 percent) in the risk of continued diarrhea during days 1 through 3 and a reduction of 38 percent (95 percent confidence interval, 27 percent to 48 percent) after day 3. When zinc supplementation was initiated within three days of the onset of diarrhea, there was a 39 percent reduction (95 percent confidence interval, 7 percent to 61 percent) in the proportion of episodes lasting more than seven days. In the zinc-supplementation group there was a decrease of 39 percent (95 percent confidence interval, 6 percent to 70 percent) in the mean number of watery stools per day (P = 0.02) and a decrease of 21 percent (95 percent confidence interval, 10 percent to 31 percent) in the number of days with watery diarrhea. The reductions in the duration and severity of diarrhea were greater in children with stunted growth than in those with normal growth.

CONCLUSION

For infants and young children with acute diarrhea, zinc supplementation results in clinically important reductions in the duration and severity of diarrhea.

A study on estimation of age from pubic symphysis

The present study has been carried on 82 pairs of pubic symphysis collected from fresh male cadavers. Various features were noted on the symphyseal surface--ridges and furrows, dorsal margin, ventral bevelling, lower extremity, ossific nodule, upper extremity, ventral rampart, dorsal plateau and symphyseal rim. Varying combination of these features were used as criteria for age estimation of the subjects.