Discrimination of normal and transformed cells in vitro by cytologic and morphologic analysis

Malignant A-549 lung carcinoma and adenovirus-12 SV40 hybrid virus transformed non-tumorigenic human bronchial epithelial cells (BEAS-2B) were objectively discriminated from normal bronchial epithelial (BE) cells on the basis of Papanicolaou stained nuclear features (e.g. shape, chromatin texture, hyperchromasia) and nucleolar morphology (e.g. number per cell, irregular contours). Morphometric analysis indicated that significant differences in cellular morphology existed between BE, BEAS-2B, and A-549 cells. Similar analyses of transformed, tumorigenic cell lines demonstrated that nuclear features (i.e., chromatin texture, clearing of parachromatin, hyperchromasia, variation in thickness of the nuclear envelope, sharp indentations in the nuclear envelope), and nucleolar features (i.e., degree of roundness, presence of angular projections, number per cell) discriminated chemically and virally transformed cells from spontaneously transformed cells. Nuclear and nucleolar features were correlated with the growth rate of tumorigenic cell lines. These analytical approaches will be helpful in studies of the effects of various factors (e.g. vitamin A, phorbol ester, oncogene transfection) on cellular proliferation and/or differentiation.

Managing skin disease in resource-poor environments - the role of community-oriented training and control programs

Programs that have been devised to improve the lot of patients with skin disease, or disease presenting with skin signs and symptoms, in resource-poor regions have focused mainly on education and training or community-oriented control measures. However, both have in common an objective of managing disease at population level. Training has been delivered in different ways both by direct teaching for varying periods of time or by web-based and electronic communication; control measures have been less in evidence and there is a great need for more support from funding agencies. Despite this, there is now a growing number of successful initiatives in health improvement for skin conditions that cover many parts of the world. This report describes many of these schemes as an example of what can be done to help patients.

SUMO-modified nuclear cyclin D1 bypasses Ras-induced senescence

Oncogene-induced senescence represents a key tumor suppressive mechanism. Here, we show that Ras oncogene-induced senescence can be mediated by the recently identified haploinsufficient tumor suppressor apoptosis-stimulating protein of p53 (ASPP) 2 through a novel and p53/p19(Arf)/p21(waf1/cip1)-independent pathway. ASPP2 suppresses Ras-induced small ubiquitin-like modifier (SUMO)-modified nuclear cyclin D1 and inhibits retinoblastoma protein (Rb) phosphorylation. The lysine residue, K33, of cyclin D1 is a key site for this newly identified regulation. In agreement with the fact that its nuclear localization is required for its oncogenic activity, we show that nuclear cyclin D1 is far more potent than wild-type (WT) cyclin D1 in bypassing Ras-induced senescence. Thus, this study identifies SUMO modification as a positive regulator of nuclear cyclin D1, and reveals a new way by which cell cycle entry and senescence are regulated.

Interdigital lesions and frequency of acute dermatolymphangioadenitis in lymphoedema in a filariasis-endemic area

BACKGROUND

Lymphatic filariasis (LF) is a mosquito-borne nematode infection that causes permanent lymphatic dysfunction in virtually all infected individuals and clinical disease in a subset of these. One major sequel of infection is lymphoedema of the limbs. Lymphoedema of the leg affects an estimated 15 million persons in LF-endemic areas worldwide. Acute dermatolymphangioadenitis (ADLA) in people with filarial lymphoedema causes acute morbidity and increasingly severe lymphoedema. Episodes of ADLA are believed to be caused by bacteria, and it has been shown that entry lesions in the skin play a causative role. Clinical observations suggest that interdigital skin lesions of the feet, often assumed to be fungal, may be of particular importance.

OBJECTIVES

To investigate the epidemiology and aetiology of interdigital lesions (IDL) of the feet in filarial lymphoedema.

METHODS

The frequency and mycological aetiology of IDL in 73 patients with filarial lymphoedema were compared with 74 individuals without lymphoedema in a region of Guyana highly endemic for Wuchereria bancrofti.

RESULTS

More than 50% of patients with lymphoedema had one or more IDL (odds ratio 2.69; 95% confidence interval 1.31-5.66; P<0.005 compared with controls). The number of lesions was the strongest predictor of frequency of ADLA. Only 18% of the lesions had positive microscopy or culture for fungi (dermatophytes and Scytalidium).

CONCLUSIONS

These findings highlight the importance of interdigital entry lesions as risk factors for episodes of ADLA and have implications for the control of morbidity from filarial lymphoedema.

Literature review. Onychomycosis

Onychomycoses have been divided into several categories depending on the site of nail penetration by the fungus. However, not all cases entirely fit with this classification, such as potentially the deep spread of superficial fungi, suggesting alternative penetration routes. A recent European study showed that the prevalence of onychomycosis may be as high as 26.9%. The main causative agent varies according to climate; dermatophyte infections are common worldwide (70% in Europe). Mycological examination is currently the preferred diagnostic method, despite a false-negative rate of 30%. A clinical diagnostic aid that can be used alongside mycological tests is currently being developed. Newer diagnostic approaches include calcofluor, which stains fungi in nails, and molecular genetic techniques for species recognition (e.g. RFLP). Restriction fragment length polymorphism (RFLP) can also distinguish between failed treatment and reinfection. Onychomycosis can be treated with numerous oral and topical agents alone or in combination. In some studies, combination therapy appears more effective than monotherapy.

Pharmacoeconomics--an aid to better decision-making

OBJECTIVES

The first aim of this workshop was to define pharmacoeconomic concepts and terminology. Pharmacoeconomics can be defined as the branch of economics that uses cost-benefit, cost-effectiveness, cost-minimization, cost-of-illness and cost-utility analyses to compare pharmaceutical products and treatment strategies. Economic evaluations provide healthcare decision-makers with valuable information, allowing optimal allocation of limited resources. However, pharmacoeconomics is based on long-term benefits, whereas physicians are typically forced to seek immediate savings. The second aim was to review pharmacoeconomic studies in the field of onychomycosis and finally to discuss future perspectives.

RESULTS AND CONCLUSIONS

We discussed current pharmacoeconomic issues on the management of onychomycosis. Consensus was reached on the following issues: * Published pharmacoeconomic studies concerning onychomycosis are flawed. Future studies should be based on internationally validated principles and appropriate models. The fact that costs of different drugs, laboratory examinations and physician visits vary worldwide should be considered. Cost-benefit studies are required. * The National Institute for Clinical Excellence (NICE) recommendations are often considered in countries other than the UK, even when not adapted to the country in question. * Generic drugs might reduce costs, but this depends on their effectiveness (bioavailability). * Sampling requests affect the economic cost (dependent on methodology, which depends on country) and physicians often trust their instincts even when tests are repeatedly negative. * The cost of adverse event management is usually considered to be 10%; this may be too high for onychomycosis, as treatments are relatively safe without severe side-effects. * Probability of recurrence for each drug should be determined. * Need for disease severity standardization, definition of diagnostic criteria and successful treatment (mycological and clinical cure).

A guide to antibiotic resistance in bacterial skin infections

The emergence of bacterial resistance to commonly used antibiotics is not new. In this review we have tried to cover the ever increasing problems facing the treatment and containment of bacterial skin infections. We have tried to give an overview of the varied mechanisms by which bacteria gain and spread antimicrobial resistance, whilst dealing with the patterns of resistance exhibited by some of the commonly encountered organisms. Where there is evidence, we have formulated an approach on how to tackle antibiotic resistance. Where there is a lack of evidence we have formulated what we perceive to be appropriate guidelines.

Patients at risk of onychomycosis - risk factor identification and active prevention

OBJECTIVES

The aims of this workshop were to identify risk factors for onychomycosis and to reach consensus on the management of high-risk groups to allow the development of guidelines to help doctors recognize risk factors that complicate treatment.

RESULTS AND CONCLUSIONS

Previous Trichophyton rubrum infection, older age, abnormal nail morphology, immunodeficiency and genetic factors were identified as risk factors for initial infections. Risk factors for recurrence (relapse and re-infection) are largely the same. The experts agreed that the prevention of onychomycosis and its recurrence should be based on the correct treatment of tinea pedis, screening family members and adequate patient education. In addition, generic management recommendations for each high-risk group were discussed: * Immunosuppressed patients Usual dose and treatment length not appropriate Follow-up required Beware of drug interactions * Diabetics Prophylactic foot care combined with nail treatment Good opportunity for patient education, footwear, foot care, etc. Beware of drug interactions * Psoriatics and patients with abnormal nails Dermatophyte eradication does not restore normal nails * Children High failure rate possibly due to compliance problems.

Definition of an algorithm for the management of common skin diseases at primary health care level in sub-Saharan Africa

In order to help primary health care (PHC) workers in developing countries in the care of common skin diseases, an algorithm for the management of pyoderma, scabies, superficial mycoses, contact dermatitis and referral of early leprosy cases (based on the identification of diseases through the presence of objective key signs, and on treatments by generic drugs) was elaborated. One thousand patients were seen by trained dermatologists, who established diagnoses and treatments; in addition, there was systematic recording of each key sign, according to the successive algorithm steps. We compared the diagnostics and treatments obtained for several combinations of diagnostic signs, with those of the dermatologists. Sensitivity, specificity, positive predictive value and negative predictive value of defined combinations were high for pyoderma, scabies and superficial mycoses. Values were less exact for dermatitis and leprosy, but were considered sufficient for the level of health care targeted. The apportionment of treatments between the algorithm and the dermatological approaches was considered appropriate in more than 80% of cases; mismanagement was possible in 7% of cases, with few predictable harmful consequences. The algorithm was found satisfactory for the management of the dermatological priorities according to the standards required at the PHC level.

Cytokine production and lymphocyte proliferation in patients with Nocardia brasiliensis actinomycetoma

IFN-gamma, TNF-alpha, IL-4, IL-10 and IL-12 concentrations in the supernatant of peripheral blood mononuclear cell (PBMC) cultures and the in vitro proliferation of PBMC were studied in 25 patients with actinomycetoma caused by Nocardia brasiliensis and in 10 healthy controls from endemic zones. Cell cultures were stimulated by a N. brasiliensis crude cytoplasmic antigen (NB) and five semi-purified protein fractions (NB2, NB4, NB6, NB8, and NB10) separated by isoelectric. Phytohemagglutinin (PHA) and purified protein derivative (PPD) of Mycobacterium tuberculosis were used as control antigens. Skin tests were performed by injecting 0.1 ml of candidin and PPD intradermally (ID). Patients showed a poor response to tuberculin, while their response to candidin was more than two fold greater than that observed in the controls. Cell proliferation showed no statistically significant differences in either group. IFN-gamma production was higher in the healthy controls than in the patients, whereas TNF-alpha secretion was slightly higher in the patients' cultures. IL-4 was detected in the patients' cultures but not in the controls. IL-10 and IL-12 were present at low concentrations in both groups. These results suggest that patients with actinomycetoma show normal antigen recognition, but with low IFN-gamma production, and higher concentrations of IL-4, IL-10 and TNF-alpha in the patients' PBMC cultures, indicating that they probably have a Th2 type of immune response.

Superficial white onychomycosis revisited

BACKGROUND

Superficial white onychomycosis (SWO) is a distinct pattern of fungal nail invasion, which is usually treated with topical antifungals.

OBJECTIVE

This paper presents a case of SWO with deep penetration and records other similar cases.

METHODS

The clues to deep invasion of the nail plate are twofold: an inability to clear the discoloration by scraping the nail and a clinical involvement of the nail plate in the proximal nailfold area. Histology of the nail keratin will confirm deep penetration beyond the superficial layers of the nail plate.

RESULTS

In the light of this finding the authors propose a further subdivision of SWO to reflect previously unrecognized variants with therapeutic implications into: (i) the classical SWO type; (ii) the dual invasion of the nail plate, superficial and ventral; and (iii) the pseudo-SWO with deep fungal invasion of the nail plate.

CONCLUSIONS

This subdivision of SWO allows the clinician to treat the patient appropriately using topical antifungals when the disease is restricted to the dorsum of the nail. Systemic drugs either in isolation or in combination with topical treatment are mandatory when deep penetration or ventral fungal invasion are observed.

The International Foundation for Dermatology: an exemplar of the increasingly diverse activities of the International League of Dermatological Societies

The International Foundation of Dermatology (IFD) was established by the International League of Dermatology Societies to promote the care of skin disease in the developing world. Starting from an initial base of the Regional Dermatology Training Centre in Tanzania it has successfully trained a cadre of clinical officers and dermatology residents from different African countries. It has now broadened this approach to an assessment of the effectiveness of focused training in Mali. The IFD is also completing a global assessment of dermatological needs in developing countries with a view to establishing guidelines and programmes for the control of common skin diseases. An ongoing strategy has been to work with other agencies to help ease the burden of other endemic tropical diseases that affect the skin; preventing the development of elephantiasis in filarial lymphoedema has been one such project implemented through a programme of skin hygiene.

High prevalence of foot diseases in Europe: results of the Achilles Project

OBJECTIVE

To provide an insight into the prevalence of foot disease in Europe, and to include an assessment of the prevalence of predisposing factors and their correlation with foot disease.

DESIGN

Large population-based survey conducted in 16 European countries.

SETTING

The project consisted of two parts (study I and study II), in which all patients presenting to general practitioners and dermatologists over a defined time period were invited to participate. Patients. In study I, 70,497 patients presenting to dermatologists or general practitioners were recruited, and in study II 19,588 patients presenting to dermatologists were recruited.

MAIN OUTCOME MEASURE

The feet of all participants were examined for signs of foot disease. The assessors also recorded relevant details such as the age and sex of patients, and the presence of predisposing factors for foot disease. In addition, patients in study II were offered a free mycological examination of the toenails and skin on the feet.

RESULTS

In study I, 57.0% of patients had at least one foot disease. In study II, 61.3% had at least one foot disease. The proportions of patients with fungal foot disease and non-fungal foot disease in study I were 34.9% and 38.4%, respectively, and in study II were 40.6% and 41.7%, respectively. Orthopedic conditions and metatarsal corns were the most frequently reported non-fungal foot diseases, and onychomycosis and tinea pedis were the most frequently observed fungal infections.

CONCLUSIONS

This large-scale survey suggests that the prevalence of fungal and non-fungal foot disease is higher than previously estimated.