Fluconazole for the prevention and treatment of tinea gladiatorum

BACKGROUND

Tinea gladiatorum is a common problem in competitive wrestling. It impacts on a wrestler's ability to compete. Several methods have been advocated to prevent these infections; however, no well-designed study of pharmacologic prophylaxis has been conducted.

METHODS

In a double blind placebo-controlled trial during the 1998 to 1999 regular wrestling season, wrestlers were randomized to receive 100 mg of fluconazole once weekly or placebo once weekly. Those not involved in the study were treated as a second control group. The effects of prophylaxis were also examined by assessing treatment of clinical infections with fluconazole 200 mg weekly for 4 weeks.

RESULTS

There was a significantly smaller incidence of infection in those given fluconazole (6%) than in those receiving placebo (22%) and those not involved in the prophylaxis phase (18%) (P<0.05). There was also a significant reduction in the total number of infections in the fluconazole group (P<0.05). Prophylaxis with fluconazole did not impact on the severity of disease, if contracted, when compared with the placebo prophylaxis participants who contracted tinea corporis. Of 21 wrestlers with tinea infections and positive cultures, 14 were able to have their isolates identified as Trichophyton tonsurans.

CONCLUSIONS

Fluconazole is effective and safe for primary prevention of tinea gladiatorum. We must now define when and in what population prophylaxis would be warranted.

Cell division, guillotining of dimer chromosomes and SOS induction in resolution mutants (dif, xerC and xerD) of Escherichia coli

We have studied the growth and division of xerC, xerD and dif mutants of Escherichia coli, which are unable to resolve dimer chromosomes. These mutants express the Dif phenotype, which includes reduced viability, SOS induction and filamentation, and abnormal nucleoid morphology. Growth was studied in synchronous cultures and in microcolonies derived from single cells. SOS induction and filamentation commenced after an apparently normal cell division, which sheared unresolved dimer chromosomes. This has been called guillotining. Microcolony analysis demonstrated that cell division in the two daughter cells was inhibited after guillotining, and microcolonies formed that consisted of two filaments lying side by side. Growth of these filaments was severely reduced in hipA+ strains. We propose that guillotining at dif destroys the expression of the adjacent hipBA genes and, in the absence of continued formation of HipB, HipA inhibits growth. The length of the filaments was also affected by SfiA: sfiA dif hipA mutants initially formed filaments, but cell division at the ends of the filaments ultimately produced a number of DNA-negative cells. If SOS induction was blocked by lexA3 (Ind-), filaments did not form, and cell division was not inhibited. However, pedigree analysis of cells in microcolonies demonstrated that lethal sectoring occurred as a result of limited growth and division of dead cells produced by guillotining.

Method for determining antiphase dynamics in a multimode laser

We measure the cross spectrum of the intensity fluctuations of pairs of modes for a multilongitudinal mode neodymium-doped yttrium aluminum garnet laser operating in the steady state regime. From the data we build up a picture of how the longitudinal mode fluctuations interfere and directly show the antiphase dynamics of the intensity fluctuations.

Hydroquinone: genotoxicity and prevention of genotoxicity following ingestion

Plant-derived polyphenolics and other chemicals with antioxidant properties have been reported to inhibit the expression of genotoxic activity by pro-oxidant chemicals (Sai et al., 1992, 1994; Teel and Castonguay, 1992). In vitro and in vivo studies with ionizing radiation suggest that hydroquinone (HQ) may have similar protective effects (Babaev et al., 1994). The present study was conducted to determine whether HQ is capable of inhibiting the induction of micronuclei in the bone marrow of mice following exposure to an oxidant, potassium bromate or KBrO3 (Nakajima et al., 1989; Sai et al., 1992, 1994). To be able to interpret the results of this work, it was also necessary to determine whether HQ is itself genotoxic when fed in the diet. HQ diets (0.8%) fed to mice for 6 days reduced the background incidence of micronuclei compared with the basal diet. KBrO3 dosed ip (12.5-100 mg/kg) produced a dose-dependent increase in micronuclei as reported by others. Mice fed 0.8% HQ diets 6 days, and then dosed intraperitoneally with KBrO3, showed a 36% reduction in micronuclei across the range of KBrO3 dose levels. This effect was associated with a reduction in the background micronucleus response as well as a reduction in response to KBrO3. Statistical significance (P < or = 0.05), observed at a dose of 25 mg/kg KBrO3 in the mice fed the control diet, was abolished in the group fed 0.8% HQ. When mice were given 50 mg HQ/kg by oral gavage and then given 50 mg KBrO3/kg ip 20 min later, the micronucleus response induced by KBrO3, was lower in animals given HQ. The results of this study demonstrate that large doses of HQ may be given orally without induction of micronuclei or bone marrow depression, that HQ reduces the background micronucleus response in animals fed a basal diet, and that the HQ reduces the micronucleus response to KBrO3 as well as background incidence of micronuclei in KBrO3-dosed animals. The protective effect of HQ may be due to enzyme induction or a direct antioxidant effect of HQ against oxidants commonly present in the diet.

Validation of the Health of the Nation Outcome Scales

BACKGROUND

The Health of the Nation Outcome Scales (HoNOS) were developed to assess the outcome of severe mental disorders in relation to the Health of the Nation Strategy for England.

AIMS

To validate the HoNOS.

METHOD

One hundred and fifteen patients were assessed by keyworkers using HoNOS, and by research workers using SCAN, SBS, and SRPS, and completing HoNOS in the light of this additional material. These assessments were repeated after 6 weeks.

RESULTS

The performance of HoNOS in the hands of keyworkers was generally poor, in relation both to the research workers' rating of HoNOS and to the criterion instruments. Performance was particularly poor when the change in scores was used as a measure of outcome.

CONCLUSIONS

There are serious problems in using HoNOS as a routine measure of clinical status in busy psychiatric services. Its performance is probably related to the training and experience of keyworkers. Sequential ratings are not a good method for assessing outcome. Managers and planners should be cautious in adopting HoNOS, but it is worthy consideration in developing a suite of locally agreed outcome measures.

Barriers to effective communication in skilled nursing facilities: differences in perception between nurses and physicians

BACKGROUND

Effective communication between nurses and physicians is central to the clinical care of nursing home residents. Anecdotal evidence suggests that communication between the groups is unsatisfactory, but no empirical data exist with which to validate assumptions. The purpose of this pilot study was to compare perceptions of potential communication barriers among nurses and physicians in four California nursing homes.

METHODS

Registered nurses (n = 59), and physicians (n = 47) involved in the direct clinical care of nursing home residents completed a 12-item questionnaire designed to elicit perceptions about potential communication barriers. Five specific categories of barriers were identified. These included nurse competence, time burden of calls, necessity of calls, professional respect, and language comprehension. Responses were compared using t test analysis.

RESULTS

Significant differences in perceived communication barriers were identified. Physicians, but not nurses, perceive nursing competence to be a significant barrier. Nurses perceive physicians to be unpleasant. Both physicians and nurses perceive that physicians do not value nurses' opinions. Neither group perceived language expression, language comprehension, or time burden of phone calls to be barriers to communication.

CONCLUSIONS

Issues related to the perceived competency of nurses by physicians is consistent with existing data from other clinical settings. Differences in awareness about scope of practice and regulatory requirements between the groups may offer a partial explanation for the discordant perceptions. Perceptions by nurses (but not physicians) of unpleasantness and/or disrespect during telephone encounters may reflect the broader ongoing differences in professional culture, social status, and gender inequality between the two groups. Further clarification of the causes of barriers to effective communication is essential in order to plan appropriate interventions.

Efficacy of computerized decision support for mechanical ventilation: results of a prospective multi-center randomized trial

200 adult respiratory distress syndrome patients were included in a prospective multicenter randomized trial to determine the efficacy of computerized decision support. The study was done in 10 medical centers across the United States. There was no significant difference in survival between the two treatment groups (mean 2 = 0.49 p = 0.49) or in ICU length of stay between the two treatment groups when controlling for survival (F(1df) = 0.88, p = 0.37.) There was a significant reduction in morbidity as measured by multi-organ dysfunction score in the protocol group (F(1df) = 4.1, p = 0.04) as well as significantly lower incidence and severity of overdistension lung injury (F(1df) = 45.2, p < 0.001). We rejected the null hypothesis. Efficacy was best for the protocol group. Protocols were used for 32,055 hours (15 staff person years, 3.7 patient years or 1335 patient days). Protocols were active 96% of the time. 38,546 instructions were generated. 94% were followed. This study indicates that care using a computerized decision support system for ventilator management can be effectively transferred to many different clinical settings and significantly improve patient morbidity.

Combined liver-kidney transplantation in patients with cirrhosis and renal failure: effect of a positive cross-match and benefits of combined transplantation

Patients with renal failure after liver transplantation have a particularly poor prognosis. Therefore, in the setting of end-stage renal disease requiring dialysis or severe renal insufficiency that will not improve after liver replacement, combined liver-kidney transplantation (LKT) is the preferred approach. We have adopted a policy of LKT in patients with end-stage liver disease and renal insufficiency undergoing dialysis or with a creatinine clearance less than 35 mL/min and evidence of chronic renal dysfunction. Since 1991, we have performed 208 orthotopic liver transplantations. Fourteen patients (8%) have undergone combined LKT, including 6 patients undergoing hemodialysis. Cytotoxic cross-matches (modified Amos technique and antihuman globulin method) were performed on 13 of 14 patients and were positive in 3 patients. Two patients died less than 4 months after LKT and 12 patients are alive and well. Graft survival censored for patient death was 100% for liver allografts and 93% for renal allografts, with a mean follow-up of 39 +/- 24 months. The most recent serum creatinine level in the patients with the 11 functioning grafts was 1.1 +/- 0.6 mg/dL. Biopsy-proven acute rejection occurred in 50% of simultaneous liver allografts. By contrast, only a single episode (6%) of renal allograft dysfunction was attributable to acute rejection. All rejection episodes occurred in the first 90 days after transplantation and were steroid sensitive. Three of 14 combined procedures were performed in the setting of a positive cytotoxic cross-match. In 2 recent patients, the results were confirmed by positive cross-matches to the donor's T and B cells by flow cytometry. Flow cytometric cross-matches reverted to negative 1 hour after liver transplantation and several hours before the administration of antithymocyte globulin. The cross-matches remained negative on postoperative days 1 and 7. Presently, all 3 patients with a positive cross-match enjoy normal hepatic and renal function at 631, 706, and 2275 days follow-up. Renal scans were performed in 4 LKT recipients not previously undergoing hemodialysis and indicated varying and unpredictable degrees of function in the native and transplanted kidneys. In conclusion, combined LKT can be performed safely and is associated with a low rate of acute rejection, even in the setting of a positive cross-match. Predicting which patients with renal insufficiency will benefit from LKT remains challenging; however, these results suggest that LKT should be encouraged in patients with evidence of irreversible renal insufficiency who require liver transplantation.

Herpes simplex virus hepatitis in macrophage-depleted mice: the role of massive, apoptotic cell death in pathogenesis

Infection with herpes simplex virus or hepatitis viruses can lead to fulminant hepatitis, but there is controversy about the underlying conditions needed for such disease. To investigate how the impairment of host defences might be involved, macrophages were depleted by administration of silica to mice before intravenous injection with herpes simplex virus type 1 (HSV-1). Such mice died rapidly and their livers were yellowish and shrunken (acute yellow atrophy), and occasionally grossly haemorrhagic. Small foci of apoptotic cells developed in the liver lobules; these rapidly became confluent and zonal over time. The overall lesion pattern was similar to massive hepatic necrosis, and there was extensive HSV replication in the liver lesions. In the liver, DNA fragmentation characteristic of apoptosis followed the time course of HSV-1 propagation. These findings suggest that one of the underlying conditions for fulminant viral hepatitis may be inadequate macrophage response, and that the massive hepatic damage, often defined as cell necrosis, may actually be apoptosis of liver cells subsequent to virus infection.

Changes in regional cerebral blood flow following light treatment for seasonal affective disorder: responders versus nonresponders

BACKGROUND

Several brain imaging studies of antidepressant pharmacologic treatment utilizing single photon emission computed tomography (SPECT) have reported a normalization of deficits in cerebral blood flow (CBF) associated with recovery; other studies report no change, or a reduction in CBF following successful treatment. There have been no published SPECT studies of seasonal affective disorder (SAD) assessing response to light treatment in relation to changes in regional CBF (rCBF). In this study, we sought to test the hypothesis that increases in rCBF would be observed in SAD patients who responded to light treatment.

METHODS

Ten depressed patients with SAD underwent functional brain imaging studies with 99mTc-hexamethylpropyleneamine oxime SPECT before and after light treatment.

RESULTS

Relative increases in rCBF were observed in all brain regions compared to cerebellum in treatment responders, whereas nonresponders showed no change or decreases in rCBF relative to cerebellum. Significant differences in mean percentage change in rCBF between responders (n = 5) and nonresponders (n = 5) were detected in frontal and cingulate cortex, and thalamus.

CONCLUSIONS

These findings provide preliminary support for the hypothesis that an increase in rCBF is associated with recovery from depression in SAD.

Gestational herpes simplex virus hepatitis

Hepatitis due to herpes simplex virus (HSV) is unusual in healthy individuals. To date, only 56 cases of HSV hepatitis in adult patients have been reported, including 21 pregnant patients. We describe a 25-year-old white woman in her 30th week of gestation who had progressive acute hepatitis. Histologic examination of the liver biopsy specimen showed diffuse microabscesses involving more than 50% of the hepatic parenchyma, with multiple hepatocytes containing Cowdry type A and ground-glass nuclear inclusions. The diagnosis of herpes hepatitis was confirmed by positive immunoreactivity to HSV antibodies in the tissue sections. Intravenous acyclovir therapy was immediately initiated, and the patient's condition improved dramatically. She then had a normal baby at term. Subsequently, the patient had a second pregnancy and an uncomplicated vaginal delivery without recurrence of the disease. Even though alterations of the humoral and cell-mediated immunity occur during pregnancy, herpes hepatitis is rare in pregnant women. Since the prompt administration of antiviral drugs is a lifesaving measure, we recommend including HSV hepatitis in the differential diagnosis of acute hepatitis in pregnancy.

Variability in breathing patterns during latent labor. A pilot study

This study examined the breathing patterns of a small sample of women (n = 21) during latent labor. The study also examined the different thoughts or cognitions the women experienced during their early contractions and assessed whether these cognitions, when classified as associative or dissociative in orientation, were related to breathing styles and length of labor. Respiration rate and tidal volume were monitored during and between contractions using a noninvasive plethysmograph system. The breathing results indicated considerable variation among women in individual respiration rate and tidal volume both between and during contractions. In addition, marked variability was found in both the direction and degree of change in breathing frequency and tidal volume in response to contractions. Women who relied predominantly on associative strategies during early labor had lower breathing rates and higher tidal volumes than did women who employed dissociative strategies.

Hidden covariation detection: a fundamental and ubiquitous phenomenon

H. Hendrickx, J. De Houwer, F. Baeyens, P. Eelen, and E. Van Avermaet (1997) reported a series of (mostly unsuccessful) studies on nonconscious hidden covariation detection (HCD); for example, they reported that out of 3 attempts to replicate P. Lewicki et al.'s studies, only 1 produced the expected results. They concluded that HCD may be not as general and robust as the previous research suggested, and they considered boundary conditions. In this article, the authors discuss a number of weaknesses of H. Hendrickx et al.'s experiments (and systematic deviations from the original methodology) that are potentially responsible for the lack of the expected results and discuss missing facts in their arguments (e.g., they failed to mention any published replications of the HCD studies from other than the present authors' laboratories). It is argued that when all evidence is considered, the proper conclusion is that nonconscious processing of covariations is not only general and robust but also a ubiquitous phenomenon mediating a variety of processes of acquisition of information.

Hidden covariation detection: a fundamental and ubiquitous phenomenon

H. Hendrickx, J. De Houwer, F. Baeyens, P. Eelen, and E. Van Avermaet (1997) reported a series of (mostly unsuccessful) studies on nonconscious hidden covariation detection (HCD); for example, they reported that out of 3 attempts to replicate P. Lewicki et al.'s studies, only 1 produced the expected results. They concluded that HCD may be not as general and robust as the previous research suggested, and they considered boundary conditions. In this article, the authors discuss a number of weaknesses of H. Hendrickx et al.'s experiments (and systematic deviations from the original methodology) that are potentially responsible for the lack of the expected results and discuss missing facts in their arguments (e.g., they failed to mention any published replications of the HCD studies from other than the present authors' laboratories). It is argued that when all evidence is considered, the proper conclusion is that nonconscious processing of covariations is not only general and robust but also a ubiquitous phenomenon mediating a variety of processes of acquisition of information.

Regional cerebral blood flow changes after light therapy in seasonal affective disorder

There is considerable evidence to indicate that depressive disorders may be associated with changes in regional cerebral blood flow (rCBF), and that successful treatment may reverse these changes. We studied patients with seasonal affective disorder (SAD) using 99Tcm-hexamethylpropylene amine oxime (99TCm-HMPAO) single photon emission tomography (SPET) to examine the effect of light therapy on rCBF. Ten depressed patients (8 females, 2 males) with a mean (+/- S.D.) age of 33.5 +/- 11.3 years underwent 99TCm-HMPAO SPET studies before and after light therapy. The treatment response was evaluated using the Structured Interview Guide for the Hamilton Depression Rating Scale-Seasonal Affective Disorders Version (SIGH-SAD). A patient was considered responsive to light therapy if the post-treatment SIGH-SAD score was reduced by 60% or more in comparison to the pre-treatment score (responders, n = 5; non-responders, n = 5). Pre- and post-treatment SIGH-SAD scores and SPET data were compared in each patient. An improvement in depressive symptoms after light therapy was associated with an increase in rCBF in the frontal and cingulate regions as well as the thalamus. Such changes were not seen in non-responsive subjects.

MR perfusion imaging of the kidney pre- and post-dipyridamole stress

Animal studies have demonstrated that renal MR contrast enhancement depends on the timing of image acquisition. Limited human studies have demonstrated effects of dipyridamole (DP) on total renal perfusion. This study assessed the effect of DP on total and regional renal perfusion using gated perfusion MRI for patients undergoing DP stress. Five subjects with no evidence of renal ischemia were examined at rest and after DP stress. Rest MRI images in the left kidney were acquired using electrocardiogram (ECG)-gated MR: turbo fast low-angle shot (FLASH); echo time (TE) = 12, repetition time (TR) = 6, flip angle = 12, inversion time (TI) = 100) 10 to 45 seconds after injection of gadopentetate dimeglumine. Stress was induced in the MRI scanner (DP, .56 mg/kg over 4 minutes) followed by stress MRI after a second bolus of gadopentetate dimeglumine in the same position and identical time intervals. MR signal in the whole left kidney and renal medulla and cortex pre- and post-DP demonstrated a 70% depression of total renal perfusion with relative preservation of cortical perfusion at the expense of medullary perfusion. Post-DP MR images demonstrated a decrease in cortical perfusion with an additional 29% depression of medullary perfusion (P < .001) with respect to cortical perfusion. Turbo FLASH MRI can provide adequate time and spatial resolution to demonstrate changes in renal perfusion. Depression of renal medullary perfusion after DP appears to be caused by the intrarenal effect of DP and may have clinical impact.

Routine perioperative dipyridamole 201Tl imaging in diabetic patients undergoing vascular surgery

OBJECTIVE

To assess the utility of dipyridamole thallium testing in symptomatic and asymptomatic patients with diabetes undergoing vascular surgery.

RESEARCH DESIGN AND METHODS

Dipyridamole 201Tl myocardial scintigraphy was performed preoperatively in 93 consecutive patients with diabetes undergoing peripheral vascular procedures. The utility of clinical and thallium variables in predicting cardiovascular complications was assessed.

RESULTS

Two groups of patients were identified: group A (36 patients) without clinical evidence of cardiac disease and group B (57 patients) with clinical evidence of cardiac disease. Dipyridamole thallium scans were abnormal in 21 of 36 (58%) of group A patients compared with 53 of 57 (93%) of group B patients (P < 0.0001). Compared with group B patients with perfusion defects, group A patients with perfusion abnormalities tended to have fewer defects per scan (2.7 +/- 1.5 vs. 3.6 +/- 1.9, P = 0.05). No perioperative cardiac complications occurred in group A patients while perioperative cardiac complications occurred in 9 of 57 (16%, 95% CI 7-28%) group B patients (P = 0.01). For the entire study population, the complication rate was 10%.

CONCLUSIONS

Diabetic individuals without clinical markers for coronary artery disease appear to be at low risk for adverse postoperative cardiac events after vascular surgery. Preoperative myocardial perfusion imaging may add little to cardiovascular risk assessment in this subgroup of patients with diabetes.