Contact dermatitis with cervical lymphadenopathy following exposure to the hide beetle, Dermestes peruvianus

Contact with beetles of the family Dermestidae can produce a variety of disorders including skin, gastrointestinal and respiratory tract disease. Dermatological disorders include dermatitis, vesicular, pustular and vasculitic lesions. In addition, there may be pruritus, desquamation and urticaria. We report a patient who developed dermatitis, a vasculitic eruption, cervical lymphadenopathy and pulmonary nodular interstitial infiltration as a result of contact with the 'hide beetle' Dermestes peruvianus.

The use of personal protective measures in control of malaria in a defined community

Malaria is one of the main health problems in the non-immune immigrant workers and army personnel of the malaria endemic areas in Myanmar. Due to changes in the vector bionomics and multiresistant strains of P. falciparum, chemoprophylaxis alone is not an effective means of control of malaria in them. So it is envisaged that the combined used of personal protective measures (deltamethrin impregnated bed-nets, scalves and hand-bands) and the chemoprophylaxis will be an effective means of control of malaria in the define group of people. The study also intended to find out the side effects of the deltamethrin and feasibility and acceptability of methods by the users. The study was conducted in Theini Township, Northern Shan State, from March to November 1993. The study population consisted of all ages of both sexes 554 and 440 persons in the test and control groups respectively. At the initial phase of the study, malaria infected persons from both the groups were treated. The experimental group received personal protective measures with impregnation of bed-nets using 25 mg ai/m2 of deltamethrin at 4 monthly intervals and the scarves and hand-bands at twice the concentration of the insecticides at monthly intervals. Chemoprophylaxis was given to both the groups at weekly intervals using age adjusted dosage of Pyrixine tablet (sulfadoxine-pyrimethamine). The parasitological, entomological, and epidemiological indices were collected at two month intervals in both the groups. The study clearly showed the impact of personal protective measures and chemoprophylaxis on malaria infection in the studied subjects. During the study period, the out patient malaria cases of the test group was 6% to 11.2% and that of the control group was 12% to 21.6% in Theini Hospital. The reinfection rate of the test group (0.9 to 4.7%) was also significantly lower than the control group (6.1 to 14.3%) from July to November. Acceptance of the treated bed-nets, scarves and hand-bands was high and good compliance was found in the follow up. The results of the study clearly showed that malaria can be controlled effectively in the defined group of persons for a malaria transmission season by using chemoprophylaxis and personal protective measures.

Allergen reduction measures in houses of allergic asthmatic patients: effects of air-cleaners and allergen-impermeable mattress covers

Recommendations for allergen avoidance or allergen reduction measures play an important part in the treatment of allergic asthmatic patients. The purpose of this study was to test recently developed air-cleaners with respect to their capacity to capture airborne allergen particles and to improve clinical parameters of asthmatic patients sensitized to aeroallergens. Forty five allergic asthmatic patients were studied in a double-blind procedure for 6 months. The patients were divided into three groups of 15 patients. In Group 1, the intervention consisted of the application of active air-cleaners in living-rooms and bedrooms. In Group 2, placebo air-cleaners were used in combination with allergen-impermeable mattress covers. In Group 3, the same intervention was performed as in Group 2 but with active air-cleaners. Allergen levels in mattress and floor dust were measured before, and 3 and 6 months after the interventions. After 6 months, the air-cleaners were dismantled and the filters were analysed for the amount of dust collected and allergen content. Immunological and lung function parameters were measured before, and 3 and 6 months after the interventions. Considerable amounts of airborne dust and allergenic particles were captured in the filters of the air-cleaners. Up to the 18.9 g of dust, 4,513 ng of house dust mite allergen, Der p 1, and 50,000 mU of cat allergen, Fel d 1, (in houses with cats) were collected by air-cleaners in living-rooms. Only in Group 3 (in which both active air-cleaners and mattress covers were used) was a small (less than 1 doubling dose) but statistically significant improvement of provocative concentration of histamine causing a 20% fall in forced expiratory volume in one second (PC20) observed (from 5.96 to 9.02 mg x mL(-1)). The amount of dust and house dust mite allergen collected in the filters was significantly correlated with an improvement of peak flow variation. In combination with other allergen avoidance measures, the examined air-cleaners can contribute to diminished allergen exposure and improvement of airway hyperresponsiveness in asthmatic patients.

Case-control study of sudden infant death syndrome in Scotland, 1992-5

OBJECTIVE

To investigate the relation between routine infant care practices and the sudden infant death syndrome in Scotland.

METHODS

National study of 201 infants dying of the sudden infant death syndrome (cases) and 276 controls by means of home interviews comparing methods of infant care and socioeconomic factors.

RESULTS

Sleeping prone (odds ratio 6.96 (95% confidence interval 1.51 to 31.97) and drug treatment in the previous week (odds ratio 2.33 (1.10 to 4.94)) were more common in the cases than controls on multivariate analysis. Smoking was confirmed as a significant risk factor (odds ratio for mother and father both smoking 5.19 (2.26 to 11.91)). The risk increased with the number of parents smoking (P < 0.0001), with the number of cigarettes smoked by mother or father (P = 0.0001), and with bed sharing (P < 0.005). A new finding was an increased risk of dying of the syndrome for infants who slept at night on a mattress previously used by another infant or adult (odds ratio 2.51 (1.39 to 4.52)). However, this increased risk was not established for mattresses totally covered by polyvinyl chloride.

CONCLUSIONS

Sleeping prone and parental smoking are confirmed as modifiable risk factors for the sudden infant death syndrome. Sleeping on an old mattress may be important but needs confirmation before recommendations can be made.

The effects of a neonatal positioner on scapular rotation

OBJECTIVE

This clinical study investigated the effects of an individually fabricated prone positioner on heart rate, respiratory rate, and scapular position of premature infants in the neonatal intensive care unit. The prone positioner consisted of dense foam with cutouts to position the shoulders forward and toward midline.

METHOD

Six measurements of scapular rotation, respiratory rate, heart rate, and behavioral state were made with 20 infants on and off the prone positioner. The repeated measures allowed each infant to act as his or her own control.

RESULTS

Heart and respiratory rates were not significantly different between the two methods of prone positioning. Upward scapular rotation was significantly greater with the infant on the prone positioner. Behavioral state did not influence the results.

CONCLUSION

These results suggest that a prone positioner can be helpful in the prevention of scapular-humeral tightness and shoulder retraction commonly observed in premature infants.

A reason why measures to avoid mite-induced asthma are more effective in children than in adults

Mite-sensitive asthmatics seem to respond more markedly to a reduction in mite allergen in the bedding if they are children than if they are adults. In order to investigate this difference, 882 children who attended our allergy clinic were studied. The accompanying parents were asked standardized questions, and skin prick tests to Dermatophagoides pteronyssinus and D. farinae were performed on the children. The number of hours that the children spent in bed lessened progressively with increasing age, from a mean of 13.6 hrs. for 1 year olds to 9.5 hrs for 17 yr olds: the mean for the total population was 12.0 hrs. This was significantly longer than the mean for the parents, 8.4 hrs (p=.000). It is likely that a longer period of exposure to mite allergen in bed is an important reason why children respond more markedly to avoidance measures in the bedroom than adults do.

Clothing as protection from ultraviolet radiation: which fabric is most effective?

BACKGROUND

With increasing levels of solar ultraviolet radiation (UVR) in the earth's near environment and evidence that exposure to UVR contributes to skin cancer, cataracts, and photoaging, protection of the skin is imperative during exposure to the sun. The purpose of this study was to examine the effectiveness of various fabrics in screening UVR and to determine if specific characteristics of fabric are directly related to the amount of protection provided.

METHODS

Transmission of UVR was measured using spectrophotometric techniques. This transmission, as a function of wavelength over the range 250-400 nm, was weighted with solar and biological spectral data to determine a "sun protection factor" (SPF) for each fabric.

RESULTS

The transmission of UVR through fabric depends on the wavelength and varies with factors such as type of fiber, fabric mass, cover, and color.

CONCLUSIONS

Of 28 white fabrics tested, 19 offered less protection than a sunscreen with SPF 15. Polyester fabrics offered increased protection over cotton. The presence of dyes increased protection considerably.

The effects of malaria control on nutritional status in infancy

Both malaria and undernutrition are major causes of paediatric mortality and morbidity in sub-Saharan Africa. The introduction of insecticide-treated bed nets (ITBN) during a randomized controlled trial on the Kenyan coast significantly reduced severe, life-threatening malaria and all-cause childhood mortality. This paper describes the effects of the intervention upon the nutritional status of infants aged between 1 and 11 months of age. Seven hundred and eighty seven infants who slept under ITBN and 692 contemporaneous control infants, were seen during one of three cross-sectional surveys conducted during a one year period. Standardized weight-for-age and mid-upper arm circumference measures were significantly higher among infants who used ITBN compared with control infants. Whether these improvements in markers of nutritional status were a direct result of concomitant reductions in clinical malaria episodes remains uncertain. Never-the-less evidence suggests that even moderate increases in weight-for-age scores can significantly reduce the probability of mortality in childhood and ITBN may provide additional gains to child survival beyond their impressive effects upon malaria-specific events.

The Melbourne house dust mite study: eliminating house dust mites in the domestic environment

BACKGROUND

Hypersensitivity to house dust mite allergens is associated with increased asthma morbidity. Asthma severity appears to be related to the degree of mite allergen exposure. Short-term studies suggest that complete avoidance reduces disease severity.

OBJECTIVE

The study was designed to assess the effect of different mattress covers and floor coverings on mite allergen concentrations in the homes of mite-sensitive children with asthma in the city of Melbourne, Australia.

METHODS

Mite allergen Der p 1 concentration was measured on mattress covers, mattress surfaces, and carpeted and uncarpeted floors in 107 dwellings; and measurement was performed on three occasions over a 5-month period. After the first sampling, all mattress covers and impermeable encasements were permanently removed.

RESULTS

The initial geometric mean concentrations of Der p 1 (micrograms per gram of fine dust) from the surfaces of sheepskin, wool, and cotton mattress coverings were greater than those from the surfaces of impermeable mattress encasements (116, 113, and 19 vs 0.4) (p < 0.001); corresponding concentrations on the underlying mattresses were 142, 38, 20, and 0.6, respectively (p < 0.05 to 0.001). At the end of the study these mattress surface concentrations were 79, 65, 9.7, and 3.1, respectively. In 24 dwellings an uncarpeted room was adjacent to a carpeted room. At each visit the concentration of Der p 1 in uncarpeted rooms was below the reported threshold for sensitization and significantly less than that in the adjacent carpeted room.

CONCLUSION

In homes of children with asthma, "asthmogenic" concentrations of Der p 1 were found on nonencased mattresses and carpeted floors, but the use of impermeable mattress encasements and carpet exclusion were associated with concentrations of Der p 1 below the reported threshold for sensitization.

Use of nephrostomy drape for nonendoscopic procedures

The use of a nephrostomy drape for perineal prostatectomy and laparoscopic renal/ureteral surgery is illustrated. Draping is simplified, fixation sites for cords are present, and a large pocket for instruments and drainage is provided. The nephrostomy drape is recommended for use during operations performed on nonhorizontal surfaces, or when several instruments attached by cords are used.

Comparison of three rewarming methods in a postanesthesia care unit

Postoperative hypothermia is problematic because patients in postanesthesia care units (PACUs) often feel very cold, and unrecognized or prolonged postoperative hypothermia can aggravate patients' underlying cardiovascular disorders. The researchers compared three methods of rewarming PACU patients who had undergone laparotomy procedures. Patients were assigned randomly to three groups. Each patient in group one received the standard PACU rewarming intervention (ie, two warmed thermal blankets and a hospital bedspread). Each patient in group two received the standard PACU rewarming intervention plus a reflective blanket. Each patient in group three received the standard PACU rewarming intervention plus a reflective blanket and a reflective head covering. Nurses measured patients' vital signs on admission to the PACU and every 15 minutes thereafter until patients' sublingual temperatures reached 36 degrees C (96.8 degrees F). No significant temperature differences occurred among patients in the three groups, but an inverse relationship existed between patients' PACU admission temperatures and the time they required to reach normothermia.

Use of neonatal boundaries to improve outcomes

Technological advances have dramatically improved survival rates for the high-risk infant, yet developmental delays are common due to complications resulting from immature organ systems. The neonatal intensive care unit environment itself may pose barriers to optimal development of these infants. The purpose of this study was to investigate the effects of an oval-shaped cloth nest to make the environment less stressful and enhance neonatal development. Specifically, the study hypothesized that infants who were placed in the cloth nest would gain more weight and would have shorter lengths of hospital stay than would infants receiving routine care. A total of 102 healthy infants ranging from 26 to 31 weeks of gestation were recruited into the study. No significant differences were found in the groups on amount of weight gained. Infants who were placed in the cloth nest actually had longer hospital stays than did infants receiving routine care. Perhaps infants who received routine care received more touch than did nested infants, and the touch may have facilitated development as measured by length of stay.

Draping of the pelvis and proximal femur: an improved method for applying self-adherent plastic drapes

It can be difficult to isolate the operative field from the perineum when draping for procedures involving the pelvis or proximal femur. A draping technique using two self-adherent plastic sheets is described; it reliably creates a watertight seal around the perineum yet allows substantial movement of the leg during the procedure.

Cervical pain: a comparison of three pillows

OBJECTIVE

To compare three pillows with regard to pain intensity, pain relief, quality of sleep, disability, and overall satisfaction in subjects with benign cervical pain. The three pillows evaluated were the subjects' usual pillow, a roll pillow, and a water-based pillow.

STUDY DESIGN

Subjects used their usual pillows for the first week of this 5-week randomized crossover design study. They were subsequently randomly assigned to use each of the other two pillows for 2-week periods.

SETTING

Outpatient neurology and physiatry clinics.

PATIENTS

Forty-one subjects with benign cervical pain syndromes and free of cognitive impairments.

MAIN OUTCOME MEASURES

Visual analog scale (VAS), Sleep Questionnaire, Sickness Impact Profile (SIP), and a satisfaction scale rating the pillows.

RESULTS

The water-based pillow was associated with reduced morning pain intensity, increased pain relief, and improved quality of sleep. The duration of sleep was significantly shorter for the roll pillow. Overall SIP findings showed a significant advantage for the water-based pillow over the roll pillow and standard pillow.

CONCLUSIONS

Proper selection of a pillow can significantly reduce pain and improve quality of sleep but does not significantly affect disability outcomes measured by the SIP.

Effect of a bed covering system in children with asthma and house dust mite hypersensitivity

Allergen avoidance is regarded as an important approach to management of atopic asthma. The effect of Intervent bed covering systems on house dust mite (HDM) allergen exposure, asthma symptoms and markers of inflammation was investigated in 31 HDM sensitive asthmatic children. Dust concentrations of Dermatophagoides pteronyssinus allergen 1 (Der p 1) were monitored before and after covering the mattress, duvet and pillow with active and placebo covers for 3 months, in a single-blind, cross-over trial. Twice daily peak expiratory flow rate (PEFR), daily symptom scores and treatment schedule were recorded. Bronchial hyperresponsiveness was monitored by histamine challenge (provocative concentration of histamine causing a 20% fall in forced expiratory volume in one second (PC20)), and inflammation by measuring eosinophil cationic protein (ECP), eosinophil protein X (EPX), eosinophil peroxidase (EPO), and soluble interleukin-2 receptor (sIL-2R) in serum. There was a significant reduction in Der p 1 when the mattress, duvet and pillow were covered with the active bedding. There was no significant improvement in symptoms of asthma, PEFR, bronchodilator usage of PC20. Also, ECP, EPX, sIL-2R concentrations did not change for either treatment. EPO concentrations were significantly lower in the active compared to the placebo period. The active bed covers reduced retrievable Dermatophagoides pteronyssinus allergen 1 (Der p 1) from the bedding, with short term clinical benefit.

Mosques against malaria

In a community-based malaria control project covering a predominantly Muslim population in the United Republic of Tanzania, difficulty was encountered in motivating people to have their mosquito nets reimpregnated with insecticide at six-monthly intervals. Education on this subject was therefore provided in mosques during Friday noon prayers. People who attended these services considered them an appropriate forum for discussing health concerns and viewed them as a credible source of information.

An audit of paediatric day care surgery in a district general hospital

At a 620 bed District General Hospital, questionnaires were issued to the patients of 142 consecutive paediatric day surgery cases and the nurses involved in the care of these children. Most of the children were not upset by day case surgery, although nearly a quarter were distressed by changing into a theatre gown. Postoperatively, pain was more of a problem than nausea and vomiting. Relatively minor problems occurred at home. The majority of the 93 parents who replied were happy with the overall care of their child. They valued being present for induction of anaesthesia and would have liked to be present in recovery when their child was awake, although the nurses felt this would not have been helpful. Nonclinical matters also influenced their assessment of the quality of care.