Surveillance report: disease trends at New Zealand sexually transmitted disease clinics 1977-1993.

AIM--To document trends in sexually transmitted diseases (STDs) recorded by New Zealand STD Clinics from 1977-1993. METHODS--Clinic disease figures have been recorded since clinics commenced in the 1920s and were recorded in a comprehensive format from the 1970s. The New Zealand Venereological Society has collated these data since 1986. RESULTS--The most common STDs in New Zealand clinics are genital warts, non-specific genital infections, chlamydia and genital herpes. Genital Wart infection has been the commonest STD diagnosed in clinics since 1988 and occurred in 17.9% of new patients in 1993. Non Specific Genital Infections were the commonest diagnosis from 1977 to 1988 affecting 17.5% of new patients in 1993. Chlamydia has shown a fall since the mid 1980s diagnosed in 5.4% of new patients in 1993 compared with 14.6% in 1986. Gonorrhoea incidence has fallen steadily since 1975 affecting only 1.1% new patients in 1993. Genital Herpes numbers tripled from 1977 to 1993 and 54% are primary cases. HIV Disease has increased clinic workload greatly with screening and counselling conducted in 25% of new patients in 1993. HIV disease was diagnosed or managed in 0.2% new clinic patients (49 cases). Syphilis has remained at a low incidence in New Zealand diagnosed in 0.3% new patients in 1993. CONCLUSION--Attendance for the viral diseases, HIV disease, genital warts and genital herpes is increasing while for the bacterial diseases, gonorrhoea and chlamydia is decreasing. The rise in disease numbers since 1990 may be due to meeting service needs rather than a true rise in disease incidence. STD surveillance in New Zealand is improving with new reporting systems being developed.     

Patch testing in New Zealand: Barriers to evidence‐based care

Allergic contact dermatitis is a disabling condition, significantly impacting on quality of life, which can only be alleviated by identification and avoidance of a relevant allergen. Patch testing remains the gold standard diagnostic test for allergic contact dermatitis. The consistency with which patch testing is used varies throughout the world. The purpose of this study was to look at the adequacy of current patch testing practice in New Zealand. We undertook literature review of current guidance regarding patch testing and created a web‐based survey to evaluate use of patch testing in New Zealand. This was sent to all 75 vocationally registered New Zealand dermatologists. Of respondents, 46% do not perform patch testing. The most commonly cited barriers were lack of nursing support, poor remuneration, time pressure and lack of facilities. 23% noted that public patch testing services are not available in their region. The majority do not record patch test results in a database. Access to and utilisation of patch testing in New Zealand is suboptimal. Increasing services in the public sector requires investment by health boards, as there remains a dermatology workforce shortage in New Zealand. In private practice, patients often find it unsatisfactory to pay for negative tests, and adequate remuneration of patch testing by private insurers is necessary. Surveillance of patch test results at a national level is lacking, and the development of a centralised database to identify common allergens affecting our population is recommended.     

新西兰兔感染梅毒螺旋体体内扩散模型构建

【摘要】 目的 构建新西兰兔梅毒螺旋体感染体内扩散模型。方法 新西兰兔睾丸内复苏梅毒螺旋体标准株（Nichols）,并连续分离传代,收集第2代梅毒螺旋体菌株悬液接种于新西兰兔背部皮肤。感染21 d后麻醉处死新西兰兔,收集血液,无菌分离感染部位组织以及肝脏、脾脏、睾丸和淋巴结。荧光实时定量PCR检测各组织器官梅毒螺旋体扩散情况。结果 新西兰兔梅毒螺旋体感染后第21天所有接种部位均出现皮肤损伤（硬结和溃疡）,病理检查显示感染部位出现大量炎症细胞,主要包括浆细胞、巨噬细胞和淋巴细胞,实时定量PCR显示肝脏、脾脏、睾丸等组织器官存在大量梅毒螺旋体。结论 新西兰兔背部皮肤接种梅毒螺旋体后能通过血液和淋巴结扩散到肝脏、脾脏、睾丸等组织器官,成功构建新西兰兔梅毒螺旋体感染体内扩散模型。     

FOUR NON-ENDEMIC NEW ZEALAND CASES OF CHROMOBLASTOMYCOSIS

The majority of cases of chromoblastomycosis are reported from tropical to subtropical countries; only one previous case being reported from New Zealand. Four non-endemic cases in Pacific Island patients are described. All of the New Zealand cases were caused by Fonsecaea pedrosoi. In the present report, one patient was successfully treated by excision of the lesion followed by skin grafting. Another was treated with 200 mg ketoconazole daily for 10 weeks with no obvious improvement. No follow-up on the treatment of this case nor of the remaining two patients is available. This disease must be included in the differential diagnosis in patients who present with chronic lesions affecting the skin and subcutaneous tissues.     

Allergic contact dermatitis from exposure to Grevillea robusta in New Zealand

There are a number of reports in the literature of allergic contact dermatitis as a result of exposure to the sawdust and plant parts of Grevillea robusta . While this tree is prevalent in New Zealand, there seems to have been no previous published accounts of contact dermatitis, although anecdotal evidence indicates that such cases may be common. Two brief case reports are provided regarding severe phytodermatitis to G. robusta among professional arborists in New Zealand. As with other common plants capable of inducing allergic contact dermatitis, greater awareness among arborists, orchardists, forestry workers, gardeners, and health professionals will likely result in a reduction of cases.     

Case Reports: Acute Febrile Neutrophilic Dermatosis of Sweet

Three new cases of acute febrile neutrophilic dermatosis of Sweet are described. They are the first reported from New Zealand. No new light is shed on aetiology.     

Patient satisfaction with post-operative telephone calls after Mohs micrographic surgery: a New Zealand and U.K. experience

Background Mohs micrographic surgery (MMS) is regarded as the gold standard for treating nonmelanoma skin cancers of the head and neck. Surgical interventions can generate anxiety for patients and efforts to minimize this may enhance their experience. Objectives To assess the perceived patient benefits of post-operative telephone follow-up (TFU) calls after MMS. Methods A prospective, controlled, questionnaire-based assessment of patient satisfaction with TFU calls in patients undergoing MMS was conducted in two centres (New Zealand and U.K.) over a 4-month period from June to September 2011. All individuals in the study group were telephoned on the evening of their surgery by the operating surgeon. Questionnaires were completed by all patients at the time of suture removal. Results The median Likert score on a 10-point scale relating to patients' perception of the TFU service was higher in the study group compared with the control group (10 vs. 9), with no correlation to closure type of the surgical defect. Overall patient satisfaction with the TFU service was high (94% New Zealand; 96% U.K.), and this was independent of the patient's place of residence. There was no age or sex difference in the minority who did not find the TFU call helpful. The majority of patients felt the best time to call was the night of the surgery (89% New Zealand; 94% U.K.). All patients who had undergone MMS previously found the TFU call just as useful as the first time. The majority of patients (94% New Zealand; 96% U.K.) did not need to call the doctor post-surgery, although 7% of patients in the control group rang the surgeon with issues that could have been readily dealt with by the TFU service. Comparatively, more patients from the U.K. felt their satisfaction would have been the same with a nurse-led TFU call service compared with New Zealand (94% vs. 66%). A significant proportion of those who preferred to be called by the doctor underwent cutaneous flap closures. Patients felt that other specialities that perform surgical procedures under local anaesthetic should adopt a TFU service post-surgery. Conclusions TFU calls post-MMS are a cost-effective, time-efficient way of achieving high levels of patient satisfaction.     

Extremely high levels of melanoma in Tauranga, New Zealand: possible causes and comparisons with Australia and the northern hemisphere

The objective of the study was to determine the incidence of melanoma in the Tauranga region of New Zealand, to compare these findings within Australasia and the northern hemisphere, and to understand the causes of the relatively high rates in Tauranga. Data were obtained from retrospective review of histology reports from the public and private health systems in greater Tauranga (Tauranga and Western Bay of Plenty Districts). Primary cutaneous melanomas (including both invasive and in situ melanomas) reported during 2003 were included. Age-standardized melanoma rates were calculated for the entire population as well as for the non-Maori population of the region, identified from the 2001 New Zealand Census. The age-standardized incidence of invasive melanoma in the non-Maori population of the greater Tauranga region was 79/100,000. The age-standardized rate for the entire population was 70/100,000. The rate of in situ disease was 78/100,000 for non-Maori and 72/100,000 for the entire population. The Tauranga region of New Zealand has an exceptionally high incidence of invasive and in situ melanomas. This is likely related to environmental, geographical and societal factors, including relatively high levels of UV exacerbated in recent times by ozone depletion, relatively cool summer temperatures which encourage outdoor exposure, and relatively fair skin colouring.     

8-甲氧补骨脂素乳膏皮肤刺激性和致敏性实验研究

目的观察8-甲氧补骨脂素乳膏对动物皮肤的毒性作用。方法用健康新西兰兔进行皮肤刺激性试验;用健康豚鼠进行皮肤刺激和致敏试验。结果8-甲氧补骨脂素乳膏对新西兰兔完整皮肤和破损皮肤无刺激性,对豚鼠完整皮肤无致敏作用。结论8-甲氧补骨脂素乳膏皮肤局部用药对实验动物具有较好的安全性。     

BOOK REVIEW

Book reviewed in this article:
Connective Tissue Diseases Of The Skin. Charles M Lapriere and Thomas Krieg (Editors). Marcell Dekker, Inc, New York. 1993. RRP $150.
Itch. Mechanisms and Management of Pruritis. 1st Ed. Jeffrey D. Bernhard. (Ed). McGraw-Hill Inc. New York. 454 pages. RRP $96 (Australia); $144.95 (New Zealand).     

Familial halo naevi

The incidence of halo naevi in the population has been estimated to be 1%. We now report the simultaneous occurrence of such naevi in four members of a family previously resident in New Zealand.     

Oxidative stress as a potential causal factor for autoimmune hemolytic anemia and systemic lupus erythematosus

The kidneys and the blood system mutually exert influence in maintaining homeostasis in the body. Because the kidneys control erythropoiesis by producing erythropoietin and by supporting hematopoiesis, anemia is associated with kidney diseases. Anemia is the most prevalent genetic disorder, and it is caused by a deficiency of glucose 6-phosphate dehydrogenase(G6PD), for which sulfhydryl oxidation due to an insufficient supply of NADPH is a likely direct cause. Elevated reactive oxygen species(ROS) result in the sulfhydryl oxidation and hence are another potential cause for anemia. ROS are elevated in red blood cells(RBCs) under superoxide dismutase(SOD1) deficiency in C57BL/6 mice. SOD1 deficient mice exhibit characteristics similar to autoimmune hemolytic anemia(AIHA) and systemic lupus erythematosus(SLE) at the gerontic stage. An examination of AIHA-prone New Zealand Black(NZB) mice, which have normal SOD1 and G6 PD genes, indicated that ROS levels in RBCs are originally high and further elevated during aging. Transgenic overexpression of human SOD1 in erythroid cells effectively suppresses ROS elevation and ameliorates AIHA symptoms such as elevated anti-RBC antibodies and premature death in NZB mice. These results support the hypothesis that names oxidative stress as a risk factor for AIHA and other autoimmune diseases such as SLE. Herein we discuss the association between oxidative stress and SLE pathogenesis based mainly on the genetic and phenotypic characteristics of NZB and New Zealand white mice and provide insight into the mechanism of SLE pathogenesis.     

Measuring performance in skin cancer practice: the SCARD initiative

Background The Skin Cancer College of Australia and New Zealand (SCCANZ) has developed a unique project named SCARD – the Skin Cancer Audit and Research Database. Designed initially as a self‐audit tool for primary care skin cancer practitioners, SCARD acts as a tracking tool to enhance practice safety, and it also creates practice performance reports. Pooling of de‐identified data enables participating practitioners to confidentially compare their own practice to that of their peers. Additionally, this creates a large database with significant research potential, as SCARD records for every lesion de‐identified practitioner and patient data, and extensive details of location, provisional and histological diagnosis, and the procedure(s) performed in its treatment. Methods Preliminary data collected in the database have been presented in this study. Results An initial pool of data from 177 practitioners contains 77,553 specimens from 41,006 individual patients. Conclusions The data presented are being analyzed for further studies, and additional data continues to be collected from this ongoing project. SCARD is a useful tool at practice level, and substantial uptake by Australian primary care skin cancer practitioners has provided a unique opportunity for research into skin cancer and its management. SCCANZ, a professional college of predominantly primary care medical practitioners, with a commitment to the management of skin cancer in Australia and New Zealand, has formed a partnership with the School of Medicine at the University of Queensland to ensure that these data are managed and analyzed appropriately.     

Antibiotic susceptibilities, serotypes and auxotypes of Neisseria gonorrhoeae isolated in New Zealand.

OBJECTIVE--The aim of the study was to determine the distribution of auxotypes and serotypes and the prevalence of antibiotic resistance among New Zealand isolates of Neisseria gonorrhoeae. MATERIALS AND METHODS--A total of 486 gonococci isolated in 1988 were auxotyped, serotyped, and tested for susceptibilities to ten antibiotics. RESULTS--The gonococci were susceptible to all the antibiotics tested except penicillin and tetracycline. Eleven (2.2%) produced beta-lactamase, one (0.2%) showed chromosomal penicillin resistance, and 18 (3.7%) were resistant to a low-level of tetracycline. Most of the gonococci belonged to six auxotypes. The three predominant auxotypes were arginine-requiring (Arg-), non-requiring (NR), and arginine, hypoxanthine, uracil-requiring (AHU-). The majority of the isolates belonged to serogroup IB and to six serovars. The most prevalent serovars were IB-3 and IB-1. There was an association between penicillin susceptibility and auxotype or serovar among non-penicillinase producing N. gonorrhoeae (PPNG) isolates. CONCLUSIONS--Antibiotic resistance, including penicillin resistance, remains uncommon among gonococci in New Zealand. Baselines have been established for future epidemiological studies using both auxotyping and serotyping.     

Chronic bullous disease of childhood in three patients of Polynesian extraction

Chronic bullous disease of childhood is an acquired subepidermal bullous disease. Its true incidence is unknown and to our knowledge there have been no reported cases in Polynesians. We report three cases who presented within 1 year to the Dermatology Department, Auckland Public Hospital, New Zealand.     

Academic dermatology in Australia and New Zealand between 2017 and 2022: A cross-sectional bibliometric analysis

Introduction

Academic dermatologists in Australia and New Zealand provide high-quality and meaningful contributions to the understanding of disease and therapeutic translational research. Concerns have been raised by the Australian Medical Association regarding the decline of clinical academics in Australia as a whole, however, such trends in scholarly output have not previously been analysed for Australasian dermatologists.

Methods

A bibliometric analysis of dermatologists in Australia and New Zealand was conducted in January and February 2023. Available Scopus profiles for all dermatologists were used to measure lifetime H index, scholarly output, citation counts and field-weighted citation impact (FWCI) in the last 5 years (2017–2022). Trends in output over time were measured using non-parametric tests. Differences in output between subgroups stratified by gender and academic leadership positions (associate professor or professor) were measured using Wilcoxon rank-sum and one-way ANOVA tests. The scholarly output of recent College graduates was also analysed as a subgroup, comparing the same bibliographic variables in the 5 years preceding and 5 years following awarding of their fellowships.

Results

From the 463 practising dermatologists in Australia and New Zealand, 372 (80%) were successfully matched to Scopus researcher profiles. Of these dermatologists, 167 were male (45%) and 205 (55%) were female, and 31 (8%) held academic leadership positions. Most dermatologists (67%) published at least one paper in the last 5 years. The median lifetime H index was 4, and between 2017 and 2022 median scholarly output was 3, the median citations were 14 and the median FWCI was 0.64. There was a non-significant trend towards fewer publications per year, however, citation count and FWCI decreased significantly. By subgroups, female dermatologists published significantly more papers between 2017 and 2022, and other bibliographic variables were comparable to male dermatologists. However, women were underrepresented in positions of academic leadership—comprising only 32% of this cohort despite representing 55% of dermatologists. Professors were also significantly more likely to have higher bibliographic outcomes than associate professors. Finally, analysis of recent College graduates highlighted a significant decline in bibliometric outcomes pre- and post-fellowship.

Conclusion

Overall, our analysis identifies a trend towards decreased research output by dermatologists in Australia and New Zealand in the last 5 years. Strategies to support dermatologists in research endeavours, particularly women and recent graduates, will be essential in maintaining strong scholarly output among Australasian dermatologists and thereby sustaining optimal evidence-based patient care.     

LEVELS OF POLYCYCLIC AROMATIC HYDROCARBONS IN SOME COAL TAR SKIN PREPARATIONS

Seven coal tar-containing skin preparations available in New Zealand have been analysed for several polycyclic aromatic hydrocarbons (PAHs) by a gas chromatographic method. All the preparations were found to contain PAHs that have been shown to be carcinogenic to animals. A notable feature of the results was the considerable range in concentrations of these compounds. Levels of benzo(a)pyrene were found to vary from 1 to 360 mg/kg.     

梅毒螺旋体Tp0821基因的克隆、表达、纯化及免疫活性研究

目的 构建梅毒螺旋体(Tp)膜脂蛋白Tp0821的重组质粒,表达、纯化其相应蛋白,研究其免疫活性.方法 构建重组质粒pQE32/Tp082l,诱导表达其相应蛋白,以纯化的重组蛋白免疫新西兰兔,制备多克隆抗体并测定其效价.建立间接ELISA法,检测80份梅毒参比血清、临床经FTA-ABS确诊的阳性血清各150份.结果 成功构建重组质粒pQE32/Tp0821,十二烷基硫酸钠-聚丙烯酰胺凝胶电泳(SDS-PAGE)分析重组蛋白分子量与预期结果相符.将亲和层析后所获高纯度重组蛋白免疫新西兰兔,制备的多克隆抗体效价达1:6400.间接ELISA法检测梅毒参比血清、临床梅毒患者血清,与间接免疫荧光螺旋体抗体吸附试验(FTA-ABS)法比较,其灵敏度、特异度分别为92.6%和98.6%,差异有统计学意义(P<0.05).结论 Tp0821重组蛋白具有较好的免疫活性,可用于梅毒血清学检测.     

The Incidence and Comparison of Skin Diseases in Hong Kong and New Zealand

Tabulation and craluation of the new cases seen in our gear, in Hong Kong and in the East Coast region of the North Island of New Zealand, by dermatological diagnosis. Racial differences, i.e. Orirulat and Caucasimo and while skin, age group rariations, and economic and social factors are considered. Significant curiations in the incidence of Light indueed, and industrial dermatitis are exptaixed by skin, social way explain the curculations in and infections. In general the incidence of Atopic Ecomo, Psoriasis and Fangal Infections and Neurotermutitis not rury significantly.     

Methyl aminolevulinate-photodynamic therapy for basal cell carcinoma

Basal cell carcinomas (BCCs) are the most common malignant tumors of the skin. Treatment of BCCs should be chosen according to clinical type, tumor size, and location. Methyl aminolevulinate (MAL) photodynamic therapy (PDT) has the potential to become a therapy with equal effectiveness to classical therapeutic modalities with an excellent cosmesis, but without complications like scar formation, requirement for grafts, need of repetitive treatments over longer time periods, or pigmentary changes. MAL is licensed in Europe, Australia, New Zealand, and Brazil for the treatment of actinic keratoses, Bowen's disease, and nodular and superficial BCC. Conclusions are drawn from extensive studies in past years using MAL-PDT for both nodular and superficial BCCs.