Conversation with Ove Fernö

In this occasional series we record the views and personal experience of people who have especially contributed to the evolution of ideas and practice in the journal's field of interest. Ove Fernö is the father of nicotine replacement therapy. He first conceived the idea of nicotine replacement as a strategy to help smokers stop in 1967 then researched and developed the idea until the first product licence was received in 1978 in Switzerland. Ove Fernö was born in Göteborg, Sweden in 1916, studied at the Royal Institute of Technology, Stockholm from 1936–40, and worked for the pharmaceutical company, Aktiebolaget Leo of Helsingborg in Southern Sweden, from 1941–81. He was Director of Research and Development from 1946–1961, Vice President of Research and Development from 1961–1973, and Executive Vice President from 1973 until his retirement in 1981.     

Primary cytomegalovirus infection with accompanying <Emphasis Type="Italic">Pneumocystis jiroveci</Emphasis> pneumonia in a patient with large-vessel vasculitis

A 70 year-old female patient presented with fever, nausea and dyspnea. She had been receiving immunosuppressive therapy with methotrexate and prednisone for large-vessel vasculitis. The patient was shown to have coexistent Pneumocystis jiroveci pneumonia and primary cytomegalovirus (CMV) infection with presumed CMV pneumonitis and colitis. To our knowledge, this is the first case report on the occurrence of combined primary cytomegalovirus and Pneumocystis jiroveci infection in a patient with vasculitis. It illustrates the importance of being aware of the possibility of combined opportunistic infections in patients with rheumatologic diseases.     

Range of motion exercise of temporo-mandibular joint with hot pack increases occlusal force in patients with Duchenne muscular dystrophy

The purpose of this study is to evaluate whether the range of motion exercise of the temporo-mandibular joint (jaw ROM exercise) with a hot pack and massage of the masseter muscle improve biting disorder in Duchenne muscular dystrophy (DMD). The subjects were 18 DMD patients (21.3 ± 4.1 years old). The jaw ROM exercise consisted of therapist-assisted training (2 times a week) and self-training (before each meal every day). The therapist-assisted training consisted of the application of a hot pack on the cheek of the masseter muscle region (15 minutes), the massage of the masseter (10 minutes), and jaw ROM exercise (5 minutes). The self-training involved jaw ROM exercise by opening the mouth to the maximum degree, ten times. These trainings continued for six months. Outcomes were evaluated by measuring the greatest occlusal force and the distance at the maximum degree of mouth opening between an incisor of the top and that of the bottom. Six months later, the greatest occlusal force had increased significantly compared with that at the start of jaw ROM exercise (intermediate values: from 73.8N to 97.3N) (p = 0.005) as determined by the Friedman test and Scheffé''s nonparametric test. The patients'' satisfaction with meals increased. However, the maximum degree of mouth opening did not change after six months of jaw ROM exercise. Jaw ROM exercise in DMD is effective for increasing the greatest occlusal force.Key words: Duchenne muscular dystrophy, exercise, occlusal force     

EDTA‐induced pseudo‐neutropenia resolved with kanamycin

This report describes a case of spurious neutropenia caused by EDTA‐dependent in vitro agglutination of neutrophils. After raising the temperature of the sample to 37°C the agglutination was irreversible, but it resolved completely after addition of kanamycin. Previously this method has been shown to be effective in EDTA‐dependent pseudo‐thrombocytopenia, but this is the first report demonstrating successful application in EDTA‐dependent pseudo‐neutropenia.     

Meningococcal meningitis with ‘normal’ cerebrospinal fluid

A prospective study was made of all patients with normal CSF counts and positive cultures for Neisseria meningitidis diagnosed in “El Vallés” County, Barcelona between January 1987 and December 1990. Meningococcal meningitis was documented in 82 patients, eight of whom (seven children, five boys and two girls with a mean age of 5·6 ± 3·3 years, and a 69-year-old male patient) had no apparent CSF abnormalities in the initial lumbar puncture. At the time of admission all patients had fever (mean 39·1 °C) of 10·8 ± 5·6 hour duration and petechial rash which had been present for a mean of 3·6 ± 3·3 hours. Signs of meningeal irritation were not found. A 4-month-old infant with symptoms of circulatory collapse, intracranial hypertension and impairment of consciousness subsequently died of septicemia in 48 hours. Group B N. meningitidis was isolated in six cases (reduced penicillin-susceptibility in two cases) and group C N. meningitidis in the remaining two (reduced penicillin-susceptibility in one case). Patients without pleocytosis did not differ in a statistically significant fashion from the patients with high pleocytosis in the duration of temperature, and petechial rash, leukopenia, positive blood culture and fatal outcome.     

UV-visible marker confirms that environmental persistence of <Emphasis Type="Italic">Clostridium difficile</Emphasis> spores in toilets of patients with <Emphasis Type="Italic">C. difficile</Emphasis>-associated diarrhea is associated with lack of compliance with cleaning protocol.

Background  

An ultraviolet visible marker (UVM) was used to assess the cleaning compliance of housekeeping staff for toilets in a tertiary healthcare setting.     

Recent Developments with Lipoprotein-Associated Phospholipase A<Subscript>2</Subscript> Inhibitors

Lipoprotein-associated phospholipase A₂ (Lp-PLA₂) is a calcium-independent phospholipase A₂ enzyme secreted by leukocytes and associated with circulating low-density lipoprotein and macrophages in atherosclerotic plaques. Until recently, the biological role of Lp-PLA₂ in atherosclerosis was controversial, but now the preponderance of evidence demonstrates a proatherogenic role of this enzyme. Lp-PLA₂ generates two proinflammatory mediators, lysophosphatidylcholine and oxidized nonesterified fatty acids, which play a major role in the development of atherosclerotic lesions and formation of a necrotic core, leading to more vulnerable plaques. These findings have opened the door to a potential novel therapeutic target, selective inhibition of Lp-LPA₂. Recently, both animal models and human studies have shown that selective inhibition of Lp-PLA₂ reduces plasma Lp-PLA₂ activity, plaque area, and necrotic core area. This article reviews the most recent developments with Lp-PLA₂ inhibitors.