Oral and subcutaneous sumatriptan in the acute treatment of migraine: an open randomized cress-over study

In an open, randomized cross-over study in 124 patients, we compared the efficacy, safety and patient preference of oral and subcutaneous sum triptan in the acute treatment of migraine. Patients were treated for 3 attacks or 3 months and then crossed over. Primary clinical efficacy was defined as a reduction in headache severity on a four-point self-rating scale from severe (3) or moderate (2) to mild (1) or none (0), or mild (1) to none (0). Efficacy was evaluated 2 h after the administration of subcutaneous and 4h after the administration of oral sumatriptan. Subcutaneous sumatriptan was significantly more effective than oral sumatriptan in relieving headache (over all three attacks 78% vs 61% improvement), improving clinical disability (55% vs 41 % improvement) and relieving nausea (69% vs 53%), vomiting (72% vs 32%) and phono- or photophobia (67% vs 49%). Median time to recurrence was shorter after subcutaneous (12.5 h) than after oral sumatriptan (18 h); the number of patients experiencing a recurrence was similar Patients reported more adverse events after subcutaneous sumatriptan (1.32 per attack) than after the oral form (0.85 per attack), but all adverse events were mild to moderate in intensity and of short duration. Patient opinion was more often positive after subcutaneous sumatriptan. These results may be useful in counselling patients to choose between the available marketed formulations of sumatriptan.     

Microbial penetration of gloves following usage in routine dental procedures.

Unsterile polyvinyl, regular latex, and powder-free, modified latex examination gloves were evaluated following usage in routine dental procedures to assess their loss of integrity. Glove fingers were filled with a suspension of red-pigmented Serratia marcescens and drawn across the surface of tryptic soy agar plates. The appearance of red-pigmented Serratia colonies on the plates was used as an indication of glove defects. Unused, unwashed gloves taken at random from boxes served as controls. Of the gloves used in clinical procedures, 83.3% of the polyvinyl gloves, 35.0% of the regular latex gloves, and 7.5% of the powder-free, modified latex gloves allowed penetration of Serratia. Data thus suggest that advances in technology continue to develop a glove with more resistance than regular latex and vinyl gloves to routine clinical usage.     

Accelerating effects of epidermal growth factor on skin lesions of pemphigus vulgaris: a double-blind, randomized, controlled trial

BACKGROUND: Pemphigus vulgaris (PV) is a severe blistering disease involving the skin and mucous membranes. The most common causes of death in these patients are adverse effects of drugs, and infection. Skin lesions are one of the important sources of infection. Thus, any local treatment that could reduce healing time of lesions and consequently reduce the total dosage of drugs needed to treat is favourable. OBJECTIVE: To evaluate the efficacy of epidermal growth factor (EGF) in reducing healing time of lesions in patients with pemphigus vulgaris. METHODS: In this randomized, double-blind, within-patient, left/right, controlled trial, 20 hospitalized patients with pathologial and immunohistologial (direct and indirect immunoflourecence) proven pemphigus vulgaris (PV) were chosen. In addition, all patients had at least one appropriate pemphigus lesion on each side of the body that had not healed after 2-week systemic therapy and sterile saline washing. EGF (10 microg/g) in 0.1% silver sulfadiazine cream vs. 0.1% silver sulfadiazine cream alone was applied randomly on one side of the body. RESULTS: Kaplan-Meier survival analysis suggested that median time to heal with application of EGF plus silver sulfadiazine cream was 9 days, in comparison with 15 days for silver sulfadiazine cream alone (log-rank test, P=0.0003). No intervention-related adverse effect was observed during the study. CONCLUSIONS: EGF can significantly reduce healing time of skin lesions in patients with pemphigus vulgaris, at least when this cream base is applied (Cochrane skin group identifier: CSG20).     

A cross-sectional study of health complaints among 79 data entry operators using video display terminals

This paper reports on the findings of a cross-sectional study of 79 data entry clerks employed by an Ontario-based organization in five separate offices. The study was conducted to identify factors associated with physical complaints experienced by these office workers. A large percentage of the data entry clerks reported chronic physical complaints (eyestrain, musculo-skeletal pains, headache) as well as emotional or mental stress which they felt were associated with their occupation. Poorly designed overhead lighting systems in all offices contributed to both eyestrain and headache. Duration of employment as a data entry operator within the organization was not associated with stress or physical health complaints. The presence of an adjustable workstation did not in itself guarantee any protection from these conditions. Highly significant associations between occupational stress levels and some physical complaints were observed. The presence of these associations indicated that the management of both physical and stress complaints within these office environments should be tackled simultaneously.     

Rochalimaea henselae sp. nov., a cause of septicemia, bacillary angiomatosis, and parenchymal bacillary peliosis.

Nine strains of Rochalimaea spp. that were isolated from patients over a period of 4.5 years were characterized for their enzyme activities, cellular fatty acid compositions, and DNA interrelatedness among Rochalimaea spp., Bartonella bacilliformis, and Afipia felis (cat scratch disease bacillus). All except one isolate, which was Rochalimaea quintana, were determined to belong to a newly proposed species, Rochalimaea henselae sp. nov. After recovery from clinical material, colonies required 5 to 15 days of incubation to become apparent. Cells were small, gram-negative, curved bacilli and displayed twitching motility. Enzyme specificities for amino acid and carbohydrate substrates showed that R. henselae could be distinguished from Rochalimaea vinsonii by L-arginyl-L-arginine and L-lysyl-L-alanine peptidases, but not all strains could be distinguished from R. quintana on the basis of peptidases or carbohydrate utilization. R. henselae also closely resembled R. quintana in cellular fatty acid composition, with both consisting mainly of C18:1, C18:0, and C16:0 fatty acids. However, the strains of R. henselae all contained C18:0 in amounts averaging greater than or equal to 22%, in contrast to R. quintana, which contained this cellular fatty acid in amounts averaging 16 and 18%. DNA hybridization confirmed the identification of one clinical isolate as R. quintana and showed a close interrelatedness (92 to 100%) among the other strains. Under optimal conditions for DNA reassociation, R. henselae showed approximately 70% relatedness to R. quintana and approximately 60% relatedness to R. vinsonii. Relatedness with DNA from B. baciliformis was 43%. R. henselae was unrelated to A. felis. R. henselae is the proposed species of a newly recognized member of the family Rickettsiaceae, which is a pathogen that may be encountered in immunocompromised or immunocompetent patients. Prolonged fever with bacteremia or vascular proliferative lesions are clinical manifestations of the agent.     

Tests for detecting degradation of gelatin: comparison of five methods.

Five methods for detecting degradation of gelatin by bacteria were compared. These were liquefaction in nutrient broth, hydrolysis in nutrient agar, hydrolysis of charcoal gelatin strips, degradation of the gelatin on strips of photographic film, and alkalinization of gelatin agar. Degradation of photographic film is a rapid and convenient method but, like hydrolysis of gelatin in broth and in agar, may fail to detect weakly positive strains of bacteria. Alkalinization of gelatin in an agar medium is a convenient and sensitive method to detect degradation of gelatin, particularly by Pseudomonas fluorescens, but this method may not be applicable to some species.     

Ether phospholipids in control and 20∶4-depleted rat PMN: Additional evidence for a 1-0-alkyl-2-20∶4-sn-glycerol-3-phosphocholine specific phospholipase A2

Earlier studies from our laboratory have shown that PAF and LTB₄ biosynthesis are inhibited in rat PMN depleted of its 203 (JBC. '86,261, 7592). To test whether these cells contain sufficient 1-O-alkyl-2-acyl-GPC to support PAF synthesis, phosphotidyl choline was isolated from these 204-depleted cells, fractionated into different subclasses and their fatty acid composition determined. These results were compared with those obtained with control PMN. Both control and 204-depleted PMN contained significantly large amounts of alkylacyl-GPC and diacyl-GPC. Small amounts (4%) of alkenylacyl-GPC were also present. The amount of 203 in 204-depleted cells was more or less equal to the amount of 204 in control cells. About 62% of PC-bond 204 in control PMN and about 56% of PC-bound 203 in the 204-depleted PMN was found associated with the alkylacyl species. These results show that both control and 204 depleted PMN have ample precursor substrates to support PAF biosynthesis and these substrates are enriched with 204 in control cells and with 203 in 204-depleted cells. These findings are consistant with the existance of a highly specific phospholipase A₂ capable of distinguising 204 from 203 containing phospholipids.