Insecticide resistance in head lice: clinical,parasitological and genetic aspects

Insecticide treatment resistance is considered to be a major factor in the increasing number of infestations by head lice. The large insecticide selection pressure induced by conventional topical pediculicides has led to the emergence and spread of resistance in many parts of the world. Possible mechanisms of resistance include accelerated detoxification of insecticides by enzyme-mediated reduction, esterification, oxidation that may be overcome by synergistic agents such as piperonyl butoxide, alteration of the binding site, e.g. altered acetylcholinesterase or altered nerve voltage-gated sodium channel, and knockdown resistance (kdr). Clinical, parasitological and molecular data on resistance to conventional topical pediculicides show that treatments with neurotoxic insecticides have suffered considerable loss of activity worldwide. In particular, resistance to synthetic pyrethroids has become prominent, probably because of their extensive use. As other treatment options, including non-insecticidal pediculicides such as dimeticone, are now available, the use of older insecticides, such as lindane and carbaryl, should be minimized, owing to their loss of efficacy and safety concerns. The organophosphorus insecticide malathion remains effective, except in the UK, mostly in formulations that include terpineol.     

Adéquation en dialyse péritonéale : mise au point

The optimal method to assess the adequacy of peritoneal dialysis therapies is controversial. Today, the adequacy must not be considered as a number or a concept assessed only by two parameters (total KT/V urea and total solute clearance) but defined by many more items. In the absence of data, based on theoretical considerations, the reanalysis of the CANUSA study showed that renal kidney function, rather than peritoneal clearance, was associated with improved survival. Residual renal function is considered as a major predictor factor of cardiovascular mortality. Results of this reanalysis were supported by the adequacy data in ADEMEX, EAPOS and ANZDATA studies. Therefore, clinical assessment plays a major role in PD adequacy. The management of fluid balance, the regular monitoring of malnutrition, the control of mineral metabolism and particularly the glucose load, considered as the “corner-stone” of the system, are the main points to be considered in the adequacy of PD patients. The essential goal is to minimize glucose load by glucose-sparing strategies in order to reduce the neoangiogenesis of the peritoneal membrane.     

Association of Maternal Obesity and Childhood Obesity: Implications for Healthcare Providers

The purpose of this critical appraisal was to assess the available literature on the association of maternal obesity as a risk factor for childhood obesity and to explore the implications for incorporating this evidence into practice. The increasing prevalence of childhood obesity, with its documented adverse health effects, is a critical public health threat in the United States and worldwide. Research studies have documented increased rates of childhood obesity associated with maternal obesity. Healthcare providers are challenged to expand their competencies to recognize the association of maternal obesity and childhood obesity and to address both primary and secondary prevention of childhood obesity. Stopping the cycle of obesity before it becomes the leading cause of preventable disease and death in the United States is a priority for community health nurses.     

Isolated coronary surgery in the octogenarian. Immediate results and analysis of long-term survival rate and quality of life

BACKGROUND:

There are almost three million octogenarians living in France, many of whom present with a coronaropathy. Moreover, it appears that life expectancy at 80 years of age is still important.

OBJECTIVE:

To evaluate the results of coronary surgery among these patients.

METHODS:

Eighty-eight consecutive octogenarians who had an isolated coronary artery bypass surgery between 1996 and 2002 were compared with 165 patients 60 to 70 years of age; the two groups had been paired according to the main risk factors. Patients were contacted by telephone and then received a quality-of-life-related questionnaire.

RESULTS:

Operative mortality was 2.3% in the octogenarian versus 1.2% in the 60- to 70-year-old group (P not significant). There was more low cardiac output syndrome, postoperative acute renal failure and transfusion in octogenarians. Long-term survival (average duration of follow-up was 3.8 years) was higher in the 60- to 70-year-old group: 89.7% versus 77.9% (P=0.025). Four independent risk factors of long-term increased mortality were found: age, diabetes, history of stroke and postoperative blood transfusion. Finally, the long-term survival in the octogenarians who had this surgery was higher than in the octogenarians of the general French population to a significant degree, with a quality of life considered to be satisfactory.

CONCLUSION:

For selected octogenarians, an isolated coronary surgery can be proposed, with short- and long-term results comparable with those of a younger population.     

Thrombotic microangiopathy and the antiphospholipid antibody syndrome.

A 23-year-old woman with the antiphospholipid syndrome developed severe thrombocytopenia (14 x 10(9)/l) and microangiopathic hemolytic anemia after plasma exchange. A relation was suspected between rising anticardiolipin level and development of thrombotic microangiopathy. The mechanism responsible may be interference between anticardiolipin antibody, platelet membrane and endothelial cell.     

Hepatitis after intravenous buprenorphine misuse in heroin addicts

BACKGROUND: Sublingual buprenorphine is used as a substitution drug in heroin addicts. Although buprenorphine inhibits mitochondrial function at high concentrations in experimental animals, these effects should not occur after therapeutic sublingual doses, which give very low plasma concentrations. CASE REPORTS: We report four cases of former heroin addicts infected with hepatitis C virus and placed on substitution therapy with buprenorphine. These patients exhibited a marked increase in serum alanine amino transferase (30-, 37-, 13- and 50-times the upper limit of normal, respectively) after injecting buprenorphine intravenously and three of them also became jaundiced. Interruption of buprenorphine injections was associated with prompt recovery, even though two of these patients continued buprenorphine by the sublingual route. A fifth patient carrying the hepatitis C and human immunodeficiency viruses, developed jaundice and asterixis with panlobular liver necrosis and microvesicular steatosis after using sublingual buprenorphine and small doses of paracetamol and aspirin. CONCLUSIONS: Although buprenorphine hepatitis is most uncommon even after intravenous misuse, addicts placed on buprenorphine substitution should be repeatedly warned not to use it intravenously. Higher drug concentrations could trigger hepatitis in a few intravenous users, possibly those whose mitochondrial function is already impaired by viral infections and other factors.