Screening for vancomycin‐resistant enterococci: results of a survey in Stockholm

Fang H, Nord CE, Ullberg M. Screening for vancomycin‐resistant enterococci: results of a survey in Stockholm. APMIS 2010; 118: 413–7. Vancomycin‐resistant enterococci (VRE) are emerging in Stockholm hospitals. To rapidly screen for VRE from stool and rectal swab samples, a detection assay combining broth enrichment and real‐time PCR was set up. From September to December 2008, 6914 samples were screened for VRE using the broth‐PCR combined assay. Of them, 5463 samples were reported as negative the day after sampling. Among the 6914 samples, 47 was screened as vanA probable and 44 of them were confirmed as VRE; 1314 samples was screened as vanB probable and 93 of them were confirmed as VRE. The 44 vanA‐type VRE isolates, detected from 31 patients, were clustered into four genetic types by pulsed‐field gel electrophoresis (PFGE). The same PFGE type was observed in multiple isolates recovered from the same patient with vanA VRE. The 93 vanB‐type VRE isolates were detected from 60 patients, 59 of them harboring VRE with PFGE type 1. One patient with vanB VRE had two isolates of distinct PFGE types (types 1 and 5). PFGE type 1 and PFGE type 2 were predominant clones in vanB and vanA strains, respectively, represented by 98.3% (59/60) of patients with vanB VRE and 77.4% (24/31) of patients with vanA VRE.     

Female factor IX deficiency due to maternally inherited X‐inactivation

Esquilin JM, Takemoto CM, Green, NS. Female factor IX deficiency due to maternally inherited X‐inactivation. X‐chromosome inactivation is normally a random event that is regulated by the X chromosome itself. Rarely, females are affected by X‐linked disorders from extremely skewed X‐chromosome inactivation. Here, we report a family with hemophilia B with female expression through inherited X skewing that appears to be independent of either X chromosome. This finding suggests the possibility of a dominant autosomal contribution to inherited skewed X inactivation.     

High resolution mapping of reticulated water fluoride in Western Australia: opportunities to improve oral health

Background: Drinking water with an optimum fluoride concentration is a recognized effective method to reduce dental decay. Methods: In this study normal suppliers of drinking water in Western Australia provided map data regarding the distribution of their supplies and the locations of their test points. These data were collated into a single unified map of Western Australian water supplies and fluoride levels. It is clear that the effect of prevention in regionally isolated communities is significant as the cost of providing service is anywhere between 2 and 4 times higher than that in high density regions. Results: The current study found that although a very significant proportion of the population has access to water with fluoride concentrations that would be caries protective, most of these are large urban centre based. Conclusions: Those with high burdens of dental disease are mostly residential in rural and remote areas where water is either not fluoridated, nor regulated, or low in fluoride. However, it is acknowledged that water fluoridation, for many reasons, is not always feasible in rural and remote communities, and preventive efforts through alternative sources of fluoride (e.g. toothpaste) should be considered, even if less effective at community level.     

Autologous melanocyte–keratinocyte suspension in the treatment of vitiligo

Background In stable vitiligo, several techniques of autologous transplantation of melanocytes are used. Autologous melanocyte transplantation of non‐cultured melanocytes is one of those techniques with variable reported outcomes. Objective The objective of this study was to evaluate the response to autologous melanocyte–keratinocytes suspension transplantation in cases of stable vitiligo. Methods A total of 25 cases of vitiligo were treated by autologous melanocyte–keratinocytes suspension transplantation. After 6–17 months, patients’ response was evaluated according to the extent of pigmentation (excellent 90–100%, good 50–89%, fair 20–49% and poor response <20%). Results Of the 25 patients treated, 22 continued the follow‐up period. Five (23%) patients showed excellent response, 7 (32%) good, 6 (27%) fair and 4(18%) showed poor response. Conclusion Unlike transplantation of cultured melanocytes, which requires experience in culture technique, autologous melanocyte–keratinocytes suspension transplantation is an easy economic technique, which may be used in resistant areas of stable vitiligo.     

Factors associated with the use of breast and cervical cancer screening services among Chinese women in Hong Kong

We conducted a cross-sectional survey using a self-administered questionnaire among attendees of a well women clinic in Hong Kong during June and July 1998. The study aimed to examine the factors associated with the past and future use of screening services among Chinese women in Hong Kong and their perception of service providers. Of the 430 respondents (64% response rate), 87% were aged 31-50 y, 85% married, 93% attained education to upper secondary school level, and 96% were non-smokers. Nearly all respondents (99%) reported having sexual experience and most of them (87%) had such experience with only one partner; 59% reported having a pap-smear test, 28% a mammogram and 44% a breast self-examination. Women who were health conscious (ate a lower fat diet and performed regular exercise) were more likely to have used the screening service (mammogram and pap-smear test) and performed breast self-examination. Staff manner, privacy and cost were the most common contributing factors for respondent's desire for future use of the screening service. Respondents showed a preference for doctors (70%) over nurses (30%), and females (80%) over males (20%) as their service providers. The findings suggest the need to disseminate appropriate information on screening services among the public to dispel misconceptions about the preference for doctors over nurses and females over males. Improving clinician- and other staff-patient communication would be important for breast and cervical screening programs in Hong Kong.