Cutaneous manifestations of waterborne infections

Although waterborne pathogens are relatively uncommon causes of cutaneous infections, these agents are being recognized with increasing frequency. Humans are exposed to water through a variety of recreational and occupational activities. Poor sanitary conditions in developing nations place the human populations at constant risk. Some aquatically acquired skin infections respond well to therapy, whereas other diseases do not require a specific treatment. However, many of these infections are rare, and effective therapy has not been defined. Gram-negative bacilli constitute the largest group of aquatic pathogens that cause skin infections. Other agents include mycobacteria, fungi, viruses, and amoeba and other parasites. Toxins from aquatic animals and parasites are associated with cutaneous diseases. Because waterborne skin infections, which are caused by a wide variety of pathogens, occur infrequently, most of the literature on the topic are case reports. This paper reviews the aquatic pathogens associated with cutaneous infections in humans and the available treatments.     

The need to address poor numeracy skills in the emergency department environment

Substantial evidence exists for lack of numerical skills among many health professionals. Although poor numeracy has long been recognised as a contributor to medication error, other activities for which numerical literacy are required, such as interpretation of diagnostic results, have been largely ignored. Poor self‐awareness of lack of numerical literacy increases the risk, especially in the busy and hurried emergency environment. System changes, such as standardising units and improving number presentation, reduce the potential for misinterpretation; however system changes do not address the underlying deficiencies in mathematical skills. The training of doctors in numeracy has been largely ignored. In contrast, education for nurses frequently occurs during both pre‐ and post‐registration programmes. Interventions have had mixed success, although additional emphasis in increasing conceptual understanding of numbers is encouraging. The consequences of poor numerical literacy should be addressed in all clinical staff, not only by practice change to remove the potential for errors to be made, but also complemented by self‐awareness and education.     

The effect of proinflammatory cytokine gene and angiotensin-converting enzyme polymorphisms on erythropoietin requirements in patients on continuous ambulatory peritoneal dialysis.

BACKGROUND: The correction of anemia by recombinant human erythropoietin (rHuEPO) improves quality of life and prolongs life in end-stage renal failure. rHuEPO requirements for an individual are determined by a range of factors, including iron deficiency and inflammation. Single nucleotide polymorphisms in the promoter sequence of several proinflammatory cytokines have been shown, in different fields of medicine, to influence the cytokine response to different stimuli, with effects on clinical outcome. METHODS: The angiotensin-converting enzyme (ACE) insertion/deletion polymorphism and polymorphisms in the promoter regions of the genes for tumor necrosis factor alpha (-308 A/G), interleukin-6 (-174 G/C), and interferon gamma were examined for their association with rHuEPO requirements in 112 patients on continuous ambulatory peritoneal dialysis (CAPD). Genomic DNA was extracted from peripheral blood leukocytes and genotyping performed with ARMS-PCR methodology, with sequence-specific primers. We examined rHuEPO requirements and C-reactive protein at baseline and during a 6-month study period. RESULTS: We found no significant effect of proinflammatory cytokine polymorphisms on rHuEPO responsiveness. However, throughout the study, we observed that there was a significantly higher rHuEPO requirement in the II and ID ACE genotypes compared with the DD group, which remained an independent association following multivariate analysis. CONCLUSIONS: ACE insertion/deletion polymorphism may determine rHuEPO responsiveness in CAPD patients and should be considered in relative rHuEPO resistance.     

Performance of institutionalized and community-active old persons on concrete and formal Piagetian tasks

This study investigates the effects of age, level of education, and institutionalization on the development of logical thinking. Seven Piagetian tasks, encompassing three levels of difficulty, were administered to thirty-four persons sixty-eight years of age or older. A significant positive relationship was found between success on task and educational level. With education controlled, Community-active elders performed significantly better than Institutionalized elders. Within the limitations of a cross-sectional design, results supported the hypothesis that cognitive abilities in old age retain an orderly structure.     

Presence of HLA antibodies in single-donor-derived fresh frozen plasma compared with pooled, solvent detergent-treated plasma (Octaplas).

Adverse reactions to plasma transfusion are well documented. One of the most serious hazards of transfusion, transfusion-related acute lung injury (TRALI), has nearly as high an incidence of mortality and major morbidity as that reported for the transfusion of incorrect blood components. The specific mechanisms of plasma component-induced adverse reactions remain unclear, but a major contribution may be related to the presence of alloantibodies. In this study, a laboratory analysis was undertaken to determine the presence of HLA antibodies in leucodepleted single-donor-derived fresh frozen plasma (FFP). A comparison was made with a pooled plasma product that has undergone solvent detergent treatment. In total, 58 plasma samples from single-donor units of leucodepleted FFP were tested along with samples from 12 units (three for each ABO blood group) of the pooled plasma (Octaplas); Octapharma Ltd, Coventry, UK), for the presence of HLA antibodies. HLA-specific enzyme-linked immunosorbent assay (ELISA) methods were used to screen for their presence, and complement-dependent cytotoxicity and flow cytometry analyses were used to further define their presence, specificity and class [immunoglobulin G (IgG)/IgM]. In the study groups, HLA antibodies were found to be present in five of the single-donor units (9%) while the pooled plasma samples tested negative.     

21-hydroxylase deficiency families with HLA identical affected and unaffected sibs.

During our investigations of polymorphisms at, and in the immediate chromosomal vicinity of, the 21-hydroxylase locus in families with 21-hydroxylase deficiency, three families were found to show marked discordance in clinical features of HLA identical subjects. In one family, there is discordance between a boy with the simple virilising form of 21-hydroxylase deficiency and his two younger sisters, who are both HLA identical to their brother, but who have additional salt wasting features. In the other two families, one subject is severely affected and has very high 17-hydroxyprogesterone levels, but has an HLA identical sib who is asymptomatic and shows only slightly raised 17-hydroxyprogesterone levels. In all cases, HLA identity, as indicated by protein polymorphism studies (HLA-A, B, DR, C4A, C4B, and Bf typing), has been verified at the gene organisation level using 21-hydroxylase and complement C4 DNA probes. An HLA-Bw47 bearing haplotype in one of the latter families has not been transmitted to the affected child and appears to carry a normal 21-OHB allele and two genes which specify C4A allotypes.