Incidence of erythromelalgia: a population-based study in Olmsted County, Minnesota

Objective   To estimate the population-based incidence of erythromelalgia.
Background   Only one report describing the incidence of erythromelalgia has been published previously.
Study design   A population-based analysis of data from the Rochester Epidemiology Project.
Setting    Tertiary care medical centre in Olmsted County, Minnesota (a rural county in the south-eastern portion of the state).
Patients   Thirty-three residents of Olmsted County with a diagnosis of erythromelalgia during the study period.
Methods   Age- and sex-specific incidence rates of erythromelalgia were determined.
Intervention   None.
Main outcome   Population-based incidence rate.
Results   The overall age- and sex-adjusted incidence rate (95% confidence interval, 95% CI) was 1.3 (0.8–1.7) per 100 000 people per year. The incidence of primary and secondary erythromelalgia was 1.1 (0.7–1.5) and 0.2 (0.02–0.4) per 100 000 people per year, respectively. The age-adjusted incidence rates (95% CI) were 2.0 (1.2–2.7) per 100 000 women and 0.6 (0.1–1.1) per 100 000 men. The study was limited by the small sample size and potential variability in recognition of erythromelalgia.
Conclusion   The population-based incidence of erythromelalgia has increased with each decade in Olmsted County over the past three decades; overall incidence was 1.3 per 100 000 people per year, approximately 5 times higher than previously reported.     

Preferential expression of double-stranded ribonucleic acid in tumor versus normal cells: biological and clinical implications

In an effort to develop a new tumor marker suitable for flow cytometric analysis, we examined the value of double-stranded ribonucleic acid (ds- RNA) measurements using propidium iodide after DN'ase treatment. Cellular ds-RNA content was evaluated both in experimental cell lines and in clinical specimens. Higher levels of ds-RNA were present in tumor cells as compared with normal cells. In tumor cells, fluorescence was intensely localized in the nucleolus and was more diffuse in the cytoplasm. Change of less than 10% in the ds-RNA levels was observed in cell lines as a function of cytokinetic determinants such as cycle phase, culture age, and cycle traverse rate. Tumor differentiation by dimethylsulfoxide resulted in a significant decrease in cellular ds-RNA content. For quantitative comparison of clinical material, a ds-RNA excess was defined in relationship to normal peripheral blood lymphocytes. ds-RNA excess greater than 30% was observed in only one of 34 normal tissues (3%) as compared with 124 of 201 neoplastic tissue samples (62%). This incidence was higher in patients with acute leukemia (76%), high-grade and intermediate-grade lymphoma (75%), and high tumor stage myeloma (83%), as compared with chronic leukemia (20%), low-grade lymphoma (25%), and intermediate or low tumor mass myeloma (43%). Prognostically, a high pretreatment ds-RNA excess in myeloma was associated with a lower remission rate. The persistence of ds-RNA excess in the bone marrow of patients with acute myelogenous leukemia in remission predicted for a shorter remission duration (seven v 22 months; P = .05). We conclude that ds-RNA excess, as readily measured objectively and quantitatively by flow cytometry, may have important diagnostic and prognostic implications for the management of patients with malignant disease.     

Pasteurella multocida infected total knee arthroplasty: a case report and review of the literature

Pasteurella multocida is a rare cause of prosthetic joint infection. This infection generally follows significant animal contact, usually licks and scratches. We report a case of P multocida infection that was treated with linezolid with salvage of the implant. Linezolid is generally active against Gram-positive organisms only with the exception of Pasteurella, which is Gram-negative. We extensively review the previous reported cases of implant infection with P multocida.     

Screening of Tanzanian medicinal plants for anti-Candida activity

Background  

Candida albicans has become resistant to the already limited, toxic and expensive anti-Candida agents available in the market. These factors necessitate the search for new anti-fungal agents.     

Linkage analysis of candidate regions for coeliac disease genes

A strong HLA association is seen in coeliac disease [specifically to the DQ(alpha1*0501,beta1*0201 heterodimer], but this cannot entirely account for the increased risk seen in relatives of affected cases. One or more genes at HLA-unlinked loci also predispose to coeliac disease and are probably stronger determinants of disease susceptibility than HLA. A recent study has proposed a number of candidate regions on chromosomes 6p23 (distinct from HLA), 6p12, 3q27, 5q33.3, 7q31.3, 11p11, 15q26, 19p13.3, 19q13.1, 19q13.4 and 22cen for the location of a non-HLA linked susceptibility gene. We have examined these regions in 28 coeliac disease families by linkage analysis. There was excess sharing of chromosome 6p markers, but no support for a predisposition locus telomeric to HLA. No significant evidence in favour of linkage to coeliac disease was obtained for chromosomes 3q27, 5q33.3, 7q31.3, 11p11, 19p13.3, 19q13.1, 19q13.4 or 22cen. There was, however, excess sharing close to D15S642. The maximum non-parametric linkage score was 1.99 (P = 0.03). Although the evidence for linkage of coeliac disease to chromosome 15q26 is not strong, the well established association between coeliac disease and insulin dependent diabetes mellitus, together with the mapping of an IDDM susceptibility locus (IDDM3) to chromosome 15q26, provide indirect support for this as a candidate locus conferring susceptibility to coeliac disease in some families.      

Does obesity contribute as much to morbidity as poverty or smoking?

The prevalence of obesity is increasing in America, but its impact on morbidity relative to other health risks is unclear. This paper compares the effects of overweight, poverty, smoking and problem drinking on occurrence of chronic conditions and health-related quality of life. The data were collected from a nationally representative household telephone survey of 9585 adults fielded in 1998, using self-reported measures of height and weight, poverty, smoking status, problem drinking, chronic conditions and SF-12 global scales. Regression analyses were used to estimate effects of health risk factors on morbidity. Thirty-six percent of adults are overweight but not obese (25< or =BMI<30) and another 23% are obese (BMI> or =30). Controlling for demographics, obesity is associated with more chronic conditions and worse physical health-related quality of life (P<0.01). Smoking history and poverty predict having chronic conditions, but their effect sizes are significantly smaller. Even after controlling for chronic conditions, obesity predicts physical health-related quality of life, in that case with an effect size similar to poverty. The effect of problem drinking is always smaller. Obesity is highly prevalent and associated with at least as much morbidity as are poverty, smoking and problem drinking. Nevertheless, the latter have achieved more consistent attention in recent decades in clinical practice and public health policy.     

HLA DRB1* typing and cartilage oligomeric matrix protein (COMP) as predictors of joint destruction in recent-onset rheumatoid arthritis

The carriage of a characteristic sequence of amino acids at position 67- 72 in the third hypervariable region of the HLA DRB1 chain has been linked to susceptibility to rheumatoid arthritis (RA). Whether this epitope is also a predictor of more severe disease remains controversial. Cartilage oligomeric matrix protein (COMP) is a protein, the serum levels of which have been found to correlate with large joint destructive disease in previous work. In this paper, we compare DRB1* typing and serum COMP levels in a prospectively observed group of RA patients with or without early hip joint destruction. The COMP levels at study inclusion, median 11 months from onset of symptoms, were significantly higher in the patients with early hip joint destruction compared to the patients in the more benign group. There was no difference in the number of disease susceptibility-related epitopes between the groups. DRB1*04, in contrast, was found among 8/8 patients with hip destruction, but also in 5/8 more benign cases. We conclude that in this type of RA patient, COMP serum levels are more informative predictors of aggressive disease than HLA DRB1* typing.      

Risk factors for under-nutrition among children aged one to five years in Udupi taluk of Karnataka,India: A case control study

Background

Despite her apparent economic success, India is plagued by a high burden of under-nutrition among children under five. This study was aimed at understanding some of the risk factors for under-nutrition in a region with favourable maternal and child health indicators.

Method

A case control study was carried out among children aged one to five years attending the paediatric outpatient department in six rural health care centres in Udupi taluk of Karnataka in Southern India. A total of 162 children were included in the study, of which 56 were cases. A semi-structured questionnaire was used to interview the caregivers of the children and the nutritional status was graded according to the Indian Academy of Paediatrics (IAP) grading of protein-energy malnutrition.

Results

Under-nutrition was associated with illness in the last one month [OR– 4.78 (CI: 1.83 –12.45)], feeding diluted milk [OR–14.26 (CI: 4.65 – 43.68)] and having more than two children with a birth interval ≤2 years [OR– 4.93 (CI: 1.78 – 13.61)]. Lack of exclusive breast feeding, level of education of the caregiver and environmental factors like source of water did not have an association.

Conclusion

Childhood illness, short birth interval and consumption of diluted milk were some of the significant contributory factors noted among this population. Information, Education, Communication (IEC) campaigns alleviating food fads and promoting birth spacing is needed.