Antimicrobial resistance of invasive pneumococci in Finland in 1999-2000

The resistance patterns and macrolide resistance mechanisms of 910 Finnish invasive pneumococci isolated during 1999 and 2000 were studied. Macrolide resistance was detected in 6.9% of isolates. Penicillin resistance was detected in 1.5% of isolates, and penicillin intermediate resistance was detected in 4.0% of isolates. Active macrolide efflux, mediated by the mef(A) gene, was the most common macrolide resistance mechanism. Four macrolide-resistant isolates had mutations in rRNA or ribosomal protein L22.     

Cladophialophora bantiana as an Emerging Pathogen in Animals: Case Report of Equine Endometritis and Review of the Literature

We present an unusual equine endometritis case associated with Cladophialophora bantiana in a 15-year-old mare. The mare displayed infertility and uterine fluid accumulation with numerous black, hairy granules. Microscopically, the fluid revealed numerous septate, dark fungal hyphae and conidia in chains. Culture yielded C. bantiana (CBS 138271); the species was confirmed by internal transcribed spacer (ITS) sequencing. Treatment was unsuccessful. C. bantiana causes cerebral phaeohyphomycosis in humans, while animal cases are rare. Animal cases are reviewed.     

Asthma Programme in Finland: the quality of primary care spirometry is good

AIMS: To assess the quality of primary care spirometry by visual inspection of the flow-volume expiratory curve and to study the quantity of clinical information provided on the spirometry report sheets. METHODS: Retrospective audit of 868 expiratory flow-volume curves referred to three pulmonary clinics assessed against five predefined quality criteria. Clinical information included on the spirometry report sheets was also collected. RESULTS: Quality was good in 78% of pre-bronchodilation curves and in 80% of post-bronchodilation curves. Obtaining a sharp PEF value and full vital capacity exhalation seemed to be the critical points of measurement. Inter-rater reliability of the curve assessment was mainly good. Data on where the spirometry took place, and comments on the use of respiratory medication and patient co-operation were often lacking. CONCLUSIONS: The quality of primary care spirometry was good. Adequate clinical information on the report sheets would further improve the quality of this diagnostic process.     

Age-related changes in endogenous steroids of human fetal testis during early and midpregnancy

The steroidogenic activity of human fetal testes during early and midgestation was monitored by analyzing 58 individual fetal testes (aged 6-20 weeks of pregnancy) for endogenous pregnenolone (P5), progesterone, 17-hydroxyprogesterone, dehydroepiandrosterone, androstenedione, testosterone (T) and estradiol. A clear increase in testicular steroid concentrations, especially in those of T and other 3-keto-4-ene steroids, occurred between 8-11 weeks of gestation and reached maximum between 11-14 weeks. The three steroids present in highest concentrations were P5, androstenedione, and T (maximum concentrations, 1.9-2.7 ng/mg wet tissue). The levels of all of the C-19 steroids measured decreased clearly between weeks 14-20 of gestation, whereas those of the C-21 steroids, P5, progesterone, and 17-hydroxyprogesterone, remained relatively high. Our results suggest that the metabolic reactions converting P5 to androgens are activated in the human fetal testis within a short time range between 8-11 weeks of gestation. The increased androgen production is possibly a consequence of increased 3 beta-hydroxysteroid dehydrogenase activity. Testicular androgen production decreases in the beginning of the second trimester of pregnancy, most likely due to a blockade in the C-21 steroid side-chain cleavage.     

Incidence of juvenile idiopathic arthritis in the Nordic countries. A population based study with special reference to the validity of the ILAR and EULAR criteria

OBJECTIVE: To find the incidence of juvenile arthritis according to the ILAR and EULAR criteria within defined areas in the Nordic countries, and to study the validity of the ILAR and EULAR criteria from this perspective. METHOD: A longitudinal, prospective, population based study with patients enrolled according to the ILAR and EULAR criteria. Twenty doctors in Iceland, Norway, Sweden, Denmark, and Finland collected data from the incidence cases within their catchment areas over a period of 1.5 years, beginning July 1, 1997. Clinical and serological data from the first year of the disease were collected. RESULTS: In the whole group of 315 patients, the incidence rate was 15 per 100,000 children/year (95% CI 13-17) according to the ILAR criteria, varying from 7 (1-13) in Iceland, 19 (7-31) and 23 (10-36) from 2 different regions in Norway, and 9 (5-12) and 16 (9-23) from 2 different areas in Denmark, to 15 (12-18) in Sweden and 21/100,000/year (15-26) in the Helsinki region in Finland. An early peak in distribution for age of onset was found in girls but not in boys. The number of antinuclear antibody (ANA) positive children in the whole group, made up of children who had undergone at least one analyzed ANA test, was 123/315 (39%). Girls were ANA positive in 83/197 (42%) and boys in 40/118 (34%). Uveitis developed in 27/315 (8.6%) children during the first 6 months of the disease. CONCLUSION: Incidence rates of juvenile arthritis for areas within the Nordic countries were in accord with previous data. The ILAR criteria present slightly higher incidence rates, with a shorter disease duration for inclusion, compared to the EULAR criteria. Patients in one subgroup in either of the criteria sets do not necessarily belong to the expected subgroup in the other set of criteria; e.g., for juvenile ankylosing spondylitis (EULAR) and enthesitis related arthritis (ILAR). Our epidemiological findings are a reminder to be aware of possible new subgroups in children with juvenile arthritis.     

Intravenous drug dependence in adolescence

Purpose To explore psychosocial background and preceding substance use related to intravenous drug dependence (IDD) among adolescents.

Methods A clinical sample of 278 adolescents (age 12–17) admitted to psychiatric inpatient hospitalization between April 2001 and January 2004 was studied. Data concerning psychosocial variables and substance use were gathered from the Schedule for Affective Disorder and Schizophrenia for School‐Age Children Present and Lifetime (K‐SADS‐PL), the European Addiction Severity Index (EuropASI) and the interview schedule of the First Treatment Demand protocol of the Pompidou Group of the Council of Europe.

Results The prevalence of IDD was increased if the adolescent was living without biological father or mother, had history of truancy or had been transferred to special class. Initiation age of IDD was significantly lower if the adolescent was living without biological father or mother, the mother of the adolescent was employed full‐time or if the adolescent had been transferred to special class. Early substance experiment was associated with IDD and with earlier initiation of intravenous use. The progression from regular tobacco use to IDD was faster among girls compared to boys.

Implications Common milestones in the progression of IDD are school problems, disturbed relations to parents and previous substance experiments at young age.     

Are the blood pressure and endocrine responses of healthy subjects exposed to cold stress altered by an acutely increased sodium intake?

In the study reported here, we examined blood pressure and endocrine responses in cold conditions during salt load in young healthy subjects who had previously shown increased resting blood pressure during acutely increased sodium intake. Subjects (n=53) added 121 mmol sodium into their normal diet for 1 week. If their mean arterial pressure had increased by a minimum of 5 mmHg compared to the previous measure they were selected for subsequent experiments. The subjects (n=8) were given 121 mmol supplemental sodium · day⁻¹ for 14 days. They were then put into a wind tunnel for 15 min (temperature −15 °C, wind speed 3.5 · ms⁻¹). Their blood pressure increased (P < 0.05) during the cold exposure, independent of the sodium intake. Their mean (SEM) plasma noradrenaline increased from 3.58 (0.62) nmol · l⁻¹ to 5.61 (0.79) nmol · l⁻¹ (P < 0.05) when the subjects were given a normal diet, and from 2.45 (0.57) nmol · l⁻¹ to 5.06 (0.56) nmol · l⁻¹ (P < 0.05) when the subjects were given an elevated sodium diet. The starting concentrations and the endpoint concentrations were statistically similar. The plasma levels of the N-terminal fragment of pro-atrial natriuretic peptide decreased during the whole-body cold exposure: with the sodium load the change was from 256.6 (25.5) nmol · l⁻¹ to 208.0 (25.3) nmol · l⁻¹, and with the normal diet, from 205.8 (16.4) nmol · l⁻¹ to 175.1 (16.1) nmol · l⁻¹. The haematocrit and red blood cell count increased (P < 0.05) with normal and elevated sodium diet in cold conditions, but haemoglobin increased (P < 0.05) only with high salt in cold conditions. To conclude, acutely increased sodium intake does not change the blood pressure response or hormonal responses to exposure to acute cold stress in healthy subjects. Accepted: 28 September 2000