A pilot methodology study for the photographic assessment of post‐inflammatory hyperpigmentation in patients treated with tretinoin

Background Post‐inflammatory hyperpigmentation (PIH) is a common occurrence in patients with acne vulgaris, particularly in those with skin of colour. Aims A previous study has demonstrated the benefit of tretinoin (retinoic acid) in the treatment of PIH; however, there is currently no standard protocol to evaluate change in PIH following treatment. Based on these findings, we performed a pilot, exploratory, blinded, intraindividual‐controlled methodology study that consisted of a photographic assessment protocol with facial mapping. Materials and methods The study was based on a secondary analysis of a phase 4, community‐based trial of 544 acne patients who were treated with tretinoin gel microsphere 0.04% or 0.1%. Only patients with Fitzpatrick types III–V (skin of colour) were included in the study; subjects with Fitzpatrick skin type VI were excluded because the photographic assessment did not allow for proper evaluation. Results Despite the small number of subjects evaluated (n = 25), the results revealed consistent assessment of improvement in PIH between two independent graders (weighted κ = 0.84). Conclusion Further study with a larger population is recommended to validate the accuracy of this method.     

10 Years Experience with Bacterial Screening of Platelet Concentrates in the Netherlands

SUMMARY: BACKGROUND: Contamination of platelets with bacteria is the major microbiological risk of blood transfusion. Screening for bacterial contamination can reduce the frequency of bacterial transmission considerably. In the present paper, the results of 10-year screening in the Netherlands are described. METHODS: All platelet concentrates were cultured with the BacT/Alert culturing system with large volume (7.5 ml) cultures in either an aerobic or an anaerobic bottle. Products were released on a 'negative-to-date' basis. RESULTS: After introduction of the diversion of the first milliliters of collected blood, the number of positive screening cultures decreased significantly from 0.85% to 0.37%. The frequency of transfusion-transmitted bacterial infections by platelet concentrates is currently less than 1 per 2 years in the Netherlands. CONCLUSION: Over a period of 10 years the bacterial screening system for platelet concentrates proved to result in a safe system with respect to microbiological infection as a result of platelet transfusions.     

Resurgence of bedbugs in southern France: a local problem or the tip of the iceberg?

Background Bedbugs (Cimex lectularius) have been feeding on sleeping human beings since prehistory. In Europe, bed bugs were common and endemic until World War II when improved body and home hygiene, and widespread use of insecticides led to almost complete eradication. Current evidence indicates that bedbugs are making a comeback in Europe, USA, Canada and Australia. In our practice in Southern France, we observed several cases within a period of only 1 year. Objectives Based on this experience, we conducted an epidemiological study to evaluate the status of bedbugs in France. Methods During summer 2009, we mailed a short questionnaire to all hospital professors in the CEDEF (Collège des Enseignants de Dermatologie de France) asking four questions: number of suspected diagnosis of bedbugs in the year 2009, and number of certain positive diagnosis, difficulties in treatment, use of a pest control professional for treatment, and finally personal opinion on actual incidence of bedbugs, compared with past years. Results Of the 84 questionnaires sent, there were only 26 responses despite two reminders. The responses were predominantly southern France, probably as a result of intensive immigration and increased travel and trade. Difficulties encountered during diagnosis and treatment are also mentioned. Utilizing the services of entomological experts and pest control professionals is essential. Conclusions France has the same experience regarding the resurgence of bedbugs as several European countries, USA, Canada and Australia, especially the southern regions. This emerging health problem has to be known by dermatologists. A national programme has been launched in France to assess actual incidence and study C. lectularius‐ related diseases.     

Prostaglandin E2 9-ketoreductase activity in human decidua vera tissue

Amnion is believed to be a tissue of central importance in the biochemical processes of parturition. In this tissue, prostaglandin E2 is the near exclusive prostaglandin produced. And although the production of prostaglandin E2 is increased during labor in women, the levels of the major metabolite of prostaglandin E2 in maternal plasma are not elevated; rather, the levels of 13,14-dihydro-15-ketoprostaglandin F2 alpha, the major circulating metabolite of prostaglandin F2 alpha, are increased strikingly. Because of this apparent paradox, we considered the possibility that prostaglandin E2, originating in amnion, chorion laeve, or decidua vera, is converted to prostaglandin F2 alpha in decidua vera by the action of prostaglandin E2-9-ketoreductase. We found that prostaglandin E2 9-ketoreductase, the enzyme that catalyzes the conversion of prostaglandin E2 to F2 alpha, is present in cytosolic fractions prepared from homogenates of uterine decidua vera tissue. The specific activity of 9-ketoreductase in cytosolic fractions of decidua of six women varied from 3.2 to 155 pmol X min-1 X mg-1 protein. We also evaluated the conversion of exogenous prostaglandin E2 to F2 alpha in intact human endometrial stromal cells in monolayer culture. We found that prostaglandin E2, added to the culture medium, was converted to prostaglandin F2 alpha by endometrial stromal cells that were maintained in the presence of inhibitors of prostaglandin synthase. The extent of conversion of exogenous prostaglandin E2 to F2 alpha, however, was low relative to the specific activity of prostaglandin E2 9-ketoreductase found in decidual cytosol. These findings are consistent with the possibility that prostaglandin E2 formed in decidua vera tissue may be converted in that tissue to prostaglandin F2 alpha by 9-ketoreductase; on the other hand, prostaglandin E2 formed in contiguous tissues probably is not converted significantly to prostaglandin F2 alpha by decidual 9-ketoreductase.     

Attitude of women in western Uganda towards pre-packed,unit-dosed malaria treatment for children

In the context of a larger study on malaria related knowledge, attitudes, practices and beliefs in western Uganda 813 women aged 15-49 years were shown a sample of a pre-packed, unit-dosed malaria treatment for children, its use was explained and attitudes of the women were investigated. Of all women, 90.5% (86% urban, 92% rural) said they would prefer the pre-packed over the conventional type of treatment and 93.9% of these were willing to pay between 0.17 (rural) and 0.29 (urban) US dollars more for this treatment. Two-thirds (67.8%) thought that they would not have to ask their spouses before making a decision on the kind of treatment and 59.5% said they would rather stock the treatment at home than buy it when a child gets sick. The most mentioned reason for preferring pre-packs was their safety and cleanliness, while ease of application, dosing and compliance were secondary. We conclude that pre-packed, unit-dosed malaria treatment is accepted by the caretakers of children in the area studied and that they readily understand and accept its concept. This indicates a high potential for this approach to improve the home management of malaria fevers and reduce malaria-related morbidity and mortality if adequate coverage can be achieved and if the intervention is embedded into an appropriate programme of behavioural change communication and provider training.     

Imaging of atherosclerosis. Elastography

Intravascular ultrasound elastography is a method for measuring the local elastic properties of coronary atherosclerotic plaques using intravascular ultrasound (IVUS). Mechanical properties of the different tissues within a plaque are measured through strain. In the last decade, several groups have applied elastography intravascularly with various levels of success. In this paper, the approaches of the different research groups will be discussed and the focus will be on our approach to the application of intravascular elastography.     

Long-term effects of St. John's wort and hypericin on monoamine levels in rat hypothalamus and hippocampus

Hypericum perforatum L. (St. John’s wort) is one of the leading psychotherapeutic phytomedicines and, because of this, great effort has been devoted to clarifying its mechanism of action. Chronic effects of St. John’s wort and hypericin, one of its major active compounds, on regional brain amine metabolism have not been reported yet. We used a high-performance liquid chromatography system to examine the effects of short-term (2 weeks) and long-term (8 weeks) administration of imipramine, Hypericum extract or hypericin on regional levels of serotonin (5-HT), norepinephrine, dopamine and their metabolites in the rat brain. We focused our interest on the hypothalamus and hippocampus, as these brain regions are thought to be involved in antidepressant drug action. Imipramine (15 mg/kg, p.o.), Hypericum extract (500 mg/kg, p.o.), and hypericin (0.2 mg/kg, p.o.) given daily for 8 weeks significantly increased 5-HT levels in the hypothalamus (P<0.05). The 5-HT turnover was significantly lowered in both brain regions after 8 weeks of daily treatment with the Hypericum extract (both P<0.05). Consistent changes in catecholamine levels were only detected in hypothalamic tissues after long-term treatment. Comparable to imipramine, Hypericum extract as well as hypericin significantly decreased 3,4-dihydroxyphenylacetic acid and homovanillic acid levels in the hypothalamus (P<0.01). Our data clearly show that long-term, but not short-term administration of St. John’s wort and its active constituent hypericin modify levels of neurotransmitters in brain regions involved in the pathophysiology of depression.