Preconception Health Assessment in China,Lebanon and the Philippines: Applicability to Other Countries

To test the utility of a preconception checklist tool in identifying preconception health needs of women in three countries; China, Lebanon and the Philippines. An academic medical center within each country participated in the development and testing of a preconception checklist tool, which was administered over a 6 month period to selected target groups in each country. The checklist provided valuable data on the preconception health of 6,530 women. Aggregated data identified common preconception health needs across all countries, including provision of modern contraceptives and adequate immunization coverage; HIV and STI screening; treatment for anemia; and counseling for maintenance of a healthy weight. A preconception checklist tool was found to be useful in distinct cultural settings. The study was a pilot. Future steps include validation and standardization of the checklist, data from which could be used to help shape preconception care policies and implementation strategies.     

Autoimmune hepatitis as an adverse effect of long-term methotrexate therapy

Methotrexate (MTX) is one of the most commonly used medicines in the treatment of psoriatic arthritis. The drug can produce steatosis and cirrhosis. Autoimmune hepatitis is a rare and serious adverse effect. We describe the case of a 53-year-old woman who developed autoimmune hepatitis after a long-term use of MTX for psoriatic arthritis. Hepatitis was completely resolved 4 months after stopping this drug. The pathophysiologic mechanisms of a drug-induced autoimmunity are unclear and complex. This report confirms the need to monitor liver enzymes carefully in patients using long-term treatment with MTX for psoriasis or rheumatoid arthritis.KEY WORDS: Autoimmune hepatitis, drug-induced autoimmunity, methotrexate, psoriatic arthritis     

Retractable Syringes in a Swiss Prison Needle and Syringe Exchange Program: Experiences of Drug-using Inmates and Prison Staff Perceptions

Needle and Syringe Exchange Programs (NSP) prevent infectious diseases in community and prisons. Less than 1 % of prisons worldwide have NSP. One barrier is organizational concern for needle stick injuries from used syringes. Given these concerns, we introduced retractable syringes into our prison NSP and evaluated 1) injection drug users’ experiences with retractable syringes and 2) beliefs and knowledge about NSP among prison officers (PO) and healthcare staff (HS). In 2010, we replaced usual syringes with retractable needle devices in the prison of Champ-Dollon, Geneva, Switzerland. We examined demographics, clinical profiles and NSP use among NSP participants, and asked about ease and safety of retractable syringes use in interviews. We distributed questionnaires to PO and HS, to assess knowledge and general opinions on NSP. The majority of participants expressed that retractable syringes were acceptable alternatives, but needed improvements. Of the questionnaires, 90.3 % of PO and 9.6 % of HS were still concerned about misuse of soiled syringes as weapons. Improving the quality and ease of use of use may increase the acceptance of retractable syringes. Continuing to address PO and HS safety concerns is an important step towards more disseminated NSP implementation and useful innovation.     

Does the association between smoking and mortality differ by educational level?

Some researchers suggest that the effect of smoking on health depends on socioeconomic status; while others purport that the effect of smoking on health is similar across all social groups. This question of the interaction between smoking and socioeconomic status is important to an improved understanding of the role of smoking in the social gradient in mortality and morbidity. For this purpose, we examined whether educational level modifies the association between smoking and mortality. Information on smoking by age, gender and educational level was extracted from the Belgian Health Interview Surveys of 1997 and 2001. The mortality follow up of the survey respondents was reported until December 2010. A Poisson regression was used to estimate the hazard ratio of mortality for heavy smokers, light smokers, and former smokers compared with never smokers by educational level controlling for age and other confounders. Among men, we found lower hazard ratios in the lowest educational category compared with the intermediate and high-educated categories. For instance, for heavy smokers, the hazard ratios were 2.59 (1.18-5.70) for those with low levels of education, 4.03 (2.59-6.26) for those with intermediate levels of education and 3.78 (1.52-9.43) for the highly educated. However, the interaction between smoking and education was not statistically significant. For women, the hazard ratios were not significant for any educational category except for heavy smokers with intermediate levels of education. Also here the interaction was not statistically significant. Our results support the hypothesis that educational attainment does not substantially influence the association between smoking and mortality.     

Whole Exome Sequencing allows the identification of two novel groups of Xeroderma pigmentosum in Tunisia,XP-D and XP-E: Impact on molecular diagnosis

Background

Skin cancers (SC) are complex diseases that develop from complex combinations of genetic and environmental risk factors. One of the most severe and rare genetic diseases predisposing to SC is the Xeroderma pigmentosum (XP) syndrome.

Annular elastolytic giant cell granuloma mimicking cutaneous sarcoidosis

Annular elastolytic giant cell granuloma (AEGCG) is a benign skin disorder, with, unknown cause. It appears as erythematous papules or annular plaques. Few challenging cases of AEGCG have been reported in the literature. We describe a rare clinical presentation of AEGCG mimicking cutaneous sarcoidosis.     

Multiple nodules in the scrotal wall

Herein, we report a rare case of extensive ISC. It affects dark‐colored skin men aged from 20 to 40 years old, suggesting an ethnic susceptibility. Pathogenesis of scrotal calcinosis remains controversial.