Dissemination in Cutaneous Leishmaniasis I. Subcutaneous Nodules

In a study of cutaneous leishmaniasis (CL) caused by Leishmania major in Saudi Arabia, 10% of the patients were found to have subcutaneous nodules (SCN). The SCNs were usually inconspicuous, painless, and proximal to the primary skin lesions; when multiple, they showed a "sporotrichoid" configuration or appeared as "beaded cords." Their number ranged from 1-16 (average 3 25 +/- 2.50; mean +/- 1 SD). In some patients, the SCNs seemed to be triggered by antileishmanial treatment. The clinical picture and pathologic findings suggest that SCNs in patients with CL represent lymphatic dissemination, a phenomenon not widely recognized.     

Atypical parakeratotic spires and HCII HPV results: correlation in liquid-based cervicovaginal cytology specimens interpreted as ASC-US

The 2001 Bethesda System (2nd edition) indicates that parakeratosis with nuclear enlargement, hyperchromasia, irregular contours, and/or three dimensionality should prompt consideration of an interpretation of ASC-US or greater. The authors retrospectively reviewed 812 liquid-based cervicovaginal cytology samples (CVCSs) interpreted as ASC-US during an 11-month period. All slides were studied for the presence or absence of atypical parakeratotic spires (APKSs), a specific form of atypical parakeratosis. Results from corresponding Hybrid Capture II high risk (HR) HPV testing were recorded (blinded). Of 812 women, 28% (230/812) had APKSs and 20% (163/812) had positive HCII assays for HR HPV. Three percent of all reflexed ASC-US vials (26/812) had both APKSs and positive HR HPV assays (sensitivity = 16%, specificity = 69%). APKSs in liquid-based CVCSs interpreted as ASC-US do not independently correlate to a positive reflex test for HR HPV (P < 0.0001). This suggests that APKSs are most often unrelated to underlying HR HPV infection. The finding of APKSs alone in CVCSs does not warrant an interpretation of SIL and should be used only in concert with other findings to label a sample as ASC-US.     

The pathology of visible blood vessels on the nasal septum in children with epistaxis

Objective

Epistaxis is common in children, but its cause remains unknown. About half the children who present with epistaxis have prominent vessels on the nasal septum. The aim of this study was to determine the pathological nature of the prominent septal vessels in children with recurrent epistaxis.

Methods

4 mm punch biopsies of the nasal septal mucosa were taken from 5 children undergoing nasal cautery under general anaesthesia.

Results

Histology showed that the prominent vessels were thin-walled arterioles and capillaries with a surrounding inflammatory infiltrate. There was no evidence of venous varicosities or arterial microaneurysms.

Conclusion

We postulate a mechanism for septal neovascularisation due to chronic low-grade inflammation as a cause for recurrent epistaxis in children.     

Provision of emergency contraception: a pilot study comparing access through pharmacies and clinical settings

OBJECTIVE: The study was conducted to compare the provision of emergency hormonal contraception (EHC) through pharmacies and clinical services to determine whether aspects of client satisfaction and subsequent sexual health outcomes vary significantly between these services. STUDY DESIGN: A pilot observational study was conducted in South London. Participants were recruited from pharmacies and clinical services when they presented requesting EHC and met with the researcher to complete a structured questionnaire 4 months later. RESULTS: One hundred thirty-three women were enrolled in the study, 50 of whom accessed a community pharmacy for EHC plus 83 women who obtained EHC from a clinical service. Seventy percent of women who went to a pharmacy and 43.9% who went to a clinical service obtained EHC within 24 h (p=.004). A greater proportion of women attending a clinical service felt at least quite comfortable asking for EHC, compared to those who went to a pharmacy (p=.007). Those who obtained EHC from a clinic also felt significantly better informed about both EHC (p=.015) and their future contraceptive options (p=.000), compared to the women who attended a pharmacy. CONCLUSIONS: This pilot study found that women who went to a pharmacy had more rapid access to EHC compared to those who chose to attend a clinical service. Other aspects of provision and client satisfaction seem to favor attendance at a clinical setting over a pharmacy as a venue for obtaining EHC.     

Cervical screening: why young women should be encouraged to be screened

BACKGROUND: The English National Health Service Cervical Screening Programme (NHSCSP) recommendation not to offer cervical screening to women aged 20-24 years is considered in the context of national rates of cervical intraepithelial neoplasia grade 3 (CIN3) and invasive cervical carcinoma, falling screening coverage in young women, detection of screen-detected invasive cancers and risks of excisional treatment of CIN. METHODS: Registrations of invasive and in situ cervical carcinoma were obtained from the Office for National Statistics, data on screening coverage and cytology results from the NHSCSP website and data on screen-detected cancers from an audit at Guy's & St Thomas' NHS Foundation Trust (GSTFT). RESULTS: Before and after the introduction of organised screening in England, CIN3 was primarily detected in women aged 20-39 years. Increasing rates of CIN3 were recorded in women aged 20-24 years during the last decade (3000-4000 cases per year) despite falling screening coverage. The peak incidence of invasive cancer in screening age groups is now 35-39 years. At GSTFT in 1999-2006, 24 of 32 cancers (75%) in women aged 20-34 years were screen-detected and that percentage declined in subsequent 15-year age bands (p < or =0.0001). DISCUSSION AND CONCLUSIONS: Delaying the age for screening eligibility carries a risk of CIN becoming more extensive, and therefore more difficult to excise, as well as a risk of progression. The NHSCSP should reconsider its decision and encourage young women to be screened, not excluding those aged 20-24 years. Facilities for taking the tests should be made more convenient. Women should be informed that low-grade CIN is potentially reversible and may safely be monitored. Cervical screening also provides an opportunity for education on healthy lifestyles and safer sex while treatment should be reserved for high-grade CIN.     

A prospective,single‐blind,randomized controlled trial of antiseptic cream for recurrent epistaxis in childhood

A prospective, single‐blind, randomized controlled trial of antiseptic cream for recurrent epistaxis in childhood Epistaxis is common in children. Trials show antiseptic cream is as effective as cautery, but it is not known whether either is better than no treatment. We wished to know the efficacy of cream in children with recurrent epistaxis. The design was a single‐blind, prospective, randomized controlled trial set in the Otolaryngology clinic in a children's hospital. The participants were 103 children referred by their general practitioner for recurrent epistaxis. Excluded were those with suspected tumours, bleeding disorders or allergies to constituents of the cream. Referral letters were randomized to treatment and no treatment groups. Treatment was antiseptic cream to the nose twice daily for 4 weeks, which was prescribed by the general practitioner before clinic attendance. All children were given an appointment for 8 weeks after randomization. The main outcome measures were the proportion of children in each group with no epistaxis in the 4 weeks preceding clinic review. Complete data were available for 88 (85%) of the children. Of the treatment group, 26/47 (55%) had no epistaxis in the 4 weeks before the clinic appointment. Of the controls, 12/41 (29%) had no epistaxis over the 4 weeks. This is a relative risk reduction of 47% for persistent bleeding (95% CI 9–69%) and an absolute risk reduction of 26% (95% CI 12–40%), giving a number needed to treat of 3.8 (95% CI 2.5–8.5). We conclude that antiseptic cream is an effective treatment for recurrent epistaxis in children.