Simian Varicella Virus Pathogenesis in Skin during Varicella and Zoster

Primary simian varicella virus (SVV) infection and reactivation in nonhuman primates is a valuable animal model in the study of varicella zoster virus disease [varicella (chickenpox) and herpes zoster (shingles)]. To understand SVV pathogenesis in skin, we inoculated 10 rhesus macaques with SVV, resulting in varicella rash. After the establishment of latency, eight of the monkeys were immunosuppressed using tacrolimus with or without irradiation and prednisone and two monkeys were not immunosuppressed. Zoster rash developed in all immunosuppressed monkeys and in one non-immunosuppressed monkey. Five monkeys had recurrent zoster. During varicella and zoster, SVV DNA in skin scrapings ranged from 50 to 10⁷ copies/100 ng of total DNA and 2–127 copies/100 ng of total DNA, respectively. Detection of SVV DNA in blood during varicella was more frequent and abundant compared to that of zoster. During varicella and zoster, SVV antigens colocalized with neurons expressing β-III tubulin in epidermis, hair follicles, and sweat glands, suggesting axonal transport of the virus. Together, we have demonstrated that both SVV DNA and antigens can be detected in skin lesions during varicella and zoster, providing the basis for further studies on SVV skin pathogenesis, including immune responses and mechanisms of peripheral spread.     

Vaccines for children: policies,politics and poverty

The dawn of the 21st century ushered in spectacular advances in vaccine production technology. However, the benefits of these developments have been largely confined to the world's most affluent and least afflicted. Of the 14 million deaths that occur world-wide in children aged less than 5 years, over 95% of these occur in developing countries and at least 70% are caused by infections for which vaccines are already available in other countries.While impoverished countries do not have a right to be assisted with the provision of funds or vaccines by affluent developed countries, an initiative for the global eradication of a vaccine preventable disease, requires a global effort. Assisting developing countries to achieve such goals should be a high priority for wealthy nations, even if only to protect their own populations. With improved international travel, not only can newly emerging diseases spread across the globe, but pathogens eliminated from one population can be re-imported by travellers or immigrants.In contrast, the recent decline in acceptance of immunisation programmes in developed countries are secondary to strong anti-vaccine movements attributing unproven adverse reactions to vaccines, placing these life-saving vaccines into disrepute. A fertile ground for propagation of these ideologies is created by parents who in their lifetime may not have seen a child killed or maimed from bacterial meningitis or measles and therefore have little understanding of the risk-benefit of vaccination.The development and deployment of vaccines must be a global effort as are the treaties for global disarmament for weapons of mass destruction.     

Predicting financial deficits from a standard neuropsychological assessment: preliminary evidence in mild cognitive impairment

Neurological Sciences - Patients with mild cognitive impairment (MCI) might experience difficulties in numerical and financial abilities of daily living that compromise their autonomy. The aim of...     

The SMART‐COP score performs well for pneumonia risk stratification in Australia’s Tropical Northern Territory: a prospective cohort study

Objective To prospectively compare a modified pneumonia severity scoring system, SMARTACOP, with other severity scores in patients presenting with pneumonia to the emergency department (ED) of a tertiary referral hospital in tropical Australia. Methods We conducted a prospective observational study of adult patients presenting with radiologically confirmed pneumonia over a 12‐month period. The sensitivity of risk stratification scores were assessed against the need for intensive respiratory or vasopressor support (IRVS). Results There were 367 ED attendances for pneumonia of whom 77.1% were admitted to hospital, 10% required intensive respiratory or vasopressor support and 2.8% died. Mean age was 50.0 years, 52% were men and 59% were Indigenous. The sensitivity of a SMART‐COP score ≥3, a SMARTACOP score ≥3 and a pneumonia severity index (PSI) class ≥3 for predicting IRVS was 97%, 97% and 78% respectively. Conclusions We found no significant advantage of the SMARTACOP over the SMART‐COP score for the prediction of intensive respiratory or vasopressor support, but both scores significantly outperformed PSI. The SMART‐COP score should replace the PSI in tropical Australia and should be assessed in other tropical areas for pneumonia risk stratification in emergency departments.     

Addressing Environmental Health Concerns near Trecatti Landfill Site,United Kingdom

Residents near the Trecatti landfill site located in South Wales, United Kingdom, expressed concern about odors and health effects they attributed to site emissions. The authors compared routinely collected, population-based, health data from potentially exposed electoral wards (i.e., United Kingdom electoral tracts) with data from both wards nearby, matched for socioeconomic deprivation scores, and with wards where residents were likely to attend the same hospital. Mortality rates were higher for all causes and neoplastic diseases (but not respiratory disease) in the exposed wards, but there was no change in rates after the site opened. Hospital data revealed a transient increase in admissions for asthma during the 3 yr that preceded the peak in odor complaints. The birth prevalence of congenital malformations was raised in the exposed wards, but the authors could not exclude a possible artifact resulting from differences in reporting practices between hospitals. The absence of environmental monitoring in the community during the period of public concern was a significant weakness of this study.     

Fistula Secondary to Unoperated Benign Gastroduodenal Ulcer

The physician must be prepared to recognize bizarre fistulas complicating benign gastroduodenal ulcer and occurring without previous gastric surgery. A benign, often subclinical ulcer crater may suddenly perforate any hollow structure in the upper abdomen or lower chest. The consequences may be remarkably benign or immediately calamitous, depending on the anatomy of the resulting fistula.