An overview of clinical manifestations and survival of systemic lupus erythematosus patients in Asia

Aim: To provide an overview of the clinical manifestations, survival and causes of mortality of systemic lupus erythematosus (SLE) patients in Asia. Methods: Literature retrieval utilized the following sources: (i) computerized bibliographic database of the National Library of Medicine (MEDLINE 1986–2006) by PubMed; (ii) articles on SLE published in journals of national medical or rheumatology societies; and (iii) abstracts presented in national, regional and international rheumatology and SLE conferences. The available materials were cited to summarize and extrapolate data deemed most representative of each Asian country. Results: The average age at SLE diagnosis ranged from 24–33 years, with a ratio ranging from 8–28 females to one male. Cutaneous and musculoskeletal manifestations were the most frequently observed, ranging from 45–98% and 36–85%, respectively. Renal involvement ranged from 6–100% (overall), or 26–74% (excluding presenting manifestations, and data obtained from a renal centre). Survival rates ranged from 65–98% at 5 years, and 50–84% at 10 years, with a trend for improved survival in more recent reports. Infection and active SLE disease were the predominant causes of mortality, with renal and central nervous system involvement as the main organs involved at time of death. Summary: This overview substantiates the potential vastness of clinical material on SLE in Asia, and reinforces the need for concerted efforts to encourage more research designed to address special issues and develop a more efficient health care delivery system tailored to the Asian lupus patient.     

Improving Patient Retention After Botulinum Toxin Type A Treatment

BACKGROUND: Botulinum toxin treatments have been associated with consistently high patient satisfaction rates, but calculation of patient retention rates is not routinely performed. Retention measurements serve as critical indicators of clinical performance and can be optimized by evaluation of current office policies and implementation of strategies to improve patient retention. PURPOSE: To investigate the reasons patients discontinue botulinum toxin treatments and to evaluate the effect of a single intervention intended to improve patient retention. METHODS: A retrospective chart review was performed of all patients who received botulinum toxin injections in a private cosmetic dermatology practice over a 2-year time period to determine the patient retention rate. Patients who had discontinued botulinum toxin treatment after a single session were surveyed to discern their reasons for terminating treatment. A change in office policy was instituted wherein all patients who received their first botulinum toxin treatment were required to undergo a 2-week post-treatment evaluation to determine treatment effect and to receive touch-up treatment as necessary. Retention rates were calculated over the 1-year period immediately after initiation of the new policy. RESULTS: The initial patient retention rate was 55%. The most common reasons cited for discontinuance of botulinum toxin treatments were procedural cost, patient failure to re-schedule, perceived lack of product longevity, and clinical effect falling short of expectations. After initiation of the mandatory 2-week post-treatment office evaluation, a 67% patient retention rate was achieved. CONCLUSIONS: Managing patient expectations of botulinum toxin treatments and mandatory post-treatment appointments for evaluation of the initial procedure increase the patient retention rate.     

Studies on the pathogenesis of fever. IV. The site of action of leucocytic and circulating endogenous pyrogen

By means of a method designed to compare the febrile responses produced by intracarotid and intravenous injections, the endogenous pyrogen, which is contained in leucocytic exudates and is present in the serum of rabbits 2 hours after intravenous injections of typhoid vaccine, has been shown to act directly upon the thermoregulatory centers of the brain. In contrast, the exogenous bacterial pyrogen present in serum obtained 5 minutes after vaccine injections was found to act by a different and less direct mechanism. These observations add strong support to the original hypothesis that endogenous pyrogen, presumably derived from polymorphonuclear leucocytes, is an essential factor in the pathogenesis of endotoxin fever.     

Studies on the pathogenesis of fever. III. The leucocytic origin of endogenous pyrogen in acute inflammatory exudates

The evolution of an acute inflammatory exudate produced in rabbits by the intraperitoneal injection of saline has been described. Evidence has been presented that polymorphonuclear leucocytes release endogenous pyrogen into the cell-free fluid of the exudate. Leucocytes from such exudates have also been shown to release pyrogen into the surrounding medium during incubation in vitro at 37°C. The results of parallel cytological studies have provided evidence which suggests that the leucocytes give up their pyrogen while functionally intact. These observations add further support to the hypothesis that polymorphonuclear leucocytes play a significant role in the pathogenesis of fever.     

An Outbreak of Nocardia asteroides Infection in a Renal Transplant Unit

An outbreak of Nocardia asteroides infection occurred in thenephro-urological intensive care unit, St Peter's Group of Hospitals,London in 1979. It is suggested that the outbreak has been dueto patient-to-patient transmission. Five months before the outbreak, N. asteroides was first isolatedfrom nephrostomy urine from an asymptomatic patient who hadundergone several urological operations. Subsequently six ofthe seven patients admitted for renal transplant over a threemonth period developed proven infections. The first transplantpatient had an abdominal abscess and the other five had onlypulmonary disease with obvious radiological lesions. Bacteriologicaldiagnosis was made in three patients by examination of sputumand in the other three from bronchoscopic specimen, pleuralfluid and pus from an abscess respectively. Five of the sixrenal transplant patients were treated with amoxycillin anderythromycin. Clinical and radiological improvement was observedand no patient died as a result of the infection. In the intensive care unit air and dust samplings were positivefor N. asteroides. The unit was closed and fumigated with formaldehydeand when the air sampling continued to be negative the unitwas then re-opened.     

Recent Advances in the Treatment of Common Intestinal Helminths

The major symptomatology produced by common intestinal helminths in the United States is reviewed. Worm eradication is required only for helminths of high pathogenic potential, i.e. worms which may produce disease when present singly or in small numbers or worms which can multiply in man. Other helminths are appropriately treated for relief of symptoms or reduction in parasite transmission; in these cases reduction in worm burden rather than eradication is an appropriate therapeutic goal. Current therapy and new drugs are compared. Major recent advances include mebendazole for trichuriasis, niclosamide for tapeworms and possibly bithionol for fascioliasis.     

Hepatitis C virus infection in non-Hodgkin‘s lymphoma

Hepatitis C virus (HCV) infection is associated with immune-complex mediated disorders, including Type II mixed cryoglobulinaemia. Mixed cryoglobulinaemia is itself a low-grade B-cell lymphoproliferative disorder which may progress to non-Hodgkin‘s lymphoma (NHL). Studies from Europe and Asia have found a prevalence of hepatitis C virus infection in non-Hodgkin‘s lymphoma patients as high as 34%. Other viral infections are also associated with non-Hodgkin‘s lymphoma. We speculated that non-Hodgkin‘s lymphoma patients in the midwestern USA would have an increased prevalence of hepatitis C infection. We tested 73 patients with NHL and 20 controls with Hodgkin‘s disease for anti-HCV antibodies by EIA-2. Only 1/73 patients and no control subject was positive for anti-HCV. The anti-HCV positive patient had no identifiable risk factors for hepatitis C, and ALT was persistently normal. HCV-RNA testing by RT-PCR was negative. Thus, none of 73 non-Hodgkin‘s lymphoma patients could be confirmed to have hepatitis C infection. In a second part of the study, of 438 patients with HCV infection followed an average of 28.1 months, only one patient developed non-Hodgkin‘s lymphoma. We conclude that in our population, non-Hodgkin‘s lymphoma is not associated with hepatitis C virus infection. Based on these results and review of the literature, there are marked regional differences in the prevalence of hepatitis C infection in Non-Hodgkin‘s lymphoma.     

Different effects of short- and long-term dietary choline-deficiency on hepatic microsomal phospholipids and drug oxidation

Prolonged administration of a choline-deficient diet to male rats results in the development of hepatic cirrhosis and alterations in oxidative drug metabolism. The present study was designed to assess whether the changes in drug metabolism were related to the development of cirrhosis or merely to the effects of choline-deficiency on hepatic microsomal lipid composition. Male rats were given a synthetic choline-deficient diet for either 1 week (short-term) or 30 weeks (long-term), and results at each time were compared with age-matched control rats given the same diet but with supplementary choline.
After both 1 week and 30 weeks of the choline-deficient dietary regimen, the proportion of microsomal phospholipid present as phosphatidylcholine was significantly decreased, and that present as phosphatidylethanolamine was significantly increased, compared with appropriate controls. However, microsomal cholesterol content (per mg of microsomal protein) was not significantly changed at either time. Cytochrome P-450 levels and the turnover of ethylmorphine N -demethylase (enzyme activity/nmol cytochrome P-450) were significantly reduced in the cirrhotic (30 week) model whereas short-term intake of the diet did not alter the levels of cither enzyme. These findings suggest that the effects of changes in phosphatidylcholine and phosphatidylethanolamine levels in choline-deficiency cirrhosis have minimal importance with respect to changes in drug oxidation. Instead, altered regulation of specific cytochrome P-450 isozymes appears to be the principal cause of impaired oxidation.     

Influence of biofilm formation in the susceptibility of Pseudomonas aeruginosa from Brazilian patients with cystic fibrosis

Ferreira AG, Leão RS, Carvalho‐Assef APD, Folescu TW, Barth AL, Marques EA. Influence of biofilm formation in the susceptibility of Pseudomonas aeruginosa from Brazilian patients with cystic fibrosis. APMIS 2010; 118: 606–12. Biofilms play a key role in the occurrence of lung infections by Pseudomonas aeruginosa in patients with cystic fibrosis (CF). In this study, we examined 40 isolates of P. aeruginosa from CF patients according to their capacity to form biofilm. We also compared their in vitro response to antimicrobials according to different modes of growth (planktonic vs biofilm) and performed molecular typing. All isolates proved capable of forming biofilm. However, there was no difference in biofilm development according to the mucoid and nonmucoid phenotypes and among isolates obtained at different periods of the chronic infection. All isolates tested for antimicrobial susceptibility in the biofilm state (BIC) were consistently more resistant to antibiotics than the same isolate tested in the planktonic state. The molecular typing indicates a considerable clonal diversity among isolates. We identified five patients harboring the same strain over different periods. These strains, however, displayed different levels of biofilm formation and BIC values for antibiotics tested. The results of the present study demonstrate that there is a marked difference in the susceptibility profile according to the mode of growth of CF P. aeruginosa, as cells tested in the biofilm state proved consistently more resistant to antibiotics.