<Emphasis Type="Italic">Setaria tundra</Emphasis> microfilariae in reindeer and other cervids in Finland

Harmful parasites of the wild northern boreal mammals are still surprisingly poorly studied. In 2003-2006, a peritonitis outbreak caused by the filarioid nematode, Setaria tundra, emerged in Finland's reindeer population. In order to gain knowledge about the basic biology, epidemiology, and transmission dynamics of this parasite, samples for S. tundra were collected from reindeer and other cervids during the follow-up period 2004-2006. Using morphology and molecular biology methods, we describe here S. tundra's first larval stage, microfilaria (smf), for the first time scientifically. The prevalence and densities of smf were higher in reindeer calves than in adults, overall prevalence being 42%. The overall smf prevalences for moose, wild forest reindeer and roe deer were 1.4-1.8%, 23%, and 39%, respectively. The focus of microfilaremia moved north and settled down in the south simultaneously with the peritonitis outbreak. The peak microfilaremia occurred in the first summer after the infection, and smf disappeared from the blood after 2 years. Captive reindeer were smf positive over the year. The prepatent period of S. tundra was estimated to be about 4 months, and the life span at least 14 months. This parasite likely has an important impact on boreal ecosystems.     

生活方式改善对预防糖尿病的重要作用

营养过剩、肥胖．缺少运动是糖尿病发病的重要原因。本文针对这些原因阐述了防止肥胖、控制饮食和增加运动等生活方式的改善对预防糖尿病的重要作用。     

呼和浩特市区餐饮单位的餐具消毒效果

目的了解呼和浩特市餐饮单位餐具消毒状况,分析不同规模餐饮单位餐具消毒效果。方法采用大肠菌群快速检测纸片法,抽取2005-2007年本市餐饮单位消毒后备用餐具进行检测。结果3年共检测餐具7957份,合格率为64.28％;大、中、小型餐饮单位合格率分别为74.59％、65.32％和36.33％;大中专院校食堂合格率为68.21％。结论呼和浩特市餐具消毒总体合格率较低,应加大执法力度,加强监测频率,尤其要督促搞好学校食堂餐具消毒工作。     

Management of resistant halo nevi

Background: Halo nevus (HN) is a rare dermatologic disorder characterized by typical whitish rim surrounding an existing melanocytic nevus resembling halo. It is a cosmetic problem that may be linked to vitiligo, and it is advised to remove these nevi in order to avoid development of vitiligo.

Objectives: The aim of the present study is to evaluate the cosmetic outcome after nevus removal and leukoderma dermabrasion with epithelial graft followed by narrow-band ultraviolet B (NB-UVB) phototherapy as management of resistant halo nevi and avoidance of development of vitiligo.

Patients and Methods: Ten patients with persisting halo nevi were selected as candidates in this study. Superficial dermabrasion was carried out using proper diamond fraises on depigmented rim and then punch biopsy probes with suitable size were used to harvest the nevus. Thiersch graft was prepared and applied on the dermabraded depigmented area. After 1 week of the procedure, patients were exposed to NB-UVB twice weekly and were followed up for 3 months.

Results: Repigmentation was noticed in 2 weeks and was nearly fully accomplished in all 10 patients within the 3-month period. No other vitiligo lesions developed during this period in all patients except for one case.

Conclusion: Excision of Sutton’s nevus with combined dermabrasion and Thiersch grafting followed by phototherapy is a good aesthetic maneuver in treating halo nevi and helps in avoiding further vitiligo depigmentation.     

The quality of electronic patient records in Finnish primary healthcare needs to be improved

Objective

To analyse the technical quality of electronic patient records in relation to legislation and to evaluate their quality associated with the quality of consultations as rated by patients and GPs.

Design

Cross-sectional study of electronic patient records.

Setting

Four primary healthcare (PHC) centres in Finland using three different electronic patient record systems.

Subjects

Patient records of 175 PHC consultations by 50 GPs, rated as the best (n=86) and the worst (n=89) of a total of 2191 consultations.

Main outcome measures

Documentation of records compared with legislation, the general informative value of records, and its relation to the experienced quality of consultations and to the electronic system employed.

Results

Reason for encounter was mentioned in 79% of cases and patient history in 32%. An acute problem was described moderately well or well in 84%, examination findings in 62%, medical problem or diagnosis in 90%, and treatment in 95% of cases. Medication was documented adequately in 38% of the cases where medication was documented. Concerning general informative value, 18% were assessed as poor, 62% as moderate, and 20% as good. No correspondence was found between experienced quality of consultation and general informative value in the patient records. The quality of patient records was found to change according to the electronic system employed.

Conclusions

Finnish patient records are inadequate documents of consultations and below the standard of that country''s legislation. Developing better models of recording would guarantee a higher quality of work.     

Case mix measures and diagnosis-related groups: opportunities and threats for inpatient dermatology

OBJECTIVE: The changing healthcare environment world-wide is leading to extensive use of per case payment systems based on diagnosis-related groups (DRG). The aim of this study was to examine the impact of application of different DRG systems used in the German healthcare system. METHODS: We retrospectively analysed 2334 clinical data sets of inpatients discharged from an academic dermatological inpatient unit in 2003. Data were regarded as providing high coding quality in compliance with the diagnosis and procedure classifications as well as coding standards. The application of the Australian AR-DRG version 4.1, the German G-DRG version 1.0, and the German G-DRG version 2004 was considered in detail. To evaluate more specific aspects, data were broken down into 11 groups based on the principle diagnosis. MAIN OUTCOME MEASURE: DRG cost weights and case mix index were used to compare coverage of inpatient dermatological services. Economic impacts were illustrated by case mix volumes and calculation of DRG payments. RESULTS: Case mix index results and the pending prospective revenues vary tremendously from the application of one or another of the DRG systems. The G-DRG version 2004 provides increased levels of case mix index that encourages, in particular, medical dermatology. CONCLUSIONS: The AR-DRG version 4.1 and the first German DRG version 1.0 appear to be less suitable to adequately cover inpatient dermatology. The G-DRG version 2004 has been greatly improved, probably due to proceeding calculation standards and DRG adjustments. The future of inpatient dermatology is subject to appropriate depiction of well-established treatment standards.     

Increased infection mortality and decreased neutrophil migration due to a component of an artificial blood substitute

We previously showed that an artificial blood substitute containing perfluorocarbons, Fluosol-DA, inhibited both neutrophil migration and adherence, due to its detergent component, Pluronic F-68. The purpose of the studies we report here was to determine if Fluosol or Pluronic might also reduce in vivo neutrophil migration and impair host resistance to bacterial infection. We studied in vivo PMN migration by injecting mice intraperitoneally (IP) with glycogen, followed by intravenous (IV) infusion of saline, Fluosol, or Pluronic. Peritoneal lavage after eight hours showed a significant decrease in the accumulation of PMN in lavage fluids of animals given either Fluosol or Pluronic (control--.19 +/- .03 X 10(6) PMN/mL, glycogen--1.35 +/- .14; glycogen/Fluosol--0.63 +/- .12; glycogen/Pluronic--0.69 +/- .07). We ascertained the effect of Fluosol and Pluronic on infection mortality by injecting mice IV with saline, Fluosol, or Pluronic, followed by a quantity of E coli (0.6 X 10(7] IP shown in preliminary studies to kill 20% to 50% of the mice in 24 hours. The 24-hour mortality was 14/45- saline, 24/32-Fluosol (chi 2 = 17.1; P less than .001) and 17/23 - Pluronic (chi = 11.2; P less than .001). Neither Fluosol nor Pluronic caused mortality without E coli. The increase in infection mortality occurred when Fluosol was given either two hours before, or simultaneously with E coli, but only with the simultaneous administration of bacteria and Pluronic. Pluronic did not alter reticuloendothelial system (RES) clearance function. These studies indicate that, in an animal model, Fluosol-DA, due to its detergent component Pluronic F-68, impaired neutrophil delivery to an inflammatory locus, and resulted in an increased rate of infection mortality. Since Pluronic did not result in RES blockade, but did impair the delivery of PMN to an inflammatory locus, our results suggest that the latter effect is responsible for the increase in infection mortality.