In vitro dermal absorption of methyl salicylate, ethyl parathion, and malathion: first responder safety

In vitro tests with fresh dermatomed (0.3 to 0.4 mm thick) female breast skin and one leg skin specimen were conducted in Bronaugh flow-through Teflon diffusion cells with three chemicals used to simulate chemical warfare agents: 14C-radiolabeled methyl salicylate (MES), ethyl parathion (PT), and malathion (MT), at three dose levels (2, 20, and 200 mM). Tests were conducted at a skin temperature of 29 degrees C using a brief 30-min exposure to the chemical and a 6.5-h receivor collection period. Rapid absorption of all three chemicals was observed, with MES absorbed about 10-fold faster than PT and MT. For MES, PT, and MT, respectively, there was 32%, 7%, and 12% absorption into the receivor solution (Hank's HEPES buffered saline with 4% bovine serum albumin [BSA], pH 7.4) at the low dose (2 mM), 17%, 2%, and 3% at the medium dose (20 mM), and 11%, 1%, and 1% at the high dose (200 mM) levels. Including the skin depot for MES, PT, and MT, respectively, there was 40%, 41%, and 21% (low dose), 26%, 16%, and 8% (medium dose), and 13%, 19%, and 10% (high does) absorption. Efficacy of skin soap washing conducted at the 30 min exposure time ranged from 31% to 86%, varying by chemical and dose level. Skin depot levels were highest for the relatively lipophilic PT. "Pseudo" skin permeability coefficient (K(p)) data declined with dose level, suggesting skin saturation had occurred. An in-depth comparison with literature data was conducted and risk assessment of first responder exposure was briefly considered.     

Treatment of chronic myeloid leukemia in the imatinib era: perspective from a developing country

BACKGROUND: There is paucity of data from developing countries on the efficacy and safety of imatinib mesylate in chronic myeloid leukemia (CML). The primary objective of this study was to document complete and partial cytogenetic responses to imatinib in all phases of CML. Secondary objectives included evaluations of complete hematologic response, safety, time to progression, and survival. METHODS: Two hundred seventy-five patients in all phases of CML who received treatment with imatinib from January 2001 to December 2005 were included in the study. All patients had on bone marrow or BCR-ABL positive in peripheral blood by polymerase chain reaction. RESULTS: After a median follow-up of 18 months, major cytogenetic responses (Ph <35%) in chronic phase (CP), accelerated phase (AP), and blastic phase (BP) were documented in 61%, 57%, and 28% of patients, respectively. A complete cytogenetic response was observed in 39.4%, 35.7%, and 14.3% of patients in CP, AP, and BP, respectively; and a complete hematologic response was observed in 90%, 86%, and 30%, respectively. The median time to progression at 18 months was 91% in CP and 68% in AP. The overall survivals in CP, AP, and BP at 18 months was 92%, 74%, and 38%, respectively. CONCLUSIONS: Impressive hematologic, cytogenetic, and molecular responses to imatinib were observed, similar to the responses reported in patients from Western countries. Patients had good compliance, toxicity was limited, and overall quality of life was improved markedly. The results indicated that the biology of CML is not different in patients from developing countries.     

Evaluation of coexistence of the Human Herpesvirus type 8 (HHV‐8) infection and pemphigus

Background Human Herpesvirus type 8 (HHV‐8) is a new member of the herpes virus family, first found in the tissue of acquired immune deficiency syndrome (AIDS)‐related Kaposi’s sarcoma. Environmental factors including viral infection may play a role in the onset and/or development of pemphigus. Some studies based on polymerase chain reaction findings suggest an association between HHV‐8 and pemphigus. The aim of this study is investigation of the association of pemphigus with HHV‐8 and the relationship between inflammatory and acantholytic cells with HHV‐8 infection. Methods Tissue‐extracted DNA from 41 paraffin‐embedded skin tissues from patients first presenting with pemphigus was tested using nested PCR for the presence of HHV‐8. A total of 37 cases had pemphigus vulgaris (PV) and 4 patients had pemphigus foliaceus (PF). For our control group, normal skin of 21 cosmetic surgery patients were included. Furthermore, microscopic slides with H&E staining were evaluated for the number of inflammatory and acantholytic cells per microscopic field. Results Skin lesions from 13 of 37 patients (35.1%) with PV and 2 of 4 cases (50%) with PF were positive for HHV‐8 DNA. All specimens in our control group were negative for this virus. Conclusion HHV‐8 infection might be a contributing factor in the initiation or development of pemphigus.     

Early spica cast for fracture shaft of femur in children: the north of Jordan experience

This is a case series study that was conducted to assess the findings and usefulness of early spica in children less than 10 years of age. Forty patients less than 10 years of age with femoral shaft fractures were treated by early hip spica between 2000 and 2005 and were followed up for 6 months. The setting was a public university hospital and a public university-affiliated hospital in the north of Jordan. Ultimate shortening of the affected limb of ≥2 cm was observed in those patients with an overlap between fragments of ≥2 cm in the first post-spica X-ray. One case of significant angulation and no cases of rotation deformities were observed. It is concluded that early spica cast in children under the age of 10 is an effective treatment modality. Only in the presence of overlap of ≥2 cm between fragments in the first post-spica X-ray, there would be a chance of ultimate shortening of the affected limb by ≥2 cm. Children aged ≥6 are more liable to develop leg shortening.     

Prevalence of Comorbid Mental Illness and Drug Use Recorded in General Practice: preliminary findings from the General Practice Research Database

Preliminary analysis of a large UK general practice database was conducted in order to determine the prevalence of mentally ill patients in primary care who are also diagnosed with a drug abuse problem and vice versa. The baseline population was 527,000 of whom 1308 patients (prevalence 0.25%) were diagnosed with a drug abuse problem; 59,359 patients suffered a mental illness (11.26%) between 1993 and 1997. Comorbidity was defined by diagnoses of mental illness and drug abuse at any time between 1993 and 1997 (i.e. not necessarily simultaneously): 621 (0.12%) patients were found to be comorbid according to this definition. Neurosis was the most common condition for both mentally ill and drug-abusing patients. Drug abusers were found to have higher rates of psychosis, schizophrenia, paranoia and personality disorders than those with only a mental illness. However, little difference was observed in the prevalence of these conditions between those classed as drug addicts and non-addicts. These findings show that those regarded as non-dependent suffer from mental illness to the same extent as those who are addicted or dependent on drugs. This raises issues regarding service and treatment provision, as emphasis is usually placed on treating the addicted. Future analysis will concentrate on elucidating the time relationships in order to determine possible patterns of causality.     

Nerve conduction studies and its importance in diagnosis of acute poliomyelitis

Motor nerve conduction velocities was performed on 50 subjects in the pediatric age group. Thirty two patients with acute poliomyelitis and 18 controls. The MNCV was studied in the median nerve in the upper limb and the posterior tibial in the lower limb. The motor nerve conduction velocity in polio patients matched well with the controls, as well as within the accepted standards for normal. The MNCV of the median nerve ranged from 41.8±2.76 m/sec in under 1 year to 44±2.1 m/sec in 3–8 years, in polio patients, while the range in controls varied from 37 to 53 m/sec. Similarly, for the posterior tibial nerve, in polio patients the value of MNCV varied from 38.7±4.9 m/sec to 42.5±3.1 m/sec. In the controls, also the MNCV ranged from 38.5±6.3 m/sec to 48.4±3.42 m/sec. Thus, no delay on the motor nerve conduction velocity was seen. Poliomyelitis is a major problem in developing countries like Pakistan and India, where serological diagnosis is a luxury. The determination of motor nerve conduction velocity provides a quick and easy method of distinguishing poliomyelitis from other motor nerve disorders esp. Guillian Barre syndrome.     

The Disclosure Process and its Impact on South Asian Families with a Child with Severe Intellectual Disabilities

Background Although several research studies have investigated parental experiences of the disclosure process in White families with a child with severe disabilities, little work has focused on the experiences of South Asian families. Materials and methods This study aimed to provide a rich picture of the disclosure experiences of South Asian parents of a child with severe intellectual disabilities, using semi‐structured qualitative interviews with 26 parents over two time points, and structured quantitative interviews with 136 parents. Results Parents reported variable experiences of the disclosure process, with many parents experiencing disclosure in the wrong language for them and most parents reporting little post‐disclosure support. Parents identified good practice in disclosure as prompt disclosure in the appropriate language, with the partner present (where possible), with emotional support as part of the process, with clear and practical information, and linked to post‐disclosure support from a keyworker. Conclusions Good practice in disclosure was also associated with parental understanding of their child, and parents being more likely to mobilize informal and formal supports. The implications of these findings are discussed.