Comparison of patch test results among white Europeans and patients from the Indian subcontinent living within the same community

Background There are few studies comparing the incidence of allergic contact dermatitis among different racial groups living within the same community. Objectives The objectives of this study were to compare white European patients with Fitzpatrick's skin phototypes (FSP) I to IV and patients from Indian, Pakistan and Bangladesh with FSP V living within the same community. Referral rates for patch testing, incidence of contact allergies and differences in contact allergens found were assessed. Method All patients referred to the Contact Dermatitis Unit at Dewsbury and District Hospital between 2004 and 2006, inclusive, were included in the study. All patients were patch tested to the British Contact Dermatitis Society standard series, plus other series according to their clinical history, occupational history and clinical findings. Results Four hundred and thirty‐five consecutive patients from the patch testing clinic were included in the study. Fewer patients from the Indian subcontinent underwent patch testing (11.5%) than would have been expected for the size of the local population (18%). Fewer patients from the Indian subcontinent (44%) had one or more positive reactions compared with the white European patients (56%). No significant differences in the contact allergens responsible were detected between the two racial groups. Conclusion There is a lower incidence of positive patch test results among patients with racial origins from the Indian subcontinent compared with white Europeans. This modest difference could be explained by a lower average age within the study population, and increased or differing exposure to contact allergens rather than demonstration of variability in the susceptibility to develop contact sensitivities following equal exposure.     

Sun Protection Policies and Practices at Child Care Centers in Massachusetts

We assessed the relationship between sun protection policies and practices at child care centers in Massachusetts. We hypothesized that centers with sun protection policies were more likely to have regular sun protection practices in place compared to centers without these policies. We conducted a telephone survey with directors or assistant directors at 327 child care centers during the summer of 2002. The main outcome measure was sun protection practices, which included time spent outside during mid-day and the use of sunscreen, hats, and protective clothing by the majority of children assessed over the last 5 program days. The 36-item survey also inquired about the center’s sun protection policy and included demographic questions. Most centers (73%) reported having a written sun protection policy. Sun protection policies were positively associated with reported sunscreen (χ²=14.63, p = 0.0001) and hat use (χ²=30.98, p < 0.0001) and inversely associated with time outside (χ²=10.76, p = 0.001). Seventy-seven percent of centers followed recommended sunscreen practices. However, centers were far less likely to have recommended hat use (36%) and protective clothing (1.5%) practices. A formal sun protection policy may be an effective way to increase sun protection practices in the child care setting. Further research should assess this relationship in other states. Improving and expanding existing state regulations may be a reasonable strategy to increase sun protection at child care centers. Stacey A. Kenfield is a doctoral candidate in the Epidemiology Department, Harvard School of Public Health, Boston, MA; Alan C. Geller is Research Associate Professor in the Department of Dermatology at the Boston University School of Medicine, Boston, MA; Elizabeth M. Richter is Cancer Prevention and Control Director, Bureau of Family and Community Health, Massachusetts Department of Public Health, Boston, MA; Steve Shuman is Health Specialist for ACF Region 1 Head Start Quality Initiative, Boston, MA; David O’Riordan is Assistant Professor at the Cancer Research Center of Hawaii, University of Hawaii, Honolulu, HI; Howard K. Koh is Harvey V. Fineberg Professor of the Practice of Public Health, Division of Public Health Practice, Harvard School of Public Health, Boston, MA; Graham A. Colditz is Professor of Medicine at Harvard Medical School, Boston, MA.     

Idiopathic myelofibrosis: dental treatment considerations

Idiopathic myelofibrosis is a myeloproliferative disorder of unknown origin. The bone marrow becomes fibrotic with an associated decrease in hematopoiesis resulting in anemia, bleeding problems, splenomegaly, and other secondary abnormalities. Although idiopathic myelofibrosis is usually diagnosed in middle age, there have been a few reports of the disorder in the pediatric population. This case report documents dental treatment considerations in a 6-year-old female with idiopathic myelofibrosis, severe anemia, and abnormal blood coagulation studies. The patient was successfully treated in a hospital after medical consultation, transfusion of packed red blood cells, and administration of prophylactic antibiotics. Local hemostatic measures following multiple extractions of carious teeth controlled bleeding. No postoperative sequelae occurred.     

Focal MRI findings in early SSPE

Many investigators have identified localized cortical involvement in subacute sclerosing panencephalitis (SSPE) by clinical and electrophysiologic criteria. Some investigators have reported such abnormalities in the posterior cerebrum early in the course of the disease, but without radiologic correlation. Recently, magnetic resonance imaging has been used to follow the progression of SSPE. The largest reported study of SSPE utilizing magnetic resonance imaging indicated that focal abnormalities were distinctly rare and actually mitigated against the diagnosis of SSPE. We report an SSPE patient with focal cerebral dysfunction and magnetic resonance imaging evidence of distinctly focal inflammatory disease early in the course of the illness.     

Prognostic factors for relapse after complete response in patients with metastatic germ cell tumors

Among 216 patients with metastatic germ cell tumors who achieved a complete response (CR) to cisplatin-based chemotherapy (CT), 38 have experienced a relapse. Prognostic factors for time to relapse from time of response were considered using the Cox proportional hazards model. Compared with patients who responded to CT and did not require surgery and patients whose surgery showed only either necrotic debris or mature teratoma, those who required surgery for residual tumor after CT were at much higher risk for relapse, although their residual tumor was totally resected. Of the 19 patients who required this surgery, eight have experienced a relapse. Other prognostic factors for relapse included lactate dehydrogenase (LDH) and human chorionic gonadatropin (hCG) at the time of initial CT. Although those who require surgery for residual tumor after CT receive additional CT, there is still a high risk of relapse.     

Use of synthetic oligonucleotides in the characterization of antithrombin III Northwick Park (393 CGT----TGT) and antithrombin III Glasgow (393 CGT----CAT)

Antithrombin III (ATIII) Northwick Park is caused by a single amino acid substitution, Arg 393---Cys and antithrombin III Glasgow is caused by Arg 393----His. Examination of the genetic code and the sequence of normal antithrombin III revealed that these amino acid substitutions could arise from the substitution of either two nucleotides or a single nucleotide at codon 393 of the antithrombin III gene. In two families, detection of the ATIII variants by genetic linkage analysis was not possible owing to lack of informative RFLP markers. Consequently, we synthesized two 22-base-long oligonucleotides specific for the single- base substitutions in the region of codon 393 and demonstrated by oligonucleotide hybridization that the molecular defect of ATIII Northwick Park is caused by the CGT----TGT mutation at codon 393 and that ATIII Glasgow is caused by the CGT----CAT mutation at codon 393. These oligonucleotide probes should prove useful as an alternative method for early detection of the ATIII variants.     

Intravenous fluids in minor gynaecological surgery. Their effect on postoperative morbidity

Postoperative morbidity was assessed in 100 patients who underwent minor gynaecological procedures. Fifty patients received intra-operative crystalloid (1000 ml compound sodium lactate solution) and the remaining fifty none. Identical short-acting intravenous anaesthetic techniques were used in both groups. There was no statistically significant difference between the groups in symptoms of nausea, vomiting, headache and drowsiness within the first 6 hours after operation. Patients who received intra-operative fluids exhibited a decreased incidence of dizziness within the first 6 hours and a decreased incidence of nausea when questioned at 3 days compared with those who did not receive any fluid; the difference was statistically significant.