Surveillance of foodborne infections— the role of the Communicable Disease Surveillance Centre

The paper describes the work of the Public Health Laboratory Service, popularly referred to as “Colindale”, and reviews the types of infection which are commonly food or waterborne and their relative importance. Cholera, typhoid and paratyphoid are rare diseases usually acquired abroad. Bovine tuberculosis, brucellosis and foodborne helmenthiasis have been almost eliminated as indigenous diseases. However, salmonellosis and Campylobacter enteritis are increasing. The increase has not been satisfactorily explained but is probably due to bovine and poultry infections. Although most notified food poisoning incidents are due to salmonella, a number of other organisms have been implicated, the cause being defective food hygiene. Viral foodborne diseases, including hepatitis A, have been associated mainly with shellfish. The incidence of new foodborne infections may be increasing.     

Psychological status of men with haemophilia and HIV infection: two-year follow-up

This study aimed to assess the psychological status of men with haemophilia and HIV infection and to monitor changes in psychlogical status over time, in order to evaluate the need for psychological support. The study included 24 HIV seropositive men and a control group of 21 HIV seronegative men who attended the Haemophilia Centre in Bari (Italy). Subjects underwent psychological tests (STAl-Y: State and Trait Anxiety Inventory; SDS: Self-Rating Depression Scale) and completed a questionnaire on the emotional impact of AIDS. Assessment was repeated at 6-monthly intervals over a 2-year period. Contrary to expectation, HIV seronegative men with haemophilia had worse anxiety and depression scores, reported more confusion and fear, and had more reluctance towards the use of blood products (despite their present safety) than HIV seropositives. Possible reasons for these findings are considered, and their implications for clinical practice discussed.     

THE ROLE OF VASCULAR ENDOTHELIAL GROWTH FACTOR IN A MURINE CHRONIC GRANULOMATOUS TISSUE AIR POUCH MODEL OF ANGIOGENESIS

Chronic granulomatous inflammation may be considered an angiogenic-dependent process. Recently it has been demonstrated that vascular endothelial growth factor (VEGF) or vascular permeability factor is essential for tumour angiogenesis. Its role in inflammation-mediated angiogenesis has yet to be determined. In this study, the murine chronic granulomatous air pouch model was used to investigate the role of VEGF in angiogenesis. Animals were treated twice weekly with 10 μ g per animal of neutralizing antibody to rh VEGF and the vascularity and granuloma dry weight were assessed after 7 days. This resulted in significant suppression of both angiogenesis and granuloma dry weight. Western blot analysis demonstrated the presence of VEGF; the levels of protein paralleled the angiogenic response. These results demonstrate for the first time that VEGF may be an important regulator of angiogenesis in inflammation.     

A double-blind assessment of additive intolerance in children using a 12 day challenge period at home

Alleged food-additive intolerance (respiratory, dermatological, behavioural or abdominal) was assessed in 19 children using daily challenge drinks of either, base product alone, base product plus sunset yellow/tartrazine, or base product plus sodium metabisulphite/sodium benzoate. The same type of drink was given for 12 days, double-blind and in random order. During the trial the children were maintained on an additive-free diet under supervision. Diary cards were used to record symptoms and medication usage. If there was an apparent association between symptoms and drink ingredient the trial was repeated, again double-blind. Additive intolerance was confirmed by a consistent deterioration of symptoms in only three children. In one, urticaria was induced by the colourings, in another extremely abnormal behaviour was induced by the preservatives and a third child was only free of asthma and abdominal pain on placebo. This form of individual trial, using 12 daily drinks, overcomes some of the objections to a single challenge study. Despite this, intolerance to the additives was only confirmed in 3/19 children in whom it had been believed to occur.     

High Energy Transcatheter Cardioversion for Chronic, Poorly Tolerated Atrial Fibrillation

Between August 1991 and May 1993, 14 patients affected by chronic, poorly tolerated atrial fibrillation (AF) were submitted to high energy transcatheter Cardioversion. Mean duration of AF was 27.4 ± 45.1 months. In nine patients (56%), AF lasted for > 1 year. All patients had underlying heart disease, with a mean LVEF of 45.2%± 11.8% and a NYHA Class ≥ II. Previously, a mean of 2.9 ± 1.3 patients failed external electrical Cardioversion, with and without antiarrhythmics, have been attempted. Transcatheter conversion was performed by pulling the His-bundle catheter back in the right atrial cavity until no His bundle activity was recorded on distal poles, and then delivering the shock between a proximal electrode (cathode) and a back plate (anode). In all patients, transcatheter conversion restored sinus rhythm. Transient complete atrioventricular (AV) block was observed in four patients (28%), and treated by prophylactic temporary pacing. At 1 year, seven patients (50%) were still in sinus rhythm. In this series, only younger age could be related to AF recurrence (46.1 ± 10.8 vs 63.4 ± 6.8 years, P ≤ 0.004), even if prophylaxis with amiodarone showed a positive trend versus sinus rhythm maintenance (71 % vs 14%, P = NS). In conclusion, high energy transcatheter Cardioversion is a safe and effective method of restoring sinus rhythm in patients with chronic, poorly tolerated AF. In these patients, high energy transcatheter Cardioversion could be considered as an alternative to AV node ablation techniques, avoiding pacemaker implant and embolic risk. Larger studies are needed to determine better patient selection and delineate drug strategy after the procedure.