Biomedical subjects
Publications and source records attributed to J H Olafsson.
A simple Gram stain evaluation for the diagnosis of bacterial vaginosis was assessed in comparison to Nugent's method. The sensitivity (90%), specificity (94%), positive and negative predictive values (90% and 94%), and good interobserver agreement obtained indicate that the test method can be performed reliably in the routine clinical microbiology laboratory.
Combination therapy is one way of improving the cure rate of onychomycosis. The LION Study examined the efficacies of terbinafine and itraconazole. The Icelandic cohort of the study reported that after 5 years only 46% of the terbinafine-treated patients and 13% of the itraconazole-treated patients were still disease-free, suggesting that relapses and reinfections were common in the long term treatment of onychomycosis with monotherapy. Combination therapy is a well-established principle in mycology; the current strategy involves the combination of oral and topical antifungal treatments. A number of specific drug combinations have proved to be useful in the treatment of onychomycosis: tioconazole and griseofulvin, amorolfine and griseofulvin, amorolfine and terbinafine, and amorolfine and itraconazole. However, comparison of the combination trials can be difficult because of the short duration of some of the studies and variation in global cure rates. Although it is necessary to consider these factors it is clear that combination therapy offers advantages when compared with monotherapy. Combination therapy can be administered sequentially or in parallel. Parallel therapy is recommended for patients who are likely to fail therapy (e.g. patients with diabetes), whereas sequential therapy is recommended for patients who show a poor response to initial treatment.
Occupational skin diseases are among the most frequent work-related diseases in industrialized countries. Good occupational skin disease statistics exist in few countries. Questionnaire studies are needed to get more data on the epidemiology of occupational skin diseases. The Nordic Occupational Skin Questionnaire Group has developed a new questionnaire tool - Nordic Occupational Skin Questionnaire (NOSQ-2002) - for surveys on work-related skin disease and exposures to environmental factors. The 2 NOSQ-2002 questionnaires have been compiled by using existing questionnaires and experience. NOSQ-2002/SHORT is a ready-to-use 4-page questionnaire for screening and monitoring occupational skin diseases, e.g. in a population or workplace. All the questions in the short questionnaire (NOSQ-2002/SHORT) are included in the long version, NOSQ-2002/LONG, which contains a pool of questions to be chosen according to research needs and tailored to specific populations. The NOSQ-2002 report includes, in addition to the questionnaires, a comprehensive manual for researchers on planning and conducting a questionnaire survey on hand eczema and relevant exposures. NOSQ-2002 questionnaires have been compiled in English and translated into Danish, Swedish, Finnish and Icelandic. The use of NOSQ-2002 will benefit research on occupational skin diseases by providing more standardized data, which can be compared between studies and countries.
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OBJECTIVE: To evaluate two automated amplification systems for the detection of Chlamydia trachomatis in urogenital specimens, the Cobas Amplicor (Roche Diagnostic Systems, Branchburg, NJ) and the LCx (Abbott Laboratories, Abbott Park, IL). STUDY DESIGN: The two systems were compared testing specimens from 302 high-risk patients, including 98 female cervical swab specimens and 204 male urine specimens. The patients attended the state STD clinic in Reykjavik, Iceland, either because of symptoms or as a result of contract tracing. RESULTS: The prevalence of C. trachomatis infection was 15.3% in women and 13.2% in men. For the male urine specimens, the sensitivity and specificity were 100% and 99.4% for the Cobas Amplicor and 74.1% and 100% for the LCx. In the cervical swabs, both systems detected all 15 true-positive specimens. The internal control used with the Cobas Amplicor detected inhibition in 2% of the male urine and 20% female cervical swabs, respectively. CONCLUSION: The Cobas Amplicor demonstrated slightly better sensitivity than LCx in male urine specimens. Both systems offer the benefits of automation for routine diagnostic testing.
The treatment of onychomycosis has previously often been protracted and unsuccessful. Terbinafine has been shown to be effective in short-term regimens. In this double-blind, placebo-controlled study, 148 patients with toenail dermatophytosis were randomized to treatment with either 250 mg terbinafine daily or placebo for 3 months. An additional treatment was given for 3 months to patients whose infection had not responded. The patients were followed clinically and mycologically through 12 months. After 3 months 82% of the terbinafine-treated group, versus 5% of the placebo group, showed significant improvement, i.e. negative culture and growth of unaffected nail more than 2 mm (p = < 0.0001). After 12 months clinical and mycological cure was seen in 40% of the patients treated with terbinafine for 3 or 6 months, while 67-81% were clinically cured, but with positive microscopy. Side-effects occurred in 13.5% of the terbinafine group, versus 5.4% of the placebo group, and were mild. 250 mg terbinafine daily for 3 months was significantly more effective than placebo. The efficacy did not appear to improve with additional treatment for 3 months.
BACKGROUND: The prevalence and pattern of Chlamydia trachomatis infection among women requesting induced abortion in the three year period 1992-95 was evaluated and compared to the results of a previous study in 1982-84, where the prevalence of chlamydial infection had been 13.5%. METHODS: A total of 1995 women requested termination, 1855 (93%) of whom were tested for Chlamydia and were included in the study. Two types of tests for chlamydial infection, ELISA and PCR, were used in two consecutive periods. In addition cultures for gonorrhea were done in each case. Information on age, marital status, parity, gestational age and the results of chlamydia and gonorrhea tests of the women and sexual partners were recorded. RESULTS: Chlamydia trachomatis positive women were 149 (8.0%), a significant reduction from the previous 1982-84 study (p<0.001). Women with positive tests were significantly younger (80% < or = 25 years of age; p<0.001) and more frequently single (86.6%; p<0.001), than those with negative tests, as in the previous period. Of the partners, 80.4% were contacted, and 52.1% presented for investigation. Of those tested 42.1% were Chlamydia positive. Four women (0.2%) had Neisseria gonorrhea but none of the partners. CONCLUSIONS: The prevalence of Chlamydia trachomatis is receding among women coming for termination of pregnancy. As treatment before or at operation has repeatedly been shown to be of benefit and since the prevalence is still considerable, continued screening of these women is justified.
A mixture of glycerol monoethers was extracted from the liver oil of deep sea shark (Centroporus squamosus). It consisted mainly of monoethers of glycerol and linear monounsaturated octadecanol, and glycerol and linear monounsaturated hexadecanol. Only about 11% of the extract consisted of glycerol monoethers derived from linear saturated fatty alcohols. The glycerol monoether extract was somewhat less effective as skin penetration enhancer than oleic acid and other potent fatty acid penetration enhancers, but it was still a very effective enhancer in the hairless mouse skin model used in this study.
The effects of several marine lipids on the penetration of hydrocortisone and nitroglycerin through excised hairless mouse skin have been studied. Fatty acid extracts obtained by hydrolysis of Portuguese dog-fish-liver-oil or by hydrolysis of cod-liver-oil were shown to be effective skin penetration enhancers. Phospholipid obtained from squid was also shown to be effective enhancer. However, the enhancing effect of the marine products could generally be associated with their content of free unsaturated fatty acids. The fatty acid extract obtained from cod-liver-oil caused insignificant skin irritation when incorporated into an ointment base and applied to human skin.
Recently the polymerase chain reaction (PCR) has been shown to be more sensitive than older methods in detecting Chlamydia trachomatis, when performed on endocervical swabs. A total of 203 high-risk females were enrolled in a comparative study of 3 methods for diagnosing C. trachomatis infections: McCoy cell culture and Amplicor PCR on endocervical swabs, and urine. Thirty-four had positive cultures, 38 positive PCR from cervix and 37 had positive PCR on urine specimens. When discrepancy occurred, the leftover Amplicor specimen was retested by Roche with Amplicor and a primer for the major outer membrane protein (MOMP) gene. In all three tests, 32 were positive. The sensitivity of culture was 87%, 92% in cervical PCR and 95% in urinary PCR. The specificity was 100% in both culture and urinary PCR but 98% in cervical PCR. Amplicor PCR performed on female urine is at least as sensitive and specific as cell culture.
We have compared bathing in a thermal lagoon in Iceland, combined with UVB treatment, to UVB treatment only in an open comparative study. Twenty-three psoriasis patients bathed 3 times daily and were treated with UVB 5 times a week for 4 weeks. The control group was only treated with UVB 5 times a week for 4 weeks. Psoriasis Area and Severity Index (PSAI) was used to estimate the severity of the disease. The mean PASI score in the bathing group decreased from 20.8 to 2.8 (p < 0.01). In the control UVB group, the PASI score decreased from 16. 7 to 6.9. The percentage difference between the groups was significant after 1, 2, 2 and 4 weeks. Bathing in the lagoon combined with UVB was found to be a very effective treatment and better than UVB treatment in our control group.
A fully automated enzyme-linked fluorescent assay (ELFA) on the Vitek Immunodiagnostic Assay System (VIDAS CHL) was evaluated for the detection of chlamydial antigen in specimens from symptomatic and asymptomatic high-risk patients. The results were compared with those from McCoy cell culture and Chlamydiazyme with a blocking assay. False-positive VIDAS specimens were centrifuged and the pellet stained with direct fluorescent antibody (DFA). Of the 158 urine specimens, 52 (33%) were infected by Chlamydia trachomatis. The sensitivity and specificity of the VIDAS when compared with cell culture, DFA, and Chlamydiazyme were 75% and 96%, respectively, for urine specimens while the predictive value of a positive (PVP) and a negative (PVN) were 91% and 88%, respectively. Of the 245 urethral swabs, 75 (31%) were considered positive. The sensitivity and specificity were 71% and 92%, respectively, and the PVP and PVN were 80% and 87%, respectively. The sensitivity and specificity on the 108 cervical swabs, 22 of which were positive, were 95% and 95%, respectively, and PVP and PVN were 88% and 99%, respectively. Compared with Chlamydiazyme, the VIDAS was more sensitive on specimens from female patients and urine specimens, but less sensitive on urethral specimens from male patients.
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One hundred and eighty-two patients were enrolled in a randomized third-party blinded study to assess the efficacy and safety of azithromycin in the treatment of sexually transmitted diseases. Three regimens of azithromycin, including a single oral dose, were compared with a standard treatment with doxycycline. The patients were followed for four weeks. Efficacy was evaluated in 168 patients (113 azithromycin, 55 doxycycline). Fourteen patients had negative cultures or did not come for all follow-up visits. Of the 168, 138 were infected with Chlamydia trachomatis, 43 with Neisseria gonorrhoeae, and 45 with Ureaplasma urealyticum. Ninety-six per cent of patients with chlamydial infections and 92% of those with gonorrhoea were cured with azithromycin. Two patients infected with N. gonorrhoeae, four with C. trachomatis and six with U. urealyticum had positive cultures on follow-up visits after receiving azithromycin. Of these 11 patients with positive cultures on follow-up visits, seven (five with U. urealyticum and two with C. trachomatis) violated the protocol by having intercourse with infected individuals during the study. Azithromycin was very well tolerated; one patient complained of mild abdominal pain shortly after receiving the drug, seven patients complained of mild nausea and two patients had mild diarrhoea.
Chronic urticaria is a disease for which the available range of treatment modalities is limited. Ultraviolet radiation has recently been shown to affect histamine release from mast cells. We therefore studied the effects of PUVA and UVA on chronic urticaria. Nineteen patients took part in the study, which was designed as a randomized double-blind study. Eleven patients received PUVA, and 8 received UVA plus a placebo. In the PUVA group, 7 patients showed improvement, 3 noticed no change, and 1 became worse. In the group that received UVA plus placebo, 5 patients experienced an improvement, whereas the other 3 showed no change. The differences between the groups were not statistically significant. However, the probability of achieving this degree of improvement in both groups just by chance is less than 1%. Consequently, the improvement noted could have been due to either UVA alone or a placebo effect. It is concluded that PUVA is not better than UVA in the treatment of chronic urticaria.
The mast cell distribution and number were studied in skin biopsies of 18 mastocytosis patients and 10 controls. The biopsies were stained for mast cells with toluidine blue at pH 0.5. The number in the upper dermis of lesional abdominal skin was at least twice as high as that of normal adjacent skin. Fixation in iso-osmotic 0.6% formaldehyde and 0.5% acetic acid, revealed more mast cells than conventional 4% formaldehyde fixation. Staining for 5 days, when compared to the normal for 30 min, increased the number of demonstrable mast cells just as did the change in fixation. Conventional formaldehyde fixation thus partially blocks the dye-binding of cutaneous mast cells, about 20% of the cells escaping detection. The degree of aldehyde blocking was similar in lesional and normal skin. A more pronounced blocking of dye-binding has been demonstrated previously in gut mucosal mast cells. Whether the blocking of dye-binding is an expression of heterogeneity in dermal mast cells remains to be determined.
The bone marrow sections from five normal subjects and 18 patients with mastocytosis were examined to establish criteria to distinguish urticaria pigmentosa from systemic mastocytosis. Nine patients had increased numbers of mast cells in bone marrow sections stained with a long toluidine blue staining technique specific for mast cells, whereas five patients exhibited increased numbers of mast cells on May-Grünwald-Giemsa-stained smears of bone marrow. A positive correlation between the number of mast cells in sections of the bone marrow and the urinary excretion of the main histamine metabolite tele-methylimidazoleacetic acid was found. In ten of the examined bone marrow specimens, focal lesions containing mast cells, lymphocytes, and eosinophils appeared. The presence of these focal lesions together with either an increased number of mast cells in bone marrow sections and/or increased urinary excretion of telemethylimidazoleacetic acid is considered diagnostic of systemic mastocytosis. No patient exhibited myeloproliferative condition or other major hematologic abnormality.
Mast cell proliferative disorders include urticaria pigmentosa, localized to the skin, and systemic mastocytosis, with progression from urticaria pigmentosa to systemic mastocytosis in some adults. We have evaluated the presence of basophil/mast cell precursors in urticaria pigmentosa and systemic mastocytosis using an in vitro assay for cells which form histamine-positive peripheral blood granulocyte colonies in methylcellulose. In 17 cultures from 10 patients with mast cell proliferative disorders (6 urticaria pigmentosa, 4 systemic mastocytosis), the frequency of histamine-positive granulocyte colonies was significantly higher in systemic mastocytosis (40% colonies picked) than in urticaria pigmentosa (15%, p less than 0.002). The mean histamine content per cell of urticaria pigmentosa patient colonies was less than or equal to 0.1 pg compared to 0.7 +/- 0.1 pg in systemic mastocytosis patient colonies. Precursor assays done serially at different times in individual patients appeared to reflect clinical extent of disease. In one patient with urticaria pigmentosa, a repeatedly normal number of histamine-positive colonies paralleled no change in clinical course, while in 2 others (1 systemic mastocytosis, 1 urticaria pigmentosa) increasing skin lesions, leukopenia, increased urinary histamine or refractoriness to therapy was accompanied by an increase in the frequency of basophil/mast cell precursors. Using an index of disease activity, the frequency of histamine-positive colonies was significantly higher in active, versus inactive, mast cell proliferative disorders (p less than 0.0001). These studies confirm the biologic relevance of mast cell proliferation in mast cell proliferative disorders, and suggest that precursor assays using histamine content of granulocyte colonies may be useful in predicting extent of disease.