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PubMed1978

The prevalence and severity of major disabling conditions--a reappraisal of the government social survey on the handicapped and impaired in Great Britain.

This paper re-examines the data gathered for the Government Social Survey on the Handicapped and Impaired in Great Britain. The underlying cause of disablement is considered in conjunction with severity and prevalence. When these are taken together a picture emerges in which stroke, arthritis, and circulatory disorders are the most frequent cause of severe disability in the community. An attempt is also made to examine the way in which the survey might be biased by the non-inclusion of those in institutions.

Adult↗

PubMed1992

Granulomatous endometritis associated with histologically occult cytomegalovirus in a healthy patient.

This report describes the case of a 32-year-old female with chronic pelvic pain who was otherwise in good health. Endocervical curettings contained rare cells with intranuclear and cytoplasmic inclusions characteristic of cytomegalovirus (CMV) infection. Endometrial curettings demonstrated a stromal lymphocytic and plasmacytic infiltrate as well as numerous small, non-necrotizing granulomas, but no CMV by microscopic examination. However, CMV was identified by the polymerase chain reaction in DNA extracted from a paraffin section of the endometrial tissue. In conjunction with previous reports, the clinical and pathologic features of this case suggest that CMV can cause chronic endometritis in nonimmunocompromised patients. Furthermore, CMV infection should be considered in the differential diagnosis of granulomatous endometritis. This case demonstrates the usefulness of using the polymerase chain reaction to detect CMV in paraffin-embedded material.

Adult↗

PubMed1994

Solvent vapor abuse leukoencephalopathy. Comparison to adrenoleukodystrophy.

Chronic organic solvent vapor inhalation can cause permanent damage to the central nervous system. Clinical features and radiologic abnormalities are well known, but pathology has not been definitely established. This study describes the gross, microscopic and ultrastructural changes and fatty acid composition of cholesterol esters in the brain of two chronic paint sniffers as well as the electron microscopic findings from a third, all with permanent neurological impairment. The abnormalities which were the same in all cases consisted of a demyelinating process which grossly manifested itself as brain atrophy and subtle discoloration of the cerebral and cerebellar white matter. Periodic acid-Schiff-positive macrophages in the absence of foamy macrophages were the histological hallmark of this process. Electron microscopy revealed oval membrane-bound cytoplasmic bodies filled with bundles of trilaminar inclusions composed of 3 nm paired dense leaflets separated by a space 3-7 nm wide in macrophages. Biochemical analysis showed an increase of very long chain fatty acids in the white matter cholesterol esters. This study defines the morphologic substrate of solvent vapor abuse leukoencephalopathy. The novel ultrastructural observations in conjunction with biochemical findings provide a link with adrenoleukodystrophy and raise the possibility of similar mechanisms of myelin degradation in both.

Administration, Inhalation↗

PubMed1999

Giant papillary conjunctivitis in frequent replacement contact lens wearers: a retrospective study.

PURPOSE: We conducted a retrospective study of 47 patients who wore frequent replacement contact lenses on a daily-wear basis to determine the incidence of giant papillary conjunctivitis (GPC) and to assess the potential risk factors that may predispose frequent replacement contact lens wearers to develop GPC. METHODS: We reviewed the records of patients with no prior contact lens experience who were fit with frequent replacement contact lenses from September 1993 to February 1997. RESULTS: Forty-seven of 260 patients met the requirements for inclusion in the study. Ten (21.27%) patients had developed GPC. The incidence varied with the frequency of contact lens replacement. The contact lens replacement schedule ranged from 1 day to 12 weeks. In those patients replacing their contact lenses every 4 weeks or at a longer interval, the incidence of GPC was 36%, while for patients who replaced their lenses more frequently, the incidence was 4.5%. Coated contact lenses were also more common among patients who replaced their lenses at 4 weeks or longer (P = 0.23). A significantly greater number of patients in the GPC group incorporated enzymatic cleaning into their contact lens care system (P = .0004). A history of allergy was more prevalent in patients who developed GPC and was statistically significant (P = .012). There was no significant difference found between the groups for age, gender, average daily wearing time, FDA classification of contact lens material, time in contact lenses from fitting to diagnosis or last follow-up period, or the parameters and fitting characteristics of the contact lenses. CONCLUSION: The frequency at which patients replace their contact lenses appears to be an important variable in developing GPC. Although frequent replacement contact lenses do not eliminate GPC, patients on a 1-day to 3-week replacement cycle had a significantly lower risk of developing GPC than patients who replaced their lenses at longer intervals. Lens coating was present less often on contact lenses replaced daily and up to 3 weeks. For patients who are at high risk for GPC, replacing lenses at intervals ranging of one day to two weeks appears to offer a better strategy for avoiding GPC than incorporating enzymatic cleaning into their lens care system.

Adolescent↗

PubMed2003

Bleaching of bagasse pulp with enzyme pre-treatment.

The effluent from pulp bleaching processes containing chlorinated lignin and degraded polyphenolic intermediates remains as a major source of water pollution from the pulp and paper industries. Alternative elemental chlorine free bleaching methods based on the usage of chlorine dioxide, ozone and hydrogen peroxide are potential substitutes. Bio-bleaching methods, which involve pre-treatment of pulp with microbial enzymes such as xylanases, have emerged as viable options. Investigations reported in this paper aim at exploring the suitability of commercial bacterial xylanase enzyme preparations for bio-bleaching of bagasse pulps in conjunction with specific chemical bleach sequences employing hydrogen peroxide (P), alkali extraction (E), ozonation (Z), hypochlorite (H) and chelation (Q) stages. The effluent profiles and pulp qualities obtained for each of the bleach combinations (involving bio-bleaching and chemical bleaching sequences) were monitored. Analysis of the results clearly indicates that the inclusion of enzyme pre-treatment with the TCF (total chlorine free) and ECF (elemental chlorine free) sequences has a significant effect on the effluent (COD, lignin and colour) and pulp quality (kappa number, brightness) parameters. In conclusion, the findings of this investigation indicate the potential promise of enzyme pre-treatment in combination with chemical bleaching to enhance the quality of pulps and combined effluents.

Biodegradation, Environmental↗

PubMed2002

[Evaluation of the efficacy and safety of lodoxamide in patients with allergic eye diseases].

PURPOSE: To evaluate the effectiveness of lodoxamide in the therapy and prophylaxis of the ocular allergies. PATIENTS AND METHODS: This prospective study included 64 patients divided in 2 groups. In the first group there were 47 symptomatic patients suffering from seasonal allergic conjunctivitis (n = 27), perennial allergic conjunctivitis (n = 16) and giant papillary conjunctivitis (n = 4). The symptomatic patients were examined upon arrival and every 2 weeks until the symptoms were reduced. During the period, lodoxamide drops were administered 4 times a day. In the second group there were 17 patients who had a history of seasonal ocular allergies during previous years but were still not symptomatic upon arrival. In the group of 17 patients who were very likely to develop ocular allergy but up to inclusion into the study had no ocular symptoms, 12 (70%) presented with allergic rhinitis while 5 (30%) had asthma. The symptoms intensity (itching, discomfort, foreign body sensation, pain, tearing) was graded on a 0-3 scale. The clinical signs (follicles, papillae, hyperemia, conjunctival edema, Trantas dots, stromal infiltrates) were detected on a slit lamp examination and graded on a 0-3 scale. RESULTS: In the group of 47 symptomatic patients 2-4 weeks after lodoxamide administration, 70-80% of symptomatic patients examined clinically had less or no follicles, 60-70% had reduced or no edema, the secretion was stopped or greatly reduced in 50-70% of patients. All of the patients reported reduced or no itching, 60% of patients reported less discomfort, photophobia and reduced tearing. In the asymptomatic group two weeks after the initiation of the prophylaxis 88% of patients were still with no ocular signs of allergy while 12% of patients had a conjunctival hyperemia and follicles. After 4 weeks of the prophylaxis 76% of patients patients were still asympthomatic while only 4 developed a mild form of allergic conjunctivitis (conjunctival hyperemia and papillae), but less severe than during previous episodes. CONCLUSION: Lodoxamide was effective in reduction of symptoms and clinical signs of the ocular allergies. The best results were obtained if the drug was administered as a prophylaxis or very early in the course of the disease.

Anti-Allergic Agents↗

PubMed1999

Giant papillary conjunctivitis in frequent-replacement contact lens wearers: a retrospective study.

PURPOSE: A retrospective study was done of 47 patients who wore frequent-replacement contact lenses on a daily basis and replaced them every 1 day to 12 weeks. The incidence of giant papillary conjunctivitis (GPC) was determined, and potential risk factors that may predispose frequent-replacement contact lens wearers to develop GPC were assessed. METHODS: The records of patients who were fitted with frequent-replacement contact lenses with no prior contact lens experience (September 1993 to February 1997) were reviewed. RESULTS: Forty-seven of 260 patients met the requirement for inclusion in this study. Ten (21.27%) of the patients developed GPC. The incidence varied according to how often the contact lenses were replaced. Incidence was 36% in patients who replaced their lenses at 4 weeks or longer and 4.5% in patients who replaced their lenses at less than 4 weeks. Lenses were coated more often in patients who replaced their lenses at 4 weeks or longer (pi = .23). A significantly greater number of patients in the GPC group incorporated enzyme into their contact lens care system (pi = .0004). A history of allergy was present, significantly more often in patients who developed GPC (pi = .012). There was no significant difference between the groups for age, sex, average daily wearing time, Food and Drug Administration classification of contact lens material, time in contact lenses from fitting to diagnosis or last follow-up period, or the parameters and fitting characteristics of the contact lenses. CONCLUSION: The frequency of contact lens replacement appears to be an important variable in development of GPC. Although frequent-replacement contact lenses do not eliminate GPC, patients on a 1-day to 3-week replacement cycle had a significantly lower risk of developing GPC than patients who replaced their lenses at longer intervals. Coating was present less often on lenses replaced every 1 day to 3 weeks. In patients who are at high risk for GPC, replacing lenses at intervals of 1 day to 2 weeks appears to offer a better strategy in avoiding GPC than incorporating enzymatic cleaning into their care system.

Adult↗

PubMed1995

Allergy to Ficus benjamina (weeping fig) in nonatopic subjects.

Occupational allergy to Ficus benjamina (Fb), or weeping fig, occurs in about one in four plant-keepers. Sensitization to this plant occurs in about 3-4% of persons with clear-cut atopy. I now report on four female nonatopic patients with rhinoconjunctivitis who were sensitized only to weeping fig. All four had a positive skin prick test and RAST test to Fb. The identification of a preventable respiratory allergen is of considerable importance for the patient. Inclusion of Fb in the standard prick test panel may therefore be considered. Furthermore, the findings suggest that it may be unwise to choose Fb as an ornamental indoor plant.

Adult↗

PubMed2004

Economic and quality-of-life impact of seasonal allergic conjunctivitis in Oxfordshire.

PURPOSE: The purpose of this study was to examine the economic and quality-of-life (QoL) impact of seasonal allergic conjunctivitis (SAC) from the individual patient perspective. SETTING: The study population was drawn from the general public of Oxfordshire, England. METHODS: Participants were recruited from either general practices or the casualty department of the Oxford Eye Hospital (OEH). All persons who were between 16 and 80 years of age and English speaking were eligible for enrollment in the study. The inclusion criteria for cases was that participants: 1) experienced itchy, bloodshot and watering eyes at some time between February and August every year since 1999, and 2) considered it likely that this was in response to seasonal allergens. Controls were drawn from the same sources and were age- and sex-matched to cases. Participants completed the EQ-5D Health Questionnaire, the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), the National Eye Institute (U.S.) Visual Functioning Questionnaire 25 (VFQ-25), and a specially developed Health Economic and Demographic Questionnaire. RESULTS: Most participants in both groups were female (67.5% in the SAC and 70% in the control group, P=0.565). Weekly earnings were lower in the SAC group (P<0.001), as the SAC group also worked fewer hours per week (P<0.001). Participants with SAC also experienced a greater degree of pain and discomfort as measured by the EQ-5D (P=0.018) and a lower perception of health using the EQ-VAS (P=0.039). Statistically significant differences between both groups were detected in all domains of the VFQ-25, except general and colour vision, although the differences were thought to be clinically significant only for the ocular pain domain. The RQLQ scores were also all found to differ significantly between groups (P<0.001). The total of both the public health care and private out-of-pocket costs of SAC in our study population ranged on average between pound sterling 64.61 for a pensioner to pound sterling 123.69 for a person with SAC in paid employment. CONCLUSIONS: SAC is a costly, highly prevalent, chronic condition associated with significant reductions in both ocular and general quality of life, as well as ongoing out-of-pocket expenses and health care costs. Medications that reduce this demand on health care systems and out-of-pocket expenses by patients could be of potential importance in reducing the overall economic and health burden of illness posed by SAC.

Adolescent↗

PubMed2005

Plasmodium falciparum: discovery of peroxidase active organelles.

Staining with 3,3' diaminobenzidine tetrahydrochloride (DAB) is a common method used for the detection of peroxidases. Using this histochemical staining method in conjunction with transmission electron microscopy, we observed oxidation of DAB that was localized to a discrete set of organelles displaying morphological similarity to small (75-90 nm diameter) versions of higher eukaryotic microbodies or peroxisomes. These single membrane bounded organelles were characterized by an asymmetrical matrix capable of oxidizing DAB to an electron dense inclusion. Oxidation of DAB was further found to be dependent upon hydrogen peroxide (H2O2) as a substrate. Given a lack of peroxisomal import proteins and enzymes, it is unlikely that these represent conventional peroxisomes. Rather, they likely represent specialized organelles containing endogenous peroxidase or pseudo-peroxidase activity.

3,3'-Diaminobenzidine↗

PubMed2002

Development and implementation of an HIV/AIDS case management outcomes assessment programme.

The Case Management Section of the New York State Department of Health AIDS Institute coordinates the provision of case management services for people living with HIV/AIDS throughout the state. The Community Follow-Up Program (CFP), providing intensive case management for HIV-positive individuals and their families, operates under the auspices of the Case Management Section. This article focuses on a public/private outcomes assessment partnership, sponsored by the Case Management Section, and developed in conjunction with a team of CFP programme managers from across the state. The process used to develop outcome indicators and measures is described; challenges encountered along the way are detailed; and suggestions for other public/private partnerships are outlined. Results from two years of outcomes data collection are also presented. The article concludes that the inclusion of providers in the identification and measurement of desired outcomes can help overcome provider resistance to outcomes assessment and can help ensure that outcomes data are used to improve programme performance.

Acquired Immunodeficiency Syndrome↗

PubMed1988

An outbreak of post-vaccinal suspected distemper-like encephalitis in farmed ferrets (Mustela putorius furo).

Two outbreaks of an encephalitis apparently induced by an attenuated live distemper vaccine occurred in a large ferret breeding establishment in New Zealand. Approximately 350 of 6,000 young ferrets 16-22 weeks old died. Many were found dead with no premonitory signs, others showed severe neurological signs. Some with central nervous system (C.N.S.) signs recovered. Pathological examination showed no gross abnormalities except for a few with mild conjunctivitis, rhinitis and lung emphysema. Microscopically there was a moderate to massive non-inflammatory necrosis of hippocampal nerve cell bodies. In those animals which survived for several days with CNS signs there was also a mild to moderately severe non-supportive encephalitis, and in some of these distinct neuronal intranuclear and intracytoplasmic eosinophilic inclusion bodies were seen. Some ferrets also had a bronchiolitis with intracytoplasmic eosinophilic inclusion bodies in bronchiolar epithelium. All these lesions suggest that a distemper like condition was involved. About half of the ferrets also had a mild to severe inflammatory myocardial necrosis.

Journal Article↗

PubMed1986

Isolation of a relatively nontoxic 65-kilodalton protein inclusion from the parasporal body of Bacillus thuringiensis subsp. israelensis.

Ultrastructural studies of the mosquitocidal bacterium Bacillus thuringiensis subsp. israelensis revealed that the parasporal body contained three major inclusion types, designated types 1, 2, and 3, which could be differentiated on the basis of electron opacity and size and, to some extent, shape. The type-2 inclusion, which was of moderate electron density and often appeared as a bar-shaped polyhedral body, was isolated on NaBr gradients from purified parasporal bodies and characterized by sodium dodecyl sulfate-polyacrylamide gel electrophoresis, transmission electron microscopy, and bioassays against neonate larvae of Aedes aegypti. Purified inclusions averaged 150 to 200 nm by 500 to 700 nm in transverse sections and consisted almost exclusively of a 65-kilodalton (kDa) protein contaminated with minor quantities of 38- and 28-kDa proteins. Lethal concentration values at the 50% level for preparations of the purified parasporal body and the type-2 inclusion were, respectively, 0.66 and 43 ng/ml, indicating that the 65-kDa protein is only slightly toxic to mosquitoes in comparison to the intact parasporal body. Analysis of the type-2 polyhedral inclusion by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and bioassays during different stages of purification demonstrated a positive correlation between the toxicity of the preparation and the degree of contamination with the 28-kDa protein. These results indicate that the 65-kDa protein is not the primary larvicidal toxin, although it may act in conjunction with other parasporal body proteins to produce the high mosquitocidal toxicity characteristic of this bacterium.

Bacillus thuringiensis↗

PubMed2006

Association between protein tyrosine phosphatase 22 variant R620W in conjunction with the HLA-DRB1 shared epitope and humoral autoimmunity to an immunodominant epitope of cartilage-specific type II collagen in early rheumatoid arthritis.

OBJECTIVE: To analyze the genetic impact of allelic variants of the protein tyrosine phosphatase N22 (PTPN22) and HLA-DRB1 alleles on IgG autoantibody formation directed toward an immunodominant conformational epitope (C1(III); amino acid residues 359-369) of type II collagen (CII) in early rheumatoid arthritis (RA). METHODS: Sera obtained at study inclusion from an inception cohort of RA patients (n = 221; mean symptom duration 6 months) were analyzed for circulating anti-C1(III) IgG autoantibodies. An enzyme-linked immunosorbent assay based on solid-phase-coupled synthetic triple-helical collagen peptides was used to quantify humoral autoimmune responses. HLA-DRB1 genotypes were determined by allele-specific polymerase chain reaction amplification of genomic DNA and sequence-specific hybridization. PTPN22*620W genotyping was performed using an allelic discrimination TaqMan assay. RESULTS: Anti-C1(III) IgG autoantibody titers were significantly elevated in patients with early RA as compared with those in healthy controls (n = 70). The increased titers were more pronounced in RA patients harboring alleles of the RA-associated HLA-DRB1 shared epitope (SE) consensus sequence than in those lacking the SE. In addition, the PTPN22*620W variant was strongly associated with a vigorous humoral autoimmune response to the cartilage-specific CII determinant C1(III). CONCLUSION: Allelic variants encoding the binding pocket for peptide presentation (SE) to T cells and a functional domain of a negative regulator of T cell receptor signaling (PTPN22*620W), respectively, synergize in early RA to break self tolerance toward C1(III), an evolutionarily conserved cartilage determinant that is also frequently targeted in arthritogenic humoral autoimmunity in mice.

Arthritis, Rheumatoid↗

PubMed1992

Asteroid bodies and calcium oxalate crystals: two infrequent findings in fine-needle aspirates of parotid sarcoidosis.

We have studied 3 cases of sarcoidosis involving the parotid gland by means of fine-needle aspiration cytology (FNAC). The main findings were noncaseating granulomas, multinucleated giant cells (MGCs), and lymphocytes. In one case MGCs contained asteroid bodies and in another case we observed calcium oxalate crystals (COCs) over both stromal fragments and MGCs. Although nonpathognomonic for sarcoidosis, these 2 findings may help in the diagnosis of this condition. However, both are easily overlooked and must be borne in mind when viewing noncaseating granulomas. Sarcoid granulomas displaying COC must be differentiated from foreign-body granulomas. The aforementioned cytological findings must be assessed in conjunction with clinical findings. Nevertheless, in most cases the diagnosis of sarcoidosis is made by exclusion.

Adult↗

PubMed2004

Randomised double masked trial comparing the efficacy and tolerance of 0.05% mequitazine eye drops versus 0.05% levocabastine and placebo in allergic conjunctivitis induced by a conjunctival provocation test with Dermatophagoides pteronyssinus.

AIM: A double masked randomised trial comparing 0.05% mequitazine eye drops with 0.05% levocabastine and placebo was carried out in otherwise healthy volunteers allergic to house dust mites (Dermatophagoides pteronyssinus). METHOD: Double masked, randomised, single centre study, comparing three parallel treatment groups. 60 healthy adults with a confirmed history of allergic conjunctivitis to house dust mites for at least 2 years were included and completed the trial. Conjunctival provocation tests (CPT) were done at screening, at visit 2 (V2) (1 week later), and at visit 3 (V3) (2 weeks after V2). Treatment was instilled in the same eye, 5 minutes after the CPT at V2, and twice daily until V3. CPT were scored 5, 10, 15, and 60 minutes after instillation of the dose of Dermatophagoides pteronyssinus antigen determined at inclusion (V2, curative test) or resulting in positivity (V3, preventive test) RESULTS: In the V2 (curative) test the difference between the active treatments and placebo on the redness+itching scores was not significant. At the V3 (preventive) CPT there was a lower number of reactions at the threshold dose with mequitazine (20%) compared to placebo (60%, p = 0.01) or levocabastine (45%, p = 0.10). CONCLUSION: This trial failed to clearly demonstrate curative superiority of topical antihistamines with placebo, when a single dose of treatment was instilled following CPT. However mequitazine 0.05% eye drops were superior to placebo in preventing a reaction to CPT, after 2 weeks of treatment.

Adolescent↗

PubMed1998

Prognostic staging system for recurrent, persistent, and second primary cancers of the oral cavity and oropharynx.

OBJECTIVE: To develop a practical staging system for predicting mortality of patients with recurrent squamous cell tumors of the oral cavity and oropharyngeal mucosa. DESIGN AND SETTING: An inception cohort at an academic medical center. PATIENTS: A total of 308 patients who had evidence of recurrent, persistent, or second primary tumors of the oral cavity and oropharynx between January 1, 1980, and December 31, 1991, of whom 162 (52.6%) met inclusion criteria. MAIN OUTCOME MEASURE: One-year mortality. RESULTS: The median survival time was 10 months. In bivariate analysis, the TNM stage of the recurrent tumor, invasion of pharyngeal constrictors and the floor-of-mouth muscles, weight loss, local and systemic symptoms, and eating function had significant effects on mortality. Multivariable analysis (done by conjunctive consolidation and Cox regression) identified constrictor invasion, the TNM stage of the recurrence, and weight loss as having a substantial effect on mortality. A composite 4-stage system using these 3 variables demarcated 1-year survival rates of 88.2% (30/34), 71.9% (23/32), 32.6% (16/49), and 4.2% (2/47). CONCLUSIONS: The TNM status of recurrent tumors predicts mortality, but constrictor muscle invasion and weight loss also have major prognostic importance. The consolidation of these variables into a composite staging system successfully stratifies patients with widely divergent mortality rates. Improved staging of recurrent head and neck tumors can lead to more effective decisions about the comparisons and merits of additional treatment.

Aged↗

PubMed1979

Isolation of Chlamydia trachomatis from different areas of conjunctiva in relation to intensity of hyperendemic trachoma in school children in Southern Tunisia.

The simplified one-passage technique of culture in irradiated McCoy cells, in conjunction with certain other developments in technique, was used to isolate Chlamydia trachomatis from specimens collected from 78 children with trachoma in Douz, Southern Tunisia. The results show that C. trachomatis is not confined to the upper tarsal area of the conjunctiva in hyperendemic trachoma. The higher isolation rate and corresponding increase in the number of inclusions obtained from swabbings of the upper fornix and lower lid in addition to the conventional collection from the upper tarsus show the superiority of collecting specimens for culture from the whole conjunctiva. Specimens could be collected from the whole conjunctiva by using 1 swab for each eye and pooled for subsequent inoculation, so that the laboratory incurred no additional work. A close correlation was observed between isolation rate, together with the number of inclusions, obtained in cell culture, and intensity of inflammatory disease in hyperendemic trachoma. The sensitivity and practicability of this cultural test should provide a valuable laboratory index for use in epidemiological and therapeutic studies of trachoma.

Child↗