bluuebunny/crossref_metadata_2025 huggingface dataset:
Between caring and curing
Authors: Kottow Michael H.
Published: March 2003

Summary Care and cure have been described as different kinds of ethical approaches to clinical situations. Female concerns in nursing care have been contrasted with masculine, cure orientated physician's attitudes. Ethics in such different voices may have sociologic determinants, but they do not represent intrinsic distinctions. Medicine has shown a divergent development, on the one hand stressing cure in a deterministic and instrumental way, on the other hand being aware that disease is as much a pathographic as a biographic, care‐requiring existential situation. Disease is a breakdown of the living organism, to be cured by therapeutic efforts, but it is also the distressing failure of the lived body, requiring concern and care. Based on Lévinas’ ethics of encounter, it is suggested that any interpersonal relatedness is based on concern for the other, being grounded on an essentially ethical interaction. The clinical encounter is a paradigm of such ethics‐based relationships, which necessarily builds on awareness of the other qua other, and is concerned with fulfilling the therapeutic mandate. Caring for the other means doing one's best to help her/him, so that care and cure are inextricably interwoven, although care is the more fundamental form of human relatedness. Thus, neither gender nor professional tasks can allow for a caring attitude to develop without curing concerns, just as trying to cure without caring is unthinkable.
Evolution and nursing1
Authors: Hussey Trevor
Published: March 2003

Evolutionary theory has been a very popular topic in recent years and it has been claimed that it can make a major contribution to the advance of several sciences such as medicine, psychology, psychopathology and sociology: even providing them with new paradigms. This paper explores the possibility that nursing could benefit similarly by adopting an evolutionary perspective. After sketching the scientific and philosophical background to the recent developments concerning evolution, and briefly mentioning the chief features of evolutionary theory, the paper discusses whether it makes sense to talk of ‘evolutionary nursing’, and whether there are any benefits in doing so. It uses a comparison with Darwinian medicine and evolutionary psychology. Several problems and objections are considered. The modest conclusion is reached that nurses need to adopt an evolutionary perspective to serve as a guide for some of their research and a source for research hypotheses. They also need to be informed about evolutionary ideas so as to be aware of the developments in the disciplines with which they work, and this understanding will assist them in maintaining vigilance against the misuse of science, religion and politics on behalf of their patients.
Beyond polarities of knowledge: the pragmatics of faith
Authors: Hartrick Gweneth A.
Published: March 2003

The dissociation between the domains of knowledge continues to perpetuate the fragmentation of people’s health and healing experiences. Of particular significance are the polarities that have been created between the objective, subjective and spiritual dimensions of knowledge and human experience. This paper offers a consideration of how faith might serve as a pragmatic avenue towards assuaging the polarities between knowledges and enhancing nurses’ ability to attend to the complex and mulitdimensional nature of health and healing processes.
Nature's sunscreen from the Great Barrier Reef, Australia
Authors: DUNLAP W.C. , CHALKER B.E. , BANDARANAYAKE W.M. , WU WON J.J.
Published: March 2003

All shallow‐water marine organisms have natural features and behaviours that can reduce exposure to UV radiation and limit the amount of photodamage to functional biomolecules and organelles. Protection from UV radiation often includes the production of UV‐absorbing compounds which, in marine organisms, are usually mycosporine‐like amino acids (MAAs) having a range of absorption maxima between 310 and 360 nm. Shallow‐water corals produce large quantities of MAAs and their apparent ability to withstand long‐term environmental UV exposure suggests utilization of their UV‐absorbing chromophore for sunscreen applications. We present an overview of the biochemical photophysiology of tropical reef‐building corals, and of the development of a new class of synthetic sunscreen, 1‐alkyl‐3‐alkanoyl‐1,4,5,6‐tetrahydropyridines, based on their natural UV protection. Several sunscreen candidates have been examined for sunscreen suitability and a limited selection is being tested for potential use in human skin‐care and cosmetic products. Resume Tous les organismes marins d'eau peu profonde ont des caracteristiques naturelles et des comportements qui peuvent reduire l'exposition aux rayons U.V. et limiter la proportion des dommages causes aux biomolecules fonctionnelles et aux organelles. La protection contre les rayons U.V. comprend souvent la production de composes absorbeurs d'U.V. qui, chez les organismes marins, sont en general des acides amines de type mycosporine (MAA) ayant des maxima d'absorption compris entre 310 et 360 nm. Les coraux d'eau peu profonde produisent de grandes quantites de MAA et leur capacite apparente a supporter une exposition aux U.V. de longue duree suggere qu'ils utilisent leur chromophore absorbeur d'U.V. a des fins d'ecran solaire. Nous presentons une vue d'ensemble de la photophysiologie biochimique de coraux tropicaux formant des recifs, et du developpement d'une nouvelle classe d'ecran solaire synthetique, les 1‐alkyl‐3‐alcanoyl‐1,4,5,6‐tetrahydropyridines, basee sur cette protection naturelle contre les U.V. Nous avons analyse la qualite d'ecran solaire de plusieurs candidats et teste une selection limitee pour son usage potentiel dans des produits cosmetiques et dermatologiques pour l'homme.
In vitro skin permeation evaluation: the only realistic option
Authors: Walters K.A. , Watkinson A.C. , Brain K.R.
Published: March 2003

Increasing requirements for cruelty‐free risk assessment in the cosmetic industry have led to the development of several alternative experimental evaluation strategies. Quantification of the potential dermal absorption of ingredients of cosmetic and other formulations by determination of human skin permeation rates in vitro is particularly relevant. Using modifications of standard in vitro protocols the human skin permeation rates of several cosmetic ingredients and potential contaminants have been determined under conditions designed to mimic consumer use. Skin penetration and permeation of octyl salicylate (a sunscreen), nonylphenol ethoxylates (surfactants) and three nitrosamines (potential contaminants) is discussed. The data demonstrate the usefulness of this technique as a tool in the overall risk assessment of cosmetic formulations.
Determination of Panthenol, Cholecalciferol and Tocopherol in Cosmetic Products by Gas Chromatography‐Mass Spectrometry in SIM Mode
Authors: Jeong H.‐J. , Lee M.‐H. , Ro K.‐W. , Hur C.‐W. , Kim J.‐W.
Published: March 2003

Synopsis

A novel simple method to detect vitamins in cosmetic products by gas chromatography‐mass spectrometry (GC‐MS) has been developed. Three vitamins (panthenol, cholecalciferol and tocopherol) were used for this study. Vitamins were prepared by dissolving in tetrahydrofuran (ThF), and silylated with bis‐trimethylsilyltri‐fluoroacetamide‐ trichloromethylsilane (BSTFA). Silylated vitamins were separated on a fused‐silica capillary column coated with DB‐5. The identification of each vitamin was accomplished by retention time and mass spectrum library search with a computer, and the quantitation was made in the selected‐ion monitoring (SIM) mode of GC‐MS. SIM mode had given sensitivity to determine 50 pg of panthenol, 285 pg of cholecalciferol and 130 pg of tocopherol. Linearity was maintained over the range 0.005–0.20% for each vitamin. Each cosmetic product (i.e. hair tonic and lotion) was found to contain amounts of the vitamins. This method was sensitive and gave 77.5–99.9% recovery of each vitamin from these cosmetic products. From these results, we concluded that silylation with BSTFA followed by GC‐MS analysis allows the simple, convenient and exact determination of panthenol, cholecalciferol and tocopherol.
Histopathological, morphometric and stereological studies of ascorbic acid and magnesium ascorbyl phosphate in a skin care formulation
Authors: Silva  , Maia Campos
Published: March 2003

Synopsis

Ascorbic acid (vitamin C) has been widely used in cosmetics and dermatological formulations due to its inhibitory effect on melanogenesis by affecting collagen synthesis and scavenger properties. However, ascorbic acid (AA) is quickly oxidized and decomposes in aqueous solution and to solve this problem, vitamin C derivatives were synthesized.

In the present investigation, histopathological, morphometric and stereological studies were carried out to investigate the possible alterations caused by formulations containing AA or magnesium ascorbyl phosphate (MAP) in the epidermis.

Gel creams either with or without 2% AA or its derivative were selected for investigation. Guinea‐pigs were shaved on the back, and four areas of 1.5 cm2 each were used for the experiments. One untreated area was used for control and the others for the application of gel cream formulations either with or without AA or its derivatives. The formulations were applied daily for 2, 4 and 8 weeks and biopsies were then obtained from each area using a dermatological punch. The material collected was analysed by histopathological, morphometric and stereological techniques.

We observed that, under the present experimental conditions, whole formulations acted on the epidermis causing a thickening of the epithelium, with cells of larger volume in the granulose and spinous layers.

Résumé

En raison de son effet inhibiteur sur la melanogènese, sur la synthèse du collagène et de ses propriétés régénérantes, l’acide ascorbique (vitamine C) est depuis longtemps largement utilisé en Cosmétique et en Dermatologie. Cependant, l’acide ascorbique, en solution aqueuse, est très vite oxydé et décomposé. Dans le but de trouver une solution à ce problème, des dérivés de la vitamine C ont été synthétisés.

Nous avons procédéà des études histopathologiques, morphométriques et stéréologiques pour analyser les altérations provoquées sur l’epiderme par des formules contenant de l’acide l‐ascorbique ou du phosphate de magnésium
l‐ascorbyl.

Des gels contenant 2% d’acide ascorbique ou ses dérivés, et les autres ne le contenant pas (contrôle), ont été sélectionnés pour tests. Quatre segments de 1,5 cm2 chacun ont été rasés sur le dos de cobayes pour des études plus approfondies. Un site non traité a été désigné comme groupe témoin alors que les autres ont été traités par des formules de gel contenant soit 2% d’acide ascorbique ou ses dérivés ou le véhicule. Les formules ont été appliquées une fois par jour pendant 15, 30 ou 60 jours suivis d’un prélèvement, avec une pince dermatologique, en vue d’obtention de biopsies. Le matériel prélevé a été analysé par des techniques histopathologiques, morphométriques et stéréologiques.

Nous avons pu observer, dans les conditions des essais, que les formules agissaient sur l’épiderme en provoquant un épaississement de l’épithélium, formant une membrane cellulaire plus volumineuse disposée en plusieurs couches granuleuses et spineuses.
Circadian rhythms in axillary skin surface pH
Authors: Burry J. , Coulson H. F. , Roberts G.
Published: March 2003

Synopsis

Sweat and skin surface pH are critical parameters in determining the performance of antiperspirants. The mechanism of action, the so‐called ‘plug theory’ first proposed by Reller and Luedders, involves the expression of eccrine sweat onto the surface of the skin into which the solid antiperspirant salts, typically an aluminium chlorohydrate or zirconium aluminium glycine, dissolve. The resultant acidic ‘solution’ then diffuses with time into the sweat glands, where it hydrolyses in more alkaline sweat and forms an amorphous metal hydroxide agglomerate that physically plugs the ducts some 20–100 μm into the glands. It is therefore important to understand whether diurnal variations in skin surface pH exist in the axilla, as these may influence strongly the time of day at which antiperspirant should be applied in order to yield maximal protection.

Clinical studies demonstrate a significant fall in axillary skin surface pH between the morning (pH = 5.87 ± 0.23) and the evening (pH = 5.49 ± 0.23). This diurnal variation in skin surface pH suggests that antiperspirant efficacy will be optimal when products are applied in the morning. In addition, the data suggest a circadian rhythm in axillary skin barrier function, indicating that chronopharmacology, the timing of administration of medication, could be used to optimize treatment of axillary hyperhidrotics using topical administration of anticholinergic drugs.
What are meters measuring?
Authors: Dykes P. J.
Published: March 2003

Synopsis

There is increasing pressure on manufacturers of cosmetic products to provide data to support claims. Data are available from many sources including historical (published literature), laboratory data, cell culture experiments and human studies. Undoubtedly, human studies are the most reliable, and there are a wide range of tests available. Many meters have been developed for measuring different aspects of skin physiology but an understanding of these devices is essential, otherwise the data generated is of little value. There is some confusion as to what exactly some meters measure, an example of which is transepidermal water loss (TEWL) and water content (hydration) of the stratum corneum. Measurement of TEWL is used mainly to support claims that a product may, in the short or long term, improve or repair the barrier function of skin. It is not an indicator of hydration of the stratum corneum. One way to measure hydration is to look for the changes in electrical properties of the stratum corneum that the increased water content produces, i.e. measure capacitance or conductance. It is important that we do not loose sight of the fact that meters may measure something that is imperceptible to the consumer or has no meaning to them. Reliance only on devices that give numbers may lead to problems. An example of a study where three facial cosmetic products were subjected to perceptual tests and to a standard volunteer test for moisturization will be discussed. The relationship between any measured parameter, and what it means to the consumer, needs to be understood. A moisturization claim may be technically supported by a study using a device such as the Corneometer. However, a 20% increase in water content almost certainly does not represent a 20% better moisturization as far as the consumer is concerned. The way forward is to relate the two approaches to product testing during product development. Hopefully, this will allow the product development process to be more systematic.
An update on folates and folic acid: contribution of MAFF‐funded research
Authors: Hughes Joyce , Buttriss Judy
Published: March 2003

The Ministry of Agriculture, Fisheries and Food (MAFF) recently commissioned the British Nutrition Foundation to review critically its Optimal Nutrition Status programme and identify future research requirements. MAFF describes two main scientific objectives for this programme: (a) to understand the links between optimal nutrition status and the maintenance of good health, and (b) to develop accurate measures of bioavailability of micronutrients from foods. Five projects funded under this programme have been concerned with folates and folic acid.

The B vitamin folate/folic acid occurs in food as folic acid (the synthetic form used for fortification and dietary supplements) and a range of naturally occurring folate vitamers (folates). Measurement of folates in foods and biological samples has been difficult because of the different natural forms of folate. Several MAFF‐funded projects have addressed this difficulty and new assays for food folates and folates in biological samples have been developed.

There is good evidence that the synthetic form of the vitamin, folic acid, in its free form as in supplements, is stable and more bioavailable than the naturally occurring folates at typical intake levels, but its bioavailability from fortified foods is less well established. Understanding of the bioavailability of endogenous food folates is also incomplete, and it is not possible at this time to predict the bioavailability for a given diet. Stable isotopic methods, as used in some of the MAFF‐funded projects, show great promise for the determination of folate bioavailability in whole diets, fortified foods and dietary supplements.

An understanding of the function and metabolism of folates/folic acid is critical in identifying indicators of status. Recent and current research (some funded by MAFF), especially that relating to plasma homocysteine as a functional marker, is described in this paper. Human intervention studies that are being used to determine dose response of both natural food folates, and folic acid in fortified foods and supplements are also described.

As yet there is insufficient evidence to determine functional markers of optimal nutrition status of folates/folic acid in population groups and hence to be in a position to review the Dietary Reference Values. Further research requirements were identified in the review and refined at a workshop of experts. These are set out under individual MAFF programme objectives in a table at the end of the paper.
An update on copper: contribution of MAFF‐funded research
Authors: Buttriss Judy , Hughes Joyce
Published: March 2003

Abstract This paper summarises the findings with respect to copper of the British Nutrition Foundation's recent review of the outcomes of the Ministry of Agriculture, Fisheries and Food's Optimal Nutrition Status research programme and identifies future research requirements. The typical human adult body contains approximately 100 mg of copper (Cu), the majority of which is tightly bound to about 30 enzymes and proteins. Cu is an essential transition element that plays a fundamental role in biochemistry by permitting the transfer of electrons in critical metabolic pathways. The paper provides an overview of current knowledge about the function, sources and habitual intakes of copper in the UK; absorption, bioavailability and metabolic regulation; and assessment or indicators of human copper status. Further research requirements to determine optimal nutrition status for copper were identified in the review and refined at a workshop of experts. These have been presented to the Food Standards Agency and are included in the paper.
Enhanced photosynthesis and growth of transgenic plants that express ictB, a gene involved in HCO3− accumulation in cyanobacteria
Authors: Lieman‐Hurwitz Judy , Rachmilevitch Shimon , Mittler Ron , Marcus Yehouda , Kaplan Aaron
Published: March 2003

Transgenic Arabidopsis thaliana and Nicotiana tabacum plants that express ictB, a gene involved in HCO3− accumulation within the cyanobacterium Synechococcus sp. PCC 7942, exhibited significantly faster photosynthetic rates than the wild‐types under limiting but not under saturating CO2 concentrations. Under conditions of low relative humidity, growth of the transgenic A. thaliana plants was considerably faster than the wild‐type. This enhancement of growth was not observed under humid conditions. There was no difference in the amount of ribulose 1,5‐bisphosphate carboxylase/oxygenase (RubisCO) detected in the wild‐types and their respective transgenic plants. Following activation in vitro, the activities of RubisCO from either low‐ or high‐humidity‐grown transgenic plants were similar to those observed in the wild‐types. In contrast, the in vivo RubisCO activity, i.e. without prior activation, in plants grown under low humidity was considerably higher in ictB‐expressing plants than in their wild‐types. The CO2 compensation point in the transgenic plants that express ictB was lower than in the wild‐types, suggesting that the concentration of CO2 in close proximity to RubisCO was higher. This may explain the higher activation level of RubisCO and enhanced photosynthetic activities and growth in the transgenic plants. These data indicated a potential use of ictB for the stimulation of crop yield.
MANAGEMENTOF ADULT IMMUNE THROMBOCYTOPENIA
Authors: Lechner Klaus
Published: March 2003

Immune thrombocytopenia (ITP) is a heterogeneous disease with regard to pathogenesis, severity, spontaneous course and response to treatment. Except in patients with severe bleeding tendency and very low platelet counts (< 10 × 109/L), there are no clear rules on the indications for treatment. The standard initial therapy is corticosteroids, but the optimal dose and duration of therapy is unknown and in practice, some patients may be overtreated by aiming for complete remission (CR). In patients who have no sustained response after steroids, the most effective single therapy is splenectomy. Laparascopic splenectomy has a very low mortality and moderate morbidity. Preoperative prediction of success is difficult. About 50% of patients are in CR or partial remission after 5 years, but there are few data on the long‐term outcome. Patients who fail steroids and splenectomy are difficult to treat. The choice may be palliative, with low doses of steroids or aggressive therapy with the intention of sustained remission. In selected patients, high‐dose immunoglobulin or anti‐D may be useful to temporarily raise the platelet count. Other drugs tried in ITP had either no or very limited clinically meaningful efficacy.
Childhood acute lymphoblastic leukemia
Authors: Pui Ching‐Hon , Relling Mary V. , Campana Dario , Evans William E.
Published: March 2003

As cure rates in childhood acute lymphoblastic leukemia reach 80%, emphasis is increasingly placed on the accurate identification of drug‐resistant cases, the elucidation of the mechanisms involved in drug resistance and the development of new therapeutic strategies targeted toward the pivotal molecular lesions. Pharmacodynamic and pharmacogenomic studies have provided rational criteria for individualizing therapy to enhance efficacy and reduce acute toxicity and late sequelae. Currently, assessment of the early response to treatment by measurement of minimal residual disease (MRD) is the most powerful independent prognostic indicator. MRD is affected by both the drug sensitivity of leukemic cells and the pharmacodynamic and pharmacogenetic properties of the host cells. Rapid advances in biotechnology and bioinformatics should ultimately facilitate the development of molecular diagnostic assays that can be used to optimize antileukemic therapy and elucidate the mechanisms of leukemogenesis. In the interim, prospective clinical trials have provided valuable clues that are further increasing the cure rate of childhood acute lymphoblastic leukemia.
T‐cell telomere length maintained in HIV‐infected long‐term survivors
Authors: Tucker V. , Jenkins J. , Gilmour J. , Savoie H. , Easterbrook P. , Gotch F. , Browning M.J.
Published: March 2003

Background and methods We have used the erosion of telomeric DNA as a measure of cellular division to study the replicative history of isolated T‐lymphocyte subpopulations from a group of HIV‐infected long‐term survivors and age‐matched healthy controls.

Results In keeping with previous studies, we found that CD45RO+ (memory) T‐cells showed greater telomere erosion than CD45RA+ (naive) T‐cells. We did not, however, find any significant differences in the telomere lengths of isolated CD4+, CD8+, CD45RA+ or CD45RO+ T‐cells between HIV‐infected long‐term survivors and age‐matched controls. Further, we found no evidence of telomerase activation in

T‐cells from the HIV‐infected groups to account for the lack of telomere erosion.

Conclusions Our data show no evidence, through telomere shortening, of clonal exhaustion or replicative senescence due to an increased rate of immune cell turnover in HIV‐infected long‐term survivors.
The shrinking of human rights: the controversial revision of the Helsinki Declaration
Authors: Botbol‐Baum M
Published: March 2003

The right of access to health care for HIV patients in developing countries has been weakened by the 1999 revision of the Helsinki Declaration. There is a dichotomy between discussions of human rights and liberal international public health policy. Utilitarian ethics, devoid of a sound notion of universal justice, encourage discrimination against economically vulnerable patients in developing countries. Greater coherence is needed between ethical principles and practical issues, particularly with regard to scientific research.
Changes in lean body mass and total body weight are weakly associated with physical functioning in patients with HIV infection
Authors: Wilson IB , Jacobson DL , Roubenoff R , Spiegelman D , Knox TA , Gorbach SL
Published: March 2003

Context

For clinicians managing weight loss in patients with HIV, it would be useful to understand how changes in lean body mass (LBM) effect physical functioning, and whether LBM is more strongly related to physical functioning than total body weight (TBW).

Objective

To determine the relationship of changes in LBM and changes in total body weight (TBW) to changes in self‐reported physical functioning in men and women with HIV infection.

Methods

Study design was longitudinal analysis of 1474 patient‐intervals (each interval was approximately 6 months long) in 486 persons. Patients were participants in Nutrition for Healthy Living, a cohort study of HIV positive persons in Massachusetts and Rhode Island. The main outcome measure was change in self‐reported physical functioning.

Results

Of the 1474 intervals, 1165 were contributed by men and 309 by women. The mean CD4 count for the 1474 intervals was 383 cells/µL. In men, 5 kg changes in LBM and TBW were associated with 2.2 (95% confidence interval, 0.9, 3.4, P= 0.001) and 2.6 (95% confidence interval, 1.3, 3.9, P= 0.0002) point changes in physical functioning (on a 100‐point scale), respectively, after adjusting for covariates. The relationships of changes in LBM and TBW to changes in physical functioning were linear. In women, there were no significant relationships between changes in LBM or TBW to changes in physical functioning.

Conclusions

In this longitudinal analysis of relatively healthy persons with HIV infection, changes in LBM and TBW were significantly related to changes in physical functioning in men, but the magnitude of the relationship was small. In women, changes in LBM and TBW were not related to changes in physical functioning. Our data suggest that it is not necessary to measure body composition (lean and fat compartments) to understand the impact of changes in weight on physical functioning – it is sufficient to follow total body weight.
Discrepant results in the interpretation of HIV‐1 drug‐resistance genotypic data among widely used algorithms
Authors: Kijak GH , Rubio AE , Pampuro SE , Zala C , Cahn P , Galli R , Montaner JS , Salomón H
Published: March 2003

Objectives

The aim of this study was to assess the concordance on the interpretation of HIV‐1 drug‐resistance genotypic data by three widely used algorithms: Stanford University Database (SU), TruGene (Visible Genetics, Canada) (VG) and VirtualPhenotype (Virco, Belgium) (VP).

Methods

Genotypic data from 293 HIV‐1‐infected individuals with treatment failure was interpreted for 14 antiretroviral drugs by the three algorithms.

Results

Complete concordant results among the three systems for all the drugs studied were found in 40/293 (13.7%) samples. Low concordance in the interpretation was observed for most nucleoside reverse transcriptase inhibitors (NRTIs), while results agreed highly for all nonnucleoside reverse transcriptase inhibitors (NNRTIs) and most protease inhibitors (PIs). In pair‐wise comparisons, discordant interpretations between SU and VP were found in over 50% of the samples for didanosine, zalcitabine, stavudine and abacavir, and the level of disagreement between VG and VP exceeded 40% for the same drugs. Major discrepancies (high‐level resistance interpretation by one algorithm with sensitive interpretation by another) were observed between VG and VP in over 10% of the cases for didanosine, zalcitabine, stavudine and abacavir. On the other hand, the three algorithms had concordant results for lamivudine in over 90% of the cases.

Conclusions

This work demonstrates the great level of discordance in the interpretation of genotyping results among algorithms, clearly showing the necessity for clinical validation. Moreover, these results suggest that a joint effort from the scientific community as well as national and international HIV societies is needed to achieve a consensus for the interpretation of genotypic data.
Modelling the 3‐year risk of myocardial infarction among participants in the Data Collection on Adverse Events of Anti‐HIV Drugs (DAD) study
Authors: Law M , Friis‐Møller N , Weber R , Reiss P , Thiebaut R , Kirk O , D'Arminio Monforte A , Pradier C , Morfeldt L , Calvo G , El‐Sadr W , De Wit S , Sabin CA , Lundgren JD ,   for the DAD Study Group
Published: March 2003

Objectives

To estimate the 3‐year risk of myocardial infarction (MI) among participants in the Data Collection on Adverse Events of Anti‐HIV Drugs (DAD) study.

Methods

Conventional cardiovascular risk equations were applied to baseline data from the DAD study to estimate the 3‐year risk of MI. Best estimates were obtained by simply applying the risk equations, with upper and lower limits based on worst case and optimistic case scenarios. Three‐year risks of AIDS or death were also estimated based on a prognostic scoring system for patients receiving antiretroviral (ARV) treatment, and on estimated AIDS rates in untreated people with HIV for those patients not on ARVs or if they were to cease ARVs.

Results

Analyses were based on 17 600 patients (24.3% female) recruited into the DAD study with baseline data and no previous MI. The overall 3‐year risk of MI was estimated to be 0.72% (lower limit 0.35, upper limit 1.12%), corresponding to a total predicted 127 (65–197) MIs over a 3‐year follow‐up period. The risk was much greater for men than women (0.92% vs. 0.07%), with only three (2–8) MIs predicted in women. The 3‐year risk of MI was estimated to increase from 0.30% (0.20–0.38%) in ARV naive patients to 1.07% (0.43–1.77%) in patients receiving ARVs from all three drug classes. The estimated 3‐year risk of AIDS or death was in the range 6.2% to 11.1% in patients receiving ARVs if they continued treatment, and 22.5% to 29.4% if they ceased ARVs.

Discussion

These models suggest that although the increase in relative risk of MI as a result of ARV treatment may be as high as threefold in a worst case scenario, the absolute risk is modest with a best estimate of 3‐year risk less than or equal to 1% in all groups of patients, and is outweighed by the benefits of ARV treatment in terms of reduced risk of AIDS and death in most patients. As estimates are based on models not validated for people receiving ARV drugs, all estimates should be interpreted cautiously.
Epidemiological study of classic Kaposi’s sarcoma: a retrospective review of 125 cases from Northern Israel
Authors: Weissmann A , Linn S , Weltfriend S , Friedman‐Birnbaum R
Published: March 2003

Background The morphology of Kaposi’s sarcoma is clinically and histologically the same in all clinical forms of the disease. However, there is a difference in the clinical and biological behaviour of the different forms of the disease. The behaviour also differs among individuals with the same form. The factors involved in the initiation and prognosis of the disease are still unknown. The classical form is more common in middle‐aged Jews of East European or Mediterranean origin, people of Italian and southern Greek origin. Classic Kaposi’s Sarcoma is seen relatively more frequently in Israel than in many other countries.

Objective The aim of this study was to examine risk factors that influence the development and course of the disease.

Methods This retrospective study includes 125 patients with Kaposi’s sarcoma, all diagnosed and followed in the Department of Dermatology at Rambam Medical Center in Haifa.

Results The group included 85 (68%) men and 40 (32%) women. Fourteen subjects received corticosteroid therapy and three were kidney transplant recipients. Age at onset of the disease was 21–87 years, with a mean age of 67. A total of 121 patients (96.8%) were Jews and four (3.2%) were non‐Jews. A majority (61.6%) were of East European origin. The number of new cases each year was constant in relation to the general population, except for two peaks, one in 1970 and another in 1986–89. The lower limbs were involved in most patients.123 Extracutaneous involvement was present in 18.4%. Of all the subjects, 28 (22.4%) had diabetes mellitus and 21 (16.8%) had a second primary malignancy. The malignancies were of lymphoreticular origin in 10 patients, four in the urinary bladder, three had carcinoma of the large bowel and one of the pancreas.

Conclusion Our study shows similar clinical findings to those described in other series. The relatively high frequency of carcinomas of the colon and urinary bladder was not reported elsewhere. We observed a consistent rate of new cases each year with two peaks in 1970 and 1986–1989, the cause of which deserves explanation. Of interest is the relative rise in the number of females with Kaposi’s sarcoma. A relative high risk for developing Kaposi’s sarcoma has been found among Jews of Ashkenazi origin compared to those of other ethnic groups. Israeli‐born subjects presented a relatively more aggressive course of disease than others.
Epidemiology of sexually transmitted infections and human immunodeficiency virus in Europe
Authors: Adler MW , Meheus AZ
Published: March 2003

Sexually transmitted infections and HIV in Europe present considerable social and medical problems and are not always adequately controlled. The recent trends for sexually transmitted infections and HIV in Western and Eastern Europe are reviewed.
Melanoma screening: results of the first one‐day campaign in Belgium (‘Melanoma Monday’)
Authors: Vandaele Mm , Richert B , Van der Endt Jd , Boyden B , Brochez L , Del Marmol V , De Boulle K , Garmyn M , Laporte M , Maselis T , Pirard Ch , Roseeuw D , Schramme M , Tromme I
Published: March 2003

Background

Although the incidence of melanoma is increasing and many informative campaigns have been organized. The general population is still little informed about this tumour.

Aims

To organize a media campaign, with more relevant information and the opportunity for free skin inspections.

Methods

A ‘Task Force’ organized a media campaign in April 1999 and convinced 65% of the Belgian dermatologists to give up 4 h of their time to do free skin examinations for skin cancer on Monday 26 April 1999; it was called ‘Melanoma Monday’.

Results

A total 2767 patients were screened. We found 25 melanomas and suspected 59 basal cell carcinomas. In the following 4 weeks another 141 melanomas were found. These 166 melanomas found in one month represent 15–20% of the total number of melanomas per year in Belgium.

A media campaign with relevant information combined with screening opportunities can lead to the early detection of melanomas in a large number of patients and can continue to alert people at risk in the following weeks.
Dermoscopy as a second step in the diagnosis of doubtful pigmented skin lesions: How great is the risk of missing a melanoma?
Authors: Carli P , De Giorgi V , Giannotti B
Published: March 2003

Background

Little is known about the occurrence of false negatives in the diagnosis of melanoma using dermoscopy in clinical practice: in the literature dermoscopy only increased the accuracy of diagnosis of equivocal lesions that were to undergo biopsy anyway.

Aim and methods

We collected the 81 lesions clinically diagnosed as probable melanomas by experienced specialists (from a series of 256 pigmented skin lesions submitted to excisional biopsy) and reviewed them for possible false negative results in the diagnosis of melanoma using in vivo dermoscopy and dermoscopy performed on slide images. Both procedures were carried out by the same experienced dermatologists who classified the lesions clinically.

Results

Dermoscopy made on slide images (observers blinded for clinical features of the lesions) yielded three false negative results (91% sensitivity) in a group of 35 histologically confirmed melanomas. In vivo dermoscopy showed better results, with no melanomas missed (100% sensitivity). The frequency of false positive results in the diagnosis of melanoma was 13.5% (11 of 81) with dermoscopy on slide images and 2.5% (two of 81) with in vivo dermoscopy.

Conclusions

Only in vivo dermoscopy by fully trained dermatologists with both clinical and dermoscopic experience avoids the risk of misclassification of melanomas otherwise correctly classified on clinical grounds.
The use of antidepressant drugs in dermatology
Authors: Gupta MA , Gupta AK
Published: March 2003

This paper provides an updated review of the use of antidepressant drugs in dermatology. Some of the psychiatric disorders that are usually comorbid with dermatological disorders and respond to antidepressants include major depressive disorder, obsessive compulsive disorder, body dysmorphic disorder, social phobia and post‐traumatic stress disorder usually secondary to trauma and abuse during early life. Cutaneous symptoms may be the feature of a primary psychiatric disorder, e.g. cutaneous body image problems, dermatitis artefacta, neurotic excoriations and trichotillomania, or psychiatric syndromes may be comorbid with a primary dermatological disorder such as the association of major depressive disorder or social phobia with psoriasis and obsessive compulsive disorder with acne excoriee. Some of the salient pharmacological properties of the tricyclic antidepressants (TCAs) and the selective serotonin reuptake inhibitor (SSRI) antidepressants are reviewed. The review indicates that the SSRI antidepressants are potentially beneficial in the management of all the major psychiatric syndromes that are encountered in dermatological disorders. The generally more favourable side‐effect profile of the SSRIs, such as lower cardiotoxicity in contrast to the TCAs, has made them the first‐line agents for the treatment of depression. Furthermore, some of the pharmacological properties of the antidepressant agents that are not related to their antidepressant activity, such as the histamine H1 blocking effect of TCAs, such as doxepin, amitriptyline and trimipramine, are of benefit in dermatological conditions such as urticaria and pruritus. This paper reviews the general guidelines for use of antidepressants and salient drug–drug interactions resulting mainly from the inhibition of the cytochrome P450 (CYP) 2D6 and 3A3/4 isoenzymes by some of the SSRI antidepressants. Before prescribing an antidepressant agent, the specific guidelines, side‐effect profile, drug–drug interactions and most current indications should always be obtained.
Hypopigmentation after non‐permanent henna tattoo
Authors: Wöhrl S , Hemmer W , Focke M , Götz M , Jarisch R
Published: March 2003

A young girl presented with a hypopigmentation in the shape of the sun. During a holiday in Egypt 3 months before a non‐permanent henna tattoo had been applied on her right upper arm. Three to 4 days later there was a severe cutaneous reaction followed by massive swelling of the arm. The lesion took 6 weeks to subside. Patch testing revealed positive reactions to para‐phenylenediamine (PPD) but not to henna or any other standard allergen. Especially in Arabic countries PPD is a common additive in natural henna preparations to enhance the weak colouring properties of the natural henna dye. We conclude that henna preparations may contain ‘hidden’ allergens, such as PPD, which can provoke severe cutaneous reaction without any cosensitization to the henna dye itself.
Treatment principles of atopic dermatitis
Authors: Thestrup‐Pedersen K.
Published: March 2003

Atopic dermatitis (AD) is today the most common, chronic inflammatory skin disease among children in developed countries. Its cumulative prevalence varies from 20% in northern Europe and the USA to approximately 5% in Mediterranean countries. As a chronic disease it puts a special demand on treatment. There is no curative therapy, but competent guidance on treatment principles can control the disease in most, if not all children. This article summarizes the evidence‐based knowledge that relates to the treatment of atopic eczema. It also gives advice and opinions on prophylactic measures as these are the focus of interest from most parents.

Learning objective

This article should enable you to give advice and guidance to parents of children with AD, including what is necessary for diagnosis, what is of value and importance considering allergies and allergological investigations, allergen exposure, prophylactic measures, diets and indoor environment. Finally, you should be able to explain the diversity of treatment principles for parents.
Urethral caruncle in a male: a case report
Authors: Karthikeyan K , Kaviarasan PK , Thappa DM
Published: March 2003

Urethral caruncle in a 60‐year‐old male labourer is being reported. Its occurrence in male urethra has not been reported so far in the literature.
Chronic prostatitis and chronic pelvic pain in men: aetiology, diagnosis and management1
Authors: Luzzi GA
Published: March 2003

Patients with chronic prostatitis/pelvic pain syndrome typically report genital or pelvic pain (in or around the penis, perineum, scrotum) lasting >3 months. Whereas true chronic bacterial prostatitis is an uncommon condition characterised by recurrent prostatic and urinary infection, chronic pelvic pain syndrome (CPPS) is a common condition in which no infection is found. Recent surveys suggest a prevalence of 2.5–3% for CPPS. The four‐glass test, traditionally used to distinguish inflammatory and inflammatory forms of CPPS, has not been adequately validated; whether the distinction is clinically meaningful is increasingly questioned. The aetiology of CPPS is not known; urodynamic studies imply a neuromuscular origin. More recent work supports a role for proinflammatory cytokines in the pathogenesis. In the management of chronic bacterial prostatitis, trials support the use of quinolone antibiotics as first‐line treatment. In contrast, the management of CPPS is generally unsatisfactory, as no reliable treatment has been identified. Treatments commonly tried include antibiotics (notably tetracyclines, quinolones and macrolides), anti‐inflammatory agents, and alpha blockers. Newer approaches include trials of finasteride, quercetin and rofecoxib. A recent systematic review demonstrated that none of the current diagnostic and treatment methods for CPPS is supported by a robust evidence base.
Temporal arteritis presenting with scalp ulceration
Authors: Monteiro C , Fernandes B , Reis J , Tellechea O , Freitas J , Figueiredo A
Published: March 2003

We report the case of a 75‐year‐old‐woman who presented with bilateral scalp ulcerations and blindness, accompanied by severe headache and scalp tenderness, due to bilateral temporal arteritis without systemic involvement. A biopsy taken from the border of an ulceration showed evidence of giant cell arteritis. She was treated with oral prednisone, 60 mg per day. The ulcerations healed in a few weeks but the vision loss was irreversible.

 This case highlights for temporal arteritis the importance of accurate and timely diagnosis as well as the need for prompt therapy with systemic steroids in order to avoid major complications, namely loss of vision. It also demonstrates that scalp necrosis and ulcerations are skin signs associated with a poor prognosis.
A case of bacillary angiomatosis presenting as leg ulcers
Authors: Karakaş M , Baba M , Homan S , Akman A , Acar MA , Memişoǧlu HR , Gümürdülü D
Published: March 2003

We report a 32‐year‐old immunocompetent man who had multiple leg ulcers caused by bacillary angiomatosis without a history of direct contact with cats. Bacillary angiomatosis should be kept in mind in the differential diagnosis of leg ulcers in cases of unknown aetiology.
A Preliminary Study Investigating How People with Mild Intellectual Disabilities Perform on the Rivermead Behavioural Memory Test
Authors: Martin Claire , West Jenny , Cull Chris , Adams Malcolm
Published: March 2003

Twenty participants with mild intellectual disabilities (IQ = 55–75) completed the Rivermead Behavioural Memory Test (RBMT; adult version). There was a significant difference in performance across the 12 subtests, with the tests relying on verbal memory (e.g. story recall) proving the most difficult and those depending on visual memory (e.g. picture recognition) the easiest. There was also a negative correlation between age and RBMT scores. It is concluded that the RBMT is a suitable test to use with this population; it provides useful clinical information, but as the test currently stands, identification of specific memory impairments may not be possible.
Interrogative Suggestibility, Memory and Intellectual Disability
Authors: Beail Nigel
Published: March 2003

Background  Psychologists are often asked to prepare reports on suspects, complainants and witnesses with intellectual disabilities for court. Increasingly, the Gudjonsson Suggestibility Scales are being used as part of the assessment process. This paper critically examines the use of the Gudjonsson Suggestibility Scales with adults with intellectual disabilities and considers alternative explanations for test data.

Argument  It is argued that the scales have been developed in a way that significantly disadvantages people with intellectual disabilities compared with those of average ability. The scales are more likely to elicit acquiescent responses from people with intellectual disabilities as participants are questioned on information they can barely recall. Drawing on models of memory developed in the field of cognitive neuroscience, it is argued that this is a consequence of examining unimodal input into semantic memory, which is impaired in people with intellectual disabilities. Police interviews are rarely concerned with semantic memory alone but with autobiographical event memory of multimodal input. Research on people with intellectual disabilities' event memory shows higher levels of accuracy, less of a tendency to acquiesce and greater resistance to suggestion.

Conclusions  Currently, the Gudjonsson Suggestibility Scales are the only tests available for the assessment of interrogative suggestibility. However, psychologists using these scales with adults with intellectual disabilities should do so with caution as their validity is questionable. Studies of intellectually disabled adults' autobiographical event memory show that they can provide reasonably accurate accounts of events and resist questions designed to alter their account.