Allergic contact hand dermatitis due to constituents of nitrile gloves

Purpose: This report of a case of allergic contact hand dermatitis due to constituents of nitrile gloves is to bring to the attention of practitioners four important practice points: 1) allergic contact dermatitis may occur due to exposure to chemicals in nitrile gloves; 2) skin patch testing is used to identify the causative allergens; 3) targeted allergens may be necessary in addition to the baseline European standard series if the standard series is unhelpful; and 4) there are potential interventions to manage nitrile glove dermatitis. Findings: A laboratory analyst had occupational exposure to several allergens and had worn latex gloves. She was exposed to laboratory chemicals and powdered ore dust, containing precious metals. She developed hand dermatitis and was relocated to administrative duties not requiring glove use. Her dermatitis cleared but recurred when she returned to the laboratory and started using nitrile gloves. On history, nitrile gloves and platinum group metal ore dust were consistently associated with her hand dermatitis, but laboratory chemicals were not. Latex-specific immunoglobulin E (IgE) was negative, as were skin patch tests for 13 allergens in the metal series, including salts of platinum group metals. She had positive allergic reactions to cobalt chloride, formaldehyde, nickel sulphate, and quaternium 15 in the European standard series patch tests. She did not react to the rubber chemicals in the European standard series, including thiuram mix. The patient was then tested with the rubber additives series because of the glove-relatedness of her hand dermatitis. She had positive reactions to three thiuram compounds used as accelerators in rubber gloves. The patient went on vacation during which time her dermatitis improved. She was relocated to a position without glove use or ore contact and her dermatitis did not recur. Conclusions: An analytic laboratory worker developed hand allergic contact dermatitis due to nitrile glove constituents. The diagnosis is supported by the improvement in her dermatitis after cessation of glove use, negative metal series patch tests, and positive patch tests to accelerators found in rubber gloves. Nevertheless, a contribution to the dermatitis by metals in the platinum group metal ore dust cannot be excluded. Recommendations: Nitrile glove constituents should be considered in wearers who develop hand dermatitis. Skin patch testing is recommended to investigate putative agents. Specific patch test series for more targeted testing may be required

Rat hepatoproliferin revealed the status of a complete hepatomitogen in human hepatoma cells.

Hepatoproliferin (HPF), a liver regeneration factor isolated from rat hepatocytes, was assessed for its mitogenic status in the human hepatoma cell line PLC/PRF-5. HPF was able to enhance hepatoma cell growth on its own without the aid of the established complete mitogens EGF and TGF-alpha or the hepato-priming factor TNF-alpha. HPF therefore acted as a complete hepatomitogen and had no co-mitogenic properties since it did not augment proliferation when combined with EGF or TGF-alpha but showed only an additive effect in the presence of TGF-alpha. Rat HPF was phylogenetically unrestricted, because it was found active in human cells. When each of the established growth factors (GFs) was used alone, the hepatoma cells responded with the same kind of response profile, namely a bi-phasic bell-shaped dose-dependent response due to stimulation at low levels and inhibition at higher levels. However, hepatocyte growth factor (HGF) was an exception since it did not induce a growth response in hepatoma cells. On the contrary HPF, on its own, showed a progressive enhanced linear dose response at the levels used for the GFs (ie 1.0-15 ng/5 x 10(5) cells). The comparative potency (CP) (dpm x 10(3)/microg DNA/ng GF) of HPF (CP = 13) was in the same range as for the complete hepatomitogens EGF (CP = 12) and TGF-alpha (CP = 14), revealing that HPF has indeed the status of a complete mitogen.

The nutritional status of black adults in rural districts of Natal and Kwazulu.

A nutritional field survey was undertaken in 11 rural districts of Kwazulu. Standard anthropometric measurements (weight, height, triceps skinfold thickness, mid-arm circumference) were taken from 1 725 adults (616 males, 1 109 females), including 337 old-age pensioners, and a recall dietary intake questionnaire was completed by 297 male and 572 female Zulus. Mean body weights (+/- SD) were 95 +/- 10% of ideal for males and 118 +/- 15% for females. Consequently 39% of the male sample was undernourished (i.e. less than 80% ideal weight) and 17% of the female group obese (greater than 140% ideal weight). Undernutrition was significantly more common in old-age pensioners, with 73% of males and 23% of females being below 80% of the standard for body weight. Diet consisted mainly of refined maize meal (putu) 2-3 times per day. Meat and fresh milk were rarely taken, the average intake frequency for men being once a week and for women once a fortnight. Vegetable intake was seasonal, wild spinach and cabbage being consumed daily only during the summer rainfall months. Average fibre intake was therefore surprisingly low at approximately 10 g/d per individual. In conclusion, although poor socio-economic conditions are the root cause of most of the malnutrition problems observed, basic nutritional education can at least partially help by advising the population of the importance of a varied diet and the problems associated with obesity. More use of legumes, eggs, milk and fish products should significantly improve the diet. The reasons for the particularly high incidence of malnutrition among the elderly need further investigation.

Relationship between nutritional status, dietary intake patterns and plasma lipoprotein concentrations in rural black South Africans.

Coronary artery disease remains rare in rural Africans. The survey reported here was conducted in order to investigate nutritional factors that might be responsible for this. The nutritional status, dietary intake and plasma lipoprotein concentrations of a representative sample (42 men, 60 women) of the inhabitants of a rural district in Zululand, South Africa, were measured. Results demonstrated that whilst men were generally underweight (ie, 20 per cent below 80 per cent of ideal body weight), women were commonly obese (20 per cent were over 140 per cent of ideal). The major dietary component was refined commercial maize-meal with infrequent intakes of animal and dairy products. Dietary fibre intake was consequently low (approximately 10 g/d). Low plasma cholesterol concentrations were found in 67 per cent of men and 42 per cent of women. High density lipoprotein (HDL) concentrations were generally lower than quoted 'desirable' levels. The results of our survey suggest that the low incidence of ischaemic heart disease (IHD) in rural Africans is associated with a diet low in cholesterol but often excessive in carbohydrate, resulting in obesity. HDL concentration and dietary fibre intake were low and therefore could not be invoked as 'protective'. The possibility of genetic resistance to IHD remains.