Clinical standards for the management of adverse effects during treatment for TB.

BACKGROUND: Adverse effects (AE) to TB treatment cause morbidity, mortality and treatment interruption. The aim of these clinical standards is to encourage best practise for the diagnosis and management of AE.METHODS: 65/81 invited experts participated in a Delphi process using a 5-point Likert scale to score draft standards.RESULTS: We identified eight clinical standards. Each person commencing treatment for TB should: Standard 1, be counselled regarding AE before and during treatment; Standard 2, be evaluated for factors that might increase AE risk with regular review to actively identify and manage these; Standard 3, when AE occur, carefully assessed and possible allergic or hypersensitivity reactions considered; Standard 4, receive appropriate care to minimise morbidity and mortality associated with AE; Standard 5, be restarted on TB drugs after a serious AE according to a standardised protocol that includes active drug safety monitoring. In addition: Standard 6, healthcare workers should be trained on AE including how to counsel people undertaking TB treatment, as well as active AE monitoring and management; Standard 7, there should be active AE monitoring and reporting for all new TB drugs and regimens; and Standard 8, knowledge gaps identified from active AE monitoring should be systematically addressed through clinical research.CONCLUSION: These standards provide a person-centred, consensus-based approach to minimise the impact of AE during TB treatment.

Factors influencing sunless tanning with dihydroxyacetone.

BACKGROUND: Sunless tanning preparations have been used for more than 50 years and are still very popular because they provide temporary pigmentation resembling an ultraviolet-induced tan. The pigment is the product of reactions between dihydroxyacetone (DHA) and amino acids in the stratum corneum. OBJECTIVES: To understand the factors that influence the reactions of DHA with amino acids in the stratum corneum with the ultimate goal of producing pigmentation with greater photoprotection. METHODS: The influence of hydration and/or oxygen on the development of DHA-induced pigment was assessed in vivo using an occlusive dressing and ex vitro on human epidermal preparations. Two spectroscopic techniques, diffuse reflectance and fluorescence emission, were used to monitor the extent of pigment development. The optimal relative humidity for DHA-induced pigmentation was assessed on the epidermal preparations. The formation of products from reactions between DHA and nine amino acids was studied in solutions buffered at pH 5 and 7. RESULTS: Development of DHA-induced pigmentation was inhibited by a 24-h occlusive dressing but appeared after its removal, indicating that DHA was still present. High hydration but not the absence of oxygen inhibited coloration of occluded skin. The extent of pigmentation did not vary in a simple manner with hydration, as pigment formation was positively correlated with humidity from 0 to 75% but negatively correlated from 75 to 100%. Lysine, glycine and histidine reacted most rapidly with DHA, with reaction rates greater at pH 7 than at pH 5. The products absorbed with maxima at wavelengths up to 340 nm. CONCLUSIONS: These results indicate that extent of hydration, pH and availability of certain amino acids influence the development of DHA-induced pigmentation in the stratum corneum and suggest that manipulation of these factors might produce pigmentation with greater photoprotection.

Endogenous skin fluorescence is a good marker for objective evaluation of comedolysis.

OBJECTIVE: evaluation of comedone lesions, especially in vivo, remains a challenge. We have used the rhino mouse model in combination with topical application of all-trans retinoic acid as a comedolytic agent, to investigate the potential of fluorescence spectroscopy as a noninvasive technique in the assessment of noninflammatory acne. The results indicate that there is a strong correlation between the fluorescence excitation spectral features assessed in vivo, and the histologic changes identified, particularly the size of the utriculi as well as the dermal and epidermal thickness. We conclude that fluorescence excitation spectroscopy represents a promising novel and useful tool in the quantitative evaluation of the pseudocomedones and could also be used for the rapid and noninvasive assessment of comedolysis induced by the application of pharmacologic agents such as retinoids.

Multicenter clinical trial of ultrasmall superparamagnetic iron oxide in the evaluation of mediastinal lymph nodes in patients with primary lung carcinoma.

The purpose of this study was to evaluate the clinical efficacy of ultrasmall superparamagnetic iron oxide particles as a magnetic resonance (MR) contrast agent in differentiating metastatic from benign lymph nodes. Eighteen patients with primary lung malignancy and suspected regional lymph node metastases underwent MR imaging before and after Combidex(R) infusion in a multi-institutional study. All MR sequences were interpreted by one or more board-certified radiologists experienced in imaging thoracic malignancy. Each patient was evaluated for the number and location of lymph nodes, homogeneity of nodal signal, and possible change of MR signal post contrast. All patients underwent resection or sampling of the MR-identified lymph node(s) 1-35 day(s) post contrast MR imaging. In all, 27 lymph nodes or nodal groups were available for histopathologic correlation. Combidex had a sensitivity of 92% and a specificity of 80% in identifying pathologically confirmed metastatic mediastinal lymph nodes. Based on our preliminary data, Combidex MR imaging may provide additional functional information useful in the staging of mediastinal lymph nodes.

Information needs and information-seeking behaviors of on-call radiology residents.

RATIONALE AND OBJECTIVES: The authors performed a baseline analysis of the information needs and information-seeking behaviors of on-call radiology residents to learn how to better serve their on-call information needs in the future. MATERIALS AND METHODS: Print, electronic, and human information resources were made conveniently available to on-call radiology residents. A prospective, descriptive study was performed by using a modification of the critical incident technique to gather data from the residents every morning after being on call. Residents were asked to recall questions that arose, whether they sought answers to the questions, where they searched for answers, whether their search was successful, and whether they believed that patient care was affected. RESULTS: The residents had 182 questions that encompassed all organ systems, imaging modalities, and aspects of radiologic practice. Residents sought answers to 138 of the 182 questions (76%) by using a wide variety of resources, with staff members and textbooks being the most common. They found answers to 114 of 138 questions (83%); 100 of the 114 (88%) answered questions affected patient care. CONCLUSION: The ideal way to meet the information needs of on-call radiology residents is to devise an authoritative information resource that is compatible with their information-seeking behaviors.

CH4 and CO emissions from rice straw burning in South East Asia.

Atmospheric samples collected during rice straw burning at four different locations in Viet-Nam during the dry (March 1992, February 1993) and wet season (August 1992) were analysed for CO2, CO, and CH4. The emission ratios relative to CO2 for CO and CH4 for rice straw burning during the dry season were comparable to those observed on samples collected during burning of savanna in Africa or forest in the USA. During the wet season, however the emission ratios for CO and CH4 relative to CO2 were 3 to 10 times higher. With these emission ratios and estimates of rice production from Southeastern Asia, we estimated that burning of rice straw emits annually about 2.2 Tmol of CO (26 TgC) and 0.2 Tmol of CH4 (2.4 TgC) to the atmosphere. Taking into account these new results, CO and CH4 fluxes from biomass burning could be reevaluated by 5-21% and 5-24%, respectively, in respect with previous estimates of these gas emissions from all biomass burning activities.

[Influence of calcic and magnesic sulphurous thermal water on the metabolism of lipoproteins in the rat]. / Influence d'une eau thermale sulfatée calcique magnésienne sur le métabolisme des lipoprotéines chez le rat.

We have studied in rats fed hypercholesterolemic diet the action of calcic and magnesic sulphurous water from Capvern on the modification of the lipoproteins metabolism caused by hypercholesterolemia. The rats subjected to a hypercholesterolemic diet with thermal water of Capvern was found to have a plasma level of cholesterol significantly less increased (P less than 0.01) compared to those subjected to the same diet with ordinary drinking water (25%). We demonstrated after 105 days of experimentation on tested rats that thermal water may affect the cholesterol catabolism by increased level of cholesterol HDL (52%) and stabilizing level of cholesterol LDL comparatively to the controls. These data suggest that the thermal water from Capvern enhanced the transformation of cholesterol to biliary acids and their biliary secretion. A possible relationship between the influence of the thermal water and the metabolism of lipoproteins would be explained by a possible increase of hepatic receptors which identify apolipoproteins B (LDL) and E (HDLc) on cholesterol fed rats, suggesting a great synthesis of nascent apolipoproteins HDL which are antiatherogenic.