Quantitative risk assessment of FMDV introduction in a FMD free country through bone-in beef and offal importation from a FMD free with vaccination country/zone.

Quantitative risk assessment was used to estimate the risk of introducing foot-and-mouth disease (FMD) through bone-in beef from Argentina (FMD-free with vaccination status) into other FMD-free countries. A stochastic model was built to characterize all the steps from primary production to bone-in beef export and introduction into an FMD-free country. The probability that bone-in beef from at least one animal infected with the FMD virus (FMDV) was exported during a year was 5.27 × 10-3 (95% CI <10-10 - 5.19 x 10-2) or in other words one case in 190 years. The risk of FMDV introduction was sensitive to the probability of an outbreak occurring in Argentina (r [Spearman´s rank correlation] = 0.99) and the number of herds affected during an outbreak (r = 0.10). Additionally, the probability that susceptible animals in the importing country came into contact with infective material (bones) and generated an outbreak was 6.16 × 10-4 (95% CI <10-10 - 6.20 ×10-3) or one FMD outbreak every 1623 years on average. Based on the quantitative risk assessment results, the probability of FMDV introduction into a FMD-free country where vaccination is not practiced from a FMD-free country where vaccination is practiced associated with bone-in beef trade from Argentina was negligible. The risk of an FMD outbreak caused by the potential introduction of the FMDV was associated with the existing conditions in the country. Thus, maintaining the FMD-free status with or without vaccination would not be relevant.

Implementation of an HACCP model in foot and mouth disease control programmes.

The organisation and structure of the official Veterinary Services (OVS) are designed to meet a specific aim--the health certification of animal health, welfare and food safety in the production and processing stage. Disease prevention and control calls for programmes and projects that, depending on the characteristics of each disease, may involve any branch of the OVS, from the laboratory to field activities. For the purpose of this work, the model used is that of a country that is 'free from foot and mouth disease with vaccination' in accordance with the conditions stipulated in Chapter 8.8. of the World Organisation for Animal Health Terrestrial Animal Health Code. These conditions state that, to maintain this health status, a programme of monitoring and continuous control of the relevant variables must be implemented. This is achieved by applying good practice and identifying the critical control points in all processes, using a checklist that simplifies the task. The system that is developed can also serve as a guide for internal or external programme audits.

'Look and Lletz'--a Chris Hani Baragwanath Hospital experience.

OBJECTIVES: An audit was undertaken of a 'colposcopy and treatment' clinic between April 2003 and December 2006, to determine: (i) the frequency of overtreatment with Papanicolaou smear on its own, colposcopy on its own or a combination of the two methods; (ii) differences in overtreatment between patients who are HIV positive and those who are HIV negative; and (iii) the short-term complications of Lletz (large loop excision of the transformation zone) at this clinic. DESIGN: An analysis of the data from the colposcopy clinic database of patients, who were referred according to national guidelines. SETTING: Patients who are referred to Chris Hani Baragwanath Hospital. RESULTS: Normal histology was found in 1.3% of patients, and cervical intraepithelial neoplasia (CIN)1 or human papillomavirus (HPV) in 8.4%. The overall complication rate was 3%. CONCLUSION: The high loss to follow-up and the low early complication rate together with an acceptable overtreatment rate make this a justifiable approach in our situation. HIV-negative women were more likely to be overtreated than HIV-positive patients(p=0.03).

Cervical length at 23 weeks' gestation--relation to demographic characteristics and previous obstetric history in South African women.

OBJECTIVES: To determine the distribution of cervical length in a routine population of singleton pregnancies; to examine the relationship between cervical length, demographic characteristics, and previous obstetric history; and to compare these data with data from a similar study undertaken in the UK. PATIENTS AND METHODS: The study was conducted among women attending routine antenatal clinics at Coronation, Johannesburg General and Chris Hani Baragwanath hospitals. Cervical length was measured by means of transvaginal ultrasound at 23 weeks' gestation in women with singleton pregnancies attending these clinics, as part of a multicentre randomised trial investigating the value of cerclage in a short cervix. The distribution of cervical length was determined and the significance of differences in median cervical lengths between subgroups was calculated according to maternal age, ethnic origin, maternal body mass index (BMI), cigarette smoking, alcohol intake, and previous obstetric history. RESULTS: Cervical screening was offered to women (N = 2 173) attending clinics for a 23-week scan during the study period (July 1999-September 2002). Most women (N = 1 920) accepted, while 253 declined. Complete outcomes (date and mode of delivery, gestation at delivery, birth weight, Apgar scores, maternal blood loss, whether the patient was cerclaged or not, and any complications) were obtained for 1 603 women who accepted screening. Cervical length was measured successfully in all cases. Median cervical length was 33.7 mm and in 64 cases (3.3%) the length was 15 mm or less. Significantly shorter cervical lengths were found in those with a history of previous miscarriage, preterm delivery, those aged less than 20 years and those with an abnormal BMI. Cervical length was not significantly shorter in black women than in coloured and white women. CONCLUSIONS: At 23 weeks' gestation the median cervical length in a South African population was 33.2 mm. In 3.3% of the population the length was < or = 15 mm. There was an association between cervical length, demographic characteristics and previous obstetric history.

Bovine spongiform encephalopathy in South America: a regional preventive approach.

Bovine spongiform encephalopathy (BSE) is a neurodegenerative disease of cattle caused by prions that was first described in the United Kingdom (UK) in 1986. The BSE epizootic that commenced in the UK in the 1980s has since spread into other countries in Europe and Asia through exports of contaminated meat-and-bone meal or infected cattle. Over the past few years, other emerging or reemerging diseases have spread into previously free countries or regions through international trade. This negative effect of globalisation means that to implement successful preventive and strategic programmes to safeguard animal health, such programmes must, as a priority, take a regional approach. Global thinking, regional planning and local performance constitute the key factors for the successful control of animal diseases. In South America, initial preventive actions against BSE were adopted in 1989. Further measures adopted since then and based on new scientific and technical findings, have led to the demonstration that the region is free of BSE. These early preventive actions have reliably protected the region from importing BSE-infected material. An integral part of the project to determine the BSE status of South America was the training of personnel, the incorporation of technology and the provision of updated information through close relationships with international organisations and prominent international researcher workers. Regional activities aimed at harmonising BSE prevention programmes, producing objective and transparent data on the equivalence of regional BSE status and facilitating regional and international trade have recently been launched. Maintaining the BSE-free status of the region must be given high priority by the beef agro-industrial sectors.

Glycyrrhizic acid: the assessment of a no effect level.

Because from earlier experiments in rats and a pilot study in humans a no-effect level of glycyrrhizic acid could not be established, a second experiment was performed in healthy volunteers. The experiment was performed in females only, because the effects were most marked in females in the pilot study. Doses of 0, 1, 2 and 4 mg glycyrrhizic acid/kg body weight were administered orally for 8 weeks to 39 healthy female volunteers aged 19-40 years. The experiment lasted 12 weeks including an adaptation and a "wash-out" period. A no-effect level of 2 mg/kg is proposed from the results of this study, from which an acceptable daily intake (ADI) of 0.2 mg/kg body weight can be extrapolated with a safety factor of 10. This means consumption of 12 mg glycyrrhizic acid/day for a person with a body weight of 60 kg. This would be equal to 6 g licorice a day, assuming that licorice contains 0.2% of glycyrrhizic acid. The proposed ADI is below the limit advised by the Dutch Nutrition Council of 200 mg glycyrrhizic acid/day. This reflects the relatively mild acute toxicity of glycyrrhizic acid, which is also emphasised by the "generally recognised as safe" (GRAS) status of glycyrrhizic acid in the USA in 1983. However, the long-term effects of a mild chronic intoxication (causing, for example, a mild hypertension), although not immediately lethal, justify special attention to the amount of glycyrrhizic acid used daily.

Betamimetics in fetal distress: randomised controlled trial.

The objective of the study was to investigate if a single dose of Hexoprenaline administered to patients diagnosed as having fetal distress improves neonatal outcome and whether there are any side effects and complications related to hexoprenaline injection. Patients with fetal distress diagnosed by electronic fetal heart rate monitoring with a gestational age of 35 weeks or more in active labor were eligible. Once the decision to deliver the patient by Cesarean section was made, patients were approached and randomised by sealed opaque envelopes to hexoprenaline or control groups. Ten micrograms of hexoprenaline were administered intravenously to study patients. Main outcomes were cord blood gas values, Apgar scores, the need for resuscitation and admission to intensive care. There were no statistically significant differences in the main outcome measures between the two groups. Fewer babies in the hexoprenaline group had a pH of < 7.2 and a base excess of < -10, but this was not statistically significant. The fetal heart rate pattern was improved in significantly more patients after hexoprenaline administration than controls. In conclusion, despite the statistically significant improvement in fetal heart rate tracings, Apgar scores and blood gas values showed only a trend towards improvement in the hexoprenaline group.

Bovine spongiform encephalopathy surveillance in Argentina.

Bovine spongiform encephalopathy (BSE) is a new disease of cattle first described in the United Kingdom in November 1986. BSE belongs to the scrapie-related group of diseases. The epidemiological studies performed in the United Kingdom demonstrate that the BSE epidemic was caused by feeding cattle with ruminant-derived protein contaminated by a scrapie-like agent. Until June 1994, the disease had been detected in indigenous cattle in Ireland, Switzerland and France. Three cases reported in Germany, two in the Sultanate of Oman, and single cases in the Falkland Islands (Islas Malvinas), Denmark, Portugal and Canada occurred in animals imported from the United Kingdom. Several countries have implemented surveillance programmes analysing the risk factors involved in the epidemic. An analysis of risk factors conducted in Argentina shows that it is highly unlikely that BSE or scrapie exist in the country, or will arise via feed in the future. As a continuation of the analysis of risk factors, a surveillance programme was implemented in the field and in abattoirs. Specialised personnel were trained in the clinical, histopathological and biochemical detection of the disease through a network of laboratories which covered 85% of the total cattle population and 100% of the high-risk group (dairy cows over five years of age). By using a statistical procedure with reference to the bovine population in nine provinces, 1,019 brains from animals belonging to the high-risk group were selected and studied by histopathological and biochemical analyses for BSE detection. The results were negative in all cases. It can be concluded from this analysis (with a sensitivity of detection of 2.95 per 1,000, and 95% statistical confidence) that Argentina may be regarded as BSE-free, and that the importation of infected animals or by-products may represent the sole potential source of introduction of BSE infection into the country in the future.

[Analysis of risk factors associated with bovine spongiform encephalopathy in Argentina]. / Análisis de los factores de riesgo asociados a la encefalopatía espongiforme bovina en Argentina.

Epidemiological studies conducted in the United Kingdom have revealed the risk factors involved in the epidemic of bovine spongiform encephalopathy (BSE). This has facilitated a detailed study of risk factors associated with the possible introduction of BSE into Argentina. An analysis has been made of the numbers and geographical distribution of cattle in the country, the structure of the Veterinary Services responsible for controlling animal diseases, the way in which cattle and sheep are slaughtered, and the use of slaughter waste in the feed industry. The results of this analysis form the basis of a discussion of whether scrapie or BSE could become endemic in Argentina through contaminated feed or another route. The authors conclude that Argentina may be regarded as free from BSE, and that the importation of infected bovines is the sole potential risk for introduction of BSE in the future.

Polycystic ovarian syndrome. Evidence for an autoimmune mechanism in some cases.

Antiovarian autoantibodies localized to the granulosa cells were detected in 50% of a group of eight patients diagnosed with polycystic ovarian syndrome. An analogy is drawn to other endocrinopathies characterized by hypersecretion of hormones, notably thyroid and adrenal, and a pathogenetic mechanism involving stimulating antibody is postulated.

The no-effect level of sodium bromide in healthy volunteers.

1. A total of 0, 4 and 9 mg kg-1 body weight sodium bromide was administered orally to 45 healthy female volunteers. 2. The experiment lasted for six menstrual cycles: only during the first three cycles was bromide administered; 3. At the start, at the end of the administration period and at the end of the experiment a physical examination and haematological and routine clinical chemistry tests were performed. Except for nausea in relation to the intake of bromide, no adverse effects were observed. 4. The bromide concentration in plasma rose to 3.22 +/- 0.93 mmol kg-1 in the 4 mg kg-1 group and to 7.99 +/- 1.89 in the 9 mg kg-1 group by the end of the administration period. 5. Before and at the end of the experiment the thyroid hormones (T4, FT4, TBG, T3 and TSH) were analysed. No significant differences were observed between the groups. 6. Before, after three menstrual cycles and at the end of the experiment an EEG with a Visual Evoked Response was recorded. At the 4 and 9 mg kg-1 dose level in the alpha 1-band and the beta-bands significant changes were found (P < 0.1 and P < 0.05, respectively). The Visual Evoked Response showed no significant differences between the three groups. 7. From this experiment and previous experiments a no-effect level in humans for sodium bromide of 4 mg kg-1 body weight is proposed.

Motives and perception of healthy volunteers who participate in experiments.

Healthy volunteers who participated in an experiment were asked to complete a questionnaire about their experiences. Special attention was paid to their motives and the informed consent procedure. The motives of healthy volunteers for participating in a study differed according to age. Young volunteers mostly participated because of the financial compensation, while older volunteers mainly participated to get a medical check-up, which was part of the selection procedure, or because of the benefit that other people might obtain from the results of the experiment. In most experiments the volunteers were content with the information given about the experiment, which was provided orally and in a hand-out. The information procedure was crucial for the experiment, because optimum information was of the utmost importance in keeping the volunteers motivated during the experiment. Another conclusion was that the researcher should not be afraid that too much information was given. Adequate information was also important in recruiting new volunteers, because they mostly become interested because of information obtained from their predecessors. A personal approach towards the volunteers during the experiment was appreciated by them and was an important help in keeping the volunteers motivated during the experiment.

The effects of histamine administered in fish samples to healthy volunteers.

The effects of histamine administered in samples of fish to eight healthy volunteers (4 females and 4 males), aged 21-30 years, were studied. The subjects were given 0, 45 and 90 mg of histamine that had been metabolized from histidine by photobacteria in the fish and 90 mg of histamine added to fresh fish, for breakfast. The subjects were observed during 6 h after breakfast. Special attention was paid to clinical symptoms, blood pressure and ECG. The pH of the gastric contents was recorded continuously from 5 min before to 6 h after the meal. Blood samples to measure the histamine concentration were taken at intervals during 24 h after breakfast. Two of the subjects showed effects (facial flushing, headache) that could be attributed to the ingestion of histamine. No significant changes were observed in the blood pressure and ECG. The pH of the gastric fluids did not decrease significantly. The histamine concentration in plasma correlated closely with the histamine dose ingested (p < 0.001, r = 0.996). The Cmax of the dose of 90 mg did not differ statistically significant from the Cmax of the dose of 90 mg histamine added to unspoiled fish.

[A drowsy child: benzodiazepine poisoning?]. / Een suf kind: benzodiazepine-intoxicatie?

In The Netherlands accidental intoxications in children due to benzodiazepines are regularly encountered. In 1987 of 1630 requests for information at the National Poison Control Centre about probable benzodiazepine intoxications 144 (8.8%) concerned children 0-12 years of age. The symptoms of this type of intoxication are non-specific and if the physician does not think of benzodiazepine intoxication extensive diagnostic procedures may be performed. If children show symptoms e.g. unconsciousness, ataxia and hypotonia, the physician should always think of benzodiazepine intoxication and try to confirm or to exclude this possibility by toxicological analysis. We discuss ways and means of the diagnosis and how to avoid pitfalls on the way.