Arsenic in the cerebrospinal fluid of a patient receiving arsenic trioxide for relapsed acute promyelocytic leukemia with CNS involvement

We report on a 42-year-old patient whose relapse of acute promyelocytic leukaemia (APL) included meningeal infiltration. Since he had previously experienced ATRA syndrome, he received arsenic trioxide (ATO) plus intrathecal therapy with cytarabine, prednisone, and methotrexate. We measured the concentration of arsenic in his cerebrospinal fluid (CSF). Arsenic showed a peak CSF concentration of 0.008mg/l (0.11mumol/l) and a nadir of 0.002mg/l (0.027mumol/l), both representing about 14% of blood levels. ATO thus crosses the blood-CSF-barrier when administered intravenously, but the concentration in CSF is probably not sufficient for treatment of meningeal leukemia

Management of environmental health issues for the 2004 Athens Olympic Games: is enhanced integrated environmental health surveillance needed in every day routine operation?

BACKGROUND: Management of environmental health issues is an integral part of public health systems. An active integrated environmental health surveillance and response system was developed for the Athens Olympics to monitor and prevent exposure to environmental hazards. The potential for permanent implementation of the program was examined. METHODS: The environmental health surveillance and response system included standardization, computerization and electronic transmission of data concerning environmental inspections of 17 site categories (restaurants, swimming pools etc) of public health interest, drinking and recreational water examinations and suggested corrective actions. The Olympic Planning Unit integrated and centrally managed data from 13 public health agencies, recommended, supervised and coordinated prompt corrective actions. Methods used to test the effectiveness of the program were the assessment of water quality test and inspection results trends over time using linear regression and epidemiological surveillance findings. RESULTS: Between January 2003 and September the 30th, 2004, 196 inspectors conducted 8562 inspections, collected 5024 water samples and recommended 17 027 corrective actions. In 10 cruise ships used as floating hotels inspectors conducted 10 full inspections, 2 re-inspections, and 27 follow-up inspections. Unsatisfactory inspection results (r = 0.44, p < 0.0001) and positive water quality tests (r = 0.39, p < 0.001) presented an overall decrease trend over time. In August, 2003, an outbreak of salmonellosis was linked to a hotel restaurant which accommodated athletes during a test event. CONCLUSION: Lessons learned for future events include timely implementation and installation of communication processes, and rapid and coordinated response to unsatisfactory inspection results. Routine national programs need to adopt enhanced environmental health surveillance aimed at public health decision-making, but with a different perspective

The magnitude and distribution of infectious intestinal disease in Malta: a population-based study

Routine sources of information on infectious intestinal disease (IID) capture a fraction of the actual disease burden. Population studies are required to measure the burden of illness. A retrospective age-stratified cross-sectional telephone study was carried out in Malta in order to estimate the magnitude and distribution of IID at population level. A random sample of 3504 persons was interviewed by a structured questionnaire between April 2004 and December 2005. The response rate was 99·7%. From the study, the observed standardized monthly prevalence was 3·18% (95% CI 0·7–5·74) with 0·421 (95% CI 0·092–0·771) episodes of IID per person per year. The monthly prevalence was higher in the <5 years age group and in females aged 31–44 years. The mean duration of illness was 6·8 days and a median duration of 3 days. A bimodal seasonal distribution was observed with peaks in June–July and October–November

Estimating the burden and cost of infectious intestinal disease in the Maltese community

The aim of this study was to estimate the burden of infectious intestinal disease (IID) and cost of illness at the community level from a societal aspect. A retrospective, age-stratified cross-sectional telephone study was carried out in Malta in 2004–2005. The number of cases, resources used and cost of resources were computed. The resources involved direct costs (health-care services, stool culture tests, medicines and personal costs) and indirect costs (costs from lost employment by cases and caregivers). This study estimated 0·421 (95% CI 0·092–0·771) separate episodes of IID per person per year in Malta which corresponds to 164 471 (95% CI 35 941–301 205) episodes of IID per year or 450 (95% CI 98–825) episodes of IID each day. The largest proportion of cost is due to provision of health-care services with €10 454 901 [Maltese liri (Lm) 4 558 970] per year; followed by €963 295 (Lm 2 209 393) in lost productivity; €1 286 286 (Lm 561 078) in medicines; €152 335 (Lm 66 452) in stool culture testing and €71 487 (Lm 31 183) in personal costs, giving a total cost of illness of over €16 million (7 million Lm) per year. The burden and cost of IID are high enough to justify efforts to control the illness. Such estimates are important to assess the cost-effectiveness of proposed specific interventions

Health management practices and disease prevalence in dairy sheep systems in Argentina Práticas de manejo sanitário e frequência de doenças em ovinos leiteiros na Argentina

A cross-sectional survey of 19 dairy sheep farms in Argentina was carried out with the purpose to know farm management, health practices, and occurrence and mortality of diseases. The survey comprised 40% of all sheep milking farms in Argentina. A questionnaire was conducted by way of personal interviews with sheep owners during farm visits. The proportions of farms reporting routine vaccination for clostridial diseases, contagious ecthyma, pneumonia and mineral and vitamin parenteral administration were 63%, 47.3%, 16.6% and 42.1% respectively. Regular treatment against lice was used in 37.5% of the farms, and 89.5% o the farmers treated against gastrointestinal nematodes (GIN). The mean number of GIN drenches per farm was 2.26&plusmn;1.78 annually. In 68.4% of the milking flocks the California Mastitis Test was regularly done and 55.6% of the farmer managers had sampled their flocks once a year for Brucella ovis antibodies. During the pre-mating period respectively 68.4% and 50% of farmers clinically examined their rams and ewe for general health and teeth condition. The udders of ewes were frequently inspected at the start of each milking period. The most important parasite problems noticed were GIN (reported by 57.9% of farmers), lice (57.9%) and scabies (10.5%) and the most frequent infectious diseases were ecthyma (73.7%), pneumonia and other respiratory problems (57.9%), clinical mastitis (55.6%), clostridial diseases (36.9%) and foot lameness (35.2%). Photosensitivity (47.4%) and ruminal acidosis (42.1%) were reported as other frequent toxic or metabolic disorders. Owners mentioned that the mean lifespan or milk productive time per ewe was 4.5&plusmn;1.4 years. Perinatal lamb mortality was 8.5% and the total flock mortality rates, above the first 24 h of life was 6.9%. The high rates of lamb mortality during the pre-weaning (10.3%) and post-weaning (5.9%) periods indicate that this problem, as well as the most prevalent diseases, should be the subject of further studies.<br>Foi realizado um levantamento longitudinal em 19 fazendas de ovinos leiteiros na Argentina com o objetivo de conhecer práticas de manejo, medidas sanitárias e ocorrência e freqüência das enfermidades. O levantamento incluiu 40% de todas as fazendas do país que produzem leite ovino. Um questionário foi utilizado com entrevistas pessoais com os ovinocultores durante visita às fazendas. A percentagem de fazendas que relataram vacinação rotineira contra clostridioses, ectima contagioso, pneumonia e administração parenteral de minerais e vitaminas foi 63%, 47,3%, 16,6% e 42,1%, respectivamente. Parte dos produtores (37,5%) realizava tratamento regularmente contra piolhos e 89,5% contra nematódeos gastrintestinais. O número médio de tratamentos anti-helmínticos anuais, por fazenda, era de 2,26+1,78. Em 68,4% dos rebanhos leiteiros o Califórnia Mastite Teste (CMT) era regularmente realizado e 55,6% dos produtores colhiam amostras de seus rebanhos uma vez por ano para diagnóstico de Brucella ovis. Durante o período de pré-acasalamento 68,4% e 50% dos produtores examinavam clinicamente seus carneiros e a condição geral e de dentes de suas ovelhas. O úbere das ovelhas era geralmente inspecionado no início da ordenha. Os principais problemas parasitários eram nematódeos gastrintestinais (mencionado por 57,9% dos produtores), piolhos (57,9%) e sarna (10,5%) e as doenças infecciosas mais frequentes foram ectima contagioso (73,7%), pneumonia e outros problemas respiratórios (57,9%), mastite clínica (55,6%), clostridioses (36,9%) e laminite (35,2%). Fotossensibilização (47,4%) e acidose ruminal (42,1%) foram relatadas como as principais desordens tóxicas ou metabólicas. Na visão dos produtores, a expectativa de vida produtiva ou o tempo de produção de leite por ovelha era de 4,5+1,4 anos. A mortalidade perinatal foi de 8,5% e a taxa de mortalidade total do rebanho, depois das primeiras 24 horas de vida, foi de 6,9%. As altas taxas de mortalidade de cordeiros durante os períodos de pré-desmame (10,3%) e pós-desmame (5,9%) indicam que isto, assim como as doenças mais prevalentes, deve ser tema de mais estudos