Search

BACKGROUND: Treatment of cutaneous leishmaniasis (CL) and mucosal leishmaniasis (ML) in travelers is still controversial. Over the last decade, national and international consortia have published recommendations for treating CL in travelers. These guidelines harmonize many issues, but there are some discrepancies. METHODS: Leishmania parasites causing CL can now be genotyped by polymerase chain reaction techniques for detecting Leishmania DNA. Therefore, treatment recommendations can now be species based rather than based on geographical exposure. To review the evidence on which the recommendations were based, "LeishMan" (Leishmaniasis Management), a group of experts from 13 institutions in eight European countries, performed a PubMed MEDLINE) literature search and considered unpublished evidence and the experts' own personal experiences. The Oxford evidence grading system was used to evaluate the information. RESULTS AND CONCLUSION: In this article, the authors provide practical treatment recommendations for imported CL and ML in Europe, drawn up from the review by the European experts.

Background: Diuretics still enjoy continued popularity for elderly patients, both in terms of effectiveness in reliably lowering blood pressure and cost considerations. Due to the frequency not only of the indications prompting prescription of diuretics, but also the high rate of drug prescription itself in this context, attempts have been made to quantify their overall toxicity and their contribution to adverse drug events and cases of hospitalization in elderly patients, particularly those with multiple illnesses and polypharmacy. Adverse drug reactions (ADRs) commonly observed and recorded which may specifically be attributed to diuretics during visits to the emergency ward and during hospital stays include: dehydration, dizziness, falls, electrolyte disturbances potentially culminating in delirium, and thrombosis. Case presentation: Four cases of diuretic toxicity in the elderly are reported in this paper, representing variable features of a complex, but typical syndrome for which the term Morbus diureticus in the elderly has been proposed. The clinical picture, treatment and outcome of four patients displaying varying symptoms and degrees of severity as described above have been recorded and assessed according to our definition of Morbus diureticus. Conclusion: These cases are by no means extraordinary or uncommon. They have been selected to illustrate the array of challenges associated with the prescribing and monitoring of diuretic use. The compromising use of diuretics could be amended in all the cases described here, resulting in the patients’ satisfactory to excellent recovery.

Currently available studies on supercritical fluid phase separations are limited to chemically nonreactive systems at low pressure. The present study is concerned with a possible influence of chemical reactions on a supercritical phase change above 1 GPa. We will first give a brief review of statistical mechanical theory, which is designed to handle chemically reactive systems, as used in this work. We next apply the theoretical formulation to chemically reactive systems containing species composed of C, H, N, O, F atoms. These systems produce mixtures such as CO, CO2, H2O, N2, HF, etc. Our earlier calculations [1] without F atoms predicted that these molecular systems separate into an N2-rich and an N2-poor fluid phases at high pressure and high temperature. This prediction has been experimentally confirmed in part for a N2+H2O mixture [2]. Addition of F atoms complicates the chemical equilibrium, as the chemical species can react with H or C atoms to produce HF and CF4. The chemical equilibrium calculations described below predict that fluorine occurs mostly as HF in the N2-poor phase up to a certain pressure, beyond which it appears mostly as a constituent in CF4 in the N2-rich phase. But the shift in fluorine chemistry is sensitive to intermolecular potentials involving HF and can be abrupt in thermodynamic sense, thereby enhancing the character of the N2-fluid phase change. Relevance of the present prediction to detonation properties of high explosives containing fluorine binders is discussed.

BACKGROUND: The off-label use of topical tacrolimus (Protopic) for inflammatory external eye diseases is gaining popularity. However, there are no reports on the safety profile of this new treatment option. PATIENTS AND METHODS: We treated six patients with different inflammatory eye diseases with topical tacrolimus (Protopic 0.03 %) as off-label use in addition to the conventional anti-inflammatory treatment. Patients were interviewed for side effects and serum drug concentrations were measured under steady state conditions one hour after topical application of tacrolimus ointment. RESULTS: Two patients reported a slight burning sensation immediately after application, in one patient we found a slight worsening of the dry eye problems. No patient abandoned the treatment due to side effects. Serum drug concentrations remained below the analytical threshold in all cases (< 1.5 ng/ml). CONCLUSIONS: Tacrolimus for the topical treatment of anterior segment inflammatory eye diseases is well tolerated without detectable systemic drug resorption.

Oestrus ovis is the most common cause of human ophthalmomyiasis, and infection is often misdiagnosed as acute conjunctivitis. Although it typically occurs in shepherds and farmers, O. ovis ophthalmomyiasis has also been reported in urban areas. We report the first case study of O. ovis infection from Afghanistan.

In January 2013 in the Netherlands, a man in his 50s from Suriname underwent hemihepatectomy because of a cystic liver mass, assumed to be a cystadenoma. Pathology revealed an echinococcal infection. PCR analysis of cyst material identified Echinococcus vogeli, causing polycystic hydatid disease. This echinococcus species is rarely diagnosed outside South America. The patient received adequate treatment, but this case emphasises the importance of awareness of this infection when treating patients with cystic tumours from endemic areas.

Statistical mechanical chemical equilibrium calculations of N2 and O2 show that these molecules dissociate behind strong shock waves. Our determination of accurate intermolecular potentials has required the consideration of the dissociation products N and O. Our previous theoretical efforts to predict the thermodynamic properties of these molecules relied in part on corresponding states theory and shock wave data of argon, without consideration of the dissociation products. Recent high‐pressure Hugoniot measurements, however, allowed a more accurate determination of the potentials and the explicit inclusion of the dissociation products. The best fit to the data is obtained with the exponential‐6 coefficients, for O2–O2: e/k=125 K, r*=3.86 A, α=13.2; for O–O: e/k=700 K, r*=2.40 A, α=11.0; for N2–N2: e/k=293 K, r*=3.91 A, α=11.5; and for N–N: e/k=600 K, r*=2.47 A, α=10.0. The unlike pair interactions are obtained from these like interactions with a modified Lorentz–Berthelot rule. The coefficients in the mo...

The amount of carbon monoxide recovered from calorimetry tests of high explosives is far larger than the amount predicted by equilibrium calculations. The present kinetics study of PETN ([(nitro(oxy)methyl]propanediol dinitrate) has revealed that the cooling of the calorimetry bomb after detonation of a PETN sample sufficiently slows those reactions that would otherwise lead to equilibrium so that these reactions are effectively frozen in the time scale of recovery of detonation products. Among these reactions, those that can create CH4 are the most important ones. Their rates are generally slow at all temperatures relevant to calorimetry tests. This and the slowing down of a reaction, CO + H2O → H2 + CO2, at temperatures below 1500 K are the main cause of the freeze-out of CO. A possible slow rate of the soot formation (i.e., condensed carbon) is not responsible for it. The sensitivity of the present result to the cooling rate of the detonation products and to free radicals is also examined.

Background Previous studies investigating the travellers’ knowledge, attitudes and practices (KAP) profile indicated an important educational need among those travelling to risk destinations. Initiatives to improve such education should target all groups of travellers, including business travellers, those visiting friends and relatives (VFRs), and elderly travellers. Methods In the years 2002 to 2009, a questionnaire-based survey was conducted at the Dutch Schiphol Airport with the aim to study trends in KAP of travel risk groups towards prevention of malaria. The risk groups last-minute travellers, solo-travellers, business travellers, VFRs and elderly travellers were specifically studied. Results A total of 3,045 respondents were included in the survey. Travellers to destinations with a high risk for malaria had significantly more accurate risk perceptions (knowledge) than travellers to low-risk destinations. The relative risk for malaria in travellers to high-risk destinations was probably mitigated by higher protection rates against malaria as compared with travellers to low risk destinations. There were no significant differences in intended risk-taking behaviour. Trend analyses showed a significant change over time in attitude towards more risk-avoiding behaviour and towards higher protection rates against malaria in travellers to high-risk destinations. The KAP profile of last-minute travellers substantially increased their relative risk for malaria, which contrasts to the slight increase in relative risk of solo travellers, business travellers and VFRs for malaria. Conclusions The results of this sequential cohort survey in Dutch travellers suggest an annual 1.8% increase in protection rates against malaria coinciding with an annual 2.5% decrease in intended risk-seeking behaviour. This improvement may reflect the continuous efforts of travel health advice providers to create awareness and to propagate safe and healthy travel. The KAP profile of last-minute travellers, in particular, substantially increased their relative risk for malaria, underlining the continuous need for personal protective measures and malaria chemoprophylaxis for this risk group.

A fatal human case of Duvenhage virus (DUVV) infection in a Dutch traveller who had returned from Kenya was reported in 2007. She exhibited classical symptoms of rabies encephalitis with distinct pathological findings. In the present study we describe the isolation and characterization of DUVV in vitro and its passage in BALB/c mice. The virus proved to be neuroinvasive in both juvenile and adult mice, resulting in about 50% lethality upon peripheral infection. Clinical signs in infected mice were those of classical rabies. However, the distribution of viral antigen expression in the brain differed from that of classical rabies virus infection and neither inclusion bodies nor neuronal necrosis were observed. This is the first study to describe the in vitro and in vivo isolation and characterization of DUVV., Author Summary Lyssaviruses have been known for centuries to cause lethal encephalitis in animals and humans, representing a serious public health problem especially in developing countries. Little is known about the way that lyssaviruses in general, and Duvenhage virus in particular cause disease. Studies of pathogenesis have been hampered by the fact that the virus has not yet been propagated and characterized extensively. In this paper, we describe the characterization of Duvenhage virus in vitro. Further, we characterized the virus in BALB/c mice. We compared Duvenhage virus with a wild type rabies virus (silver-haired bat rabies virus) and we found that while in vitro the differences of these two viruses were not significant, the in vivo characteristics of these two viruses differed significantly. Histological analyses of infected mouse brains suggest that differences in virulence may be associated with difference in tropism. Elucidating the differences in pathogenesis between different lyssaviruses might help us in the design of novel treatment protocols.

Background. Previous studies investigating the travelers' knowledge, attitudes, and practices (KAP) profile indicated an important educational need among those traveling to risk destinations. Initiatives to improve such education should target all groups of travelers, including business travelers, those visiting friends and relatives (VFR), and older adult travelers. Methods. In the years 2002 to 2009, a longitudinal questionnaire-based survey was conducted at the Dutch Schiphol Airport with the aim to study trends in KAP of travel risk groups toward prevention of hepatitis A. The risk groups last-minute travelers, solo travelers, business travelers, travelers VFR, and older adult travelers were specifically studied. Results. A total of 3,045 respondents were included in the survey. Travelers to destinations with a high risk for hepatitis A had significantly less accurate risk perceptions (knowledge) than travelers to low-to-intermediate-risk destinations. The relative risk for hepatitis A in travelers to high-risk destinations was probably mitigated by less intended risk-seeking behavior and by higher protection rates against hepatitis A as compared with travelers to low-to-intermediate-risk destinations. Logistic regression analyses showed that an age > 60 years was the only significant determinant for improvement of their knowledge. Trend analyses showed a significant change over time in attitude toward more risk-avoiding behavior and toward higher protection rates against hepatitis A in travelers to high-risk destinations. The KAP profile of the risk groups travelers VFR (irrespective of hepatitis A risk of their destination) and solo as well as last-minute travelers to high-risk destinations substantially increased their relative risk for hepatitis A. Conclusions. The results of this longitudinal survey in Dutch travelers suggest an annual 5% increase in protection rates against hepatitis A coinciding with an annual 1% decrease in intended risk-seeking behavior. This improvement may reflect the continuous efforts of travel health advice providers to create awareness and to propagate safe and healthy travel. The KAP profile of travelers visiting friends and relatives (VFR) and solo as well as last-minute travelers to high-risk destinations substantially increased their relative risk for hepatitis A. These risk groups should be candidates for targeted interventions

Parasite loads were quantified in repeated skin biopsies from lesions of 2 patients with Old-World cutaneous leishmaniasis (CL) caused by Leishmania major and L. infantum during and after treatment with miltefosine. Miltefosine induced a rapid therapeutic effect on both infections with an initial decline of parasites of ∼1 log/week for the L. major infection. These observations illustrate the usability of quantifying parasite loads in skin lesions as a pharmacodynamic measure and quantitative descriptor of drug effect for CL supporting clinical assessment., Author Summary The clinical evaluation of the ulcerated lesions in cutaneous leishmaniasis (CL) is both difficult and subjective. As a result, the evaluation of therapeutic efficacy of drugs for CL remains complicated. The relationship between dose and effect of antileishmanial drugs in CL is unclear and a good quantitative descriptor of drug effect has not yet been established. This report describes the use of quantifying the parasite load in repeated full-thickness skin biopsies from lesions of two patients with extensive Old-World CL (Leishmania major and L. infantum) who both were treated with miltefosine to demonstrate the dynamics of parasite clearance within CL lesions. Therapeutic effect of miltefosine was already noticeable directly after start of treatment, with a rapid, log-linear decline in parasite load in the skin biopsies of approximately 1 log/week for the L. major infection. These observations illustrate the applicability of quantifying parasite loads as a pharmacodynamic measure for CL supporting clinical assessment. The methodology described here might enable better evaluation and comparison of standard and new therapeutics in future randomized clinical trials for CL.

A different clinical picture and therapeutic response were observed when data from Leishmania major-infected Dutch military personnel stationed in southern (N = 8) and northern (N = 169) Afghanistan were analyzed. Clinical presentation of cutaneous leishmaniasis in personnel in the south was milder and seemed to respond better to antileishmanial treatment; molecular analyses of parasite isolates seem to indicate that these differences may be genetic.

Summary Skin lesions occur frequently in travelers to tropical countries. Military personnel acquire skin lesions regularly during jungle training as did Dutch troops who trained in the jungle of Belize in 1998, 2004 and 2009, in an area endemic for cutaneous leishmaniasis. Demographic and clinical data were collected retrospectively. Diagnostic investigations for cutaneous leishmaniasis included Giemsa stain, culture, PCR and NASBA and histopathology of biopsies. Treatment of leishmaniasis was with sodium stibogluconate, given intravenously or intralesionally, the latter with cryotherapy. In 1998 and 2004 cutaneous leishmaniasis due to Leishmania braziliensis and Leishmania mexicana infection was diagnosed in 25 persons out of 99 (attack rate 25.2%) and 14 persons out of 80 (attack rate 17.5%) respectively. In 2009 cutaneous leishmaniasis was not acquired. Skin problems were common during and after jungle training. Cutaneous leishmaniasis was important in the first two cohorts but not observed in the third cohort. Factors that could have played a role in the absence of cutaneous leishmaniasis in the third cohort include variability in transmission and availability of better preventive measures and adherence to these. Sodium stibogluconate treatment, intralesional or intravenous, was effective.

Background Counts of malaria parasites in peripheral blood are important to assess severity of Plasmodium falciparum malaria. Thin and thick smears are routinely used for this purpose. Methods In this study the Binax NOW® Malaria Test, an easy-to-perform rapid diagnostic test, with Histidine Rich Protein-2 (HRP-2) and aldolase as diagnostic markers, was used for semi-quantitative assessment of parasitaemia of P. faciparum. Results In 257 patients with imported P. falciparum malaria, reactivity of aldolase increased with higher parasitaemia. In all patients with a parasitaemia above 50,000 asexual parasites/μl (> 1%) co-reactivity of HRP-2 and aldolase was observed. Absence of aldolase reactivity in the presence of HRP-2 was a reliable predictive marker to exclude high (> 1%) parasitaemia in P. falciparum malaria. Conclusions Assessment of HRP-2 and aldolase co-reactivity can be of help in clinical decision making in the acute care setting of returning travellers suspected of having malaria.

Ignoring sexual orientation in career counseling practice is presented as a specific case of failing to integrate an aspect of the personal dimension into career counseling. Three case examples illustrate specific actions that career counselors must take to integrate this important aspect of the personal dimension into career counseling. The actions suggested involve three general areas: (a) signaling lesbian and gay affirmation in career counseling practice, (b) enhancing the development of a positive gay or lesbian identity in the context of career development work, and (c) recognizing and integrating the reality of anti-gay stigma in career counseling.

The authors describe how their participation in a doctoral-level career counseling practicum has influenced their perceptions of the relationship between career and personal counseling, attitudes toward career services, and career interventions skills.

The likelihood of a first-order liquid-liquid phase change in carbon from a mostly graphitic configuration to one that is more tetrahedral in character is explored. Liquid-phase changes in other materials are noted. Pertinent data on liquid carbon are reviewed and the model is briefly described. The model is consistent with a positive diamond-melting-line slope. Constraints on the strain energy between graphitic and diamondlike liquid clusters allow a phase diagram with a liquid-liquid transition and a graphite-liquid-liquid triple point. An upper limit on the strain energy is the constraint that the graphite melting line should have a reasonable curvature that agrees with melting-line data. The transformation of liquid structure from graphitic to diamondlike under compression significantly increases the compressibility.

Cutaneous leishmaniasis caused by Leishmania major infection affected 172 (18.3%) of 938 Dutch military troops deployed in northern Afghanistan in 2005. The high attack rate was a result of initial insufficient availability of means of prevention and insufficient adherence to preventive measures. At presentation, the lymphatic system was involved in 24.8%. Treatment with intralesional injections of antimony with or without cryotherapy was satisfactory, but 19.5% of patients received secondary treatment with miltefosine. Six months after treatment, 128 (77.1%) of 166 treated patients were cured, 16 (9.6%) were lost to follow-up, and 22 (13.3%) already experienced cure at six weeks but were not seen at six months. Natural evolution played a role in this observational study, which showed cure of all patients seen at six months. In general, management of cutaneous leishmaniasis was feasible under field conditions.

Cutaneous leishmaniasis in Surinam is generally caused by infection by Leishmania guyanensis. We report three cases of infection with Leishmania (Viannia) naiffi, a Leishmania species not described from Surinam before. Treatment with pentamidine proved to be effective.

We review work performed on a three-phase theoretical carbon equation of state. The algorithm has been used, with good success, in a chemical equilibrium code of mixtures (of solids, liquids, and gasses), in which the gas phase is modeled by a statistical mechanical theory of mixtures. We use simple Gruneisen models for the solid phases and compute the corresponding liquid phases with a “scaling” theory. A modified Lindemann model is used in the scaling theory to predict melting properties. The liquid carbon consists of a mixture of expanded graphitic and diamond-like forms. Terms that describe the electronic energy change of the liquid have been estimated with the INFERNO code. Both experimental and theoretical work has been used to determine the best equation of state parameters. The resulting model yields a phase diagram consistent with all known mutually consistent data. Significant uncertainties still exist in the melting data.

The off-label use of topical tacrolimus (Protopic) for inflammatory external eye diseases is gaining popularity. However, there are no reports on the safety profile of this new treatment option.We treated six patients with different inflammatory eye diseases with topical tacrolimus (Protopic 0.03 %) as off-label use in addition to the conventional anti-inflammatory treatment. Patients were interviewed for side effects and serum drug concentrations were measured under steady state conditions one hour after topical application of tacrolimus ointment.Two patients reported a slight burning sensation immediately after application, in one patient we found a slight worsening of the dry eye problems. No patient abandoned the treatment due to side effects. Serum drug concentrations remained below the analytical threshold in all cases (1.5 ng/ml).Tacrolimus for the topical treatment of anterior segment inflammatory eye diseases is well tolerated without detectable systemic drug resorption.

11Department of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands, 2Department ofNeurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands, 3Department of Intensive Care, Academic Medical Center, University ofAmsterdam, Amsterdam, The Netherlands, 4Department of Clinical Virology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands,5Department of Virology, Erasmus Medical Centre, Rotterdam, The Netherlands, 6Department of Radiology, Academic Medical Center, University of Amsterdam,Amsterdam, The Netherlands, 7Department of Pathology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands, 8Centre of Expertise forRabies, Canadian Food Inspection Agency, Ottawa Laboratory (Fallowfield), Ottawa, Ontario, Canada

This is the second part of a two–part study of the NH3NH4SCN cellulose solvent system. Quasielastic light scattering was used to determine the diffusion coefficients of cellulose in solution and the effective hydrodynamic radius of the dissolved molecules. Additionally, the system was studied using light microscopy to determine the minimum critical volume fraction or liquid crystal formation. Very little change was found in the diffusion coefficients with change in cellulose concentration indicating little interaction between the chains in solution. Values of 7.69 and 2.66 × 108 cm2/s were measured for samples having a degree of polymerization of 153 and 969. The value of the coefficient relating the hydrodynamic volume to the radius of gyration was found to be in the range of 0.33 to 0.53, indicating an extended coil conformation according to the Kirkwood-Riseman theory. The minimum critical volume fractions necessary for liquid crystal formation, υ2′ were 0.039, 0.038, and 0.048 for the three solvent compositions studied. The values calculated for υ2′ based on the measured persistence lengths were much larger than the predicted values, indicating strong deviation from theory or possible aggregation in the system.

The dissociative phase transition of fluid nitrogen at pressures in the range 30–110 GPa (0.3–1.1 Mbar), temperatures in the range 4000–14 000 K, densities up to 3.5 g/cm3, and internal energies up to 1 MJ/mol was investigated by shock compression. Equation‐of‐state, shock‐temperature, and electrical‐conductivity experimental data are presented and analyzed in detail.

Povidone-iodine alone or in combination with antibiotics is commonly used for presurgical disinfection in cataract surgery. In spite of the use of the combination Povidone-iodine and ofloxacin, the rate of ocular contamination as assessed from surgical knives was reported to be as high as 26 %. The aim of this study was to investigate the efficacy of diluted Povidone-iodine alone for surgical disinfection.126 consecutive patients undergoing elective cataract surgery with a conjunctival wound and a scleral tunnel received prior to surgery a disinfection with diluted Povidone-iodine eye drops (Braunol 1:10 diluted = 0.8 % Povidone-iodine, 3 times every 5 min). To assess residual bacteria on the ocular surface after disinfection, the surgical knives for the side ports and the scleral tunnel were cultured in thioglycolate broth.In 8 out of 126 (6 %) patients the culture from the surgical knives revealed a positive result (89 % coagulase negative Staphylococci). Four of these 8 cases occurred during a single list. All control cultures remained negative.Diluted Povidone-iodine eye drops alone are highly effective for bacterial disinfection when applied properly. The rate of contamination using 0.8 % Povidone-iodine in our series was considerably lower as compared to that of other studies.

Chronic silver intoxication is a rare disease and therefore the typical ocular findings may be missed. Based on a case with severe intoxication, the clinical and histological findings as well as the prognosis in argyria are presented.A 33-years-old-employee of a battery production plant developed a biopsy proven systemic argyria. On slit lamp examination the conjunctiva showed a dark, blue-grey discoloration in the areas of the tear flow and the small conjunctival arteries. Diffuse silver deposits were noticed on the level of Descemet's membrane without endothelial damage. Silver deposits were also visible in the trabecular meshwork. Chemical reaction of the silver particles upon exposure to UV light results in irreversible tissue discoloration. Without options for an effective treatment, early diagnosis and prevention of overexposure are most important.The typical ocular findings in systemic argyria are helpful in occupational medicine for establishing the correct diagnosis.

Adenoviral conjunctivitis causes high socioeconomic costs due to high contagiousness and therefore the need for extended quarantine. To date the only potentially active, topical antiviral agent is povidone-iodine (PVI). The aim of this study was to investigate the effect of diluted PVI on free adenovirus and adenoviral infected cells as well as to evaluate the cellular toxicity of PVI on non-infected cells.PVI was diluted to a final concentration of 0.0008 %. Virucidal activity was measured IN VITRO using adenovirus 8 and A549 human epithelial cell cultures. Cytotoxicity effects on healthy cells after short- and long-term exposure to diluted PVI were measured in A549 cell cultures.Exposure to PVI at a concentration of 1:10 (0.8 %) completely extinguishes infectivity of free adenovirus after an exposure time of 10 minutes. PVI is less effective against intracellular adenovirus resulting in a decreased infectivity and viral activity for approximately one day with a narrow spectrum between toxicity and virucidal activity. Healthy epithelial cells can be exposed to PVI for up to 6 hours without a cytotoxic effect.PVI is highly effective against free adenovirus but less effective against intracellular adenoviral particles in already infected cell. Short- and long-term exposure of PVI causes little cytotoxicity for healthy cells. Therefore, administration of diluted PVI at a concentration of 1:10 is a potential option to reduce contagiousness in cases of adenoviral infections.

With increasing migration tropical diseases such as Loa loa infections are becoming more frequent in Europe. While the ocular diagnosis is usually straight forward, systemic work-up and treatment requires an interdisciplinary approach. We review the diagnostic and therapeutic work-up of ocular Loa loa infections based on a series of 4 cases that presented between 1998 and 2004.The first symptoms in all cases were ocular irritations occurring 2 months to 8 years after a trip to West Africa. One case presented with a swollen upper eyelid without a visible worm. In three patients microfilariae were detected in the blood.In two cases visible subconjunctival worms could be removed under the slit lamp. Three cases required systemic treatment as inpatients while one case could be observed without systemic treatment. All 4 cases had a favourable outcome with complete eradication of the disease.Surgical removal of adult Loa loa worms from the subconjunctival space only improves the ocular symptoms. An interdisciplinary approach (ophthalmology, infectious disease and parasitology) for a systemic work-up and treatment is usually required.

A wide variety of pepper sprays is currently available and gaining increasing popularity among both professional guardians and amateurs. Adverse side effects to the anterior segment of the eye are known but underestimated.We present two cases with severe corneal and conjunctival damage after accidental self injury by a pepper spray (Jet Protector Guardian Angel), benzyl alcohol 90.1 %, capsaicinoids 2.6 %).Despite immediate and intensive irrigation, a complete epithelial defect, extensive ischemia to the limbus and the conjunctiva and a circular conjunctival chemosis were diagnosed. After slow re-epithelialization in both cases, a neurotrophic superficial keratitis, a reduced corneal sensibility and in one case deep stromal scarring were noted.Pepper spray application to the eye might result in severe and permanent damage to the corneo-conjunctival tissue which is not adequately addressed in the current literature. From the present case reports arise the discussion whether the irritative and lipophilic capsacin/benzyl alcohol mixture or the pyrotechnical additives nitrocellulose und sinoxide are responsible for the anterior segment injuries.

BACKGROUND Lethal midline granulomas (LMG) are very rare angiocentric NK/T-cell lymphomas in association with Epstein-Barr virus. LMG are reported mainly in East Asia occurring in immune compromised patients. HISTORY AND SIGNS A 41-year old male patient presented with a conjunctival swelling of his upper left eyelid. The lesion had increased over a period of 2 months despite topical corticosteroid treatment. Conjunctival biopsy revealed a highly malignant, CD3 + and BCL2 + extranodal T-cell lymphoma with features of an NK/T-cell origin (CD56 +, TIA + TCR-rearrangement: germline). All lymphoma cells were positive for Epstein-Barr virus RNA. The proliferation rate was highly elevated at 100 %. THERAPY AND OUTCOME Systemic 1 (st) cycle chemotherapy with cyclophosphamide, doxorubicin, vincristin and prednisone resulted in a complete remission of the swelling within 4 days. However, one week later a massive conjunctival tumour reappeared with only partial regression after combined chemo- and radiotherapy. The patient died within a month because of untreatable pancytopenia due to malignant bone marrow infiltration. CONCLUSIONS LMG is a rare but highly malignant Epstein-Barr virus associated NK/T-cell lymphoma that can occur in healthy, immune competent Caucasians. This is the first reported case of an LMG in an immune-competent Caucasian patient with primary ocular manifestation. The LMG has a high mortality rate despite systemic treatment and can be lethal within a few months or even weeks.

Cutaneous leishmaniasis (CL) in western countries seems to be appearing more frequently. Our aim was to determine if there has been a shift in countries where CL is acquired and whether the incidence has changed, and to assess current diagnostic procedures and treatment modalities. In a retrospective study medical records of patients with the diagnosis of CL at the Departments of Tropical Dermatology and Tropical Medicine, Academic Medical Center, Amsterdam, the Netherlands, from 1990 to 2000 were analysed. CL was diagnosed in 78 patients. The majority was acquired in Belize, Surinam, French Guyana and Bolivia. Giemsa stains were positive for the parasite in impression smears from 43% and in biopsies from 71%. Seventy-eight per cent of cases were culture-positive and 89% were PCR-positive. Sixty-two patients were treated systemically: pentavalent antimony (32), pentamidine isetionate (11), itraconazole (19), and 13 locally, the majority with a combination of cryosurgery and intralesional pentavalent antimony. Imported CL is becoming more frequent, with South and Middle American countries being important sources of infection. Multiple tests, of which PCR is the most sensitive, are required to confirm the diagnosis. Systemic treatment was given to the majority of the patients.

The aim of this study was to evaluate patients' acceptance and intraocular pressure (IOP) readings of a new digital mobile tonometer (TGDc-01) and compare it to Goldmann applanation tonometry.Measurements repeated five times with the TGDc-01 and three times with Goldmann tonometry were performed in 100 eyes of 100 patients by two independent investigators. Patients' acceptance of both techniques was evaluated by a visual analogue scale (VAS).The mean IOP with the TGDc-01 yielded 15.4 mmHg for investigator 1 and 12.7 mmHg for investigator 2 (range: 4-43 mmHg). Results of the measurements with Goldmann tonometry showed 17.6 mmHg for investigator 1 and 17.3 mmHg for investigator 2 (9-42 mmHg). The IOP difference of the two tonometry methods was highly significant (p0.001). The intraobserver variability was 29% for investigator 1 and 8% for investigator 2. Mean IOP values of the two investigators taken with the TGDc-01 differed significantly (p0.01) from each other by a mean of 2.6 mmHg.The new mobile tonometer TGDc-01 is better accepted by patients but IOP values are significantly lower compared to Goldmann tonometry and variability is high. Regarding glaucoma diagnostics it seems to be less suitable than Goldmann tonometry.

Three Dutch tourists, a man aged 57 and two women aged 55 en 52 years, acquired African trypanosomiasis in the national parks of Tanzania. Two, without central nervous system involvement, were cured after treatment in the Netherlands, albeit one after having suffered a relapse. In the third patient, involvement of the central nervous system was diagnosed in Africa and she was treated with melarsoprol. After an apparently uneventful recovery she was readmitted with cerebral complaints and symptoms. While being treated with melarsoprol she lapsed into coma. She died following repatriation. An epidemic of trypanosomiasis is currently raging through Central Africa. In several western countries, trypanosomiasis has been diagnosed recently in tourists who visited Tanzania.

Background Leishmaniasis is increasingly reported among travellers. Leishmania species vary in sensitivity to available therapies. Fast and reliable molecular techniques have made species-directed treatment feasible. Many treatment trials have been designed poorly, thus developing evidence-based guidelines for species-directed treatment is difficult. Published guidelines on leishmaniasis in travellers do not aim to be comprehensive or do not quantify overall treatment success for available therapies. We aimed at providing comprehensive species-directed treatment guidelines. Methodology/Principal Findings English literature was searched using PubMed. Trials and observational studies were included if all cases were parasitologically confirmed, the Leishmania species was known, clear clinical end-points and time points for evaluation of treatment success were defined, duration of follow-up was adequate and loss to follow-up was acceptable. The proportion of successful treatment responses was pooled using mixed effects methods to estimate the efficacy of specific therapies. Final ranking of treatment options was done by an expert panel based on pooled efficacy estimates and practical considerations. 168 studies were included, with 287 treatment arms. Based on Leishmania species, symptoms and geography, 25 clinical categories were defined and therapy options ranked. In 12/25 categories, proposed treatment agreed with highest efficacy data from literature. For 5/25 categories no literature was found, and in 8/25 categories treatment advise differed from literature evidence. For uncomplicated cutaneous leishmaniasis, combination of intralesional antimony with cryotherapy is advised, except for L. guyanensis and L. braziliensis infections, for which systemic treatment is preferred. Treatment of complicated (muco)cutaneous leishmaniasis differs per species. For visceral leishmaniasis, liposomal amphotericin B is treatment of choice. Conclusions/Significance Our study highlights current knowledge about species-directed therapy of leishmaniasis in returning travellers and also demonstrates lack of evidence for treatment of several clinical categories. New data can easily be incorporated in the presented overview. Updates will be of use for clinical decision making and for defining further research., Author Summary Human leishmaniasis is caused by unicellular parasites that are injected into the skin by sand-flies, small, flying insects. Many different Leishmania species cause various manifestations of disease, both of the skin and internal organs. Leishmaniasis is a curable disease but clear guidelines on the best available treatment are lacking. Leishmania species differ in sensitivity to available drugs. Until recently, identification of the infecting Leishmania parasite was laborious, thus therapy could not precisely be targeted to the infecting species, in contrast to many other infectious diseases. Nowadays, Leishmania parasites can be identified relatively easily with new DNA techniques. We studied efficacy of therapies for diseases due to different Leishmania species, limited to the English literature. Efficacy was summarized and presented in an easy to read format. Because of difficulties with identification of parasite species in earlier studies, quality of evidence was often limited. Our findings are a major help for clinicians to easily find optimal treatment for specific patients. Moreover, our results demonstrate where additional research is needed to further improve treatment of leishmaniasis.

Vitreoretinal adhesions play a crucial role in the development of a macular hole. To visualize vitreoretinal adhesion we used optical coherence tomography to investigate fellow eyes of patients with macular holes.In a prospective study we scanned the retina in 188 patients with a macular hole stage III or IV (Gass classification). The foveal shape and vitreous were classified into grades.Of the 188 patients 45% showed no vitreous reflex, 45% a partial vitreous detachment with foveolar adhesions, and 10% a vitreous detachment with complete separation from the fovea. While eyes with normal foveolar shape displayed partial vitreous detachment in 33%, this figure rose to 66% in eyes with a macular hole stage I.Diffuse thickening of the fovea is followed by an intraretinal split and formation of a cyst. The shape of the foveolar adhesion suggests that continuing anteroposterior vitreal traction leads to a retinal break and formation of a full-thickness macular hole.

A 28-year-old woman presented with extensive erythematous lesions on her back after visiting Malawi. Skin biopsies showed ova, which could belong to Schistosoma spp. Sequencing of the Schistosoma 28S rRNA gene, extracted and amplified from paraffin biopsies, identified DNA of Schistosoma haematobium. Cutaneous ectopic schistosomiasis can present with extensive lesions and should be considered in the differential diagnosis of skin lesions in returning travelers. Microscopy and serology are the classical methods to obtain a diagnosis. Alternatively, molecular methods can be a valuable new tool for diagnosis and species determination.

Recently, a first-order phase transition is predicted to occur in liquid carbon using atomistic simulation and Brenner’s bond order potential. There are also experimental data suggesting a possibility for a first-order phase transition. In light of this, a thermochemical equilibrium code (CHEQ) is used to provide guidance to experiments to find a liquid-liquid phase change in carbon foam and carbon-rich aerogel, resorcinol formaldehyde. Isotherms and Hugoniots are computed using the model of carbon by van Thiel and Ree. The present calculations predict the liquid-liquid-graphite triple point to be at 5000 K and 5.2 GPa and its critical point to be at 6000 K and 8.8 GPa. The Hugoniot calculations suggest that the liquid-liquid phase transition may be detected by performing a shock experiment with initial density of approximately 0.15 g/cm3.

On 19 November 2007, a 34-year-old woman was admitted to the Academic Medical Center of the University of Amsterdam in the Netherlands with dysarthria, hypesthesia of both cheeks and unsteady gait, all of which started the day before. She had also experienced dizziness, nausea and general malaise since 16 November.

Impression cytology is a non invasive technique for the diagnosis of external eye disease. As infected epithelial cells are losing their adhesion to neighbouring cells they are an ideal target for impression cytology. Despite its diagnostic potential impression cytology has not yet become a routine diagnostic tool because of technical inconvenience in use of conventional membranes. The aim of this study was to evaluate a practicable technique of impression cytology for the rapid diagnosis of superficial viral eye disease.52 patients with suspected viral conjunctivitis or keratitis underwent impression cytology with a Biopore membrane device. After air fixation immunologic detection tests using either peroxidase antiperoxidase or fluorescent techniques were performed directly on the membrane.21 of 38 patients with suspected Herpes-simplex-virus (HSV), 3 of 4 patients with suspected Varicella-Zoster-virus (VZV) and 2 of 10 patients with suspected Adenovirus infection had a positive result on the impression cytology membrane. These results were confirmed by virus cultures or polymerase chain reactions (PCR) a few days later. No patient with a negative impression cytology had a positive culture result. Using impression cytology and an immunodetection test results became available within 1 to 4 hours.Impression cytology combined with immunologic detection tests is a rapid, sensitive and practicable diagnostic test for superficial viral eye diseases.

Statistical mechanical studies predict that a chemically reactive system containing species composed of C, H, N, O atoms can exhibit a phase separation into a N2-rich and a N2-poor phase. The present work is concerned with the effect of the fluid phase separation upon addition of F atoms to the system. Our study shows that F atoms mainly appear as a constituent of HF in a N2-poor fluid phase up to a certain pressure beyond which they occur as CF4 in a N2-rich phase and that the phase separation may be abrupt in a thermodynamic sense. The pressure at the phase boundary can occur at about 30 GPa at 3000 K and about 10 GPa to 20 GPa at 1000 K. Some of these ranges may be accessible by present-day experimental high-pressure techniques. We discuss implications of this study to detonation physics.

From June until October 1993, a battalion of Dutch marines was stationed in Cambodia for a United Nations deployment. In 73 volunteers who used mefloquine as malaria chemoprophylaxis, possible mefloquine-related adverse events were monitored with special emphasis on QT prolongation. All participants started mefloquine chemoprophylaxis with a loading dose (250 mg a day for three days) one week before departure, followed by a weekly dose (250 mg) for approximately 25 weeks. One month before (t - 1) and one (t + 1) and three (t + 3) months after mefloquine prophylaxis was started, an at rest electrocardiogram was made. Frequency, PR-, and QT-intervals were measured; blood samples for liver transaminases, total white blood cell count, and mefloquine concentration were obtained after one and three months. Adverse events such as dizziness, headache, coordination problems, and nausea were spontaneously reported in one (1.4%) and three (4.1%) persons at t + 1 and t + 3, respectively, while specific questioning revealed adverse events in nine (12.3%) and five (6.9%) persons, respectively, at the same time point. Three months after starting chemoprophylaxis, the heart rate at rest and total white blood cell count were lower (P < 0.05), while the QTc-interval was longer and levels of liver transaminases increased (P < 0.05), although both were still within the normal range. There was no extreme prolongation of the QTc-interval or increased levels of liver transaminases that resulted in a need to stop the chemoprophylaxis. No accumulation of mefloquine in the serum occurred, and no relationship was observed between the incidence of adverse events and serum mefloquine concentrations. The incidence of self reported mefloquine-related adverse events was low. In conclusion, mefloquine chemoprophylaxis was safe and well-tolerated in this group.

Statistical mechanical chemical equilibrium calculations of the properties of high-pressure high-temperature reactive C,H,N,O mixtures are made to derive an accurate self-consistent set of inter-molecular potentials for the product molecules. Previous theoretical efforts to predict such properties relied in part on Corresponding States theory and shock wave data of argon. More recent high-pressure Hugoniot measurements on a number of elements and molecules allow more accurate determination of the potentials of these materials, and explicit inclusion of additional dissociation products. The present discussion briefly reviews the previous analysis and the method used to produce a self-consistent set of potentials from shock data on N{sub 2}, O{sub 2}, H{sub 2}, NO, an N{sub 2} + O{sub 2} mixture, carbon, CO{sub 2}, and CO, as well as some simple explosive product mixtures from detonation of hexanitrobenzene, PETN, and a mixture of hydrazine nitrate, hydrazine and water. The results are tested using the data from an HMX explosive formulations. The effect of the non-equilibrium nature of carbon clusters is estimated using data for TNT as a standard to determine a nonequilibrium equation of state for carbon. The resulting parameter set is used in a survey of 27 explosives. For the subset that contains no fluorine or two-phase carbon effects the rms deviation from experimental detonation velocity is 1.2%.