- Email: [email protected]
HUMAN PAPILLOMAVIRUS SUBTYPE 16a
170 function of the twin was normal. No behavioural differences between the twins had been noted during the neonatal period either by the parents or by the referring physician. In this pair of monoamniotic twins with different thyroid function, the hypothyroid fetus may have been protected by thyroid hormone secreted by the unaffected twin. This would explain the false-negative result of neonatal screening and the subsequent
Thyroid
was done by electrophoresis of the polymerase chain reaction (PCR) amplification fragment along a 3% ‘Nusieve’/1% normal ’Agarose’ gel. All 19 women with significant cytological abnormality had CIN at colposcopy. 12 carried HPV-16a, 1 HPV-16b, 1 had a dual infection, and 5 were negative for HPV-16:
subtyping
development of hypothyroidism. Department of Paediatrics, University of Leuven, 3000 Leuven, Belgium
F. DE ZEGHER M. VANDERSCHUEREN-LODEWEYCKX
SCURVY AND ANAEMIA IN REFUGEES
SIR,-It is very disappointing to learn from Dr Seaman and Dr (May 27, p 1204) that iron-deficiency anaemia remains a severe problem in Somali refugee camps. The cereal, oil, and milk diet supplied by the United Nations and its donors is not the sole Rivers
explanation. Iron deficiency is a major nutritional defect amongst nomadic Somali pastoralists in Somalia, Ethiopia, and north-east Kenya. Their diet consists almost entirely of milk, and the milks used (camel, cow, and goat) are low in iron. In the 1960s nomads in Somalia had a milk diet with a 38% deficiency of iron.1 North-eastern Kenya, populated by Somali nomads, is unique among the provinces of Kenya in that diseases of blood head the list of causes of death in hospital at all ages.2 Community studies in the 1970s revealed severe iron deficiency to be widespread in Kenyan Somalis on a milk diet.3 The prevalence of Hb levels below 8 g/dl was 24%, and 4% of those studied had Hb below 5 g/dl. Of 24 10 had Hb below 8 g/dl. Of 144 non-pregnant women 6 had Hb below 5 g/dl and 4 of these had babies only a few months old. In one area 46% of boys had Hb below 8 g/dl.
pregnant
women
Nutritional iron deficiency was compounded by effects of Schistosoma haematobiwn infection in adolescent boys. Thus iron-deficiency anaemia is likely to be well established in refugees before they enter the camps. In 1978 Murray et af suggested that iron deficiency in Somali refugees might be protective against some infections and that it might be unwise to attempt to correct it in the face of quiescent infection. The risks of ignoring such severe anaemia, however, are great, and, as Seaman and Rivers report, persist to this day. Iron supplementation of the diet of Somali refugees is of great
importance. Paediatric Department,
Billinge Hospital, Billinge, Wigan WN5 7ET
R. GREENHAM
Agricultural Organisation of the United Nations 1965. Food consumption surveys: report to the Government of Somalia. Report number 2042. Rome F.A.O. 2. Bonte J. Patterns of mortality and morbidity. In: Vogel LC, Muller AS, Odingo RS, Onyango Z, De Geus A, eds. Health and disease in Kenya, Nairobi: East African Literature Bureau, 1974: 75-90. 3. Greenham R. Anaemia and Schistosoma haematobium infection in the North-Eastern Province of Kenya. Trans R Soc Trop Med Hyg 1978; 72: 72-75. 4. Murray MJ, Murray AB, Murray MB, Murray CJ. The adverse effect of iron repletion on the course of certain infections. Br Med J 1978; 2: 1113-15. 1. Food and
HUMAN PAPILLOMAVIRUS SUBTYPE 16a
SIR,-Patients with cervical
smears showing borderline change dyskaryosis are difficult to manage. A few will be harbouring a significant lesion (cervical intraepithelial neoplasia grade 3) (CIN3) but many will not, using up limited colposcopy services unnecessarily.1 Dr Tidy and colleagues (June 3, p 1225) report that human papillomavirus (HPV) subtype 16a may be preferentially associated with cervical neoplasia. We have investigated the prevalence of HPV-16a in women with borderline smears at presentation to see if subtyping is a useful marker for or
mild
CIN3. The 64 women presented for routine cervical cytology in the Greater Manchester area and were found to have borderline changes. A repeat smear was requested by the laboratory and in 19 women this suggested a significant CIN lesion. In the other 45 the repeat smear was normal and cytological surveillance has so far revealed no recurrence of cytological abnormality. HPV-16
the 45
Of women in whom cytology was subsequently normal, 22 had HPV-16a,1a dual infection, and 22 were negative for HPV-16. This difference is not significant. Comparison of these results with data from a group of women with no history of cytological abnormality2 shows that HPV16a is associated with borderline changes in the cervical smear:
However, HPV-16a is not a marker for underlying CIN, and careful cytological follow-up remains the mainstay of management of the
patient with a single mildly abnormal smear. We thank Mrs Wendy Binns, section of epidemiology, Institute of Cancer (Manchester), the staff of the collecting clinics, and the staff of the cytology department, Christie Hospital, Manchester. P. W. and G. N. P. are supported by a grant from the Cancer Research Campaign.
P. WARD G. N. PARRY R. YULE D. V. COLEMAN A. D. B. MALCOLM
St Mary’s Hospital Medical School, London W2 1PG; Charing Cross Hospital Medical School,
London; and Christie Hospital, Manchester
1. Robertson JH, Woodend BE, Crozier EH, Hutchinson J. Risk of cervical associated with mild dyskaryosis. Br Med J 1989; 297: 18-21. 2. Tidy J, Parry GN, Ward P, et al. High rate of HPV16 infection in cytologically cervices. Lancet 1989; i: 434.
cancer
normal
UVA FILTERS IN SUNSCREEN PREPARATIONS
SIR,-Beverley Summers and R. S. Summers (June 17, p 1387) suggest that we are mistaken that sunscreens available in the UK afford little or no protection against ultraviolet A (UVA) radiation. They say that a large number of products do, in fact, contain UVA absorbers and single out ’Piz Buin 24 Sunblock’ lotion as an example. Although they are correct that many sunscreens do contain ingredients that absorb some UVA, at the concentrations used in commercial products the protection against UVA is always less than the sun protection factor (SPF), which, as we stated previously, largely reflects the strong ultraviolet B (UVB) absorption offered by sunscreen products. Using an in-vitro assay1 we have measured the protection against ultraviolet radiation of different wavelengths for SPF 24 (table). This product offers excellent protection against UVB radiation and the SPF of 22 derived from our data is in good agreement with the manufacturer’s published SPF. However, despite the presence of UVA absorbers, the protection afforded over the UVA spectrum ranged from 36 to 2; the median was 4, which is less than the published SPF of 24. PROTECTION FACTORS FOR DIFFERENT WAVELENGTHS OF ULTRAVIOLET RADIATION AFFORDED BY PIZ BUIN 24 SUNBLOCK APPLIED AT 1
5 ul/cm
Thyroid
was done by electrophoresis of the polymerase chain reaction (PCR) amplification fragment along a 3% ‘Nusieve’/1% normal ’Agarose’ gel. All 19 women with significant cytological abnormality had CIN at colposcopy. 12 carried HPV-16a, 1 HPV-16b, 1 had a dual infection, and 5 were negative for HPV-16:
subtyping
development of hypothyroidism. Department of Paediatrics, University of Leuven, 3000 Leuven, Belgium
F. DE ZEGHER M. VANDERSCHUEREN-LODEWEYCKX
SCURVY AND ANAEMIA IN REFUGEES
SIR,-It is very disappointing to learn from Dr Seaman and Dr (May 27, p 1204) that iron-deficiency anaemia remains a severe problem in Somali refugee camps. The cereal, oil, and milk diet supplied by the United Nations and its donors is not the sole Rivers
explanation. Iron deficiency is a major nutritional defect amongst nomadic Somali pastoralists in Somalia, Ethiopia, and north-east Kenya. Their diet consists almost entirely of milk, and the milks used (camel, cow, and goat) are low in iron. In the 1960s nomads in Somalia had a milk diet with a 38% deficiency of iron.1 North-eastern Kenya, populated by Somali nomads, is unique among the provinces of Kenya in that diseases of blood head the list of causes of death in hospital at all ages.2 Community studies in the 1970s revealed severe iron deficiency to be widespread in Kenyan Somalis on a milk diet.3 The prevalence of Hb levels below 8 g/dl was 24%, and 4% of those studied had Hb below 5 g/dl. Of 24 10 had Hb below 8 g/dl. Of 144 non-pregnant women 6 had Hb below 5 g/dl and 4 of these had babies only a few months old. In one area 46% of boys had Hb below 8 g/dl.
pregnant
women
Nutritional iron deficiency was compounded by effects of Schistosoma haematobiwn infection in adolescent boys. Thus iron-deficiency anaemia is likely to be well established in refugees before they enter the camps. In 1978 Murray et af suggested that iron deficiency in Somali refugees might be protective against some infections and that it might be unwise to attempt to correct it in the face of quiescent infection. The risks of ignoring such severe anaemia, however, are great, and, as Seaman and Rivers report, persist to this day. Iron supplementation of the diet of Somali refugees is of great
importance. Paediatric Department,
Billinge Hospital, Billinge, Wigan WN5 7ET
R. GREENHAM
Agricultural Organisation of the United Nations 1965. Food consumption surveys: report to the Government of Somalia. Report number 2042. Rome F.A.O. 2. Bonte J. Patterns of mortality and morbidity. In: Vogel LC, Muller AS, Odingo RS, Onyango Z, De Geus A, eds. Health and disease in Kenya, Nairobi: East African Literature Bureau, 1974: 75-90. 3. Greenham R. Anaemia and Schistosoma haematobium infection in the North-Eastern Province of Kenya. Trans R Soc Trop Med Hyg 1978; 72: 72-75. 4. Murray MJ, Murray AB, Murray MB, Murray CJ. The adverse effect of iron repletion on the course of certain infections. Br Med J 1978; 2: 1113-15. 1. Food and
HUMAN PAPILLOMAVIRUS SUBTYPE 16a
SIR,-Patients with cervical
smears showing borderline change dyskaryosis are difficult to manage. A few will be harbouring a significant lesion (cervical intraepithelial neoplasia grade 3) (CIN3) but many will not, using up limited colposcopy services unnecessarily.1 Dr Tidy and colleagues (June 3, p 1225) report that human papillomavirus (HPV) subtype 16a may be preferentially associated with cervical neoplasia. We have investigated the prevalence of HPV-16a in women with borderline smears at presentation to see if subtyping is a useful marker for or
mild
CIN3. The 64 women presented for routine cervical cytology in the Greater Manchester area and were found to have borderline changes. A repeat smear was requested by the laboratory and in 19 women this suggested a significant CIN lesion. In the other 45 the repeat smear was normal and cytological surveillance has so far revealed no recurrence of cytological abnormality. HPV-16
the 45
Of women in whom cytology was subsequently normal, 22 had HPV-16a,1a dual infection, and 22 were negative for HPV-16. This difference is not significant. Comparison of these results with data from a group of women with no history of cytological abnormality2 shows that HPV16a is associated with borderline changes in the cervical smear:
However, HPV-16a is not a marker for underlying CIN, and careful cytological follow-up remains the mainstay of management of the
patient with a single mildly abnormal smear. We thank Mrs Wendy Binns, section of epidemiology, Institute of Cancer (Manchester), the staff of the collecting clinics, and the staff of the cytology department, Christie Hospital, Manchester. P. W. and G. N. P. are supported by a grant from the Cancer Research Campaign.
P. WARD G. N. PARRY R. YULE D. V. COLEMAN A. D. B. MALCOLM
St Mary’s Hospital Medical School, London W2 1PG; Charing Cross Hospital Medical School,
London; and Christie Hospital, Manchester
1. Robertson JH, Woodend BE, Crozier EH, Hutchinson J. Risk of cervical associated with mild dyskaryosis. Br Med J 1989; 297: 18-21. 2. Tidy J, Parry GN, Ward P, et al. High rate of HPV16 infection in cytologically cervices. Lancet 1989; i: 434.
cancer
normal
UVA FILTERS IN SUNSCREEN PREPARATIONS
SIR,-Beverley Summers and R. S. Summers (June 17, p 1387) suggest that we are mistaken that sunscreens available in the UK afford little or no protection against ultraviolet A (UVA) radiation. They say that a large number of products do, in fact, contain UVA absorbers and single out ’Piz Buin 24 Sunblock’ lotion as an example. Although they are correct that many sunscreens do contain ingredients that absorb some UVA, at the concentrations used in commercial products the protection against UVA is always less than the sun protection factor (SPF), which, as we stated previously, largely reflects the strong ultraviolet B (UVB) absorption offered by sunscreen products. Using an in-vitro assay1 we have measured the protection against ultraviolet radiation of different wavelengths for SPF 24 (table). This product offers excellent protection against UVB radiation and the SPF of 22 derived from our data is in good agreement with the manufacturer’s published SPF. However, despite the presence of UVA absorbers, the protection afforded over the UVA spectrum ranged from 36 to 2; the median was 4, which is less than the published SPF of 24. PROTECTION FACTORS FOR DIFFERENT WAVELENGTHS OF ULTRAVIOLET RADIATION AFFORDED BY PIZ BUIN 24 SUNBLOCK APPLIED AT 1
5 ul/cm