Workplace injuries in Fiji: a population-based study (TRIP 7)

BACKGROUND

Workplace injury rates in low and middle-income countries are known to be high. Contemporary data on this topic from Pacific Island countries and territories are scant.

AIMS

To describe the epidemiology of fatal and hospitalized workplace injuries in Fiji using a population-based trauma registry.

METHODS

An analysis of data from a prospective population-based surveillance registry investigated the characteristics associated with workplace injuries resulting in death or hospital admission among people aged 15 years and older in Viti Levu, the largest island in the Republic of Fiji, from October 2005 to September 2006. Incidence rates were calculated using denominator data from the 2004-05 Fiji Employment Survey.

RESULTS

One hundred and eighty-nine individuals met the study eligibility criteria (including nine deaths). This corresponded to annual injury-related hospitalization and death rates of 73.4 and 3.7 per 100 000 workers, respectively. Males accounted for 95% of injuries, and hospitalization rates were highest among those aged 15-29 years (33 per 100 000 workers). Fijian and Indian workers had similar rates of admission to hospital (38.3 and 31.8 per 100 000 workers, respectively). Fractures (40%) and 'cuts/bites/open wounds' (32%) were the commonest types of injury while 'being hit by a person or object' (34%), falls (27%) and 'cutting or piercing' injuries (27%) were the commonest mechanisms. Overall, 7% of injuries were deemed intentional.

CONCLUSIONS

Acknowledging the likely underestimation of the overall burden of workplace injuries, these findings support the need to identify context-specific risk factors and effective approaches to preventing workplace injuries in Fiji.

Clinical profile of diabetic ketoacidosis in adults

Introduction: Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes mellitus. Recent epidemiological studies indicate that hospitalizations for DKA in the U.S. are increasing. Epidemiological studies from India are limited. We undertook this observational study to analyse the clinical profiles of DKA in adults in south India.Methods: This study was conducted in at a tertiary care center in Andhra Pradesh for one year from Aug 2010 to July 2011. Diagnosis of DKA was made by the presence of (1) Plasma glucose level of 250mg/dl or higher (2) Serum bicarbonate level of 15mEq/lt or lower (3) Arterial blood pH of 7.3 or lower or a venous blood pH of 7.25 or lower (4) Presence of moderate or large urine ketones. All the patients were treated with institutional treatment protocol.Results: Of 27 patients, 22(81%) had type2 diabetes and 5(19%) had type 1 DM .10 were females and 17 males. Age of the patients ranged between 18 to 70 years, with an average of 45.3 years. Precipitating factors were present in 60% of the admissions. Non-compliance or discontinuation of drug therapy was seen in fifty per cent of patients. Average length of hospital stay was slightly longer in type 1 than type 2 DM patientsConclusion: A significant proportion of DKA occurs in patients with type 2 diabetes and many of these cases can be prevented with proper patient education and effective communication with a health care provider during an inter-current illness.DOI: http://dx.doi.org/10.3126/hren.v10i2.6569 Health Renaissance 2012; Vol 10 (No.2); 80-86 

Evaluation of alkaline phosphatase detection in dairy products using a modified rapid chemiluminescent method and official methods

Alkaline phosphatase is a ubiquitous milk enzyme that historically has been used to verify adequate pasteurization of milk for public health purposes. Current approved methods for detection of alkaline phosphatase in milk include the use of enzyme photoactivated substrates to give readings in milliunits per liter. The U.S. and European public health limit for alkaline phosphatase in pasteurized drinks is 350 mU/liter. A modified chemiluminescent method, fast alkaline phosphatase, was compared with the approved fluorometric and chemiluminescent alkaline phosphatase methods to determine whether the modified method was equivalent to the approved methods and suitable for detecting alkaline phosphatase in milk. Alkaline phosphatase concentrations in cow's, goat's, and sheep's milk and in flavored drinks and cream were determined by three methods. Evaluations in each matrix were conducted with pasteurized samples spiked with raw milk to produce alkaline phosphatase concentrations of 2 to 5,000 mU/liter. The tests were performed by the method developer and then reproduced at a laboratory at the National Center for Food Safety and Technology following the criteria for a single laboratory validation. The results indicated that the fast alkaline phosphatase method was not significantly different from the approved chemiluminescent method, with a limit of detection of 20 to 50 mU/liter in all the studied matrices. This modified chemiluminescent method detects alkaline phosphatase in the 350 mU/liter range with absolute differences from triplicate data that are lower and within the range of the allowed intralaboratory repeatability values published for the approved chemiluminescent method.

Reduction in perseverative errors with adjunctive ethyl-eicosapentaenoic acid in patients with schizophrenia: Preliminary study

INTRODUCTION

Patients with schizophrenia have significant cognitive deficits, generally resistant to conventional treatment. This preliminary study examined the effects of ethyl-eicosapentanoate (EPA) on an executive function in early course patients.

PATIENTS AND METHODS

Patients with schizophrenia were given, after an informed consent, 2 g of an EPA daily for 24 weeks, in an open-label study. The Wisconsin Card Sort Test (WCST) was administered at baseline, weeks 4, 12 and 24.

RESULTS

The 27 patients, with a mean duration of illness of 4.2 years, were all receiving atypical antipsychotics; treatment remained unchanged for the study. Perseverative errors - the key measure derived from WCST - were significantly reduced from the baseline mean of 28.2 to 18.4 errors at week 24. Positive symptoms also improved significantly. There were no correlations between EPA levels and any clinical or other neuropsychological measures.

CONCLUSION

These findings suggest that an EPA has procognitive effects for patients with schizophrenia, but controlled trials are required.

Inventory management

A critical aspect of blood transfusion is the timely provision of high quality blood products. This task remains a significant challenge for many blood services and blood systems reflecting the difficulty of balancing the recruitment of sufficient donors, the optimal utilization of the donor's gift, the increasing safety related restrictions on blood donation, a growing menu of specialized blood products and an ever-growing imperative to increase the efficiency of blood product provision from a cost perspective. As our industry now faces questions about our standard practices including whether or not the age of blood has a negative impact on recipients, it is timely to take a look at our collective inventory management practices. This International Forum represents an effort to get a snap shot of inventory management practices around the world, and to understand the range of different products provided for patients. In addition to sharing current inventory management practices, this Forum is intended to foster an exchange of ideas around where we see our field moving with respect to various issues including specialty products, new technologies, and reducing recipient risk from blood transfusion products.

Response assessment of HCC undergoing chemoembolization by necrosis-adjusted models

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Background: Chemoembolization (CE) is an accepted therapy for unresectable HCC. As treated tumors may not shrink in size, response assessment via measurement of the enhancing tumor (EASL) has been proposed as an alternate to whole tumor (RECIST) measures. However, the reliability of this model has not been tested in clinical practice. Methods: We identified 29 HCC patients treated with CE with known overall survival (OS) in whom MRI before and after initial CE therapy was available for review. Three radiologists evaluated the imaging, measuring the largest liver lesion in three dimensions and the largest enhancing region in two dimensions. Readers also assessed percent tumor necrosis and overall tumor response qualitatively. Response models in 1-, 2-, or 3- dimensions, with or without necrosis adjustment, were created to assign patients to CR/PR/SD/PD classes, based on majority classification. Predictive value for OS was assessed for PD vs. other, and for PR/CR vs. SD/PD by the Students’ t-test. Inter-reader concordance was assessed by the Fleiss κ statistic. Results: For non-necrosis adjusted models, OS for progressors vs. non-progressors was statistically significant (p values: 0.0002–0.04), but could not identify early responders. Necrosis adjusted models failed to identify early progressors, but identified responders with improved OS (p values: 0.02–0.12). Inter-reader concordance was higher for necrosis adjusted models (κ range: 0.36–0.52) than for non-necrosis adjusted models (0.16–0.23). Viable tumor response by a two-dimensional product was superior to a one-dimensional diameter for predicting OS (p=0.04 vs. 0.74), and demonstrated higher inter-reader concordance (κ=0.46 vs. 0.30). Qualitative assessment of hepatic tumor could predict differences in OS for both PD vs. others (p=0.0001) and responders vs. non-responders (p=0.04), with acceptable inter-reader concordance (κ=0.34). Conclusions: Two- dimensional, but not one-dimensional, viable tumor measurement can identify response of HCC to chemoembolization and predict OS. Models which incorporate qualitative reader assessment of tumor necrosis may be more flexible than direct measures of viable tumor, and should be considered as alternatives for tumor assessment in chemoembolization.

No significant financial relationships to disclose.

Use of an Internet-based protocol to collect clinical information and blood from patients with lung cancer who never smoked cigarettes

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Background: At least 10% of patients develop lung cancer despite smoking <100 cigarettes in a lifetime. These “never smokers” with lung cancer have a unique clinical course and likely represent a subgroup genetically distinct from lung cancer patients with a history of cigarette smoking. Few genes associated with the development of lung cancer in this population have been found. To identify genetic risk factors, we plan to perform genome-wide association studies (GWAS) but need to study a large group of cases - more than that seen at a single institution in a reasonable timeframe. To speed accrual, we hypothesized that we could use the internet to collect clinical information and blood from never smokers with lung cancer. Methods: We established an IRB- approved protocol to collect prospectively clinical information and blood samples from patients recruited via the internet. Interested patients enroll via the website ( www.mskcc.org/neversmokerswithlungcancer ), or by email ( neversmokerswithlungcancer@mskcc.org ). Eligibility criteria: age ≥18 yo, pathologic diagnosis of lung cancer, smoking history <100 cigarettes in a lifetime, resident of the U.S. Study materials (information packet, screening questionnaire, consent form, and tissue sample collection kit) are directly sent to patients. Bloods are drawn at routine local doctor visits and returned to study investigators by free overnight shipping. All data are kept confidential. Results: The website went online on 14 Sept 2008. As of 5 Jan 2009, 70 patients from 25 states contacted us via the internet. 33 patients signed the consent form, 27 were eligible, and 19 sent blood samples. For those who sent blood, the median time between first email contact and receipt of blood was 29 days. Conclusions: Collection of clinical information and blood samples from cancer patients is feasible over the internet. We are expanding efforts to connect with individuals appropriate to this study, with a target of 2000 patients. The identification of risk variants associated with lung cancer through GWAS can facilitate the development of new strategies for prevention, diagnosis, and treatment.

No significant financial relationships to disclose.

Sodium MR imaging detection of mild Alzheimer disease: preliminary study

BACKGROUND AND PURPOSE

There is significant interest in the development of novel noninvasive techniques for the diagnosis of Alzheimer disease (AD) and tracking its progression. Because MR imaging has detected alterations in sodium levels that correlate with cell death in stroke, we hypothesized that there would be alterations of sodium levels in the brains of patients with AD, related to AD cell death.

MATERIALS AND METHODS

A total of 10 volunteers (5 with mild AD and 5 healthy control subjects) were scanned with a 20-minute sodium (23Na) MR imaging protocol on a 3T clinical scanner.

RESULTS

After normalizing the signal intensity from the medial temporal lobes corresponding to the hippocampus with the ventricular signal intensity, we were able to detect a 7.5% signal intensity increase in the brains of patients with AD (AD group, 68.25% +/- 3.4% vs control group, 60.75% +/- 2.9%; P < .01). This signal intensity enhancement inversely correlated with hippocampal volume (AD group, 3.22 +/- 0.50 cm3 vs control group, 3.91 +/- 0.45 cm3; r2 = 0.50).

CONCLUSIONS

This finding suggests that sodium imaging may be a clinically useful tool to detect the neuropathologic changes associated with AD.

Prosthetic rehabilitation of an adolescent with hypohidrotic ectodermal dysplasia with partial anodontia: case report

Ectodermal dysplasia is a hereditary syndrome characterized by dysplasia of tissues of ectodermal origin (hair, skin, nails, and teeth) and occasionally, dysplasia of mesodermally derived tissues. The triad of nail dystrophy (onychodysplasia), alopecia, or hypotrichosis (scanty, fine, light hair on the scalp and eyebrows) and palmoplantar hypohidrosis is usually accompanied by lack of sweat glands and partial or complete absence of primary and permanent dentition. Hypohidrotic ectodermal dysplasia usually has an X-linked inheritance and affects only males severely, while female heterozygotes show only minor defects. The clinical management of children with ectodermal dysplasia provides a unique opportunity for cooperative effort between the pedodontist and the prosthodontist. The following case report discusses the management of a young boy with hypohidrotic ectodermal dysplasia. Removable prostheses were employed in the treatment. The aim was to rehabilitate the adolescent prosthodontically and boost him psychologically.

Sleepiness in medical ICU residents

BACKGROUND AND METHODS

Sleepiness in medical residents has crucial implications for the safety of both patients and residents. Measures to improve this have primarily included an Accreditation Council for Graduate Medical Education-mandated reduction in work hours in residency programs. The impact of these work-hour limitations has not been consistent. The purpose of this study was to provide an objective assessment of daytime sleepiness in medical residents working in the medical ICU. Sleep times for 2 days/nights prior to on call and on the day/night of being on call were assessed by actigraphy and sleep diaries. On-call and post-call measurements of residents' sleepiness were measured both objectively, by means of a modified multiple sleep latency test (MSLT) [two nap sessions], as well as subjectively, by the Stanford Sleepiness Scale.

RESULTS

Our data showed that despite an average sleep time of 7.15 h on nights leading to being on call, the mean sleep latency (MSL) on the on-call day was (+/- SD) 9 +/- 4.4 min, and 4.8 +/- 4.1 min (p < 0.001) on the post-call day. On the post-call day, 14 residents (70%) had an MSL of < 5 min, suggesting severe sleepiness, compared to 6 residents (30%) on the on-call day.

CONCLUSION

Our results demonstrate that residents working in the ICU despite reductions in work hours demonstrate severe degree of sleepiness post-call.

Immunogenicity and safety of an indigenously developed DTPw hepatitis B combination vaccine in Indian infants

OBJECTIVE

To evaluate the safety and immunogenicity of an indigenous hepatitis B, diphtheria, tetanus and B. pertussis tetravalent vaccine (Shantetra) in comparison with Tritanrix HBTM in healthy Indian infants.

DESIGN

Multicentric, randomized, single blind intention-to-treat study with 12-18 weeks of follow up period.

SETTING

5 out patient departments at tertiary care referral centers across India.

PARTICIPANTS

151 infants were randomized in a 2:1 ratio to recruit 101 in the Shantetra and 50 in the Tritanrix HBTM groups respectively. A total of 136 subjects completed the study. No patients were withdrawn from the study due to any adverse effects.

INTERVENTIONS

Recruited subjects were randomized to receive three doses of either of the two DTPw-Hepatitis B combination vaccines as per the EPI schedule.

MAIN OUTCOME MEASURES

Monitoring the humoral immune response (seroconversion rates) induced by each antigenic component three to six weeks after the last dose of vaccine in both the groups.

RESULTS

Seroprotective immune response was observed in 98.9% subjects for diphtheria, tetanus and hepatitis B components in the Shantetra group as compared to 95.5% subjects in the Tritanrix HB group. Anti pertussis antibody response was seen in 89% and 91.1% in the Shantetra and Tritanrix HB groups, respectively. The commonly observed adverse events in both the groups were, pain at injection site, mild fever and transient crying.

CONCLUSION

The safety and immunogenicity of indigenously developed DTPwHepatitis B combination vaccine was demonstrated in the present study.

Mechanical ventilator for delivery of ¹⁷O₂ in brief pulses

The ¹⁷O nucleus has been used recently by several groups for magnetic resonance (MR) imaging of cerebral metabolism. Inhalational delivery of ¹⁷O₂ in very brief pulses could, in theory, have significant advantages for determination of the cerebral metabolic rate for oxygen (CMRO₂) with MR imaging. Mechanical ventilators, however, are not typically capable of creating step changes in gas concentration at the airway. We designed a ventilator for large animal and human studies that provides mechanical ventilation to a subject inside an MR scanner through 25 feet of small-bore connecting tubing, and tested its capabilities using helium as a surrogate for ¹⁷O₂. After switching the source gas from oxygen to helium, the 0-90% response time for helium concentration changes at the airway was 2.4 seconds. The capability for creating rapid step changes in gas concentration at the airway in large animal and human studies should facilitate the experimental testing of the delivery ¹⁷O₂ in brief pulses, and its potential use in imaging CMRO₂.

Pelvic leiomyoma presenting as perineal hernia

Primary perineal hernias are rare and can be a diagnostic challenge. We report the case of a 45-year-old female patient who presented with painless perineal swelling suggestive of perineal hernia. Computed tomography (CT) scanning revealed a pelvic mass herniating through the pelvic floor into the perineum. The lesion was completely excised by an abdominoperineal approach. Histopathological examination of the lesion revealed a leiomyoma. This case report suggests that the possibility of perineal herniation of a pelvic leiomyoma should be considered in a female patient with suspected primary perineal hernia. We recommend an abdominoperineal approach for the surgical management of such a lesion.

Nurse specialist led flexible sigmoidoscopy in an outpatient setting

OBJECTIVE

There has been an increasing demand for diagnostic flexible sigmoidoscopy. In order to improve our diagnostic services, we established a nurse specialist led flexible sigmoidoscopy clinic in 1999. The aim of this study was to review the outcomes of this service between 1999 and 2004.

METHOD

The following information was collected prospectively: source of referral, presenting symptoms, the result of the flexible sigmoidoscopy, depth of insertion, the follow-up plan and complications.

RESULTS

A total of 3956 patients had a flexible sigmoidoscopy performed between 1999 and 2004. The presenting symptoms were as follows: rectal bleeding (RB) in 1915 patients, change of bowel habit (CBH) in 421 patients, RB+CBH in 814 patients. The depth of insertion of the sigmoidoscope was as follows: rectum in 85 patients, sigmoid colon in 595 patients, descending colon in 1969 patients, splenic flexure in 958 patients and transverse colon in 311 patients. The findings at sigmoidoscopy were as follows: normal in 1560 patients, cancer in 132 patients, inflammatory bowel disease in 276 patients, polyps in 415 patients, diverticular disease in 584 patients and haemorrhoids in 926 patients. Two patients sustained an iatrogenic rectal perforation.

CONCLUSION

The nurse specialist led flexible sigmoidoscopy clinic offers an efficient and safe diagnostic service for patients presenting with colorectal symptoms.

Identification and molecular characterization of a novel protein Saglin as a target of monoclonal antibodies affecting salivary gland infectivity of Plasmodium sporozoites

Molecular mechanisms underlying the interaction between malarial sporozoites and putative receptor(s) on the salivary glands of Anopheles gambiae remain largely unknown. In previous studies, a salivary gland protein of ~100 kDa was identified as a putative target based on recognition of the protein by a monoclonal antibody (mAb) 2A3 that caused a >/= 70% reduction in the average number of sporozoites per infected salivary gland when fed to mosquitoes. Using affinity purification we purified the target of this mAb from extracts of female A. gambiae salivary glands and it was found to be a novel protein by tandem mass spectrometric analysis. Biochemical and molecular characterization of the 100 kDa protein showed that this molecule, designated Saglin, exists as a disulphide-bonded homodimer of 50 kDa subunits. The ability to form homodimers was retained even in the recombinant Saglin expressed in mammalian cells (HEK293). The amino acid sequence of Saglin contains a signal peptide suggesting that Saglin is a secreted protein. If Saglin is indeed involved in the process of invasion of A. gambiae salivary glands by sporozoites of Plasmodium, it could provide a novel target for future investigations aimed at interruption of malaria transmission.