Assessment of H2S and BTEX concentrations in ambient air using passive sampling method and the health risks

Wastewater treatment plants (WWTPs) may be a source of nuisance in neighbouring places due to hydrogen sulphide (H₂S) and BTEX (benzene, toluene, ethylbenzene, and xylenes) emissions. In this study, samples were collected from WWTP workplace ambient air and outdoor ambient air around one of the largest WWTPs in Istanbul with a capacity of 250,000 m³/day to evaluate the effects of H₂S and BTEX emissions. Samples were collected in three seasons for 15-day durations: winter (November 2015), spring (May 2015), and summer (August 2016). Average concentrations of H₂S and BTEX were determined as 1.1 and 56.2 µg/m³, respectively. Average concentrations BTEX components were 4.9, 20.7, 6.4, and 24.2 µg/m³, respectively. Health risk assessment for plant workers and local residents was performed for H₂S and BTEX inhalation exposure using the method by USEPA. Results show that H₂S and BTEX emissions do not have harmful effects on human health.

Incidence, aetiology, and control of sternal surgical site infections

BACKGROUND

Since sternal surgical site infections (SSIs) can be life-threatening, every effort should be made to reduce their rate of occurrence.

AIM

To measure the rate of sternal SSIs after open heart surgery and to define the efficacy of infection control interventions in reducing this rate.

METHODS

Surveillance of sternal SSIs was carried out prospectively for adult patients who underwent sternotomy between 2005 and 2012. Infection control interventions that were undertaken during the study period at different time intervals were prophylaxis with cefazolin or vancomycin, surveillance of sternal SSIs and feedback, preoperative nasal Staphylococcus aureus screening and decolonization with mupirocin, isolation of patients infected with or colonized by meticillin-resistant S. aureus, appropriate management of perioperative blood glucose level and chlorhexidine/alcohol usage for skin antisepsis.

FINDINGS

There were 479 sternal SSIs in 18,460 patients during the study period (2.59%). The most frequent causes of sternal SSIs were coagulase-negative staphylococci (CoNS) (36%) and S. aureus (31%). Infection control interventions reduced the rate of sternal SSIs from 3.63% in 2005 to 1.65% in 2012 (P < 0.0001).

CONCLUSION

Our study shows that the rate of sternal SSIs can be decreased with proper infection control interventions. However, the interventions that were undertaken were effective only in reducing the rate of sternal SSIs caused by S. aureus. It is time to find interventions to control sternal SSIs caused by CoNS, the pathogen responsible for most sternal SSIs in hospitals where S. aureus SSIs are successfully controlled.

EULAR evidence based recommendations for the management of hand osteoarthritis: report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT)

OBJECTIVES

To develop evidence based recommendations for the management of hand osteoarthritis (OA).

METHODS

The multidisciplinary guideline development group comprised 16 rheumatologists, one physiatrist, one orthopaedic surgeon, two allied health professionals, and one evidence based medicine expert, representing 15 different European countries. Each participant contributed up to 10 propositions describing key clinical points for management of hand OA. Final recommendations were agreed using a Delphi consensus approach. A systematic search of Medline, Embase, CINAHL, Science Citation Index, AMED, Cochrane Library, HTA, and NICE reports was used to identify the best available research evidence to support each proposition. Where possible, the effect size and number needed to treat were calculated for efficacy. Relative risk or odds ratio was estimated for safety, and incremental cost effectiveness ratio was used for cost effectiveness. The strength of recommendation was provided according to research evidence, clinical expertise, and perceived patient preference.

RESULTS

Eleven key propositions involving 17 treatment modalities were generated through three Delphi rounds. Treatment topics included general considerations (for example, clinical features, risk factors, comorbidities), non-pharmacological (for example, education plus exercise, local heat, and splint), pharmacological (for example, paracetamol, NSAIDs, NSAIDs plus gastroprotective agents, COX-2 inhibitors, systemic slow acting disease modifying drugs, intra-articular corticosteroids), and surgery. Of 17 treatment modalities, only six were supported by research evidence (education plus exercise, NSAIDs, COX-2 inhibitors, topical NSAIDs, topical capsaicin, and chondroitin sulphate). Others were supported either by evidence extrapolated from studies of OA affecting other joint sites or by expert opinion. Strength of recommendation varied according to level of evidence, benefits and harms/costs of the treatment, and clinical expertise.

CONCLUSION

Eleven key recommendations for treatment of hand OA were developed using a combination of research based evidence and expert consensus. The evidence was evaluated and the strength of recommendation was provided.

Rehabilitation of flexor tendon injuries by use of a combined regimen of modified Kleinert and modified Duran techniques

OBJECTIVE

Kleinert (active extension, rubber-band passive flexion) and Duran (passive extension, passive flexion) protocols are two basic types of early motion programs for rehabilitation of flexor tendon injuries. Researchers have been working on various modifications or combinations of these two protocols to improve rehabilitation results. The purpose of this study was to analyze the quality of the functional results of flexor tendon repair after a postoperative regimen of early mobilization by use of a combined regimen of modified Kleinert and modified Duran techniques.

DESIGN

Thirty-seven patients (74 digits) with repaired flexor tendon injuries were treated. Functional results of the fingers were evaluated by the Buck-Gramcko system and total active motion measurements.

RESULTS

The results were excellent in 73% of the fingers, good in 24%, fair in 1.5%, and none was rated poor.

CONCLUSION

Our results are comparable with the previous studies that used various postoperative rehabilitation techniques. This postoperative management provides an effective way of achieving satisfactory results. Patient-assisted passive exercises are very safe and more cost effective than therapist-assisted passive exercises.

Psychosocial function, clinical status, and radiographic findings in a group of chronic low back pain patients

Low back pain is considered a problem with multiple facets for which the underlying causative factors should be determined. The aim of this study was to evaluate the relationships between depression, clinical status, and radiographic findings in a group of fifty patients with low back pain for more than 6 months. The patients underwent clinical examination and they completed Beck depression inventory (BDI), Aberdeen back pain scale (ABPS) and research questionnaire. Radiographic evaluations were performed. Clinical score and duration of symptoms were found to be positively correlated. The BDI scores were not found to be correlated with the existing variables. The ABPS scores were positively correlated with clinical scores and number of medications used.

Bone mineral density in children with juvenile chronic arthritis

The aim of this study was to evaluate bone mineral density changes in patients with juvenile chronic arthritis (JCA) and to determine the most likely causes of osteoporosis in these patients. Eighteen (11 male, 7 female) patients suffering from JCA and 14 healthy controls (10 male, four female) were included in this study. The mean age of the patients and control groups were 11.0 +/- 3.2 and 10.9 +/- 2.9 years respectively. Disease activity was determined by clinical and laboratory evaluation and 'Articular Disease Severity Score' (ADSS). Bone mineral density (BMD) of the femoral neck and lumbar spine was measured by dual photon absorptiometry. BMD of the patients at the lumbar spine was significantly lower than the control group (p < 0.05). This difference was more marked in patients treated with steroids. Femoral neck BMD was also lower in the patient group but this difference was not statistically significant. There was a negative correlation between ADSS and BMD at the spine. In conclusion, trabecular bone loss is characteristic for osteoporosis in JCA. Our results indicate that steroid treatment and disease severity are important factors in the development of osteoporosis in JCA.

Bowel dysfunction and irritable bowel syndrome in fibromyalgia patients

Fibromyalgia and irritable bowel syndrome are both common conditions which account for most of the referrals to physical medicine and rehabilitation-rheumatology and gastroenterology clinics, and they frequently coexist. In this study, we utilized a previously validated questionnaire to assess the prevalence of symptoms of bowel dysfunction and irritable bowel syndrome, and to survey the range of bowel pattern in 75 patients with fibromyalgia as compared to 50 normal controls. Symptoms associated with irritable bowel syndrome (p < 0.05) were reported in 41.8% of the fibromyalgia patients and 16% of the normal controls. In conclusion, we found that patients with fibromyalgia have a high prevalence of gastrointestinal complaints confirming the results indicating that fibromyalgia and irritable bowel syndrome frequently coexist. This may suggest a common pathogenic mechanism for both conditions.

Etiological and functional evaluation of the pediatric population with spinal cord injuries

Spinal cord lesions are the result of many etiological factors and are associated with motor, sensorial and autonomic dysfunctions. The subjects evaluated were a total of 217 paraplegics and quadriplegics who had been enrolled in a rehabilitation program during the last five years conducted by the Department of Physical Medicine and Rehabilitation of the Hacettepe University Faculty of Medicine. Forty-three of these patients were in the pediatric age group. In this clinical trial, the patients with spinal cord injuries were examined according to their age, sex, etiological factors and functional status. Frankel's scale was used for functional assessment. The mean age of patients was 9.19 +/- 4.19 years and varied between 1-16 years. The results of our classification according to etiological factors were as follows: Nineteen patients with tumors (44.1%), nine patients with infections (20.93%), five patients with congenital abnormalities (11.63%), five patients with vascular lesions (11.63%), four patients with trauma (9.30%), and one patient with a degenerative central nervous system disorder (2.32%). The effect of the rehabilitation program on the functional status of the patients is discussed.

Diagnosis and treatment of intraspinal lipomas

In this article a 32-case series of intraspinal lipoma localized to the lumbosacral region is presented. All of the patients underwent surgery. Recent reports in the literature indicate that although these lesions show advanced and progressive neurological deficits, very good results can be achieved with surgical treatment. The advantages of computed tomography in diagnosis and the importance of early surgical intervention and postoperative rehabilitation are emphasized.