Methylprednisolone in acute spinal cord injuries

BACKGROUND

Methylprednisolone is the only neuroprotective therapy advocated in acute non-penetrating spinal cord injury. Trials indicate improved neurological outcome following early administration of a high dose regime. The National Spinal Injuries Unit (NSIU) has promoted this regime by a simple laminated poster sent to all Irish A&E departments.

AIM

To assess the use of methylprednisolone in patients with spinal cord injuries.

METHODS

A retrospective audit of patient data for all patients admitted with traumatic neurological impairment over a 12-month period.

RESULTS

One hundred ninety-six patients were admitted during the study period, 28 (14%) received intravenous methylprednisolone of which six had clear records documenting compliance. One patient received both dexamethasone and methylprednisolone in high doses and three had incorrect bolus dosages administered. Six patients received methylprednisolone infusion longer than the protocol, while five patients were given infusions shorter than recommended. Three patients were admitted to the unit that could have received the steroid regime at the point of transfer.

CONCLUSIONS

There was poor documentation of prescription orders and timing of administration. Only six patients had clear documentation allowing confirmation of adherence to the protocol of the National Acute Spinal Cord Injury Study (NASCIS) III trial.

Reducing fumigant emissions after soil application

ABSTRACT Volatilization and soil transformation are major pathways by which pesticides dissipate from treated agricultural soil. Volatilization is a primary source of unwanted agricultural chemicals in the atmosphere and can significantly affect fumigant efficacy. Volatile pesticides may cause other unique problems; for example, the soil fumigant methyl bromide has been shown to damage stratospheric ozone and will soon be phased out. There is also great concern about the health consequences of inhalation of fumigants by people living in proximity to treated fields. Because replacement fumigants will likely face increased scrutiny in years ahead, there is a great need to understand the mechanisms that control their emission into the atmosphere so these losses can be minimized without loss of efficacy. Recent research has shown that combinations of vapor barriers and soil amendments can be effective in reducing emissions. In this paper, some potential approaches for reducing fumigant emissions to the atmosphere are described.