Masala [PDF]
There is good news for healthcare workers
(HCWs). The transmission of tuberculosis occurs via the airborne
route and HCWs would seem vulnerable. However, a review of records
between 1992 and 2001 at Vellore, Tamil Nadu, India did not find
an increased overall incidence of sputum-positive tuberculosis
in HCWs compared with the general population. However, the probability
of developing extrapulmonary tuberculosis was higher (J Hosp
Infect 2004;57:339–42).
Another piece of good news for those at occupational risk (Occup
Environ Med 2004;61:577–85).
Fifty years of data on a cohort of over 50 000 employees
of the UK
Atomic Energy Authority show
no evidence of a higher mortality than the general population
and certainly no excess incidence of cancer. Indeed, the
mortality rates were generally lower, probably reflecting
the healthy
nature of the recruits.
Cardiac arrest is a desperate situation. While high levels of
epinephrine in doctors and nurses might help, such levels are
not good for the patient. High dose epinephrine (0.1 mg/kg) was
tested as a rescue therapy after the failure of a standard initial
dose of epinephrine (0.01 mg/kg) in children with cardiac arrest.
In this prospective, randomized study in children, 24 hours after
the cardiac arrest, the high dose epinephrine group had a worse
outcome (N Engl J Med 2004;350:1722–30).
Radiofrequency ablation (RFA) loses the race to surgery in the
treatment of potentially resectable hepatocellular carcinoma
(HCC) in cirrhotic livers. A study that compared the outcomes
in two different surgical units found that the overall and disease-free
survival was significantly higher in the unit that treated HCC
by surgery. Only the hospital stay was substantially lower in
the unit employing RFA for HCC (Ann Surg 2004;240:102–7).
Money cannot buy everything. A partial dichotomy between the
health status of the population and spending on health is well
established. Even though the USA spent more than twice as much
per capita on healthcare than countries of the European Union,
self-ratings of health were lower at all ages in the USA. Essentially,
expensive and technologically advanced procedures have yielded
disappointing outcomes in population health (J Epidemiol
Community Health 2004;58:529–30).
Get rid of sweetened soft drinks from your children’s
menu (Pediatrics 2004;113:152–4). While much of the focus on
the harmful effects of sugary beverages has been on the obesity
crisis in children and adolescents, the document raised concerns
about soft drinks displacing milk from children’s diets.
This could set the stage for fractures and osteoporosis later
in life. Similar doubts about the safety of soft drink consumption
and bone fractures among teenaged girls were raised in another
study (Arch Pediatr Adolesc Med 2000;154:610–13).
This may have implications for the health of both teenagers
and older
women.
A new ‘look’ at the pathogenesis of hypertension.
The deleterious consequences of hypertension include arterial
narrowing. Interestingly, narrowing of the arterioles may
contribute to the development of hypertension. The diameter
of retinal
arterioles and venules using digitized fundus photographs
were measured
in over 2000 normotensive individuals. Over a 10-year period,
subjects with smaller arterioles had a higher incidence of
hypertension (BMJ 2004;329:79–82).
Obesity will be the biggest epidemic of the twenty-first century.
Liposuction may make beautiful figures but fails to improve the
metabolic complications of obesity. Large volume abdominal liposuction
was carried out in women with abdominal obesity. Sadly, it did
not alter the insulin sensitivity, levels of plasma interleukin-6
and tumour necrosis factor-alpha, or other risk factors for coronary
heart disease. The chef wonders who the culprit is in obese subjects
(N Engl J Med 2004;350:2549–57).
Housestaff or residents are often flogged in till they drop.
Things may be changing with initiatives for reforms in housestaff
working hours, but does it help outcomes? In Cleveland, Ohio,
sentinel events, medication errors, maternal and neonatal outcomes
were measured before and after the Accreditation Council of Graduate
Medical Education (ACGME) work-hour reforms. The obstetric outcomes
were largely unchanged. Postpartum haemorrhage and neonatal resuscitations
decreased significantly over time. Reported medication errors
associated with resident performance were too rare for comparison
across time periods (Obstet Gynecol 2004:103:613–16).
Bugs love toys. In hospitals, children are commonly provided
with toys. A study (Am J Infect Control 2004;32:287–90)
was conducted to determine whether toys were contaminated with
potentially pathogenic bacteria when they arrived in the hospital.
Cultures from children’s toys were obtained within
the first 48 hours of admission and then the toys were cleaned
with an antiseptic. All first cultures were positive for
at
least
1 pathogenic microorganism and, after the toys were cleaned,
subsequent cultures showed significant decreases in the bacterial
growth rates. Interestingly, almost half of the toys were
brought from home!
This one is fit for the Discovery Channel crime documentary.
In 1999, two young women informed the Rio de Janeiro Police Department
that they had been victims of sexual assault. A suspect was arrested
and the victims identified him as the offender. The suspect maintained
that he was innocent. Usually, the investigation of suspected
rape includes preparation of vaginal swabs from the rape victim
and some of the biological material collected is then transferred
to glass slides. The Rio sleuths decided to send these vaginal
smear slides to the DNA diagnostic laboratory for DNA analysis
3 months after the crimes. The analysis showed that it was 3.3
billion times more probable that it was the examined suspect
who had left sperm cells in the victims, rather than any other
individual in the population of Rio de Janeiro (Sao Paulo
Med J 2004;122:70–2).
Viagra (sildenafil) may be the first drug to increase exercise
capacity during severe hypoxia both at sea level and at high
altitude. Alveolar hypoxia causes pulmonary hypertension and
enhanced right ventricular afterload, which may impair exercise
tolerance. Healthy mountaineers and trekkers were studied both
at low as well as high altitude (the Mount Everest base camp).
At low altitude, sildenafil ameliorated acute hypoxia-induced
reduction in arterial oxygen saturation and improved the maximum
exercise capacity. However, at high altitude, sildenafil had
no effect on arterial oxygen saturation at rest and during exercise,
though it improved the maximum workload and cardiac output (Ann
Intern Med 2004;141:169–77).
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