Air Pollution and the Risk of Cardiac Defects: A Population-Based Case-Control Study

Previous epidemiologic studies have assessed the role of the exposure to ambient air pollution in the development of cardiac birth defects, but they have provided somewhat inconsistent results. To assess the associations between exposure to ambient air pollutants and the risk of cardiac defects, a population-based case-control study was conducted using 1087 cases of cardiac defects and a random sample of 10,870 controls from 1,533,748 Taiwanese newborns in 2001 to 2007.Logistic regression was performed to calculate odds ratios for 10 ppb increases in O₃ and 10 μg/m³ increases in PM₁₀. In addition, we compared the risk of cardiac defects in 4 categories-high exposure (>75th percentile); medium exposure (75th to 50th percentile); low exposure (<50th–25th percentile); reference (<25th percentile) based on the distribution of each pollutant. The risks of ventricular septal defects (VSD), atrial septal defects (ASD), and patent ductus arteriosus (PDA) were associated with 10 ppb increases in O₃ exposure during the first 3 gestational months among term and preterm babies. In comparison between high PM₁₀ exposure and reference category, there were statistically significant elevations in the effect estimates of ASD for all and terms births. In addition, there was a negative or weak association between SO_2, NO₂, CO, and cardiac defects_.The study proved that exposure to outdoor air O₃ and PM₁₀ during the first trimester of gestation may increase the risk of VSD, ASD, and PDA.     

Localized Kaposi''s sarcoma in a patient with pemphigus vulgaris

We report the case of a patient with a 13-year history of pemphigus vulgaris (PV) treated with immunosuppressive agents, prednisone and mycophenolate mofetil who had developed lesions of Kaposi's sarcoma (KS) on a sole plaque of PV that had been previously treated with intralesional injections of steroids. The lesions were surgically removed and polymerase chain reaction (PCR) demonstrated human herpesvirus-8 (HHV-8) DNA. There were neither recurrences nor later dissemination of KS following gradual decrease of the immunosuppressive therapy. We suggest that the treatment with intralesional steroids may have influenced the local reactivation of a latent infection of the virus, determining the appearance of this localized KS.     

FEASIBILITY OF CONDUCTING CARDIOVASCULAR OUTCOME RESEARCH IN AUSTRALIAN GENERAL PRACTICE: RESULTS FROM THE ANBP2 PILOT STUDY

1. The present study aimed to determine the feasibility of conducting a 5 year cardiovascular outcome trial of the treatment of 6000 elderly hypertensive patients in Australian general practices. 2. General practitioners (GPs) were invited to participate by mail and personal follow-up. Patient records were reviewed to identify subjects for a blood pressure (BP) screening programme. Blood pressure was measured on three occasions and eligible subjects were included if the average BP was 160 mmHg systolic or 90 mmHg diastolic if systolic BP was 140 mmHg. 3. Seven hundred and forty-one GPs were approached and 89 were enrolled in the study (12% of mail invites and 75% of those receiving a personal contact). In 16 practices where screening was completed, 82 000 records were reviewed to identify 4% patients eligible for screening. Twenty-two per cent of eligible subjects attended screening. Of 1938 subjects screened, 180 (9%) had BP 5=160/90 mmHg. Forty-seven percent of subjects (n = 916) were receiving antihypertensive therapy and 184 (20%) were withdrawn from therapy. One hundred and sixteen (63%) of these subjects had BP return to study entry levels within 6 weeks. Fifty-seven newly diagnosed and 81 previously treated subjects were randomized (7% of the screened population). 4. Based on the high participation rate of GPs, the response rate of patients to attend a BP screening programme and the 7% randomization to screening ratio for entry into the study, the ANBP2 pilot study has demonstrated that it is feasible to recruit subjects from Australian general practices to a cardiovascular outcome trial.     

SELECTIVE IgA DEFICIENCY PRESENTING WITH HYPERSPLENISM

SUMMARY A young patient presenting with splenomegaly and hypersplenism was inadvertently found to have selective IgA deficiency. There were no symptoms of immunodeficiency and the patient responded well to splenectomy, with return of blood counts to normal without adverse effects. No other cause for the hypersplenism was found. We postulate selective IgA deficiency as a cause of splenomegaly and hypersplenism.     

Successful treatment of periungual warts using photodynamic therapy: a pilot study

AIM: The aim of this pilot study was an investigation on photodynamic therapy (PDT) whether it is a good alternative for treating periungual and subungual warts of the hands. STUDY DESIGN: Twenty patients (mean age: 30.5 years) with a total of 40 periungual and subungual warts were treated with PDT. A photosensitizer, 20%delta-aminolevulinic acid was applied on the warts. After a mean incubation time of 4.6 h (SD: 1.2), the warts were irradiated with the VersaLight for 5-30 min (15.2 +/- 4.3 min). RESULTS: After a mean of 4.5 treatments a mean clearance of 100% was achieved in 90% of the patients. One patient (5%) showed a clearance of 50% and another showed no improvement. The subungual or periungual location of the wart had no influence on the number of treatments or end result (P > 0.05). There were two recurrences during the mean follow-up period of 5.9 months (SD: 7.6). Besides mainly pain and hyperpigmentation, most treatments had no side-effects. CONCLUSION: PDT can offer a good alternative for treating periungual warts of the hands. Larger studies are indicated.     

Prescribing strengthening exercises for my patients: which equipment should I select?

This paper examines various devices used in strength building exercise programs. These include free weights, pulley machines, variable resistance weight machines, isokinetic units and elastic tubing and banding. Advantages and disadvantages of each are discussed and examined from the view point of the health care provider and the suitability of each type of device for prescribed progressive resistance exercise programs for patients. In addition to such practical aspects such as cost and maintenance, biomechanical factors, types of contraction elicited, ease of patient instruction and proprioception benefits are also compared in order to assist the clinician in selecting the most appropriate equipment for each individual patient.     

Air recirculation and sick building syndrome: a blinded crossover trial.

OBJECTIVE. This study tested the hypothesis that recirculated air in mechanically ventilated buildings causes symptoms commonly referred to as the sick building syndrome and perceptions of poor indoor air quality. METHODS. A blinded, four-period crossover trial was carried out in two identical buildings, contrasting 70% return air (index phase) with 0% of return air (reference phase). Each period lasted 1 work-week. The study population comprised 75 workers who had reported symptoms related to the work environment or perceptions of poor indoor air quality. Participants reported their ratings of symptoms, their perceptions, and related information in a daily diary. The outcome criteria included aggregative symptom scores for mucosal irritation, skin reaction, allergic reaction, and general symptoms formed of ratings of component symptoms. Perceptions of unpleasant odor, stuffiness, or dustiness were additional outcome criteria. RESULTS. All 75 participants returned their diaries. For no symptoms did the scores differ between the two phases more than could be expected by chance. Mean rating of unpleasant odor was significantly smaller during the index phase, but mean ratings of dustiness and stuffiness did not differ materially between the two phases. CONCLUSIONS. Our results suggest that 70% recirculated air, when accompanied by an adequate intake of outdoor air, can be used without causing adverse effects.