The sick building syndrome: what is it when it is?

Sick building syndrome is a commonly applied diagnosis; often abused and misinterpreted to denote headaches, dizziness, fatigue and eye irritation associated with a building The authors have stated that they do not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article.     

CPR: is it cruel or is it kind?

When people have a cardiac arrest, whether in hospital or the community, there is a presumption is that cardiopulmonary resuscitation should be attempted in all but exceptional circumstances. This is based on ethical, legal, political and cultural principles. However, few patients leave hospital with their faculties intact following CPR, which often simply postpones death for a short time. The authors argue that this represents a poor use of public resources and condemns many patients to severe debilitation. They suggest that the focus should move towards preventing cardiac arrest, so that scarce resources can be redirected to interventions with proven benefits.     

Allometric scaling of flow‐mediated dilation: is it always helpful?

Flow‐mediated dilation (FMD) is calculated as the greatest percent change in arterial diameter following an ischaemic challenge. This Traditional %FMD calculation is thought to have statistical bias towards baseline diameter (D_base), which is reduced by allometric scaling. This study examined whether allometric scaling FMD influenced the difference between a group of healthy young and older adults compared to the Traditional %FMD, and to determine whether a New (allometric) scaling %FMD improved the ability to obtain individually scaled FMD. Popliteal artery FMD was assessed in 18 young (26 ± 3 years) and 17 older adults (77 ± 5 years). ‘Corrected’ mean FMD was generated from a log‐linked ANCOVA model. Individual %FMD was evaluated using three calculations: (1) Traditional %FMD calculation; (2) Atkinson (allometric) scaling %FMD (peak diameter ); and (3) New scaling %FMD . Traditional %FMD was significantly larger in young (5·82 ± 2·58%) versus old (3·72 ± 1·26%). ‘Corrected’ FMD means (Y: 5·97 ± 2·12%; O: 3·98 ± 2·06%) were similar to Traditional %FMD; however, the logarithmic transformation prevents statistical interpretation of group differences. Individually scaled %FMD using the Atkinson scaling resulted in values that were corrected for variations in D_base but that were twofold to threefold larger than those of the Traditional calculation. New scaling %FMD resulted in values that were similar to values expected (Y: 6·21 ± 2·75%; O: 3·98 ± 1·36%); however, it did not effectively correct for variation in D_base. Recommendations regarding the advantages of allometrically scaling %FMD should be made with caution until research clearly establishes the benefits of this approach.     

Aprotinin: is it prothrombotic?

Controversy continues as to whether aprotinin (Trasylol) is prothrombotic. The recent discovery of the thrombin receptor family, known as the protease-activated receptor family (PAR) has been essential in aiding our understanding of the mechanism of action of aprotinin. Our results show that aprotinin has no effect on platelet aggregation induced by adrenaline, adenosine diphosphate, phorbol-12-myristate-13-acetate, collagen or PAR 1 agonist peptide. However, aprotinin inhibits thrombin-induced platelet activation as assessed by macroaggregation, microaggregation and platelet membrane calcium flux. Aprotinin inhibits proteolytic activation of platelets, but platelets can still be activated by non-proteolytic mechanisms.     

Rash: is it shingles?

CASE PRESENTATION: Mrs. Smith, a 56-year-old Caucasian woman, was seen in the office for complaints of a rash at her waist. She completed three cycles of dose-dense cyclophosphamide and doxorubicin chemotherapy for stage III breast cancer. The third cycle was 10 days prior. Grade III neutropenia was the only complete blood count abnormality.