Thermal stress and physiological strain of children exposed to hot environments in a glass bangle factory

Summary A group of 19 male children (mean age 12.1 years SEM 1.6 years) occupationally exposed to an excessively hot environment for an average duration of 2.5 years SEM 1.7 years in the glass bangle factory in Firozabad, India, were studied to evaluate the physiological strain induced by the thermal radiation (mean radiant temperature 46.2° SEM 5.1° C) and high ambient temperature (38.2° SEM 3.4° C) prevailing in the factory. Over a work-shift the mean increase in oral temperature was 0.90° C in the exposed children, in comparison with the 0.40° C increase recorded in the control children (p<0.05). The maximum increase in oral temperature was recorded in ‘gulliwalas’ (0.90° C) and the minimum in ‘battiwalas’ (0.80° C). The mean peak value of oral temperature (37.5° C) was observed at 1600 hours. A significant increase in the pulse rate (25.9 beats·min⁻¹) during the work-shift was observed in the exposed children in comparison with a mean increase of 9.4 beats·min⁻¹ in the control group. Ventilatory studies showed pulmonary hyperventilation in the exposed workers. The increase in pulmonary ventilation was in the form of an increase in tidal volume and respiratory frequency induced by high environmental temperatures and thermal radiation. The cardio-respiratory responses showed physiological strain induced by the high ambient temperature and radiant heat prevailing in the glass bangle factory.     

Review of positive direct antiglobulin tests found on cord blood sampling

Until recently, all babies born in Wellington had umbilical cord blood sampling for direct antiglobulin test (DAT). It is considered to be an important test in identifying babies who are at risk of haemolytic disease of the newborn (HDN). OBJECTIVE: The aim of this review was to examine the utility of positive DAT results and ascertain: -- How many cases required phototherapy? -- Were any babies readmitted for phototherapy? -- Did the positive DAT influence the detection and treatment of HDN? METHODS: The clinical records of all newborn babies found to have positive DATs by Wellington Hospital Blood Bank, over a 6-month period (January 2001-June 2001) were reviewed. Blood group serological results of all babies that received phototherapy during this period were also reviewed. RESULTS: Ninety-four babies had a positive DAT, of which 22 (23%) received phototherapy. The incidence of a positive cord blood DAT was found to be 5.5%. In total, 1724 cord blood samples were analysed by Blood Bank over the first 6 months in 2001. Overall 145 babies received phototherapy, 117 were DAT-negative and six were not tested. Six of the 22 (27%) DAT-positive babies that received phototherapy were alerted by a positive DAT, leading to measurement of serum bilirubin (SBR). Twelve of the 22 (55%) were initially alerted by clinical jaundice, leading to measurement of SBR. Two DAT-positive cases were diagnosed antenatally, both were due to anti-D. Overall 10 babies were readmitted for phototherapy, two had a positive DAT. One baby received an exchange transfusion in addition to phototherapy. Two babies that received phototherapy had SBRs in the exchange transfusion range. Eighty-six per cent of the DAT-positive cases treated with phototherapy were due to anti-A. There were four cases of DAT-negative ABO HDN. CONCLUSIONS: The positive predictive value of a positive DAT for HDN is 23%. The sensitivity was estimated to be 86%. Ten babies required readmission for phototherapy, two of these were DAT-positive. Jaundice, rather than the positive DAT, was the first alert in the majority of cases of HDN requiring phototherapy. Recommendations for testing are discussed but remain controversial in practice. Assessment for hyperbilirubinaemia in all infants early in life is fundamental.     

Evaluation of cervical screening in rural North India

Objective

To assess the accuracy of cervical screening with visual inspection and cytology testing, and the cure rate of cervical intraepithelial neoplasia (CIN) after treatment, in a rural population in North India.

Methods

A cross-sectional study evaluated the detection rates of CIN 2 and CIN 3 lesions by cytology testing and by visual inspection of the cervix following the application of 5% acetic acid (VIA) or Lugol's iodine (VILI). It also evaluated the cure rates following treatment of CIN.

Results

Of 5050 women approached in 17 villages, 3000 (59.4%) participated (range, 41%-91%). Of these, 14.2% were positive by VIA, 15.6% by VILI, and 5.4% by cytology testing at ASCUS threshold, and 37 women were diagnosed as having CIN 1 and 20 as having CIN 2 or CIN 3. Detection rates of CIN 2 or 3 using VIA, VILI, and cytologic findings of ASCUS and LSIL were 3.7, 3.3, 4.5, and 4.2 per 1000 women, respectively, and 91.4% of the treated women were cured.

Conclusion

Both VIA and VILI were found to be accurate screening tests and the cure rates for CIN were satisfactory.