INTERRELATION OF BIOMETRIC AND CLINICAL METHODS IN THE APPRAISAL OF NUTRITIONAL STATUS

It is the purpose of this paper to discuss certain phases of the pro- blem of nutritional assessment. Particular attention will be directed to(1) the reasons for failure of the commonly used height-weight rclationship to provide an adequate basis for nutritional appraisal, (2) the importance of the stem-length (sitting-height) in relation to weight, and the peculiar merits of von Pirquet''a jelidisi index based on this relationship, (3) certain fundamental principles bf biometric and statis- tical analyses upon which the correct interpretation and application r,f such indices depend, and (4) the necessity of combining both clinical and biometric methods of nutritional appraisal in the interesfs of arriving at the most adequate nutritional assessment possible in specific cases.     

The characteristics of acute non‐fatal medication‐related events attended by ambulance services in the Melbourne Metropolitan Area 1998–2002

Introduction and Aims. To describe the characteristics of non‐fatal medication‐related ambulance attendances in Melbourne. Design and Methods. A retrospective analysis of 16 705 patient care records completed by ambulance paramedics in Melbourne where medications had a causal role in the attendance. Results. A single medication only was implicated in 11 765 cases (70% of the total). Of these, 85% involved one of six types of medication: benzodiazepines (52%), paracetamol (15%), selective serotonin re‐uptake inhibitors (6.5%), combination paracetamol and opioids (4%), phenothiazines (3.4%) and tricyclic antidepressants (TCA) (3.7%). Cases involving benzodiazepines were significantly (P < 0.001) older (Average = 37 years) than those involving paracetamol (Average = 30 years). Thirty‐four per cent of cases involved concurrent alcohol use, and this varied according to drug type (paracetamol 26%, benzodiazepines 40%, selective serotonin re‐uptake inhibitors 35%, paracetamol and opioids 35%). An abnormal Glasgow Coma Scale score was found in 19% of cases, again varying according to drug type (paracetamol 10%, TCA 39%, benzodiazepines 21%, paracetamol and opioids 17%, phenothiazines 15%). Ten per cent of cases were not transported to hospital ranging from 3% for TCA to 13% for benzodiazepines. Discussion and Conclusions. The majority of non‐fatal medication events attended by ambulance paramedics involve one of six substances. Benzodiazepines were most commonly implicated and, as management may require only simple supportive treatment, significant numbers are not transported to hospital. The unique clinical population is identified in this study and the ongoing medical and psychiatric treatment of these patients not transported to hospital in the study period needs to be considered. [Hutton J, Dent A, Buykx P, Burgess S, Flander L, Dietze P. The characteristics of acute non‐fatal medication‐related events attended by ambulance services in the Melbourne Metropolitan Area 1998–2002. Drug Alcohol Rev 2009]     

Lyme Disease as a Cause of Acropapular Dermatitis of Childhood

Abstract:  Acropapular dermatitis of childhood is a symmetric self-limited papulovesicular exanthem that classically occurs on the cheeks, extensor extremities, and buttocks in young children. The eruption of acropapular dermatitis of childhood represents a reaction to a variety of infections usually of viral origin. We present a child with typical findings of acropapular dermatitis of childhood whose serologic workup revealed an acute Lyme infection.     

Localization of the Origin of Arrhythmias for Ablation: From Electrocardiography to Advanced Endocardial Mapping Systems

Radiofrequency catheter ablation techniques have had a dramatic impact on the treatment of a variety of cardiac arrhythmias. However, catheter ablation of complex arrhythmias, such as intra-atrial reentry, ventricular tachycardias, and atrial fibrillation, continues to pose a major challenge. This stems from limitations of fluoroscopy and conventional catheter-based mapping techniques that limit the accurate anatomic localization of complex arrhythmogenic substrates. In this article, ECG features of complex arrhythmias are reviewed, which may facilitate the planning of an ablation procedure. The physical principles of the newly available catheter-based endocardial mapping techniques and their clinical applicability for treatment of complex arrhythmias are discussed. The role of intracardiac echocardiography to facilitate mapping and ablation is reviewed.     

Nutrition during treatment of head and neck cancer

The importance of nutrition during the treatment of head and neck cancers has been discussed in relation to oral health. The side effects of surgery, radiation therapy, and chemotherapy are described as well as their effects on nutrition. Common presentations of therapy-induced malnutrition are presented. Parameters for nutritional assessment are listed and an instrument is proposed to assist with the monitoring of nutritional status and to aid in organizing interventions that support adequate nutrition. The practitioner who is capable of recognizing and helps to prevent nutritional deficiencies in patients with head and neck cancers provides a valuable service that increases the comfort of the patient and improves the prognosis for successful therapy.     

Supplying emergency hormonal contraception in the pharmacy: the perspectives of service users

□ Pharmacists have been supplying emergency hormonal contraception via patient group direction in Manchester, Salford and Trafford health action zone since late 1999 □ This paper presents preliminary results of a questionnaire survey of users experiences of obtaining emergency contraception from this source □ Four hundred and thirty out of a total of 5,020 questionnaires distributed by pharmacists were completed □ Ninety‐nine per cent of service users were either very satisfied or satisfied with the manner in which their request for emergency contraception was dealt with □ Ninety‐one per cent of respondents felt either comfortable or very comfortable discussing emergency contraception with the pharmacist     

Disposition and Metabolism of [14C]Dibenzo[c,g]carbazole Aerosols in Rats after Inhalation

Disposition and Metabolism of [^l4C]Dibenzo[c,g]carbazole Aerosolsin Rats after Inhalation. Bond, J. A. Ayres, P. H., Medinsky,M. A., Cheng, Y. S., Hirshfield, D., and McClellan, R. O. (1986).Fundam Appl Toxicol. 7, 76-85. Dibenzo[c.£]carbazole (DBC)is a nitrogen-containing polycyclic aromatic hydrocarbon thathas been detected in tobacco tars, industrial oils, and dieselengine exhaust fumes. DBC is carcinogenic in respiratory tracttissue of hamsters and in lungs, kidneys, and livers of mice.The purpose of this research was to determine the respiratorytract deposition, distribution in tissues, metabolism, and excretionof DBC in rats after inhalation. Rats were exposed nose-onlyto 1.1 or 13 Mg [¹⁴C]DBC/liter air for 60 min. Activity medianaerodynamic diameters for the two concentrations of DBC rangedfrom 0.7 to 0.8 pm. Unne. feces, and selected tissues were collectedfor various times after exposure. The fractional depositionfor the 1.1 and 13 ug/liter exposure concentrations was similar,13 and 16%, respectively. The dominant route of excretion of¹⁴C following exposure to either concentration of DBC was thefeces, accounting for approximately 95% of the total 14C eliminated.Half-time for fecal excretion was 20 ± 6 hr (x ±SE). Gastrointestinal absorption of [I4C]DBC was 43%. Radioactivitywas widely distributed to all tissues examined, with the respiratorytract (lung, trachea, larynx, and nasal turbinates), upper gastrointestinaltract (stomach and small intestine), the liver, and the adrenalscontaining the highest concentrations of [I4C]DBC equivalentswithin 1 hr after exposure. At both concentrations of DBC tested,clearance of I4C from tissues was rapid, with approximately60 to 98% of the initial tissue burden being cleared with half-timesranging from 1 to 16 hr. The remaining 2 to 40% in the tissueswas cleared with half-times that ranged from 1.5 to 14 days.Several metabolites were detected in the urine and feces, noneof which appeared to be either glucuronide or sulfate conjugates.Small quantities of [I4C]DBC were detected in the urine, althoughquantities were less than 1% of the initial respiratory tractburden of [I4C]DBC. The results from this research indicatethat DBC was rapidly absorbed from the lungs and translocatedto many tissues. Prior to elimination, primarily in the feces,DBC was extensively metabolized There appeared to be no effectof exposure concentration on the toxicokinetics of inhaled DBC.