Chronic low-level arsenic exposure reduces lung function in male population without skin lesions

Objectives

The respiratory effects of chronic low-level arsenic exposure from groundwater have been investigated in West Bengal, India.

Methods

The participants (834 non-smoking adult males) were subdivided in two groups: an arsenic-exposed group (n = 446, mean age 35.3 years) drinking arsenic-contaminated groundwater (11–50 μg/L) and a control group of 388 age-matched men drinking water containing <10 μg/L of arsenic. Arsenic in water samples was measured by atomic absorption spectroscopy. The prevalence of respiratory symptoms was documented by structured, validated questionnaire. Pulmonary function test (PFT) was assessed by portable spirometer.

Results

Compared with control, the arsenic-exposed subjects had higher prevalence of upper and lower respiratory symptoms, dyspnea, asthma, eye irritation and headache. Besides, 20.6 % of arsenic-exposed subjects had lung function deficits (predominantly restrictive and combined types) compared with 13.6 % of control (p < 0.05). A positive association was observed between arsenic concentration in drinking water and the prevalence of respiratory symptoms, while a negative association existed between arsenic level and spirometric parameters.

Conclusions

The findings suggest that even low-level arsenic exposure has deleterious respiratory effects.     

The role and value of oral metronidazole in acute appendicitis

A prospective, randomized study was undertaken in 246 patients 4 – 15 years of age with simple or complicated appendicitis and local peritonitis to determine the efficacy of oral metronidazole (OM) threrapy. Those referred on odd days were chosen as the study group (SG) and those on even days as a control group (CG). The SG received OM 10 mg/kg per dose 2 h preoperatively and every 8 h after operation according to the following intraoperative findings: inflamed (mild to severe), 3 doses; gangrenous or perforated with no pus, 3 days, the same with pus, 5 days. The CG received 20 mg/kg cephalexin 2 h before operation and, if the appendix was inflamed, 6-hourly for 3 doses postoperatively. The routine combination in our center of penicillin, chloramphenicol, and gentamicin was given to the patients in the CG with complicated appendicitis, as in the SG, for 3 or 5 days. All cases with generalized peritonitis were excluded from the study. Serum concentrations of metronidazole after one postoperative dose were in the bactericidal range in 18 of 20 patients in whom the measurement was performed. The incidences of wound infection and intraabdominal abscess were quite similar in both groups with the same degree of pathology. However, in patients with complicated appendicitis the hospital stay in the SG was about 1 day less than in the CG. Moreover, hospital costs per patient day were less in the SG. We conclude that OM is a cost-effective drug, more convenient for the patient and nursing staff, and can be used as an effective antibiotic even in complicated appendicitis.     

Approach to a child with a heart murmur

The vast majority of children with heart murmurs have an ‘innocent’ murmur. Differentiation of such murmurs from those due to structural cardiac disease, so called ‘pathological’ murmurs, is largely clinical. Pediatricians are capable of differentiating one from the other, provided a detailed evaluation is done. This article outlines the salient features of innocent murmurs that help us recognize them clinically.     

A new technique for esophagoplasty in relatively long esophageal strictures

A 3-year-old girl with severe dysphagia secondary to caustic stricture of the cervical esophagus (about 4 cm in length) underwent esophagoplasty by a new technique following failed attempts at esophagoscopy and dilatation. This procedure results in a neoesophagus in the region with a lumen approximately twice its previous diameter, which will further increase in size gradually after a number of dilatations. The postoperative course was uneventful. She had almost no dysphagia following four successive dilatations 1, 2, 3 and 5 months after surgery. Barium swallow revealed an acceptable lumen. She was asymptomatic 2 years after surgery.     

Neonatal parotitis

Neonatal parotitis is a rare condition. Infection of the parotid glad is more common than that of the submandibular glad. Dehydration is the most important predisposing factor for this. Most common organism responsible for this condition is Staphylococcus aureus. Untreated condition can lead to various complications.     

Staphylococcal sepsis presenting as pulmonary embolism

Deep vein thrombosis in children is rare and is often secondary to a predisposing condition. Staphylococcal sepsis following furunculosis and complicated by deep vein thrombosis and septic pulmonary emboli in a fourteen-yr-old boy is presented. He was managed successfully with antibiotics and anticoagulation.     

Clinical manifestations of co-infection with malaria and leptospirosis

Though both malaria and leptospirosis are frequent in the tropics, co-infections are under-recognized due to overlapping of clinical features. Here, we reviewed clinical manifestations of published co-infection along with our three cases. Out of a total of 18 patients, nine patients (50%) required ICU admission. Almost all patients had prodromal symptoms in the form of fever, headache and myalgia. Seven patients (37%) had altered sensorium, three patients (17%) had hypotension at admission, and 11 patients (61%) had acute kidney injury (AKI). Pulmonary manifestations in the form of pulmonary bleeding were present in four cases (22%). Three (17%) patients had acute lung injury/ acute respiratory distress syndrome. Almost 55% patients had DIC in the form of altered prothrombin time, activated partial thromboplastin time and low fibrinogen level. Four patients (22%) had subconjuctival suffusion, two of them had haematuria, while one presented with nasal bleeding. All patients had altered liver function tests. Of all the 18 patients, 17 (94%) survived, while one died.