Showing papers by "Saint Francis University published in 2015"

Pulmonary Rehabilitation and Physical Activity in Patients with Chronic Obstructive Pulmonary Disease

Abstract: Physical inactivity is common in patients with chronic obstructive pulmonary disease (COPD) compared with age-matched healthy individuals or patients with other chronic diseases. Physical inactivity independently predicts poor outcomes across several aspects of this disease, but it is (at least in principle) treatable in patients with COPD. Pulmonary rehabilitation has arguably the greatest positive effect of any current therapy on exercise capacity in COPD; as such, gains in this area should facilitate increases in physical activity. Furthermore, because pulmonary rehabilitation also emphasizes behavior change through collaborative self-management, it may aid in the translation of increased exercise capacity to greater participation in activities involving physical activity. Both increased exercise capacity and adaptive behavior change are necessary to achieve significant and lasting increases in physical activity in patients with COPD. Unfortunately, it is readily assumed that this translation occurs naturally. This concise clinical review will focus on the effects of a comprehensive pulmonary rehabilitation program on physical activity in patients with COPD. Changing physical activity behavior in patients with COPD needs an interdisciplinary approach, bringing together respiratory medicine, rehabilitation sciences, social sciences, and behavioral sciences.

The gap between policy and practice: a systematic review of patient-centred care interventions in chronic heart failure.

Abstract: Patient-centred care (PCC) is recommended in policy documents for chronic heart failure (CHF) service provision, yet it lacks an agreed definition. A systematic review was conducted to identify PCC interventions in CHF and to describe the PCC domains and outcomes. Medline, Embase, CINAHL, PsycINFO, ASSIA, the Cochrane database, clinicaltrials.gov, key journals and citations were searched for original studies on patients with CHF staged II-IV using the New York Heart Association (NYHA) classification. Included interventions actively supported patients to play informed, active roles in decision-making about their goals of care. Search terms included 'patient-centred care', 'quality of life' and 'shared decision making'. Of 13,944 screened citations, 15 articles regarding 10 studies were included involving 2540 CHF patients. Three studies were randomised controlled trials, and seven were non-randomised studies. PCC interventions focused on collaborative goal setting between patients and healthcare professionals regarding immediate clinical choices and future care. Core domains included healthcare professional-patient collaboration, identification of patient preferences, patient-identified goals and patient motivation. While the strength of evidence is poor, PCC has been shown to reduce symptom burden, improve health-related quality of life, reduce readmission rates and enhance patient engagement for patients with CHF. There is a small but growing body of evidence, which demonstrates the benefits of a PCC approach to care for CHF patients. Research is needed to identify the key components of effective PCC interventions before being able to deliver on policy recommendations.

The influence of perceived behaviour control, attitude and empowerment on reported condom use and intention to use condoms among adolescents in rural Tanzania

Abstract: Despite the declining trends of Human immunodeficiency virus (HIV) infection in Sub-Saharan Africa (SSA), unsafe sexual behaviours among adolescents still represent a public health challenge. It is important to understand factors acting at different levels to influence sexual behaviour among adolescents. This study examined the influence of perceived behaviour control, subjective norms, attitudes and empowerment on intention to use condoms and reported use of condoms among adolescents in rural Tanzania. We used a questionnaire to collect data from 403 adolescents aged 14 through 19 years from nine randomly selected secondary schools in the Newala district located in the Southern part of Tanzania. The self-administered questionnaire collected information on sexual practices and factors such as attitudes, subjective norms, perceived behaviour control and empowerment. Binary logistic regression was performed to identify factors associated with intention to use and reported use of condoms. Sexually active adolescents constituted 40.6 % of the sample, among them 49.7 % did not use a condom at last sexual intercourse and 49.8 % had multiple sex partners. Many (85 %) of sexually active respondents had their sexual debut between the ages of 14 to 17 years. Girls became sexually active earlier than boys. Perceived behaviour control predicted intentions to use condoms (AOR = 3.059, 95 % CI 1.324-7.065), thus demonstrating its importance in the decision to use a condom. Empowerment (odds ratio = 3.694, 95 % CI 1.295-10.535) and a positive attitude (AOR = 3.484, 95 % CI 1.132-10.72) predicted reported condom use, thus turning the decision to actions. Subjective norms had only indirect effects on intention and reported use of condoms. The findings suggest that unsafe sex practices are prevalent among school adolescents in rural areas of Tanzania. Perceived behaviour control and positive attitudes predict intensions to use condoms whereas empowerment predicts reported condom use. The findings may imply that safe sex promotion interventions that simultaneously address socio-cognitive and ecological determinants of sexual behaviours may improve adolescents’ safe sex behaviours.

Prevalence of HIV and syphilis infections among pregnant women attending antenatal clinics in Tanzania, 2011

Abstract: The occurrence of HIV-1 and syphilis infections during pregnancy poses major health risks to the foetus due to mother-to-child transmission. We conducted surveillance of HIV and syphilis infections among pregnant women attending antenatal clinics (ANCs) in Mainland Tanzania in 2011. This surveillance was carried out in 133 ANCs selected from 21 regions in Tanzania. In each region, six ANC sites were selected, with urban, semi-urban, and rural areas contributing two each. All pregnant women who were attending selected sentinel ANC sites for the first time at any pregnancy between September and December 2011 were enrolled. Serial ELISA assays were performed to detect HIV infection in an unlinked anonymous manner using dried blood spot (DBS) after routine syphilis testing. Data analysis was conducted using Stata v.12 software. A total of 39,698 pregnant women representing 2.4 % of all pregnant women (1.68 million) attending ANCs in the Mainland Tanzania were enrolled. The overall HIV prevalence was found to be 5.6 % (95 % CI: 5.4–5.8 %). The risk for HIV infection was significantly higher among women aged 25–34 (cOR = 1.97, 95 % CI: 1.79–2.16; p < 0.05), older than 35 years (cOR = 1.88, 95 % CI: 1.62–2.17; p < 0.05) and those having 1–2 and 3–4 previous pregnancies. HIV infection was less prevalent among women attending rural ANC clinics (cOR = 0.46, 95 % CI 0.4–0.52; p < 0.05). The overall syphilis prevalence was 2.5 % (95 % CI: 2.3, 3.6). The risk for syphilis infection was significantly higher among women attending semi-urban and rural clinics and those having 3–4, and 5 previous pregnancies (p < 0.05). Marital status and level of education were not statistically significant with either of the two infections. HIV and syphilis co-infections occurred in 109 of 38,928 (0.3 %). The overall prevalence of HIV infection (5.6 %) and syphilis (2.5 %) found among pregnant women attending ANC clinics in Tanzania calls for further strengthening of current intervention measures, which include scaling up the integration of prevention of mother to child transmission (PMTCT) services in Reproductive and Child Health (RCH) clinics.

Melatonin and Melatonin Agonist for Delirium in the Elderly Patients

Abstract: The objective of this review is to summarize the available data on the use of melatonin and melatonin agonist for the prevention and management of delirium in the elderly patients from randomized controlled trials (RCTs). A systematic search of 5 major databases PubMed, MEDLINE, PsychINFO, Embase, and Cochrane Library was conducted. This search yielded a total of 2 RCTs for melatonin. One study compared melatonin to midazolam, clonidine, and control groups for the prevention and management of delirium in individuals who were pre- and posthip post-hip arthroplasty. The other study compared melatonin to placebo for the prevention of delirium in older adults admitted to an inpatient internal medicine service. Data from these 2 studies indicate that melatonin may have some benefit in the prevention and management of delirium in older adults. However, there is no evidence that melatonin reduces the severity of delirium or has any effect on behaviors or functions in these individuals. Melatonin was well tolerated in these 2 studies. The search for a melatonin agonist for delirium in the elderly patients yielded 1 study of ramelteon. In this study, ramelteon was found to be beneficial in preventing delirium in medically ill individuals when compared to placebo. Ramelteon was well tolerated in this study.

Stereotactic Body Radiotherapy for Clinically Localized Prostate Cancer: Toxicity and Biochemical Disease-Free Outcomes from a Multi-Institutional Patient Registry.

Abstract: Objectives: To report on initial patient characteristics, treatment practices, toxicity, and early biochemical disease-free survival (bDFS) of localized prostate cancer treated with stereotactic body radiotherapy (SBRT) and enrolled in the RSSearch® Patient Registry. Methods: A retrospective analysis was conducted on patients with clinically localized prostate cancer enrolled in RSSearch® from June 2006 - January 2015. Patients were classified as low-risk (PSA ≤ 10 ng/ml, T1c-T2a, Gleason score ≤ 6), intermediate-risk (PSA 10.1 - 20 ng/ml, T2b-T2c, or Gleason 7), or high-risk (PSA > 20 ng/ml, T3 or Gleason ≥ 8). Toxicity was reported using Common Toxicity Criteria for Adverse Events, version 3. Biochemical failure was assessed using the Phoenix definition (nadir + 2 ng/ml). The Kaplan-Meier analysis was used to calculate bDFS and association of patient and tumor characteristics with the use of SBRT. Results: Four hundred thirty-seven patients (189 low, 215 intermediate, and 33 high-risk) at a median of 69 years (range: 48-88) received SBRT at 17 centers. Seventy-eight percent of patients received 36.25 Gy/5 fractions, 13% received 37 Gy/5 fractions, 6% received 35 Gy/5 fractions, 3% received 38 Gy/4 fractions, and 5% received a boost dose of 19.5-29 Gy following external beam radiation therapy. Median follow-up was 20 months (range: 1–64 months). Genitourinary (GU) and gastrointestinal (GI) toxicities were minimal, with no acute or late Grade 3+ GU or GI toxicity. Late Grade 1 and 2 urinary frequency was 25% and 8%. Late Grade 1 and 2 proctitis was 3% and 2%. Median PSA decreased from 5.8 ng/ml (range: 0.3-43) to 0.88, 0.4, and 0.3 ng/ml at one, two, and three years. Two-year bDFS for all patients was 96.1%. Two-year bDFS was 99.0%, 94.5%, and 89.8% for low, intermediate, and high-risk patients (p 20 ng/ml (p < 0.0001). Clinical T Stage was not significantly associated with bDFS. Conclusions: Early disease outcomes of SBRT for the treatment of clinically localized prostate cancer from a multicenter patient registry compare favorably with reports from single institutions. Acute and late GU and GI toxicities were minimal, and PSA response to SBRT was highly encouraging. Continued accrual and follow-up will be necessary to confirm long-term results.

Repeat HIV testing during pregnancy and delivery: missed opportunities in a rural district hospital in Zambia

Abstract: Objective To assess coverage of repeat HIV testing among women who delivered in a Zambian hospital. HIV testing of pregnant women and repeat testing every three months during pregnancy and breastfeeding is the recommended policy in areas of high HIV prevalence. Methods A prospective implementation study in a second level hospital in rural Zambia. Included were all pregnant women who delivered in hospital during May and June 2012. Data regarding antenatal visits and HIV testing were collected by two investigators using a standardized form. Results Of 401 women who delivered in hospital sufficient antenatal data could be retrieved for 322 (80.3%) women. Of these 322 women 301 (93.5%) had attended antenatal care (ANC) at least once. At the time of discharge after delivery in hospital 171 (531%) had an unclear HIV status because their negative test result was more than three months ago or of an unknown date or because they had not been tested at all during pregnancy or delivery. An updated HIV status was present for 151 (46.9%) women: 25 (7.8%) were HIV positive and 126 (391%) had tested negative within the last three months. In this last group 79 (245%) had been tested twice or more during pregnancy. During the study period none of the women was tested during admission for delivery. Conclusion Despite high ANC coverage opportunities for repeat HIV testing were missed in almost half of all women who delivered in this hospital in a high-prevalence HIV setting.

Women's perceptions of the quality of emergency obstetric care in a referral hospital in rural Tanzania

Abstract: Objectives To assess perceptions of the quality of obstetric care of women who delivered in a rural Tanzanian referral hospital. Methods A descriptive-exploratory qualitative study, using semistructured in-depth interviews and participatory observation. Nineteen recently delivered women and 3 health workers were interviewed. Results Although most women held positive views about the care they received in hospital, several participants expressed major concerns about negative attitudes of healthcare workers. Lack of medical communication given by care providers constituted a major complaint. Conclusions A more positive attitude by health workers and the provision of adequate medical information may promote a more positive hospital experience of women in need of obstetric care and enhance attendance. Objectifs Evaluer les perceptions sur la qualite des soins obstetricaux des femmes qui ont accouche dans un hopital de reference en zone rurale en Tanzanie. Methodes Une etude qualitative exploratoire, descriptive et au moyen d'entretiens semi-structures en profondeur et l'observation participative. 19 femmes venant d'accoucher et trois agents de sante ont ete interviewes. Resultats Bien que la plupart des femmes aient une opinion positive sur les soins recus a l'hopital, plusieurs participantes ont exprime des preoccupations majeures sur les attitudes negatives des agents des soins de sante. Le manque d'information medicale fournie par les prestataires de soins constituait une plainte majeure. Conclusions Une attitude plus positive des agents de la sante et la fourniture d'informations medicales adequates peuvent favoriser une experience d'hopital plus positive pour les femmes necessitant des soins obstetricaux et ameliorer la frequentation. Objetivos Evaluar las percepciones sobre la calidad de los cuidados obstetricos de mujeres que dieron a luz en un hospital rural de referencia en Tanzania. Metodos Estudio de calidad descriptivo-exploratorio, utilizando entrevistas semiestructuradas en profundidad y observacion participante. Se entrevisto a 19 mujeres que habian dado a luz recientemente y a 3 trabajadores sanitarios. Resultados Aunque la mayoria de las mujeres tenian perspectivas positivas sobre los cuidados recibidos en el hospital, algunas participantes expresaron preocupacion sobre las actitudes negativas de los trabajadores sanitarios. La falta de comunicacion medica que ofrecian los proveedores de cuidados constituia una de las principales quejas. Conclusiones Una actitud mas positiva por parte de los trabajadores sanitarios, asi como la entrega de informacion medica adecuada podria promover una experiencia hospitalaria mas positiva para las mujeres que requieran de atencion obstetrica, y por lo tanto mejorar la asistencia.

Estimated glomerular filtration rate leads to higher drug dose recommendations in the elderly compared with creatinine clearance.

Abstract: Summary Purpose The elderly are at risk for adverse drug events because of inappropriate dosing of renally eliminated medications. The purpose of this study was to evaluate differences in estimates of kidney function and recommended doses of select medications in the elderly using the Modification of Diet in Renal Disease (MDRD) or the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations compared with the Cockcroft-Gault (CG) equation. Methods Patients 65 years of age and older were included in this retrospective, observational analysis. Kidney function was estimated by CG, MDRD and CKD-EPI equations for all patients and by age category (65–69, 70–79, 80–89 and 90–100 years). Differences in estimates and dosing of allopurinol, enoxaparin, gabapentin, piperacillin/tazobactam and sulfamethoxazole/trimethoprim using the MDRD and CKD-EPI compared with the CG were assessed. Results In the 4160 patients (98% male, mean age 74 ± 7 years), the MDRD and CKD-EPI estimates were significantly higher than CG estimates for all patients and by age category (p < 0.001). Dosing discordance was predominantly because of a higher dose recommended by MDRD and CKD-EPI estimates compared with CG. Discordance was highest with gabapentin (27%), the medication with the greatest number of dosing stratifications by estimated kidney function, and increased by 66% from the youngest to the oldest age category. Conclusions Until newer equations are used uniformly to develop dosing nomograms, it is prudent to adopt a process for drug dosing in the elderly that is more conservative than eGFR based dosing, but that considers the potential for underestimating kidney function with the CG equation.

The role of anxiety sensitivity in the sexual functioning of young women

Abstract: High anxiety sensitivity (AS; fear of arousal-related bodily sensations) is a known risk factor for psychopathology and medical pathology. High AS individuals tend to avoid activities that induce feared arousal-related sensations; yet, few studies have examined AS and sexual activity, those that did have produced mixed results, and no study to date has examined AS and sexual avoidance. In Study 1, 296 young adult women completed the Anxiety Sensitivity Index-3 (ASI-3) and the Female Sexual Distress Scale-Revised, which were positively correlated, r = 0.34, p < .001. Women scoring in the highest and lowest quartiles on the ASI-3 were recruited for Study 2. As predicted, high (vs. low) AS women reported significantly more sexual distress, impairments in sexual functioning (including sexual pain), and avoidance of sexual activity, and less sexual satisfaction. Results suggest that high AS can limit the frequency and quality of sexual functioning in young adult women, or lead to avoidance of sexual activity a...

Demography and burden of care associated with patients readmitted for urinary tract infection.

Abstract: Background Urinary tract infection (UTI) is one of the most prevalent admission diagnoses in hospital-based clinical practice Despite its frequency, few data are available regarding its demographics and economic implications Purpose To describe the demography, epidemiology, and burden of care of patients admitted to hospital with UTI and compare these characteristics depending on admission status Methods A retrospective cohort study using an administrative database of patients admitted to Hartford Hospital (September 2011–August 2012) with UTI Patient demographics, hospital characteristics, and total costs of care were examined Results A total of 2345 unique patients were included The mean age of the patients was 78 years and 71% were female Median length of stay and total cost were 5 days and $8326 (interquartile range $5388–$14,179), respectively A total of 359 patients (164%) were readmitted within 30 days, of which 111 patients (51%) had UTI on readmission Only 163% of readmitted patients were infected with the same causative pathogen A significant increase in the incidence of Enterococcus faecalis (12% vs 93%; p = 0046) occurred upon readmission, whereas occurrence of Enterobacteriaceae infection decreased in the readmission group (500% vs 256%; p = 0006), including a lower proportion of Escherichia coli (325% vs 116%; p p = 0004) and cefepime (87% vs 276; p = 005) Conclusion UTI is highly prevalent and is associated with significant utilization of health-care resources among hospitalized patients These findings, coupled with considerable rates of 30-day readmission, stress the importance of proper diagnosis and treatment

Vomiting-Induced Gastric Emphysema and Hepatoportal Venous Gas: A Case Report and Review of the Literature

Abstract: Gastric pneumatosis is the presence of air within the wall of the stomach. It represents a spectrum of conditions ranging from benign disease to septic shock and death. Etiopathologically, it can be classified into emphysematous gastritis or gastric emphysema (GE). Along with hepatoportal venous gas (HPVG), it was considered as an ominous radiological sign and warranted an emergent surgical exploration; however, with widespread use of computerized tomographic (CT) scan, an increasing number of benign causes of GE and HPVG have been reported in the literature, where patients can be managed by noninvasive and conservative measures. We hereby describe a case where recurrent episodes of vomiting led to development of GE and HPVG and the patient was managed successfully by conservative measures.

Assisted History Matching Using Pattern Recognition Technology

Abstract: This study examines the application of pattern recognition technologies to improve the time and effort required for completing successful history matching projects. The pattern recognition capabilities of artificial intelligence and data mining techniques are used to develop a surrogate reservoir model (SRM), which is then employed to perform the assisted history matching process. A well-known reservoir model, PUNQ-S3, was selected to study the potentials of the SRM in an assisted history matching process. The SRM is a prototype of a full-field reservoir simulation model that demands a low development cost and has a high implementation pace. SRMs are built based on a spatio-temporal database, which includes different types of data extracted from a few realisations of the simulation model. The SRM was coupled with the differential evolution optimisation method to construct an automated history matching workflow. The results of this study prove the SRMs' capability in assisting history matching processes. [Received: December 3, 2015; Accepted: June 17, 2016]

Safety and Efficacy of Continuous Femoral Nerve Catheter with Single Shot Sciatic Nerve Block vs Epidural Catheter Anesthesia for Same-Day Bilateral Total Knee Arthroplasty

Abstract: In a retrospective analysis, we evaluated the safety and efficacy of peripheral nerve blocks (PNB) compared to epidural anesthesia in 221 consecutive patients undergoing same-day bilateral total knee arthroplasty (TKA). Primary outcome measures included: hypotension requiring physician intervention, number of blood transfusions, perioperative hespan and crystalloid consumption, incidences of respiratory desaturation, pruritis, urinary retention, and nausea/vomiting. The incidences of hypotension, urinary retention, and pruritis were all higher in the epidural group, compared to PNB. Epidural patients also required more blood transfusions and greater volumes of hespan and crystalloid. PNB are safe and efficacious modality of analgesia for same day bilateral TKA and provide adequate pain relief with a significant decrease in postoperative complications compared to epidural anesthesia.

Posterior reversible encephalopathy syndrome due to targeted agents: vemurafinib among suspects!

Abstract: Posterior reversible encephalopathy syndrome features reversible cortical neurologic dysfunction and characteristic findings on brain imaging studies. This syndrome can be caused by several agents including traditional chemotherapy and immunosuppressive drugs. Targeted therapies such as agents binding vascular endothelial growth factor/VEGFR, CD20 and cytotoxic T-cell lymphocyte antigen 4 (CTLA-4) antigens are also among the culprits. Vemurafenib is a BRAF gene inhibitor that has not been previously linked with posterior reversible encephalopathy syndrome. We report herein the first such case and believe that further studies confirming this association are warranted. We further review the existing posterior reversible encephalopathy syndrome cases associated with targeted therapies in the scientific literature.

Efficiency of Screening for the Recurrence of Antenatal Group B Streptococcus Colonization in a Subsequent Pregnancy: A Systematic Review and Meta-analysis with Independent Patient Data.

Abstract: Objective The objective of this study was to evaluate the risk of recurrent group B streptococcus (GBS) colonization in a subsequent pregnancy and to assess clinical characteristics that influence this risk. Study Design A systematic review and meta-analysis was performed. Databases were searched from inception through June 2015 using PubMed, Embase, Scopus, Central, and ClinicalTrials.gov. Studies were eligible if they assessed antenatal GBS colonization in two successive pregnancies. The quality of included studies was evaluated. Independent patient data was requested from the authors of the included trials. Unadjusted odds ratios (OR) were pooled using the Mantel–Haenszel fixed effect model. Results In the five studies identified, two studies lacked a nonexposed cohort. GBS colonization in the index pregnancy was associated with a higher risk of recurrence of GBS colonization in a subsequent pregnancy (three studies: 50.2 compared with 14.1%; pooled fixed effects OR, 6.05; 95% confidence interval [CI], 4.84–7.55). When heavy colonization with GBS was compared with colonization by vaginal culture only, an increased risk of recurrence was shown (four studies: 52.0 compared with 45.1%, pooled fixed effects OR, 1.54; 95% CI, 1.02–2.31). Conclusion Women colonized with GBS are at significantly higher odds for recurrent colonization in a subsequent pregnancy when compared with women who were not colonized in an index pregnancy. If the individual is considered heavily colonized with GBS, there appears to be an association with an increased risk compared with conventional culture. Subgroup analysis of the variables time interval ≤ 12 months between subsequent pregnancies, body mass index ≥ 30 kg/m2, race, ethnicity, and primiparous in the subsequent pregnancy showed no effect.

Antibiotic Tissue Penetration in Diabetic Foot Infections A Review of the Microdialysis Literature and Needs for Future Research.

Abstract: Although many antimicrobial agents display good in vitro activity against the pathogens frequently implicated in diabetic foot infections, effective treatment can be complicated by reduced tissue penetration in this population secondary to peripheral arterial disease and emerging antimicrobial resistance, which can result in clinical failure. Improved characterization of antibiotic tissue pharmacokinetics and penetration ratios in diabetic foot infections is needed. Microdialysis offers advantages over the skin blister and tissue homogenate studies historically used to define antibiotic penetration in skin and soft-tissue infections by defining antibiotic penetration into the interstitial fluid over the entire concentration versus time profile. However, only a select number of agents currently recommended for treating diabetic foot infections have been evaluated using these methods, which are described herein. Better characterization of the tissue penetration of antibiotic agents is needed for the development of methods for maximizing the pharmacodynamic profile of these agents to ultimately improve treatment outcomes for patients with diabetic foot infections.

A Hospice-Based Bereavement Support Group Using Creative Arts An Exploratory Study

Abstract: There is evidence of the value of individual creative arts (art, drama, music, etc.) in helping people to cope with bereavement. However, there is a gap in the research on the effectiveness of the ...

Recurrent pseudocellulitis due to gemcitabine: underrecognized and underreported?

Abstract: Pseudocellulitis has been previously described with the use of chemotherapy agent gemcitabine. This condition is thought to occur due to vascular toxicity and increased localized permeability of the skin capillaries. We report herein a case of recurrent pseudocellulitis due to gemcitabine in a patient with metastatic pancreatic cancer. We believe this condition is underreported and underrecognized. Furthermore, it may be misdiagnosed as cellulitis and inappropriately treated with systemic antibiotics. As the diagnosis is clinical and the condition is self-limited, referral to other specialists is usually not required. Awareness of gemcitabine-induced pseudocellulitis is important in order to reassure the patients, their families, and non-oncology providers and to avoid unnecessary (and often costly) diagnostic work-up.

Hydrogen sulfide suicide: a new trend and threat to healthcare providers.

Abstract: First popularized in Japan, hydrogen sulfide (H2S) gas suicide is an underreported form of suicide with known risk for secondary disaster. Mortality rate commonly exceeds 90% because of the gas's lethal, noncontained nature. Instances in the United States are increasing, up from 2 cases in 2008 to 18 in 2010. Because H2S poisonings remain rare, there exists a lack of knowledge regarding the residual effects of gas venting after victim extrication. Identifying instances of the efficacious use of personal protection equipment (PPE) is critical in the effort to alleviate risks faced by hospital and rescue personnel. The current case demonstrates the effective use of PPEs after prolonged H2S exposure. In 2011, a 20-year-old man threatened suicide using H2S gas inside a vehicle on a remote rural highway. First responders identified a "rotten egg smell" and subsequently experienced low poisoning symptoms. After prolonged Hazmat-assisted extrication (4 hours) the patient was unconscious and experiencing seizures. He was decontaminated on-scene (20 minutes) and transported to the closest hospital (22 minutes). Ambulance personnel who wore PPE and used the ambulance's reverse ventilation system (RVS)reported no adverse effects. The patient was transferred to the authors' burn facility by helicopter (38 minutes). Life-flight personnel, who did not wear PPE (no ventilatory system available), complained of watery eyes, headache, and dizziness. Hospital personnel, who did not use PPE (or RVS), complained of watery eyes or headache. Exposed personnel demonstrated no deficits or residual effects. In spite of spontaneous movement, the patient began to seize and died. This case is unique given the multiple primary and secondary H2S gas exposures involved. Exposed personnel without RVS and not using PPE demonstrated moderate H2S symptoms. PPE (self-contained breathing apparatuses) and RVS were shown to be effective during an H2S emergency; however, there are currently limited data supporting their appropriate use. Until data demonstrating duration of H2S venting for small enclosed spaces are made available, PPEs should be required.

Possible health effects of living in proximity to mining sites near Potosí, Bolivia.

Abstract: Objective: The goal of this study was to determine the health effects of living downstream from mines in the Potosregion of Bolivia. Methods: Histories, physical examinations, and urinalyses were completed on adults recruited from mining and nonmining villages in Bolivia. Blood concentrations of Cd, Hg, and Pb were determined in a subset of participants. Multiple logistic re- gression analyses were performed. Results: Mining region participants had significantly higher frequencies of hypertension, hematuria, and ketonuria. Hematuria was significantly elevated among those watering livestock down- stream from mines and eating grains from their own farm (odds ratio = 4.3; 95% confidence interval, 1.1 to 17.7). Significantly higher blood concen- trations of Pb were observed in a subsample of participants with hematuria (4.80 μg/dL vs 10.91 μg/dL; P = 0.026). Conclusions: Efforts to abate environmental exposure to toxic metals seem warranted. T