bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy of Magnesium Sulphate and Dexmedetomidine in Controlled Hypotension for Functional Endoscopic Sinus Surgery: A Randomised Clinical Study
Authors: Nayantara KP , Katti Vijay V , Patil Basavaraj N
Published: February 2024

Introduction: The treatment of nasal sinus diseases with Functional Endoscopic Sinus Surgery (FESS) is a wellestablished and popular method. This procedure is performed under general anaesthesia or local anaesthesia. Intentional induction of hypotension has helped limit intraoperative blood loss. A bloodless surgical field improves visibility and lowers the possibility of damaging nearby structures, achieved by reducing the baseline Mean Arterial Pressure (MAP) by 30% or maintaining MAP at 60-70 mmHg. Aim: To compare the efficacy of dexmedetomidine and Magnesium Sulphate (MgSO4 ) in producing hypotensive anaesthesia during FESS. Materials and Methods: This randomised clinical study was conducted at BLDE Shri BM Patil Medical College and Research Centre, Vijayapura, Karnataka, India, from January 2021 to July 2022. In this study, 70 patients, aged 18 to 60 years of either sex, admitted for FESS surgeries under general anaesthesia with American Society of Anaesthesiologists (ASA) Grade 1 and 2 were randomly divided into two groups: 35 patients in the dexmedetomidine group and 35 patients in the MgSO4 group. Dexmedetomidine was given to group D as a loading dose of 1 µg/kg, followed by an infusion of 0.5 µg/kg/h, and MgSO4 was given to group M as a loading dosage of 40 mg/kg, followed by an infusion of 15 mg/kg/h. MAP was kept above 65 mmHg during induced hypotension. Parameters studied included Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), MAP. Data was analysed using International Business Machines (IBM) Statistical Package for Social Sciences (SPSS) Statistics Software Version 23.0. A p-value <0.05 was considered statistically significant. Results: The demographic profiles regarding age, gender, ASA grade, and duration of surgery in both groups were comparable and showed no significant differences. At 30 minutes of surgery, MAP in group D was found to be statistically lower than that in group M with a p-value of 0.0001. Dexmedetomidine induced a significant reduction in HR, which was statistically validated with a p-value of 0.004 at 15 minutes. A statistically significant reduction in MAP was found in group D compared to group M at the time of intubation and later at 10 minutes (p-value=0.005) and 15 minutes (p-value=0.006). Conclusion: The target MAP of 60-70 mmHg or a 30% reduction from the baseline MAP was achieved significantly earlier in group D as compared with group M. Group D had lower infusion dosages, better surgical field visibility, and caused less bleeding. The dexmedetomidine group experienced extended sedation and postoperative recovery
Comparative Evaluation of the Efficacy of Shallakyadi Plaster and Standard POP in the Management of Simple Fractures of Long Bones of the Upper Limb: A Research Protocol
Authors: Jaivarshaa GV Pavithra , Dasar Devyani
Published: February 2024

Introduction: Fracture management is one of the wellestablished concepts in Ayurveda with numerous fracture healing drugs mentioned for topical application. The present study is an attempt to form a compound of few of those drugs which can be used as a plaster cast. The effect of this Herbomineral ayurvedic plaster cast on fractures would be studied both in aspects of immobilisation and fracture healing. Shallakyadi plaster which is a novel compound composed of resin of Boswellia serrata Roxb, resin of Acacia nilotica (Linn.) Willd.ex Del, root of Glycirrhiza glabra Linn, whole plant of Cissus quadrangularis Linn, Stem of Rubia cordifolia Linn, bark of Terminalia arjuna Wight & Arn (W&A), resin of Commiphorawightii Arn, Kaolinite (phyllosilicate of aluminium) and hydrated magnesium silicate can be used as a herbomineral ayurvedic compound for the healing of fractures. Need of Study: Standard Plaster of Paris (POP) cast has no therapeutic role on healing of fracture other than the purpose of immobilisation, whereas the drugs in Shallakyadi Plaster have known effects on bone healing and also provide the adequate immobilisation provided by Standard POP cast. Hence, the present study will compare the efficacy of Shallakyadi Plaster and Standard POP in the management of simple fractures of long bones of upper limb. Aim: To study and compare the efficacy of Shallakyadi plaster and standard POP in the management of simple fractures of long bones of upper limb. Materials and Methods: The present study is designed as a randomised control trial which would be conducted in Mahatma Gandhi Ayurveda College Hospital and Research Centre (MGACHRC), Salod Hirapur (H), Maharashtra, India for three months, in which 60 patients will be enrolled. Standard POP Plaster or Shallakyadi plaster will be applied for local application over the fractured area. Parameters like pain, swelling, loss of function, tenderness would be studied subjectively and callus formation would be taken as the objective parameter. Statistical analysis would be done using GraphPad Prism 7.0 V software and statistical tests- Chi-square test, Wilcoxon’s rank sum test and Wilcoxon’s signed rank test will be applied with level of significance as 0.05.
Antibiofilm and Antibacterial Properties of Herbal Extracts as Alternatives to Current Treatment Approaches: A Narrative Review
Authors: Rasmi T. R.  , Attavar Pavan Chand , Hydrose Sona P. , Kotian M. Shashidhar , Delna N. S.
Published: February 2024

Bacterial biofilm formation poses significant challenges in the healthcare sector due to increased antibiotic resistance and persistent infections. This literature review explores the potential of some herbs and their extracts as alternative approaches to combat biofilm formation and multidrug-resistant bacteria. A detailed literature search was conducted across databases for published studies till 2023, to identify studies on medicinal plants' anti-biofilm and antibacterial properties. Key compounds within plant extracts showing anti-biofilm activity and their mechanisms of action were highlighted. A combination of keywords, MeSH terms, and Boolean operators were used to formulate the search strategy. Numerous studies demonstrated the efficacy of medicinal plants in inhibiting biofilm formation and combating multidrug-resistant bacteria. Active compounds such as benzyl (6Z,9Z,12Z)-6,9,12-octadecatrienoate, 3-benzyloxy-1-nitro-butan-2-ol, Pyridine, 3-(1-methyl-2-pyrrolidinyl)-(S), and others exhibited anti-biofilm and antibacterial potential. Extracts from Berginia ciliata, Clematis grata, and Clematis viticella showed over 80% inhibition of biofilm formation, while mango leaf extracts interfered with quorum sensing mechanisms in Pseudomonas aeruginosa PAO1. Salvadora persica extracts displayed significant biofilm inhibition against cariogenic Streptococcus mutans isolates. Medicinal plants and their extracts hold promise as alternative strategies to combat bacterial biofilms and multidrug-resistant bacteria. The identification of active compounds provides opportunities for further research and drug development. Molecular docking studies are crucial for understanding the molecular interactions between these compounds and bacterial targets, guiding the design of effective antibacterial agents based on natural compounds. Further research, including preclinical and clinical trials, is essential to validate the safety and efficacy of these extracts and their compounds for practical application in healthcare.
The Long Run and Short Run Impact of GDP and Real Income on Solid Waste in Nigeria Using Vector Error Correction Model
Authors: Shehu A.  , Adenomon M. O.  , Nweze N. O.
Published: February 2024

This study investigates the long-run and short-run impacts of economic growth on solid waste generation in Nigeria using a Vector Error Correction Model (VECM). Analyzing data from 1982 to 2022, the study reveals cointegration among solid waste, GDP, and real income, indicating a long-run equilibrium relationship. Key findings show that economic growth has a statistically significant and positive impact on waste generation in the long run, indicating a potential environmental trade-off associated with economic development. Conversely, resource intensity shows no significant long-run influence on waste generation. In the short run, past waste generation exhibits a positive and significant effect on current levels, highlighting the need for effective waste management practices to combat inertia and prevent further waste accumulation. Interestingly, the short-run impacts of both economic growth and resource intensity are found to be statistically insignificant. Based on these findings, we propose several policy recommendations for sustainable waste management in Nigeria: promoting environmentally friendly production processes, supporting resource recovery and waste-to-energy initiatives, implementing extended producer responsibility, expanding and improving waste collection infrastructure, investing in sorting and recycling facilities, and conducting public awareness campaigns. We further call for further research to explore the nuanced relationship between resource intensity and waste generation across different income groups and sectors.
Global Climate Change and Its Effects on Medicinal and Aromatic Plants: A Review Article
Authors: Shruti Saumya , Trivedi Ashwin , Chaudhary K. B. , Ghadiali Jatinkumar
Published: February 2024

Medicinal herbs have been used for a long time to cure health problems and prevent disease, including epidemics. Medicinal plants are used for different purposes and in diverse uses of human beings. People around them have a basic knowledge and using through their traditional medicine from the past several years. Natural and manmade calamities, such as rapid climate change, urban growth, industrial boom, overpopulation pollution, declining forest cover, habitat loss, over-harvesting, destructive harvesting, and floods, are the principal reasons of the reduction of wild medicinal plant species. The life cycles and distribution of the world's vegetation, especially wild medicinal plants, are being affected by climate change. The impact of global climate change on medicinal plants could have a huge influence, especially in terms of their utility in conventional medication systems and as economically useful plants. The current essay emphasises the importance of study to improve our understanding of climate influences on medicinal plants properties, phenology and metabolic responses. The purpose of this paper is to review the impact of abiotic variables on secondary metabolite formation and different adaptation measures as well as future research initiatives. Furthermore, such issues with global climate change will undoubtedly become more visible or immediate threats, putting further strain on medicinal plant species. The impact of global climate change on medicinal plants could negatively correlate with environment concerns parameters, especially in terms of their utility in conventional medication systems and as economically useful plants.
Effect of Weather Parameters on Population Dynamics of Bihar Hairy Caterpillar [Spilarctia (Spilosoma) obliqua Walker] in Mungbean [Vigna radiata (L.) Wilczek]
Authors: Patel Pradip Kumar , Kumar Pankaj , Kumar Arvind , Kumar Vijay
Published: February 2024

The present investigation revealed that Bihar hairy caterpillar was first recorded during 32nd standard week (1.92 larvae/plant) which reached to its maximum during 41st standard week (11.93 larvae/plant) and there after gradually decreased up to 1.33 larvae/plant during 44th standard week.

The maximum temperature showed non-significant positive correlation, minimum temperature and relative humidity showed non-significant negative correlation while rain fall showed significant negative correlation with the population buildup of Bihar hairy caterpillar.
Acute basophilic leukemia: Case report
Authors: Gupta Ritu , Jain Paresh , Anand Mona
Published: May 2004

The term “basophilic leukemia” has been in use for 75 years. However, consistent diagnostic criteria are lacking. This is due to the rarity of the disease and to the routine unavailability of special tests that are often required to confirm a diagnosis. We report an unusual case of acute basophilic leukemia in a child who was referred to our Center, arriving with partially treated acute lymphoblastic leukemia. Basophilic differentiation on light microscopy was evident from the coarse basophilic granules in blasts, a progressive maturation of blasts toward basophils, and toluidine positivity on cytochemistry. Blasts showed a myeloid immunophenotype (CD13+, CD33+, CD117+) with a characteristic dual positivity for CD34 and CD25, highly suggestive of basophilic nature of the blasts. Conventional cytogenetic studies revealed translocation t(8;21)(q22;q22). A diagnosis of acute basophilic leukemia with t(8;21) was made. Review of pre‐therapy slides showed features consistent with AML‐M2 with basophilia. There were no basophilic blasts. With these features, a diagnosis of acute basophilic leukemia secondary to AML‐M2 was made. In our patient, basophilic leukemia appears to have evolved from selective clonal proliferation of “basophil‐committed blasts” during the course of the disease in a case of AML‐M2 with basophilia. Am. J. Hematol. 76:134–138, 2004. © 2004 Wiley‐Liss, Inc.
Thromboembolic complications after splenectomy for hematologic diseases
Authors: Mohren Martin , Markmann Ilka , Dworschak Ulrike , Franke Astrid , Maas Christian , Mewes Sabine , Weiss Günter , Jentsch‐Ullrich Kathleen
Published: May 2004

Thromboembolic complications following splenectomy for hematologic diseases occur in up to 10% of patients and may range from portal vein thrombosis (PVT) to pulmonary embolism (PE) and deep vein thrombosis (DVT). Up to now there exist no recommendations for the duration and intensity of prophylactic anticoagulation, which usually follows local institutional protocols. We report on three consecutive patients with severe portal vein thrombosis and/or pulmonary embolism—one with fatal outcome—7 to 35 days after splenectomy for autoimmune hemolytic anemia, immunothrombocytopenia, and indolent lymphoma, respectively. Incidence and pathophysiology of thromboembolic events (TE) in this patient group as well as prophylactic anticoagulation will be discussed, including a review of the current literature on this topic. Am. J. Hematol. 76:143–147, 2004. © 2004 Wiley‐Liss, Inc.
Inflammatory potential of neutrophils detected in sickle cell disease
Authors: Lum Aaron F.H. , Wun Ted , Staunton Donald , Simon Scott I.
Published: May 2004

An early event in the inflammatory response is neutrophil recruitment to endothelium in response to chemotactic stimulation, which in turn activates CD18‐integrin, which anchors neutrophils to the vessel wall under the shear force of blood flow. Activated neutrophils circulating in sickle cell disease (SCD) patients may significantly contribute to vascular occlusions (VOC) as neutrophils adherent to inflamed endothelium recruit sickle red blood cells inducing VOC. To elucidate the mechanisms by which neutrophils may participate in VOC in SCD, CD18‐integrin expression and function in fresh blood samples of non‐crisis patients were measured by flow cytometry. CD11b/CD18 membrane expression was ∼70% higher on unstimulated SCD neutrophils than controls, which correlated with a 1‐fold higher rate of adhesion to ligand. Unstimulated SCD neutrophils expressed ∼30,000 active CD18 per cell, while controls expressed ∼6,000. Stimulation with a low concentration of IL‐8 (0.1 nM) upregulated 100% more active CD18 and induced 60% more adhesion of SCD than control neutrophils. These data demonstrate that neutrophils from SCD patients constitutively express active CD18 in blood and respond with enhanced sensitivity to chemokine activation of adhesion, thus increasing their propensity for exuberant adhesion. Am. J. Hematol. 76:126–133, 2004. © 2004 Wiley‐Liss, Inc.
Warfarin‐induced limb gangrene in the setting of lung adenocarcinoma
Authors: Klein Liviu , Galvez Angel , Klein Oana , Chediak Juan
Published: May 2004

A 53‐year‐old man with lung adenocarcinoma developed pulmonary embolism and bilateral popliteal venous thrombosis. Treated with intravenous unfractionated heparin and discharged home on warfarin, he returned a week later with extending thrombosis. Treatment with heparin followed by warfarin was reinitiated. Twenty‐four hours following the re‐administration of warfarin, the patient's INR increased to 14.5. The platelet count dropped by more than 50%, and he developed venous limb gangrene of the left leg and skin necrosis of the right leg. Heparin‐induced thrombocytopenia was ruled out, and coagulation studies showed a severe depletion of protein C as well as increased thrombin generation. The patient was transfused with fresh frozen plasma, and vitamin K was given. Heparin was continued, and after 4 weeks, the patient improved markedly showing only minimal necrosis of the toes. Venous limb gangrene is a major complication associated with warfarin therapy. Its pathogenesis is explained by a transient hypercoagulable state produced by protein C depletion that leads to microvascular thrombi progressing to venous limb gangrene. The present case emphasizes the importance of careful anticoagulation with heparin followed by slow initiation of low‐dose warfarin, in order to minimize thrombotic complications. Am. J. Hematol. 76:176–179, 2004. © 2004 Wiley‐Liss, Inc.
Management of acute chest wall sickle cell pain with nebulized morphine
Authors: Ballas Samir K. , Viscusi Eugene R. , Epstein Kenneth R.
Published: May 2004

This paper describes, for the first time, the utilization of nebulized morphine in the management of severe chest pain in two young adult African‐American patients who suffered from generalized acute sickle cell painful episodes. While hospitalized, both patients developed new sharp chest wall pain, and were treated with nebulized morphine started at 20 mg MOSO4 in 3.0‐ to 5.0‐mL physiologic buffered saline solution. Within minutes, both patients reported significant relief of chest wall pain. Patient 1 achieved 90% pain relief as well as a significant decrease in the pain intensity score. Patient 2 reported 40% pain relief, and the pain intensity score decreased to a mean of 5.6/10. Hence, treatment every 6 hr was continued for 10 days, after which the chest wall pain subsided. These findings indicate that nebulized morphine may prove effective in the management of acute chest pain in patients with sickle cell anemia. This is a desirable alternative in patients with difficult venous access and may more specifically target chest pain. Am. J. Hematol. 76:190–191, 2004. © 2004 Wiley‐Liss, Inc.
Hemophagocytic syndrome as a presenting sign of transformation of smoldering to acute adult T‐cell leukemia/lymphoma: Efficacy of anti‐retroviral and interferon therapy
Authors: Aouba Achille , Lambotte Olivier , Vasiliu Viorel , Divine Marine , Valensi Françoise , Varet Bruno , Bazarbachi Ali , Hermine Olivier
Published: May 2004

A 55‐year‐old Caribbean woman with a 6‐year history of smoldering adult T‐cell leukemia/lymphoma presented with clinical and biological symptoms of hemophagocytic syndrome. An extensive search for infectious diseases was negative. A lymph node biopsy showing large T‐cell lymphoma (CD4−, CD25+) and findings of high LDH count and severe lymphocytosis led to the diagnosis of acute adult T‐cell leukemia/lymphoma. Anti‐retroviral therapy combining zidovudine, lamivudine, and interferon‐α was started, resulting in rapid control of both hemophagocytic syndrome and symptoms of acute adult T‐cell leukemia/lymphoma. Thus, we propose that adult T‐cell leukemia/lymphoma must be added to the spectrum of etiologies of hemophagocytic syndrome. Am. J. Hematol. 76:187–189, 2004. © 2004 Wiley‐Liss, Inc.
Ablation of hemophilic FVIII inhibitors with FVIII priming, cyclophosphamide immune suppression, and rapid tapering of FVIII immune tolerance
Authors: Kobrinsky Nathan L. , Sjolander Diane E. , Moser Deb K. , Stegman Dottie A.
Published: May 2004

The efficacy and toxicity of factor VIII (FVIII) priming, cyclophosphamide immune suppression, and rapid tapering of concurrent FVIII immune tolerance for subjects with hemophilic inhibitors were evaluated. Four subjects with hemophilic inhibitors were studied. Before treatment, inhibitors were present for a median of 8 months (mean 13 ± 14.0 months). The median FVIII inhibitor titer was 16 BU/mL (mean 27.2 ± 29.2 BU/mL). Following FVIII priming (80.0 ± 70.2 U/kg), subjects received cyclophosphamide 1,418 ± 636 mg/M2 i.v. q3 weeks for 4.4 ± 1.7 courses. Subjects concurrently received a low (6 U/kg/day), moderate (30 U/kg/day), or high (100 U/kg/day) dose of FVIII followed by a rapid taper as the inhibitor titer decreased or resolved. During treatment, the inhibitor titer initially increased but then rapidly declined. Inhibitors resolved in 3.9 ± 2.9 months. One inhibitor recurred at 2.8 years, but it was successfully re‐treated. Effectiveness did not depend on the FVIII dose. Toxicity was minimal. Cyclophosphamide (1,400 mg/M2) administered after a priming dose of FVIII (80 U/kg) i.v. q3 weeks for 2–6 cycles with a rapid taper of concurrently administered daily FVIII as the inhibitor titer falls is an effective approach to hemophilic inhibitor ablation. Am. J. Hematol. 76:180–184, 2004. © 2004 Wiley‐Liss, Inc.
Thrombotic microangiopathy (TMA) and stroke due to human herpesvirus‐6 (HHV‐6) reactivation in an adult receiving high‐dose melphalan with autologous peripheral stem cell transplantation
Authors: Belford Amy , Myles Otha , Magill Alan , Wang James , Myhand Rick C. , Waselenko Jamie K.
Published: May 2004

We report an adult autologous stem cell transplant (ASCT) patient who developed transplant‐associated thrombotic microangiopathy (TMA) due to human herpesvirus‐6 (HHV‐6) reactivation. A 58‐year‐old female with Stage IIIA IgGκ multiple myeloma received a melphalan (200 mg/m2) ASCT with discharge home after resolution of ASCT‐related toxicities. She presented on D+20 with dyspnea, rash, and fever to 105°F, followed by worsening dyspnea, hypotension, and capillary leak. Mental status (MS) changes were noted on D+23, but head CT and EEG were unremarkable. On D+29, a generalized seizure occurred with decline in platelet count and haptoglobin. TMA was noted on peripheral blood smear and therapeutic plasma exchange (TPE) was initiated on D+31. Lumbar puncture (LP) revealed CSF protein 74 mg/dL and white blood count 7,000/mm3 with 74% lymphocytosis. TPE was continued without improvement in her MS or thrombocytopenia despite improvement in microangiopathy. An MRI of the brain showed a left hippocampus abnormality, and an EEG was consistent with encephalopathy. Serum polymerase chain regimen (PCR) was negative for CMV, HSV1, and HSV2 but was strongly positive for HHV‐6. Repeat LP protein was 597 mg/dL. Foscarnet was initiated, and cerebrospinal fluid (CSF) PCR for HHV‐6 revealed 1,400 DNA copies/mL. Her MS greatly improved within 48 hr of antiviral therapy, serum HHV‐6 became negative, and TPE was tapered without recurrence of her TMA. TMA with HHV‐6 reactivation is likely an underdiagnosed entity. Given its fulminant course and favorable response to therapy, HHV‐6 reactivation should be considered a potential etiology in patients with TMA after ASCT. Am. J. Hematol. 76:156–162, 2004. © 2004 Wiley‐Liss, Inc.
Vulvar cancer in a patient with Fanconi's anemia, treated with 3D conformal radiotherapy
Authors: Harper Jennifer L. , Jenrette Joseph M. , Goddu S. Murty , Lal Asheesh , Smith Tim
Published: May 2004

Fanconi's anemia (FA) is rare autosomal recessive disorder characterized by aplastic anemia, congenital anomalies, and cancer susceptibility. FA patients have deficiencies in DNA repair pathways that cause cellular sensitivity to ionizing radiation and cross‐link agents such as mitomycin C and diepoxybutane (DEB). If these patients survive until early adulthood, they are at high risk for developing solid tumors, most commonly squamous cell carcinoma of the oropharynx, esophagus, and vulva. Treatment of these solid tumors with radiotherapy is complicated by the increased risk of normal tissue toxicity. Three‐dimensional (3D) conformal radiotherapy is a technique that uses CT images to more accurately target tumors and maximize the dose to the tumor volume while limiting the dose to normal tissue. This report describes application of 3D conformal radiotherapy techniques to the treatment of vulvar cancer in a patient with FA in an attempt to limit the normal tissue volume exposed to radiation. Am. J. Hematol. 76:148–151, 2004. © 2004 Wiley‐Liss, Inc.
Hemophagocytic syndrome associated with retinoic acid syndrome in acute promyelocytic leukemia
Authors: García‐Suárez J. , Bañas H. , Krsnik I. , De Miguel D. , Reyes E. , Burgaleta C.
Published: May 2004

A 56‐year‐old woman with an acute promyelocytic leukemia (APL) developed a severe all‐trans‐retinoic (ATRA) syndrome on day 17 of treatment. Shortly after, she presented a picture of pancytopenia, hepatosplenomegaly, increased triglycerides, ferritin, and liver enzymes. A bone marrow biopsy showed abundant macrophages and no evidence of leukemia. Tests for secondary hemophagocytic syndrome (HPS) were negative. A diagnosis of HPS was made. Treatment with dexamethasone and high‐dose immunoglobulins was unsuccessful. Consolidation chemotherapy with idarubicin and ATRA rapidly reversed the HPS. The HPS in this patient could be related to the release of macrophage‐stimulating cytokines by APL cells during ATRA syndrome. Am. J. Hematol. 76:172–175, 2004. © 2004 Wiley‐Liss, Inc.
Successful anti‐CD20 monoclonal antibody treatment of severe autoimmune hemolytic anemia due to warm reactive IgM autoantibody in a child with common variable immunodeficiency
Authors: Wakim Mary , Shah Ami , Arndt Patricia A. , Garratty George , Weinberg Kenneth , Hofstra Thomas , Church Joseph
Published: May 2004

Autoimmune hemolytic anemia due to warm reactive IgM autoantibodies is unusual, severe, and often fails to respond to standard immunosuppressive therapies in both adults and children. A 6‐year‐old girl with common variable immunodeficiency had longstanding steroid dependent, splenectomy‐unresponsive, warm IgM autoantibody‐mediated autoimmune hemolytic anemia. Rituximab, a monoclonal antibody directed against CD20 antigen, was used to deplete B lymphocytes and reduce autoantibody production. She received a total of six doses of rituximab (375 mg/m2). Therapy was well tolerated, and B‐lymphocytes were effectively depleted from the peripheral blood. The patient was completely tapered off glucocorticoids. The patient has remained off immunosuppressive agents for 16 months despite the return of B lymphocytes to the peripheral circulation. She continues to require IVIG. Early treatment with rituximab might be an option for patients with warm reactive IgM autoantibody‐mediated autoimmune hemolytic anemia not responding to other treatments or experiencing untoward side effects from those treatments. Am. J. Hematol. 76:152–155, 2004. © 2004 Wiley‐Liss, Inc.
Mild hyperhomocysteinemia in adult patients with sickle cell disease: A common finding unrelated to folate and cobalamin status
Authors: Dhar Meekoo , Bellevue Rita , Brar Shabneet , Carmel Ralph
Published: May 2004

Homocysteine has associations with both vitamin insufficiency and vascular complications, and its status is therefore of interest in sickle cell disease (SCD). However, information is limited, especially in adults. We studied plasma total homocysteine (tHcy) and three of its major modifiers, cobalamin, folate, and creatinine, in 90 adult patients with SCD and 76 control subjects. The patients had higher tHcy levels than did controls (P = 0.03) and had elevated tHcy more often (20% vs. 3%, P = 0.0005). None of the hyperhomocysteinemic patients had low cobalamin or folate levels; on the contrary, patients with SCD had high folate levels more often than control subjects (32% vs. 7%; P < 0.0001). Although serum creatinine values were lower in SCD patients than in control subjects (P = 0.03), high levels also tended to occur more often (8% vs. 1%; P = 0.054). Most importantly, creatinine levels correlated significantly with tHcy (P < 0.0001) and logistic regression analyses showed creatinine to be the only significant predictor of high tHcy levels in SCD (P = 0.01). Our results show that hyperhomocysteinemia affects 20% of adults with SCD despite routine folate supplementation and is independent of folate and cobalamin status. Creatinine was the major identifiable influence on tHcy, but renal insufficiency explained only 4 of the 18 elevated tHcy levels. Longitudinal studies will be needed to determine whether the frequent hyperhomocysteinemia of SCD influences the vascular complications in SCD. If reducing tHcy becomes advisable, then interventions other than folate therapy will be needed. Am. J. Hematol. 76:114–120, 2004. © 2004 Wiley‐Liss, Inc.
Determinants of ELISA D‐dimer sensitivity for unstable angina pectoris as defined by coronary catheterization
Authors: Shitrit David , Bar‐Gil Shitrit Ariella , Rudensky Bernard , Sulkes Jaqueline , Tzviony Dan
Published: May 2004

Unstable angina pectoris is associated with elevated D‐dimer levels. However, the operating characteristics (sensitivity, specificity, positive and negative predictive value) of the D‐dimer assay for the diagnosis of coronary artery disease (CAD) are unknown. Using a prospective, observational design, we collected blood from 54 patients with unstable angina pectoris at admission and assayed for ELISA D‐dimer levels. The sensitivity, specificity, and negative and positive prediction values for angiographically determined coronary artery disease were calculated at multiple discriminate levels. All patients underwent coronary catheterization. A statistically significant correlation was noted between ELISA D‐dimer levels and age, male sex, hypertension, use of β‐blocker, fibrinogen levels and catheterization findings. No correlation was noted between ELISA D‐dimer levels and degree of the coronary artery disease. Best results were provided at a discriminate level of 270 ng/ml, with sensitivity 70%, negative predictive value 72%, and overall accuracy 67%. All discriminate levels, however, provided values too low for diagnosis. In conclusion, ELISA D‐dimer assay is a non‐sensitive, non‐specific test for coronary artery disease as defined by coronary catheterization. However, the assay adds information regarding the severity of disease in patients presenting with acute coronary syndrome. Am. J. Hematol. 76:121–125, 2004. © 2004 Wiley‐Liss, Inc.
Cutaneous ulcers: An unusual manifestation of inherited thrombophilia
Authors: Mavragani Clio P. , Pikazis Dimitris , Aroni Kyriaki , Paikos Spiros , Voulgarelis Michalis
Published: May 2004

We report two cases with cutaneous lesions found to be associated with factor V Leiden mutation and low S protein levels. At the time of presentation, no other symptoms were reported. Histopathology of both lesions revealed the presence of widespread intravascular thrombi. The therapeutic response to oral anticoagulants in the first case was dramatic, leading to complete healing of the lesions. Inherited causes of thrombophilia manifested as cutaneous lesions, although rare, should be considered in the differential diagnosis of occlusive vasculopathy. Am J Hematol 76:139–142, 2004. © 2004 Wiley‐Liss, Inc.
Trends in occupational lead exposure since the 1978 OSHA lead standard
Authors: Okun Andrea , Cooper Gregory , Bailer A. John , Bena James , Stayner Leslie
Published: May 2004

Background

The purpose of the study was to evaluate trends in occupational lead exposures throughout U.S. industry after the establishment of the general industry lead standard in 1978 and the construction industry standard in 1993.

Methods

Lead exposure measurements collected by the Occupational Safety and Health Administration (OSHA) under their compliance and consultation programs were analyzed. Time trends in the distributions of exposure levels were evaluated graphically. Trends in the proportion of exposures above the OSHA permissible exposure limit (PEL) were analyzed using logistic regression models.

Results

The distribution of lead exposure levels declined over the study time period for general industry, but not for construction. The median exposure levels for general industry facilities decreased five‐ to tenfold. Logistic regression models reveal statistically significant declines in the odds of a lead exposure exceeding the PEL.

Conclusions

This study provides evidence for relatively large decreases in lead exposure levels in general industry facilities over time. The study does not provide similar evidence for the construction industry. Given the limited number of years of data available since the implementation of the revised construction standard for lead, re‐analysis of lead exposure levels within this industry would be worthwhile when more data become available. Am. J. Ind. Med. 45:558–572, 2004. Published 2004 Wiley‐Liss, Inc.
Neglecting safety precautions may lead to trenching fatalities
Authors: Deatherage J. Harold , Furches Lisa K. , Radcliffe Mike , Schriver William R. , Wagner John P.
Published: May 2004

Background

Trench collapses ranked as the seventh leading cause of the possible twenty‐nine causes of OSHA‐inspected fatal construction events during the period 1991–2001. This study aims to examine why these fatalities occurred.

Methods

Forty‐four case files from OSHA inspections of fatal trench collapses were reviewed.

Results

Improper protection of the excavation site where work was taking place was the leading fatality cause. Several organizational or physical conditions were present at many fatal sites; the most frequent was that no training had been provided for trenching.

Conclusions

Presence of a competent, diligent person at the site would have prohibited most fatalities. The top cited violation was lack of protection, that is, benching, shoring, sloping, trench boxes, etc. (29 CFR 1926.652 (a) (1)). Am. J. Ind. Med. 45:522–527, 2004. © 2004 Wiley‐Liss, Inc.
The doctors and the dockers
Authors: Greenberg Morris
Published: May 2004

Background

London Dockers unloading a dusty asbestos cargo in 1965, consulted an eminent Occupational Health physician, Dr. Donald Hunter who informed them that they had been at serious risk. A second, opinion provided jointly by a Consultant Chest Physician, the Port Medical Officer, and the Medical Advisor to the Trades Union Congress, declared that they knew of no disease affecting dockers, and stated that intermittent exposure to asbestos constituted an inconsiderable risk that with certain precautions would be eradicated.

Methods

Archival material have been obtained to supplement limited published material and eyewitness accounts of the event, to provide a clearer picture of the issues.

Results

Reassured by the Chest Physician, the Port Medical Officer, and the Medical Advisor to the Trades Union Congress that they had little to fear, London dockers resumed unloading asbestos. From time to time dockers at other ports were to express concern and interrupt work, only to be similarly reassured.

Conclusions

Had the medical troika in 1965 considered the available health statistics, they would have had reason to take a less sanguine attitude to the cancer mortality of dockers. An analysis of data for 16 selected occupations for the years 1900–1902, showed dockers to have an unhealthy job, with deaths from ‘All Cancers’ of 1.09 per 1,000 years of life (the fourth highest). The Registrar General's occupational mortality report for 1951, noted excess tumors of the lung and stomach for dockers. Elevated Standardized Mortality Ratios for lung cancer had consistently been calculated by the Registrar General for the 20–64 age group of dockers; in 1931 (183), 1951 (149), and 1961 (169): by 1971 it would be 182. A total of 266 dockers were to be registered in the UK by 1999 as having died of malignant mesotheliomas, proving that Donald Hunter's concern for dockers had not been excessive. Am. J. Ind. Med. 45:573–581, 2004. © 2004 Wiley‐Liss, Inc.
Occupational exposure to diesel and gasoline engine exhausts and risk of lung cancer among Finnish workers
Authors: Guo Johannes , Kauppinen Timo , Kyyrönen Pentti , Lindbohm Marja‐Liisa , Heikkilä Pirjo , Pukkala Eero
Published: May 2004

Background

Studies on engine exhausts and lung cancer have given inconsistent results.

Methods

Economically active Finns were followed‐up for lung cancer during 1971–95 (33,664 cases). Their Census occupations in 1970 were converted to exposures to diesel and gasoline engine exhausts with a job–exposure matrix. The relative risks (RRs) for cumulative exposure (CE) were defined by Poisson regression, adjusted for smoking, asbestos, and quartz dust exposure, and socioeconomic status.

Results

RR for engine exhausts among men did not increase with increasing CE. In women, RR for gasoline engine exhaust was 1.58 (95% CI 1.10–2.26) in the CE‐category of 1–99 mg/m3‐y and 1.66 (1.11–2.50) among those with ≥100 mg/m3‐y (lag 20 years). With a lag of 10 years RR for the middle/highest diesel exhaust category in women was 1.42 (0.94–2.13).

Conclusions

Occupational exposure to engine exhausts was not consistently associated with lung cancer in this study, possibly due to low exposure levels. Am. J. Ind. Med. 45:483–490, 2004. © 2004 Wiley‐Liss, Inc.
Surveillance of hazardous materials events in 17 states, 1993–2001: A report from the Hazardous Substances Emergency Events Surveillance (HSEES) System
Authors: Horton D. Kevin , Berkowitz Zahava , Kaye Wendy E.
Published: May 2004

Background

Thousands of acute hazardous materials (HazMat) releases occur annually throughout the United States. To prevent human exposure and resulting injuries, it is critical to understand the frequency with which these releases occur, the locations involved, the industries associated, and the specific substances being released.

Methods

HazMat events data from the Agency for Toxic Substances and Disease Registry's Hazardous Substances Emergency Events Surveillance (HSEES) system were analyzed for frequency and locations of occurrence, major industry categories and sub‐categories involved, and substances released. The data analyzed were collected from 17 participating state health departments for 1993 through 2001.

Results

During 1993 through 2001, 53,142 HazMat events occurred. Of the 17 states analyzed, Texas had the most releases, comprising 38.3% of all HSEES events. Of the 14 major US Census industry categories analyzed, the manufacturing category had the highest percentage of events (48.7%) followed by transportation, communication, and other public utilities (27.5%). Of the 10 states that participated during the entire analysis period, the numbers of events increased 64.3%. Twelve of 14 major industrial categories experienced increases in numbers of events over the analysis period, while public administration and active duty military events decreased. The substances released most frequently overall included ammonia, sulfur dioxide, and sulfuric acid, respectively.

Conclusions

The HSEES data appear to reflect an upward trend in the occurrence of hazardous HazMat events. While it is difficult to definitively conclude whether this trend is due to more events actually occurring or from other factors, reviewing historical HazMat data may help communities, government agencies, and industries prevent or better prepare for potential events in the future. Am. J. Ind. Med. 45:539–548, 2004. Published 2004 Wiley‐Liss, Inc.
A disease and non‐battle injury model based on Persian Gulf War admission rates
Authors: Wojcik Barbara E. , Hassell L. Harrison , Humphrey Rebecca J. , Davis James M. , Oakley Carolyn J. , Stein Catherine R.
Published: May 2004

Background

Military planners must ensure adequate medical care for deployed troops—including care for disease and non‐battle injuries (DNBI). This study develops a heuristic model with the three distinct phases of a warfighting operation (build‐up, ground combat, post‐combat) to assist in predicting DNBI incidence during warfighting deployments.

Methods

Inpatient healthcare records of soldiers deployed to the Persian Gulf War who were admitted with DNBI diagnoses were analyzed. DNBI admission rates for the three phases of the operation were examined and compared to rates for US Army Forces Command (FORSCOM) posts in the US.

Results

DNBI admission rates among the phases were distinctly different. The operation's overall rate and 95th percentile daily rate were less than the FORSCOM FY 1990 annual rate.

Conclusions

The level of combat must be considered. The traditional use of average or overall rates should be abandoned when forecasting DNBI rates. Medical support projections should use separate 95th percentile DNBI admission rates for each of the phases. Am. J. Ind. Med. 45:549–557, 2004. Published 2004 Wiley‐Liss, Inc.
Kantaputra mesomelic dysplasia: A second reported family
Authors: Shears Deborah J. , Offiah Amaka , Rutland Paul , Sirimanna Tony , Bitner‐Glindzicz Maria , Hall Christine
Published: May 2004

We present the clinical and radiographic findings in a mother and son with a dominantly inherited mesomelic skeletal dysplasia almost identical to that described in a large Thai family by Kantaputra et al., in which ankle, carpal and tarsal synostoses were noted. The proband in the family is a 48‐year‐old woman with mesomelic limb shortening, most pronounced in the upper limbs. Her parents were of normal stature and build. Her 15‐year‐old son has similar mesomelic limb shortening, and in addition talipes equinovarus. Radiological examination showed severe shortening of the radius and ulna with bowing of the radius and dislocation of the radial head. Multiple carpal and tarsal synostoses were present and in addition, the talus and calcaneum were fused. In the original Thai family, linkage to chromosome 2q24‐q32, which contains the HOXD cluster has been reported, and it is postulated that the phenotype may result from a disturbance of regulation of the HOXD cluster. Although linkage analysis was not possible in our family, molecular analysis was undertaken and HOXD11 was sequenced, however, no mutations were detected. This is only the second reported family affected with Kantaputra mesomelic dysplasia (MIM 156232), a distinct mesomelic skeletal dysplasia. © 2004 Wiley‐Liss, Inc.
MICRO syndrome: An entity distinct from COFS syndrome
Authors: Graham John M. , Hennekam Raoul , Dobyns William B. , Roeder Elizabeth , Busch David
Published: May 2004

Children born with the findings of microcephaly, cataracts and microcornea can result not only from a prenatal viral infection, but also from an autosomal recessive Mendelian disorders. We present three pairs of affected siblings with MICRO syndrome, who were born with congenital microcephaly, microcornea, and cataracts. MICRO syndrome is an autosomal recessive syndrome consisting of congenital microcephaly, cortical dysplasia, microcornea, cataracts, optic atrophy, severe mental retardation, hypotonic diplegia, and hypogenitalism. At birth, MICRO syndrome resembles Cerebro‐Oculo‐Facio‐Skeletal (COFS) syndrome, but it differs in the lack of the rapidly progressive neurologic features leading to severe brain atrophy with calcifications. Patients with MICRO syndrome manifest frontal cortical dysplasia, hypoplasia of the corpus callosum, cortical blindness with optic atrophy, profound mental retardation, and progressive joint contractures with growth failure. COFS syndrome shares also many clinical and cellular similarities with Cockayne syndrome (CS), and cultured cells in both conditions demonstrate hypersensitivity to ultraviolet (UV) radiation due to impaired nucleotide excision repair (NER). NER studies in cultured fibroblasts from MICRO patients give normal results, so MICRO syndrome should be considered in children with features resembling COFS syndrome and CS, but who have normal NER. MICRO should be distinguished from other similar clinical disorders with normal NER by the presence of significant visual impairment and cortical blindness despite early surgery for congenital cataracts, frontal polymicrogyria, thin corpus callosum, and cortical atrophy by MRI. © 2004 Wiley‐Liss, Inc.
Psychological impact of genetic testing for familial hypercholesterolemia within a previously aware population: A randomized controlled trial
Authors: Marteau Theresa , Senior Victoria , Humphries Steve E. , Bobrow Martin , Cranston Treena , Crook Martin A. , Day Lorna , Fernandez Maryam , Horne Rob , Iversen Andrew , Jackson Zoe , Lynas Jacqui , Middleton‐Price Helen , Savine Richard , Sikorski Jim , Watson Melanie , Weinman John , Wierzbicki Anthony S. , Wray Richard
Published: May 2004

This trial tests the hypothesis that confirming a clinical diagnosis of familial hypercholesterolemia (FH) by finding a genetic mutation reduces patients' perceptions of control over the disease and adherence to risk‐reducing behaviors. Three hundred forty‐one families, comprising 341 hypercholesterolemia probands and 128 adult relatives, were randomized to one of two groups: (a) routine clinical diagnosis; (b) routine clinical diagnosis plus genetic testing (mutation searching in probands and direct gene testing in relatives). The main outcome measures were perceptions of control over hypercholesterolemia, adherence to cholesterol‐lowering medication, diet, physical activity, and smoking. There was no support for the main hypothesis: finding a mutation had no impact on perceived control or adherence to risk‐reducing behavior (allP‐values > 0.10). While all groups believed that lowering cholesterol was an effective way of reducing the risk of a heart attack, participants in whom a mutation was found believed less strongly in the efficacy of diet in reducing their cholesterol level (P = 0.02 at 6 months) and showed a trend in believing more strongly in the efficacy of cholesterol‐lowering medication (P = 0.06 at 6 months). In conclusion, finding a mutation to confirm a clinical diagnosis of FH in a previously aware population does not reduce perceptions of control or adherence to risk‐reducing behaviors. The pattern of findings leads to the new hypothesis that genetic testing does not affect the extent to which people feel they have control over a condition, but does affect their perceptions of how control is most effectively achieved. Further work is needed to determine whether similar results will be obtained in populations with little previous awareness of their risks. © 2004 Wiley‐Liss, Inc.
Infantile systemic hyalinosis: A clinicopathological study
Authors: Criado Germán Rodríguez , González‐Meneses Antonio , Cañadas Manuela , Rafel Enrique , Yanes Francisco , de Terreros Ignacio Gómez
Published: May 2004

Infantile systemic hyalinosis (ISH) is a presumed autosomal recessive connective tissue condition. Symptoms usually begin at birth or shortly thereafter, and are characterized by pain when handled, painful and swollen joints and, later on, dermal anomalies, diarrhea, failure to thrive and recurrent infections, which usually lead to death around the age of 2. The skin has generally diminished elasticity with small pearly papules appearing on neck, ears, coccygeal region, and face. We present two unrelated patients with ISH, with specific focus on clinical and pathologic studies. In the first patient the diagnosis was made several years after she died, in a retrospective study of her clinical file. On ultrastructural examination both patients showed an accumulation of fibrillogranular material in the extracellular matrix with long‐spacing collagen of 90 nm. The first child died at the age of 1½ years and the second at 3 years. © 2004 Wiley‐Liss, Inc.