Treatment phase of the Alabama chronic respiratory disease program.
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From the data presented it appears that acupuncture helped in more than 50% of the patients by either completely or partially controlling pain from certain disorders. Patients helped by acupuncture received 8.55 treatments on the average, while patients not helped by acupuncture only received 4.75 treatments. There is difference between the male and female patients as to the response to acupuncture. However, we noticed that the younger the patient and the shorter the duration of their of problems, the better the response. Patients who had not had surgery to treat the pain syndrome responded better than those who had had previous surgery. Patients with backache who had previously had laminectomy showed better response to acupuncture than patients who had had spinal fusion. It appears that good general health plays an important role in favorable response to acupuncture treatment. Acupuncture may be a valuable extension of a conventional pain clinic and an alternative in patients who are desperate to obtain relief from pain which they failed to obtain from other methods.
In recent years, all cases of tetanus reported in the United States have occurred either in unimmunized persons, partially immunized persons, or persons whose immunization history was uncertain. We present our experience with three unimmunized individuals who acquired this disease. One patient became ill after a "clean, minor wound." Present guidelines do not encourage immediate protection with human tetanus immune globulin (TIG) for unimmunized patients with this type of injury. We believe serious consideration should be given to modification of current recommendations to include the more liberal use of TIG, especially in nonimmune persons.
Eastern poison oak, Toxicodendron toxicarium, is a nonclimbing shrub whose leaves have three leaflets. The leaflets with their numerous round lobes resemble somewhat the leaves of some oaks in the white oak groups. The plant grows in nutritionally poor, sandy soil, and especially in dry pine-oak woodland. Deposits resembling black enamel paint can often be seen where plants have been injured. During winter, the U- or V-shaped leaf scars, the naked fruit stalks in female plants, and the sparse upright branches all aid in recognition. Other features can be useful in spring and fall. While poison oak and poison ivy are so closely related that the sensitivity of individuals and resulting dermatitis are not markedly different, accurate recognition is important in avoiding contact.
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Death or injury resulting from crashes involving light trucks (ie, pickup trucks) is a significant problem. Data show that fatal crashes and occupant fatalities involving light trucks have steadily increased since 1983. This project describes vehicle crashes involving passengers riding in the beds of pickup trucks. Actual crashes were identified through the Fatal Accident Reporting System (FARS) of the National Highway Traffic Safety Administration. The 40 incidents studied involved 204 pickup truck passengers. Of these, 45 were killed, 107 sustained visible injuries or were carried from the scene, 6 had bruises and abrasions, and 2 had no visible injury but were briefly unconscious or had a documented complaint of pain. The risk of death among pickup truck passengers who were fully ejected from the vehicle was nearly six times that of passengers not fully ejected. Correspondingly, the risk of ejection from the truck was 26.7 times greater among occupants riding in the bed than occupants riding in the cab.
BACKGROUND: Carisoprodol is a skeletal muscle relaxant with the potential for abuse. A carisoprodol overdose is rarely considered fatal. Nevertheless, we encountered carisoprodol in several cases, prompting review of our experience. METHODS: We did a retrospective study of cases examined at the Jefferson County Coroner/Medical Examiner Office from January 1, 1986, to October 31, 1997, reviewing investigative reports and autopsy findings. RESULTS: Carisoprodol was present in 24 cases. Seventeen decedents died of acute drug intoxication. Carisoprodol was never the sole drug detected at autopsy, nor was it ever the sole cause of death. Propoxyphene was a co-intoxicant in 8 of the 24 cases. CONCLUSIONS: Carisoprodol causes respiratory depression. Since the mechanism of death was respiratory depression in 82% of the decedents who died of acute intoxication, we consider that carisoprodol was probably responsible, in part, for those deaths. The simultaneous use of propoxyphene and carisoprodol seems to be especially dangerous.
We analyzed hemochromatosis detection in a 11.5-year multiphasic health screening program at a forest products mill. There were 2199 participants: 2032 Whites (1506 men, 526 women) and 167 African Americans (124 men, 43 women); 85.0% of employees were screened. Iron and transferrin saturation were measured in a serum biochemistry profile on specimens obtained after overnight fasting; ferritin was measured in participants with elevated iron concentrations or transferrin saturation > 48%. Participants with elevated ferritin levels underwent further evaluation. Eight White men were diagnosed to have hemochromatosis (frequency 0.0039 in Whites, 0.0053 in White men). The estimated cost per case detected was $8826. Family members of two participants with hemochromatosis were also diagnosed to have hemochromatosis or iron overload. We conclude that detecting hemochromatosis in a workplace multiphasic health screening program is efficacious and economical.
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This study documented the prevalence of exercise-induced asthma (bronchospasm) in rural elementary schools and described the use of a free-running asthma screening test (exercise-challenge) and peak expiratory flow rate measurements for screening in a school setting. Of 437 children screened, 25 (5.72%) had a > or = 15% decrease in post-exercise peak expiratory flow rate which is indicative of exercise-induced asthma. Absenteeism and poverty were associated with findings of exercise-induced asthma. Early detection of exercise-induced asthma in school-age children through screening would facilitate early treatment, enhance exercise-related activities, and decreases school absences.
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Recent Vibrio parahaemolyticus outbreaks associated with consumption of raw shellfish in the United States focused attention on the occurrence of this organism in shellfish. From March 1999 through September 2000, paired oyster samples were collected biweekly from two shellfish-growing areas in Mobile Bay, Ala. The presence and densities of V. parahaemolyticus were determined by using DNA probes targeting the thermolabile hemolysin (tlh) and thermostable direct hemolysin (tdh) genes for confirmation of total and pathogenic V. parahaemolyticus, respectively. V. parahaemolyticus was detected in all samples with densities ranging from <10 to 12,000 g(-1). Higher V. parahaemolyticus densities were associated with higher water temperatures. Pathogenic strains were detected in 34 (21.8%) of 156 samples by direct plating or enrichment. Forty-six of 6,018 and 31 of 6,992 V. parahaemolyticus isolates from enrichments and direct plates, respectively, hybridized with the tdh probe. There was an apparent inverse relationship between water temperature and the prevalence of pathogenic strains. Pathogenic strains were of diverse serotypes, and 97% produced urease and possessed a tdh-related hemolysin (trh) gene. The O3:K6 serotype associated with pandemic spread and recent outbreaks in the United States was not detected. The efficient screening of numerous isolates by colony lift and DNA probe procedures may account for the higher prevalence of samples with tdh(+) V. parahaemolyticus than previously reported.
A serological investigation for neutralizing antibody to bovine respiratory syncytial virus (BRSV) was conducted using an antigenically related human strain of respiratory syncytial virus. Results demonstrated the effectiveness of the procedure. Sixty-seven percent of healthy, adult cattle tested were found to have antibody to BRSV. Calves in several herds were exposed to conditions to encourage development of respiratory tract disease. In three herds in which respiratory tract disease subsequently developed, the incidence of BRSV seroconversions approached 100%. In a herd in which no respiratory tract disease was detected, BRSV seroconversions indicated a high incidence of subclinical infections. It was concluded that, in this country as has been shown in others, BRSV is probably a significant pathogen of the bovine respiratory tract.