Incidence of injuries and factors related to injuries in combat soldiers.

INTRODUCTION: Musculoskeletal injuries to the lower extremities are major factors contributing to drop out from military tasks. The aim of the present study was to determine the incidence of musculoskeletal injuries and the parameters that differentiate between the soldiers who incurred these injuries and those who did not along 14 weeks of an infantry commanders course. METHODS: One-hundred and sixty-eight participants were recruited from an infantry commanders course. The soldiers were tested before (pre), in the middle (middle) and at the end (last) of the course for anthropometric measurements, proprioceptive ability and dynamic postural balance (DPB), and filled out an ankle stability questionnaire (Cumberland Ankle Instability Tool (CAIT). A physiotherapist followed and recorded all musculoskeletal injuries incurred by the participants during the course. RESULTS: Fifty-eight participants out of the 168 (34.5%) reported some pain/injury. Time effects were found for body mass index, DPB asymmetry, DPB in posterior-medial (P-M) direction and proprioception ability. Injury effects were found for DPB asymmetry, DPB in P-M direction, CAIT and proprioception ability. An interaction was found for proprioception ability. The Cox regression showed that the variables that are mostly effecting injuries were pretesting proprioception ability, DPB asymmetry and CAIT. CONCLUSIONS: More than one out of three participants incurred musculoskeletal injuries, with deficits in proprioception ability, DPB and ankle stability in pretesting as major factors contributing to injuries. Further studies should look at the effect of specific exercises such as proprioception, DPB and ankle stability exercises for prevention and treatment of musculoskeletal injuries among combat soldiers.

A systematic review of the effectiveness of Kinesio Taping--fact or fashion?

In this systematic review article, we assessed the effects of therapeutic Kinesio Taping (KT) on pain and disability in participants suffering from musculoskeletal, neurological and lymphatic pathologies. Four online databases (CINAHL, Cochrane Library, MEDLINE, PEDro) were comprehensively searched from their inception through March 2012. The initial literature search found 91 controlled trials. Following elimination procedures, 26 studies were fully screened. Subsequently, 12 met our inclusion criteria. The final 12 articles were subdivided according to the basic pathological disorders of the participants' musculoskeletal (N.=9), neurological (N.=1) and lymphatic (N.=2) systems. As to the effect on musculoskeletal disorders, moderate evidence was found supporting an immediate reduction in pain while wearing the KT. In 3 out of 6 studies, reduction of pain was superior to that of the comparison group. However, there is no support indicating any long-term effect. Additionally, no evidence was found connecting the KT application to elevated muscle strength or long-term improved range of movement. No evidence to support the effectiveness of KT for neurological conditions. As to lymphatic disorders, inconclusive evidence was reported. Although KT has been shown to be effective in aiding short-term pain, there is no firm evidence-based conclusion of the effectiveness of this application on the majority of movement disorders within a wide range of pathologic disabilities. More research is clearly needed.

The removal of 10/0 polyester (Mersilene) sutures after small incision congenital cataract surgery.

PURPOSE: To evaluate the use of 10/0 polyester (Mersilene) sutures for closure of small corneal incision after congenital cataract surgery. METHODS: The authors retrospectively reviewed the medical records of 58 cases (42 patients) who underwent congenital cataract extraction and intraocular lens implantation between 1999 and 2004, using Mersilene sutures. An examination looking for suture-related complications and retinoscopy was done 1 week after surgery and then every month for 6 months. The sutures were removed in cases of local tissue reaction, but not due to high postoperative astigmatism. Paired t-test was used to compare patients' age and astigmatism level in those cases who had suture removal (Group 1) as opposed to those who did not (Group 2). RESULTS: In 10 cases (17%) corneal vascularization, necessitating suture removal, was found during 6-month follow-up period, without the trigger of loose suture. Patient age was 3.5+/-3.3 years and 4.4+/3.3 years in Groups 1 and 2, respectively. At 1 week postoperatively the astigmatism value was 1.7+/-1.7 diopter (D) and 2.3+/-2.2 D in Groups 1 and 2, respectively, and it reduced to 0.9+/-0.8 in both groups at 6 months postoperatively. One case of endophthalmitis was encountered 2 days after suture removal. CONCLUSIONS: Removal of Mersilene sutures after congenital cataract surgery is required in cases of corneal vascularization, occurring during the first months postoperatively. Owing to the risk of general anesthesia and infection, suture removal should be considered with caution in cases of postoperative astigmatism.

Astigmatism outcomes of scleral tunnel and clear corneal incisions for congenital cataract surgery.

PURPOSE: To evaluate astigmatism outcomes after congenital cataract surgery with intraocular lens implantation using clear corneal or scleral tunnel incisions. METHODS: We retrospectively reviewed the medical records of 46 children (67 eyes), aged 2 months to 12 years, who had undergone nontraumatic cataract extraction and intraocular lens implantation between 1996 and 2001, using a scleral tunnel incision (group 1), or a clear corneal incision (group 2). Refractive astigmatism was measured at 1 week, 3 months, and 5 months after surgery. Paired t-test was used to compare those variables, and Spearman's correlation was used to determine their relation to patient's age. RESULTS: Mean+/-SD astigmatism at 1 week postoperatively was 3.1+/-2.8 Diopter (D) and 2.1+/-1.7 D in groups 1 and 2, respectively. It significantly reduced to 1.1+/-1.2 D and 0.9+/-1.0 D, respectively, in the two groups at 5 months postoperatively (P<0.007). In both groups patients' age was significantly correlated with 1-week postoperative astigmatism (group 1: r=0.64; P=0.001; group 2: r=-0.58; P=0.003), and with the change in cylinder magnitude between 1 week and 3 months postoperatively (group 1: r=-0.67; P=0.001; group 2: r=0.50; P=0.013). CONCLUSION: Children who underwent congenital cataract surgery using clear corneal or scleral tunnel incisions showed high postoperative astigmatism at 1 week postoperatively, which spontaneously reduced during 5 months follow-up. Therefore, suture removal is not necessary in those cases.

Changes in circulating IGF-I and their correlation with self-assessment and fitness among elite athletes.

The evaluation of training load and effectiveness in elite athletes is difficult. We determined the effect of a four-week training camp on changes in self-assessment physical conditioning scores, fitness and circulating IGF-I in elite Israeli handball players during their preparation for the 1999 World Junior Handball Championship. Training consisted of two weeks of intense training followed by two weeks of relative tapering. Fitness was assessed by field test measurements of 1000-m run, 4 x 10-m shuttle run and vertical jump. Serum IGF-I levels were measured by immunoradiometric assay. Measurements were performed before, after two weeks, and at the end of training. Training resulted in a significant (p < 0.05) improvement in the results of the 4 x 10-m run, 1000-m run and vertical jump. Changes in the self-assessment physical conditioning score showed a bi-directional pattern. After two weeks of training the players reported decreased physical conditioning scores, with return to basal levels after four weeks. Similarly, circulating IGF-I decreased significantly after two weeks, and returned to basal levels after four weeks of training. We found a significant correlation between changes in circulating IGF-I, and self-assessments of physical conditioning scores (r = 0.71, p < 0.001). Intensive training resulted in a decrease, while tapering was associated with an increase in IGF-I levels. These changes were accompanied by parallel changes in subjective physical conditioning self-assessments.

Amyotrophic lateral sclerosis in a battery-factory worker exposed to cadmium.

A 44-year-old patient died from amyotrophic lateral sclerosis (ALS) after nine years of heavy exposure to cadmium (Cd) in a nickel cadmium (Ni-Cd) battery factory. Two years after starting work he and co-workers had experienced pruritus, loss of smell, nasal congestion, nosebleeds, cough, shortness of breath, severe headaches, bone pain, and proteinuria. Upper back pain and muscle weakness progressed to flaccid paralysis. EMG findings were consistent with motor neuron disease. Cd impairs the blood-brain barrier, reduces levels of brain copper-zinc (Cu-Zn) superoxide dismutase (SOD), and enhances excitoxicity of glutamate via up-regulation of glutamate dehydrogenase and down-regulation of glutamate uptake in glial cells. High levels of methallothionein, a sign of exposure to heavy metals, have been found in brain tissue of deceased ALS patients. The effects of Cd on enzyme systems that mediate neurotoxicity and motor neuron disease suggest a cause effect relationship between Cd and ALS in this worker.

Asthma in Gaza refugee camp children and its relationship with house dust mites.

Three hundred asthmatic children aged 3 to 15 years, and 100 age-sex-neighborhood matched controls, were studied for environmental risk factors for asthma during 1986 to 1987. In 98% of the asthmatic patients, exposure to house dust aggravated the symptoms. In 97% of the cases, the symptoms were more severe at home; in more than 50%, the symptoms persisted throughout the year. Significantly more cigarettes were smoked in the homes of the allergic children than in the control homes. House dust samples from homes of 20 asthmatic and 20 nonasthmatic children were examined for the presence of house dust mites. Twelve species of mites were identified, of which Dermatophagoides pteronyssinus, the most prevalent (97%), was found in all samples examined. The average number of mites per gram dust was 447 in homes of children with asthma, and 399 in homes of controls. Although dust and mites seem to be the most important factors causing allergies in Gaza and most of the children are exposed to large numbers of mites in their homes, it appears that those who are genetically predisposed and who are exposed to environmental tobacco smoke are at greater risk for allergic symptoms.

Medical findings in nickel-cadmium battery workers.

Thirty-eight workers from a factory producing nickel-cadmium and other types of batteries came to us for medical evaluation. They included 21 women and 17 men (seniority 2-20 years, age range 31-63 years), and represented a self-selected subset of 700-900 ever-employed and 200+ recently or currently employed workers in the factory. Thirty-four worked on the nickel-cadmium assembly line. Symptoms and signs included: headache in 34; weakness, fatigue and lassitude in 26; dizziness in 16; pruritus and skin eruptions in 37; gingivitis, teeth loss and caries in 34; nasal congestion, nosebleeds and anosmia in 30; cough, phlegm production, wheezing and shortness of breath in 26; "asthma" in 14; bone pain in 18; urinary frequency, beta 2 microglobulinuria and kidney stones in 17; and sterility or multiple abortions (33) in 8 of 21 women. One additional patient had died from an "amyotrophic lateral sclerosis-like syndrome", while CT scans in six workers revealed brain atrophy. One other worker had leukemia, and two had died from cancer (lung and pancreas). Those who had worked for more than 10 years had more symptoms and signs than shorter-term employees, especially neurological illness, bone pain and urinary tract problems, including beta 2 microglobulinuria. Past blood and urinary cadmium levels were in the range of 1.6-8.7 micrograms/dl and 8-306 micrograms/l, respectively. Our findings indicated that: a) health risks for workers were not confined to the nickel-cadmium assembly line or to older workers, b) hazardous exposures still existed and illness appeared in new workers after a clean-up and intervention program, and c) exposures involved increased risks for renal disease and cancers. Finally, there is a need to control exposures and determine health risks in the full cohort of those ever employed, in the workers' children, and in the surrounding environment (air, ground, water) due to the dumping of waste from the plant.

Bone marrow and peripheral blood modifications in C57BL mice administered with cyclophosphamide and levan.

The effects of cyclophosphamide (CY) and levan at low (0.1 mg) and high (10 mg) doses (previously found to inhibit and stimulate, respectively, B16 melanoma growth) were studied. in single and combined administration, on the blood and bone marrow of C57BL mice. Very marked changes in the cellular composition of blood and bone marrow were induced by the various treatments. CY caused a sharp depletion of leukocytes in blood and bone marrow followed by a restoration of granulocytes while lymphocytes remained low. Levan caused a sharp dose-dependent depletion in bone marrow lymphocytes. Blood lymphocytes were not affected, however, by the polysaccharide. With the high levan dose, after a temporary granulocytopenia and monocytopenia, prominent granulocytosis was observed. While CY affected equally the different types of cells, levan decreased the number of lymphocytes and erythroblasts to a greater degree than the number of granulocytes. In the combined CY-levan treatments, the low levan dose generally attenuated the suppressive effect of CY, while the high concentration aggravated it.

Codeine-induced mast cell degranulation in human skin: effect of calcium channel blockers.

Codeine and other opiates can induce immediate type wheal and flare skin reactions. Calcium channel blockers including nifedipine have been shown to inhibit mast cell degranulation in different systems. The oral administration of nifedipine (10 mg) did not affect the size of codeine-induced skin reactions in ten normal volunteers. Mean wheal over flare sizes were 11.7 mm/29.2 mm before nifedipine and 11.5 mm/31.0 mm at peak nifedipine blood levels. Similar observations were made when codeine was injected locally with or without 20 micrograms nifedipine (12.1/29.2 mm and 13.2/29.2 mm, respectively). These data suggest that codeine-induced mast cell degranulation may be mediated by a calcium-independent mechanism. Alternatively, mast cells in the human skin may differ in their reactions to secretagogues when compared with basophils and mast cells from other human tissues or other species.

Respiratory disease in animal house workers.

A cross-sectional survey was made to determine the prevalence of respiratory disorders, and the association between symptoms and workplace exposure, in 90 animal-house workers (AHW) and 100 controls (C) without occupational exposure to laboratory animals. Each subject provided a detailed history and serum for radioimmunoassays, and underwent: physical examination, skin testing with common inhalant and animal-derived antigens, and pulmonary function studies. Both groups were comparable with respect to age, sex, smoking habits, and atopy. Rhinitis occurred with similar frequency in each group. However, a more frequent occurrence of asthma (p less than 0.05, non-specific infectious respiratory disease (p less than 0.005), and impaired pulmonary functions (p less than 0.001) was found among AHW. An atopic background was a predisposing factor for the development of laboratory-animal-related respiratory symptoms. These findings imply an increased vulnerability to respiratory disease related to workplace exposure to laboratory animals in atopic individuals.

Fulminant cutaneous T-cell lymphoma and Sézary syndrome.

The term cutaneous T-cell lymphoma (CTCL) has recently been coined to describe a group of rare lymphoproliferative T-cell disorders classically beginning in the skin and pursuing a chronic, progressive, and indolent course eventually followed by visceral involvement. This term encompasses the spectrum of the traditional mycosis fungoides and Sézary syndrome. A unique case of CTCL that developed a fulminant course leading to death within a few months following the initial symptoms is presented. The clinical course bears a striking similarity to a group of acute T-cell malignancies, while the cytologic-pathologic findings favor the diagnosis of Sézary syndrome. Regardless of the exact classifications, this entity appears to be a highly malignant T-cell disorder, resistant to chemotherapy.

Occupational respiratory disease in veterinarians.

In order to determine the effect of occupational animal exposure on the occurrence of respiratory disease, we studied 257 active veterinarians and 100 control subjects who had not had occupational animal contact. All participants provided a detailed medical history and underwent spirometry, skin tests, and determination of total serum IgE levels. Asthma was significantly more prevalent in veterinarians (16.3%) than in controls (6%), (P less than .05), as was infectious/obstructive respiratory disease, 10.5% in veterinarians, 3% in controls (P less than .025). Only 13 of 257 veterinarians had respiratory symptoms related to animal contact; of these, seven experienced only allergic rhinitis while six reported both asthma and rhinitis. Animal-related allergic rhinitis was found more frequently in laboratory animal veterinarians than among veterinarians in farm, pet, or poultry practice. No symptoms typical of hypersensitivity pneumonitis were reported in veterinarians, nor were precipitins to animal antigens demonstrable.

Antigen-induced enhancement of bronchial reactivity.

Bronchial hyperreactivity as determined by the airway response to methacholine was evaluated pre- and post-antigen challenge in three patients with specific antigen sensitivity. No significant change in pulmonary function was noticed after inhalation of antigen alone. However, transient but significant increase in methacholine responsiveness followed the antigen challenge. The studies indicate a need for a nonspecific inhalation challenge following a negative antigen challenge when clinically indicated.

Immunoregulation in hypersensitivity pneumonitis: phenotypic and functional studies of bronchoalveolar lavage lymphocytes.

We examined the immunologic phenotype and function of bronchoalveolar lymphocytes isolated from 4 pigeon breeders who developed symptoms of hypersensitivity pneumonitis on exposure to pigeons, and 6 asymptomatic but equally exposed individuals. Similar numbers of bronchoalveolar lymphocytes were found in symptomatic breeders compared with the asymptomatic, and the percent of T11, T4, and T8 bearing cells as well as the T4/T8 ratios were similar in both groups. Despite these similarities, the groups had significantly different functional activity. Bronchoalveolar lymphocytes from symptomatic breeders demonstrated a marked (p less than 0.001) increase in blastogenic activity to both phytohemagglutinin and pigeon serum stimulation when compared with asymptomatic breeders. In addition, enriched bronchoalveolar T-cells suppressed the response of autologous preincubated peripheral blood lymphocytes to both phytohemagglutinin and pigeon serum in the asymptomatic compared with the symptomatic breeders. These studies suggest a discrepancy between the phenotype and function of immunoregulatory T-cell subsets in bronchoalveolar lavage lymphocytes in pigeon breeder's disease, and support a role for functional immunoregulatory imbalances in the pathogenesis of hypersensitivity pneumonitis.

Occupational asthma in poultry workers.

Sixteen poultry workers with poultry house--related rhinitis and/or asthma underwent clinical and laboratory evaluation that included history and physical examination, skin tests with common inhalant and PAg, total- and specific-IgE levels, and pulmonary-function studies. Sixteen age- and sex-matched atopic subjects who were not occupationally exposed to poultry and 12 asymptomatic veterinarians with occupational exposure to poultry served as controls. Rhinitis and asthma developed only in symptomatic poultry workers after exposure to poultry; only in these individuals could immediate wheal-and-flare reactions to poultry antigens be detected (p less than 0.001). The elapsed time between the initial poultry exposure and the onset of poultry house--related symptoms averaged 10 yr. In the symptomatic poultry workers, immediate skin test reactivity and RAST reactions were most frequently associated with NFM. The association between respiratory symptoms temporally related to poultry house exposure and the demonstrable IgE antibody-mediated reaction suggests a relationship between the two.

Occupational asthma due to poultry mites.

The possible role of the northern fowl mite (NFM) in occupation-related respiratory disease of poultry workers was examined. The study population included 16 poultry workers with workplace-associated asthma and rhinitis, 27 atopic individuals with similar symptoms but no occupational exposure to poultry, and 12 asymptomatic nonatopic poultry-exposed controls. Ten of the 16 atopic poultry workers had immediate wheal-and-flare reactions to NFM, as compared with two of 27 non-poultry-exposed controls (p less than 0.001). In cutaneous testing with five poultry-related antigens, the NFM was the most reactive. On skin tests, four atopic poultry workers were positive for NFM and negative for Dermatophagoides farinae; four workers were negative for NFM and positive for D. farinae. Radioallergosorbent test (RAST) showed specific IgE levels for NFM, with positive RAST scores in 60% of poultry workers having positive skin tests. A provocative bronchial test with NFM extract in a poultry worker having positive NFM skin test and RAST score resulted in an immediate 25% reduction in the FEV1 and a 62% fall in forced expiratory flow volume at 25% of vital capacity. Collectively, the established presence of NFM in the poultry workplace, associated clinical histories, positive cutaneous tests, positive specific-IgE assays, and positive bronchial challenge combine to establish a role for NFM in occupational allergic respiratory disease of poultry farmers.