Work-relatedness of lateral epicondylitis: Systematic review including meta-analysis and GRADE work-relatedness of lateral epicondylitis.

BACKGROUND: Lateral epicondylitis (LE) is a highly prevalent musculoskeletal disorder in workers, often associated with physically demanding work. Knowledge of work-relatedness of LE is crucial to develop appropriate preventive measures. This study investigates the prospective association between work-related physical risk factors and LE. METHODS: A systematic literature review was conducted in MedLine using PubMed from January 1, 2010 until February 16, 2021. Published reports were included if: (1) LE was clinically assessed, (2) exposure to work-related physical risk factors was assessed, and (3) associations between LE and work-related physical risk factors were reported in prospective studies. Quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation. RESULTS: In total, 318 workers with LE from a population of 5036 workers in five studies were included. Meta-analyses revealed high-quality evidence for associations between LE and a Strain Index (SI) score >5.1 (odds ratio [OR]: 1.75, 95% confidence interval (CI): 1.11-2.78) and moderate-quality evidence for forearm rotation >4 h/day or forearm rotation ≥45° for ≥45% time (OR: 1.85, 95% CI: 1.10-3.10). Gripping, flexion and extension of the wrist, and repetitive movements showed no significant associations with LE. CONCLUSION: High-quality evidence was found indicating that a higher SI increased the risk of LE. Moderate-quality evidence was found for an association between forearm rotation and LE. No associations were found between other physical risk factors and LE. Primary preventive interventions should focus on a reduction of the SI and of high forearm rotation in work.

[Do cognitive deficits in depressive disorders remit?]. / Remittieren kognitive Defizite bei depressiven Störungen?

OBJECTIVE: The importance of cognitive deficits concerning schizophrenics is well-known. Much less material of that kind has been collected from patients with affective disorders, which was the aim of this clinical study. METHODS: Inclusion criterions were in- and outpatients with affective disorders (ICD-10: F31-F33) aged < 61. The clinical status was determined by use of the HAMD-21, the subjects were examined by means of standardised computerised cognitive performance tests (CGT-[M], DAUF). The results were correlated with the HAMD and the psychiatric pharmacotherapy. RESULTS: In each of the three subtests the heavily depressive group (HAMD > 24, n = 14) came off significantly (Mann-Whitney-U-Test, p < 0.05) worse than the remitted group (HAMD < or = 8, n = 18) while 8 of the 18 remitted patients showed pathological results in the CGT-(M). Only patients who took tranquilizers performed significantly worse than patients without such medication (p < 0.05). CONCLUSION: In some cases of affective disorders, a "cognitive residual syndrome" persists which is rather part of the disease than pharmacotherapy-associated.

[Perinatal herpes infection. Clinical aspects--therapy--follow-up]. / Die perinatale Herpesinfektion. Klinik--Therapie--Verlauf.

Herpes simplex virus may cause serious infections in neonates. In case of foetal infection in the first trimenon, abortions, stillbirth, prematurity, intrauterine growth retardation (not obligatory) and various malformations may result. Neonatal HSV infection is mostly the consequence of intrapartum virus acquisition during passage through the birth canal. The infection is mostly localised on the skin, at the eyes or the mouth or disseminated with or without HSV meningoencephalitis. It is difficult to establish the diagnosis, because neonatal herpes disease in the early stage is not easy to distinguish from other diseases in the newborn such as RDS, NEC or ICH. Antiviral therapy with aciclovir is the treatment of choice and seems to improve the outcome of neonatal herpes. Prognosis depends on early therapy. Treatment should be initiated in relation to clinical findings, because available diagnostic techniques do not always permit an early detection of the disease.

[Intrauterine stab injury with a knife in the head of a fetus in the 29th week of pregnancy]. / Intrauterine Messerstichverletzung des Kopfes bei einem Feten in der 29. Schwangerschaftswoche.

Penetrating head trauma in children causes uncommon and potentially life-threatening injuries. We report on a case of penetrating cranial stab wound to the right parietal region of the head to a 29-week fetus. The child was delivered by emergency Caesarian section. Neurosurgical intervention after birth was necessary. The injury caused a posthaemorrhagic hydrocephalus. Real-time ultrasound examination visualises the brain damage and the development of a hydrocephalus e vacuo.

[Effect of enalapril on heart rate, arterial blood pressure and exocrine pancreatic secretion in the alert dog]. / Wirkung von Enalapril auf Herzfrequenz, arteriellen Blutdruck und exokrine Pankreassekretion beim wachen Hund.

A changed exocrine pancreatic secretion could be a pathogenetic factor of an acute pancreatitis after administration of angiotensin-converting enzyme (ace) inhibitors. In six conscious dogs with gastric and duodenal Thomas fistulas we studied the effect of an intravenous (iv.) bolus injection of 10 mg enalaprilat, an intraduodenal (id.) bolus injection of 20 and 40 mg enalapril (e.), and 0.15 M NaCl (20 ml iv., resp., id.) on pancreatic bicarbonate- and protein output in response to secretin (20.5 pmol/kg bw/h and caerulein (29.6 pmol/kg bw/h). Arterial blood pressure and heart rate we also measured. The iv. and id. injection of enalapril(at) significantly increased heart rate by 28% after 10 mg of e. iv. [peak 101 +/- 11 beats/min, N = 6, X +/- SEM] and by 13 resp. 37% after 20 resp. 40 mg e. id. [peak 89 +/- 4, resp., 108 +/- 7 beats/min] as compared to control [peak 79 +/- 5 beats/min]. Systolic blood pressure was significantly decreased by 6% after 10 mg e. iv. [lowest value 121 +/- 2 mm Hg] and by 8% and 9% after 20 and 40 mg e. id., respectively, [lowest value 119 +/- 2, resp., 118 +/- 1 mm Hg] as compared to control [lowest value 129 +/- 1 mm Hg]. The applied enalapril(at) doses had no significant effect on hormonal stimulated pancreatic bicarbonate- and protein output. The results confirmed the well known effects of enalapril(at) on heart rate and on arterial blood pressure. Beyond that the results exposed that therapeutical doses of enalapril(at) had no significant effect on exocrine pancreatic secretion. Conclusion of this study is that a pathogenetic role of pancreatic exocrine secretion in the ace-inhibitors and the acute pancreatitis induced by ace-inhibitors is unlikely.

Public policy impacts on the generation and disposal of hazardous waste in New York State.

A number of policies adopted by the federal government and the state have been designed to promote waste reduction or influence the choice of waste disposal technologies employed by generators of hazardous waste. Graphic analysis of smoothed time series data for hazardous wastes manifested in New York State for the period between June 1982 and February 1987 suggests that some of these policies have had the intended effects. Significant shifts in manifested waste volumes are evident that coincide with the following policy interventions: (1) increased state waste-end tax rates; (2) state and federal landfill bans; (3) federal restrictions on burning hazardous wastes and waste oils for energy recovery; and (4) changes in the federal regulatory definition of hazardous waste. Other changes in waste generation and management appear to be attributable to such factors as state and regional economic conditions and changes in instate treatment and disposal facility capacity. Analysis of the management of specific waste types supports evidence from the graphic analysis that waste generators changed from land disposal to "higher" waste handling technologies in response to several policy interventions.

[The depression ward--a review of the current status]. / Depressionsstationen--Eine Ubersicht zum heutigen Stand.

New therapeutic concepts are usually developed and realised step by step. Over the past years changes occurred mainly in two ways. There is a trend to reduce the size of the psychiatric hospital as such and/or to section off certain areas by introducing specialised units. From the experience with the so called "Affective Disorder Units" or "Mood Clinics" developed the concept of a Depression Unit, first introduced in Europe for research purposes at the Psychiatric University Hospital in Basle in 1968. In Germany the first Depression Unit was established at the PLK Weissenau in 1976. Similar units followed over the years at the PLK Reichenau, Weinsberg, the BKH Günzburg, the Landesklinik Nordschwarzwald Hirsau/Calw and the Rheinische Landesklinik Bedburg-Hau, other hospitals are planning them. Existing units are described in terms of their structural organisation, staffing situation and the service they provide. The concept of the Depression Unit according to criteria laid down agreed upon in the literature is summed up, and emotional atmosphere, structural organisation, activation, and individual therapeutic measures, discussed. Advantages are mentioned such as better understanding of patients, allowing them to let go and be cared for, aimed regression, the effects of being taken along, improved communication, and a way of dealing with suicidal thoughts and depressive behavior that reduces anxiety. Disadvantages such as the danger of spoiling patients or inducing a sense of resignation both in patients and staff are discussed.

Does digoxin sensitize left ventricular mechanoreceptors?

Afferent nerve fibre activity from left ventricular mechanoreceptors was recorded in 10 anaesthetized cats before and after two intravenous injections of 15 micrograms/kg digoxin at 1 hour interval. These receptors are activated by coronary artery occlusion and induce a depressor cardiovascular reflex resulting in bradycardia and hypotension. Neither the spontaneous activity of the receptor's afferent nerve fibres nor their maximum activity during temporary coronary artery occlusion was affected by digoxin. The results show that digoxin in therapeutic doses has no sensitizing effect on left ventricular mechanoreceptors with vagal afferent fibres. The sensitization of cardiopulmonary baroreflexes by digitalis glycosides shown in previous investigations is thus more likely to be mediated by a central nervous effect of the drug.

Disturbed cortisol secretion in man: contrasting Cushing's disease and endogenous depression.

A disturbed regulation of cortisol secretion is the principal pathology of Cushing's disease and is also the most widely reported neuroendocrine dysfunction in endogenous depression. Because additional clinical signs in both diseases indicated a hypothetical common pathway, we examined 17 patients suffering from Cushing's disease, following a protocol identical to that used in depressed patients (e.g., Hamilton Rating Scale for Depression, self-rating scales, and a clinical interview). Affective disorders, frequently observed in patients with Cushing's disease, were undetectable after surgical treatment (adrenalectomy or microadenomectomy of hypercortisolism). This was an unexpected result, since we found that recovered patients were still characterized by a disturbance of glucocorticoid feedback regulation, probably acting at the hypothalamic level. Our results, as well as numerous reports from others, failed to support the hypothesis that an impaired regulation of cortisol is directly linked to depressive illness.