Hospital-associated transmission of Brucella melitensis outside the laboratory.

Brucella melitensis was identified in an aspirate obtained from a patient's hip joint during a procedure at a hospital in Canada. We conducted an investigation into possible exposures among hospital workers; 1 worker who assisted with the procedure tested positive for B. melitensis. Aerosol-generating procedures performed outside the laboratory may facilitate transmission of this bacterium.

A systematic review of contact dermatitis treatment and prevention.

BACKGROUND: Contact dermatitis (CD) is a common occupational disease. There have been no systematic reviews of CD treatment or prevention. METHODS: Multiple databases were systematically searched. Using independent double review and published quality review criteria, articles were rated as good, fair, or poor. Treatment benefit data were tabulated and conclusions were based on the rated strength of published evidence. RESULTS: In all, 49 studies met inclusion criteria. Barrier creams containing dimethicone or perfluoropolyethers, cotton liners, and softened fabrics prevent irritant CD. Lipid-rich moisturizers both prevent and treat irritant CD. Topical skin protectant and quaternium 18 bentonite (organoclay) prevent rhus dermatitis. Diethylenetriamine pentaacetic acid (chelator) cream prevents nickel, chrome, and copper dermatitis. Potent or moderately potent steroids effectively treat allergic CD. There were no macrolide immunomodulator trials that met inclusion criteria. This review did not include studies of children, animals, or non-English language publications. CONCLUSIONS: A limited number of interventions effectively prevent or treat irritant and allergic CD, but well-controlled, outcome-blinded studies, particularly in the area of allergic CD prevention are needed.

Hydrofluoric acid burn: a case report.

A case of occupational hydrofluoric acid exposure is presented, accentuating the importance of eliciting an occupational history during the initial emergency department evaluation. Patients who present with major hydrofluoric acid burns are at risk for systemic complications, including potentially fatal hypocalcemia. Information regarding the accident and workplace circumstances may well allow the physician to anticipate the exposed patient's course. These patients should be considered occupational index cases that will require follow up by government occupational health services. Identification of potential hazards, risk assessment and enforcement of recommendations for change (such as engineering controls, personal protective equipment, education) may be key to preventing similar injuries in the future.

Managing environmental sensitivity: an overview illustrated with a case report.

While the adverse impact of certain environmental agents is well established and affect individuals in a predictable dose-dependent manner, the validity of some exposure syndromes, such as environmental sensitivity, attributed to the influence of environmental chemicals in low, usually harmless doses, is less certain. Diagnosis of environmental sensitivity is subjective, and both standard medical and complementary and alternative treatment often fails to provide clinically meaningful functional gains. Existing evidence suggests that in many individuals with these syndromes, psychosocial factors play a prominent role. In this article we present an approach to managing patients presenting with sensitivities to environmental agents that includes identifying and managing organic disease, obtaining a thorough biopsychosocial history, confirming a diagnosis, and developing a rehabilitative process that focuses on support and improvements in function. A case of multiple chemical sensitivity illustrates this approach.