Absolute lymphocytosis associated with nonsurgical trauma.

Absolute lymphocytosis after nonsurgical trauma was investigated in three patient groups at an acute-care tertiary referral hospital. The first group, with mild-to-moderate trauma, consisted of 64 patients who survived knife wounds to the chest and abdomen. Thirteen of the 64 patients had admission lymphocyte counts greater than 5.0 X 10(9)/L (mean +/- SD: 6.0 X 10(9) +/- 2.4 X 10(9]. Within 24 hours, all 13 showed a significant drop in lymphocyte count to 1.9 X 10(9) +/- 0.9 X 10(9)/L. The second group, with severe trauma, consisted of 11 patients admitted to the intensive care unit. Admission lymphocyte values averaged 5.9 X 10(9) +/- 0.6 X 10(9)/L and decreased to 1.54 X 10(9) +/- 0.3 X 10(9)/L within six hours. The relative importance of trauma as a cause of lymphocytosis was established by reviewing all hospitalized patients with lymphocyte counts greater than 5.0 X 10(9)/L between August 1983 and October 1985. The survey indicates that trauma and hemorrhage account for 16% of all cases of lymphocytosis, and that trauma, together with other acute stresses, constitutes the most common cause of lymphocytosis studied. The authors conclude that trauma is frequently associated with a lymphocytosis that usually changes to a lymphopenia within hours of injury.

Review of University of British Columbia Family Practice Resident Research Projects 1990-1997.

BACKGROUND: Resident research projects can be an important component of building a strong and diversified research presence in family medicine. One of the requirements for graduation from the University of British Columbia (UBC) Family Practice Residency Program is that family practice residents complete a scholarly piece of work. METHODS: UBC family practice resident projects from 1990-1997 were reviewed and classified by methodology. A survey was sent to 251 former residents to determine 1) if their project was published, 2) if not, was there any interest in publication, and 3) what were the main reasons for not pursuing publication. Fifteen projects were selected as suitable for publication and were, with permission of the resident, submitted to medical journals. RESULTS: Sixty-nine percent of the resident projects involved data collection and hypothesis testing, and 40% were cross-sectional, of which patient surveys were the most common method. A total of 190 former residents (71%) have responded to our survey. Seven percent of respondents stated that their project had been published, and 55% would have liked to have tried to publish their project. Of the 15 resident projects we submitted for publication, seven were accepted. CONCLUSIONS: Family practice residents are capable of producing a wide variety of research projects. Only a minority of projects are being published despite the fact that the majority of residents are interested in pursuing publication. Greater assistance by faculty can increase publication of research projects.

Differences in diabetic co-morbidity between Aboriginal and non-Aboriginal people living in Bella Coola, Canada.

OBJECTIVES: (1) To identify which medical disorders are significantly associated with being a diabetic in the setting of an isolated, rural community; and (2) to determine if there are differences between Aboriginal and non-Aboriginal diabetics. DESIGN: population based retrospective chart review. STUDY POPULATION: people living in the Bella Coola Valley, Canada, and having a chart at the Bella Coola Medical Clinic as at September 2001. MAIN OUTCOME MEASURES: known diabetes related co-morbidity (retinopathy, nephropathy, coronary artery disease, peripheral vascular disease, neuropathy). RESULTS: There were 126 adult (>18 years old) diabetics living in the Bella Coola Valley. Prevalence rates for history of alcohol issues, retinopathy, coronary artery disease, cerebrovascular disease, peripheral vascular disease, peripheral neuropathy, hypertension, hypercholesterolemia, and nephropathy were 44%, 14%, 19%, 8%, 7%, 10%, 54%, 47%, and 7% respectively. For the 1597 non-diabetics living in the Bella Coola Valley, respective prevalence rates for these same co-morbidities were 20%, 0.3%, 2%, 1.5%, 1%, 1%, 10%, 6%, and 0.6%. The study did not demonstrate that Aboriginal people living in the Bella Coola Valley have an increased prevalence of diabetes associated co-morbidities over and above that found in the non-Aboriginal diabetic population. This was despite the fact the smoking rate was higher in the Aboriginal population. CONCLUSIONS: The development of diabetes in both Aboriginal and non-Aboriginal people living in the Bella Coola Valley was clearly associated with the presence of multiple co-morbidities, including hypertension, hypercholesterolemia, coronary artery disease, cerebrovascular disease, and neuropathy. Rates of diabetes associated co-morbidities were similar for both Aboriginal and non-Aboriginal diabetic populations. The authors speculate that a diet rich in fish oils (omega-3 fatty acids) accounted for the lower than expected rates of cardiovascular disease among this Aboriginal population.

The prevalence of overweight adults living in a rural and remote community. The Bella Coola Valley.

OBJECTIVE: To determine the prevalence of overweight adults living in the Bella Coola Valley. DESIGN: A retrospective chart review of all people attending the Bella Coola Medical Clinic, and residing in the Bella Coola Valley. MAIN OUTCOME MEASURES: Weight (killograms) and body mass index (BMI). RESULTS: More than 92% of clinic charts had a recent measurement of weight and 65% of clinic charts had height measured; accordingly, we were able to calculate the BMI on 65% of the clinic population. Over 50% of the adults residing in the Bella Coola Valley are considered overweight (BMI > 27, the Health Canada definition) and only 25% have a BMI within an acceptable range (20.0 to 24.9). Proportionately more Aboriginal people are overweight (65%) than non-Aboriginal people (47%); men and women were similarly overweight (56% and 53%, respectively); and proportionately more people were overweight with increased age. The prevalence of being overweight in people aged 65 years and older is 66%. As weight increased so did the prevalence of diabetes mellitus, hypertension, hypercholesterolemia, diverticular disease, dyspepsia/gastroesophageal reflux disease (GERD), alcohol issues, asthma, depression, coronary artery disease, and eczematous dermatitis. There was no relationship between increasing weight and atrial fibrillation, cerebrovascular disease, inflammatory arthritis, hypothyroidism, chronic back/neck pain, peripheral vascular disease, chronic obstructive lung disease, congestive heart failure, and cancer. CONCLUSION: Living in a remote community does not protect against obesity and the complications of obesity. Obesity is present in a greater proportion of Aboriginal people. The treatment and prevention of obesity in rural populations of differing ethnicity may need to be individualized.

The relationship between self-rated health, stress, health care, overall quality of life and weight in a rural population.

OBJECTIVE: To determine if there is a relationship between self-rated health, stress, health care, satisfaction, overall quality of life scores and weight. DESIGN: A mailed survey and retrospective chart review of people living in the Bella Coola Valley who attend the Bella Coola Medical Clinic. STUDY POPULATION: Adults living in the Bella Coola Valley who are registered with the Bella Coola Medical Clinic. MAIN OUTCOME MEASURES: Self-rated health, stress, health care received, satisfaction with health, happiness, overall quality of life scores and weight (body mass index). RESULTS: An estimated 1734 residents live in the Bella Coola and are registered with the clinic. A total of 968 useable surveys were returned for a response rate of 56% (968/1734). Nine hundred and eighteen survey respondents had a recent weight in kilograms documented; 803 survey respondents had a height documented. A higher weight was associated with poorer self-rated health, higher stress levels, and lower satisfaction with health. It was also associated with lower self-esteem and satisfaction scores, particularly in younger obese people. A higher weight was not correlated with spirituality, overall quality of life, health care rating, or happiness scores. CONCLUSION: Increasing weight may contribute to poorer health, higher stress, lower satisfaction with health and poorer self-esteem. However, we found no evidence that increased weight impairs happiness or overall quality of life. This may be one reason for the lack of success of weight loss strategies that focus on happiness and overall quality of life to increase readiness and motivation. Alternatively, focussing on secondary medical benefits and self-esteem may be useful.

The role of the polymorphonuclear leukocyte in the pathogenesis of the adult respiratory distress syndrome.

A major nonrespiratory function of the mammalian lung is that of a polymorphonuclear leukocyte reservoir. Within this reservoir, granulocytes are distributed between marginating and circulating pools. Under normal conditions these cells release little, if any, toxic metabolites. Situations which facilitate chemotactic release, activation of complement, or prolonged lowering of pulmonary blood flow lead to sequestration of large numbers of polymorphonuclear leukocytes in the lungs. If these polymorphonuclear leukocytes are then stimulated to release toxic oxygen species, proteases or other metabolites, existing defense mechanisms are overwhelmed and lung injury results. Anaphylatoxins generated by complement activation, humoral factors released from platelets or macrophages, and activation of the kallikrein-kinin and coagulation systems, may exacerbate damage to the alveolar-capillary membrane. Permeability of this membrane increases, there is interstitial and then alveolar edema, with subsequent pulmonary dysfunction. While there is little doubt that this scenario holds true for some experimental models of acute lung injury, its applicability to adult respiratory distress syndrome is still controversial. Nevertheless, adult respiratory distress syndrome does arise under conditions facilitating chemotactic factor release from macrophages (e.g. hyperoxia), in situations where widespread activation of complement occurs (e.g. sepsis, trauma, microemboli), and in shock conditions where pulmonary blood flow is often lowered. Correlations exist between adult respiratory distress syndrome and activation of complement, acute neutropenia, sequestration of polymorphonuclear leukocytes and enhanced functional and metabolic activity of granulocytes. Although these findings suggest that polymorphonuclear leukocytes are an important factor in the pathogenesis of adult respiratory distress syndrome, its precise role remains to be determined.

Effect of Devil's Club Tea on Blood Glucose Levels in Diabetes Mellitus.

Devil's club (Oplopanax horridum) is a popular medicinal plant used by Native Indian tribes in the Pacific Northwest. One reported indication for using this plant is in the treatment of diabetes mellitus. Several physicians have reported patients with diabetes who were able to maintain normal blood glucose levels while taking devil's club preparations. The authors performed a pilot study in which blood glucose levels were carefully monitored in an insulin-dependent diabetic patient, a newly diagnosed non-insulin-dependent diabetic, and two healthy adults while they drank devil's club tea. The limited data do not show any hypoglycemic effect of devil's club tea.

Mental health, job satisfaction, and intention to relocate. Opinions of physicians in rural British Columbia.

OBJECTIVE: To determine the prevalence of depression and burnout among family physicians working in British Columbia's Northern and Isolation Allowance communities. Current level of satisfaction with work and intention to move were also investigated. DESIGN: Cross-sectional, mailed survey. SETTING: Family practices in rural communities eligible for British Columbia's Northern and Isolation Allowance. PARTICIPANTS: A random sample of family physicians practising in rural BC communities. Initial response rate was 66% (131/198 surveys returned); excluding physicians on leave and in temporary situations and those who received duplicate mailings gave a corrected response rate of 92% (131/142 surveys returned). MAIN OUTCOME MEASURES: Demographics; self-reported depression and burnout; Beck Depression Inventory and Maslach Burnout Inventory scores; job satisfaction; and intention to leave. RESULTS: Self-reported depression rate was 29%; the Beck Depression Inventory indicated 31% of physicians suffered from mild to severe depression. About 13% of physicians reported taking antidepressants in the past 5 years. Self-reported burnout rate was 55%; the Maslach Burnout Inventory showed that 80% of physicians suffered from moderate-to-severe emotional exhaustion, 61% suffered from moderate-to-severe depersonalization, and 44% had moderate-to-low feelings of personal accomplishment. Depression scores correlated with emotional exhaustion scores. More than half the respondents were considering relocation. CONCLUSION: Physicians working in these communities suffer from high levels of depression and very high levels of burnout and are dissatisfied with their current jobs. More than half are considering relocating. Intention to move is strongly associated with poor mental health.

Transient leucopenia associated with adult respiratory distress syndrome.

The hypothesis that a change in white blood cell (WBC) count might be a useful predictor of the onset of adult respiratory distress syndrome (ARDS) was tested by monitoring total and differential WBC count in 40 patients at high risk of ARDS. ARDS developed in 10 patients and in 8 of these the systemic leucocyte count fell to less than 4200 cells/microliter. The other 2 patients showed a fall from 25 400 and 15 000 cells/microliter to 4500 and 6000 cells/microliter, respectively. Only 4 of the 30 patients in whom ARDS did not develop showed a fall to less than 4200 cells/microliter. The acute fall in WBC that was associated with the onset of severe respiratory failure indicates that frequent measurement of the leucocyte count in high-risk patients may be useful in identifying those in whom ARDS will develop.

Effect of pulmonary blood flow on leukocyte uptake and release by dog lung.

The effect of pulmonary blood flow on leukocyte uptake and release by the lung was examined in 10 anesthetized spontaneously breathing dogs. Pulmonary arterial and pulmonary venous blood was sampled with catheters placed into the right ventricle and aorta, respectively. Pulmonary blood flow was lowered by inflating a balloon catheter located in the inferior vena cava. In five experiments simultaneous blood samples were drawn from the right ventricle and aorta at 10-s intervals during a control period, a 2- to 3-min period of low flow, and a recovery period. In five additional experiments, less frequent samples were taken over periods of 15-60 min. Total leukocyte concentrations and differential counts were determined for each blood sample. The study shows that large numbers of leukocytes become sequestered within the lung when pulmonary blood flow is low and that an equivalent number of cells are released from the lung after deflation of the balloon catheter. Both the polymorphonuclear leukocytes and the lymphocytes were taken up by the lung when pulmonary blood flow was reduced. We conclude that pulmonary blood flow has a marked effect on the uptake and release of leukocytes by the dog lung.