Late introduction of fish and eggs is associated with increased risk of allergy development - results from the FARMFLORA birth cohort.

The prevalence of allergy is markedly low in children growing up on farms. An increasing number of studies indicate that the timing of food introduction may affect allergy development. We aimed to investigate if protection against allergy in farm environments may be mediated through differences in food-introduction practices between farm and non-farm families, using an explorative approach. Twenty-eight farm and 37 non-farm children were included in the FARMFLORA birth cohort. Practices of breastfeeding and introduction of formulas and complementary foods were collected by questionnaires at 6, 12, and 18 months of age. Allergy was diagnosed by pediatricians at 3 years of age. The only difference in food-introduction practices observed between farm and non-farm children was an earlier introduction of nuts in farmers (median month: 11 [IQR: 8-6] in farmers, 15 [12-19] in non-farmers). One farm child (4%) and 10 non-farm children (27%) were allergic at 3 years of age. Lower risk of allergy development was associated with early exclusive breastfeeding (continuous variable; OR = 0.59, 95% CI: 0.39-0.89), but also having received eggs (OR = 0.08, 95% CI: 0.13-0.54) and fish (logistic regression not applicable, P = 0.01 in likelihood ratio testing [χ2]) at 10 months of age or earlier compared to later. Our results were not affected by reverse causation, as judged by a questionnaire sent to the families in retrospect. Timing of introduction of complementary foods is unlikely to contribute to the lower risk of allergy among farm children. Although early exclusive breastfeeding was associated with a lower rate of allergy development, postponed introduction of complementary foods might increase the risk of developing allergy. Owing to the limited sample size, our results are only indicative, but support prior findings.

Urbanization impact on sulfur content of groundwater revealed by the study of urban speleothem-like deposits: Case study in Paris, France.

Speleothem-like deposits that develop underground in urban areas are an archive of the environmental impact of anthropic activities that has been little studied so far. In this paper, the sulfate content in shallow groundwater from northern Paris (France) is compared with the sulfur content in two 300-year-old urban carbonate deposits that grew in a historical underground aqueduct. The present-day waters of the aqueduct have very high sulfur and calcium contents, suggesting pollution from gypsum dissolution. However, geological gypsum levels are located below the water table. Sulfur content was measured by micro-X-ray fluorescence in these very S-rich carbonate deposits (0.5 to 1% of S). A twofold S increase during the second half of the 1800s was found in both samples. These dates correspond to two major periods of urbanization above the site. We discus three possible S sources: anthropic sources (industries, fertilizers…), volcanic eruptions and input within the water through gypsum brought for urbanization above the studied site (backfill with quarry waste) since the middle of the 19th century. For the younger second half of the studied section, S input from gypsum brought during urbanization was confirmed by the study of isotopic sulfur composition (δ34S=+15.2‰ at the top). For the oldest part, several sulfur peaks could be related to early industrial activity in Paris, that caused high local air pollution, as reported in historical archives but also to historical gypsum extraction. This study provides information on the origin and timing of the very high SO42- levels measured nowadays within the shallow groundwater, thus demonstrating the interest in using carbonate deposits in urban areas as a proxy for the history of urbanization or human activities and their impact on water bodies.

Proarrhythmic Effects Of Antiarrhythmic Drugs: Case Study Of Flecainide Induced Ventricular Arrhythmias During Treatment Of Atrial Fibrillation.

PURPOSE: Flecainide is a class 1C antiarrhythmic drug especially used for the management of supraventricular arrhythmia. Flecainide also has a recognized proarrhythmic effect in patients treated for ventricular tachycardia. It is used to treat a variety of cardiac arrhythmias including paroxysmal atrial fibrillation, paroxysmal supraventricular tachycardia and ventricular tachycardia. Flecainide has local anesthetic effects and belongs to the class 1C AADs that block sodium channels, thereby slowing conduction through the heart. It selectively increases anterograde and retrograde accessory pathway refractoriness. The action of flecainide in the heart prolongs the PR interval and widens the QRS complex. The proarrhythmic effects however noted are not widely reported. METHOD: We report a case of paroxysmal atrial fibrillation with structurally normal heart who was treated with oral Flecainide. There were no adverse events and no QTc prolongation was noted on ECG. Despite subjective improvement a repeat Holter detected him to have multiple short non sustained ventricular arrhythmias. RESULTS: Development of ventricular arrhythmias, salvos and non-sustained ventricular tachycardia after a month of initiation of oral flecainide detected by 24 hours ECG Holter lead to discontinuation of flecainide and subsequent early electrophysiological studies and successful ablation. CONCLUSION: Initiation of oral Flecainide in a case of atrial fibrillation with subjective improvement and regular ECG monitoring, no QTc prolongation can still lead to development of dangerous ventricular arrhythmias. A cautious approach and thorough investigations and follow up are recommended.

Remanence of lead pollution in an urban river system: a multi-scale temporal and spatial study in the Seine River basin, France.

Total lead (Pb) concentration and Pb isotopic ratio ((206)Pb/(20)7Pb) were determined in 140 samples from the Seine River basin (France), covering a period of time from 1945 to 2011 and including bed sediments (bulk and size fractionated samples), suspended particulate matter (SPM), sediment cores, and combined sewer overflow (CSO) particulate matter to constrain the spatial and temporal variability of the lead sources at the scale of the contaminated Seine River basin. A focus on the Orge River subcatchment, which exhibits a contrasted land-use pattern, allows documenting the relation between hydrodynamics, urbanization, and contamination sources. The study reveals that the Pb contamination due to leaded gasoline that peaked in the 1980s has a very limited impact in the river nowadays. In the upstream Seine River, the isotopic ratio analysis suggests a pervasive contamination which origin (coal combustion and/or gasoline lead) should be clarified. The current SPM contamination trend follows the urbanization/industrialization spatial trend. Downstream of Paris, the lead from historical use originating from the Rio Tinto mine, Spain ((206)Pb/(207)Pb=1.1634 ± 0.0001) is the major Pb source. The analysis of the bed sediments (bulk and grain size fractionated) highlights the diversity of the anthropogenic lead sources in relation with the diversity of the human activities that occurred in this basin over the years. The "urban" source, defined by waste waters including the CSO samples ((206)Pb/(207)Pb=1.157 ± 0.003), results of a thorough mixing of leaded gasoline with "historical" lead over the years. Finally, a contamination mixing scheme related to hydrodynamics is proposed.

No-patch 23-gauge vitrectomy under topical anesthesia: a pilot study.

A pilot study was designed to evaluate the safety and efficacy of 23-gauge vitrectomy under topical anesthesia. Five eyes of five patients underwent 23-gauge sutureless vitrectomy under topical anesthesia with a pledget soaked in 0.5% proparacaine hydrochloride anesthetic, for vitreous hemorrhage (four eyes), epiretinal membrane (one eye). Subjective pain and discomfort were graded using a visual analogue chart from 0 (no pain or discomfort) to 4 (severe pain and discomfort). At the end of surgery no patch was applied and patients were given dark glasses. Patients underwent an immediate postoperative assessment, followed by next day and one week postoperative evaluation. Four patients had Grade 0 pain during the surgery. One patient had Grade 1 pain during the placement and withdrawal of the micro cannulas. The surgical outcomes were favorable. 23-gauge vitrectomy under topical anesthesia is safe and effective in selected cases. Further study is recommended to validate the outcome of this study.

The state of the unions in the clinical laboratory. Part I. A disenchanted profession asks: are unions the answer?

Apprehension and lack of knowledge characterize laboratorians' impressions of unionization. While some remain adamantly opposed, others reluctantly say unions might cure current ills.

The state of unions in the clinical laboratory. Part II. Impassioned stares at a crystal ball.

Will unions become more prevalent in the lab? In fact, should they? Readers offer predictions, assessments, and a multitude of strong opinions.

AIDS precautions in practice.

Are labs taking appropriate measures to prevent HIV transmission? MLO's national survey indicates that efforts are admirable overall, although follow-up can be inconsistent.

A longitudinal study of pulmonary function in cotton gin workers in the San Joaquin Valley.

In a previous study we found no significant effects of acute exposure to the cotton gin environment on FEV1 in San Joaquin Valley gin workers compared with concurrent control subjects, nor was there an excess of obstructive lung disease among the same gin workers. The present study looked at the mean annual decline in FEV1, FEV1/FVC, and FEF25-75% in San Joaquin Valley cotton gin workers vs concurrent control subjects over four years. The FEV1 of gin workers completing all four years of the study declined 27.3 ml vs 35.5 ml in control subjects (p = 0.37); FEV1/FVC declined 0.21 percent in gin workers and 0.23 percent in control subjects (p = 0.86); FEF25-75% declined 0.058 L/s in gin workers and 0.066 L/s in control subjects (p = 0.68). Also, the mean annual rate of change of FEV1 was less among the gin workers who did not complete all four years than the gin workers completing all four years. The presence of "byssinosis" symptoms did not significantly influence the results. This prospective, longitudinal study failed to find any detrimental effect of the cotton gin environment on the rate of decline of FEV1, FEV1/FVC, and FEF25-75%. This result was independent of "byssinosis" symptoms and the effect of "dropouts."

Study of respiratory effect of short- and long-term cotton gin exposure.

No excess of obstructive airway disease was found in a group of 265 cotton gin workers when compared with other San Joaquin Valley agricultural workers. After an average of eight weeks' employment in San Joaquin Valley cotton gins, 125 workers showed no appreciable deterioration of pulmonary function compared with pre-employment measurements. In studies of pulmonary function during a workshift, cotton gin workers showed slightly greater mean decrements than control agricultural workers. These differences did not reach a level of statistical significance and were lower than those usually found in byssinosis. The unusual temporal pattern of employment in cotton gins in California precludes a simple approach to diagnosis by symptoms. No correlation was found in this study between symptoms of byssinosis and objective decrements in FEV1. The questionnaire as proposed by the Cotton Dust Standard was found to be of no value in detecting reactors in this study of gin workers.

Silicate pneumoconiosis of farm workers.

Abnormal numbers of birefringent particles have been found in the lungs of seven patients (five vineyard workers, one farmer, and one rural resident) in association with a spectrum of early to late interstitial inflammation and fibrosis. Nodular granulomas of the type seen in silicosis were absent. Scanning electron microscopy and energy dispersive x-ray analysis of 177 individual particles (less than 5 micrometer.) in situ in the lungs of four of the patients showed mostly silicates (notably aluminum, silicon, and potassium), with 5 to 10 per cent silicon dioxide. An analysis of particles less than 5 micrometer. from both vineyard and non-vineyard soil showed lung and soil particles to have a similar composition. The presence of large amounts of silicates in the lung tissues, in association with chronic inflammation and fibrosis, implicates the silicates in the causation of the fibrosis. The silicate deposits may, in large part, be a marker, reflecting a mixture of toxic soil additives or pesticides found in commercial clay silicate products or in dusts from the soil itself. The findings do not exclude lung pathology of a similar nature in regions outside of the farm.

Prevalence of respiratory disease in a cotton compress and warehouse. A preliminary survey.

A preliminary survey was undertaken to explore the relationship of respiratory symptoms and disease to work in a cotton compress and warehouse operation. A respiratory history was obtained from all 70 employees in a single cotton compress and warehouse complex. Sixteen of 70 employees (23%) had respiratory symptoms but none were typical of byssinosis. Fifteen of the 16 employees with positive respiratory symptoms were further studied by objective pulmonary function tests. Five of these 15 workers had abnormal results: one with an FEV1 decrement greater that 5% only, one with a ratio of FEV1, to FVC less than 70% only, and two with both abnormalities. One additional employee had an FEV1 of 73% predicted as his only abnormality.