Fatal hydrogen sulphide poisoning in unconfined spaces.

Fatal hydrogen sulphide poisoning usually occurs in confined spaces. We report two fatal accidents in unconfined spaces. The first accident caused the death of three workers who entered an unconfined room in a silo of sludge at the same time that a truck dumped several tons of sludge from water purification stations. The hydrogen sulphide that had accumulated inside the silo spilled out into the interior of the room due to a 'splashing effect' caused by the impact of the dumped sludge. The second accident occurred when the foreman of a wastewater treatment plant entered one of the substations to perform routine checks and suddenly lost consciousness. Although he was rapidly transferred to an intensive care unit, death occurred a few hours later. Hydrogen sulphide production was, in this case, due to an 'embolism effect' produced by the displacement of wastewater when the substation pumps were activated. We suggest ways in which accidents such as these caused by sudden release of hydrogen sulphide can be prevented.

Palaeogenetic evidence supports a dual model of Neolithic spreading into Europe.

The peopling of Europe is a complex process. One of the most dramatic demographic events, the Neolithic agricultural revolution, took place in the Near East roughly 10000 years ago and then spread through the European continent. Nevertheless, the nature of this process (either cultural or demographic) is still a matter of debate among scientists. We have retrieved HVRI mitochondrial DNA sequences from 11 Neolithic remains from Granollers (Catalonia, northeast Spain) dated to 5500 years BP. We followed the proposed authenticity criteria, and we were also able, for the first time, to track down the pre-laboratory-derived contaminant sequences and consequently eliminate them from the generated cloning dataset. Phylogeographic analysis shows that the haplogroup composition of the Neolithic population is very similar to that found in modern populations from the Iberian Peninsula, suggesting a long-time genetic continuity, at least since Neolithic times. This result contrasts with that recently found in a Neolithic population from Central Europe and, therefore, raises new questions on the heterogeneity of the Neolithic dispersals into Europe. We propose here a dual model of Neolithic spread: acculturation in Central Europe and demic diffusion in southern Europe.

A patient with cyclic neutropenia complicated by severe persistent neutropenia successfully delivered a healthy baby.

We describe a 24-year-old pregnant woman complicated by cyclic neutropenia (CN), who was successfully treated with granulocyte-colony stimulating factor (G-CSF). Her white blood cell (WBC) and neutrophil count fluctuated from 2,600 to 4,600/microl, and 26 to 2,530/microl, respectively. The peak neutrophil count gradually decreased as pregnancy advanced, resulting in the disappearance of its cyclicity. At 39 weeks of pregnancy when the neutrophil count became 84/microl, the patient was started on G-CSF and her neutrophil count increased to 1,550/microl on the fourth day after delivery. She delivered a healthy baby without any complications at 39 weeks of pregnancy.

[Drug interactions in chronic prescription]. / Interacciones farmacológicas en la prescripción crónica.

OBJECTIVE: Application of computerized program for detection of potential drug interactions (PDI) in chronic prescriptions in four primary care centers. To evaluate the clinical significance of PDI identified according to clinical criterions. DESIGN: An observational crossover study. SETTING: Clutat Vella health district (City of Barcelona). MEASUREMENTS AND RESULTS: Using information of Consejo General de Colegios Oficiales de Farmaceuticos databases and the chronic prescriptions database of the primary care centers, computerized drug-interaction system have been developed for detection of PDI in patients. A panel of primary care physicians and clinical pharmacists developed criteria that were used to evaluate the clinical significance of PDI. 9840 Cards of Authorized Prescription (CAP) were analyzed, 36108 medicaments and 42877 drugs. A total of 2140 patients were involved for a total of 3406 PDI, 21.75% of patients with CAP. Clinical signification for the panel was found in 40.07% of these 3406 PIF; 3.78% were suggest to avoid the association drugs. CONCLUSIONS: The incidence of PDI with clinical signification are lower than other studies of the literature; it suggest a appropriate knowledge of drug prescription. The application of computerized program make much more easy the detection of adverse drug interactions in chronic prescription.

The long-term outcome of ulcerative colitis treated with 6-mercaptopurine.

OBJECTIVES: To determine the long term outcome of ulcerative colitis in patients treated with 6-MP. METHODS: The charts of 105 chronic refractory ulcerative colitis patients treated with 6-MP from 1973-1992 were reviewed. The focus was placed on clinical response, subsequent breakthrough while maintaining 6-MP, and relapse rates when 6-MP was discontinued. RESULTS: Complete clinical remission was achieved in 68 patients (65%), partial remission was achieved in 25 patients (24%), and 12 patients (11%) failed to achieve remission. Of complete responders who continued 6-MP, 35% had a breakthrough, although complete remission was restored in 88% with the majority not requiring systemic steroids. Of complete responders who discontinued 6-MP, 87% subsequently relapsed. There were few major toxicities associated with 6-MP use. CONCLUSION: 6-MP is a reasonably safe and effective treatment for refractory ulcerative colitis. Patients who discontinue 6-MP after successful treatment have high relapse rates, therefore, 6-MP must be maintained long term to sustain remission.

[Left ventricular hypertrophy in a general hypertensive population in Barcelona]. / Hipertrofia ventricular izquierda en una población hipertensa general de Barcelona.

BACKGROUND: Left ventricular hypertrophy (LVH) is a well known cardiac risk factor. There are no data available as to the epidemiology of this disease in the general hypertensive population in Spain. METHODS: A randomized sample (n = 267) of a general hypertensive population under the age of 80 years was followed in a Basic Health Care Area located in the center of Barcelona, Spain. A Doppler-echocardiographic study of the patients was carried out. The patients were considered to have LVH when they demonstrated an index > 134 g/m2 of left ventricular mass in males and > 110 g/m2 in females. The odds ratio (OR) was estimated on presentation of LVH associated with exposure to different factors. RESULTS: A prevalence of LVH diagnosed by echocardiogram was observed in 64% (confidence interval 95% from 58.3 to 69.8%). The independent risk factors associated with the presence of LVH were female sex, age and systolic blood pressure. CONCLUSIONS: Left ventricular hypertrophy is a frequent cardiovascular risk factor in the general hypertensive population in Spain. A systematic search by echocardiography cannot be recommended in primary health care until cost-effectiveness studies have been performed.

[Morbidity among African immigrant population attended at a health center]. / Morbilidad atendida de la población inmigrante africana en un centro de salud.

OBJECTIVE: To deepen the demographic study of the immigrant population from West Africa who regularly sought health-care at our Health Centre and to analyse their morbidity. DESIGN: A retrospective observation study of a crossover type. SETTING: Salt Basic Health Area, in the Girona Health Region. PATIENTS: The black population originating in West Africa and resident in Salt, whose clinical notes were in the Centre's records. RESULTS: The 57 people registered attended 436 times, of which 289 were for the Paediatric Clinics. Of these 289, 40% were handled by the paediatric nurses. The average frequency of visit by age ranged from 2 attendances a year (20-29 years old) to 14 per year (under 14 years old). In 25.95% of the consultations involving paediatric teams and in 19.05% of those involving adults, no medical diagnosis was made. The most common paediatric diagnoses were, following the CIPSAP-2-WONCA classification: Supplementary Classification (25.95%) and Pathology of the Respiratory System (20.07%). Among adults, Pathologies of the Digestive System (21.77%) and Infectious and Parasite Diseases (12.93%) were the two most common illnesses. Additional tests to assist diagnosis or a simple preventive screening were rarely requested. CONCLUSIONS: Tackling the problems of the black-african population at the Primary Care level is limited by lack of knowledge of tropical diseases, the scant specific bibliography available, linguistic and cultural barriers and the lack of institutional delivery of health-care to the clandestine population. Alternatives are proposed, such as: an operating procedure, and interdisciplinary socio-sanitary programme.

[Smoking habits in nursing students: prevalence, attitudes and knowledge]. / El tabaquismo en los estudiantes de enfermería: prevalencia, actitudes y conocimientos.

The purpose of this study has been to evaluate the prevalence of smoking habit, knowledge on the adverse health effects and attitudes towards it among nurses students in their three years of study (University School of Girona). A self-administrated questionnaire was used. A total of 135 questionnaires were answered (88%) from an estimated available population of 154 students (94% females with 21 years old of mean age). The prevalence of current smoking was 34.3%; ex smokers 23.3% and non smokers 42.5%. The mean of tobacco consumption was 367.6 cigarettes/month. 92% no smokers, 91% ex smokers and 76% smokers thought that smoking has adverse health effects (p less than 0.001). They consider the health protection like the first reason to give up smoking. 38% will advise their healthy smokers patients about the risk of their habit. We conclude: 1.-Low prevalence of smoking habit; 2.-Nurses should know methods aimed at lowering smoking rates, assuming that they have determined influence on the population behavior.

[Hypertrophic osteopathy and acropachy associated with noncirrhotic alcoholic liver disease. Apropos a case]. / Osteoartropatía hipertrófica y acropaquia asociados a enfermedad hepática alcohólica no cirrótica. A propósito de un caso.

Hypertrophic osteoarthropathy (HOA) may be an idiopathic condition or may be secondary to other diseases, the most common of which is bronchogenic carcinoma. Among non neoplastic etiologies, it is commonly associated with chronic liver disease, usually cirrhosis and chronic active hepatitis. The concomitant occurrence of HOA and hepatic steatosis is another association that has recently been reported. We report here a 70-year-old male with periostitis, clubbing of the fingers and alcoholic hepatitis stenosis. We emphasize the need to perform observational studies to validate this association.

[Arterial hypertension in the Baix Ebre region (Tarragona)]. / La hipertensión arterial en la comarca del Baix Ebre (Tarragona).

The results of a cross-sectional study for the evaluation of the prevalence of hypertension in the Baix Ebre region (Tarragona) are reported. 628 individuals from a randomly selected sample of 670 gave their consent to participate. The study was based on interview and examination at the patients home after getting an appointment by post. The prevalence of hypertension was 31.84 +/- 3.64%, and that of borderline hypertension 16.56 +/- 2.97%. Only 57% of hypertensives were previously known as such, and only 18.5% of these were being correctly treated. There was a significant association of hypertension with age (basically systolic blood pressure for women); also with alcohol intake, obesity and family history of hypertension or cardiovascular disease. There was no significant correlation with sex, residence in rural or urban areas, emigration, marital status, occupational status, social and professional level, education, or with the coexistence of hypertension in the spouse. The high prevalence of hypertension was a remarkable finding, consistent with its recognized importance as a first rate health problem.