Silicosis and silicotuberculosis among respiratory hospital admissions: A cross-sectional survey in northern Tanzania.

Background: There is little evidence describing respiratory disease among 40.5 million small-scale miners worldwide. Objectives: To describe the prevalence and clinical characteristics of adult respiratory inpatients with silicosis and silicotuberculosis in a tertiary hospital in Tanzania that serves a small-scale mining region. Methods: In this retrospective, cross-sectional survey, patient files from admissions between 2010 and 2020 were opportunistically selected and included if a respiratory diagnosis had been made. Results: Of 223 patients with respiratory conditions, 32 (14.3%; 95% confidence interval (CI) 10.0 - 19.6) were diagnosed with silicosis and 17 (7.6%; 95% CI 4.5 - 11.9) with silicotuberculosis. Mining was the most frequent occupation in those with silicosis (n=15/32; 46.9%) and silicotuberculosis (n=15/17; 88.2%). Of those with silicosis or silicotuberculosis, 26/49 (53.1%) were aged <45 years. Conclusion: Our study suggests that silicosis and silicotuberculosis are common among male and female respiratory inpatients with occupational exposure. The study highlights the role of occupational exposures in respiratory disease in developing economies. Study synopsis: What the study adds. This retrospective, cross-sectional survey describes the prevalence of silicosis and silicotuberculosis among adult respiratory inpatients admitted to a tertiary hospital in northern Tanzania. It is the first study to describe the prevalence and characteristics of respiratory inpatients with silicosis and silicotuberculosis in a small-scale mining region of Africa. A high prevalence of silicosis (14.3%) and silicotuberculosis (7.6%) was found. Patients were often aged <45 years, and the majority required oxygen therapy.Implications of the findings. The high prevalence of advanced silicosis and silicotuberculosis in miners presenting at a young age raises concerns about high occupational silica exposures and, importantly, suggests a need for community-based research, which our team is planning to undertake.

The influence of the size and symmetry of cations and anions on the physicochemical behavior of organic ionic plastic crystal electrolytes mixed with sodium salts.

The phase behaviour, ionic conductivity, electrochemical stability and diffusion coefficients of mobile components in three organic ionic plastic crystals (OIPCs): triisobutylmethylphosphonium bis(fluorosulphonyl)amide (P1i444FSI), triisobutylmethylphosphonium bis(trifluromethanesulphonyl)amide (P1i444NTf2) and trimethylisobutylphosphonium bis(trifluoromethanesulphonyl)amide (P111i4NTf2) are compared to study the effect of the anions and cations on phase behaviour and dynamics. The FSI-based OIPC shows lower melting point and higher conductivity values most likely because of the higher degree of charge distributions and weaker ion-ion interactions compared to NTf2 anion-based OIPCs. Cyclic voltammetry of electrolytes consisting of these OIPCs with 70 mol% sodium salt incorporated indicates stable sodium plating/stripping behaviour at 70 and 50 °C for all samples. The magnitude of the peak currents, however, are much higher for the FSI-based electrolyte.

Feasibility of a streamlined tuberculosis diagnosis and treatment initiation strategy.

OBJECTIVE: To assess the feasibility of a streamlined strategy for improving tuberculosis (TB) diagnostic evaluation and treatment initiation among patients with presumed TB. DESIGN: Single-arm interventional pilot study at five primary care health centers of a streamlined, SIngle-saMPLE (SIMPLE) TB diagnostic evaluation strategy: 1) examination of two smear results from a single spot sputum specimen using light-emitting diode fluorescence microscopy, and 2) daily transportation of smear-negative sputum samples to Xpert® MTB/RIF testing sites. RESULTS: Of 1212 adults who underwent sputum testing for TB, 99.6% had two smears examined from the spot sputum specimen. Sputum was transported for Xpert testing within 1 clinic day for 83% (907/1091) of the smear-negative patients. Of 157 (13%) patients with bacteriologically positive TB, 116 (74%) were identified using sputum smear microscopy and 41 (26%) using Xpert testing of smear-negative samples. Anti-tuberculosis treatment was initiated in 142 (90%) patients with bacteriologically positive TB, with a median time to treatment of 1 day for smear-positive patients and 6 days for smear-negative, Xpert-positive patients. CONCLUSION: The SIMPLE TB strategy led to successful incorporation of Xpert testing and rapid treatment initiation in the majority of patients with bacteriologically confirmed TB in a resource-limited setting.

A murine model of subglottic granulation.

OBJECTIVE: This study aimed to develop a functional model of subglottic stenosis by inducing direct airway irritation in transplanted mouse laryngotracheal complexes. METHODS: Laryngotracheal complexes from C57BL/6 mice were harvested and divided into three groups: uninjured, mechanically injured and chemically injured. Donor laryngotracheal complexes from each group were placed in dorsal subcutaneous pockets of recipient mice. Each week, the transplanted laryngotracheal complexes were harvested, and tissues were fixed, sectioned, and stained with haematoxylin and eosin. Representative slides were reviewed by a blinded pathologist, to determine the formation of granulation tissue, and graded as to the degree of granulation formation. RESULTS: Direct airway irritation induced granulation tissue formation under the disrupted epithelium of airway mucosa; this was seen as early as two weeks after chemical injury. CONCLUSION: Results indicate that granulation tissue formation in a murine model may be an efficient tool for investigating the development and treatment of subglottic stenosis.

Diagnosing Paroxysmal Atrial Fibrillation: Are Biomarkers the Solution to This Elusive Arrhythmia?

Atrial fibrillation (AF) is the commonest sustained arrhythmia globally and results in significantly increased morbidity and mortality including a fivefold risk of stroke. Paroxysmal atrial fibrillation (PAF) constitutes approximately half of all AF cases and is thought to represent an early stage of the disease. This intermittent form of atrial arrhythmia can be a challenge to identify and as a result many affected individuals are not prescribed appropriate antithrombotic therapy and hence are at risk of stroke and thromboembolism. Despite these adverse outcomes there have been relatively few diagnostic advances in the field since the introduction of the Holter monitor in 1949. This review aims to establish the available evidence for electrophysiological, molecular, and morphological biomarkers to improve the detection of PAF with reference to the underlying mechanisms for the condition.

Electrochemical and physicochemical properties of small phosphonium cation ionic liquid electrolytes with high lithium salt content.

Electrolytes of a room temperature ionic liquid (RTIL), trimethyl(isobutyl)phosphonium (P111i4) bis(fluorosulfonyl)imide (FSI) with a wide range of lithium bis(fluorosulfonyl)imide (LiFSI) salt concentrations (up to 3.8 mol kg(-1) of salt in the RTIL) were characterised using a combination of techniques including viscosity, conductivity, differential scanning calorimetry (DSC), electrochemical impedance spectroscopy (EIS), nuclear magnetic resonance (NMR) and cyclic voltammetry (CV). We show that the FSI-based electrolyte containing a high salt concentration (e.g. 1 : 1 salt to IL molar ratio, equivalent to 3.2 mol kg(-1) of LiFSI) displays unusual transport behavior with respect to lithium ion mobility and promising electrochemical behavior, despite an increase in viscosity. These electrolytes could compete with the more traditionally studied nitrogen-based ionic liquids (ILs) in lithium battery applications.

Influence of Zn2+ and water on the transport properties of a pyrrolidinium dicyanamide ionic liquid.

In order to expand our understanding of a potential zinc-based battery electrolyte, we have characterized the physical and transport properties of the ionic liquid (IL) 1-butyl-1-methylpyrrolidinium dicyanamide ([C4mpyr][dca]) containing various levels of both Zn(2+) and H2O. Detailed measurements of density, viscosity, conductivity, and individual anion and cation diffusion coefficients using pulsed-field-gradient (PFG) NMR combined with NMR chemical shifts and spin-lattice relaxation (T1) NMR experiments provide insights into the motion and chemical environment of all molecular species. We find that the various techniques for probing ion transport and dynamics form a coherent picture as a function of electrolyte composition. Zn(2+) addition causes a moderate reduction in the self-diffusion of the IL anion and cation, whereas the addition of H2O increases ion mobility by increasing the liquid's overall fluidity. Temperature-dependent (13)C T1 experiments of the dca carbon analyzed using Bloembergen-Purcell-Pound fits show monotonic slowing of anion dynamics with Zn(2+) addition, suggesting increased Zn(2+)/dca(-) association. T1 experiments show minimal change in the spin-lattice relaxation of cation or anion upon H2O addition, suggesting that H2O is playing no significant role in Zn(2+) speciation. Finally, we employ a novel electrophoretic NMR technique to directly determine the electrophoretic mobility of the C4mpyr cation, which we discuss in the context of impedance-based conductivity measurements.

Tricuspid valve papillary fibroelastoma: an unusual case of dizzy spells.

An 81-year-old woman with recurrent episodes of dizzy spells was found to have a mass in the right atrium on transthoracic echocardiography. The patient underwent successful surgery to excise the mass, which was arising from the anterior leaflet of the tricuspid valve. Histology showed a papillary fibroelastoma. Although management is still controversial when such tumours are found incidentally in asymptomatic patients, surgery may be considered, especially if the tumour is large, due to the high risk of embolism.

Factors influencing the discomfort of intraoral needle penetration.

This study with 24 volunteers compared the discomfort produced by needle penetration in different parts of the palatal mucosa. In addition, comparing a fresh needle to one that was used for a previous penetration in the same patient, we assessed the influence of the status of the needle on insertion discomfort during buccal mucosal penetration. The results showed that needle penetration in the anterior hard palate was more uncomfortable than in the posterior palate. Although men could not differentiate between fresh and used needles for a second buccal mucosal penetration, women reported a significant increase in discomfort with used needles.

Waterhouse-Friderichsen syndrome after infection with group A streptococcus.

We report a case of Waterhouse-Friderichsen syndrome associated with group A streptococcus (GAS) toxic shock syndrome in a previously healthy man. The patient presented with neck pain and fevers of 2 days' duration. Computed tomography of the neck revealed a mass in the retropharyngeal space, suggesting an abscess. Despite prompt treatment with appropriate antibiotics, the patient experienced a fulminant course and died within 8 hours of presentation. Antemortem blood cultures grew GAS positive for exotoxins A, B, and C. Postmortem examination revealed bilateral adrenal hemorrhage, consistent with Waterhouse-Friderichsen syndrome. Immunohistochemical analysis of the adrenal glands revealed the presence of GAS antigens. However, no disseminated intravascular coagulation was evident. This case demonstrates that adrenal hemorrhage can occur without associated coagulopathy and may result directly from the action of bacterial toxins.

Pulmonary nodules in patients with esophageal carcinoma.

The clinical significance of lung nodules in patients with esophageal carcinoma has received little attention. Therefore, we carried out a retrospective detailed review of 116 consecutive cases of esophageal carcinoma, including 98 squamous cell cancers, seen at the Philadelphia Veterans Affairs Medical Center between 1984 and 1997. Seventy-four percent of our patients were black; it was not surprising therefore that 84% of our patients in this series had squamous cell cancers. Initially, chest radiographs, computed tomography (CT) scans, or thoracotomy showed solitary pulmonary nodules in 22 (19%) patients. A definitive diagnosis was established in 19 patients, including 15 (68%) benign nodules and 4 (18%) new primary lung carcinomas. Three (14%) nodules were indeterminate, but in no case could a solitary lung metastasis be identified. Radiographic evidence of multiple lung metastases was present, however, in 4 (3%) of 116 patients at diagnosis. Autopsies of six patients were later performed, and three showed multiple lung metastases; two of these patients had negative chest radiographs shortly before death. Our experience suggests that for a cohort of mostly squamous cell esophageal cancers, a solitary lung metastasis is rare at diagnosis; a solitary pulmonary nodule at this time likely represents a benign abnormality or primary lung cancer. Multiple pulmonary metastases are also very unusual at diagnosis, probably become increasingly common during the terminal phases of disease, and may be radiographically occult.

Obstructive sleep apnea syndrome in acid maltase deficiency.

A patient with adult acid maltase deficiency (AMD) developed severe obstructive sleep apnea (OSA) and respiratory insufficiency. Weaning failure was followed by diffuse pneumonia and death. At autopsy, profound muscle replacement by fibrofatty tissue was noted in the tongue and diaphragm, while the accessory and nonrespiratory muscles were variably preserved. To our knowledge, this case represents the first detailed clinical description of OSA associated with adult AMD. In addition, we suggest that severe tongue weakness due to fatty metamorphosis, in concert with macroglossia, provides a unique pathophysiologic mechanism for OSA.

A general software package for the handling of medical images.

PICS (portable imaging computer software), is a software system designed for handling and processing a variety of types of medical image. It has been designed to satisfy the following criteria: (a) the software should be portable between different items of hardware with minimal alteration; (b) there should be a simple operator interface to enable use by inexperienced users, while avoiding the need for experienced users to be directed through tedious menu trees; (c) the programming environment should enable simple integration of new data handling protocols. To meet these requirements the software was written in FORTRAN using structured subroutine organization. The software has basic image handling and processing facilities and contains a comprehensive set of nuclear medicine clinical protocols. Other facilities include alignment of images from different modalities with display of superimposed images and ability to handle, analyse and display three-dimensional data sets. Data transfer programs have been written to capture data from gamma camera, CT, MRI, ultrasound and radiographs by converting the images to a common data format. The system provides a hospital with a central digital image handling resource, enabling investigation of the value of digital image processing in potential clinical applications.

Organization of health & safety in hospitals.

I intend to concentrate on how we have tackled the practicalities of Health & Safety at St Mary's Hospital in Portsmouth. We have tried to comply effectively, not just give lip service and to take a positive management initiative rather than a purely defensive attitude. This is not merely a response to the loss of crown immunity but a course of action we had already started. Key elements are the appointment of Safety and Audit Managers (SAMs) and Statements of Organisation and Arrangements (SOA) for each department and the conduct of the Health and Safety Committee.

Continuous 24 hour ambulatory monitoring of intragastric pH in man.

A system has been developed which permits continuous 24 hour ambulatory recording of intragastric pH under near-physiological conditions. The system utilises a Cecar combination pH electrode connected through a pre-amplifier to an Oxford Medical Systems Medilog 4-24 cassette recorder, and the pH recorded continuously on to tape. The data is replayed at high speed, digitised and then analysed. Sources of error included system drift, system noise and the effect of changes in electrode environment due to saliva, food, loss of fluid contact, temperature variations and electrode time constant. These were found to be small. In contrast, the major changes in pH detected reflect real changes at the electrode tip. These changes can be recorded by the system. Developments in electronics and improvements in both the size and quality of pH electrodes, over the past few decades, has enabled intragastric pH recordings to be made with greater ease. However, a large number of investigators still assess gastric acidity by infrequent, intermittent sampling of gastric secretion through a naso-gastric tube. This new ambulatory system is a significant improvement and its versatility allows studies in acid secretion physiology, pharmacology and pathophysiology.

Surgery in the very elderly.

The very elderly who underwent major surgical procedures had longer hospital stays and higher total charges than the younger age group in the majority of DRGs studied. Higher mortality rates in the very elderly for most of the DRGs were found to be associated with emergency surgery for conditions that carry very high mortality rates when surgery is not performed. Surgery in the very elderly, then, although from 30% to 40% more costly in terms of hospital days and charges, should not be withheld on the basis of age alone. Careful assessment of risks to each individual patient should be continued and can result in acceptable mortality rates.