Pathology in Practice.

In collaboration with the American College of Veterinary Pathologists.

Important considerations in the derivation of background at sediment sites.

In the United States, there is an absence of federal guidance related to deriving and applying background concentrations at contaminated sediment sites. This absence has resulted in significant variability, uncertainty, and disagreement regarding how representative background concentrations of chemicals of concern should be derived for these sites. The present article discusses important considerations in the derivation of representative background concentrations to be used in the evaluation of contaminated sediment sites. Specifically, a thorough understanding of a site is critical to selecting the background reference areas from which representative background concentrations can be derived, representative background concentrations should account for contributions from those background chemical inputs (natural and anthropogenic sources) that will continue affecting the site even after remediation, perceived outliers should not be eliminated from the background data set just because they are the highest or lowest values, and geochemical evaluation of trace metals is a useful tool for deriving representative background concentrations. On a site-specific level, representative background concentrations are critical for putting site-related risk into context, developing a cost-effective and technically feasible remedial approach, understanding the potential for recontamination, and ensuring long-term remedy success. In a broader context, clear guidance from the United State Environmental Protection Agency (USEPA) for deriving and applying background concentrations for contaminated sediment sites would help promote national consistency in site assessment and remedy decision making. Integr Environ Assess Manag 2019;00:000-000. © 2019 The Authors. Integrated Environmental Assessment and Management Published by Wiley Periodicals, Inc. on behalf of Society of Environmental Toxicology & Chemistry (SETAC).

Drugs in upper respiratory tract infections inpaediatric patients in North Trinidad / Medicamentos en infecciones del tracto respiratorio alto en pacientes pediátricos en Trinidad Norte

Objective: We explored the prescribing patterns of physicians in North Trinidad in treating upper respiratory tract infections (URTI) in paediatric patients and the appropriateness of drugs prescribed. Methods: A retrospective observational study was conducted, with a sample size of 523 paediatric patients, diagnosed with an URTI during the period of June 2003 to 22 June 2005. The study was conducted at five Primary Health Care Facilities in North Trinidad. Results: The three most frequent URTIs diagnosed were non-specific URTI, common cold, and acute tonsillitis in rank order. Four patterns of prescribing were identified, (1) no drug therapy [1.9%]; (2) antibiotic therapy alone [6.1%]; (3) antibiotic and symptomatic therapy [53.0%]; and (4) symptomatic therapy alone [39.0%]. The, most frequently prescribed antibiotics were penicillins (amoxicillin [46.3%] and amoxicillin/clavulanate [5.3%]) and a macrolide (erythromycin [6.1%]). The three symptomatic agents most frequently prescribed were paracetamol [40.1%]; diphenhydramine [29.1%]; and normal saline nasal drops [14.2%]. In 112 cases with swab analyses done, of these, 98.2% revealed a growth of commensals only, while 1.8% grew pathogenic micro-organisms. Of the cases showing commensal growth only, 84.6% were treated with an antibiotic, 14.5% were treated with symptomatic agents alone and 0.9% received no drug therapy at all. Conclusions: A large proportion of paediatric patients diagnosed with an URTI in North Trinidad was prescribed antibiotics although not indicated The inappropriate use of antibiotics can potentiate the worldwide trend of antimicrobial resistance (AU)

Objetivo: Exploramos los patrones de prescripción de los médicos en Trinidad Norte para el tratamiento de infecciones del tracto superior respiratorio (URTI) en pacientes pediátricos y la adecuación de los medicamentos prescritos. Métodos: Se realizó un estudio observacional retrospectivo, con un tamaño de muestra de 523 pacientes pediátricos diagnosticados con una URTI entre junio 2003 y 22 junio de 2005. Este estudio fue realizado en 5 centros de atención primaria en Trinidad Norte. Resultados: Las 3 URTI más frecuentemente diagnosticadas fueron, por orden, URTI no específicas, resfriado común, y amigdalitis aguda. Se identificaron 4 patrones de prescripción, (1) sin tratamiento farmacológico [1,9%]; (2) tratamiento antibiótico solo [6,1%]; (3) tratamiento antibiótico y sintomático [53,0%]; y (4) tratamiento sintomático solo [39,0%]. Los antibióticos más frecuentemente prescritos fueron penicilinas (amoxicilina [46,3%] y amoxicilina/clavulánico [5,3%]) y macrólido (eritromicina [6,1%)]. Los 3 agentes sintomáticos más frecuentemente prescritos fueron paracetamol [40,1%]; difenhidramina [29,1%]; y gotas de suero salino normal [14,2%]. En 112 casos con análisis de torundas, de los que el 98,2% reveló crecimiento de comensales, mientras que en el 1,8% crecieron microorganismos patógenos. De los casos que mostraron crecimiento de comensales sólo, se trataron con antibiótico el 84,6%, con agentes sintomáticos solos el 14,5% y el 0,9% no recibió tratamiento alguno. Conclusiones: A una gran proporción de pacientes pediátricos diagnosticados con una URTI en Trinidad Norte se le prescribió antibióticos aunque no estaban indicados. El uso inadecuado de antibióticos puede potenciar la tendencia mundial hacia las resistencias antimicrobianas (AU)

Drugs in upper respiratory tract infections in paediatric patients in North Trinidad.

OBJECTIVE: We explored the prescribing patterns of physicians in North Trinidad in treating upper respiratory tract infections (URTI) in paediatric patients and the appropriateness of drugs prescribed. METHODS: A retrospective observational study was conducted, with a sample size of 523 paediatric patients, diagnosed with an URTI during the period of June 2003 to 22 June 2005. The study was conducted at five Primary Health Care Facilities in North Trinidad. RESULTS: The three most frequent URTIs diagnosed were non-specific URTI, common cold, and acute tonsillitis in rank order. Four patterns of prescribing were identified, (1) no drug therapy [1.9%]; (2) antibiotic therapy alone [6.1%]; (3) antibiotic and symptomatic therapy [53.0%]; and (4) symptomatic therapy alone [39.0%]. The, most frequently prescribed antibiotics were penicillins (amoxicillin [46.3%] and amoxicillin/clavulanate [5.3%]) and a macrolide (erythromycin [6.1%]). The three symptomatic agents most frequently prescribed were paracetamol [40.1%]; diphenhydramine [29.1%]; and normal saline nasal drops [14.2%]. In 112 cases with swab analyses done, of these, 98.2% revealed a growth of commensals only, while 1.8% grew pathogenic micro-organisms. Of the cases showing commensal growth only, 84.6% were treated with an antibiotic, 14.5% were treated with symptomatic agents alone and 0.9% received no drug therapy at all. CONCLUSIONS: A large proportion of paediatric patients diagnosed with an URTI in North Trinidad was prescribed antibiotics although not indicated The inappropriate use of antibiotics can potentiate the worldwide trend of antimicrobial resistance.

PIXI bone density screening for osteoporosis in postmenopausal women.

OBJECTIVES: The aim of this study was to evaluate a pragmatic screening programme for osteoporosis based on the identification of known risk factors. A secondary aim was to assess the validity of peripheral instantaneous X-ray imager (PIXI) scanning against dual energy X-ray absorptiometry (DEXA) in women identified as having osteopenia. METHODS: A cross-sectional two stage screening programme. The study was carried out in 14 practices in Surrey. Women aged 60-80 years of age were screened with a questionnaire. Those identified with one or more risk factors were offered a PIXI scan of the ankle in their own surgery. Those with an intermediate score on PIXI scan were offered a DEXA scan of hip, spine and forearm. RESULTS: Four thousand six hundred and forty-six women completed questionnaires, 2688 had a PIXI scan and 553 were found to be at high risk of osteoporosis. Multivariate analysis identified the three most important risk factors associated with increased risk of osteoporotic fracture as age, a previous fracture and the presence of a stooped posture. Hormone replacement therapy (HRT) was shown to be protective. Twenty three percent of women with an intermediate score on PIXI scan were found to have osteoporosis on DEXA scan of hip and spine. CONCLUSIONS: PIXI scanning proved acceptable, practicable but only had moderate comparability with DEXA. The findings suggest that patients over the age of 60 years with a history of a fracture or evidence of spinal collapse are likely to have osteoporosis and should be offered screening. HRT past the menopause would seem to confer benefit and the recent reduction in its use may lead to increasing numbers of women suffering osteoporotic fractures.