1/22. Heat-related illnesses and deaths--missouri, 1998, and united states, 1979-1996.Although heat-related illness and death are readily preventable, exposure to extremely high temperatures caused an annual average of 381 deaths in the United States during 1979-1996. Basic behavioral and environmental precautions are essential to preventing adverse health outcomes associated with sustained periods of hot weather (daytime heat index of > or = 105 F [> or = 40.6 C] and a nighttime minimum temperature of 80 F [26.7 C] persisting for at least 48 hours). This report describes four heat-related deaths that occurred in missouri during 1998, summarizes heat-related deaths in the united states during 1979-1996, describes risk factors associated with heat-related illness and death, especially in susceptible populations (young and elderly, chronically ill, and disabled persons), and recommends preventive measures.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
2/22. Pseudomembranous enteritis after proctocolectomy: report of a case.Intestinal pseudomembrane formation, sometimes a manifestation of antibiotic-associated diarrheal illnesses, is typically limited to the colon but rarely may affect the small bowel. A 56-year-old female taking antibiotics, who had undergone proctocolectomy for idiopathic inflammatory bowel disease, presented with septic shock and hypotension. A partial small-bowel resection revealed extensive mucosal pseudomembranes, which were cultured positive for clostridium difficile. Intestinal drainage contents from an ileostomy were enzyme immunoassay positive for C. difficile toxin A. Gross and histopathologic features of the small-bowel resection specimen were similar to those characteristic of pseudomembranous colitis. The patient was treated successfully with metronidazole. These findings suggest a reservoir for C. difficile also exists in the small intestine and that conditions for enhanced mucosal susceptibility to C. difficile overgrowth may occur in the small-bowel environment of antibiotic-treated patients after colectomy. Pseudomembranous enteritis should be a consideration in those patients who present with purulent ostomy drainage, abdominal pain, fever, leukocytosis, or symptoms of septic shock.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
3/22. Environmental hyperthermic infant and early childhood death: circumstances, pathologic changes, and manner of death.infant and early childhood death caused by environmental hyperthermia (fatal heat stroke) is a rare event, typically occurring in vehicles or beds. The aims of this study were to describe the demographics, circumstances, pathology, and manner of death in infants and young children who died of environmental hyperthermia and to compare these cases with those reported in the literature. Scene investigation, autopsy reports, and the microscopic slides of cases from three jurisdictions were reviewed. The subjects in 10 identified cases ranged in age from 53 days to 9 years. Eight were discovered in vehicles and 2 in beds. When the authors' cases were grouped with reported cases, the profile of those in vehicles differed from those in beds. The former were older, were exposed to rapidly reached higher temperatures, and often had more severe skin damage. The latter were mostly infants and were exposed to lower environmental temperatures. Hepatocellular necrosis and disseminated intravascular coagulation were reported in victims who survived at least 6 hours after the hyperthermic exposure. The consistent postmortem finding among nearly all victims was intrathoracic petechiae, suggesting terminal gasping in an attempt at autoresuscitation before death. The manner of death was either accident or homicide. Recommendations for the scene investigation are made.- - - - - - - - - - ranking = 3keywords = environment (Clic here for more details about this article) |
4/22. Salbutamol intoxication: is salbutamol a drug-inducing fever? A case report and treatment strategy.A four-year-old female with salbutamol intoxication was referred to our paediatric emergency medicine unit, due to agitation, tremulousness, sinus tachycardia, mild hypokalaemia and hyperglycaemia. On admission the child was agitated and had a noticeable tremor, an axillary temperature of 38 degrees C and a pulse rate of 185 beats/min. She had no identifiable focus of infection on physical examination to explain her fever. gastric lavage, activated charcoal, intravenous hydration and electrocardiogram (ECG) monitoring were performed. Her plasma potassium level, blood sugar and QT interval were closely monitored during her hospital stay. Her fever, tachycardia and serum potassium and glucose levels returned to normal and she was discharged in good condition 24 h after admission. The difference of this case from prior cases of salbutamol intoxication was the observation of fever in the absence of evidence of infection. Since the cause of fever was not a reaction to the medication used in the treatment or related to environmental factors, it is assumed that salbutamol is a fever-inducing drug.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
5/22. A newly characterized SCN5A mutation underlying brugada syndrome unmasked by hyperthermia.Febrile illness has been rarely reported to modulate ST segment elevation in right precordial leads on ECG or even precipitate ventricular fibrillation in patients with brugada syndrome. We report the case of a patient whose Brugada ECG pattern was unmasked by hyperthermia secondary to acute cholangitis. Serial ECGs showed progressive attenuation of ST segment elevation as body temperature gradually returned to normal. Structural heart disease was ruled out. Intravenous flecainide injection reproduced a less remarkable ST segment elevation. Genetic screening demonstrated a single amino acid substitution (H681P) in the SCN5A gene, thus confirming the diagnosis of brugada syndrome. in vitro expression of this newly characterized genetic defect revealed novel biophysical abnormalities consisting of a shift in both steady-state activation and inactivation, resulting in a 60% reduction of sodium window current. Thus, SCN5A-H681P mutation induces a significant loss of transmembrane current and is clinically associated with a pathologic phenotype that is elicited by hyperthermia. overall the observed clinical features are in agreement with previous observations and strongly suggest that fever may be an environmental modifier among brugada syndrome patients with a detrimental (and possibly arrhythmogenic) effect on cardiac repolarization.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
6/22. Oligohydrosis and hyperthermia: pilot study of a novel topiramate adverse effect.A 6-year-old boy with partial complex seizures developed recurrent episodes of hyperthermia 2 months after topiramate was introduced into his antiepilepsy drug regimen. Further investigation revealed that the febrile episodes were related to environmental temperature and physical activity. A pilocarpine iontophoresis sweat test showed that the amount of sweat produced by the child was 5% that of age-matched controls. Topiramate discontinuation resulted in the disappearance of febrile episodes and normalization of sweat quantity in repeat sweat testing. Based on this observation and the previous data on zonisamide and isolated case reports on topiramate-related hyperthermia and the effect on sweat production, topiramate was suspected of causing oligohydrosis. A pilot study was carried out involving 13 additional children and young adults (age range 1-37 years) receiving topiramate. All patients were directly questioned regarding symptoms of decreased sweating and heat intolerance, went through a pilocarpine iontophoresis sweat test, and were compared with 14 age-matched controls who went through the sweat test for unrelated reasons. Nine of the patients were found to have reduced sweat quantity on the pilocarpine iontophoresis sweat test (including index case) (mean 0.089 g/30 minutes, SD 0.082; age-matched control: mean 0.21 g/30 minutes, SD 0.06). Eight of them were children (below 16 years). However, only three patients revealed symptoms related to heat intolerance. Topiramate is most likely responsible for decreased sweat production as detected by a pilocarpine iontophoresis sweat test. The effect seems to be more significant in children than in adults. There is a discrepancy between test results and clinical symptoms. Interestingly, oligohydrosis was found to be a relatively common side effect of zonisamide. Both zonisamide and topiramate share a carbonic anhydrase inhibitor activity. The significance of oligohydrosis in hot climates should not be underestimated. Its extent, the role of sweat test prediction, and clinical significance during topiramate treatment should be further estimated.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
7/22. bacteremia due to comamonas species possibly associated with exposure to tropical fish.comamonas species are environmental gram-negative rods that grow forming pink-pigmented colonies. Despite their common occurrence in nature, they rarely cause human infection. We present a case of comamonas bacteremia that we think may have been related to tropical fish exposure. The patient was treated successfully with levofloxacin.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
8/22. Polymicrobial bacteremia caused by escherichia coli, edwardsiella tarda, and shewanella putrefaciens.edwardsiella tarda, a member of enterobacteriaceae, is found in freshwater and marine environments and in animals living in these environments. This bacterium is primarily associated with gastrointestinal diseases, and has been isolated from stool specimens obtained from persons with or without clinical infectious diseases. shewanella putrefaciens, a saprophytic gram-negative rod, is rarely responsible for clinical syndromes in humans. Debilitated status and exposure to aquatic environments are the major predisposing factors for E. tarda or S. putrefaciens infection. A 61-year-old woman was febrile with diarrhea 8 hours after ingesting shark meat, and two sets of blood cultures grew escherichia coli, E. tarda and S. putrefaciens at the same time. She was successfully treated with antibiotics. We present this rare case of polymicrobial bacteremia caused by E. coli, E. tarda and S. putrefaciens without underlying disease, which is the first found in taiwan. This rare case of febrile diarrhea with consequent polymicrobial bacteremia emphasizes that attention should always be extended to these unusual pathogens.- - - - - - - - - - ranking = 3keywords = environment (Clic here for more details about this article) |
9/22. Successful neonatal outcome in 2 cases of maternal persistent vegetative state treated in a labor and delivery suite.Two cases of maternal vegetative state after motor vehicle accidents are presented. Aggressive support allowed the prolongation of both pregnancies into the third trimester without neonatal compromise. After initial medical stabilization in intensive care unit environments, both patients were treated in a labor and delivery setting with consultative supports from various subspecialists.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
10/22. Acute lung reaction due to zinc inhalation.A 27-yr-old man began work at a company that produces concrete pipes in April 1987. The pipes are linked with rings covered with zinc. In September 1987, he was transferred to a new job in the same plant where he had to heat zinc wires and shoot the heated zinc in powder form onto the iron rings. He had no past personal nor family atopic history. Two weeks after he began in his new job, he experienced an episode of chills with muscle aches and dyspnoea at the end of a working day. The fever persisted until the next day, at which time he saw a physician. A chest radiograph revealed diffuse interstitial shadows. He was off work for 10 days. His symptomatology disappeared and his chest radiograph cleared. He went back to work and experienced a similar episode. He remained away from work for one month, after which specific inhalation challenges were performed. On a control day, there were no significant changes in forced expiratory volume in one second (FEV1), forced vital capacity (FVC), or buccal temperature. Two white blood counts (WBC) showed 8,400 and 8,500 white cells. He was exposed to his usual work environment for one hour on two consecutive days. On both occasions, there were significant falls in FEV1 (16% and 20%) and FVC (10% and 11%), occurring 4-6 h after exposure. Buccal temperature reached 38.1 and 38.7 degrees C on the two occasions, and WBC were 17,000 and 15,900 at the end of each day. precipitins were negative and specific IgG antibodies could not be detected.(ABSTRACT TRUNCATED AT 250 WORDS)- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
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