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J Air Waste Manag Assoc. 2000 Aug;50(8):1380-9.
Daily mortality and air pollution in The Netherlands.

Hoek G, Brunekreef B, Verhoeff A, van Wijnen J, Fischer P.

Environmental and Occupational Health Group, Utrecht University, The Netherlands.

We studied the association of daily mortality with short-term variations in the ambient concentrations of major gaseous pollutants and PM in the Netherlands. The magnitude of the association in the four major urban areas was compared with that in the remainder of the country. Daily cause-specific mortality counts, air quality, temperature, relative humidity, and influenza data were obtained from 1986 to 1994. The relationship between daily mortality and air pollution was modeled using Poisson regression analysis. We adjusted for potential confounding due to long-term and seasonal trends, influenza epidemics, ambient temperature and relative humidity, day of the week, and holidays, using generalized additive models. Influenza episodes were associated with increased mortality up to 3 weeks later. Daily mortality was significantly associated with the concentration of all air pollutants. An increase in the PM10 concentration by 100 micrograms/m3 was associated with a relative risk (RR) of 1.02 for total mortality. The largest RRs were found for pneumonia deaths. Ozone had the most consistent, independent association with mortality. Particulate air pollution (e.g., PM10, black smoke [BS]) was not more consistently associated with mortality than were the gaseous pollutants SO2 and NO2. Aerosol SO4(-2), NO3-, and BS were more consistently associated with total mortality than was PM10. The RRs for all pollutants were substantially larger in the summer months than in the winter months. The RR of total mortality for PM10 was 1.10 for the summer and 1.03 for the winter. There was no consistent difference between RRs in the four major urban areas and the more rural areas.

PMID:_11002600 Rinsho Shinkeigaku. 2000 May;40(5):490-3.
[Tracheopulmonary-subcutaneous fistula associated with anaerobic subcutaneous abscess on mechanical ventilator support in a patient with Duchenne muscular dystrophy]

[Article in Japanese]

Kanzato N, Suehara M, Mayumi H, Hirata K, Ohta M, Kuniyoshi M, Kuniyoshi K.

Department of Neurology, National Okinawa Hospital, Japan.

A 29-year-old Japanese man with Duchenne muscular dystrophy was placed on a mechanical ventilator support at 23 years of age and admitted to our hospital at 25 years of age. He had severe neck contracture deviated to the left side which resulted in dysphagia and microaspiration. At 29 years of age, he developed left lobar pneumonia accompanied by slight fever, back pain and a foul odor from the patient's sputum. Although the patient received broad spectrum antibiotics, pneumonia disseminated to the right lung. A week later, chest computed tomography was conducted which revealed tracheopulmonary-subcutaneous fistula, and a massive subcutaneous abscess with free air production. Drainage from the subcutaneous abscess was done through a chest tube; however, respiratory hypercapnia was not corrected and the patient died. From the culture of drained fluid, anaerobic bacteria including peptostreptococcus sp. were detected. This tracheopulmonary-subcutaneous fistula was thought to be caused by chronic microaspiration of mouth anaerobes, mechanical injury of the trachea under long term ventilator support, and decreased deep back muscle bulk with substitution of adipose tissue around the chest.

PMID:_11002735 J Air Waste Manag Assoc. 1999 Sep;49(9 Spec No):154-63.
Association between levels of fine particulate and emergency visits for pneumonia and other respiratory illnesses among children in Santiago, Chile.

Ilabaca M, Olaeta I, Campos E, Villaire J, Tellez-Rojo MM, Romieu I.

Instituto Nacional de Salud Publica, Mexico.

Recent evidence has implicated the fine fraction of particulate as the major contributor to the increase in mortality and morbidity related to particulate ambient levels. We therefore evaluated the impact of daily variation of ambient PM2.5 and other pollutants on the number of daily respiratory-related emergency visits (REVs) to a large pediatric hospital of Santiago, Chile. The study was conducted from February 1995 to August 1996. Four monitoring stations from the network of Santiago provided air pollution data. The PM2.5 24-hr average ranged from 10 to 111 micrograms/m3 during September to April (warm months) and from 10 to 156 micrograms/m3 during May to August (cold months). Other contaminants (ozone (O3), nitrogen dioxide (NO2), and sulfur dioxide (SO2)) were, in general, low during the study period. The increase in REVs was significantly related to PM10 and PM2.5 ambient levels, with the relationship between PM2.5 levels and the number of REVs the stronger. During the cold months, an increase of 45 micrograms/m3 in the PM2.5 24-hr average was related to a 2.7% increase in the number of REVs (95% CI, 1.1-4.4%) with a two-day lag, and to an increase of 6.7% (95% CI, 1.7-12.0%) in the number of visits for pneumonia with a three-day lag. SO2 and NO2 were also related to REVs. We conclude that urban air pollutant mixture, particularly fine particulates, adversely affect the respiratory health of children residing in Santiago.

PMID:_11002834 J Perinatol. 2000 Sep;20(6):346-50.
Early discharge with home antibiotic therapy in the treatment of neonatal infection.

Wagner CL, Wagstaff P, Cox TH, Annibale DJ.

Division of Neonatology, Medical University of South Carolina, Charleston 29425, USA. wagnercusc.edu

OBJECTIVE: To determine the feasibility and cost of home antibiotic therapy for a select group of neonates. METHODS: A cohort of neonates at a university hospital who met criteria for home antibiotic therapy at discharge were prospectively followed (November 1995 to October 1997) for type and duration of antibiotic therapy as well as for hospital readmission. RESULTS: During the study period, 95 infants diagnosed with sepsis, presumed sepsis, pneumonia, or uncomplicated meningitis (having received > 10 days of in-hospital therapy) met prior, established, criteria for home antibiotic therapy. The mean +/- SD birth weight of the cohort was 3160 +/- 526 gm, with a mean gestational age of 38.4 +/- 2.1 weeks. A total of 59 infants (62%) received antimicrobial therapy for a clinical presentation consistent with sepsis or presumed sepsis, and 24 infants (25%) were treated for pneumonia. Ampicillin and gentamicin were prescribed for 56% of the cohort, and ceftriaxone was prescribed for 21% of the cohort. Four of those infants were switched from intravascular ampicillin/gentamicin therapy to intramuscular ceftriaxone after discharge due to loss of intravascular access. With a bilirubin level of > 8, four additional infants were changed from ceftriaxone back to ampicillin and gentamicin to complete coverage. The mean age at discharge was 5.2 days, with a mean hospitalization cost of $6121 for that period. There were no rehospitalizations or emergency department visits secondary to a worsening clinical course. CONCLUSION: In this cohort of neonates who met early discharge and defined home antibiotic therapy criteria, there were no serious complications or treatment failures reported; in addition, there were fewer costs compared with continued inpatient treatment.

PMID:_11002871 Vet Hum Toxicol. 2000 Oct;42(5):286-8.
Tiamulin-nitrovin interaction in pigs: a case report and experimental reproduction.

Noa M, Bulnes C, Valcarcel L, Abeledo MA, Figueredo JM, Torano ME.

Department of Pharmacology and Toxicology, San Jose de las Lajas, La Habana, Cuba.

Tiamulin is a diterpenic veterinary drug widely used in swine for the control of infectious diseases, including swine dysentery and enzootic pneumonia. Tiamulin is well tolerated and only a few drug interactions have been reported with some ionophore antibiotics. A case of tiamulin adverse drug interaction with nitrovin, a nitrofuranic growth promoter, in fattening pigs from a commercial farm is described. To confirm the diagnosis, experimental reproduction was conducted using 20 healthy female pigs. The animals were randomly divided into 4 groups: 1 of them receiving feed medicated with 100 mg tiamulin hydrogen fumarate/kg, another received 20 mg nitrovin/kg to establish the harmlessness of the drugs alone. The other 2 groups received feeds containing both drugs at the previous concentrations, one of which came from the farm. In the last 2 groups clinical signs appeared 72-96 h after initially feeding pigs the tiamulin hydrogen fumarate + nitrovin-containing feed. The animals had uneasiness, anxiety, skin erythema, and rash on snout, vulva and abdomen, and increased body temperatures. No mortality occurred, and there were no characteristic findings during pathological examination. The signs disappeared after 96 h of consuming the medicated feed, leaving a slight skin thickening of the affected regions. All signs disappeared spontaneously 4-5 d after ceasing medication.

PMID:_11003120





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