Assessment of the occupational health and safety system in local health centers in Metro Manila

The environment of health care workers (HCWs) is considered as one of the most hazardous settings due to the nature of their work. In the Philippines, this continues to be overlooked in terms of programs and services on occupational health and safety (OHS). One possible reason for this is the existing information gap on OHS which limits data comparability and effective monitoring and assessment of interventions.

This study assessed the OHS system in 13 barangay health centers in a selected city using the 6 building blocks of a health system framework. Assessment was done through walk-through surveys, documents review, and key informant interview. Qualitative data from the interview were coded using NVivo while quantitative data were summarized using EpiInfo.

Results showed that there remains to be gaps in terms of improving occupational health and safety in local health centers. In terms of leadership and governance, a general policy on OHS for all local health centers was found to be lacking and in effect, an absence of health and safety committees. In terms of financing, the lack of a separate budget specific for OHS programs and services was also found to be a limitation. As a result, there was no OHS personnel identified and only one staff had valid training on OHS among all 13 health centers. There was also no established information system for OHS in place. Only 2 out of 13 health centers have Safety Inspection Reports while only three have Workplace Environment Monitoring Report.

Based on the results of the study, there is a general need for improvement in terms of the occupational health and safety system in the city where the health centers were situated. Among all the elements of the occupational health and safety system, the lack of an overarching policy on OHS resulted in the absence of health and safety committees, inadequate budget and worker specific services for OHS, lack of related trainings and workshops, and poor information and reporting system.

Key messages

Data on conditions of OHS systems in the local health center setting are limited, thus the study provides information on areas of improvement for health systems strengthening. There is a need for policies on OHS in the local health center setting to strengthen the system for improved service delivery, information management and financing for OHS.

Relevance of quantification in brain PET studies with 18F-FDG

The inclusion of ¹⁸F-FDG PET as a biomarker in the diagnostic criteria of neurodegenerative diseases and its indication in the presurgical assessment for drug-resistant epilepsies allow to improve specificity of these diagnosis. The traditional interpretation of neurological PET studies has been performed qualitatively, although in the last decade, several quantitative evaluation methods have emerged. This technical development has become relevant in clinical practice, improving specificity, reproducibility and reducing the interrater reliability derived from visual analysis. In this article we update/review the main imaging processing techniques currently used. This may allow the Nuclear Medicine physician to know their advantages and disadvantages when including these procedures in daily clinical practice.

Amyloid PET in neurodegenerative diseases with dementia

Alzheimer's disease (AD) is a neurodegenerative condition characterized by progressive cognitive decline and memory loss, and is the most common form of dementia. Amyloid plaques with neurofibrillary tangles are a neuropathological hallmark of AD that produces synaptic dysfunction and culminates later in neuronal loss. Amyloid PET is a useful, available and non-invasive technique that provides in vivo information about the cortical amyloid burden. In the latest revised criteria for the diagnosis of AD biomarkers were defined and integrated: pathological and diagnostic biomarkers (increased retention on fibrillar amyloid PET or decreased Aβ_1-42 and increased T-Tau or P-Tau in CSF) and neurodegeneration or topographical biomarkers (temporoparietal hypometabolism on ¹⁸F-FDG PET and temporal atrophy on MRI). Recently specific recommendations have been created as a consensus statement on the appropriate use of the imaging biomarkers, including amyloid PET: early-onset cognitive impairment/dementia, atypical forms of AD, mild cognitive impairment with early age of onset, and to differentiate between AD and other neurodegenerative diseases that occur with dementia. Amyloid PET is also contributing to the development of new therapies for AD, as well as in research studies for the study of other neurodegenerative diseases that occur with dementia where the deposition of Aβ amyloid is involved in its pathogenesis. In this paper, we review some general concepts and study the use of amyloid PET in depth and its relationship with neurodegenerative diseases and other diagnostic techniques.

The usefulness of 18F-fluorocholine PET/CT in the detection of recurrence of central nervous system primary neoplasms

AIM

To study the usefulness of ¹⁸F-fluorocholine (FCH) in detecting the recurrence of primary brain tumours.

MATERIAL AND METHODS

A prospective study was conducted on brain PET/CT with FCH for compassionate use in 21 patients with suspected recurrence of a primary brain tumour. The distribution by pathology was: three grade ii astrocytomas, three grade iii astrocytomas, one grade ii oligodendroglioma, three grade iii oligodendrogliomas, one grade iii oligoastrocytoma, four glioblastoma multiform, one gliomatosis cerebri, and five meningiomas. Studies in which there was a visually significant uptake in the brain parenchyma were classified as positive.

RESULTS

A total of 17 patients were classified as positive, with the results being confirmed by histology (10 cases) or clinical follow-up and imaging, with no false positives or negatives. The mean SUVmax for positive patients was 8.02 and 0.94 for the negative ones, which was significantly different (P=.003) CONCLUSION: PET/CT with FCH shows encouraging results in the evaluation of patients with suspected recurrence of primary brain neoplasms.

[Interpretation of thyroid incidentalomas in (18)F-FDG PET/CT studies]

OBJECTIVE

Thyroid findings or incidentalomas in (18)F-FDG PET/CT studies are relatively frequent, being its clinical significance subject of controversy. The aim of this study was to show our experience in the detection of thyroid incidentalomas by PET/CT studies as well as its follow up.

MATERIAL AND METHODS

A retrospective and descriptive review was conducted on patients who had thyroid incidentalomas detected in (18)F-FDG PET/CT studies between June 2010 and March 2013. Patient's medical records were reviewed for age, genre, maximum standardized uptake value (SUVmax), thyroid diseases, TSH and antithyroid antibodies levels, ultrasound, fine-needle aspiration (FNA) and cytology.

RESULTS

4085 PET/CT studies for several purposes were performed. Eighty-three of these studies (2.03%) showed thyroid incidentalomas. Thirty-seven patients showed a diffuse increase of glucose metabolism in the thyroid gland and 46 showed a focal increase of glucose metabolism. Five out of 46 patients with focal uptake were diagnosed of a neoplastic disease by cytology (11%). The SUVmax of malignant pathology did not differ from that of benign thyroid diseases (Mean: 10,26 and 5,92 respectively).

CONCLUSION

In our experience, focal thyroid incidentalomas detected in (18)F-FDG PET/CT studies are related to a significant risk of malignancy (11%). Therefore, in these situations, an ultrasound study with fine needle biopsy should be recommended. Moreover, a diffuse increase of glucose metabolism in the thyroid gland is often associated with benign thyroid pathology.

Cardiac sympathetic impairment parallels nigrostriatal degeneration in Probable Dementia with Lewy Bodies

AIM

Dementia with Lewy Bodies (DLB) must be distinguished from other types of dementia because of important differences in patient management and outcome. Both reduction in cardiac 123I-metaiodobenzilguanidine (MIBG) uptake and decreased 123I-FP-CIT binding in basal ganglia have been described in DLB. The aim of this study was to assess the relationship between cardiac sympathetic activity and nigrostriatal degeneration in patients with probable DLB.

METHODS

Twenty-eight patients (15 males; mean age 77 years, range 64-88 years) with clinical international criteria of probable DLB were included in the study. All patients underwent a cardiac MIBG scintigraphy and a FP-CIT SPECT. Global cardiac MIBG uptake was semiquantified by means of heart-to-mediastinum ratio (HMR) (normal >1.56). FP-CIT binding in basal ganglia was calculated and compared with an age-matched control group. The relation between cardiac MIBG uptake and FP-CIT uptake in basal ganglia, and the relationship of these two techniques with distinctive symptoms of DLB, features of past medical history and data from the neuropsychological examination were assessed.

RESULTS

Cardiac MIBG uptake was decreased in 23 of 28 patients (HMR=1.32, range 0.95-1.85). The FP-CIT binding in basal ganglia was significantly lower than in control group (2.01±0.5 vs 2.62±0.2, P<0.05). All patients with reduced cardiac HMR showed decreased FP-CIT binding in basal ganglia. There was a positive correlation between the HMR and specific binding ratio of striatum (P<0.01). A high correlation between FP-CIT SPECT and the presence of parkinsonism also was found. No correlation between cardiac MIBG uptake and demographic, clinical or neuropsychological data was found.

CONCLUSION

In probable DLB cardiac MIBG uptake and FP-CIT binding in basal ganglia are reduced. The positive correlation between both measures suggests that cardiac sympathetic degeneration and nigrostriatal degeneration parallel similarly in patients with probable DLB.

Demencia con cuerpos de Lewy y enfermedad de Alzheimer: diagnóstico diferencial mediante estudio de la inervación simpática cardíaca con MIBG

Dementia with Lewy bodies (DLB) is the second most common cause of degenerative dementia after Alzheimer's disease (AD). At present, pre-mortem diagnosis of DLB can only be made clinically using the International Consensus Criteria. However, an accurate differential diagnosis between these diseases could improve the therapeutic handling of patients with DLB, due to their supersensitivity to neuroleptic treatment and the difficult treatment of their psychotic symptoms.

OBJECTIVE

To assess the utility of cardiac MIBG imaging as diagnostic study for DLB, to help in the differential diagnosis with AD.

MATERIAL AND METHODS

Cardiac MIBG imaging was performed in 11 patients with clinical criteria of probable DLB (7 males, mean age 77 years [range 62-89 years], mean MMSE 17 [range 11-28], and in 9 patients with clinical criteria of probable AD (3 males, mean age 79 years [range 61-87 years], mean MMSE 17 [range 4-25]). Planar anterior images of the thorax were acquired at 15 minutes. (early study) and 4 hours (late study) after tracer injection. Myocardial MIBG activity was quantified by means of a heart-to-mediastinum ratio (HMR). A HMR > 1.8 was considered normal.

RESULTS

Respect AD patients, patients with DLB showed decreased HMR in the early study (1.34 +/- 0.27 [range 1.03-1.98] vs. 1.84 +/- 0.22 [range 1.53-2.15], p<0.001) and in the late study (1.22 +/- 0.23 [range 0.95-1.75] vs. 1.73 +/- 0.08 [range 1.59-1.89], p<0.0001).

CONCLUSIONS

Cardiac MIBG imaging could be a useful tool for differential diagnosis between DLB and AD.

DMSA study performed during febrile urinary tract infection: a predictor of patient outcome?

Technetium-99m dimercaptosuccinic acid (DMSA) study has been advocated as a method for the assessment of renal sequelae after acute febrile urinary tract infection (UTI). However, it is not known whether DMSA scintigraphy performed during acute UTI has any prognostic value for outcome assessment. The objective of this study was to evaluate the usefulness of DMSA scintigraphy performed during UTI as a predictor of patient outcome, to identify children at risk of events [vesico-ureteral reflux (VUR) or recurrent UTI] that may lead to the development of progressive renal damage. One hundred and fifty-two children (including 78 girls) with a mean age of 20 months (range 1 month to 12 years) with first febrile UTI were evaluated by DMSA scintigraphy during acute UTI. After acute UTI, children were explored by voiding cysto-urethrography. Children who presented an abnormal DMSA study, or a normal DMSA study but VUR or recurrent UTI, underwent a DMSA control study 6 months after UTI. Children with VUR were followed up by direct radionuclide cystography. DMSA scintigraphy performed during acute UTI was normal in 112 children (74%). In 95 of these children, follow-up DMSA scintigraphy was not performed owing to a good clinical outcome. In the remaining 17 children, follow-up scintigraphy was normal. Forty children (26%) presented abnormal DMSA study during acute UTI. Twenty-five of them presented a normal follow-up DMSA, and 15 presented cortical lesions. Children with abnormal DMSA had a higher frequency of VUR than children with normal DMSA (48% vs 12%). It is concluded that children with normal DMSA during acute UTI have a low risk of renal damage. Children with normal follow-up DMSA and low-grade VUR have more frequent spontaneous resolution of VUR.

Evaluation of renal graft haemodynamia by 51Cr-EDTA and o-[131I]iodohippurate: its use in the early diagnosis of glomerular hyperfiltration

Chronic rejection is the most important cause of renal graft dysfunction. Non-immunological mechanisms have been suggested as a probable origin of chronic graft rejection, provoking a decrease in renal mass function, followed by glomerular hyperfiltration in the remnant nephrons, which could cause progressive glomerulosclerosis and functional loss. Early, or preclinical, identification of patients with glomerular hyperfiltration, defined as an increase in glomerular filtration fraction (GFF) and in glomerular capillary pressure (GCP), could prolong graft life. The objective of this study was to evaluate, non-invasively, stable renal graft haemodynamia and early glomerular hyperfiltration. We studied 116 renal transplant patients with stable renal function and five healthy living kidney donors with normal renal function. Glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) were determined using 51Cr-EDTA and o-[131I]iodohippurate, respectively. GFF was obtained from the relation between GFR and ERPF, and GCP from a mathematical model (Hall-Gomez' formula). A simultaneous analysis of renal function was performed. In transplant patients, the GFR and ERPF were significantly lower than in healthy, living, kidney donors (P<0.02). The same trend was observed for GCP (P<0.01), while GFF was not significantly different. Twelve patients (10.3%) had criteria of glomerular hyperfiltration. In patients without criteria of glomerular hyperfiltration, plasma level and clearance of creatinine were 128+/-33 micromol.l-1 and 56+/-15 ml.min-1, respectively; and in those patients with glomerular hyperfiltration criteria were 108+/-18 micromol.l-1 (P=NS) and 83+/-24 ml.min-1 (P=0.002) respectively. It is concluded that determinations of GFR, ERPF, GFF and GCP allow non-invasive evaluation of renal graft haemodynamia and can be useful in the early detection of glomerular hyperfiltration.

[67 Ga-citrate scintigraphy as a determiner in the diagnosis of a subacute thyroiditis]

We present the case of a 41-year-old man admitted to the hospital with fever and toxic syndrome possibly having an oncological or infectious origin. A whole body scan with 67Ga-citrate showed an intense and diffuse radiotracer accumulation in the thyroid gland. The patient was re-evaluated and studied with other diagnostic tests including a thyroid 99mTc-pertechnetate scintigraphy and a thyroidal radioiodine uptake. A correct final diagnosis of painless subacute thyroiditis was made.