Updated assessment of occupational safety and health hazards of climate change

Workers, particularly outdoor workers, are among the populations most disproportionately affected by climate-related hazards. However, scientific research and control actions to comprehensively address these hazards are notably absent. To assess this absence, a seven-category framework was developed in 2009 to characterize the scientific literature published from 1988-2008. Using this framework, a second assessment examined the literature published through 2014, and the current one examines literature from 2014-2021. The objectives were to present literature that updates the framework and related topics and increases awareness of the role of climate change in occupational safety and health. In general, there is substantial literature on worker hazards related to ambient temperatures, biological hazards, and extreme weather but less on air pollution, ultraviolet radiation, industrial transitions, and the built environment. There is growing literature on mental health and health equity issues related to climate change, but much more research is needed. The socioeconomic impacts of climate change also require more research. This study illustrates that workers are experiencing increased morbidity and mortality related to climate change. In all areas of climate-related worker risk, including geoengineering, research is needed on the causality and prevalence of hazards, along with surveillance to identify, and interventions for hazard prevention and control.

Influence of opioid choice on mechanical ventilation duration and ICU length of stay

BACKGROUND

The aim of this study was to assess the impact on mechanical ventilation and ICU outcomes of substituting remifentanil for sufentanil, in an analgesia-based sedation protocol. A database of data prospectively collected was retrospectively analyzed. The study was carried out in a 16-bed tertiary-care ICU.

METHODS

The study included 1544 mechanically ventilated patients admitted from January 2001 to December 2006. Patients were compared between two consecutive phases. Analgesia-based sedation guidelines were the same, except for the opiate used. The patient-to-nurse ratio (2.5) and ventilator weaning practices remained unchanged. 794 patients were included during the sufentanil phase, and 750 during the remifentanil phase. Remifentanil was associated with significantly less time spent on mechanical ventilation (10 days[3-21] vs. 14 days[3-27], P<0.01) and in the ICU (16 days[3-22] vs. 19 days[4-26], P<0.01). The difference was significant for patients ventilated no longer than four days (P=0.0035) but not for patients ventilated more than four days (P=0.058). Sedation target on the Ramsay scale was reached more often with remifentanil. The use and amount of hypnotic agents in addition to the opiate were significantly lower with remifentanil. The cost of analgesia-based sedation was similar in the sufentanil and the remifentanil group.

CONCLUSION

Our study suggests that using a short-acting opiate with short context-sensitive half-life in an analgesia-based sedation protocol may significantly decrease the duration of mechanical ventilation and the ICU length of stay even though not significantly in long term sedation, while improving the achievement of sedation goals despite a lower requirement for adjunctive hypnotic agents, with no additional costs.

[Tolerance of caspofungin in intensive care unit: a prospective study]

OBJECTIVE

Caspofungin has shown efficacy and very low toxicity in empirical antifungal therapy in refractory invasive Aspergillus infections and invasive candidiasis in neutropenic (or non) patients. To date, there is no data on tolerability of caspofungin in ICU patients. The aim of this study was to evaluate caspofungine tolerability in critical care patients.

PATIENTS AND METHOD

Over a 36-month period, 1430 patients were admitted in a general intensive care unit. All patients data were collected in a prospective database. All the clinical or biological side effects reported in the multicentric studies were required. The patients were laminated in two groups, according to the initial hepatic function.

RESULTS

Seventy-three patients were treated with caspofungin (5.1%) and 58% were immunocompromised. Immunosuppression was due to acute leukemia (30%), solid organ transplant (20%) or other causes of immunosuppression. In this group, SAPS2 was higher (51+/-20 versus 44+/-20; p<0.05) as mortality rate was (60% versus 23%). More than 90% of patients were ventilated and 55% needed extrarenal therapy. Caspofungin treatment was initiated for aspergillosis in 12 patients, candidiasis in 33 patients and others indications. Partial or complete response to treatment was 72%. Median duration of caspofungin administration was 11 days, no liver dysfunction or acute renal failure due to caspofungin was reported whatever initial liver function was.

CONCLUSION

This prospective open study demonstrate the very low toxicity of caspofungin even in critical care patients.

The first certifying examination in pediatric rheumatology

OBJECTIVE

On May 12, 1992, the first certifying examination in pediatric rheumatology was administered by the American Board of Pediatrics to 94 candidates. We describe the certifying process and the characteristics of the examinees.

METHODS

The Sub-board of Pediatric Rheumatology developed an examination consisting of 235 multiple choice items covering a broad range of topics pertinent to the subspecialty. Applicants with a current certificate in general pediatrics and a current medical license were admitted through one of 3 pathways requiring 2 years of fellowship training or equivalent practice experience.

RESULTS

Sixty-three percent of the candidates had completed at least 2 years of fellowship training. The total group average score was 76% correct. Eighty-five percent of the examinees passed the examination.

CONCLUSION

The 80 candidates who were certified received time limited certificates that may be renewed by a recertification process to begin in 1999. A second certifying examination was offered in 1994 and a third in 1996. Requirements for future certifying examinations will include 3 years of full time fellowship training and verification of meaningful accomplishment in research.

Second and third line hormonotherapy in advanced post-menopausal breast cancer: a multicenter randomized trial comparing medroxyprogesterone acetate with aminoglutethimide in patients who have become resistant to tamoxifen

In order to evaluate the efficacy of two different sequences of second and third line hormonotherapy in advanced post-menopausal breast cancer, 257 women aged 36-91 years (mean age: 63.6 years) who had become resistant to tamoxifen (TAM), entered into a multicenter randomized trial comparing two different regimens: 1) Aminoglutethimide (Ag) 500 mg/day with hydrocortisone supplementation from 30 to 60 mg/day; and 2) oral medroxyprogesterone acetate (MPA) 500 mg twice a day. 250 patients were evaluated following second line hormone therapy and, after cross-over, 128 following third line hormonotherapy. No significant difference was observed, during either second or third line therapies, for toxicity, survival, or response rate; however, in both second and third line therapies the median time to progression was significantly longer with Ag therapy.

Pediatric heart transplantation: surgical considerations for congenital heart diseases

Congenital anomalies of the atrium, of the pulmonary and systemic venous return, and of the great vessels are sometimes regarded as contraindications to heart transplantation. Among 10 children who underwent heart transplantation in our institution, five, aged 4 to 15 years and weighting 9 to 32 kg, previously operated on, had congenital anomalies. These lesions, encountered singly or in association, were single atrium (2), previous Mustard operation (1), hypoplastic left atrium (1), anomalous systemic venous return (3), anomalous pulmonary venous return (2), transposition or malposition of the great vessels (5), pulmonary artery hypoplasia (1). To enable correction of these lesions and to perform heart transplantation, the donor heart preparation was modified in four ways. The surgical techniques used for correcting these anomalies in this group were atrial septation, atrial enlargement, superior and inferior reroofing, double venous rerouting, septal realignment, full-length mobilization of the great vessels, and pulmonary artery reconstruction. All children survived operation and left the hospital in excellent condition. Follow-up ranged from 6 months to 3 years. All children are totally asymptomatic. As demonstrated by echocardiography, heart catheterization, and angiography, there are no stenoses, no shunts, and there is good atrial size and good orientation of the great vessels. On the basis of our experience, we conclude that with appropriate surgical techniques, most atrial, venous return, and intrapericardial great vessel anomalies are correctable at the time of orthotopic transplantation and that these techniques allow for a successful outcome in children.

Inferior vena cava stenosis in scimitar syndrome: a case report

The scimitar syndrome, first described by Chassinat in 1836, consists aessentially of an anomalous pulmonary vein draining whole or part of the right lung into the inferior vena cava. Associated anomalies are frequent, such as hypoplasia of the right lung, dextrocardia, malformations of the right pulmonary artery and bronchial tree, and abnormal arterial supply of the right lung (the so-called sequestration). This article describes a scimitar syndrome associated with stenosis of the inferior vena cava, whose initial diagnosis was made by two-dimensional echocardiographic Doppler color flow mapping. To our knowledge this is the first description of such an unusual association.

Palliative surgery in tetralogy of Fallot

Because much controversy surrounds the palliative surgical treatment of young children with tetralogy of Fallot the authors review their experience over 13 years with two procedures--the Blalock-Taussig operation and the Waterston shunt. Blalock shunts were performed 195 times in 172 patients; 147 had a single Blalock anastomosis which carried them through the critical period and allowed for later correction of the tetralogy. Thrombosis of the Blalock anastomosis occurred in two patients in the early postoperative period. In 23 patients a second shunt was necessary after the first Blalock shunt became inadequate in spite of being patent. The age of the children ranged from 2 weeks to 9 years, 74% being operated upon under the age of 2 years. There were four early deaths (2%) and five late deaths (2.5%) in this group. Of the last 91 consecutive patients operated upon between Sept. 1, 1972 and June 30, 1980 none have died. Between September 1968 and June 1980, 14 patients with tetralogy of Fallot underwent a Waterston shunt. Their ages ranged from 2 days to 4 years. Six patients were younger than 35 days at the time of operation. There were two operative deaths in this group. The Waterston shunt carries a high risk and is reserved for the occasional patient who needs palliation during the first weeks of life and in whom the anatomy of the subclavian artery does not favour a good Blalock-Taussig shunt. The Blalock-Taussig operation is preferred because it is safe and gives good sustained clinical results. The mortality was much lower than previously reported. The growth of the pulmonary arteries was good in most patients. The Blalock shunt did not increase the pulmonary resistance and it did not influence the operative mortality.

True diverticulum of the right ventricle: two cases associated with tetralogy of Fallot

A true right ventricular diverticulum is a rare malformation consisting of an accessory ventricular outpouching communicating with the right ventricle through a muscular annulus and located at the right superior margin of the right ventricle. Its normal myocardial structure causes it to function as normal ventricle and in itself does not cause functional disturbances. In all reported instances, the malformation was associated with a ventricular septal defect and obstructive lesions of the right ventricular outflow tract. The 2 patients we describe had partial resection at the time of repair of tetralogy of Fallot and are doing well one and four years postoperatively.

Cardiac angiographic findings in Friedreich's ataxia

Angiograms of 12 patients with typical Friedreich's ataxia were analyzed. The results corroborate previous reports and justify the conclusion that the cardiomyopathy is of the hypertrophic type. In 10 of 12 cases, the hypertrophy is concentric, and non obstructive. Less frequently (2 cases), this hypertrophy is accompanied by diffuse hypokinesis and depressed ejection fraction.

[Femoral nerve paralysis complicating anticoagulant treatments. A propos of 3 cases]

The authors report 3 new cases of femoral nerve paralysis complicating anticoagulant treatment. The first sign was pain, the neurological signs occurred later and the patient usually recovered but recovery was sometimes incomplete. The pathogenesis is not clear : a muscle hematoma, ischemia of the nerve trunk, and intraneural hemorrhage are the commonest theories.

A new surgical approach for correction of partial anomalous pulmonary venous drainage into the superior vena cava

Nine children with partial anomalous pulmonary venous drainage into the superior vena cava were operated upon. The technique consisted essentially of partitioning and enlargement of the superior vena cava. The partitioning was done in all but one patient, with a longitudinal suture starting above the highest pulmonary vein directing the pulmonary venous flow through the enlarged atrial septal defect into the left atrium. The anterior cavo-auricular tunnel was enlarged with a right atrial appendage-superior vena cava angioplasty. Follow-up studies were done between 1 and 3 years after surgery. The hemodynamic data were normal in 7 patients. In 8 children, the superior vena cava was unobstructed and its diameter was normal as demonstrated by cavograms. In all patients, the angiographic evaluation of the pulmonary venous return was normal. These results are encouraging and indicate that this new approach is superior to those which have previously been reported.

[Heart tumors in children. Report of 3 cases with favorable spontaneous courses]

During a 14-year period, 8 cases of primary heart tumours were observed at Sainte-Justine Hospital. Three of these patients had a favourable course without any surgical treatment. The age of these patients was respectively 3 days, 7 weeks and 6 1/2 years. In what concerns the first two patients, the clinical and paraclinical pictures were suggestive of heart disease from the onset. Catheterization and angiocardiography confirmed the presence of a tumour deforming both ventricular cavities. In these two cases, an attempt at surgical resection proved to be impossible in view of the extent of the lesion. Biopsy demonstrated a rhabdomyoma in one of the patients and a diffuse fibroma in the other. Six and four years later, the patients were still alive, and an improvement of both the electrocardiogram and of the cardio-pulmonary X-ray pictures were noted. A second cardiac catheterization showed an almost complete disappearance of the pathological pictures. In what concerns the third patient, he was a 6-year old child with a classical Bourneville's tuberous sclerosis with a localized tumour at the junction of the superior vena cava and the right atrium. Three years later a control catheterization showed the tumour to have remained unchanged. Two conclusions might be drawn from these cases: 1 a surgical operation, although always indicated, should never entail a desperate attempt at tumour removal; 2 the prognosis should never be considered as lethal from the start.