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Background@#Intravenous (IV) iron therapy is performed in community practices and hospitals with modern formulations when oral administration becomes impractical. Effective replacement of iron is important for the treatment of iron deficiency and anemia. Can IV iron be rechallenged in individuals with a history of adverse reactions? This review is to explore the challenge of this, when clinically indicated. @*Methods@#After performing a literature search, five studies (combined total sample number=1,006) for re-exposure of IV iron to individuals with a history of past reactions were identified, observed, and analyzed. Re-exposure included reactions ranging from mild to moderate and few cases of severe type. @*Results@#The majority (>80%) of IV iron rechallenges were tolerable, safe, and successful without major serious incidents. There were no reports of major reactions (severe hypersensitivity reactions or anaphylaxis) in these re-exposures. @*Conclusion@#Re-administration of IV iron therapy in patients with a previous adverse reaction is plausible, with benefit and risk stratification. A rechallenge would depend on the nature and degree of the adverse reaction and use of alternative formulations. Rechallenge to a previous severe hypersensitivity reaction or anaphylaxis with the same product has not been reported in these studies. Evidence on the benefit of premedication use is conflicting and requires further studies.
ABSTRACT
@#Food safety is a growing public health concern worldwide. Street foods are an integral part of many cultures and offer at affordable prices. However, it is associated with food safety issues, especially in developing countries. Therefore, it is essential that street food vendors understand and implement food safety practices to prevent outbreaks of food-borne illnesses. This cross-sectional study investigated the food safety knowledge and practices as well as their associated factors among street food vendors in Taunggyi Township, Myanmar. Validated structured questionnaires were used to interview 158 street food vendors, and a set of observational checklists was used to inspect the sanitary conditions of vending sites and vendors’ food hygiene practices. The association between food safety knowledge and practices was assessed using a chi-squared test. Our results revealed that most vendors had a high level of food safety knowledge and that 58.9% scored equal to or lower than the median value in food safety practices, whereas 41.1% scored higher than the median value (median=15). Sex and education level were significantly associated with participants’ food safety knowledge (p < 0.001). Similarly, education, race and monthly income were significantly associated with their food safety practices (p < 0.001), whereas food safety training attendance had no association. Additionally, participants with better knowledge scores were more likely to have better practice scores. Food safety training given to vendors should be more detailed and comply with standard guidelines, especially with regard to street food safety practices.
ABSTRACT
<p><b>INTRODUCTION</b>Although rhabdomyosarcoma (RMS) constitutes nearly 4% of all children diagnosed with cancer in the ethnically diverse small island city of Singapore, it is unknown how children with RMS fare.</p><p><b>MATERIALS AND METHODS</b>This study investigated 50 children with RMS from April 1993 to December 2010 from KK Women's and Children's Hospital (KKH) and National University Hospital (NUH). They were treated either as per Intergroup Rhabdomyosarcoma Study Group (IRSG) or Société Internationale Pediatrique D'Oncologie (SIOP) regimens.</p><p><b>RESULTS</b>Median age of diagnosis was 5.1 years (range, 0.1 to 17.3 years) with a median follow-up of 3.3 years (range, 0.4 to 15.6 years). According to IRSG classifi cation, 18 (36%) were staged as low-risk (LR); 19 (38%) were intermediate-risk (IR), 12 (24%) were high-risk (HR) and it was unknown in 1 patient. Twenty-nine (58%) were of embryonal subtype, 17 (34%) were alveolar and subclassification was not available in 4. The primary sites of tumour were: head and neck region (n = 22); genitourinary (n = 19); extremity (n = 10); and abdomen/retroperitoneal (n = 5). At the time of analysis, 80% were alive with no evidence of disease, 9 were dead of disease, and 2 were alive with disease. By disease risk group, the 5-year event-free survival (EFS) for LR group disease was 81.3% (95% CI, 62.0 to 100.0), IR group was 61.4% (95% CI, 32.3 to 90.4) and HR group was 25.0% (95% CI, 0.0 to 49.5) respectively (P <0.001). The 5-year EFS for risk by chemotherapy received as per SIOP vs per IRSG revealed: LR 83.3% vs 75.0% (P = 0.787); IR 83.3% vs 43.8% (P = 0.351); HR 0.0% vs 42.9% (P = 0.336) respectively. Of 15 relapses (HR, n = 7), at median of 2 years, 4 of 6 patients treated as per SIOP regimen were dead of disease and 3 of 8 treated as per IRSG were alive.</p><p><b>CONCLUSION</b>Radiation therapy (RT) can be avoided in LR classification although those in higher risk classification need RT to local and distant metastatic disease. The outcome of children with RMS in Singapore can be further improved by coming together as a cooperative group to provide the best total care. Improved communication, multidisciplinary team collaboration, standardisation of protocols and rigorous data collection are keys.</p>