Post-vaccination aluminium granulomas in children. / Aluminiumsgranulomer etter barnevaksinasjon.

BACKGROUND: Persistent itching subcutaneous granulomas related to aluminium-containing vaccines are poorly recognised in health care. They are often associated with aluminium hypersensitivity. CASE PRESENTATION: An intensely itching subcutaneous nodule appeared on the left thigh of a 17-month-old girl at the injection site for an aluminium adsorbed diphtheria-tetanus-pertussis-polio-HiB vaccine given at 3, 5 and 12 months. Ultrasound suggested a vascular malformation among other differential diagnoses. An MR investigation under general anaesthesia was planned, but the diagnosis was confirmed prior to this by a positive epicutaneous test with aluminium. INTERPRETATION: Despite a typical history of an itchy vaccination granuloma, the child underwent a thorough hospital workup to rule out malignancy. The diagnosis was delayed for two years. Vaccination granulomas have a good prognosis but can persist for many years. It is important to recognise the condition early in primary health care to avoid unnecessary anxiety and investigations.

The impacts of pesticides on the health of farmers in Fasa, Iran.

BACKGROUND: With the growing global population, it is becoming increasingly difficult to ignore the demands for food and energy. A major portion of the food and energy is produced via agriculture and livestock activities. The objectives of this research are to gather information regarding the demographic features of farmers, previous poisoning, and the extent of farmers' knowledge in the use of pesticides and associated hazards in different counties and villages in Fasa, a city located in the Fars province of Iran. METHODS: This cross-sectional study was carried out from March to July 2012 in the Nobandegan and Sheshdeh counties, and villages including Miandeh, Fedshkuyeh, Senan, Rahimabad, and other places in the Fasa suburban countryside. To collect data, an appropriate questionnaire was designed and implemented. RESULTS: A total of 200 farmers participated in the study. We found that 55% of farmers were illiterate. Approximately 86% of used pesticides were organophosphorus compounds. Around 30% of the farmers used no protective equipment while working with pesticides, and only 22% of farmers had read and understood the instructions on the pesticide containers. CONCLUSION: Given the toxicity and hazards of pesticides and their adverse effects on farmers' health, effective measures should be adopted to decrease the amount of pesticides used. Conducting training programs for farmers may help to reduce pesticide exposure risks.

Clinical scaphoid score (CSS) to identify scaphoid fracture with MRI in patients with normal x-ray after a wrist trauma.

INTRODUCTION: The aim of this study was to compare a combination of three commonly used tests to identify scaphoid fractures with MRI in patients with normal x-ray after a wrist trauma. PATIENTS AND METHODS: This prospective MRI study included patients between 18 years and 49 years, who attended the Emergency Department, Bergen, Norway after sustaining an acute wrist trauma within the previous week. Initial x-rays of the wrist were normal. MRI was done within a median of 1 day after the trauma. The study period lasted 1 year. The patients were examined with three commonly used clinical scaphoid tests; tenderness in the anatomical snuffbox with the wrist in ulnar deviation (3 points), tenderness over the scaphoid tubercle (2 points) and pain upon longitudinal compression of the thumb (1 point). The clinical scaphoid score (CSS) is a sum of these points, which was compared with MRI verified fracture of the scaphoid. RESULTS: We included 154 patients with wrist sprain and normal x-rays; 13 had occult scaphoid fracture. A CSS of 4 or more was the only statistically significant 'cut-off' value to identify occult scaphoid fractures (p<0.05). Diagnostic sensitivity increased with more experienced Emergency Department doctors. CONCLUSIONS: If a patient with wrist pain after injury and normal x-ray has a CSS≥4 (pain in the anatomical snuffbox in addition to pain at scaphoid tubercle or longitudinal compression or both) we recommend MRI. A CSS <4 has a negative predictive value of 96%, which makes scaphoid fracture unlikely.