Rituximab for management of refractory pregnancy-associated immune thrombocytopenic purpura.

BACKGROUND: Rituximab is a novel therapy for immune thrombocytopenic purpura (ITP); however, information about its safety in pregnancy is limited. This case illustrates the successful use of rituximab to treat pregnancy-associated ITP. CASE: A 34-year-old woman presented with severe ITP at 23 weeks' gestation. Standard treatment with corticosteroids, intravenous immune globulin, and splenectomy failed to raise the platelet count. Due to ongoing bleeding, rituximab was given in the 26th week of pregnancy. The platelet count rose to over 100 × 10(9)/L after four weeks. The neonatal B-lymphocyte count normalized at four months after delivery. There were no neonatal complications of rituximab therapy. CONCLUSION: Rituximab may be safe for use in treating pregnancy-associated ITP. This case highlights the need to investigate further the safety and efficacy of rituximab in pregnancy.

Heart rate variability of recently concussed athletes at rest and exercise.

PURPOSE: The objective of this study was to assess the neuroautonomic cardiovascular regulation in recently concussed athletes at rest and in response to low-moderate steady-state exercise, using heart rate variability (HRV). METHODS: A 5-min ECG sample was taken at rest from the 14 concussed athletes at 1.8 (+/- 0.2) days postinjury and again at 5 d later. Once asymptomatic at rest, the concussed athletes and their matched controls (N = 14) participated in an exercise protocol. The protocol consisted of a 2-min warm-up with a pedaling frequency between 50 and 60 rpm against a load of 40 W. After the warm-up, the athletes engaged in a low-moderate intensity steady state 10-min exercise bout where the pedaling frequency and load increased to 80-90 rpm and 1.5 W x kg(-1) body weight, respectively. The protocol was repeated 5 d later. A 5-min ECG sample from minutes 4 to 9 of the low-moderate intensity steady state exercise bout was used to assess HRV during exercise. Mixed model ANOVA were used to analyze the data. RESULTS: No difference at rest was detected between the concussed athletes and their matched controls in any of the HRV variables measured. However, across both exercise tests, the concussed group demonstrated a significant decrease in the mean RR interval, and low- and high-frequency power (P < 0.05) in relation to their matched controls. CONCLUSION: Low-moderate steady-state exercise elicits a neuroautonomic cardiovascular dysfunction in concussed athletes that is not present in a rested state. This dysfunction alludes to an exercise induced uncoupling between the autonomic and cardiovascular systems.

Task frequency as a function of age for the powerline technician trade.

It is traditionally believed that worker productivity declines with age. The greatest contributor to this stereotype, particularly in physically demanding jobs, is that older workers can no longer maintain their sustained level of work due to the age-associated decline in physical capacity. The objective of this study was to determine the change in the frequency of task performance as a function of age in the power line technician (PLT) trade. The task requirements of the PLT occupation were determined through the use of a detailed job demands analysis (JDA) and the frequency at which these tasks were performed was acquired through a survey derived from the JDA. The results of the survey were assessed as a function of age. Older lineworkers (> or = 50 years) were found to spend more time working on the ground whereas the younger PLTs (< or = 39 years) more frequently performed the climbing tasks and the corresponding work on the poles and towers. In contrast the older PLTs performed all pushing/pulling tasks at a greater or equal frequency to that of the younger lineworkers. Despite these differences the frequency of task performance is similar across the age groups studied.

Changes in physical capacity as a function of age in heavy manual work.

The objective of this study was to assess the changes in the physical capacity as a function of age in power line technicians (PLTs). The physical test was designed to closely represent the essential physical tasks of the occupation that were identified through a detailed job demand analysis. The results from the physical test showed that six out of nine test variables did not demonstrate a statistical difference between the mean scores of young (< or = 39 years) and old age (50+ years) groups. However the older group scored significantly lower in the aerobic capacity test, one-handed pull down, and both right and left standard handgrip tests. Despite these differences the older PLT appears to meet and exceed the physical requirements necessary to carry out the essential tasks of this trade. However a physical test with a high level of content and construct validity is necessary to accurately evaluate the workers physical capacity in relation to the job demands. Based on the principal of specificity for muscle training and testing, this study has demonstrated that heavy manual work appears to maintain physical capacity specific to the task as age progresses.