Singapore Armed Forces Medical Corps-Ministry of Health clinical practice guidelines: management of heat injury.

The Singapore Armed Forces (SAF) Medical Corps and the Ministry of Health (MOH) have published clinical practice guidelines on Management of Heat Injury to provide doctors and patients in Singapore with evidence-based guidance on the prevention and clinical management of exertional heat injuries. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the SAF Medical Corps-MOH clinical practice guidelines on Management of Heat Injury, for the information of readers of the Singapore Medical Journal. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website: http://www.moh.gov.sg/mohcorp/publications.aspx?id=25178. The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.

A comparison of aluminum levels in tea products from Hong Kong markets and in varieties of tea plants from Hong Kong and India.

This study project aimed to investigate the concentrations of aluminum (Al) in tea products available in Hong Kong markets. Tea samples consisting of 47 different tea bags and 28 samples of tea leaves were analysed for concentrations of Al. All tea samples released Al (0.70-5.93 mg L(-1)) during a standard infusion period. In comparison to the Joint FAO/WHO Provisional Tolerable Weekly Intake guideline of 7 mg Al kg(-1) body weight, it was concluded that tea made with these tea leaves will not impose adverse human health impacts. The relative effects of age, soil available Al, and genetic differences on the levels of Al accumulated by tea bushes were investigated. It was found that there was no definite trend between the amount of Al accumulated and the age of tea bushes. The soil available Al influenced the levels of Al in Camellia sinensis to a certain extent, but it was evident that the ability of different varieties of C. sinensis to accumulate Al was variable. C. sinensis accumulated Al in all stages of growth. Young seedlings had lower contents of Al while the mobility of Al within the tea bushes was high. In a manner typical of hyperaccumulators, Al was not retained in the roots, but was consistently transported to the shoots. Aluminum in the tea bush was distributed between the different parts in the following order: mature leaves>roots>branches>young leaves.

Polychlorinated biphenyls and organochlorine pesticides in human adipose tissue and breast milk collected in Hong Kong.

Contamination from persistent organic pollutants is a pervasive global problem that urgently demands global concern and action. In the present study, concentrations of organochlorine (OC) pesticides and polychlorinated biphenyls (PCBs) were determined in 37 samples of female adipose tissue collected in Hong Kong hospitals. Among the pollutants analyzed, DDTs (2.79 ng/g fat), HCHs (0.72 ng/g fat), and PCBs (0.19 ng/g fat) were prominent compounds in most of the adipose tissue. p,p'-DDE and hexachlorinated biphenyls were found in all samples, whereas heptachlor epoxide and dieldrin were found only in some samples. An estimation of toxic equivalency concentration (TEQ) due to dioxin-like coplanar PCBs was also performed. The estimated TEQ(PCBs) was 2.01 pg/g fat. This study also compared our previous results obtained from the milk samples of the same donors. Significant correlations are obtained for DDTs and HCHs between milk and adipose tissue. Detailed review of available information concerning OC pesticides and PCBs in different ecological compartments indicated that bioconcentration and biomagnification of these contaminants are common phenomena of the Pearl River Delta region, which has undergone rapid socioeconomic change in the past 20 years. It is suggested to establish a regional organization in order to coordinate the monitoring of persistent organic pollutants in the region.

Assessment of metal and nutrient concentrations in river water and sediment collected from the cities in the Pearl River Delta, South China.

The effects of anthropogenic activities, industrialization and urbanization on the accumulation of heavy metals and nutrients in sediments and water of rivers in the Pearl River Delta region were examined. Most sediments were seriously contaminated with Cd, Pb, and Zn in accordance with the classification by Hong Kong Environmental Protection Department. Total phosphorus (P) and nitrogen (N) concentrations in sediments ranged from 0.02% to 0.12% and 0.06% to 0.64%, respectively. High carbon (C), N, P and sulphur (S) levels at Yuen Long Creek were related to the discharge of industrial effluents along the river. The enrichment of P and ammoniacal-nitrogen (NH4+-N) in water were obvious. For most sites, the P concentration exceeded 0.1 mg/l, which is the recommended concentration in flowing water to encourage excessive growth of aquatic plants. Nine out of the 16 sites studied had NH4+-N concentration over 2 mg/l. The rivers in the south of Deep Bay (Hong Kong) had high nutrient exports compared with the rivers in the east region and western oceanic water. The concentrations of nitrate-nitrogen NO3--N in surface water were under the maximum contaminant level in public drinking water supplies (10 mg/l) except for one site. Although the concentrations of heavy metals in overlying water were low, their accumulations were significant. High contents of nickel (Ni) and zinc (Zn) in water were found at certain locations, suggesting the occurrence of some local contamination. These preliminary results indicated that river and sediment transported pollutants is likely one of the factors for the water quality degradation of Deep Bay water.

Organochlorine hydrocarbons in human breast milk collected in Hong Kong and Guangzhou.

In southern China, the awareness of persistent organic pollutant contamination has been increasing as a considerable number of past studies in Hong Kong had reported their trail in the coastal sediments, green-lipped mussels, muscle and viscera of pond fish, and foodstuffs. Hence there is an urgent need to assess their existence, contamination profiles, and potential impact on the public. In the present study, a survey was conducted to examine p,p'-DDT, p,p'-DDE, beta-HCH, and PCB concentrations in human breast milk, one of the most reliable bioaccumulation indicators. Milk samples (115 from Hong Kong and 54 from Guangzhou), in the lactation period from 3-5 weeks were analyzed. The results demonstrated that the mean levels of p,p'-DDT (Hong Kong: 0.39; Guangzhou: 0.70 microg/g of fat), p,p'-DDE (2.48; 2.85), and beta-HCH (0.95; 1.11) were 2-15-fold higher when compared with studies conducted elsewhere ( i.e., United Kingdom, Germany, Sweden, Spain, and Canada), and in contrast the concentration of PCBs (0.035; 0.031) was about 10 times lower. When compared to a similar study conducted 10 years ago in Hong Kong ( p,p'-DDT 2.17 microg/g of fat, p,p'-DDE 11.67, beta-HCH 15.96, and PCB 0.64), a considerable reduction in the levels of their contaminations was observed. The drastic reduction in body burdens in 10 years' time is presumably the result of effective regulatory actions. It is worth noting that body burden correlated positively with maternal age (total DDT, r = 0.93; beta-HCH, r = 0.91; PCBs, r = 0.77) and with historical record of seafood consumption (total DDT, r = 0.89; beta-HCH, r = 0.98; PCBs, r = 0.91) (p < 0.001) and potential uptake of the POPs by breastfed infants may pose adverse health hazards.