ABSTRACT
It is very important to report suspected occupational diseases in Iceland to the Administration of Occupational Safety and Health, so they can be diagnosed, investigated in details and improvements made. This article describes the illness of clam workers at Thornórshöfn, a small village in the northern part of Iceland. It lead to a detailed investigation and the diagnosis of clamworkers hypersensitivity pneumonitis. Many specialists participated in the study that lead to improvement in the factory that has benefitted the workers.
ABSTRACT
OBJECTIVE: Henoch-Schönlein purpura is a disease of small vessels which primarily affects children. The epidemiology of Henoch-Schönlein purpura in Iceland is not known. The main purpose of the study was to find out the incidence of the disease in Iceland and gather further epidemiological information. PATIENTS AND METHODS: All patients diagnosed with Henoch-Schönlein purpura during the years 1984-2000 and were admitted to the Children's Hospital Iceland, Landspítali Hringbraut as well as the paediatric department at the Landspítali Fossvogi were included in the study cohort. Information was gathered from medical records. The temporal relationship between the incidende of Henoch-Schönlein purpura and epidemics of three common infectious diseases was explored. RESULTS: A total of 101 patients were found to have Henoch-Schönlein purpura, 51 females and 50 males. The incidence of Henoch-Schönlein purpura in Iceland is therefore approximately six cases annually. The mean age at diagnosis was 5.4 years. In addition to the rash, 72.3% had arthralgia and 45.5% abdominalia, 36.6% had hematuria or proteinuria during the hospitalization and 5.9% had severe renal involvement. The disease was more common in the winter months (Nov. - April) compared to the summer months (May - Oct.) (p=0.045). CONCLUSIONS: The epidemiology of Henoch-Schönlein purpura in Iceland is comparable to other countries. The disease was most common in children aged 2-5 years, which could reflect a common infection in the community as a part of the pathogenesis. Older children may have antibodies against these infections resulting in a decreased incidence of the disease. Our results support the theory that infection may play an important role in the pathogenesis of Henoch-Schönlein purpura. However, some abnormalities or variations in the immune response are probably also involved.
ABSTRACT
OBJECTIVE: Quinine is a drug which is mainly used for prevention of nocturnal leg cramps. Serious side effects of this drug have been described in recent years, including cytopenias and the hemolytic-uremic syndrome. We report seven cases of severe adverse effects of quinine. MATERIAL AND METHODS: Seven patients who were hospitalized with adverse effects of quinine during the period 1978-2000 are described. Medical records were reviewed with respect to clinical and laboratory features. Serum samples from three patients were tested for quinine-dependent antibodies against platelets and/or granulocytes by flow cytometry. RESULTS: All patients were females aged 52 to 79 years, who were taking quinine for nocturnal leg cramps. Five of the patients experienced recurrent episodes of fever, chills, nausea and vomiting, and three had abdominal pain as well. Two of these patients had pancytopenia, one of whom had evidence for disseminated intravascular coagulation. One had leukopenia and thrombocytopenia. Two patients developed hemolytic-uremic syndrome associated with disseminated intravascular coagulation. One of them suffered irreversible renal failure requiring maintenance hemodialysis. One year later she underwent successful kidney transplantation. All patients had taken quinine several hours prior to the onset of symptoms. In two cases the clinical findings were reproduced by the administration of quinine. Quinine-dependent IgG antibodies against platelets were detected in two patients and against granulocytes in one patient. CONCLUSIONS: These cases illustrate the severe adverse effects that can be caused by quinine. Five patients had solid evidence for side effects of quinine being the cause of their illness and strong suggestions of association with the drug were present in two patients. In view of potentially life-threatening side effects, it appears prudent to prohibit the availability of quinine over the counter. Furthermore, it is important that physicians thoroughly consider the indication for each prescription of quinine and remain vigilant toward its side effects.
