[Characterization of poisoning by the coconut crab, Birgus latro, in New Caledonia: aspects of clinical and toxicological features and treatment in 23 cases]. / Caractérisation des intoxications par le crabe de cocotier Birgus latro L. en Nouvelle-Calédonie : données cliniques, toxinologiques et thérapeutiques, à partir de vingt-trois cas.

We report 23 cases of poisoning, 4 fatal, due to ingestion of coconut crab, Birgus latro, in New Caledonia. Clinical and biological features of this poisoning are characterized, and the toxin complex is described. We suggest a treatment strategy based on digoxin-specific antibody fragments for patients in a life-threatening condition.

Severity markers in severe leptospirosis: a cohort study.

We aimed to evaluate parameters for their value as severity markers in hospitalized leptospirosis patients. We recruited 47 informed adult consenting patients and assessed a number of clinical, hematological, biochemical, and biological variables. Patients were sorted according to severity based on fatality or the requirement of mechanical ventilation or dialysis; the parameters studied were compared between groups on inclusion and the next day. Beside septic shock presentation or a high severity score (Simplified Acute Physiology Score; SAPS II), increased lactate, total bilirubin, lipase, and AST/ALT ratio or a decreased cytokines IL-10/TNF-α ratio were all significantly associated with severity. The gene expression of the IL-1 receptor antagonist IL-1ra, IL-1α, and the long pentraxin PTX-3 were also transcribed at higher levels in most severe cases. Patients could rapidly improve or deteriorate, highlighting the need for a new assessment the next day. Our results add to the limited body of knowledge about severity markers in leptospirosis. They also suggest that patients should be reassessed the next day before being possibly discharged from the hospital. Further studies are needed in order to confirm relevant and reliable prognostic parameters in leptospirosis that would be helpful for the purpose of triage.

First successful curative use of digoxin-specific Fab antibody fragments in a life-threatening coconut crab (Birgus latro L.) poisoning.

We wish to report the first curative use of digoxin-specific Fab antibody fragments in a coconut crab Birgus latro L. poisoning in New Caledonia. The female patient, aged sixty-three with a previous history of cardiovascular and metabolic dysfunctions, showed marked first-degree atrio-ventricular block and several atrial pauses, and was given 760 mg of digoxin-specific Fab antibody fragments. Shortly after the perfusion her electrocardiogram returned to close to normal with only slight first-degree atrio-ventricular block and no more atrial pauses. Neriifolin LC-MS/MS tests performed on the patient's serum and urine samples confirmed cardenolide poisoning. Another, younger patient, with high neriifolin levels in her serum and urine samples only experienced gastro-intestinal symptoms and was discharged without specific treatment. The consumption of coconut crab in New Caledonia should be avoided even though the first of the two cases reported suggests that digoxin-specific Fab antibody fragments can be effective in the treatment of life-threatening poisoning caused by the ingestion of this crustacean.

WORKSAFE IOWA Occupational Medicine Associates Network: a university--community partnership in occupational safety and health.

The WORKSAFE IOWA Occupational Medicine Associates Network is a unique health care model for dispensing regional occupational medicine services in the state of Iowa, USA. WORKSAFE IOWA is an educational, informational, and consultation service of the College of Public Health at The University of Iowa. WORKSAFE IOWA includes a fee-for-service industrial hygiene program, the Occupational Medicine Associates Network, and educational and informational services. The Associates Network provides education, information, and consultation in exchange for an annual fee paid by each Associate to the university-based network. The Associates clinics provide comprehensive occupational medicine services to up to 1,500 clients through 66,000 annual clinic visits in their respective communities. The Associates Network has been financially self-sustaining over a period of 10 years, and has proven to provide valuable services to the community-based Associates, and to provide excellent training opportunities for the University students in several occupational safety and health disciplines.

The role of the School of Public Health at the Nofer Institute of Occupational Medicine in multidisciplinary training of physicians in occupational medicine.

The School of Public Health was opened on 30 June 1992 as an integral part of the Nofer Institute of Occupational Medicine. The late Director General of the Institute, Professor Janusz A. Indulski (1930-1999) was its initiator and founder. The School of Public Health is a scientific, research and didactic unit of the Nofer Institute. It offers post-graduate studies in the areas of occupational medicine, work hygiene, public health, environmental health, organization and management of health care and health promotion. The opportunity for multidisciplinary education of specialists in occupational medicine lies in the fact that the didactic process organized by the School is based on the knowledge, experience and skills of the Institutes' research workers. Lectures are provided by 100 persons, including 22 professors, 6 assistant professors and over 50 doctors. The didactic team also includes outstanding national and international experts (WHO, OECD, IAAE, etc.). During the last five years, the number of students increased from 1200 in 1996 to over 2200 by the end of 2000.

Requirements for occupational medicine training in Europe postulated by Polish professionals.

In order to determine common key competences required for occupational medicine specialists across Europe, a questionnaire has been developed and disseminated in several European countries. The questionnaire contained 115 subjects relating to eight fields of activity of an occupational medicine physician (occupational hazards to health, assessment of disability and fitness for work, communications, research methods, management, environmental medicine, occupational health law and ethics, and health promotion). Items in each part were classified into three categories: knowledge, experience and skills. For each of the subjects respondents were asked to allocate a score from 0 to 5, where 0 = not necessary, 1 = of minimal importance and 5 = most important or essential. In Poland the questionnaire was distributed between two groups of specialists: group I--chief administrators of occupational health services, and group II--relatively younger occupational medicine physicians participating in a specialist training. A comprehensive analysis of the completed questionnaires had three dimensions: (a) substantive (classification of the importance of particular key competences, as perceived by Polish specialists in occupational medicine), (b) personal (differences in opinions among occupational medicine physicians and an attempt to explain these differences in sociological terms), (c) comparative (evaluation and interpretation of similarities and differences between two groups). A hierarchy of requirements for occupational medicine training in Poland was constructed, with one set of competences recognized by the respondents as needless and others as useful with different grade of importance. Surprisingly, a wide diversity of opinions among respondents has given rise to the explanation hypotheses, some of them being verified using the material gathered.

[Attitudes of Polish occupational medicine physicians towards a proposal of requirements for occupational medicine training in Europe]. / Postawy polskich lekarzy medycyny pracy wobec europejskiego projektu wymagan szkoleniowych w tej dziedzinie.

In order to determine key competences required of occupational medicine specialists, common throughout Europe, a questionnaire has been developed and distributed among several European countries. The questionnaire contained 115 subjects related to 8 fields of activities carried out by occupational medicine physicians (occupational hazards to health, assessment of disability and fitness for work, communications, research methods, management, environmental medicine, occupational health law and ethics, and health promotion). In each of these fields, competences were classified into three following categories: knowledge, experience and skills. Respondents were asked to allocate a score from 0 to 5 for each subject, where 0 = not necessary; 1 = of minimum importance, and 5 = most important or essential. In Poland the questionnaire was distributed among two groups of specialists: group I--experienced specialists in occupational medicine (leading representatives of occupational health care management), and group II--relatively younger and less experienced occupational medicine physicians, participating in the specialist training, organised by The Nofer Institute of Occupational Medicine. A comprehensive analysis of the completed questionnaires was carried out in two dimensions: substantive (the importance of individual competences as perceived by Polish specialists in occupational medicine), and comparative (evaluation and interpretation of similarities and differences between two groups of respondents). A hierarchy of requirements, occupational medicine training in Poland is to satisfy, was reconstructed with two sets of competences, one recognised by respondents as needless and the other recognised as useful with different grades of importance. Some characteristic differences in opinions between two groups studies were highlighted.

[The role of public health schools in the training of occupational medicine specialists in the United States of America]. / Rola szkól zdrowia publicznego w ksztalceniu lekarzy specjalistów medycyny pracy w Stanach Zjednoczonych Ameryki Pólnocnej.

The author addresses some aspects of specialist training of occupational medicine physicians in the United States of America, and discusses detailed requirements of the American Board of Preventive Medicine that have to be satisfied by a physician, specialising in this field in order to obtain the title of a specialist in occupational and environmental medicine. The role of Schools of Public Health in the process of specialist training, and some new opportunities and organisational solutions offered by these Schools are presented. A residency training programme offered by an accredited School of Public Health, University of Michigan is used as an example. The number of specialised occupational medicine physicians, practising in the USA is given. The data indicate that during the last ten years the number of physicians who enter into the training process in this field continued to show an upward tendency. Some opinions trying to explain the reason for a continuous lack of occupational medicine specialists in the United States are also presented.

Polymorphism and complexity of HLA-DR: evidence for intra-HLA-DR region crossing-over events.

HLA-DR molecules were isolated from HLA-DR3, -5, and -w6 positive homozygous B-cell lines by immunoprecipitation with monoclonal antibodies and analyzed by gel electrophoretic techniques. DNA isolated from the same cell lines was digested with the restriction enzyme Taq I and hybridized with a DR beta full-length cDNA probe. We demonstrated that certain DR beta I alleles are found in combination with different DR beta III alleles as defined by Southern blotting, protein chemistry, a functional assay using purified protein derivative-specific T-cell lines, and, in one case, also alloreactive T-cell reagents. Our results indicate that within the family of HLA-DRw52-associated haplotypes DR beta chain genes may have been transferred from one haplotype to another. The implications of these findings are discussed.

Molecular, serologic, and functional evidence for an apparent HLA-DR triplet.

During routine typing procedures the individual GER was demonstrated to possess an unusual class II phenotype exhibiting three DR serotypes (DR1, DR2, DRw6). Closer serologic examination on this person's family showed that the DR1 and DR2 antigens segregated together on one haplotype. Biochemical evidence will be presented that the B cell line derived from the individual GER expresses five distinct types of DR molecules. Antigen presentation studies proved that the DR molecules carrying either DR1, DR2, or DRw6 (DRw13) allodeterminants are not only coordinately expressed but also are functional. No evidence could be found for altered DQ expression. The implications of these findings for the evolutionary aspects of the MHC class II region will be discussed.

Polymorphisms within the HLA-DR3 haplotypes. I. HLA-DR polymorphisms detected at the protein and DNA levels are reflected by T-cell recognition.

HLA-DR molecules were isolated from eight different HLA-DR3 homozygous B-cell lines by immunoprecipitation with monoclonal antibodies, and they were subsequently analyzed by two-dimensional gel electrophoresis. We found that HLA-DR3 homozygous B-cell lines of consanguineous origin express two types of HLA-DR molecules. One type of HLA-DR molecule was present in all the cell lines tested, whereas the second DR molecule appears to be polymorphic. DNA isolated from the different HLA-DR3 homozygous cell lines was studied by Southern blot analysis to determine whether any DR beta restriction fragment length polymorphism could be observed. Polymorphisms detected at both the product and genomic level have been compared to each other, and their relations to the serological (HLA-DR) and cellular (HLA-D and LB-Q1) typing data will be discussed.