Effects of gas and other fume emitting heaters on the development of asthma during childhood.

BACKGROUND: Several studies have shown adverse effects of gas cookers and heaters on respiratory health. The long term effects of early life exposure to these appliances are not known. This study investigated the effect of exposure to fume emitting heaters, currently and during the first year of life, on the risk of asthma outcomes. METHODS: A cross sectional study of schoolchildren (n = 627) aged 8-11 years was conducted in Belmont, Australia. Information on symptoms and heating types was collected by parent completed questionnaire. Atopy was assessed by skin prick tests and airway hyperresponsiveness (AHR) was assessed by histamine challenge test. RESULTS: There was no association between the current use of fume emitting heaters and any of the asthma outcomes. However, having been exposed to fume emitting heaters during the first year of life was associated with an increased risk of having AHR (relative risk (RR) 1.47, 95% confidence interval (CI) 1.06 to 2.03), recent wheeze (RR 1.44, 95% CI 1.11 to 1.86), and recent wheeze + AHR (RR 2.08, 95% CI 1.31 to 3.31). CONCLUSION: If confirmed in other settings, this finding would require a review of the range of heating types that are appropriate for use in households in which young children live.

Unplanned extubation: a local experience.

OBJECTIVES: To study the outcome of unplanned extubation (UE) in the Medical Intensive Care Unit (MICU) and to identify factors which predict the need for reintubation. METHODS: A prospective study of all mechanically ventilated patients admitted to MICU in 1998. Patients were enrolled into the study at the point of their first UE. The primary endpoint was reintubation after UE and secondary endpoint was death from any cause during hospitalisation. RESULTS: A total of 543 patients were admitted to MICU of which 312 were mechanically ventilated. UE accounted for 8.7% of our mechanically ventilated patients. The mean APACHE 11 score was 20 (+/- 10), mean time between intubation and UE was 3.1 days (+/- 3.1), mean length of MICU stay was 10.1 days (+/- 10.2) and mean hospital stay was 27.0 days (+/- 36.1). Eighty-seven percent of the UE was deliberate. The rate of reintubation after failed UE was 58.3% of which 71.4% had immediate reintubation. Twenty-nine percent of patients were undergoing weaning during UE. The in-hospital mortality was 25%. All deaths occurred in the group who failed UE. Patients who failed UE had a higher mean APACHE 11 score, a higher mean pre-extubation FiO2 level and a lower mean PaO2/ FiO2 ratio (p < 0.05). CONCLUSION: UE accounted for 8.7% of our mechanically ventilated patients and 58.3% of these patients required reintubation. Failed UE was associated with a higher mortality. A higher APACHE 11 score, higher pre-extubation FiO2 level and a lower PaO2/FiO2 ratio were associated with reintubation after failed UE.

A case of Mycobacterium scrofulaceum osteomyelitis of the right wrist.

INTRODUCTION: The objective of the case report is to highlight the possibility of osteomyelitis caused by atypical mycobacteria. Such an infection may simulate tuberculous bone infection and yet fail to respond to standard anti-tuberculous drug therapy. CLINICAL PICTURE: A 66-year-old man who suffered from diabetes mellitus presented with osteomyelitis of the right wrist, with extensive synovial swellings of the flexor tendon sheaths. The clinical features, radiological appearances and histology suggested a tuberculous infection, but subsequent culture grew an atypical mycobacterium, Mycobacterium scrofulaceum. TREATMENT AND OUTCOME: There was good clinical improvement and control of the infection with a regime of kanamycin, ethambutol and ethionamide to which the organism was sensitive. CONCLUSION: This case illustrates the need to be aware of the possibility of infection with atypical mycobacteria in cases of suspected tuberculosis of the skeletal system which fail to respond to standard treatment.