Methamphetamine exposure and chronic illness in police officers: significant improvement with sauna-based detoxification therapy.

BACKGROUND: The medical literature reports health hazards for law enforcement personnel from repeated exposure to methamphetamine and related chemical compounds. Most effects appear transitory, but some Utah police officers with employment-related methamphetamine exposures developed chronic symptoms, some leading to disability. This report is of an uncontrolled retrospective medical chart evaluation of symptomatic officers treated with a sauna detoxification protocol designed to reduce the chronic symptoms and improve the quality of life. METHODS: Sixty-nine officers consecutively entering the Utah Meth Cops Project were assessed before and after a treatment program involving gradual exercise, comprehensive nutritional support and physical sauna therapy. Evaluations included pre- and post-treatment scores of the Research and Development Corporation (RAND) 36-item Short Form Health Survey (SF-36) in comparison with RAND population norms, pre- and post-treatment symptom score intensities, neurotoxicity scores, Mini-Mental Status Examination, presenting symptom frequencies and a structured evaluation of treatment program safety. RESULTS: Statistically significant health improvements were seen in the SF-36 evaluations, symptom scores and neurotoxicity scores. The detoxification protocol was well tolerated, with a 92.8% completion rate. CONCLUSIONS: This investigation strongly suggests that utilizing sauna and nutritional therapy may alleviate chronic symptoms appearing after chemical exposures associated with methamphetamine-related law enforcement activities. This report also has relevance to addressing the apparent ill effects of other complex chemical exposures. In view of the positive clinical outcomes in this group, broader investigation of this sauna-based treatment regimen appears warranted.

Propofol versus midazolam plus meperidine for sedation during ambulatory esophagogastroduodenoscopy.

OBJECTIVE: To evaluate the efficacy and safety of propofol and meperidine plus midazolam for sedation during esophagogastroduodenoscopy (EGD) in children. METHODS: Data were collected prospectively and retrospectively from neurologically intact children (0.2-17.7 years of age) who underwent ambulatory diagnostic EGD during a 4-year period. Data were included from 155 consecutive patients receiving propofol with or without premedication with midazolam (PM group). One hundred five consecutive patients who received sedation with a midazolam plus meperidine combination served as a comparison (MM group). Outcome variables were: time required for induction of sedation, length of procedure, time for recovery, need for additional supportive measures, and need for physical restraint. RESULTS: The onset of sedation was faster and the length of procedure and recovery were significantly shorter in the PM group as compared with the MM group (P < 0.01). Patients in the MM group required restraint more often than in the PM group. A higher dose of meperidine and midazolam was used in the prospective study. This led to deeper sedation but increased need for additional support. CONCLUSIONS: Propofol is safe and effective for facilitating EGD in children.

Early ribavarin treatment of bronchiolitis: effect on long-term respiratory morbidity.

BACKGROUND: The mortality rate from respiratory syncytial virus (RSV) bronchiolitis has significantly reduced over the last decade. A major concern now is the long-term respiratory morbidity following RSV bronchiolitis. METHODS: In this prospective study, we randomly assigned 49 previously healthy infants with severe RSV bronchiolitis, early in the course of illness (< 5 days duration), to receive either conservative treatment (n = 21) or additional ribavirin treatment (n = 24). Both groups were closely matched for age and clinical characteristics. RESULTS: During a prospective, closely monitored, 1-year follow-up period, the group treated with ribavirin had significantly fewer episodes (2.7 +/- 2.3 episodes vs 6.4 +/- 4.2 episodes per patient per year) and reduced severity of reactive airway disease (0.08 episodes vs 1.09 episodes of moderate-to-severe illness per patient per year) and respiratory illness-related hospitalization (25 hospital days vs 90 hospital days per 100 patients per year). CONCLUSIONS: Early ribavirin treatment of RSV bronchiolitis in previously healthy infants resulted in reduction of incidence and severity of reactive airway disease as well as respiratory illness-related hospitalization.

Aspiration: a factor in rapidly deteriorating bronchiolitis in previously healthy infants?

The objective of this study was to evaluate the presence of indicators of aspiration in previously healthy infants with respiratory syncytial viral (RSV) bronchiolitis who experienced rapid deterioration in their respiratory status. Lipid-laden macrophage index (LLMI) was assessed in 6 previously healthy infants with RSV bronchiolitis and no prior history of aspiration, who had a rapid deterioration of their respiratory status requiring mechanical ventilation. Five of 6 infants had a LLMI of more than 100, a level that is very suggestive of aspiration. We conclude that aspiration is likely to play a role when rapid deterioration occurs in infants with RSV bronchiolitis.

Food and chemicals as environmental incitants

La susceptibilidad a provocadores ambientales de componentes presentes en el aire, la comida y el agua constituye un problema de salud conocido. Tales sensibilidades y reacciones pueden dar lugar a múltiples síntomas que afectan el músculo liso, las membranas y la sustancia colágena de los sistemas respiratorio, gastrointestinal y genitourinario. Estas reacciones pueden ser confundidas como hipocondriasis, pero son realmente reacciones a contaminantes y químicos presente en el medio ambiente casero y de trabajo del paciente. La realización de historias clínicas detalladas alertarán al médico y la enfermera de la industria, pudidendo establecer su relación, mediante eliminación y confrontamiento del paciente a las sustancias ofensivas mediante la realización de estudios cuidadosos y controlados