First case of vaccine-strain varicella infection as manifestation of HIV in healthcare worker: a case report and review of the literature.

Live-attenuated varicella vaccination is safe in non-immunocompromised populations and is associated with rare non-serious adverse events. A healthcare worker (HCW) developed varicella infection, and exposure investigation led to immunization against varicella in an exposed non-immune HCW. Subsequently, vaccine-strain-induced disseminated varicella and progressive outer retinal necrosis in the exposed HCW resulted in identification of undiagnosed human immunodeficiency virus infection. This article reviews serious adverse events from varicella vaccination, and extreme caution is advised prior to live vaccination of HCWs.

Hepatitis C screening and prevalence among urban public safety workers.

This study examines the prevalence of anti-hepatitis C virus by using an enzyme-linked immunoassay test (EIA-2) in 2447 volunteers (including 1560 police, 678 fire, and 209 emergency medical service personnel) and a self-reported questionnaire on potential occupational and non-occupational risk factors. Subjects consisted of 76% men, 54.8% blacks, and 40.3% whites. Twenty-eight individuals (1.1%) tested positive, with prevalence rates of 1.1% and 1.3%, respectively, among blacks and whites. Although firefighters and emergency medical service workers had a higher prevalence (2.3% and 2.8%) than police (0.6%), the overall prevalence was lower than that typical of urban populations. In a multivariate analysis, the most important risk factors were behavioral, with no significant occupational exposure risk observed. Previously reported racial differences were not detected in this study, most likely because the subjects were of similar socioeconomic status.

Concentration of marijuana metabolites in the urine after ingestion of hemp seed tea.

To determine whether ingestion of hemp seed tea could result in positive urine drug screens for cannabinoids, volunteers were recruited to donate urine after consuming hemp seed or placebo tea. Among the 22 participants, 10 ingested 12 ounces of hemp seed tea, 10 ingested 24 ounces, and 2 ingested 12 ounces of placebo tea. Urine cannabinoid specimens were obtained at baseline and at 4, 8, and 24 hours after ingestion. A total of 10 specimens had trace quantities of cannabinoids detected in 7 subjects on gas chromatography/mass spectrometry testing, all below the Department of Transportation cutoff level of 15 ng/mL. These results demonstrate that under the conditions of this study, hemp seed tea consumption can result in detectable urine cannabinoids but would not trigger a positive EMIT or gas chromatography/mass spectrometry urine drug test for cannabinoids.

Design issues in studies of radon and lung cancer: implications of the joint effect of smoking and radon.

Many case-control studies have been undertaken to assess whether and to what extent residential radon exposure is a risk factor for lung cancer. Nearly all these studies have been conducted in populations including smokers and nonsmokers. In this paper, we show that, depending on the nature of the joint effect of radon and tobacco on lung cancer risk, it may be very difficult to detect a main effect due to radon in mixed smoking and nonsmoking populations. If the joint effect is closer to additive than multiplicative, the most cost-effective way to achieve adequate statistical power may be to conduct a study among never-smokers. Because the underlying joint effect is unknown, and because many studies have been carried out among mixed smoker and nonsmoker populations, it would be desirable to conduct some studies with adequate power among never-smokers only.

Screening for occupational-related diseases.

This article presents an overview of and an insight into the world of medical screening. Specific examples of screening programs designed for a variety of employee populations with a potential for exposure to some very common and some very exotic work place hazards are provided. The benefits to be derived from such programs and some of their limitations are outlined.

Training and proficiency in the medical review of job applicant drug screens.

A survey was performed to examine the proficiency of urine drug screen medical review officers (MROs) and the effect of training upon their performance. One hundred thirty-nine attendees of the ACOEM basic MRO training course, and 82 attendees of the advanced course completed both pre- and postcourse surveys. The questionnaires included 10 vignettes with positive analytical results; of which only half should be reported as positive to management. The mean number of correct responses among the 10 cases presented were: basic pre-test--4.91; basic post-test--7.45; advanced pre-test--6.68; advanced post-test--7.33. Differences between all four groups were significant (P < .001 to P = .003), except for the basic post-test versus the advanced post-test, for which there was no significant difference. It is concluded that 1) inadequate knowledge and skill in the medical review of drug screens may contribute to errors in reports to management, 2) physician's performance can be improved with training, and 3) certification of MROs in both the private and public sectors should be considered.

Liver enzymes among microelectronics equipment maintenance technicians.

Equipment maintenance workers within the microelectronics industry have opportunities for occupational exposure to a variety of toxic agents. This pilot investigation compares liver enzymes in this population with that of other coworkers. Participants (n = 135) were randomly selected from a medical surveillance program at the manufacturing facility. Nine job categories were examined, including equipment maintenance workers and electronic technicians. Although abnormal liver enzymes were detected among equipment maintenance workers (odds ratio 16.4; P less than .008) and electronic technicians (odds ratio 27; P less than .0005), the numbers of participants were small (n = 8, 10). The data suggest that independent and/or interactive etiologic roles of occupation and alcohol should be further investigated. Early detection of subclinical occupational or recreational hepatotoxicity with appropriate employment of industrial hygiene control technology and/or the reduction of alcohol consumption may provide a means of preventing liver disease.

Medical management of hydrofluoric acid exposure.

Hydrofluoric acid burns are usually due to accidental exposure. Deep tissue injury may result, damaging nerves, blood vessels, tendons, and bone. Concentrated hydrofluoric acid may cause immediate pain; dilute solutions may result in a delay of symptoms for many hours. Symptoms are usually out of proportion to the observed injury. Appropriate first aid and medical management can dramatically affect the prognosis. Local treatment consists of copious water lavage and the application of topical neutralization agents. For more severe exposures, calcium gluconate injection or intraarterial infusion of calcium gluconate may be indicated as well. Life-threatening alterations of electrolytes can occur, with ensuing arrhythmias. Inhalation, ingestion, and ocular exposures require specialized treatment and referral.