- Email: [email protected]
Portable decompression chamber
1464
that might be associated with exposure to particulate pollutions was However, it is known that suspended particulate matter includes a small variable acidic component, that exposure to acid aerosols may produce changes in indices of lung function, and that asthmatic patients may be more sensitive than other individuals. But again there are insufficient data on acid aerosol levels, particularly in urban areas, to allow any assessment of likely effects to be made.
European Union of Medical Specialists (concerned with the interests of "specialists"), and the Permanent Working Group of European Junior Hospital Doctors (dealing with training and manpower issues).
not addressed because of lack of relevant information.
European doctors in training can obtain details about joining the EDA from Dr Francisco Leyva Leon, 57 Hubert Road, Selly Oak, Birmingham B29 6EE, UK.
Atovaquone for PCP
1.
Atovaquone (Mepron, Burroughs Wellcome) has been approved for marketing in the USA and Canada as treatment for mild to moderate Pneumocystis carinii pneumonia (PCP) in patients intolerant to co-trimoxazole. Atovaquone, a synthetic is also being investigated for its hydroxynaphthoquinone, antitoxoplasma’ and antimalarial activity. The hydroxynaphthoquinones were first investigated 50 years ago as an antimalarial but work was suspended because of poor absorption and rapid metabolisation. A phase II/III multinational study (principal investigator Dr Walter Hughes of St Jude Children’s Research Hospital in Memphis) of the drug in over 300 patients with PCP for the treatment of PCP showed that lack of response to atovaquone (17%) was higher than that to co-trimoxazole, but more patients on atovaquone (20%) discontinued therapy because of adverse effects than did those on co-trimoxazole (7%). Survival after 8 weeks was 97% for co-trimoxazole and 92% for atovaquone. A comparison of atovaquone with intravenous pentamidine (principal investigator Dr Peter Frame of University of Cincinnati) showed that the two drugs were equivalent in therapeutic efficacy, with atovaquone being better tolerated. The recommended dose of atovaquone is three 250 mg tablets three times a day for 21 days with meals. One cause of therapy costs the wholesaler US$402. Burroughs Wellcome is placing a cap on the annual cost of the drug for uninsured patients who require multiple causes; such patients who require more than 411 g a year will receive an additional 684 g at no cost during that year. 1. Kovacs JA, et al. Efficacy of atovaquone AIDS. Lancet 1992; 340: 637-38.
Air
in treatment of toxoplasmosis m patients with
pollution by SO2 and particulate material
Should the UK Government give advice about personal protective measures during air pollution episodes? If so, what, how, and to whom should advice be given? The Advisory Group on the Medical Aspects of Air Pollution Episodes has produced its recommendations on raised concentrations of sulphur dioxide and pollution by particulate material.1 It reports that existing evidence indicates that people without respiratory disease will not be affected by episodes of raised concentrations of sulphur dioxide as occur in the UK. In parts of the UK, however, sulphur dioxide concentrations regularly exceed those at which symptoms such as chest tightness, coughing, and wheezing can be precipitated in people with asthma. The Group did not think that these effects would justify a warning but instead recommend that when hourly average concentrations of sulphur dioxide are in the range 125 ppb (357-5 Ilg/m3) to 400 ppb (1144 Ilg/m3) advice on possible health effects should be given. The advice offered should state that these effects may be reduced by limiting time spent out of doors (especially time spent exercising out of doors), that there is no evidence to suggest that the wearing of smog masks is necessary, and that asthmatic patients may need to increase their treatment as advised by their doctors. When hourly average concentrations of sulphur dioxide exceed or are expected to exceed 400 ppb (1144 g/m3), a warning should be issued. At these concentrations many asthmatic patients may experience significant changes in indices of lung function. Such effects are likely to be mild for most patients and there is no evidence that they have any lasting effect on asthma. The Group recommends that the sulphur dioxide concentration that creates "very poor" air quality be reduced from 500 ppb to 400 ppb. The report points out that although trace amounts of carcinogens occur in association with airborne particulates, the risk of cancer
Sulphur dioxide, add aerosols and paraculates. Department of Health advisory group on the medical aspects of air pollution episodes. London: HM Stationery Office. 1992. Pp 157. £30. ISBN 0 11 321532 0.
Folic acid fortification of foods in US? The US Food and Drug Administration has been advised by its folic acid subcommittee that some foods should be fortified with folic acid to prevent neural tube defects, though no agreement was reached as to which which these foods should be. Dr David A. Kessler, FDA Commissioner, was happy to note that the recommendation was in line with the Public Health Service guidelines1 that all women of childbearing age consume 0-4 mg folic acid daily. At the time of the introduction of the PHS recommendation a few months ago, it had been reported1 that the various federal agencies responsible for promoting public health were divided in their support for this recommendation. Several reasons were offered for the reservations-that a key study influencing this decision, that from Hungary, had not yet been published; that folic acid can mask the symptoms of vitamin B12 deficiency; that it would be difficult to ensure that women received adequate folic acid early enough in the pregnancy to be effective; and that folic acid prevented recurrence rather than occurrence of neural tube defects. At that time Kessler was cited as having told an audience at Tuffs University, Boston, that the PHS recommendation "does not say that the FDA is ready to permit a health claim for folic acid". He reiterated concern then about the therapeutic ratio when he told the folic acid subcommittee, "It is our job to regulate the conditions under which folic acid is added to the food supply... What makes the folic acid question so complicated is the apparently narrow range in which it can reduce the risk of neural tube defects without raising safety concerns". 1. CDC. Recommendation for the use of folic add to reduce the number of cases of bifida and other neural tube defects. MMWR 1992; 41: (RR-14): 1-7. 2. Palca J. Agencies split on nutrition advice. Science 1992, 257: 1857.
spina
Wandaful idea Anaesthetists
might care to try the following method of general anaesthesia, especially when short-staffed. This approach is highly recommended for manipulations, reproductive operations, and sampling and is likely to be endorsed by the H.C. Andersen Institute in Copenhagen. Take a water tank, capacity 100 000 litres, 390 litres/hour, temperature 20°C. Add 30 litres 2-phenoxyethanol for short-planned procedures or 10-20 litres for longer ones. Submerge the patient (possible to anaesthetise several simultaneously). Result? Rapid induction of anaesthesia, safe maintenance, and swift recovery. According to Josa and colleagues,’1 this technique is 100% successful in adult goldfish. water turnover
1.
Josa A, Espinosa E, Cruz JI, Gil L, Falceto MV, Lozano R. Use of 2-phenoxyethanol as an anaesthetic agent in goldfish (Cyprinus carpio). Vet Rec 1992; 131: 468.
Portable
decompression chamber
The Gamow Bag is the first portable hyperbaric chamber.’ It is carried on a specially designed backpack and weighs only 6-6 kg. When inflated it becomes a nylon cylinder 2-5 m long and 0-6 m ir diameter, which is acoustically transparent. The bag could theoretically simulate a descent from the summit of Mount Everest (8874 m) to 6200 m. Since its introduction 4 years ago, the Gamow bag has been used extensively to treat patients with altitude sickness. 1. Murdoch D. The
illness. NZ Med
portable hyperbaric chamber for the J 1992; 105: 361-62.
treatment
of high altitude
that might be associated with exposure to particulate pollutions was However, it is known that suspended particulate matter includes a small variable acidic component, that exposure to acid aerosols may produce changes in indices of lung function, and that asthmatic patients may be more sensitive than other individuals. But again there are insufficient data on acid aerosol levels, particularly in urban areas, to allow any assessment of likely effects to be made.
European Union of Medical Specialists (concerned with the interests of "specialists"), and the Permanent Working Group of European Junior Hospital Doctors (dealing with training and manpower issues).
not addressed because of lack of relevant information.
European doctors in training can obtain details about joining the EDA from Dr Francisco Leyva Leon, 57 Hubert Road, Selly Oak, Birmingham B29 6EE, UK.
Atovaquone for PCP
1.
Atovaquone (Mepron, Burroughs Wellcome) has been approved for marketing in the USA and Canada as treatment for mild to moderate Pneumocystis carinii pneumonia (PCP) in patients intolerant to co-trimoxazole. Atovaquone, a synthetic is also being investigated for its hydroxynaphthoquinone, antitoxoplasma’ and antimalarial activity. The hydroxynaphthoquinones were first investigated 50 years ago as an antimalarial but work was suspended because of poor absorption and rapid metabolisation. A phase II/III multinational study (principal investigator Dr Walter Hughes of St Jude Children’s Research Hospital in Memphis) of the drug in over 300 patients with PCP for the treatment of PCP showed that lack of response to atovaquone (17%) was higher than that to co-trimoxazole, but more patients on atovaquone (20%) discontinued therapy because of adverse effects than did those on co-trimoxazole (7%). Survival after 8 weeks was 97% for co-trimoxazole and 92% for atovaquone. A comparison of atovaquone with intravenous pentamidine (principal investigator Dr Peter Frame of University of Cincinnati) showed that the two drugs were equivalent in therapeutic efficacy, with atovaquone being better tolerated. The recommended dose of atovaquone is three 250 mg tablets three times a day for 21 days with meals. One cause of therapy costs the wholesaler US$402. Burroughs Wellcome is placing a cap on the annual cost of the drug for uninsured patients who require multiple causes; such patients who require more than 411 g a year will receive an additional 684 g at no cost during that year. 1. Kovacs JA, et al. Efficacy of atovaquone AIDS. Lancet 1992; 340: 637-38.
Air
in treatment of toxoplasmosis m patients with
pollution by SO2 and particulate material
Should the UK Government give advice about personal protective measures during air pollution episodes? If so, what, how, and to whom should advice be given? The Advisory Group on the Medical Aspects of Air Pollution Episodes has produced its recommendations on raised concentrations of sulphur dioxide and pollution by particulate material.1 It reports that existing evidence indicates that people without respiratory disease will not be affected by episodes of raised concentrations of sulphur dioxide as occur in the UK. In parts of the UK, however, sulphur dioxide concentrations regularly exceed those at which symptoms such as chest tightness, coughing, and wheezing can be precipitated in people with asthma. The Group did not think that these effects would justify a warning but instead recommend that when hourly average concentrations of sulphur dioxide are in the range 125 ppb (357-5 Ilg/m3) to 400 ppb (1144 Ilg/m3) advice on possible health effects should be given. The advice offered should state that these effects may be reduced by limiting time spent out of doors (especially time spent exercising out of doors), that there is no evidence to suggest that the wearing of smog masks is necessary, and that asthmatic patients may need to increase their treatment as advised by their doctors. When hourly average concentrations of sulphur dioxide exceed or are expected to exceed 400 ppb (1144 g/m3), a warning should be issued. At these concentrations many asthmatic patients may experience significant changes in indices of lung function. Such effects are likely to be mild for most patients and there is no evidence that they have any lasting effect on asthma. The Group recommends that the sulphur dioxide concentration that creates "very poor" air quality be reduced from 500 ppb to 400 ppb. The report points out that although trace amounts of carcinogens occur in association with airborne particulates, the risk of cancer
Sulphur dioxide, add aerosols and paraculates. Department of Health advisory group on the medical aspects of air pollution episodes. London: HM Stationery Office. 1992. Pp 157. £30. ISBN 0 11 321532 0.
Folic acid fortification of foods in US? The US Food and Drug Administration has been advised by its folic acid subcommittee that some foods should be fortified with folic acid to prevent neural tube defects, though no agreement was reached as to which which these foods should be. Dr David A. Kessler, FDA Commissioner, was happy to note that the recommendation was in line with the Public Health Service guidelines1 that all women of childbearing age consume 0-4 mg folic acid daily. At the time of the introduction of the PHS recommendation a few months ago, it had been reported1 that the various federal agencies responsible for promoting public health were divided in their support for this recommendation. Several reasons were offered for the reservations-that a key study influencing this decision, that from Hungary, had not yet been published; that folic acid can mask the symptoms of vitamin B12 deficiency; that it would be difficult to ensure that women received adequate folic acid early enough in the pregnancy to be effective; and that folic acid prevented recurrence rather than occurrence of neural tube defects. At that time Kessler was cited as having told an audience at Tuffs University, Boston, that the PHS recommendation "does not say that the FDA is ready to permit a health claim for folic acid". He reiterated concern then about the therapeutic ratio when he told the folic acid subcommittee, "It is our job to regulate the conditions under which folic acid is added to the food supply... What makes the folic acid question so complicated is the apparently narrow range in which it can reduce the risk of neural tube defects without raising safety concerns". 1. CDC. Recommendation for the use of folic add to reduce the number of cases of bifida and other neural tube defects. MMWR 1992; 41: (RR-14): 1-7. 2. Palca J. Agencies split on nutrition advice. Science 1992, 257: 1857.
spina
Wandaful idea Anaesthetists
might care to try the following method of general anaesthesia, especially when short-staffed. This approach is highly recommended for manipulations, reproductive operations, and sampling and is likely to be endorsed by the H.C. Andersen Institute in Copenhagen. Take a water tank, capacity 100 000 litres, 390 litres/hour, temperature 20°C. Add 30 litres 2-phenoxyethanol for short-planned procedures or 10-20 litres for longer ones. Submerge the patient (possible to anaesthetise several simultaneously). Result? Rapid induction of anaesthesia, safe maintenance, and swift recovery. According to Josa and colleagues,’1 this technique is 100% successful in adult goldfish. water turnover
1.
Josa A, Espinosa E, Cruz JI, Gil L, Falceto MV, Lozano R. Use of 2-phenoxyethanol as an anaesthetic agent in goldfish (Cyprinus carpio). Vet Rec 1992; 131: 468.
Portable
decompression chamber
The Gamow Bag is the first portable hyperbaric chamber.’ It is carried on a specially designed backpack and weighs only 6-6 kg. When inflated it becomes a nylon cylinder 2-5 m long and 0-6 m ir diameter, which is acoustically transparent. The bag could theoretically simulate a descent from the summit of Mount Everest (8874 m) to 6200 m. Since its introduction 4 years ago, the Gamow bag has been used extensively to treat patients with altitude sickness. 1. Murdoch D. The
illness. NZ Med
portable hyperbaric chamber for the J 1992; 105: 361-62.
treatment
of high altitude