International Journal of Risk & Safety in Medicine - Volume 8, issue 2
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The International Journal of Risk and Safety in Medicine is concerned with rendering the practice of medicine as safe as it can be; that involves promoting the highest possible quality of care, but also examining how those risks which are inevitable can be contained and managed.
This is not exclusively a drugs journal. Recently it was decided to include in the subtitle of the journal three items to better indicate the scope of the journal, i.e. patient safety, pharmacovigilance and liability and the Editorial Board was adjusted accordingly. For each of these sections an Associate Editor was invited. We especially want to emphasize patient safety. Our journal wants to publish high quality interdisciplinary papers related to patient safety, not the ones for domain specialists. For quite some time we have also been devoting some pages in every issue to what we simply call WHO news. This affinity with WHO underlines both the International character of the journal and the subject matter we want to cover. Basic research, reports of clinical experience and overviews will all be considered for publication, but since major reviews of the literature are often written at the invitation of the Editorial Board it is generally advisable to consult with the Editor in advance. Submission of news items will be appreciated, as will be the contribution of letters on topics which have been dealt with in the journal.
Abstract: We studied the association between coeliac disease and other diseases in a cohort of 896 persons who were registered in the Danish National Registry of Patients during a 16-year period. The registry contains information on all discharge diagnoses from Danish somatic hospitals. The total number of observation years in the cohort was 7144 years. The background population was 5.1 million. The strongest association was found with diabetes mellitus, pancreatic diseases and dermatitis herpetiformis. A weaker association was found with small intestinal cancer, malignant haematological disorders, agammaglobulinaemia and rheumatoid arthritis. Conclusively, our population-based study supported the association between coeliac disease…and several other chronic diseases, but a weaker association than indicated in other less comprehensive studies and case reports.
Abstract: Obesity has long been regarded as an obstetric hazard. This study identified 300 primipara patients aged 20–29 years who were classified according to the estimated pre-pregnancy Body Mass Index (BMI). The study population was sub-divided into the lean (BMI < 25 kg/m2 , n = 189), the overweight group (BMI 25–29, n = 73), and the obese group (BMI > 30, n = 38). The obese group had a statistically higher incidence of hypertensive disease when compared to the lean group. They also had a statistically higher incidence of oedema, glycosuria, vaginal infections and impaired glucose tolerance. There was no…statistical difference in the incidence of a past history of a fetal loss, and a history of vaginal bleeding in the first two trimesters. Antenatal follow-up of the pregnancy in the obese group was more difficult requiring more frequent ultrasonic investigations. The obese group had a tendency towards a prolonged labour, but there did not appear to be any difference in the mode of delivery. Infants of obese women had significantly lower 1 min APGAR scores. These infants were significantly larger than those born to lean women. There was no increase in the incidences of post-partum problems.
Abstract: Workers are occupationally exposed to Pd and Pd-complexes during the refining process, in particular in Pt-refineries. The metal is increasingly used as component in fine jewellery, is commonly present in dental alloys, and is also employed in telecommunication systems. In view of the toxicity of Pd when absorbed and anticipating the possible entry of some of this material into man's environment from the use of automotive catalitic converters, the retention, tissue distribution, excretion and placental transfer of Pd were determined by several authors following different administration routes in animal experiments. Most investigations on Pd and the Pt group metals…were performed with simple and complex salts (chlorides and water-soluble ammoniacal compounds of Pt, Ir, Os, Pd, Rh and Ru). The highest retention for Pd was obtained following intravenous dosing, and the lowest retention occured after oral administration. Following a single oral dose, almost all Pd is excreted in the faeces, whereas after i.v. injections, similar quantities are excreted in both urine and faeces. Tissues containing the highest concentrations were the kidneys, spleen and liver. Following i.v. dosing of pregnant rats, a small amount is found in the fetuses. Pd and its compounds are considered to have hepatotoxic and nephrotoxic effects, acting by way of the -SH groups on complex biosystems: proteins, enzymes, etc. Oral administration of PdCh2 has obvious effects on the hepatic mono-oxygenase system and causes notable decreases in hepatic content of cytochrome-P450. Pd++ salts have also metabolic effects on a lot of other enzymes by inhibiting the activity of prolyl-hydroxylase, creatine kinase, aldolase, succinic dehydrogenase, carbonic anhydrase and alkaline phosphatase. These studies suggest that Pd may interfere with energy metabolism, acidlbase and electrolyte eqUilibria. In addition, Pd significantly increases the hepatic Se content and has a strong interaction within the Se-Hg competition. Proposed exposure limit for Pd compounds is 0.03 mg/m3 . It is highly important to make the difference between soluble Pd-salts and metallic Pd. Although simple and complex Pd-salts have obvious hepatotoxic and nephrotoxic effects, no biological incidences have been demonstrated for metallic Pd. This is important especially for its increasing use in dental alloys. Our own experiences on cell culture systems with powders of pure metallic Pd and Pd-containing dental alloys have never shown any influence on the cell viability and on the induction of inflammatory effects. Its biocompatibility is comparable to that of Au, Pt or Ti. In the last few years, however, Pd has caused a lot of controversial discussion with respect to its sensitizing effects. The present state-of-the-art of this problem is that Pd sensitization may coincide with Ni sensitization.
Abstract: The role of personality, psychopathology, suicidality and stress in the proneness of some individuals to traffic accidents is presented. Although several studies described risk factors towards traffic accidents, it is not clear how driving fitness should be determined on an individual basis. This assessment should include a combination of psychiatric diagnosis, personality questionnaire, possible stressful events, and most important, the individual's driving record. We endorse the importance of research in this area with more carefully planned studies and a greater involvement of physicians and psychologists in this field.
Abstract: A series of 124 patients had their greater saphenous vein assessed with duplex ultrasound scanning prior to planned infrainguinal bypass procedures. 33 (27%) bypass procedures thrombosed within the first year. A naturally occurring optimal vein diameter was discovered: 5.0–6.5 mm at mid-thigh level and 1.0–1.5 mm less at mid-calf level. It was significantly correlated with higher one year patency: thrombosis occured in 8% of the cases in veins with this optimal diameter combination and in 31% of the cases in all other combinations (P < 0.001).