Evaluation of fine needle aspiration cytology as the initial diagnostic test in cases of cervical lymphadenopathy

2016-11-16T23-52-51Z
Source: International Journal of Research in Medical Sciences
Gunjan P. Upadhyay, Rameshchandra M. Thakker.
Background: Cervical lymph node enlargement is common amongst the various causes of neck swelling. Proper diagnosis and early treatment is necessary for cervical lymph node disease and it is also necessary to rule out potentially curable causes as against malignancy in which the treatment is generally palliative. Fine needle aspiration cytology (FNAC) is now a day the initial investigation in most of the cases of cervical lymph node enlargement. Aims and Objectives of the study were to evaluate the sensitivity and specificity of FNAC in the diagnosis of cervical lymph node disease with an emphasis on discordant cases between the cytology and the histopathology. Methods: Patients admitted with cervical lymph node enlargement in a tertiary hospital of western India (attached with a medical college) from October 2014 to September 2016 were prospectively studied. Detailed history, clinical examination and necessary investigations of all patients were done especially fine needle aspiration cytology and histopathology examination and inference was obtained after the diagnosis was confirmed. Results: The cytological diagnoses were found to be malignant in 48 cases (30.6%) and benign in 109 cases (69.4%). The overall diagnostic sensitivity, specificity, positive predictive value, and negative predictive value of FNAC of cervical lymph nodes were 90.9%, 67.2%, 82.6%, and 81.3%, respectively. The overall diagnostic accuracy was 82.2%, while the overall discordance rate was 17.8%. Conclusions: FNAC is the initial investigation of choice in the diagnostic approach to most of the cases of cervical lymphadenopathy and it has good diagnostic sensitivity and specificity.


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Is diesel equipment in the workplace safe or not?

Objectives

Recently, diesel motor exhaust (DME) has been classified as a known human carcinogen. We used data from epidemiological studies of diesel exposures to perform a quantitative risk assessment to calculate DME exposure levels, expressed as elemental carbon (EC), corresponding to acceptable risk (AR) and maximum tolerable risk (MTR) levels of 4 to 10^–5 and 4 to 10^–3 for the lifetime excess probability of dying from lung cancer.

Methods

Previously published slope estimates (n=14) of the exposure–response curve (ERC) for EC exposure and lung cancer were used in life-table analyses to calculate EC exposure levels corresponding to the specified AR and MTR levels.

Results

Considered ERC slope factors ranged from 0.00060 to 0.0012 natural logarithm of the relative rate (InRR) per μg/m³ years based on different selections of studies and study-specific risk estimates. Exposure limits based on these slope factors were between 0.009–0.017 and 0.85–1.67 μg/m³ EC for the AR and MTR, respectively.

Conclusions

Derived exposure limits based on the AR and MTR are around or well below 1 μg/m³ EC. Such limits are below current occupational exposure levels, and in some instances even below environmental exposure levels. Although uncertainties exist in the exact slope factors, these results indicate that an acceptable excess lung cancer mortality risk can only be achieved at very low DME exposure levels, suggesting that diesel engines using older technologies should be removed from the workplace when possible or emissions strictly controlled.

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Scheduled evening sleep and enhanced lighting improve adaptation to night shift work in older adults

Objectives

We tested whether a sleep and circadian-based treatment shown to improve circadian adaptation to night shifts and attenuate negative effects on alertness, performance and sleep in young adults would also be effective in older adults.

Methods

We assessed subjective alertness, sustained attention (psychomotor vigilance task, PVT), sleep duration (actigraphy) and circadian timing (salivary dim-light melatonin onset, DLMO) in 18 older adults (57.2±3.8 years; mean±SD) in a simulated shift work protocol. 4 day shifts were followed by 3 night shifts in the laboratory. Participants slept at home and were randomised to either the treatment group (scheduled evening sleep and enhanced lighting during the latter half of night shifts) or control group (ad-lib sleep and typical lighting during night shifts).

Results

Compared with day shifts, alertness and sustained attention declined on the first night shift in both groups, and was worse in the latter half of the night shifts. Alertness and attention improved on nights 2 and 3 for the treatment group but remained lower for the control group. Sleep duration in the treatment group remained similar to baseline (6–7 hours) following night shifts, but was shorter (3–5 hours) following night shifts in the control group. Treatment group circadian timing advanced by 169.3±16.1 min (mean±SEM) but did not shift (–9.7±9.9 min) in the control group.

Conclusions

The combined treatment of scheduled evening sleep and enhanced lighting increased sleep duration and partially aligned circadian phase with sleep and work timing, resulting in improved night shift alertness and performance.

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Predictive value of the DASH tool for predicting return to work of injured workers with musculoskeletal disorders of the upper extremity

Objectives

To determine whether the Disabilities of the Arm, Shoulder, and Hand (DASH) tool added to the predictive ability of established prognostic factors, including patient demographic and clinical outcomes, to predict return to work (RTW) in injured workers with musculoskeletal (MSK) disorders of the upper extremity.

Methods

A retrospective cohort study using a population-based database from the Workers’ Compensation Board of Alberta (WCB-Alberta) that focused on claimants with upper extremity injuries was used. Besides the DASH, potential predictors included demographic, occupational, clinical and health usage variables. Outcome was receipt of compensation benefits after 3 months. To identify RTW predictors, a purposeful logistic modelling strategy was used. A series of receiver operating curve analyses were performed to determine which model provided the best discriminative ability.

Results

The sample included 3036 claimants with upper extremity injuries. The final model for predicting RTW included the total DASH score in addition to other established predictors. The area under the curve for this model was 0.77, which is interpreted as fair discrimination. This model was statistically significantly different than the model of established predictors alone (p<0.001). When comparing the DASH total score versus DASH item 23, a non-significant difference was obtained between the models (p=0.34).

Conclusions

The DASH tool together with other established predictors significantly helped predict RTW after 3 months in participants with upper extremity MSK disorders. An appealing result for clinicians and busy researchers is that DASH item 23 has equal predictive ability to the total DASH score.

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Detecting hepatitis B virus in surgical smoke emitted during laparoscopic surgery

Background

Hepatitis B virus (HBV) transmission is known to occur through direct contact with infected blood. There has been some suspicion that the virus can also be detected in aerosol form. However, this has never been directly shown. The purpose of this study was to sample and analyse surgical smoke from laparoscopic surgeries on patients with hepatitis B to determine whether HBV is present.

Methods

A total of 11 patients who underwent laparoscopic or robotic abdominal surgeries between October 2014 and February 2015 at Korea University Anam Hospital were included in this study. A high efficiency collector was used to obtain surgical smoke in the form of hydrosol. The smoke was analysed by using nested PCR.

Results

Robotic or laparoscopic colorectal resections were performed in 5 cases, laparoscopic gastrectomies in 3 cases and laparoscopic hepatic wedge resections in another 3 cases. Preoperatively, all of the patients had positive hepatitis B surface antigen (HBsAg). 2 patients had detectable HBsAb, and 2 were positive for hepatitis B e antigen. 3 patients were taking antihepatitis B viral medications at the time of the study. The viral load measured in the patients’ blood was undetectable to 1.7x10⁸ IU/mL. HBV was detected in surgical smoke in 10 of the 11 cases.

Conclusions

HBV is detectable in surgical smoke. This study provides preliminary data in the investigation of airborne HBV infection.

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Effect of working hours and precarious employment on depressive symptoms in South Korean employees: a longitudinal study

Objectives

Long working hours and precarious employment are relatively common in South Korea. Since both can impact on mental health, this study examined their independent and combined effects on depressive symptoms of employees.

Methods

Data were from the Korean Welfare Panel Study (KOWEPS), 2010–2013. A total of 2733 full-time employees without depressive symptoms were analysed. Hierarchical logistic regression models were used to investigate the effect of the number of working hours per week (eg, 35–40 hours, 41–52 hours, 53–68 hours, and >68 hours) and employment status (permanent vs precarious employment) on depressive symptoms, measured using the Center for Epidemiological Studies Depression (CES-D) 11 scale.

Results

Compared with individuals working 35–40 hours/week, employees working above 68 hours (OR 1.57, 95% CI 1.05 to 2.34) had higher odds of depressive symptoms after full adjustment. Similarly, precarious employees (OR 1.34, 95% CI 1.02 to 1.75) showed worse mental health than permanent employees. In the combined effect model, employees in precarious employment who worked above 68 hours/week (OR, 2.03 95% CI 1.08 to 3.83) exhibited the highest odds of depressive symptoms compared with permanent employees working 35 to 40 hours/week.

Conclusions

Long work hours and precarious employment status were associated with higher odds of depressive symptoms. The findings highlight the importance of monitoring and addressing the vulnerable groups of employees to reduce the mental health burden of economically active individuals.

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Prediction of prognosis for people off sick with upper extremity musculoskeletal disorders

Musculoskeletal disorders (MSDs) are the second most common cause of disability worldwide.1 Among people of working age, musculoskeletal conditions, including back pain, neck pain, upper limb disorders and arthritis account for almost a quarter of all sickness absence. Furthermore, MSDs contribute even more significantly to presenteeism (the reduction in working performance while at work because of ill health) and impaired in-work productivity (although these are more challenging to quantify accurately). Indeed, it is estimated that the total cost of lost productivity attributable to MSDs among people of working age in the European Union (EU) might be as high as 2% of gross domestic product.2 For these reasons, we urgently need to develop effective strategies to identify those individuals with recent-onset musculoskeletal pain or injury at greatest risk of long-term work disability and to develop effectual and cost-effective preventive and treatment interventions.

For these reasons, the...

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