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Biomedical subjects

G Liss

Publications and source records attributed to G Liss.

16 recordsLinked to original sources
PubMed2001

Marked tachypnea in siblings with chronic beryllium disease due to copper-beryllium alloy.

Two biological sisters working at the same factory for > 9 years developed chronic beryllium disease (CBD) from a copper-beryllium alloy. Both had marked tachypnea (36 breaths/min and 45 breaths/min at rest, respectively), persisting over 8 years. Ventilation during exercise (assessed in one sibling) was grossly excessive (57 L/min, expected 23 L/min) with a respiratory rate of 64 breaths/min even with normal baseline routine pulmonary function tests. Blood beryllium lymphocyte transformation test and lung biopsies confirmed the diagnosis. No other cases of CBD have been reported from this plant among about 120 workers. These cases support the genetic basis for berylliosis and illustrate the marked tachypnea that may accompany this disease.

Alloys↗
PubMed2000

Skin prick test reactivity to recombinant latex allergens.

BACKGROUND: Allergy to latex has become a serious and increasingly common health problem, particularly for healthcare workers and patients who undergo frequent surgical procedures. Testing for latex allergy currently involves in vitro tests and skin prick testing using crude preparations of natural rubber latex (NRL). To date, 10 latex proteins have received designation as allergens (Hev b 1 to Hev b 10) and, except for Hev b 4, have been cloned as recombinant proteins. Our aim was to compare the skin prick test (SPT) reactivity of six recombinant latex allergens with SPT reactivity to natural rubber latex proteins in known latex-allergic individuals. METHODS: Six recombinant proteins were expressed in Escherichia coli, and tested as the intact fusion proteins (Hev b 2, 5, 6, 8) or as purified proteins (Hev b 3 and 7). SPT with the six recombinant latex allergens was performed using 10-fold serial dilutions on 31 latex-allergic subjects to determine the level of reactivity to each recombinant allergen. Latex-specific IgE was determined using the AlaSTAT assay. RESULTS: All six recombinant allergens were reactive by SPT in at least 1 latex-allergic patient but not in any of the control patients. The frequency of sensitization to the various recombinant allergens was similar to previous studies using the native proteins isolated from NRL. The minimal level of protein for a positive skin test was 70 pg/ml for NRL and 1 ng/ml for one recombinant allergen (Hev b 7). In our patients, the use of a combination of recombinant latex allergens Hev b 5, 6 and 7 diagnosed latex allergy with 93% sensitivity and 100% specificity. CONCLUSION: Recombinant latex allergens are clinically reactive, can be produced in a standardized manner, and could potentially provide safe, sensitive and specific reagents for the diagnosis of latex allergy.

Adult↗
PubMed1999

The outcome of asthma related to workplace irritant exposures: a comparison of irritant-induced asthma and irritant aggravation of asthma.

STUDY OBJECTIVES: (1) To characterize workers' compensation claims accepted on the basis of new-onset asthma associated with accidental high respiratory irritant exposure at work; (2) to compare the frequency, characteristics, and outcomes in this group of workers to workers who were compensated for an exacerbation of preexisting asthma associated with accidental high respiratory irritant exposure at work. DESIGN: A retrospective review was performed of 469 asthma claims accepted by the Ontario Workers' Compensation Board (WCB) between 1984 and 1988. Among these, claims attributed to an accidental high respiratory irritant exposure at work were classified into two groups: one group with reported preexisting asthma prior to the exposure (accidental aggravation of asthma [AAA]) and another group with no previous history of asthma (irritant-induced asthma [IIA]). RESULTS: Of the 469 claims, 89 subjects (19%) had symptoms related to accidental high respiratory irritant exposure in the workplace; of these, 68 subjects (76%) had AAA, 12 subjects (13%) had IIA, and 9 subjects (10%) had possible IIA but were excluded from the analysis because of insufficient data. Those with IIA had a longer duration of work-attributed symptoms (mean, 219 +/- 208 days) than the subjects with AAA (mean, 32 +/- 38 days; p < 0.001). Nine subjects (75%) with IIA were no longer in the same work environment, while 47 subjects in the AAA group (71%) were still in the same work environment (p < 0.001). The most common triggering agent for subjects with IIA was an isocyanate spill; for those with AAA, the most common triggering agent was paint. CONCLUSIONS: The WCB-accepted claims related to accidental, high respiratory irritant exposure at work are more commonly assigned to the category of AAA than to IIA. IIA patients in this claimant group had a longer mean duration of work-attributed respiratory symptoms, perhaps due to a need for a larger (and thus less common) irritant exposure to induce asthma in previously normal subjects.

Adult↗
PubMed1998

Latex allergy in operating room nurses.

OBJECTIVE: To determine the prevalence of allergy to natural rubber latex and potential crossreacting foods in operating room nurses. METHOD: Two hundred forty-seven operating room nurses completed a latex allergy questionnaire. They were questioned about symptoms of latex reactivity and about other allergies particularly to foods that may crossreact with latex. Informed consent was obtained and skin prick testing was performed with natural rubber latex and five latex extracts representing low (0.08 to 0.25 microgram/mL) and high (18 to 106 micrograms/mL) natural rubber latex protein gloves. Skin prick tests were done with four potentially crossreacting foods (banana, avocado, kiwi, and potato), saline, and histamine controls. RESULTS: One hundred thirty-five (54.7%) nurses described allergic symptoms they attributed to latex exposure. Of these 12 (4.9%) tested positive to latex extracts alone, 12 (4.9%) tested positive to food extracts alone, and 5 (2.0%) tested positive to both latex and crossreactive foods. Three of the 17 (17.6%) nurses testing positive to latex gave no history of reactivity to latex. Indirect latex ELISA was done on the serum of skin test-positive patients with a 70.6% sensitivity. CONCLUSION: Of the nurses tested, 6.9% had positive skin prick tests to latex extracts; 17.6% of these were asymptomatic and 29.4% had associated food positive skin prick tests.

Adult↗
PubMed1998

Directives de la Societe canadienne de thoracologie pour l'asthme professionnel canadian thoracic society guidelines for occupational asthma

OBJECTIVE: To provide broad guidelines and principles to help primary care physicians, occupational physicians, allergists and respirologists with the recognition, diagnosis and management of patients with occupational asthma (OA). OPTIONS: These guidelines are mainly directed towards OA induced by a workplace sensitizing agent. However, irritant-induced asthma and workplace aggravation of underlying asthma are also addressed, and some consideration is given to other differential diagnoses. OUTCOMES: To enable the assessing physician to investigate patients with possible OA appropriately and to provide guidelines for appropriate early referral when specialized investigations are required. To provide an understanding of the appropriate management strategies following objective diagnosis. EVIDENCE: The key diagnostic and management recommendations were based on a critical review of the literature and by specialist consensus meetings. VALUES: Evidence was categorized as follows. Level 1: Evidence from at least one randomized, controlled trial. Level 2: Evidence from at least one well-designed clinical trial without randomization, from cohort or case-control analytical studies, preferably from more than one centre, from multiple time series or from dramatic results in uncontrolled experiments. Level 3: Evidence from the opinions of respected authorities based on clinical experience, descriptive studies or reports of expert committees. Evidence was further subdivided as follows: A. Good evidence to support a recommendation for use; B. Moderate evidence to support a recommendation for use; C. Poor evidence to support a recommendation for or against use; D. Moderate evidence to support a recommendation against use; E. Good evidence to support a recommendation against use. BENEFITS, HARM AND COSTS: The medical and socioeconomic risks and benefits of an incorrect diagnosis of OA and of failure to diagnose true OA were considered in the recommendations. VALIDATION: The document has been reviewed and endorsed by the Canadian Thoracic Society, the Canadian Society of Allergy and Clinical Immunology, and The College of Family Physicians of Canada. CONCLUSIONS: There is good evidence for rapid investigation and objective categorization of presented symptoms into OA, aggravation of underlying asthma, unrelated asthma or other diagnoses. OA should be suspected in all adult onset asthmatics whose asthma begins or worsens while they are working. Investigations should be directed to an objective assessment of asthma and then to an assessment of the work relationship, using a combination of investigations as feasible, which may include immunological tests, pulmonary function assessed during work and away from work, and specific challenge tests. Early specialist referral is recommended for diagnosis. Management strategies include general asthma management in addition to measures to avoid further exposure to a relevant workplace sensitizer. Compensation issues and other workers at risk of developing OA also need to be considered when the diagnosis is made.

Journal Article↗
PubMed1997

Outcome determinants for isocyanate induced occupational asthma among compensation claimants.

OBJECTIVES: To compare the outcome of occupational asthma (OA) induced by isocyanates in Ontario (where a surveillance programme for exposed workers has been in place for over 15 years), with the outcome of OA induced by other work agents. METHODS: Compensated OA claims during the period 1984-88 in Ontario were retrospectively reviewed in a standardised way. RESULTS: 136/235 compensated claims were attributed to isocyanates. Compared with other causes of OA, those attributed to isocyanates had a shorter latent period before onset (5.9 v 7.9 years, P < 0.05), shorter duration of symptoms before diagnosis (2.0 v 3.0 years, P < 0.05), and less associated atopy (43% v 58%, P < 0.05). Outcome at a mean of 1.9 years after initial assessment was significantly better in those with OA induced by isocyanates; 73% cleared or improved v 56% with other causes of OA (P < 0.05). Ten subjects with OA induced by isocyanates stayed at the same work; none cleared and four had worsened at follow up. A better outcome in OA induced by isocyanates was associated with early diagnosis (P < 0.05), and early removal from isocyanates after the onset of asthma. CONCLUSIONS: The outcome in the group with OA induced by isocyanates is similar to previous follow up studies. However, it is better than the outcome in our comparison group with OA due to other causes, perhaps because of earlier diagnosis in the group with OA induced by isocyanates. This may be attributable to the medical surveillance of workers exposed to isocyanates in Ontario, either directly from the surveillance assessments, or indirectly by increasing awareness of the condition.

Adult↗
PubMed1996

Correlation of protein levels with skin prick test reactions in patients allergic to latex.

BACKGROUND: Natural rubber latex (NRL) gloves are the major source of proteins that cause latex allergic reactions in sensitized health care workers and patients. OBJECTIVE: This study evaluated the effect of manufacturing changes on reducing protein, antigen, and allergen levels of latex medical gloves. METHODS: Three types of NRL gloves were manufactured with a common batch of compounded latex. The NRL gloves were analyzed for total protein by using the American Society for Testing and Materials D5712-95 Lowry method, and specifically for latex proteins by immunoassay. Allergen levels in the extracts were determined by end-point titration skin prick tests (SPTs) on patients allergic to NRL. RESULTS: Extracts from regular powdered gloves had detectable levels of latex proteins and allergens (62% SPT positive), whereas the powder-free gloves were low in protein content and allergenicity (5% to 8% SPT positive). No significant difference in SPT reactivity was observed between the chlorinated powder-free gloves and the polymer-coated gloves. Although the protein levels determined by the Lowry assay correlated with SPT reactivity (r = 0.95), the test was restricted by a high detection limit (9.3 micrograms/ml). Fifty-eight percent of patients allergic to latex reacted at the 50 micrograms/gm detection limit allowed by the Food and Drug Administration. The ELISA had a good correlation with SPT reactivity (r = 0.93), and because of the greater sensitivity, gloves testing below the ELISA reporting limit (0.06 microgram/ml) have a significantly lower potential for eliciting reactions in patients allergic to latex. CONCLUSIONS: Results of protein assays are acceptable criteria with which to rate the potential allergenicity of gloves; however, the American Society for Testing and Materials D5712-95 assay may lack the sensitivity to provide clinically relevant data.

Biomarkers↗
PubMed1995

A workers' compensation claim population for occupational asthma. Comparison of subgroups.

STUDY OBJECTIVE: (1) To compare patients with claims submitted to the Ontario Workers' Compensation Board (WCB) for occupational asthma, in relation to the WCB decisions reached of occupational asthma (OA); aggravation of asthma from irritant exposures (AA); unrelated asthma; no asthma; and (2) to assess determinants of outcome of WCB accepted claims at permanent disability assessments. DESIGN: A retrospective review of 609 claims submitted to the WCB 1984 to 1988. RESULTS: The WCB decision reached was OA in 39% of claims, mostly attributed to isocyanates (57% of these). A further 39% were accepted for AA. Exposure to a known sensitizer occurred in 91% with OA and to an irritant in 67% with AA. Forty percent with AA were attributed to a spill or accidental exposure and 68% had preceding asthma. Those with AA were more likely to have clearing of symptoms by the time of their main assessment (43% vs 20% with OA) and were more likely to have remained in the same work (35% vs 20% with OA). Of 200 OA accepted claims reviewed at a mean of 1.9 years later, clearing of asthma occurred in 19% and milder asthma in 47%. Outcome was best with early diagnosis (p < 0.05), and milder impairment of pulmonary function at initial assessment (p < 0.05). CONCLUSIONS: Patients with asthma induced by a workplace sensitizer demonstrate some differences from those related to workplace irritants. Accurate categorization and early removal of those with OA offers the best prognosis.

Adult↗
PubMed1995

Latex allergy in housekeeping personnel.

BACKGROUND: Latex allergy has been well described in healthcare workers and children with spina bifida. Cost effective measures to avoid latex allergic reactions are possible in these recognized risk groups. OBJECTIVE: To study the prevalence of latex allergy among hospital housekeepers regularly exposed to latex gloves. METHODS: Fifty members of the housekeeping staff at a Toronto teaching hospital were screened by questionnaire for latex allergy. Patients with possible atopy or symptoms suggestive of latex allergy (20) were skin tested with latex (Bencard Laboratories) eight common allergens and histamine control. RESULTS: Four of 20 tested had a positive latex prick skin test representing an 8% prevalence overall within this group, and a 20% prevalence among atopic housekeepers. Based on an expected 1% prevalence in the general population, this was statistically significant (P < .005). Latex-positive patients had extensive exposure to high protein-unlined latex gloves. Positive patients had a similar yet completely unique immunoblot pattern of IgE binding. All four positive patients had unrecognized latex allergic symptoms (hand dermatitis, rhinoconjunctivitis). One housekeeper experienced itchiness of her face, angioedema, and lightheadedness immediately after inflating a latex balloon. CONCLUSIONS: The 8% prevalence of a positive latex skin test in regularly exposed hospital housekeepers is similar to that observed among healthcare workers suggesting this is a new risk group.

Adult↗
PubMed1984

Amiodarone pulmonary toxicity.

Amiodarone therapy for the treatment of arrhythmias has been found to have severe side effects. Although the drug has been prescribed in Europe for more than 20 years, it has only recently been used in the United States as an investigational drug, and has been found to cause pulmonary toxicity, as well as other major side effects. In the following report, a case of pulmonary toxicity caused by Amiodarone was resolved by steroid therapy. A review of the literature suggests that physicians prescribing this medication should be alert to the possibility of pulmonary toxicity.

Journal Article↗
PubMed1982

Reaction to Mace.

Explore the source record for details and available documents.

Corneal Diseases↗
PubMed1976

Nocardia asteroides keratitis. A case report.

An 11-year-old girl developed a corneal ulcer five days after sustaining a corneal abrasion from a fishline sinker. After more than three weeks, the epithelial defect had closed, but superficial stromal opacities in a ring-like distribution had not cleared on topical gentamicin, prednisolone 1% and atropine. Several scrapings disclosed the presence of branching hyphae on smear, eventually identified as Nocardia asteroides by culture. Although sensitivity studies suggested that subconjunctival ampicillin and hourly sodium sulphacetamide would constitute effective treatment, resolution was only partial on this regimen. Only when penicillin G drops were added did the cornea clear maximally and the epithelium heal.

Ampicillin↗
PubMedDate not supplied

Occupational exposure to chemical and biological agents in the nonproduction departments of pulp, paper, and paper product mills: an international study.

As part of an international epidemiological study of workers in the pulp and paper industry, previously unpublished exposure measurements were assembled in a database. This article describes 7293 measurements in nonproduction departments from 147 mills in 11 countries. The greatest variety of agents was measured in the maintenance, construction, and cleaning department, where high exposures to asbestos, chromium [VI] compounds, copper, mercury in urine, nitrogen dioxide, ozone, styrene, sulfur dioxide, trichloroethylene, and welding fumes were observed. Measurements in the storage, yard, loading, and shipping department indicated high exposures to asbestos, carbon monoxide, fungal spores, nitrogen oxides, sulfur dioxide, and total dust. The steam and power generation department had high exposures to methyl mercaptan, silica, and total dust. Measurements in process and effluent water treatment, laboratory and research, engineering, and office, administration, and cafeteria areas had few elevated exposures. Throughout the nonproduction departments, measurements of pulp-production chemicals such as chlorine and sulfur compounds tended to be low, with many below detection limits. There were some problems with the available data; in particular, detection limits were often not specified, and the data tended to be clustered in such a way that sources of exposure variability could not be distinguished. Despite these problems, the data provide new insight into the exposures of nonproduction pulp and paper industry personnel.

Databases, Factual↗
PubMedDate not supplied

Canadian Thoracic Society guidelines for occupational asthma.

OBJECTIVE: To provide broad guidelines and principles to help primary care physicians, occupational physicians, allergists and respirologists with the recognition, diagnosis and management of patients with occupational asthma (OA). OPTIONS: These guidelines are mainly directed towards OA induced by a workplace sensitizing agent. However, irritant-induced asthma and workplace aggravation of underlying asthma are also addressed, and some consideration is given to other differential diagnoses. OUTCOMES: To enable the assessing physician to investigate patients with possible OA appropriately and to provide guidelines for appropriate early referral when specialized investigations are required. To provide an understanding of the appropriate management strategies following objective diagnosis. EVIDENCE: The key diagnostic and management recommendations were based on a critical review of the literature and by specialist consensus meetings. VALUES: Evidence was categorized as follows. Level 1: Evidence from at least one randomized, controlled trial. Level 2: Evidence from at least one well-designed clinical trial without randomization, from cohort or case-control analytical studies, preferably from more than one centre, from multiple time series or from dramatic results in uncontrolled experiments. Level 3: Evidence from the opinions of respected authorities based on clinical experience, descriptive studies or reports of expert committees. Evidence was further subdivided as follows: A. Good evidence to support a recommendation for use; B. Moderate evidence to support a recommendation for use; C. Poor evidence to support a recommendation for or against use; D. Moderate evidence to support a recommendation against use; E. Good evidence to support a recommendation against use. BENEFITS, HARM AND COSTS: The medical and socioeconomic risks and benefits of an incorrect diagnosis of OA and of failure to diagnose true OA were considered in the recommendations. VALIDATION: The document has been reviewed and endorsed by the Canadian Thoracic Society, the Canadian Society of Allergy and Clinical Immunology, and The College of Family Physicians of Canada. CONCLUSIONS: There is good evidence for rapid investigation and objective categorization of presented symptoms into OA, aggravation of underlying asthma, unrelated asthma or other diagnoses. OA should be suspected in all adult onset asthmatics whose asthma begins or worsens while they are working. Investigations should be directed to an objective assessment of asthma and then to an assessment of the work relationship, using a combination of investigations as feasible, which may include immunological tests, pulmonary function assessed during work periods and away from work, and specific challenge tests. Early specialist referral is recommended for diagnosis. Management strategies include general asthma management in addition to measures to avoid further exposure to a relevant workplace sensitizer. Compensation issues and other workers at risk of developing OA also need to be considered when the diagnosis is made.

Adult↗