[ ISSN : 2573-3680 ]
Backache; Aircraft Pilots; Prevalence
General medical practitioners in the air force often find Backache (BA) an occupational sequel in pilots. BA is often due to prolonged sitting, ineffective lumbar support, poor posture, having to lean forward to reach for navigational buttons and vibrations that can produce disc damage via microtrauma [1]. It is difficult to make a clear association between the type of aircraft and BA [2]. However, the higher incidence of BA in Helicopter Pilots (HP) has been attributed to vibrations (of around 5 Hz) as well as in-flight posture [1,3,4]. Andersen assessed the occurrence of spinal pain, i.e., low back and neck pain, among commercial helicopter pilots, along with possible associations between pain and anthropometric and demographic factors and flying exposure. He found Spinal pain to be a frequent problem [5]. BP in fighter pilots remains a serious occupational problem and found that recent advances such as the Joint Helmet Mounted Cueing System (JHMCS) in modern air combat can contribute to the development of spinal complaints in F-16 pilots [6]. Nagai found Low Back Pain (LBP) to be one of the most common musculoskeletal issues facing military helicopter pilots and stated that it is clinically important to identify differences in musculoskeletal characteristics between pilots with and without a LBP history for formulating effective interventions [7]. He found specific exercises targeted to improve trunk strength, ROM, and side-to-side symmetries may be beneficial to reduce LBP in helicopter pilots [7]. Herein, we sought to determine the prevalence of vertebral problems among 133 pilots, seeking the presence of Backache (BA), the type of aircraft and other factors associated with it.
We assessed all pilots of one air force base in eastern Tehran. BA, the type of aircraft and factors associated with it were sought. Pilots who had experienced BA underwent radiographic + MRI imaging. Demographics, flight experience (in years), daily physical exercise, flight hours as well as associated Neck Pain (NP) were assessed; data were analyzed via the Kolmogorov-Smirnov test, Student’s t-test Mann-Whitney U-test and the chi-square test.
There were 133 pilots with a mean age of 37.21±8.01 years, [pilots with BA were aged 39.62±7.98 years and pilots without were 35.36±7.69 years (P=0.079)]. Tables 1-3 depicts demographic, descriptive data and aircraft data. The Mean±SD of flight hours in pilot with NP was 1795.32±1849.98 hours. There was no association between flight hours and NP (P=0.119) (Table 1). But a significant difference was noted in work experience, daily PE duration and flight hours among pilots with BA (P=0.04, 0.034, and 0.029 respectively, Table 1). Also, there was a significant relationship between BA and NP (P=0.004) (Table 2). Pilots from 47 transport planes (Antonov), 16 fighter planes (Sukhoi) and 59 helicopters (MI17) were assessed; 56/133 pilots (43.1%) had BA (Table 3). However, here was no significant association between BA and aircraft type (P=0.358, Table 3). The mean±SD of professional experience was 17.67±7.63 years and daily Physical Exercise (PE) duration in pilots with BA was 22.57±12.56 minutes; PE in pilots without BA was 30.20±18.38 minutes (P=0.03) (Table 1). There was significant association between flight hours and BA (P=0.002) (Table 1).
Table 1: Study variables and data.
Table 2: Main result variables and data.
Table 3: BA and aircraft association.
BA is relatively common in pilots. While passengers have the luxury of getting up and moving around in the cabin, pilots and co-pilots spend most in-flight hours confined to the cockpit; thus, predisposing them to musculoskeletal problems namely BA and cervical pain. Injury prevention is one of the cornerstones of aviation healthcare [4] both in military [8] and civilian [1] populations; prevention is facilitated by early identification of risk factors [8].
Among the potential causes and risk for developing BA in highperformance aircrafts are G-forces. G-forces are forces that counteract the physiological acceleration of the body [2,4].
Wagstaff noted neck pain in fighter pilots to be relatively common. He assessed age, aircraft type, flying hours, and physical activity on NP. Any experience of spinal symptoms related to flight was included, as well as detailed questions on operational factors. Estimates regarding how NP influenced flying performance were established using a Visual Analogue Scales (VAS). Pilots also described their own in-flight techniques to avoid neck symptoms; 72% had experienced NP in flight, while 35% had experienced BP. Of these episodes, 93% were related to neck rotation. Mean G level for an acute incident of in-flight pain was 6.7 G [9].
Wagstaff stated new technologies such as night-vision goggles and helmet-mounted displays to increase helmet weight, thereby adding higher strain on the neck even in moderate G force environments [9]. We noted significant difference was noted in work experience, daily PE duration and flight hours among pilots with BA (P=0.002, 0.034, and 0.029 respectively). Andicochea stated LBP in the aviator to be a significant safety risk because it is a distraction during flight. He found Osteopathic Manipulative Therapy (OMT) as an adjunct to treatment of LBP and showed chronic LBP to respond to three OMT sessions focused at the sacrum, lumbar, and pelvis [10].
One study compared BA in fighter pilots, transport pilots, and HPs and showed that fighter pilots had significantly more chronic pain, longer lasting pain, pain requiring bed rest, and radiating pain to the leg [8]. With regard to G-force, another study found pilots exposed to high G-forces to be at a greater risk for neck pain than those exposed to low G-forces [11]. Orsello [12], found increase in height to increase the odds for developing BA in helicopter pilots. One of the limitations of our study was that we failed to assess this parameter. Our study showed BA was significantly more common among HPs compared to the other aircrafts.
Our study showed BA was significantly more common among HPs. The relationship between daily PE and flight hours among pilots with vertebral pain suggests physical exercise as a mode of early prevention.
Mirhashemi S, Motamedi MHK, Mirhashemi AH and Rasouli HR. Prevalence of Backache in Aircraft Pilots. SM J Clin Med. 2015; 1(2): 1010.
The purpose of this statement is none other than to highlight the importance of ethical standards and quality required in basic and applied research currently being done so we can subsequently inform health care professionals of new developments that are taking place in this area.
Ma. Esperanza Rodríguez-van Lier*
Chemotherapy is commonly used in cancer treatment. So far, chemotherapy agents can be categorized into three types: classical chemotherapeutic drugs, molecular target agents and cellular machineries target drugs.
Ziyou Wang1,2 and Zunnan Huang1,2*
Blood transfusion can cause some transfusion adverse reactions. In order to understand the incidence of adverse transfusion reactions, we performed a meta-analysis in Chinese hospitals. Of 809 literatures, seven studies involving a total of 211, 050 patients with blood transfusion treatment were included in this meta-analysis. Meta-analysis showed that the total incidence of adverse reactions was 0.4% [95% CI (0.2, 0.9), P < 0.0001]. Further subgroup analysis showed that the incidence of febrile and allergic reactions was 0.2% [95% CI (0.1, 0.5), P < 0.0001] and 0.2% [95% CI (0.1, 0.3), P < 0.0001], respectively. The common blood components caused adverse reactions were red blood cell, plasama, and platelet in clinical practice.
Yulu Gao1 , Qinyun Li2 , Zongshuai Gao2 , Yunxia Zhu4 , Yanqiu Liao5 , Changtai Zhu2 *# , Yongning Sun3 *#
Background: CT scanning remains one of the most routinely used diagnostic tools in a setting of Interstitial Lung Disease (ILD). New and improved technologies, such as High Resolution Computer Tomography (HRCT) have revolutionized the quality of imaging, leading to a prominent increase in number of incidental findings that may or may not be of any clinical significance. The aim of this study was to evaluate the prevalence of incidental findings on thoracic CT and their clinical significance.
Methods: Retrospective analysis was conducted on a cohort of 84 patients referred to our academic center as cases of ILD. Patients were referred for further evaluation between January 2000 and January 2014 and were followed over the disease course. CT scans were done annually as part of clinical management and patients were screened for any incidental findings. All incidental findings were reviewed, recorded in a clinical database and followed up on subsequent visits.
Results: 25 (30%) patients were found to have incidental findings. Liver abnormalities were found in 12 (14.29 %) patients. 11(13.10 %) patients were reported to have coronary artery calcifications. 5 (5.95 %) and 3 (3.57%) patients had thyroid abnormalities and renal cysts, respectively. A malignant lesion was found in 1 patient each in liver and thyroid abnormality subgroup.
Conclusion: Incidental findings are common on thoracic CT scans providing valuable and unexpected findings which warrant investigation by health care providers to exclude malignant processes.
Sonu Sahni1,2*, Sameer Verma1,2, Reeju S Thomas1 , Barbara Capozzi3 and Arunabh Talwar1,2
Hepatitis C Virus infection (HCV) is an increasing public health concern with an estimated 184 million people infected worldwide and approximately 350.000 yearly deaths from HCV-related complications.
Nesrine Gamal and Pietro Andreone*
We report a case of large cell undifferentiated lung carcinoma in a middle aged patient with previously treated tuberculosis and scarring. 20 pack years of smoking history was noted. He presented with metastasis at multiple sites including trochanter, liver and acute bilateral lateral rectus palsy. Chest radiography showed fibrosis of right upper zone with homogenous opacity. Sputum examination for AFB was negative. Computerized tomography of the thorax showed an irregular heterogeneously enhancing mass involving right upper lobe with cavitation, necrosis along with lymph node involvement and the erosion of the 4th rib with liver metastasis. Radiography of hip joint was suggestive of lesser trochanteric metastasis. MRI brain was suggestive of mass at base of brain in parasellar area. Fine needle aspiration cytology and CT guided biopsy confirmed undifferentiated large cell carcinoma of lung. Tuberculosis and smoking may increase the risk of lung scarring and malignancy and pulmonary scarring may be associated with increased lung carcinoma in ipsilateral lung. Clinician needs to be more sensitive to look for malignancy association particularly in patient with or previously treated for tuberculosis and even more emphasis to be laid if scarring of lung is observed.
Sreenivasa Rao Sudulagunta1 *, Shyamala Krishnaswamy Kothandapani2 , Mahesh Babu Sodalagunta3 , Hadi Khorram2 , Mona Sepehrar4 and Zahra Noroozpour1
Systemic Sclerosis (SSc) is a connective tissue disease characterized by fibrosis of the skin and internal organs, pronounced alterations in the microvasculature and frequent cellular and humoral immunity abnormalities. The rheumatic involvement of SSc is polymorphic and can reveal the disease or may appear during the course of its progression. Musculoskeletal involvement is dominated by non specific arthralgia, polyarthritis, and bony resorption especially acro-osteolysis. The diagnosis of these rheumatic manifestations is generally based on x rays examination. Musculoskeletal involvement in SSc is generally relieved with Non Steroidal Anti-Inflammatory Drugs (NSAID) or low dose of corticotherapy. The immunosuppressive therapy is used in corticoid-resistant or corticoid-dependent forms such us méthotrexate. The aim of our review is to presents an overview of the different osteoarticular and muscular involvement in SSc, their diagnosis and management.
Nessrine Akasbi*, Fatima Ezzahra Abourazzak and Taoufik Harzy
We encountered two autopsy cases of huge cardiomegaly with over 1000g in weight. Histochemical characteristics were examined using conventional staining including HE and Azan stains and immunohistochemical staining using antibodies against Complement Component 9 (CC9), RNA Binding Protein Motif 3(RBM3), Endothelial Type NO Synthase (eNOS) and Hypoxic Inducible Factor1α (HIF1). The reactive area with anti CC9 antibody, which presumed to be a marker of hypoxic change of myocardium, overlapped with eosinophilic area by HE and basophilic one by Azan. Although the reactive area with anti CC9 antibody showed relatively weak in the cytoplasm by anti eNOS antibody and no in the nucleus of cardiocytes with anti RBM3 antibody, outside of the reactive area with anti CC9 antibody there were intensive reactivity with anti eNOS antibody in cytoplasm and in a nucleus with anti RBM3 antibody. Anti HIF1 antibody showed weak reactivity with cytoplasm of endocardial cardiocytes and no with cytoplasm of cardiocytes in another area. The results obtained from the present cases revealed that the hypoxic change was equivalent even though the cause of cardiomegaly was deferred between two cases, and conventional staining such as HE and Azan utilized to detect hypoxic change in the heart and immunohistochemical studies seemed to be a useful tool for clarifying the cascade of hypoxic changes in the myocardium.
Satoshi Furukawa1,2*, Mayumi Kataoka1 , Satomu Morita1,2, Akari Uno2 , Masahito Hitosugi2 , Hiroshi Matsumoto1,3 and Katsuji Nishi1,2
A 45-year-old woman with multiple sclerosis was admitted to our hospital after out of hospital cardio-pulmonary resuscitation. The first ECG showed ventricular fibrillation. Following direct current defibrillation and mechanical reanimation, spontaneous circulation was restored and the ECG unremarkable without any signs of ischemia. Coronary angiography showed unobstructed coronary arteries Figure 1, (Panel A). Left ventriculography revealed apical wall obstruction, suggestive of apical aneurysm (Panel B, supplementary videos). Transthoracic echocardiography and Cardiac Magnetic Resonance Imaging (CMR) eventually lead to the diagnosis of a rare case of Apical Hypertrophic Cardiomyopathy (AHC) with ace of spades-form (Panel C,D). The patient underwent Cardioverter-Defibrillator Implantation (ICD) and amiodarone medical therapy for secondary prophylaxis. Patient’s family history and screening for HCM were unsuspicious.
Wiedemann S# *, Heidrich FM# , Speiser U and Strasser RH
We present the case of a 23-year-old female who was 23 weeks pregnant and presented to the emergency room of our Obstetric Department in nausea and vomiting that had been worsening over the course of 2 months with loss of eight kilograms in clinical presentation compatible with hyperemesis.
Elisa Picardo1*, Marco Mitidieri1, Marco Bozzaro2, Roberto Altieri2, Carlo Carmazzi1 and Saverio Danese1