Several case reports have been written regarding the relationship between the use of proton pump inhibitors (PPI) and hypomagnesemia. Some of these reported cases have electrocardiogram abnormalities where electrolytes deficiencies were the contributing factor for these events. This study investigates the correlation between different arrhythmias and the use of PPI and hypomagnesaemia incidence. Four-hundred and twenty-one patients admitted to the critical care unit with unstable angina, non-ST elevation myocardial infarction, and ST-elevation myocardial infarction were included in this study. One-hundred and eighty-four patients (43.8%) received PPI and 237 patients (51.16%) did not, magnesium levels were low (<1.8 mg/dL) in 95 patients (22.5%), and 167 patients (39.6%) developed arrhythmias. The P-values for the regression coefficient association for the use of PPI and the level of magnesium were P = 1.31e−29 and P = 8e−102, respectively. The P-values indicate that there is a statistically significant association between the PPI use, magnesium levels, and the occurrence of cardiovascular events, with a strong correlation factor of 0.817. Patients receiving PPIs should be followed closely for magnesium deficiency, especially if they experience acute cardiovascular events, because this may contribute to worsening arrhythmias and further complications.

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IntroductionCoal miners in Queensland Australia have a pre-employment medical and then medical every five years. In 2015, cases of coal workers’ pneumoconiosis (CWP) were identified among miners/ex-miners, outside the medical scheme.MethodsWe reviewed the respiratory component of the medical scheme and evaluated its design and implementation. We reviewed 91 completed medical forms, 257 chest x-rays (CXRs) and 260 spirograms and surveyed the spirometry equipment and training of providers. We interviewed employer and trades union representatives.ResultsMedicals had become focussed on fitness for work rather than surveillance. Some forms were poorly completed and the questions were inadequate to evaluate respiratory health.The criteria to trigger a CXR were unclear. Only 25% of the CXRs ‘good’ under the ILO classification scheme. 18 of the CXRs showed Category 1 simple pneumoconiosis, only two were identified in the original radiology reports.40% of the spirograms had not been performed to ATS/ERS standards and were uninterpretable. We identified 30 abnormal spirograms of which only 1 had been identified in the medical report. The survey of spirometry providers identified poor knowledge of the equipment, poor quality control processes and inadequate training.DiscussionAn effective scheme needed to more clearly articulated its surveillance purpose and to be reviewed on a regular basis.We recommended that a smaller number of experienced doctors trained and approved to undertake these assessments. The scheme needed better spirometry testing and interpretation, a better CXR referral process, improved CXR interpretation and reporting using the ILO criteria. Clinical guidelines were needed to inform diagnosis and management of CMDLD. Medical screening and surveillance is not a substitute for effective dust control, which is the primary protection against CWP. This is particularly important because it can progress even after dust exposure has ceased. These findings have implications for medical screening in other industries.

The rectal trumpet (RT) is a nasopharyngeal airway device that is inserted into the rectum for management of fecal incontinence. No published data exist on adverse events caused by the use of an RT. The purpose of this quality improvement project was to determine the rate of RT-associated hemorrhage among patients treated with an RT in our transplant intensive care unit (TICU). This quality improvement initiative and retrospective medical record review included all patients (N = 3933) cared for in a single specialty intensive care unit at a tertiary academic medical center between January 1, 2014, and May 31, 2016. We estimate that approximately 400 patients were treated with an RT. We found 3 possible and 9 probable cases of RT-associated hemorrhage, resulting in an estimated incident rate of 3% among RT-treated patients. All of these patients underwent invasive procedures for hemostasis. They received a mean of 4.9 units of packed red blood cell transfusions, and 9 experienced hypotension. Eight out of the 9 probable RT-associated hemorrhage patients experienced hemorrhage only after greater than 7 days of treatment with an RT. Following this initiative, RT use was banned in our TICU. The use of RTs can cause hemorrhage with clinically significant consequences.

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