Cádmio presente no sangue e a sua relação com o consumo de tabaco numa população de trabalhadores de um hospital

Exposure to cadmium is a public health problem due to the broad exposure to this toxic substance among the general population. The main sources of exposure are both tobacco consumption and tobacco smoke.The aim of this study was to determine the blood cadmium concentration in an employee population drawn from our hospital and its association with tobacco consumption.The exposure questionnaire PESA® was administered to 395 employees. Blood cadmium was measured by electrothermal atomization atomic absorption spectrometry.The median blood cadmium concentration was 0.29 μg/L. The median cadmium of current smokers (0.83 μg/L) was the highest, while that for ex-smokers (0.31 μg/L) was also higher than that for those who had never smoked. Among the smokers, an association was observed between the concentration of blood cadmium and the number of cigarettes inhaled.The group of ex-smokers showed an association with the number of cigarettes they had consumed and a negative correlation between the elapsed time between quitting smoking and the concentration of blood cadmium.In never smokers, there was a difference between the concentration of cadmium in those who were passive smokers (0.24 μg/L) and those who were not (0.20 μg/L).The concentration of cadmium in blood is related to the tobacco consumption. Further studies are needed to confirm the finding of higher concentrations of cadmium in passive smokers.La exposición de la población general al cadmio es un problema de salud pública, siendo las principales fuentes tanto el consumo de tabaco como la exposición al humo del mismo.El objetivo de este trabajo fue determinar la concentración de cadmio en sangre en una población laboral hospitalaria y su asociación con el consumo de tabaco.Se administró el cuestionario PESA® a 395 sujetos. El cadmio en sangre se midió por espectrometría de absorción atómica con atomización electrotérmica.La mediana de cadmio en sangre fue 0,29 μg/L. La mediana de cadmio de los fumadores (0,83 μg/L) fue la más elevada y la de los exfumadores (0,31 μg/L) fue a su vez más elevada que la de aquellos que nunca habían fumado (0,21 μg/L). Dentro del grupo de fumadores, se observó una asociación entre la concentración de cadmio y el número de cigarrillos inhalados.En el grupo de exfumadores se observó una asociación con el número de cigarrillos que habían consumido y una correlación negativa entre el tiempo transcurrido desde el abandono del hábito tabáquico y la concentración de cadmio en sangre.Dentro del grupo de los que nunca habían fumado, se observó una diferencia entre la concentración de cadmio de los fumadores pasivos (0,24 μg/L) y los que no lo eran (0,20 μg/L).La concentración de cadmio en sangre se relacionó con el consumo de tabaco. Son necesarios más estudios para confirmar el hallazgo de concentraciones de cadmio más elevadas en los fumadores pasivos.A exposição da população em geral ao cádmio é um problema de saúde pública, sendo as principais fontes o consumo de tabaco e a exposição ambiental ao fumo do mesmo. Este trabalho teve como objetivo determinar a concentração de cádmio no sangue numa população de trabalhadores de um hospital e a sua associação com o consumo de tabaco. Aplicou-se um questionário PESA® a 395 indivíduos. O cádmio no sangue mediu-se por espectrometria de absorção atómica com atomização eletrotérmica. A mediana de cádmio no sangue foi 0,29 μg/L. A mediana de cádmio nos fumadores (0,83 μg/L) foi a mais elevada e a dos ex-fumadores (0,31 μg/L) foi superior à dos indivíduos que nunca tinham fumado (0,21 μg/L). Dentro do grupo de fumadores, observou-se uma associação entre a concentração de cádmio e o número de cigarros fumados. No grupo de ex-fumadores observou-se uma associação com o número de cigarros que tinham consumido e uma correlação negativa entre o tempo decorrido desde o abandono do hábito tabágico e a concentração de cádmio no sangue. Dentro do grupo de pessoas que nunca tinham fumado, observou-se uma diferença entre a concentração de cádmio nos fumadores passivos (0,24 μg/L) em relação àqueles que não o eram (0,20 μg/L). A concentração de cádmio no sangue está relacionada com o consumo de tabaco. São necessários mais estudos para confirmar a existência de concentrações mais altas de cádmio no sangue de fumadores passivos

Fatores de risco associados aos níveis de chumbo no sangue das crianças da Comunidade de Madrid em 2010

Introduction: Lead is a toxic element for humans, with children being the most vulnerable population.Objective: To find out the risk factors associated to the existing blood lead levels (BLLs) of children in the Community of Madrid, after 9 years of lead being banned in gasoline.Methods: A cross-sectional study was carried out in 2010 with a sample of 85 children, less than 15 years of age, recruited via the outpatients’ service of the Pediatrics Department of the Hospital Clínico San Carlos in Madrid. Routine blood tests provided the opportunity for determining other blood parameters. Lead levels were measured using electrothermal-atomization atomic absorption spectrometry with the Zeeman-effect background correction. In addition, a survey was undertaken directed to the parents for gathering information about a series of socioeconomic and environmental variables.Results: The arithmetic mean of the BLLs in the children was 1.1 μg/dL (SD=0.7 μg/dL) with a range from 0.1 μg/dL to 3.4 μg/dL. The geometric mean was 0.9 μg/dL (SD= 1.1 μg/dL). The risk factors associated to these BLLs are the following: playing in the street; low educational level of the parents; leisure activities of one of the parents linked to lead; tobacco smoking of the father; and drinking tap water.Conclusions: The BLLs of the children in the Community of Madrid have decreased, but there are still sociodemographic and environmental risk factors associated to the present levels.Introducción: El plomo es un elemento tóxico para el hombre, siendo los niños la población más vulnerable.Objetivo: Conocer los factores de riesgo asociados a los niveles de plomo en sangre existente en niños de la Comunidad de Madrid tras 9 años de prohibición del plomo en las gasolinas. Métodos: Estudio transversal realizado en el año 2010 en el que se incluyeron 85 niños de ambos sexos, menores de 15 años reclutados en consulta ambulatoria del Servicio de Pediatría del Hospital Clínico San Carlos de Madrid. Se aprovechó la extracción de sangre para la determinación de otros parámetros sanguíneos. El plomo se midió por espectrometría de absorción atómica con atomización electrotérmica y corrección de fondo por efecto Zeeman. Además se pasó una encuesta a los padres recogiéndose toda una serie de variables socioeconómicas y ambientales.Resultados: La media aritmética de plomo en sangre encontrada en los niños ha sido de 1,1 μg/dL (DE=0,7 μg/dL) con un rango desde 0,1 μg/dL hasta 3,4 μg/dL. La media geométrica es de 0,9 μg/dL (DE= 1,1 μg/dL). Los factores de riesgo asociados a estos niveles son: jugar en la calle, bajo nivel de estudios del padre como de la madre, las aficiones ligadas al plomo de alguno de los padres, el consumo de tabaco del padre y beber agua del grifo.Conclusiones: Los niveles de plomo en la sangre de los niños de la Comunidad de Madrid se han reducido pero siguen existiendo factores de riesgo sociodemográficos ya ambientales asociados a estos niveles.  Introdução: O chumbo é um elemento tóxico para os seres humanos, sendo as crianças as mais vulneráveis.Objetivo: Conhecer os fatores de risco associados aos níveis de chumbo existentes no sangue das crianças da comunidade de Madrid, após 9 anos de proibição de chumbo na gasolina.Métodos: Estudo transversal realizado em 2010 que incluiu 85 crianças de ambos os sexos, com menos de 15 anos, selecionadas na consulta externa do Serviço de Pediatria do Hospital Clínico San Carlos em Madrid. Para a deteção dos níveis de chumbo foram aproveitadas amostras de sangue destinadas à determinação de outros parâmetros. O chumbo foi medido por espectrometria de absorção atómica com atomização eletrotérmica e correção de fundo por efeito Zeeman. Conjuntamente, realizou-se um questionário aos pais para recolher uma série de variáveis socioeconómicas e ambientais.Resultados: A média aritmética de chumbo no sangue encontrado nas crianças foi de 1,1 μg/dl (SD=0,7 μg/dl), com um intervalo de 0,1 μg/dl a 3,4 μg/dl. A média geométrica é de 0,9 μg/dl (SD=1,1 μg/dl). Os fatores de risco associados aos níveis apresentados são: o brincar na rua, o baixo nível de escolaridade dos pais, as atividades de lazer de um dos pais relacionadas com o chumbo, os hábitos tabágicos do pai e o consumo de água da rede pública.Conclusões: Os níveis de chumbo no sangue das crianças da Comunidade de Madrid reduziram, contudo subsistem fatores de risco sociodemográficos e ambientais associados a estes níveis

Adaptación de la asignatura Alimentación y Nutrición pediátrica al espacio Virtual

En este proyecto se pretende adaptar los contenidos existentes y crear contenidos nuevos para un entorno virtual, crear presentaciones PowerPoint con locución y vídeo y crear una autoevaluación aplicable a través del Campus Virtual

Economic appraisal of the impact of the ban on the use of lead in gasoline on the intellectual quotient of 7-8 years old in the Community of Madrid

Fundamentos: la evaluación económica de las repercusiones sanitarias de las políticas públicas es difícil y escasa. El objetivo del presente estudio fue cuantificar monetariamente los beneficios de la reducción del plomo en la sangre de los niños de 7-8 años en la Comunidad de Madrid (España), derivada de la prohibición del plomo en las gasolinas. Métodos: se calculó la disminución de puntos de cociente intelectual (CI), utilizando dos estudios realizados en niños de 7 a 8 años según los valores de plomo en sangre que presentaban: media geométrica de 3,8 μg/dL en 1995 y 0,9 μg/dL en 2010. La mejoría neta de CI se midió en términos de capacidad de producción ganada a lo largo de la vida laboral, siguiendo los métodos de Schwartz y Salkiver. Resultados: la reducción de los niveles de plomo en sangre de estos niños evitó perder entre 135.391 y 144.153 puntos de CI. La valoración económica actual de estos puntos en términos de capacidad de producción ganada a lo largo de la vida laboral de estos sujetos se estimó en un rango entre 626,4 y 865,4 millones de euros (valor 2009). Conclusiones: las cifras de beneficios económicos encontradas derivadas de la medida de prohibición de uso de plomo en las gasolinas son importantes en términos sociales.Background: the repercussions on health of public policies are hard to assess from an economic point of view, which is why this is rarely done. The purpose of this study was to financially quantify the benefits of reducing blood lead levels in children aged 7-8 years in the Community of Madrid (Spain) as a result of the ban on the use of lead in gasoline. Methods: the decrease the intellectual quotient (IQ) points was calculated through two studies on children aged 7-8 years according to their blood lead levels. A geometric mean of 3.8 μg/dl was obtained in the 1995 study and of 0.9 μg/dl in the 2010 study. The net increase in IQ was measured in terms of productivity gained throughout the working life as per the methods of Schwartz and Salkever. Results: the decrease in blood lead levels in these children prevented a loss of between 135,391 and 144,153 IQ points; the current economic valuation of these points in terms of the productivity gained throughout the working life of this cohort of children was estimated to fall within the €626.4m- €865.4m range (2009). Conclusions: the figures of the economic benefits derived from the decision to ban leaded gasoline are very high

The cardiomyopathy of cystic fibrosis: a modern form of Keshan disease

IntroductionWe conducted a study to determine the prevalence of structural heart disease in patients with CF, the characteristics of a cardiomyopathy not previously described in this population, and its possible relationship with nutritional deficiencies in CF.MethodsWe studied 3 CMP CF patients referred for heart-lung transplantation and a prospective series of 120 adult CF patients. All patients underwent a clinical examination, blood tests including levels of vitamins and trace elements, and echocardiography with evaluation of myocardial strain. Cardiac magnetic resonance imaging (CMR) was performed in patients with CMP and in a control group. Histopathological study was performed on hearts obtained in transplant or necropsy.ResultsWe found a prevalence of 10% (CI 4.6%–15.4%) of left ventricular (LV) dysfunction in the prospective cohort. Myocardial strain parameters were already altered in CF patients with otherwise normal hearts. Histopathological examination of 4 hearts from CF CMP patients showed a unique histological pattern of multifocal myocardial fibrosis similar to Keshan disease. Four of the five CF CMP patients undergoing CMR showed late gadolinium uptake, with a characteristic patchy pattern in 3 cases (p < 0.001 vs. CF controls). Selenium deficiency (Se < 60 µg/L) was associated with more severe LV dysfunction, higher prevalence of CF CMP, higher NTproBNP levels, and more severe pulmonary and digestive involvement.Conclusion10% of adults with CF showed significant cardiac involvement, with histological and imaging features resembling Keshan disease. Selenium deficiency was associated with the presence and severity of LV dysfunction in these patients

Viral RNA load in plasma is associated with critical illness and a dysregulated host response in COVID‑19

Background. COVID-19 can course with respiratory and extrapulmonary disease. SARS-CoV-2 RNA is detected in respiratory samples but also in blood, stool and urine. Severe COVID-19 is characterized by a dysregulated host response to this virus. We studied whether viral RNAemia or viral RNA load in plasma is associated with severe COVID-19 and also to this dysregulated response. Methods. A total of 250 patients with COVID-19 were recruited (50 outpatients, 100 hospitalized ward patients and 100 critically ill). Viral RNA detection and quantification in plasma was performed using droplet digital PCR, targeting the N1 and N2 regions of the SARS-CoV-2 nucleoprotein gene. The association between SARS-CoV-2 RNAemia and viral RNA load in plasma with severity was evaluated by multivariate logistic regression. Correlations between viral RNA load and biomarkers evidencing dysregulation of host response were evaluated by calculating the Spearman correlation coefficients. Results. The frequency of viral RNAemia was higher in the critically ill patients (78%) compared to ward patients (27%) and outpatients (2%) (p < 0.001). Critical patients had higher viral RNA loads in plasma than non-critically ill patients, with non-survivors showing the highest values. When outpatients and ward patients were compared, viral RNAemia did not show significant associations in the multivariate analysis. In contrast, when ward patients were compared with ICU patients, both viral RNAemia and viral RNA load in plasma were associated with critical illness (OR [CI 95%], p): RNAemia (3.92 [1.183–12.968], 0.025), viral RNA load (N1) (1.962 [1.244–3.096], 0.004); viral RNA load (N2) (2.229 [1.382–3.595], 0.001). Viral RNA load in plasma correlated with higher levels of chemokines (CXCL10, CCL2), biomarkers indicative of a systemic inflammatory response (IL-6, CRP, ferritin), activation of NK cells (IL-15), endothelial dysfunction (VCAM-1, angiopoietin-2, ICAM-1), coagulation activation (D-Dimer and INR), tissue damage (LDH, GPT), neutrophil response (neutrophils counts, myeloperoxidase, GM-CSF) and immunodepression (PD-L1, IL-10, lymphopenia and monocytopenia). Conclusions. SARS-CoV-2 RNAemia and viral RNA load in plasma are associated with critical illness in COVID-19. Viral RNA load in plasma correlates with key signatures of dysregulated host responses, suggesting a major role of uncontrolled viral replication in the pathogenesis of this disease.This work was supported by awards from the Canadian Institutes of Health Research, the Canadian 2019 Novel Coronavirus (COVID-19) Rapid Research Funding initiative (CIHR OV2 – 170357), Research Nova Scotia (DJK), Atlantic Genome/Genome Canada (DJK), Li-Ka Shing Foundation (DJK), Dalhousie Medical Research Foundation (DJK), the “Subvenciones de concesión directa para proyectos y programas de investigación del virus SARS‐CoV2, causante del COVID‐19”, FONDO–COVID19, Instituto de Salud Carlos III (COV20/00110, CIBERES, 06/06/0028), (AT) and fnally by the “Convocatoria extraordinaria y urgente de la Gerencia Regional de Salud de Castilla y León, para la fnanciación de proyectos de investigación en enfermedad COVID-19” (GRS COVID 53/A/20) (CA). DJK is a recipient of the Canada Research Chair in Translational Vaccinology and Infammation. APT was funded by the Sara Borrell Research Grant CD018/0123 funded by Instituto de Salud Carlos III and co-fnanced by the European Development Regional Fund (A Way to Achieve Europe programme). The funding sources did not play any role neither in the design of the study and collection, not in the analysis, in the interpretation of data or in writing the manuscript

Notícias e revisão da literatura

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Cadmio en sangre y su relación con el consumo de tabaco en una población laboral hospitalaria Blood cadmium and its relationship with smoking in a hospital employee population Cádmio presente no sangue e a sua relação com o consumo de tabaco numa população de trabalhadores de um hospital

La exposición de la población general al cadmio es un problema de salud pública, siendo las principales fuentes tanto el consumo de tabaco como la exposición al humo del mismo.El objetivo de este trabajo fue determinar la concentración de cadmio en sangre en una población laboral hospitalaria y su asociación con el consumo de tabaco.Se administró el cuestionario PESA® a 395 sujetos. El cadmio en sangre se midió por espectrometría de absorción atómica con atomización electrotérmica.La mediana de cadmio en sangre fue 0,29 μg/L. La mediana de cadmio de los fumadores (0,83 μg/L) fue la más elevada y la de los exfumadores (0,31 μg/L) fue a su vez más elevada que la de aquellos que nunca habían fumado (0,21 μg/L). Dentro del grupo de fumadores, se observó una asociación entre la concentración de cadmio y el número de cigarrillos inhalados.En el grupo de exfumadores se observó una asociación con el número de cigarrillos que habían consumido y una correlación negativa entre el tiempo transcurrido desde el abandono del hábito tabáquico y la concentración de cadmio en sangre.Dentro del grupo de los que nunca habían fumado, se observó una diferencia entre la concentración de cadmio de los fumadores pasivos (0,24 μg/L) y los que no lo eran (0,20 μg/L).La concentración de cadmio en sangre se relacionó con el consumo de tabaco. Son necesarios más estudios para confirmar el hallazgo de concentraciones de cadmio más elevadas en los fumadores pasivos.Exposure to cadmium is a public health problem due to the broad exposure to this toxic substance among the general population. The main sources of exposure are both tobacco consumption and tobacco smoke.The aim of this study was to determine the blood cadmium concentration in an employee population drawn from our hospital and its association with tobacco consumption.The exposure questionnaire PESA® was administered to 395 employees. Blood cadmium was measured by electrothermal atomization atomic absorption spectrometry.The median blood cadmium concentration was 0.29 μg/L. The median cadmium of current smokers (0.83 μg/L) was the highest, while that for ex-smokers (0.31 μg/L) was also higher than that for those who had never smoked. Among the smokers, an association was observed between the concentration of blood cadmium and the number of cigarettes inhaled.The group of ex-smokers showed an association with the number of cigarettes they had consumed and a negative correlation between the elapsed time between quitting smoking and the concentration of blood cadmium.In never smokers, there was a difference between the concentration of cadmium in those who were passive smokers (0.24 μg/L) and those who were not (0.20 μg/L).The concentration of cadmium in blood is related to the tobacco consumption. Further studies are needed to confirm the finding of higher concentrations of cadmium in passive smokers.A exposição da população em geral ao cádmio é um problema de saúde pública, sendo as principais fontes o consumo de tabaco e a exposição ambiental ao fumo do mesmo. Este trabalho teve como objetivo determinar a concentração de cádmio no sangue numa população de trabalhadores de um hospital e a sua associação com o consumo de tabaco. Aplicou-se um questionário PESA® a 395 indivíduos. O cádmio no sangue mediu-se por espectrometria de absorção atómica com atomização eletrotérmica. A mediana de cádmio no sangue foi 0,29 μg/L. A mediana de cádmio nos fumadores (0,83 μg/L) foi a mais elevada e a dos ex-fumadores (0,31 μg/L) foi superior à dos indivíduos que nunca tinham fumado (0,21 μg/L). Dentro do grupo de fumadores, observou-se uma associação entre a concentração de cádmio e o número de cigarros fumados. No grupo de ex-fumadores observou-se uma associação com o número de cigarros que tinham consumido e uma correlação negativa entre o tempo decorrido desde o abandono do hábito tabágico e a concentração de cádmio no sangue. Dentro do grupo de pessoas que nunca tinham fumado, observou-se uma diferença entre a concentração de cádmio nos fumadores passivos (0,24 μg/L) em relação àqueles que não o eram (0,20 μg/L). A concentração de cádmio no sangue está relacionada com o consumo de tabaco. São necessários mais estudos para confirmar a existência de concentrações mais altas de cádmio no sangue de fumadores passivos