9 research outputs found
Accumulation of polychlorinated biphenyls in the population of Greater S. Paulo, Brazil
Experimental and clinical studies have proved, conclusively, that polychlorinated biphenyls (PCBs) can effect human health adversely, to the point of constituting a serious public health problem. Thus the study of the deposition of PCBs in a significant sample of the inhabitants of Greater S. Paulo, Brazil, was considered to be of interest. Samples of subcutaneous fat were obtained from 189 people who had suffered violent death and analysed by as chromatography. Average levels of 0.8661 parts per million (ppm) were found in males, who presented a linear increase of deposition according to chronological age; this was not observed with females, however in whom the values of deposition were, in general, 1.4530 ppm 12.7% of all samples presented values greater than 1.95 ppm. The importance of such findings is discussed and protective measures that should be taken to avoid further increase of absortion by the Brazilian population are indicated.Os policloretos de bifenila (PCBs), cuja utilização iniciou-se em 1930 em sistemas fechados (capacitores e transformadores elĂ©tricos) foram observados no ambiente em 1966, atingindo a cadeia alimentar e acumulando-se no tecido subcutâneo de seres humanos; ao mesmo tempo, foi possĂvel mostrar que esses produtos quĂmicos sĂŁo potencialmente nocivos para a saĂşde humana. Como em 1976 os PCBs foram encontrados no tecido gorduroso de pequena amostra da população brasileira, decidiu-se fazer um estudo mais amplo, analisando-se por cromatografia de fase gasosa a gordura do tecido celular subcutâneo de 189 pessoas, de ambos os sexos, que tinham sofrido morte violenta. Foram encontrados nĂveis mĂ©dios de 0,8661 ppm em indivĂduos do sexo masculino, que apresentaram aumento linear das concentrações de acordo com a idade, o que nĂŁo foi observado entre os do sexo feminino, onde os valores mĂ©dios de acĂşmulo foram de 1,4530 ppm. Do total de amostras, 12,7% apresentaram nĂveis superiores a 1,95 ppm. É discutida a importância do achado e sĂŁo assinaladas as medidas de proteção da população brasileira exposta aos PCBs
Taxa de chumbo em amostra de voluntários "não expostos" habitantes da Grande São Paulo - Brasil
AtravĂ©s de um espectrofotĂ´metro de absorção atĂ´mica foram pesquisados os nĂveis de chumbo no sangue de 315 voluntários de ambos os sexos (167 do sexo masculino e 148 do feminino) que nĂŁo revelaram exposição ocupacional a esse metal. Foi encontrado um valor mĂ©dio de 17,2 µg/100 ml para o sexo masculino e 14,2 µg/100 ml para o sexo feminino. Sugere-se a execução de novos estudos que envolvam populações definidas e amostragem probabilĂstica.The level of lead in the blood of 315 volunteers (167 male and 148 female) who had not been exposed professionally to the metal, was measured by the atomic absortion spectrophotometer method. The average value was 17.2 µg/100 ml in the males and 14.2 µg/100 ml in the females. It is suggested that new studies should be carried out, using a definite population and a probabilistic sampling
A farmacopsiquiatria dos antidepressivos: The pharmacopsychiatry of antidepressants
Os fármacos antidepressivos compõem o manejo terapĂŞutico da depressĂŁo e inĂşmeros outros transtornos de origem neuropsiquiátrica. Logo, a ocorrĂŞncias destes distĂşrbios tornam viável a aplicação destes, ressaltando ser essencial individualizar o tratamento e compreender a respeito das diversas classes, mecanismo de ação, interação medicamentosa, indicação clinica, grupo de risco e a intoxicação por superdosagem. O seguinte artigo objetivou descrever a respeito das particularidades dos antidepressivos, de modo a compreender sobre seu efeito farmacopsiquiatrĂco. Trata-se de uma revisĂŁo narrativa de literatura fundamentada nas renomadas plataformas de artigos indexados a respeito do tema. Foram selecionados os estudos que apresentavam relevância clinica para a compreensĂŁo do artigo, descartando-se os demais que nĂŁo respondiam ao objetivo proposto. Na literatura cientĂfica estĂŁo disponĂveis muitas informações pertinentes ao tema, ressaltando a importância deste. Atualmente, se encontram em aplicabilidade diversas classes que sĂŁo os Inibidores Seletivos da Recaptação de Serotonina (ISRSs), Antidepressivos TricĂclicos (ADTs), TetracĂclicos e os Inibidores da Monoamina Oxidase (IMAO). Cada um destes possui um mecanismo de ação diferente, mas basicamente estes interferem no impulso nervoso de neurotransmissores beneficiando o portador de distĂşrbios neurocognitivos. Destacando que mesmo com o efeito terapĂŞutico retrĂłgrado, estes já manifestam os efeitos adversos. Logo, Ă© imprescindĂvel analisar qual o tipo e a dose do fármaco para se conduzir o melhor prognĂłstico do paciente. 
Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study
Summary
Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally.
Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies
have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of
the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income
countries globally, and identified factors associated with mortality.
Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to
hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis,
exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a
minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical
status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary
intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause,
in-hospital mortality for all conditions combined and each condition individually, stratified by country income status.
We did a complete case analysis.
Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital
diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal
malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome
countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male.
Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3).
Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income
countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups).
Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome
countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries;
p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients
combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11],
p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20
[1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention
(ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety
checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed
(ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of
parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65
[0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality.
Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome,
middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will
be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger
than 5 years by 2030
International Nosocomial Infection Control Consortiu (INICC) report, data summary of 43 countries for 2007-2012. Device-associated module
We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2007-December 2012 in 503 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study using the Centers for Disease Control and Prevention's (CDC) U.S. National Healthcare Safety Network (NHSN) definitions for device-associated health care–associated infection (DA-HAI), we collected prospective data from 605,310 patients hospitalized in the INICC's ICUs for an aggregate of 3,338,396 days. Although device utilization in the INICC's ICUs was similar to that reported from ICUs in the U.S. in the CDC's NHSN, rates of device-associated nosocomial infection were higher in the ICUs of the INICC hospitals: the pooled rate of central line–associated bloodstream infection in the INICC's ICUs, 4.9 per 1,000 central line days, is nearly 5-fold higher than the 0.9 per 1,000 central line days reported from comparable U.S. ICUs. The overall rate of ventilator-associated pneumonia was also higher (16.8 vs 1.1 per 1,000 ventilator days) as was the rate of catheter-associated urinary tract infection (5.5 vs 1.3 per 1,000 catheter days). Frequencies of resistance of Pseudomonas isolates to amikacin (42.8% vs 10%) and imipenem (42.4% vs 26.1%) and Klebsiella pneumoniae isolates to ceftazidime (71.2% vs 28.8%) and imipenem (19.6% vs 12.8%) were also higher in the INICC's ICUs compared with the ICUs of the CDC's NHSN