Determination of total mercury in workers' urine in gold shops of Itaituba, Pará State, Brazil

Universidade Federal do Pará. Departamento de Química. Belém, PA, Brasil.Universidade Federal do Pará. Departamento de Química. Belém, PA, Brasil.Universidade Federal do Pará. Departamento de Química. Belém, PA, Brasil.Instituto de Pesquisas Energéticas e Nucleares, Grupo de Caracterização Isotópica. São Paulo, SP, Brasil.Universidade Federal do Pará. Departamento de Química. Belém, PA, Brasil.Ministério da Saúde. Fundação Nacional de Saúde. Instituto Evandro Chagas. Belém, PA, Brasil.Ministério da Saúde. Fundação Nacional de Saúde. Instituto Evandro Chagas. Belém, PA, Brasil.Gold extraction and its commercialization in the Amazon region is mainly by rudimentary procedures. Therefore, during the process of extraction and recovery of this precious metal, large amounts of mercury vapors are thrown into the environment. This paper is an attempt to establish a correlation between the concentration of total mercury in the urine of workers at the gold shop in the Municipality of Itaituba, Para, and the information related to the ´ lifestyles of each individual studied. Through statistical analysis, it was possible to divide the workers into three groups: people with normal mercury concentrations, Hg w xF10 ppb, 29% ; with concentrations at the biological limit Ž . of tolerance, Hg up to 50 ppb, 49% ; and contaminated people, Hg w x Ž . w xG50 ppb 22% . It may be concluded that fish Ž . consumption, time of alcohol consumption, number of amalgam fillings, as well as working hours, are important variables when evaluating mercurial contamination of people who are occupationally exposed to mercury vapors

Evaluation of total mercury concentrations in fish consumed in the municipality of Itaituba, Tapajos River Basin, Para, Brazil

CAPES/CNPq/FINEP/SUDAM.Universidade Federal do Pará. Departamento de Química. Belém, PA, Brazil.Universidade Federal do Pará. Departamento de Química. Belém, PA, Brazil.Universidade de São Paulo. Instituto de Pesquisas Energéticas e Nucleares. Grupo de Caracterização Isotópica. São Paulo, SP, Brazil.Universidade Federal do Pará. Departamento de Química. Belém, PA, Brazil.Ministério da Saúde. Fundação Nacional de Saúde. Instituto Evandro Chagas. Laboratório de Ecologia Humana e Meio Ambiente. Ananindeua, PA, Brasil.Ministério da Saúde. Fundação Nacional de Saúde. Instituto Evandro Chagas. Laboratório de Ecologia Humana e Meio Ambiente. Ananindeua, PA, Brasil.Universidade Federal do Pará. Departamento de Química. Belém, PA, Brazil.The environmental exposure to mercury by riverine and Indian communities can occur through the ingestion of fish and products contaminated by mercury compounds. The present study aims to evaluate the total mercury concentration in the different fish species most consumed in the municipality of Itaituba, Tapajós river basin, where there are intense gold-mining activities. These fish samples were analyzed by atomic absorption spectrophotometry by cold vapor technique, Automatic Mercury Analyzer HG-3500. The largest mercury concentrations were found in the carnivorous species ranging from 112.4 to 2250 microg/g, while the detritivorous, herbivorous and omnivorous species presented total mercury levels ranging from 3.2 to 309.8 microg/g, which is below the limit established by the World Health Organization. This paper also reports and identifies which species are more polluted and present a statistical relationship among concentration and weight of the carnivorous species studied in detail, Brachyplatystoma flavicans (dourada) (r2 = 0.691) and Pseudoplatystoma sp. (surubim) (r2 = 0.654)

Tissue-specific mercury concentrations in two catfish species from the Brazilian coast

Some regions of Brazil have particularly high levels of mercury (Hg) emissions due to industrial activities, and their fish species may therefore suffer high levels of contamination through bioaccumulation. In this paper we assess Hg contamination in the muscle, liver, gills and blood of two different species of catfish collected from the Cananéia and Santos-São Vicente estuaries, São Paulo State, Brazil. Fish from the most polluted site (Santos-São Vicente) showed higher median Hg concentrations in both species (Cathorops spixii - liver: 1530 µg Kg-1, muscle: 327 µg Kg-1 and gill: 101 µg Kg-1; Genidens genidens - liver: 2617 µg Kg-1, muscle: 393 µg Kg-1 and gill: 118 µg Kg-1). Multivariate analysis revealed the importance and influence of key biological variables (size, condition, etc.) in determining the overall level of Hg and its distribution within different tissues.<br>Algumas regiões do Brasil apresentam, altos níveis de emissões de mercúrio (Hg) devido às atividades industriais, e suas espécies de peixes podem, portanto, estar expostos a elevados níveis de contaminação por meio da bioacumulação. Neste trabalho avaliamos a contaminação por Hg no músculo, fígado, brânquias e sangue de duas espécies de bagres coletados nos estuários de Cananéia e Santos-São Vicente, São Paulo, Brasil. Peixes amostrados no local mais poluído (Santos-São Vicente) mostraram maiores concentrações de Hg em ambas as espécies (Cathorops spixii - fígado: 1530 µg Kg-1, músculo: 327 µg Kg-1 e brânquias: 101 µg Kg-1; Genidens genidens - fígado: 2617 µg Kg-1, músculo: 393 µg Kg-1 e brânquias: 118 µg Kg-1). Análises multivariadas revelaram a importância e influência das principais variáveis biológicas (tamanho, condição, etc.) no teor geral de Hg e sua distribuição nos diferentes tecidos

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population.The aim of this study was to inform vaccination prioritization by modelling the impact of vaccination on elective inpatient surgery. The study found that patients aged at least 70 years needing elective surgery should be prioritized alongside other high-risk groups during early vaccination programmes. Once vaccines are rolled out to younger populations, prioritizing surgical patients is advantageous

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research