Carboxyhemoglobinemia as a laboratory finding in an outpatient

Resumen El monóxido de carbono (CO) es un gas producido principalmente por combustión incompleta de hidrocarburos. La intoxicación por exposición ambiental puede presentarse con síntomas inespecíficos y constituye la causa más importante de aumento de carboxihemoglobina (COHb). Su nivel en sangre depende de la duración de la exposición, la ventilación minuto y las concentraciones de CO y oxígeno en el ambiente. La elevada toxicidad radica en la hipoxia tisular que se genera. Se presenta el caso de un paciente masculino, 73 años, en seguimiento en el hospital por neumonía intersticial no específica como patología de base. En un control de laboratorio se encontró 11,9% de COHb, sin exposición a tabaco. No utilizaba calefacción a gas sino un panel cerámico eléctrico, recientemente pintado con esmalte sintético. La suspensión del uso del panel normalizó la COHb. El CO, producto de descomposición térmica del esmalte sintético, explica la causa de la intoxicación.

Abstract Carbon monoxide (CO) is a gas produced mainly by incomplete combustion of hydrocarbons. Poisoning from environmental exposure can present with nonspecific symptoms and is the most important cause of increased carboxyhemoglobin (COHb). Its blood level depends on the duration of exposure, minute ventilation, and the concentrations of CO and oxygen in the environment. The high toxicity lies in the tissue hypoxia that is generated. The case of a male patient, 73 years old, under follow-up in the hospital for non-specific interstitial pneumonia as the underlying pathology was presented. In a laboratory control, COHb 11,9% was found. There was no exposure to tobacco and there was no use of gas heating but of an electric ceramic panel, recently painted with synthetic enamel type paint. The suspension of the use of the panel normalised the COHb. The CO product of thermal decomposition of synthetic enamel explains the cause of poisoning.

Resumo O monóxido de carbono (CO) é um gás produzido principalmente pela combustão incompleta de hidrocarbonetos. A intoxicação por exposição ambiental pode se apresentar com sintomas inespecíficos e é a causa mais importante de aumento da carboxihemoglobina (COHb). Seu nível em sangue depende do tempo de exposição, da ventilação minuto e das concentrações de CO e oxigênio no ambiente. A alta toxicidade está na hipóxia tecidual gerada. Apresentamos o caso de um paciente do sexo masculino, 73 anos, em acompanhamento hospitalar por pneumonia intersticial inespecífica como patologia de bas. Em um controle laboratorial, achou-se 11,9% de COHb, sem exposição ao tabaco. Não utilizava aquecimento a gás e sim um painel elétrico cerâmico, recentemente pintado com esmalte sintético. A suspensão do uso do painel normalizou o COHb. O CO produto da decomposição térmica do esmalte sintético explica a causa da intoxicação.

Characterization, Antioxidant and Antibacterial Potentials of Tamarindus indica L. Fruit Pulp Extract Loaded O/W Nanoemulsions

Abstract The main purposes of the current study were to formulate o/w nanoemulsions as a carrier for Tamarindus indica (tamarind) fruit pulp extract and to study the antioxidant and antibacterial potentials of nanoemulsions containing tamarind extract, focusing on cosmetic/hygiene applications. The o/w nanoemulsions using a mixture of Tween 80 and Span 80 as an emulsifier (5%w/w) were prepared by a high pressure homogenization process. Two concentrations of sweet tamarind extract, 3.3 and 6.6%w/w, based on the bioactivity study, were incorporated into the blank nanoemulsions to produce loaded nanoemulsions, F1-3.3TE (3.3%) and F1- 6.6TE (6.6%). As compared with the unloaded nanoemulsion, both tamarind extract loaded nanoemulsions showed reduced pH and significantly increased viscosity. Overall, the loaded nanoemulsions had droplet sizes of approximately 130 nm, zeta potential around -38 mV and polydispersity index (PDI) values less than 0.2. The nanoemulsion F1-3.3TE had better stability (e.g. significantly greater % tartaric acid content and lesser PDI value) than the nanoemulsion F1-6.6TE did. The antioxidant activity using 2,2-diphenyl-1-picrylhydrazyl assay revealed that the nanoemulsions F1-3.3TE and F1-6.6TE had scavenging activities of 81.66 ± 0.77% and 63.80 ± 0.79%, respectively. However, antioxidant activity of these two formulations decreased under stress conditions (heating-cooling cycles). Such incidence did not occur for their antibacterial properties investigated by agar well diffusion technique. The two formulations exhibited inhibition zones of approximately 24.0-27.7 mm against Staphylococcus aureus and Staphylococcus epidermidis, responsible for malodor of underarms. The results suggest the potential of using sweet tamarind pulp extract loaded nanoemulsions as hygiene products.

Determinação do tempo de pré-aquecimento do leite humano ordenhado na pasteurização / Determinación del tiempo de precalentamiento de la leche humana extraída en la pasteurización / Determination of preheating time of expressed human milk in pasteurization

Esta Norma Técnica tem por objetivo estabelecer a determinação do tempo de pré-aquecimento do leite humano ordenhado no processo de pasteurização, visando a garantia da qualidade em Bancos de Leite Humano e sua certificação.

Esta Norma Técnica tiene como objetivo establecer la determinación del tiempo de precalentamiento de la leche humana extraída en el proceso de pasteurización, con el fin de asegurar la calidad en los Bancos de Leche Humana y su certificación.

Hipotermia perioperatoria / Perioperative hypothermia

Perioperative hypothermia is a common complication of general anesthesia, but it can also occur in patients undergoing regional anesthesia. It signifiicantly increases perioperative morbidity and mortality. Complications such as increased incidence of surgical site infection, delayed healing, coagulation abnormalities, increased surgical bleeding, perioperative cardiac events, decreased metabolism of drugs involved in anesthesia and a great discomfort in the immediate postoperative period (due to shivering), have been identified. The decrease in the patient's core temperature is due to a combination of physiological events related to the surgical anesthetic act. These include deterioration of the effector responses of the hypothalamus (tending to conserve heat), heat distribution between the central compartment and the periphery, and net heat loss to a generally colder environment, such as the surgical ward. Hypothermia is often an undetected complication of the anesthetic act due to the lack of regular temperature monitoring. It is not considered a basic standard of care, despite the fact that in recent years new guidelines and recommendations have emerged, which suggest its implementation in all patients in whom the duration of their surgery is expected to last longer than 1 hour. The measures aimed at keeping the patient normothermic can be classified as passive, within which the simplest is to cover the patient for as long as possible during their presence in the ward, and active, which are those that transfer heat to the body, within the which the most effective is the use of convective heat blankets. It has recently been suggested that prewarming the patient before inducing anesthesia is an efficient strategy to avoid hypothermia, decreasing temperature differences between core and peripheral tissues. However, the effectiveness of this measure remain to be evaluated with prospective, randomized trials. In the context of the emergency patient, although hypothermia shows the same characteristics as in the elective patient, it becomes more relevant in three clinical settings: patient with major burns, patient in hemorrhagic shock and the polytraumatized patient. In these scenarios, keeping the patient normothermic will prevent a series of serious complications, which can strongly affect mortality.

La hipotermia perioperatoria es una complicación frecuente de la anestesia general, pero que también se puede presentar en pacientes sometidos a anestesia regional. Se relaciona con un aumento significativo de la morbilidad y mortalidad perioperatorias, donde se han identificado complicaciones como aumento de la incidencia de infección del sitio quirúrgico, retardo de la cicatrización, alteraciones de la coagulación, aumento del sangrado quirúrgico, de los eventos cardiacos perioperatorios, disminución del metabolismo de drogas implicadas en la anestesia y sensación de gran incomodidad del paciente en el posoperatorio inmediato, por la presencia de calosfríos. La disminución de la temperatura central del paciente se debe a un combinación de eventos fisiológicos relacionados con el acto anestésico quirúrgico, con deterioro de las respuestas efectoras del hipotálamo tendientes a conservar calor, fenómenos distributivos de calor entre el compartimiento central y la periferia del propio paciente y pérdida de calor neta hacia un medio ambiente en general más frío, como lo es el pabellón quirúrgico. El hecho de que la hipotermia sea muchas veces considerada una complicación no detectada del acto anestésico, se debe a que aún la monitorización regular de la temperatura no se considera un estándar básico de cuidado, pese a que en los últimos años han surgido nuevas guías y recomendaciones, que sugieren que ésta sea implementada en todo paciente en que se proyecte una duración de la cirugía mayor a 1 hora. Las medidas tendientes a mantener al paciente normotérmico, pueden ser clasificadas en pasivas, dentro de las cuales la más simple es cubrir al paciente el mayor tiempo posible durante su presencia en pabellón y activas, que son aquellas que transfieren calor al cuerpo, dentro de las cuales la más efectiva es el uso de mantas de calor convectivo. Recientemente, se ha sugerido que una de las estrategias eficientes para evitar la HPO es el precalentamiento del paciente, que permite que sus tejidos periféricos estén a mayor temperatura al momento de inducir la anestesia, sin embargo, la efectividad de esta medida debe ser evaluada con estudios prospectivos y aleatorizados más concluyentes. La hipotermia en el contexto del paciente de urgencia, si bien presenta las mismas características que en el paciente electivo, cobra mayor relevancia en tres escenarios clínicos: el gran quemado, el paciente en hemorrágico y el paciente politraumatizado, escenarios en que mantener al paciente normotérmico, implicará evitar una serie de complicaciones graves, que pueden incidir fuertemente en la mortalidad.

Impact of maternal exposure to wood smoke pollution on fetal lung morphology in a rat model / Impacto de la exposición materna a la contaminación por humo de leña en la morfología pulmonar fetal en un modelo de rata

SUMMARY: Residential heating with wood is an important source of ambient air pollution. Evidence links air pollution to serious health effects such as respiratory and cardiovascular mortality and morbidity. We hypothesized that prenatal exposure to wood smoke pollution causes morphological changes in the development of the rat lung, leading to altered lung structure and function during later life. We presumed that analysis of the fetal lung stereology provides novel insights into the underlying processes mediating particulate matter associated developmental changes and damage. The objective of the study was to investigate the effects of exposure during gestational period to wood smoke pollution on lung fetal morphology. To test this, pregnant rats were exposed during pregestational and gestational periods to wood smoke pollution. Complete lungs samples were obtained from 24 fetus from healthy female G3 rats subjected to cesarean at 19 days post-fecundation. The lungs were prepared for histological and stereological analysis. The volume fraction of terminal bronchioles VV [tb, lung] and volume fraction of parenchyma VV [par, lung], surface density of terminal bronchioles SV [tb, lung] as well as numerical density of bronchiolar exocrinocytes NA [ec,lung] were calculated by light microscopy. Statistical analysis detected significant differences between groups in volume density VV [tb, lung; %] (p=0.0012) and surface density SV [tb, lung; mm2/mm3] (p<0.0001) of the terminal bronchioles. However, it did not show differences between groups in the stereological parameter volume density VV [par, lung; %] (p=0.0838) and numerical density of bronchiolar exocrinocytes NA [ec,lung; nº/mm2] (p=0.0705). The analysis of the evidence obtained indicates that exposure to environmental pollution was affects lung maturation, and particularly the proportion and area of terminal bronchioles in the fetal lung. In conclusion, maternal exposure to wood smoke pollution during pregnancy was associated with a decrease in the lower conducting airways of lungs, which, according to urban pollution studies, could be related to early childhood lower respiratory illness. The public health implications of this study are that reducing or avoiding exposure to wood smoke is important before and during pregnancy.

RESUMEN: La calefacción residencial con leña es una fuente importante de contaminación ambiental. La evidencia vincula la contaminación del aire con graves efectos sobre la salud, como la mortalidad y la morbilidad respiratoria y cardiovascular. Hipotetizamos que la exposición prenatal a la contaminación por humo de leña causa cambios en el desarrollo del pulmón de rata, lo que conduce a una morfo-función pulmonar alteradas durante la vida posterior, creemos que el análisis de la estereología pulmonar fetal proporcionará nuevos conocimientos sobre los procesos subyacentes que median esos cambios. El objetivo del estudio fue investigar los efectos de la exposición prenatal a la contaminación ambiental por humo de leña sobre la morfología pulmonar fetal. Ratas preñadas fueron expuestas durante los períodos pregestacional y gestacional a la contaminación por humo de leña. En fetos de 19 días post-fecundación fue obtenido el pulmón para análisis histológico y estereológico. Fue determinado la fracción de volumen de bronquiolos terminales VV [tb, pulmón], fracción de volumen del parénquima VV [par, pulmón], densidad superficial de los bronquiolos terminales SV [tb, pulmón] así como la densidad numérica de exocrinocitos NA [ec, pulmón]. El análisis estadístico detectó diferencias significativas entre grupos en la densidad de volumen V [tb, pulmón; %] (p=0,0012) y densidad superficial SV [tb, pulmón; mm2/mm3] (p<0,0001) de los bronquiolos terminales. Sin embargo, no demostró diferencias entre grupos en la densidad de volumen VV [par, pulmón; %] (p=0,0838) y numérica de exocrinocitos bronquiolares NA [ec, pulmón; nº / mm ] (p=0,0705). El análisis de la evidencia obtenida indica que la exposición a la contaminación ambiental afectó la maduración pulmonar, y particularmente la proporción y área de bronquiolos terminales en el pulmón fetal. En conclusión, la exposición materna a la contaminación por humo de leña durante la gestación se asoció a una disminución de las vías respiratorias conductoras de aire en pulmón, lo que, según estudios de contaminación urbana, podría estar relacionado con enfermedades de las vías respiratorias inferiores en la primera infancia. Las implicaciones para la salud pública de este estudio son que reducir o evitar la exposición al humo de leña es importante previo y durante la gestación. Por otro lado, la contaminación por humo de leña tiene un gran impacto en la salud pública que, en teoría, es posible prevenir.

Impacto del recambio de tecnología de calefacción en la concentración atmosférica por MP 2, 5 y en las admisiones por urgencias respiratorias en Coyhaique, Chile / Effect of the substitution of heating technology on PM 2. 5 levels and number of hospitalizations for acute respiratory conditions in Coyhaique, Chile / Efeito da substituição da tecnologia de aquecimento nos níveis atmosféricos de MP 2, 5 e no número de internações por urgencia respiratória em Coyhaique, Chile

Resumen: Coyhaique, en el sur de Chile, es una de las ciudades más contaminadas de América, debido a la quema de leña. En 2016, se lanzó una sustitución masiva de la tecnología de calefacción residencial para disminuir las concentraciones de partículas de aire en el invierno. Basado en análisis de series de tiempo, el artículo analiza el efecto de esta medida en los niveles de MP2,5 y en las hospitalizaciones por afecciones respiratorias agudas en personas menores de 15 años.

Abstract: Coyhaique (Southern Chile) is one of the most polluted cities in the Americas due to the burning of firewood. In 2016, a mass substitution of residential heating technology was launched to decrease the air concentrations of particulate matter in the winter. Based on time series analyses, the article discusses the effect of this measure on PM2.5 levels and hospitalizations for acute respiratory conditions in individuals under 15 years of age.

Resumo: Coyhaique, no sul de Chile, é uma das cidades mais poluídas devido a queima de lenha nas Américas. Em 2016 se deu início a uma massiva substituição da tecnologia de aquecimento do interior das vivendas para diminuir as concentrações atmosféricas de material particulado no inverno. Através de análises de séries temporais, o artigo discute o efeito desta medida nos níveis de MP2,5 e nas internações por urgências respiratórias em menores de 15 anos.

Different effects of heating and freezing treatments on the antioxidant properties of broccoli, cauliflower, garlic and onion. An experimental in vitro study

ABSTRACT BACKGROUND: Vegetables have some beneficial effects on human health due to their antioxidant compounds, like polyphenols. Cooking leads to many physical and chemical changes to plant structure that can alter the phytochemical compounds of vegetables. OBJECTIVES: To investigate the effects of heat treatment and freezing on the antioxidant properties of garlic, onion, broccoli and cauliflower. DESIGN AND SETTING: Experimental in vitro study in a university laboratory. METHODS: Fresh broccoli (Brassica oleracea var. italica), cauliflower (Brassica oleracea var. botrytis), garlic (Allium sativum) and onion (Allium cepa) were obtained from a local store. These vegetables were divided into three treatment groups: raw, heated and frozen. The heat treatment consisted of heating them in a drying oven at 150 °C for 20 minutes. The freezing treatment consisted of keeping them frozen at -20 °C until analysis. The total phenolic content, antioxidant activity and malondialdehyde levels of the vegetables were measured using the Folin-Ciocalteu phenol reagent, 2,2-diphenyl-1-picrylhydrazyl radical scavenging activity and thiobarbituric acid reactive substances, respectively. RESULTS: Heat treatment had deleterious effects on the antioxidant properties of onion and garlic; and it decreased the antioxidant activity of broccoli. Freezing improved the antioxidant activity of broccoli and garlic, but had detrimental effects for cauliflower and onion. CONCLUSIONS: Heat treatment and freezing exhibit different effects on the antioxidant properties of broccoli, cauliflower, garlic and onion. Convenient cooking and storage patterns should be identified for each vegetable, to obtain the best nutritional benefit from the antioxidant compounds of vegetables.

Influence of pre-heating regular resin composites and flowable composites on luting ceramic veneers with different thicknesses

Abstract The aim of this study was to evaluate of pre-heating, filler contents and ceramic thickness on film thickness, microshear bond strength, degree of conversion and color change on ceramic veneers. Two experimental composites were prepared (Bis-GMA/UDMA/BisEMA/ TEGDMA), with different amounts of filler (65% or 50%wt) simulating a conventional and a flowable composite. The flowable (F) was used at room temperature and, the conventional either at room temperature (C) or pre-heated (CPH). Disk-shaped ceramics with different thickness (0.4 mm, 0.8 mm, 1.5 mm) were prepared. The film thickness was evaluated according to the ISO 4049 (n=10). The microshear bond strength (n=10) was evaluated in enamel using tubing specimens light-cured through the ceramic veneer. The degree of conversion was evaluated using Raman spectroscopy. The color change of the ceramic restorations (n=10) was evaluated by spectrophotometry. The results were submitted to 2-way ANOVA and Tukey's post hoc test (a=5%). For the film thickness 1-way ANOVA was used (a=5%). The C presented the thicker film thickness; the CPH produced a similar film thickness in comparison to the F. All composites showed similar microshear bond strength. The degree of conversion of the F was higher than the C and CPH. The degree of conversion of the composites photo-activated through a 0.4 mm was higher than the composites photo-activated through thicker ceramics. The C showed the highest color change, while the CPH showed similar color change to the F. In conclusion, pre-heated conventional composites seem to be a potential alternative to lute ceramic veneers such as the flowable composites.

Resumo O objetivo neste estudo foi avaliar a influência do pré-aquecimento, conteúdo de carga e espessura da cerâmica na espessura da película, resistência de união ao microcisalhamento, grau de conversão e alteração de cor na cimentação de cerâmicas. Dois compósitos experimentais foram preparados (Bis-GMA / UDMA / BisEMA / TEGDMA), com diferentes quantidades de carga (65% ou 50% em peso), simulando um compósito convencional e um fluido. O fluido (F) foi usado à temperatura ambiente e o convencional, à temperatura ambiente (C) ou pré-aquecido (CPH). Foram preparados discos de cerâmica com diferentes espessuras (0,4mm, 0,8mm, 1,5mm). A espessura da película foi avaliada de acordo com a ISO 4049 (n=10). A resistência de união ao microcisalhamento (n=10) foi avaliada em esmalte utilizando espécimes ​​fotopolimerizados através da cerâmica. O grau de conversão foi avaliado usando espectroscopia Raman. A alteração de cor das restaurações cerâmicas (n=10) foi avaliada por espectrofotometria. Os resultados foram submetidos à ANOVA 2- fatores e ao teste post hoc de Tukey (a=5%). Para espessura de película foi utilizada a ANOVA 1-fator (a=5%). O grupo C apresentou maior espessura de película; o CPH produziu uma espessura semelhante ao F. Todos os compósitos mostraram resistência de união ao microcisalhamento similares. O grau de conversão do F foi maior que C e CPH. O grau de conversão dos compósitos fotoativados através 0,4 mm foi maior que dos compósitos fotoativados através de cerâmicas mais espessas. O grupo C apresentou a maior mudança de cor, enquanto o CPH apresentou mudança de cor semelhante ao F. Em conclusão, compósitos convencionais pré-aquecidos assim como compósitos fluídos, parecem ser uma alternativa em potencial para cimentar laminados cerâmicos.

Efeito da forma de aquecimento em parâmetros de qualidade e identidade de óleos vegetais / Effect of the heating means in quality and identity parameters of vegetable oils

Objetivou-se com este trabalho avaliar parâmetros de identidade e qualidade de óleo de abacate produzido nacionalmente, comparativamente a azeite de oliva e óleo de arroz, após aquecimento em bloco digestor ou micro-ondas. Avaliaram-se amostras sem aquecimento (controle) e aquecidas por 1:30 h em bloco digestor ou 3 min em micro-ondas. Determinaram-se a acidez e os índices iodo e refração. Os resultados indicaram que houve aumento de acidez, redução no índice de iodo e índice de refração após o aquecimento. Apesar do maior valor de acidez após o aquecimento, o óleo de abacate sofreu menor elevação em relação ao controle (cerca de 4 vezes) do que as demais amostras. O impacto do aquecimento foi maior no óleo de arroz, seguido do azeite de oliva. O aquecimento por micro-ondas afetou mais a qualidade das amostras que o aquecimento em bloco digestor.

Estabilidade térmica de pigmentos em óleo de abacate, arroz e azeite de oliva / Thermal stability of pigments in avocado, rice and olive oil

Sabe-se que o aquecimento do óleo pode alterar sua composição, degradando ácidos graxos e compostos minoritários. Assim, objetivou-se avaliar a estabilidade térmica dos pigmentos carotenoides e clorofilas no óleo de abacate produzido nacionalmente, em comparação com óleo de arroz e azeite de oliva após aquecimento a 180 ºC em micro-ondas, por 3, 6, 9 e 12 minutos. Observaram-se diferenças significativas entre as amostras em todos os tempos de análise, tanto para clorofilas quanto para carotenoides. Na avaliação ao longo do tempo de aquecimento somente foi verificada alteração significativa no teor de clorofilas do azeite de oliva, ainda que no óleo de abacate os percentuais de perda tenham sido maiores. Verificou-se que os teores dos pigmentos avaliados foram significativamente maiores no óleo de abacate em relação ao azeite de oliva e o óleo de arroz, mesmo após o aquecimento por 12 minutos. Destaca-se a importância destas informações para estimular o consumo do óleo de abacate.

Indoor Air Quality in the Hospital: The Influence of Heating, Ventilating and Conditioning Systems

Abstract Clean, fresh air is the most important requirement for good indoor air quality (IAQ) in all buildings, but it is especially important with regard to the environments within hospitals and other healthcare facilities. The literature indicates that buildings with heating, ventilating and air conditioning (HVAC) systems may have an increased risk of sick building syndrome (SBS) and building-related illness (BRI) if they are not well maintained. Microorganisms are brought into hospitals by people, air currents, water, construction materials and equipment. The main objective of this study was to assess the degree of fungal and bacterial contamination in the University Clinical Centre in Banja Luka, which is directly connected to the HVAC system. Airborne bacteria and fungi in the indoor hospital environment were assessed experimentally. Air samples were collected during the winter season. This paper presents the results related to the concentration of microorganisms expressed in colony forming units per cubic metre of air sampled (in CFU/m3) together with the microclimatic parameters temperature and relative humidity. The results of monitoring indicate the effectiveness of HVAC systems in reducing microbiological contamination.

Effects on the female reproductive system of air pollution produced by the use of wood combustion for residential heating: challenges and perspectives of morphological studies / Efectos sobre el sistema reproductivo femenino de la contaminación del aire producido por el uso de la combustión de madera para calefacción residencial: retos y perspectivas de los estudios morfológicos

Previous studies have shown that air pollution affects cardio-respiratory function, but its role regarding reproductive processes is unknown. There are few experimental background studies on its effects on the morpho-function in the reproductive system. The use of wood combustion for residential heating (WCRH) in the cities of south-central Chile has increased significantly. As a result, it has become a source of significant emissions of particulate matter suspended (PM) in the air. The possible association between exposure to PM and reproductive problems has been suggested only on the basis of epidemiological studies, most of them carried out in environments where the main source of PM emission is the combustion of oil by motorized vehicles and industries, ignoring the effects produced by the smoke of WCRH. For example, in the city of Temuco-Padre Las Casas, Chile, 93 % of PM emissions correspond to WCRH smoke, thus being considered an urban area with a single PM emission source and the factors that contribute to this type of contamination are reasonably representative of most of the cities in south-central Chile. We therefore suggest this as an adequate setting to evaluate the real effect of the environmental contamination produced by the smoke of WCRH in the reproductive system. The limited number of studies reported on the effects of this type of emission on the female reproductive system, present a challenge for the morphological sciences and also for those who make decisions that affect public health.

Estudios previos han demostrado que la polución del aire afecta la función cardio-respiratoria, pero el rol que tiene ésta respecto a los procesos reproductivos es desconocida. Existen escasos antecedentes experimentales sobre sus efectos sobre la morfo-función en el sistema reproductivo. El uso de la combustión de madera para calefacción residencial (WCRH) en las ciudades del centro-sur de Chile ha aumentado significativamente. Como resultado, se ha convertido en una fuente de emisión importante de material particulado en suspensión (PM) en el aire ambiental. La posible asociación entre exposición a PM y problemas reproductivos ha sido sugerida solo en base a estudios epidemiológicos, la mayoría de ellos realizados en ambientes donde la principal fuente de emisión de PM es la combustión del petróleo por vehículos motorizados e industrias, ignorando los efectos producidos por el humo de WCRH. Por ejemplo, en la ciudad de Temuco-Padre Las Casas, Chile, el 93 % de las emisiones de PM corresponden al humo de WCRH, por lo tanto, es considerada como un área urbana con una fuente de emisión de PM única y los factores que contribuyen a este tipo de contaminación son razonablemente representativos a la mayoría de las ciudades en el centro-sur de Chile, lo que permite sugerirla como un ambiente adecuado para evaluar el efecto de la contaminación ambiental producida por el humo de la WCRH en el sistema reproductivo. Los escasos estudios reportados sobre los efectos de este tipo de emisión sobre el sistema reproductivo femenino constituyen un desafío no tan solo para las ciencias morfológicas, sino que además, para quienes toman decisiones que afectan la salud pública.

Acondicionamiento del gas inhalado en pacientes con vía aérea artificial. Revisión narrativa / Humidification and heating of inhaled gas in patients with artificial airway. A narrative review

RESUMEN La instrumentación de la vía aérea del paciente crítico (tubo endotraqueal o cánula de traqueostomía) impide que ésta pueda cumplir con su función de calentar y humidificar el gas inhalado. Sumado a ello la administración de gases medicinales fríos y secos, y los altos flujos a los que se someten los pacientes en ventilación mecánica invasiva o no invasiva, generan una condición aún más desfavorable. Debido a esto es imperativo utilizar algún dispositivo para acondicionar los gases entregados incluso en tratamientos de corta duración con el fin de evitar los daños potenciales sobre la estructura y función del epitelio respiratorio. En el ámbito de terapia intensiva es habitual para esto el uso de intercambiadores de calor y humedad, como así también el uso de sistemas de humidificación activa. Para su correcta utilización es necesario poseer el conocimiento necesario sobre las especificaciones técnicas, ventajas y desventajas de cada uno de estos dispositivos ya que el acondicionamiento de los gases inspirados representa una intervención clave en pacientes con vía aérea artificial y se ha transformado en un cuidado estándar. La selección incorrecta del dispositivo o la configuración inapropiada pueden impactar negativamente en los resultados clínicos. Los integrantes del Capítulo de Kinesiología Intensivista de la Sociedad Argentina de Terapia Intensiva realizaron una revisión narrativa con el objetivo de exponer la evidencia disponible en relación al acondicionamiento del gas inhalado en pacientes con vía aérea artificial, profundizando sobre los conceptos relacionados a los principios de funcionamiento de cada uno.

ABSTRACT Instrumentation of the airways in critical patients (endotracheal tube or tracheostomy cannula) prevents them from performing their function of humidify and heating the inhaled gas. In addition, the administration of cold and dry medical gases and the high flows that patients experience during invasive and non-invasive mechanical ventilation generate an even worse condition. For this reason, a device for gas conditioning is needed, even in short-term treatments, to avoid potential damage to the structure and function of the respiratory epithelium. In the field of intensive therapy, the use of heat and moisture exchangers is common for this purpose, as is the use of active humidification systems. Acquiring knowledge about technical specifications and the advantages and disadvantages of each device is needed for proper use since the conditioning of inspired gases is a key intervention in patients with artificial airway and has become routine care. Incorrect selection or inappropriate configuration of a device can have a negative impact on clinical outcomes. The members of the Capítulo de Kinesiología Intensivista of the Sociedad Argentina de Terapia Intensiva conducted a narrative review aiming to show the available evidence regarding conditioning of inhaled gas in patients with artificial airways, going into detail on concepts related to the working principles of each one.

Contaminación intradomiciliaria por material particulado fino (MP2, 5) en hogares de recién nacidos / Indoor air pollution by fine particulate matter in the homes of newborns

Introducción: La contaminación de aire por material particulado (MP) es un importante problema de salud pública. En Chile se ha estudiado la contaminación atmosférica y MP10, y escasamente aire interior y MP2,5. Como los recién nacidos y los lactantes pasan la mayoría del tiempo en el hogar, es necesario evaluar la exposición a la contaminación intradomiciliaria en esta población susceptible. Objetivo: Determinar la concentración de MP2,5 en hogares de recién nacidos e identificar las fuentes de emisión contaminante. Pacientes y método: En 207 hogares se recolectó la concentración de MP2,5 ([MP2,5]) por 24 h y se evaluó la información sociodemográfica y los factores ambientales (calefacción, ventilación, tabaquismo intradomiciliario y aseo del hogar). Resultados: La [MP2,5] mediana fue 107,5 μg/m³. El antecedente «asma familiar¼ se asoció a menor [MP2,5] (p = 0,0495). Hogares sin uso de calefacción mostraron la menor [MP2,5] mediana, 58,6 μg/m³, mientras los que usaron leña, parafina, electricidad entre 112,5 y 114,9 μg/m³ y brasero 162,9 μg/m³. Hogares que usaron leña tuvieron diferencias significativas en [MP2,5] mediana (p = 0,0164) al usar estufa de combustión completa (98,2 μg/m³) versus cocina a leña (112,6 μg/m³) y salamandra (140,6 μg/m³). En el 8,7% de los hogares se reportó consumo de cigarrillos, no asociándose a [MP2,5]. La ventilación se asoció a mayor [MP2,5] mediana (120,6 vs. 99,1 μg/m³; p = 0,0039). Conclusión: Hubo hogares con [MP2,5] elevada, siendo el consumo residencial de leña casi universal y asociado a [MP2,5]. La ventilación natural incrementó el MP2,5 interior, probablemente por infiltración desde el exterior.

Introduction: Air pollution by particulate matter (PM) is a major public health problem. In Chile, the study has focused on outdoor air and PM10, rather than indoor air and PM2.5. Because newborns and infants spend most of their time at home, it is necessary to evaluate the exposure to indoor air pollution in this susceptible population. Objective: To determine concentration of PM2.5 in the homes of newborns and identify the emission sources of the pollutants. Patients and Method: The PM2.5 concentration ([PM2.5]) was collected over a 24 hour period in 207 households. Baseline sociodemographic information and environmental factors (heating, ventilation, smoking and house cleaning), were collected. Results: The median [PM2.5] was 107.5 μg/m³. Family history of asthma was associated with lower [PM2.5] (P = .0495). Homes without heating showed a lower median [PM2.5], 58.6 μg/m³, while those using firewood, kerosene, and electricity ranged between 112.5 and 114.9, and coal users’ homes reached 162.9 μg/m³. Wood using homes had significant differences (P = .0164) in median [PM2.5] whether the stove had complete combustion (98.2 μg/m³) vs. incomplete (112.6 μg/m³), or a salamander stove (140.6 μg/m³). Cigarette smoking was reported in 8.7% of the households, but was not associated with the [PM2.5]. Ventilation was associated with a higher median [PM2.5] (120.6 vs. 99.1 μg/m³, P = .0039). Conclusion: We found homes with high [PM2.5]. Residential wood consumption was almost universal, and it is associated with the [PM2.5]. Natural ventilation increased MP2.5, probably due to infiltration from outside.

Newborns' temperature submitted to radiant heat and to the Top Maternal device at birth / Temperatura dos recém-nascidos submetidos ao calor radiante e ao dispositivo Top Maternal ao nascimento / Temperatura de los recién nacidos sometidos a calor radiante y al dispositivo Top Maternal al nacimiento

ABSTRACT Objective: to compare the axillar temperatures of newborns that are put immediately after birth in skin-to-skin contact under the Top Maternal device, as compared to those in a radiant heat crib. Methods: comparatives observational study of the case-control type about temperature of 60 babies born at the Obstetric Center and Normal Delivery Center of a public hospital of the municipality of Sao Paulo, being them: 29 receiving assistance in heated crib and 31 in skin-to skin contact, shielded by a cotton tissue placed on mother's thorax, called Top Maternal. Results: the temperature of the babies of the skin-to-skin contact group presented higher values in a larger share of the time measures verified, as compared to those that were placed in radiant heat crib, independently from the place of birth. Differences between the two groups were not statistically significant. Conclusion: the study contributes to generate new knowledge, supporting the idea of keeping babies with their mothers immediately after birth protected with the Maternal Top, without harming their wellbeing, as it keeps the axillar temperature in recommendable levels.

RESUMO Objetivo: comparar a temperatura axilar dos recém-nascidos acomodados - imediatamente após o nascimento - em contato pele a pele, sob o Top Maternal, em berço de calor radiante. Método: estudo comparativo observacional do tipo Caso-Controle sobre a temperatura de 60 bebês nascidos no Centro Obstétrico e Centro de Parto Normal de um hospital público do município de São Paulo, sendo: 29 assistidos em berço aquecido e 31 em contato pele a pele, protegidos por uma malha de algodão colocada sobre o tórax da mãe, denominada Top Maternal. Resultados: a temperatura dos bebês do grupo de contato pele a pele teve maior valor na maioria dos tempos verificados comparada à dos que foram colocados em berço de calor radiante, independentemente do local de nascimento. A diferença entre os grupos não foi estatisticamente significante. Conclusão: o estudo contribui com a geração de um novo conhecimento que sustenta a manutenção dos bebês com suas mães imediatamente após o nascimento por meio do contato pele a pele protegidos pelo Top Maternal, sem prejuízos ao seu bem-estar, uma vez que a temperatura axilar se manteve em níveis recomendáveis.

RESUMEN Objetivo: comparar la temperatura axilar de los recién nacidos (Rn) acomodados, inmediatamente después del nacimiento, en contacto piel con piel, bajo el Top Maternal, en cuna de calor radiante. Método: estudio comparativo observacional del tipo Caso Control sobre la temperatura de 60 bebés nacidos en el Centro Obstétrico y Centro de Parto Normal de un hospital público del municipio de Sao Paulo, siendo: 29 asistidos en cuna calentada y 31 en contacto piel con piel, protegidos por un tejido de algodón colocado sobre el tórax de la madre, denominado Top Maternal. Resultados: la temperatura de los bebés del grupo de contacto piel con piel fue más alta en la mayoría de los tiempos verificados, ello comparado con los que fueron colocados en cuna de calor radiante, independientemente del local de nacimiento. La diferencia entre los grupos no fue estadísticamente significativa. Conclusión: el estudio contribuye con la generación de un nuevo conocimiento que sustenta que se debe mantener a los bebés con sus madres inmediatamente después del nacimiento por medio del contacto piel con piel protegidos por el Top Maternal, sin perjuicios a su bienestar, una vez que la temperatura axilar se mantuvo en niveles recomendables.

Pre-heating mitigates composite degradation

ABSTRACT Dental composites cured at high temperatures show improved properties and higher degrees of conversion; however, there is no information available about the effect of pre-heating on material degradation. Objectives This study evaluated the effect of pre-heating on the degradation of composites, based on the analysis of radiopacity and silver penetration using scanning electron microscopy/energy-dispersive X-ray spectroscopy (SEM/EDS). Material and Methods Thirty specimens were fabricated using a metallic matrix (2x8 mm) and the composites Durafill VS (Heraeus Kulzer), Z-250 (3M/ESPE), and Z-350 (3M/ESPE), cured at 25°C (no pre-heating) or 60°C (pre-heating). Specimens were stored sequentially in the following solutions: 1) water for 7 days (60°C), plus 0.1 N sodium hydroxide (NaOH) for 14 days (60°C); 2) 50% silver nitrate (AgNO3) for 10 days (60°C). Specimens were radiographed at baseline and after each storage time, and the images were evaluated in gray scale. After the storage protocol, samples were analyzed using SEM/EDS to check the depth of silver penetration. Radiopacity and silver penetration data were analyzed using ANOVA and Tukey’s tests (α=5%). Results Radiopacity levels were as follows: Durafill VS<Z-350<Z-250 (p<0.05). The depth of silver penetration into the composites ranked as follows: Durafill VS>Z-350>Z-250 (p<0.05). After storage in water/NaOH, pre-heated specimens presented higher radiopacity values than non-pre-heated specimens (p<0.05). There was a lower penetration of silver in pre-heated specimens (p<0.05). Conclusions Pre-heating at 60°C mitigated the degradation of composites based on analysis of radiopacity and silver penetration depth.

Heating produced by therapeutic ultrasound in the presence of a metal plate in the femur of canine cadavers / Aquecimento gerado pelo ultrassom terapêutico em presença de placa óssea metálica no fêmur de cadáveres caninos

The present study aimed to assess the heat generated by a therapeutic ultrasound (TUS) in a metal bone plate and adjacent structures after fixation to the femur of canine cadavers. Ten pairs of hind limbs were used, and they were equally distributed between groups that were subjected to 1- and 3-MHz frequencies, with each frequency testing 1- and 2-W/cm² intensities. The right hind limb was defined as the control group (absence of the metal plate), and the left hind limb was the test group (presence of the metal plate). Therefore, the control groups (CG) were denominated CGI, using TUS with 1-MHz frequency and 1-W/cm² intensity; CGII, using 1-MHz frequency and 2-W/cm² intensity; CGIII, using 3-MHz frequency and 1-W/cm² intensity; and CGIV, using 3-MHz frequency and 2-W/cm² intensity. For each control group, its respective test group (TG) was denominated TGI, TGII, TGIII and TGIV. The TUS was applied to the lateral aspect of the thigh using the continuous mode and a 3.5-cm² transducer in a 6.25-cm² area for 2 minutes. Sensors were coupled to digital thermometers that measured the temperature in different sites before (t0) and after (t1) of the TUS application. The temperatures in t1 were higher in all tested groups. The intramuscular temperature was significantly higher (P<0.05) in the groups used to test the 3-MHz frequency in the presence of the metal plate. The therapeutic ultrasound in the continuous mode using frequencies of 1 and 3 MHz and intensities of 1 and 2 W/cm2 for 2 minutes caused heating of the metal plate and adjacent structures after fixation to the femur of canine cadavers...

O objetivo deste estudo foi avaliar o aquecimento gerado pelo ultrassom terapêutico (UST) na placa óssea metálica e estruturas adjacentes após a fixação no fêmur de cadáveres caninos. Foram utilizados dez pares de membros pélvicos, distribuídos igualmente entre os grupos que utilizaram as frequências de 1 e 3 MHz. Cada frequência testou as intensidades de 1 e 2 W/cm², sendo que o membro pélvico direito foi definido grupo controle (ausência da placa óssea metálica) e o membro pélvico esquerdo o grupo teste (presença da placa óssea metálica). Portanto, os grupos controles foram denominados GCI, com UST na frequência de 1 MHz e intensidade de 1 W/cm²; GCII, com 1 MHz e 2 W/cm²; GCIII, com frequência de 3 MHz e intensidade de 1 W/cm²; e GCIV, com 3 MHz e 2 W/cm². Para cada grupo controle, seu respectivo grupo teste foi denominado GTI, GTII, GTIII e GTIV. O UST foi aplicado na face lateral da coxa, utilizando o modo contínuo, transdutor de 3,5cm², em uma área de 6,25cm², durante dois minutos. Foram utilizados sensores acoplados a termômetros digitais que mediram a temperatura em diferentes locais antes (t0) e após (t1) a aplicação do UST. Pode-se verificar que as temperaturas em t1 foram maiores em todos os grupos testados. Os grupos que testaram a frequência de 3 MHz demonstraram que a temperatura intramuscular foi significativamente maior (P<0,05) na presença da placa óssea metálica. O ultrassom terapêutico no modo contínuo de 1 e 3 MHz e intensidades de 1 e 2 W/cm2 durante dois minutos promove o aquecimento da placa óssea metálica e estruturas adjacentes após a fixação no fêmur de cadáveres caninos...

Radiator-induced erythema ab igne in 8-year-old girl

The cutaneous lesion of erythema ab Igne are characterized by a reticulate erythema, hyperpigmentation, fine scaling, epidermal atrophy and telangiectasias, and reticulated erythema. We report a case of erythema ab igne on the hands of a 8-year-old girl, induced by classic homemade radiator.