Outbreak of influenza and SARS-CoV-2 at the Armed Forces of the Philippines Health Service Education and Training Center, September 25-October 10, 2023.

In the last week of September 2023, a surge of influenza-like illness was observed among students of the Armed Forces of the Philippines (AFP) Health Service Education and Training Center, where 48 (27 males and 21 females; age in years: mean 33, range 27-41) of 247 military students at the Center presented with respiratory symptoms. Between September 25 and October 10, 2023, all 48 symptomatic students were evaluated with real-time reverse transcription polymerase chain reaction and sequencing for both influenza and SARS-CoV-2. Thirteen (27%) students were found positive for influenza A/H3 only, 6 (13%) for SARS-CoV-2 only, and 4 (8%) were co-infected with influenza A/H3 and SARS-CoV-2. Seventeen influenza A/ H3N2 viruses belonged to the same clade, 3C.2a1b.2a.2a.3a, and 4 SARSCoV-2 sequences belonged to the JE1.1 lineage, indicating a common source outbreak for both. The influenza A/H3N2 circulating virus belonged to a different clade than the vaccine strain for 2023 (3C.2a1b.2a.2a). Only 4 students had received the influenza vaccine for 2023. In response, the AFP Surgeon General issued a memorandum to all military health institutions on October 19, 2023 that mandated influenza vaccination as a prerequisite for enrollment of students at all education and training centers, along with implementation of non-pharmaceutical interventions and early notification and testing of students exhibiting influenza-like-illness.

Updated Views in Targeted Therapy in the Patient with Non-Small Cell Lung Cancer.

Non-small cell lung cancer (NSCLC) is the most frequent form of lung cancer and represents a set of histological entities that have an ominous long-term prognosis, for example, adenocarcinoma, squamous carcinoma and large cell carcinoma. Both small cell and non-small cell lung cancer are the main causes of oncological death and the oncological diseases with the highest incidence worldwide. With regard to clinical approaches for NSCLC, several advances have been achieved in diagnosis and treatment; the analysis of different molecular markers has led to the development of new targeted therapies that have improved the prognosis for selected patients. Despite this, most patients are diagnosed in an advanced stage, presenting a limited life expectancy with an ominous short-term prognosis. Numerous molecular alterations have been described in recent years, allowing for the development of therapies directed against specific therapeutic targets. The correct identification of the expression of different molecular markers has allowed for the individualization of treatment throughout the disease course, expanding the available therapeutic arsenal. The purpose of this article is to summarize the main characteristics of NSCLC and the advances that have occurred in the use of targeted therapies, thus explaining the limitations that have been observed in the management of this disease.

Exploring histopathological and serum biomarkers in lung adenocarcinoma: Clinical applications and translational opportunities (Review).

Lung cancer represents one of the most common neoplasms and the main cause of cancer­associated death worldwide. Its relationship with different risk factors such as tobacco, which is its main etiological factor, has been clearly established and despite the numerous advances achieved in the diagnosis, treatment and follow­up of these patients, the life expectancy of these patients is notably limited. Furthermore, its treatment is not exempt from comorbidities and frequently it neither provides optimal control of the disease nor improve the quality of life of these patients. Despite the possibility of performing screening tests in patients at risk, their implementation in daily clinical practice is complex and most of them are diagnosed at an advanced stage of their disease where systemic radiotherapy or chemotherapy treatments slightly improve their prognosis. Lung adenocarcinoma is the most representative type of lung cancer, with specific epidemiological, molecular and clinical features. Thus, a growing number of studies are being conducted to find potential therapeutic targets based on the study of different molecular pathways, improving the outcome for these patients. In addition, a broad spectrum of serological, immunohistochemical and genetic markers are being evaluated for use in the screening and follow­up of these patients in daily clinical practice, but unlike for other tumors, they are currently not implemented in the early diagnosis of the disease. Therefore, the aim of the present review was to summarize the main advances that have occurred in the development of serological and histological markers and their therapeutic implications in patients diagnosed with lung adenocarcinoma, explaining the limitations that have been observed and analyzing the future perspectives in the clinical management of this disease.

Clinical characterization of COVID-19 breakthrough infections, Philippines.

We clinically characterized PCR detected breakthrough infections among partially/fully vaccinated cases with majority given an inactivated vaccine, CoronaVac. From 1 March to 15 July 2021, we detected 182 SARS-CoV-2 infections among vaccinated cases with 129 classified as breakthrough infections. Majority were male, 30-39 y.o., and were asymptomatic or mildly symptomatic with few severe cases. Alpha, Beta and Delta VOCs were detected from sequenced breakthrough infections. Healthcare workers had significantly lower Ct values(higher viral loads) versus non-HCWs. Our results underscore the importance of regular PCR screening for HCWs due to the risk of SARS-CoV-2 transmission from asymptomatic breakthrough infections and provide evidence supporting administration of a booster dose especially to HCWs.

Performance of a Rapid Diagnostic Test for Influenza in a Tertiary Military Hospital, Philippines.

INTRODUCTION: It is important to evaluate the performance of existing rapid influenza diagnostic tests (RIDTs) and the factors that can affect performance especially when the circulation dynamics of influenza strains change such as the displacement and replacement of the circulating seasonal influenza strains. MATERIALS AND METHODS: Nasal swabs were collected from patients presenting at V Luna Medical Center, Armed Forces of the Philippines Health Service Command, with influenza-like illness (ILI) with one swab tested using Quickvue (QV) influenza A+B RIDT (Quidel) and the other swab tested using the ABI 7500 (Applied Biosystems) real-time reverse transcriptase-polymerase chain reaction. Sensitivity, specificity, positive predictive value, and negative predictive value were estimated. We identified clinical symptoms predictive of influenza subtype and evaluated the independence of QV sensitivity on (1) Cycle threshold (Ct) value, controlling for timing of collection; (2) timing of collection, controlling for Ct value; and (3) Ct value and timing of collection taken together. RESULTS: Between August 2011 and October 2016, patients presenting with ILI (n = 2333) underwent testing. Quickvue sensitivity across all subtypes was significantly correlated with lower Ct values (higher virus titers) (P <.001) and, except for flu A/H3 (P = .974), was also significantly associated with timing of specimen collection (P <.05). No statistically significant difference was noted in QV sensitivity for Flu A/H3 (P = .130), pandemic H1/N1 (P = .207), Flu A/H3 + pandemic H1/N1 (P = .341), and Flu B (P = .103) across different age groups but sensitivity of QV significantly differed (P <.001) across the different influenza subtypes. CONCLUSION: Overall specificity of QV was high across all flu subtypes, but overall sensitivity was low (Flu A/pdm H1) to moderate (Flu A/H3 and Flu B). The findings highlight the need to develop more sensitive influenza RDTs to detect circulating influenza strains and the use of the quadrivalent flu vaccine during the annual influenza vaccination.

Coding-Complete Genome Sequences of 11 SARS-CoV-2 B.1.1.7 and B.1.351 Variants from Metro Manila, Philippines.

Here, we report the complete genome sequences of 11 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants from the Philippines. Lineage analysis showed 3 B.1.1.7 and 8 B.1.351 sequences. One B.1.1.7 sequence contained two additional mutations, F318N and V320F, with V320F located in the receptor binding domain of the S1 subunit.

Osimertinib in advanced EGFR-T790M mutation-positive non-small cell lung cancer patients treated within the Special Use Medication Program in Spain: OSIREX-Spanish Lung Cancer Group.

BACKGROUND: AURA study reported 61% objective response rate and progression-free survival of 9.6 months with osimertinib in patients with EGFR/T790M+ non-small cell lung cancer. Due to lack of real-world data, we proposed this study to describe the experience with osimertinib in Spain. METHODS: Post-authorization, non-interventional Special Use Medication Program, multicenter, retrospective study in advanced EGFR/T790M+ non-small cell lung cancer. One hundred-fifty five patients were enrolled (August 2016-December 2018) from 30 sites. PRIMARY OBJECTIVE: progression-free survival. Secondary objectives: toxicity profile, objective response rate, and use of health service resources. RESULTS: 70% women, median age 66. 63.9% were non-smokers and 99% had adenocarcinoma. Most patients had received at least one prior treatment (97%), 91.7% had received previous EGFR-tyrosine kinase inhibitors and 2.8% osimertinib as first-line treatment. At data cutoff, median follow-up was 11.8 months. One hundred-fifty five patients were evaluable for response, 1.3% complete response, 40.6% partial response, 31% stable disease and 11.6% disease progression. Objective response rate was 42%. Median progression-free survival was 9.4 months. Of the 155 patients who received treatment, 76 (49%) did not reported any adverse event, 51% presented some adverse event, most of which were grade 1 or 2. The resource cost study indicates early use is warranted. CONCLUSION: This study to assess the real-world clinical impact of osimertinib showed high drug activity in pretreated advanced EGFR/T790M+ non-small cell lung cancer, with manageable adverse events. TRIAL REGISTRATION: Clinical trial registration number: NCT03790397 .

A multi-country field validation of the FluChip-8G Insight Assay.

INTRODUCTION: It is critical to rapidly detect novel and non-seasonal influenza strains. Currently available assays have limited sensitivity in detecting novel influenza subtypes. We performed a multi-country field validation of the FluChip-8G Insight, an assay able to detect and characterize influenza A/B viruses and non-seasonal influenza viruses. MATERIALS AND METHODS: We evaluated the performance of the FluChip-8G Insight on nasal and throat swab clinical samples from Thailand, Philippines and Nepal. Influenza PCR positive and negative samples tested using the US CDC Human Influenza Dx Panel reference standard were selected for testing using the FluChip-8G Influenza Insight. RESULTS: A total of 909 specimens were included in the analysis. The overall sensitivity and specificity of the FluChip-8G Insight to detect combined influenza A+B was 86 % and 100%, respectively. PPV and NPV were estimated at 100 % (95 % CI 99-100) and 73 % (95 % CI 68-78), respectively. Sensitivity across all influenza subtypes was 100% for specimens with <20 and 20-25 Ct values, respectively, but as Ct values increased, sensitivity across all influenza subtypes decreased significantly (p < 0.001) for specimens with Ct values ≥32. CONCLUSION: The FluChip-8G Insight showed good precision and reproducibility among all 3 sites with robust identification of both influenza A and B targets with Ct values <32 and in the absence of co-infection. Positioning this platform in countries considered as hotspots for the emergence of novel/zoonotic influenza strains can increase the lead time in detecting and containing novel influenza strains with pandemic potential.

SARS-CoV-2 Among Military and Civilian Patients, Metro Manila, Philippines.

INTRODUCTION: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) belonging to the family Coronaviridae and genus Betacoronavirus is the causative agent of COVID-19 disease and was first identified in Wuhan, China. SARS-CoV-2 spread globally with >28 million cases and 911,000 deaths recorded worldwide as of September 12, 2020. The Philippines reported the first case of community transmission on March 5, 2020, and despite the government imposing one of the longest and strictest lockdowns in Southeast Asia, the number of confirmed COVID-19 cases still surged with >250,000 cases and 4,000 deaths reported as of September 12, 2020. It is important to estimate the burden and impact of SARS-CoV-2 on the military population since this can affect the military readiness. MATERIALS AND METHODS: Nasopharyngeal and oropharyngeal swabs were collected and SARS-CoV-2 real-time RT-PCR testing was performed on the samples. Phylogenetic analysis was performed using sequences from 23 SARS-CoV-2-positive specimens from this study and sequences retrieved from GenBank and GISAID databases. RESULTS: From April 14 to August 15, 2020, a total of 12,432 specimens were tested with 763 (6%) unique individuals testing positive for SARS-CoV-2 by rRT-PCR. In the military population, majority of the patients who were tested (80%) and those who tested positive for SARS-CoV-2 (86%) were male. Military and civilian status was available for 7,672 patients with 515/5,042 (10%) positive among military patients and 248/2,630 (9%) positive among civilian patients. Both military and civilian populations had the highest case counts of SARS-CoV-2-positive cases in the 21- to 30- and 31- to 40-year-old age groups, while the 71- to 80-year-old age group had the highest proportion (18%) of SARS-CoV-2-positive cases. Sequencing analysis showed 19 different variants in the 23 genomes. Twenty of the 23 genomes were classified under clade GR/B1.1, 2 genomes were classified under clade GR/B1.1.28, and 1 genome was classified under Clade O/B.6. Twenty-two of the 23 sequences collected after June 25, 2020, contained the D614G mutation. CONCLUSION: We describe here the results of SARS-CoV-2 testing for military and civilian patients and personnel. The 21- to 30- and 31- to 40-year-old age groups had the highest case counts of SARS-CoV-2-positive cases. Sequencing results showed the presence of the D614G mutation in the spike protein in a majority of specimens collected from the end of June to July 2020.

Coding-Complete Genome Sequences of 23 SARS-CoV-2 Samples from the Philippines.

Here, we report the coding-complete genome sequences of 23 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) samples from the Philippines. Sequences were obtained from nasopharyngeal and oropharyngeal swabs from coronavirus disease 2019 (COVID-19)-positive patients. Mutation analysis showed the presence of the D614G mutation in the spike protein in 22 of 23 genomes.

Clinical-pathological and molecular characterization of long-term survivors with advanced non-small cell lung cancer.

Objective: Long-term survivors (LS) of non-small cell lung cancer (NSCLC) without driver alterations, displaying an overall survival (OS) of more than 3 years, comprise around 10% of cases in several series treated with chemotherapy. There are classical prognosis factors for these cases [stage, Eastern Cooperative Oncology Group (ECOG), etc.], but more data are required in the literature. In this multi-center study, we focused on LS of advanced NSCLC with OS above 36 months to perform a clinical-pathological and molecular characterization. Methods: In the first step, we conducted a clinical-pathological characterization of the patients. Afterwards, we carried out a genetic analysis by comparing LS to a sample of short-term survivors (SS) (with an OS less than 9 months). We initially used whole-genome RNA-seq to identify differentiating profiles of LS and SS, and later confirmed these with reverse transcription-polymerase chain reaction (RT-PCR) for the rest of the samples. Results: A total of 94 patients were included, who were mainly men, former smokers, having adenocarcinoma (AC)-type NSCLC with an ECOG of 0-1. We obtained an initial differential transcriptome expression, displaying 5 over- and 33 under-expressed genes involved in different pathways: namely, the secretin receptor, surfactant protein, trefoil factor 1 (TFF1), serpin, Ca-channels, and Toll-like receptor (TLRs) families. Finally, RT-PCR analysis of 40 (20 LS/20 SS) samples confirmed that four genes (surfactant proteins and SFTP) were significantly down-regulated in SS compared to LS by using an analysis of covariance (ANCOVA) model: SFTPA1 (P = 0.023), SFTPA2 (P = 0.027), SFTPB (P = 0.02), and SFTPC (P = 0.047). Conclusions: We present a sequential genetic analysis of a sample of NSCLC LS with no driver alterations, obtaining a differential RNA-seq/RT-PCR profile showing an abnormal expression of SF genes.

First report of the mcr-1 colistin resistance gene identified in two Escherichia coli isolates from clinical samples, Philippines, 2018.

OBJECTIVES: The first report of a plasmid-borne colistin resistance gene (mcr-1) detected in an Escherichia coli isolate from China heralded the emergence of pandrug-resistant bacteria. Since then, the mcr-1 gene has been detected worldwide, but to date it has not been reported in the Philippines. METHODS: In this study, 123 antimicrobial-resistant isolates collected from January-June 2018 from patients admitted to a tertiary hospital in Manila, Philippines, were characterised. Biochemical identification and antimicrobial susceptibility testing were performed using a BD Phoenix™ M50 system with NMIC/ID-95 panel. Conventional PCR was performed to detect the genes mcr-1 to mcr-5, and short- and long-read whole-genome sequencing was performed. RESULTS: Two mcr-1-positive E. coli clinical isolates from separate patients harboured mcr-1 on an IncI2 plasmid. One isolate was shown to carry 12 antimicrobial resistance genes (ARGs) in addition to mcr-1, including the extended-spectrum ß-lactamase blaCTX-M-55, whilst the other E. coli isolate carried 6 ARGs in addition to mcr-1. CONCLUSION: Both patients had no prior colistin treatment recorded in their medical history and no travel history outside of the country within the past 6 months from the date of hospital admission, indicating local transmission and acquisition of the colistin-resistant strain from either community or hospital settings within the Philippines. This report should serve as a signal to local public-health officials of the need to intensify surveillance efforts and to increase vigilance and implementation of antimicrobial stewardship programmes to contain and slow the spread of antimicrobial resistance.

Comparison of Carbapenem-Resistant Microbial Pathogens in Combat and Non-combat Wounds of Military and Civilian Patients Seen at a Tertiary Military Hospital, Philippines (2013-2017).

INTRODUCTION: Bacterial wound infections are a danger to both military and civilian populations. The nature of injury and infection associated with combat related wounds are important in guiding antibiotic prophylaxis and empiric treatment guidelines. MATERIALS AND METHODS: The isolates were screened for drug-resistance by the MicroScan Walkaway Plus System using either the Negative Breakpoint Combo Panel (NBCP) 30 or 34 or Positive Breakpoint Combo Panel (PBPC) 20 or 23. Isolates with a minimum inhibitory concentration (MIC) of ≥8 µg/mL to imipenem and/or meropenem were tested for both carbapenemase production using the CarbaNP test and real-time PCR to determine molecular resistance mechanisms. Plasmid conjugation analysis was performed to define potential for horizontal gene transfer. RESULTS: We characterized 634 bacterial wound isolates collected from September 2013 to December 2017 from patients seen at a Philippine military tertiary hospital presenting with combat or non-combat injuries [354 (military) and 280 (civilians)]. Staphylococcus aureus was the most predominant bacterial species isolated from wounds in both populations (104/634, 16%). A variety of Gram-negative bacterial species comprised 442/634 (70%) of the isolates identified, with the most prevalent shown to be Pseudomonas aeruginosa, Enterobacter cloacae, Klebsiella pneumoniae, Escherichia coli, and Acinetobacter sp. Carbapenemase production was detected in 34/442 (8%) Gram-negative isolates. Testing for molecular resistance mechanisms showed 32/34 (17 military, 15 civilian) wound isolates were blaNDM positive and 2 were blaVIM positive, with the two blaVIM isolates found in the civilian population. Plasmid conjugation of 14 blaNDM and 2 blaVIM positive wound isolates representatives showed 2/16 (13%) produced E. coli J53 transconjugants (E. coli from a civilian; E. cloacae from a military). CONCLUSION: We describe in this study the wound bacterial and antibiotic resistance profile in the military (combat vs non-combat associated) and civilian population. We observed that, with the exception of Acinetobacter sp., resistance of prevalent Gram-negative bacterial species to imipenem or meropenem were not significantly different between the military and civilian populations. We also presented data on the prevalent bacterial species isolated from both combat and non-combat wounds in a military tertiary care hospital setting as well as the carbapenemase-encoding gene primarily responsible for carbapenem resistance as well as evidence of horizontal transfer via mobile genetic elements. Clinicians may use this information to guide empiric antibiotic coverage for the predominant organisms if wound culture results are not readily available.A prospective, longitudinal evaluation of the wound bacterial profile documenting the changing bacterial flora using higher resolution molecular strategies can provide a more comprehensive understanding of the diversity, composition, and abundance of bacterial composition of the wound microbial community from the time of injury, during the course of evacuation from the field to higher level of care facilities, and up to wound resolution.

Impact of a Barcode Medication Administration System on Patient Safety
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OBJECTIVES: To determine the impact of barcode medication administration (BCMA) on the incidence of medication administration errors among patients in an onco-hematology day hospital and to identify the characteristics of medication errors in that setting.
. SAMPLE & SETTING: 715 patients treated in the onco-hematology day unit at the Príncipe de Asturias University Hospital in Madrid, Spain.
. METHODS & VARIABLES: A between-groups, pre-/postintervention study was conducted. Administration errors observed in patients with solid tumors (intervention group) were compared with those in patients with hematologic cancer (control group) before and after the introduction of BCMA. Error incidence, type, and severity were assessed, as was length of stay for treatment.
. RESULTS: Use of a BCMA system reduced the incidence and severity of errors in medication administration in the onco-hematology day hospital.
. IMPLICATIONS FOR NURSING: BCMA is a useful technology to check the five rights of medication administration in the onco-hematology day hospital and could help nurses increase the time spent on direct patient care activities. 
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Mango-bagasse functional-confectionery: vehicle for enhancing bioaccessibility and permeability of phenolic compounds.

Functional confectionery can be exploited as a vehicle for the protection of phenolic compounds (PCs) and for enhancing absorption during the gastrointestinal (GI) process. In this study, a confection containing 20% of mango bagasse (MB), gelatin and pectin was formulated. The PC profile, antioxidant capacity, in vitro bioaccessibility and apparent permeability (Papp) during mouth-stomach-intestine digestion (15, 30, 60, 120 min) and in vitro colonic fermentation (6, 12, 24 h) were evaluated for MB and the mango bagasse confection (MBC). HPLC-DAD analysis showed that mangiferin (830.69 µg g-1) was the most abundant compound in MBC. Total PCs (4.14 mg g-1), quercetin (244.83 µg g-1), and gallic acid (GA) (285.43 µg g-1) were highly bioaccessible mainly at the intestine at 60-120 min of digestion. GA was the most bioaccessible compound. Total flavonoids (TFs) and condensed tannins (CTs) had the maximum bioaccessibility in the mouth and stomach, respectively. For the permeability studies, PCs showed efflux rather than uptake in the intestine. Those compounds that exhibited intestinal absorption were mangiferin > GA > total PCs > TFs, whereas quercetin and CT absorption was negligible. The antioxidant capacity remained unchanged along the GI, mangiferin and quercetin being the most likely compounds to exert this activity. Overall results indicate that MBC has higher bioaccessibility, absorption and antioxidant capacity than MB, suggesting an effective protective role of gelatin and pectin, giving insight into the potential of MBC as a functional food.

Carbapenemase-Producing Enterobacteriaceae and Nonfermentative Bacteria, the Philippines, 2013-2016.

During 2013-2016, we isolated blaNDM- and blaVIM-harboring Enterobacteriaceae and nonfermentative bacteria from patients in the Philippines. Of 130 carbapenem-resistant isolates tested, 45 were Carba NP-positive; 43 harbored blaNDM, and 2 harbored blaVIM. Multidrug-resistant microbial pathogen surveillance and antimicrobial drug stewardship are needed to prevent further spread of New Delhi metallo-ß-lactamase variants.

Riesgo toxicológico ambiental y manipulación del mercurio en el consultorio odontológico de dos unidades comunitarias de salud familiar de San Salvador / Environmental toxicological risk and manipulation of mercury in the dental office of two community family health units in San Salvador

Objetivo: Determinar el riesgo toxicológico derivado de la manipulación de mercurio, por el personal de las clínicas odontológicas de las Unidades Comunitarias de Salud Familiar de Mejicanos y Monserrat de San Salvador. Materiales y Métodos: El diseño corresponde a un estudio descriptivo transversal, utilizando una guía de observación y empleando el Método Colorimétrico en vapor frío; para determinar la presencia de vapores mercuriales, producidos durante el proceso de manipulación de la amalgama de plata como material restaurativo dental. Las observaciones y mediciones fueron efectuadas en diferentes horarios de la jornada laboral, en las Unidades Comunitarias de Salud familiar de Mejicanos y Monserrat; durante los meses de Septiembre y Octubre de 2013. Los resultados obtenidos, fueron ingresados a una base de datos y analizados por SPSS 1.8. Los resultados son presentados en tablas de distribución de frecuencias y contingencia Resultados: Al evaluar el manejo de los excedentes de mercurio, se realizó un total de doce guías de observación por cada Unidad Comunitaria de Salud Familiar. En la Unidad Comunitaria de Salud Familiar de Mejicanos se encontró en tres ocasiones, el recipiente con la tapadera enroscada y humedad en su interior. En cinco ocasiones se observó tapado inadecuadamente y siempre con humedad interior. En cuatro se encontró que utilizaban otro tipo de recipientes para el manejo de los excedentes. Con respecto a la cantidad de mercurio empleada durante cuatro semanas, para el consultorio de Mejicanos fue de 2.8 onzas y de 3.5 onzas en el de Monserrat. De un total de dieciséis mediciones, en ambas se encontraron tres valores por arriba del valor límite de 0.05 mg Hg/m³. Uno fue de 0.12 mg Hg /m³ y dos de 0.10 mg Hg/m³. Estos valores exceden al promedio de exposición al cual una persona puede estar expuesta (0.05 mg Hg/m³), sin que presente efectos adversos repetitivos, durante una jornada laboral de 40 horas semanales. Conclusiones: En tres de las dieciséis mediciones, se sobrepasó el límite de saturación de vapores de mercurio, permitido por la NIOSH (0.05 mg Hg /m³). En cuanto al manejo de los excedentes de mercurio, pudo comprobarse que en los consultorios, no se cumple con la Norma Técnica del Ministerio de Salud.

Objective: To determine the toxicological risks associated with handling mercury, by the staff of the dental clinics of the Community Family Health Units of (Unidades Comunitarias de Salud Familiar) Mejicanos and Monserrat of San Salvador. Materials and methods: The design was a descriptive study, using an observation guide and employing the colorimetric method using cold steam to determine the presence of mercury vapor produced during the handling process of silver amalgam as a dental restorative material. The observations and measurements were made at different times of the workday, in the Community Family Health Units of Mejicanos and Montserrat; during September and October 2013. The results obtained, were entered into a database and analyzed by SPSS 1.8. The results are presented in tables of frequency distribution and contingency. Results: In assessing the management of excess of mercury, a total of twelve observation guides were made for each Community Family Health Units (UCSF). In the UCSF of Mejicanos in three separate occasions the container was found with the lid screwed on and humidity in its interior. In five separate occasions the lid was found fastened inadequately and humidity was always found in the inside. Four were found that they utilized a different type of container for the handling of excess. In respect to the amount of mercury used during the four weeks period by the health clinic of Mejicanos the amount was 2.8 ounces, and 3.5 ounces for the health clinic of Montserrat A total of sixteen measurements were taken in total, in both clinics, three positive values were found (method colorimetric cold steam is limited to 0.05 mg Hg /m3 ) the first value of 0.12 mg Hg /m3 and two values of 0.10 mg Hg /m3 each. These values exceed 0.05 mg Hg /m3 which are the average exposure that a worker may be repeatedly exposed to, without adverse effect, over an 8- hour shift and a 40-hour workweek. Conclusions: In three of the sixteen measurements taken, the limit of saturation of mercury vapors allowed by NIOSH (0.05 mg Hg /m³) was exceeded. Regarding the handling of the excess of mercury, it was found that both clinics are not complying with the Technical Regulations of the Ministry of Health.