Levels and control of welding fume exposure to total particulate, hexavalent chromium, and manganese in contracted activities in an oil refinery setting (2008-2018).

In response to increasing focus on occupational exposures to welding fume, a 10-year series of personal exposure measurements was analyzed for the two main welding processes (Shielded Metal Arc Welding or Stick and Tungsten Inert Gas welding or TIG) used in an oil refinery setting. Exposures from ancillary gouging and grinding were also analyzed. The operations were conducted under a permit-to-work system, which stipulated control measures in the form of ventilation and respiratory protective equipment (RPE) depending on the work environment, base metal, and welding process. The analysis focused on three health hazards of interest: total particulate (TP); hexavalent chromium (Cr (VI)); and manganese (Mn). The study's aims were the analysis of exposure levels related to operational conditions to verify the adequacy of required control measures and the generation of quantitative information for the development of predictive exposure models. Arithmetic mean exposures were 2.01 mg/m3 for TP (n = 94), 13.86 µg/m3 for Cr (VI) (n = 160), and 0.024 mg/m3 for Mn (n = 95). Requirements and practices for ventilation and use of RPE appeared adequate for maintaining exposure levels below maximum use concentrations. Predictive models for mean exposure levels were developed using multiple linear regression. Different patterns emerged for TP, Cr (VI), and Mn exposure determinants. Enclosed or confined work environments were associated with elevated exposure levels, regardless of the provision of local exhaust or general dilution ventilation. Carbon arc, used with gouging and grinding, contributed significantly to TP exposure (p = 0.006). The relative TP source strengths of the two main welding processes were comparable to the literature data. For Cr (VI), stick welding was associated with approximately 50-fold (p < 0.001) higher exposure potential than TIG welding. For Mn, this difference was approximately 2.5-fold. Differences were observed across the three analytes in exposure reduction efficiency of local exhaust ventilation (LEV) compared to natural ventilation, possibly due to ineffective use in confined spaces. These findings contribute to the overall understanding of TP, Cr (VI), and Mn exposures from welding and required controls in an oil refinery setting.

Syntheses and Electrochemical and EPR Studies of Porphyrins Functionalized with Bulky Aromatic Amine Donors.

A series of nickel(II) porphyrins bearing one or two bulky nitrogen donors at the meso positions were prepared by using Ullmann methodology or more classical Buchwald-Hartwig amination reactions to create the new C-N bonds. For several new compounds, single crystals were obtained, and the X-ray structures were solved. The electrochemical data of these compounds are reported. For a few representative examples, spectroelectrochemical measurements were used to clarify the electron exchange process. In addition, a detailed electron paramagnetic resonance (EPR) study was performed to estimate the extent of delocalization of the generated radical cations. In particular, electron nuclear double resonance spectroscopy (ENDOR) was used to determine the coupling constants. DFT calculations were conducted to corroborate the EPR spectroscopic data.

Expedient Access to Cyanated N-Heterocycles by Direct Flow-Electrochemical C(sp2 )-H Activation.

Nitriles are recurring motifs in bioactive molecules and versatile functional groups in synthetic chemistry. Despite recent progress, direct introduction of a nitrile moiety in heteroarenes remains challenging. Recent developments in electrochemical reactions pave the way to more practical cyanation protocols. However, currently available methods typically require hazardous cyanide sources, expensive mediators, and often suffer from narrow substrate scope and laborious reaction set-up. To address the limitations of current synthetic methods, herein, an effective, sustainable, and scalable procedure for the direct C(sp2 )-H cyanation of aromatic N-heterocycles with a user-friendly flow-electrochemical set-up is reported. Furthermore, high substrate and functional-group tolerance is demonstrated, allowing late-stage functionalization of drug-like scaffolds, such as natural products and pharmaceuticals.

Oxidative stress-mediated cytotoxicity of Endosulfan is causally linked to the inhibition of NADH dehydrogenase and Na+, K+-ATPase in Ehrlich ascites tumor cells.

Oxidative stress in cells caused by excessive production of reactive oxygen species (ROS) and decreased antioxidant defense is implicated in the cytotoxicity of xenobiotics including drugs and environmental chemicals. Endosulfan, a highly toxic organochlorine insecticide, causes cytotoxic cell death by inducing oxidative stress. We have investigated the biochemical basis of induction of oxidative stress, involving the role of NADH dehydrogenase and the possible role of Na+, K+-ATPase in endosulfan cytotoxicity and, whether the cytotoxicity could be attenuated by targeting ROS induction using the natural flavonoid antioxidant, quercetin, in Ehrlich ascites tumor (EAT) cells. Exposure of cells to endosulfan caused cytotoxic cell death (necrosis) which was associated with induction of ROS, lipid peroxidation as well as a reduction in glutathione levels, concomitant with loss of NADH dehydrogenase and Na+, K+-ATPase activity in a dose-dependent manner, indicating that oxidative stress and perturbation of membrane function are the major causes of endosulfan cytotoxicity. Our results showed that quercetin, protected against endosulfan-induced cytotoxicity and significantly abrogated oxidative stress, and ameliorated the inhibition of NADH dehydrogenase and Na+, K+-ATPase activity in EAT cells. Our study presents evidence that NADH dehydrogenase inhibition plays an important role in oxidative stress-mediated cytotoxicity, and perturbed membrane function as evident from inhibition of sodium-potassium pump is involved in cytotoxic cell death.

Towards the elimination of dog-mediated rabies: development and application of an evidence-based management tool.

BACKGROUND: International organizations advocate for the elimination of dog-mediated rabies, but there is only limited guidance on interpreting surveillance data for managing elimination programmes. With the regional programme in Latin America approaching elimination of dog-mediated rabies, we aimed to develop a tool to evaluate the programme's performance and generate locally-tailored rabies control programme management guidance to overcome remaining obstacles. METHODS: We developed and validated a robust algorithm to classify progress towards rabies elimination within sub-national administrative units, which we applied to surveillance data from Brazil and Mexico. The method combines criteria that are easy to understand, including logistic regression analysis of case detection time series, assessment of rabies virus variants, and of incursion risk. Subjecting the algorithm to robustness testing, we further employed simulated data sub-sampled at differing levels of case detection to assess the algorithm's performance and sensitivity to surveillance quality. RESULTS: Our tool demonstrated clear epidemiological transitions in Mexico and Brazil: most states progressed rapidly towards elimination, but a few regressed due to incursions and control lapses. In 2015, dog-mediated rabies continued to circulate in the poorest states, with foci remaining in only 1 of 32 states in Mexico, and 2 of 27 in Brazil, posing incursion risks to the wider region. The classification tool was robust in determining epidemiological status irrespective of most levels of surveillance quality. In endemic settings, surveillance would need to detect less than 2.5% of all circulating cases to result in misclassification, whereas in settings where incursions become the main source of cases the threshold detection level for correct classification should not be less than 5%. CONCLUSION: Our tool provides guidance on how to progress effectively towards elimination targets and tailor strategies to local epidemiological situations, while revealing insights into rabies dynamics. Post-campaign assessments of dog vaccination coverage in endemic states, and enhanced surveillance to verify and maintain freedom in states threatened by incursions were identified as priorities to catalyze progress towards elimination. Our finding suggests genomic surveillance should become increasingly valuable during the endgame for discriminating circulating variants and pinpointing sources of incursions.

Coordination-Driven Construction of Porphyrin Nanoribbons at a Highly Oriented Pyrolytic Graphite (HOPG)/Liquid Interface.

Nanostructures were built at the solid/liquid interface by self-assembly and/or coordination bonds. Metalloporphyrins bearing two external coordination sites and long alkyl chains allowed the self-assembly of the compounds on highly oriented pyrolitic graphite. After addition of a metal ion, long transition-metal linked porphyrin nanoribbons were obtained and visualized by scanning tunneling microscopy. In these porphyrin ribbons electronic delocalization is possible through the d orbitals of the connecting metal ions.

Synthesis and Study at a Solid/Liquid Interface of Porphyrin Dimers Linked by Metal Ions.

Several porphyrin dimers linked by metal ions were prepared. One trimeric compound was also isolated and one porphyrin dimer linked by palladium(II) could be structurally characterized. In solution, the size of the new compounds was estimated by DOSY NMR techniques. These compounds all contained long aliphatic chains (O-C12H25), which were used to assemble them at a highly oriented pyrolytic graphite (HOPG)/liquid interface. The highly ordered arrays were visualized by scanning tunneling microscopy (STM).

DNM2 mutations in a cohort of sporadic patients with centronuclear myopathy.

Centronuclear myopathy (CNM) is a rare congenital muscle disease characterized by fibers with prominent centralized nuclei in muscle biopsies. The disease is clinically heterogeneous, ranging from severe neonatal hypotonic phenotypes to adult-onset mild muscle weakness, and can have multiple modes of inheritance in association with various genes, including MTM1, DNM2, BIN1 and RYR1. Here we analyzed 18 sporadic patients with clinical and histological diagnosis of CNM and sequenced the DNM2 gene, which codes for the dynamin 2 protein. We found DNM2 missense mutations in two patients, both in exon 8, one known (p.E368K) and one novel (p.F372C), which is found in a position of presumed pathogenicity and appeared de novo. The patients had similar phenotypes characterized by neonatal signs followed by improvement and late childhood reemergence of slowly progressive generalized muscle weakness, elongated face with ptosis and ophthalmoparesis, and histology showing fibers with radiating sarcoplasmic strands (RSS). These patients were the only ones in the series to present this histological marker, which together with previous reports in the literature suggest that, when RSS are present, direct sequencing of DNM2 mutation hot spot regions should be the first step in the molecular diagnosis of CNM, even in sporadic cases.

Transcutaneous Posterior Tibial Nerve Stimulation: An Adjuvant Treatment for Intractable Constipation in Children.

BACKGROUND: Functional constipation can lead to painful defecations, fecal incontinence, and abdominal pain, significantly affecting a child's quality of life. Treatment options include non-pharmacological and pharmacological approaches, but some cases are intractable and require alternative interventions like neuromodulation. A subtype of neuromodulation, called Transcutaneous Posterior Tibial Nerve Stimulation (TPTNS), comprises electrical stimulation at the ankle level, by means of electrodes fixed to the skin. TPTNS is a minimally invasive, easy-to-apply technique that can potentially improve constipation symptoms in the pediatric population by stimulating the sacral nerves. AIM: To evaluate the clinical results and applicability of TPTNS as an adjuvant treatment for children and adolescents with functional constipation. METHODS: Between April 2019 and October 2021, 36 patients diagnosed with functional constipation according to the Rome IV Criteria were invited to participate in the study. The study followed a single-center, uncontrolled, prospective cohort design. Patients received TPTNS for 4 or 8 weeks, with assessments conducted immediately after the periods of TPTNS and 4 weeks after the end of the intervention period. The data normality distribution was determined by the Shapiro-Wilk test. The Wilcoxon test and Student's t-test for paired samples were used to compare quantitative variables, and the McNemar test was used to compare categorical variables. RESULTS: Of the 36 enrolled patients, 28 children and adolescents with intractable function constipation completed the study, receiving TPTNS for 4 weeks. Sixteen patients (57.1%) extended the intervention period for 4 extra weeks, receiving 8 weeks of intervention. TPTNS led to significant improvements in stool consistency, frequency of defecation, and bowel function scores, with a reduction in abdominal pain. Quality of life across physical and psychosocial domains showed substantial enhancements. The quality of life-related to bowel habits also improved significantly, particularly in lifestyle, behavior, and embarrassment domains. The positive effects of this intervention are seen relatively early, detected after 4 weeks of intervention, and even 4 weeks after the end of the intervention. TPTNS was well-tolerated, with an adherence rate of approximately 78%, and no adverse effects were reported. CONCLUSIONS: TPTNS is an adjuvant treatment for intractable functional constipation, improving bowel function and quality of life. The effects of TPTNS were observed relatively early and sustained even after treatment cessation.

Upper gastrointestinal histopathological findings in children and adolescents with nonulcer dyspepsia with Helicobacter pylori infection.

OBJECTIVES: The aim of the study was to investigate the histopathological lesions in the upper gastrointestinal mucosa associated with Helicobacter pylori infection in children with nonulcer dyspepsia. METHODS: A cross-sectional case-control study was performed on 185 Brazilian children and adolescents (4-17 years, mean 9.5 ±â€Š2.7 years), 63.2% girls, submitted to upper gastrointestinal endoscopy. The histopathological lesions of the esophageal and gastric mucosa were analyzed in biopsy samples. RESULTS: H pylori infection was identified in 96 children (51.8%). Moderate to severe chronic active gastritis was present in antrum (70.5%) and corpus (45.2%), with higher grading in antrum than in corpus (P < 0.05). The topographic distribution of inflammation was pangastritis (61.9%), followed by antral (32.1%) and corpus (5.9%). H pylori density was higher in antrum than in corpus. Intestinal metaplasia was not found in the H pylori-infected group, nor was significant gastric atrophy. The scores for esophagitis were significantly higher (P < 0.05) in the noninfected group (1.4 ±â€Š0.8) than in the H pylori-infected group (1.07 ±â€Š0.9), with significant negative correlation (r = 0.29; P < 0.05) with the scores of gastric inflammation. CONCLUSIONS: The prevalence of H pylori infection was high among children with dyspepsia and associated with moderate/severe degrees of gastric inflammation. The high scores of esophagitis in the noninfected group point to 2 distinct groups of pathological conditions sharing similar clinical patterns.

Labeling food allergens in the packaged food pyramid groups in Brazil: analysis of descriptions, ambiguities, and risks.

OBJECTIVE: The aim of this study was to evaluate allergenic labeling components of packaged foods for "What is the quality of food labels?" and "What is the group of Brazilian Food Pyramid that 'May contain' is predominant?." METHODS: The photographs of 916 products were obtained, of which 518 were analyzed. Data from each label were evaluated according to Brazilian Food Pyramid Groups (i.e., Cereals, Fruits, & Vegetables; Soybean & products; Milk & dairy products; Meat & eggs; Fats & oils; and Sugars & sweets). Ten items were analyzed in each label, namely, the presence of a list of ingredients, alert phrase for allergy sufferers, grouping of the alert phrase, phrase location, uppercase phrase, the phrase in bold, the color of alert phrase contrasting to the background, adequate font size, do not claim the absence for any allergen with the ingredients, and others factors that make it difficult to read. For the second question, a structured questionnaire was completed, and products were classified into two categories, namely, "Contain" and "May contain." RESULTS: The quality of the label was appropriate, and 69% of packaged foods had at least one allergen. The information "May contain" were higher in cow's milk (Cereals and Meat & eggs), soy (Soybean & products), and egg protein (Cereals). Soybean & products were the highest insecurity group. CONCLUSIONS: Brazilian health professionals can count on good-quality labeling of packaged products. Consequently, they could promote patients' and parents/caregivers' education to consult the labels and manage the risks in processed foods about precautionary allergen labeling. Soybean & products were the most significant insecurity for food choices between Brazilian Pyramid Groups.

Pediatric Functional Constipation Questionnaire-Parent Report (PedFCQuest-PR): development and validation.

OBJECTIVE: Developing and validating a disease-specific instrument in the Brazilian Portuguese language to assess the Health-Related Quality of Life of children with functional constipation, applied to parents/caregivers. METHODS: The process of developing the questionnaire was carried out in the following steps: items generation concerning functional constipation; elaboration of the preliminary questionnaire; assessment by health professionals; identifying problems or inconsistencies by the researchers; improvement of the questions; obtaining a final questionnaire named Pediatric Functional Constipation Questionnaire-Parent Form (PedFCQuest-PR) with 26 questions divided into four domains. Responses options use a Likert scale based on the events of the last four weeks. The process of validation was an observational, cross-sectional study in a sample of 87 parents/caregivers of children from 5 to 15 years of age diagnosed with Functional constipation according to the Rome IV Criteria. The questionnaire was applied simultaneously to the Pediatric Quality of Life Inventory 4.0 (PedsQL TM 4.0) as a control. RESULTS: The questionnaire validation included 87 parents/caregivers. The children's median age was 8.2 years, with a long time of constipation symptoms associated with fecal incontinence in approximately two-thirds. Internal consistency reliability for the Total Scale Score of PedFCQuest-PR by Coefficient Alpha of Cronbach score was 0.86. Convergent and divergent validity of PedFCQuest-PR was demonstrated by correlating the domains of both questionnaires. CONCLUSION: This study provides evidence that PedFCQuest-PR is a reliable instrument. The results showed a high degree of internal consistency and validity of the instrument for future applications.

A Prospective Investigation of the Impact of Telemedicine and Telemetry on Global Medical Evacuation Rates.

OBJECTIVES: This study examines whether the availability of telemedicine on offshore installations reduces medical evacuation rates. METHODS: This is a prospective cohort study on offshore platforms in the United States, Malaysia, and the United Kingdom. Emergency evacuation rates were compared between locations with telemedicine (United States) and 2 control groups without telemedicine (Malaysia, United Kingdom). RESULTS: Three hundred eighty-four cases in the telemedicine group and 261 cases in the control groups were included. The odds (adjusted and unadjusted) of medical evacuation were significantly higher for assets without telemedicine, contractors, and age older than 60 years. Analysis indicated a shift from emergency evacuation to routine transport for the telemedicine group. CONCLUSIONS: Telemedicine reduces emergency medical evacuations from offshore installations. This reduction is likely due to an increased capacity for transforming emergency care into routine care at the offshore location.

Agreement Between SARS-CoV-2 PCR Test Results Using Nasopharyngeal and Mid-Turbinate Specimens Among Asymptomatic Working-Age Adults.

OBJECTIVE: The aim of this study was to determine whether mid-turbinate specimens reliably detect active infection in asymptomatic adults undergoing regular COVID-19 PCR testing. METHODS: Qualitative agreement between 2481 paired nasopharyngeal and mid-turbinate PCR results was assessed. Mean cycle threshold values for each positive result were evaluated as an indicator of active infection. RESULTS: Overall agreement between nasopharyngeal and mid-turbinate tests was 98.4%. Positive percent agreement was 37.2%, and negative percent agreement was ~100%. Test pairs with lower cycle thresholds (≤30 and ≤25) reached 67% and 100% positive percent agreement, respectively. CONCLUSIONS: SARS-CoV-2 infections with high viral loads were detected regardless of specimen type. Mid-turbinate swabs reduced staff discomfort and may decrease repeated positive test results weeks or months after initial infection. Discordant pairs generally had high cycle threshold values (>30) indicating low viral load and little risk of transmitting COVID-19.

Impaired Health-Related Quality of Life in Brazilian Children with Chronic Abdominal Pain: A Cross-Sectional Study.

Purpose: We compared the health-related quality of life (HRQOL) of children and adolescents with functional abdominal pain disorders (FAPDs) and organic abdominal pain disorders (ORGDs). Methods: This was a single-center, cross-sectional, observational study. The PedsQL 4.0 generic cores scales parent proxy-report was administered to parents/caregivers of 130 and 56 pediatric patients with FAPDs and ORGDs respectively on their first visit. The self-reported pain intensity in the patients was assessed using a visual analog scale (VAS) and facial affective scale (FAS). Results: Irritable bowel syndrome was the most prevalent FAPDs, and the most prevalent ORGDs were reflux esophagitis (41.1%) and gastritis associated with Helicobacter pylori (21.4%). There was no difference in HRQOL among patients diagnosed with ORGDs and FAPDs (p>0.05). Patients with ORGDs and FAPDs had lower HRQOL Scale scores than healthy Brazilian and American children's references, with a high proportion of children at risk for impaired HRQOL (p<0.0001). There was no difference in the VAS and the FAS scores between the ORGDs and the FAPDs. FAPDs had a higher prevalence of girls' and couples' disagreement (p<0.02), although poor school performance (p<0.0007) and bullying (p<0.01) were higher in patients with ORGD. Conclusion: This study revealed that there was a difference in impaired HRQOL between patients with ORGDs and FAPDs. Thus, considering the high prevalence of chronic abdominal pain in children, a well-founded treatment plan is necessary for a multidisciplinary cognitive-behavioral Pain management program.

Effect of the COVID-19 pandemic on patients with inherited neuromuscular disorders.

BACKGROUND: The COVID-19 pandemic has brought substantial challenges for current practices in treating hereditary neuromuscular disorders (hNMDs). However, this infection has not been the only concern for these patients. Social distancing has compromised multidisciplinary assistance and physical activity, and has brought about several mental health issues. We presented a follow-up on 363 patients with hNMDs at a Brazilian tertiary center during the peak of the COVID-19 pandemic. OBJECTIVE: We aimed to show the frequency and severity of SARS-CoV-2 infection among hNMD patients and to demonstrate the effects of the pandemic on life habits, disease progression and multidisciplinary supportive care status. METHODS: Three hundred and sixty-three patients (58% male and 42% female) were followed for three months through three teleconsultations during the peak of the COVID-19 pandemic in Brazil. RESULTS: There were decreases in the numbers of patients who underwent physical, respiratory and speech therapies. For several patients, their appetite (33%) and sleep habits (25%) changed. Physical exercises and therapies were interrupted for most of the patients. They reported new onset/worsening of fatigue (17%), pain (17%), contractions (14%) and scoliosis (7%). Irritability and sleep, weight and appetite changes, and especially diminished appetite and weight loss, were more frequent in the group that reported disease worsening. There was a low COVID-19 contamination rate (0.8%), and all infected patients had a mild presentation. CONCLUSION: The isolation by itself was protective from a COVID-19 infection perspective. However, this isolation might also trigger a complex scenario with life habit changes that are associated with an unfavorable course for the NMD.

Validity of underlying cause of death statistics in Hermosillo, Mexico.

OBJECTIVE: This paper assesses the quality of the underlying cause of death (COD) statistics in Hermosillo, Mexico in a random sample of 300 in-hospital adult deaths. MATERIAL AND METHODS: A "gold standard" COD, determined by a systematic review of hospital medical charts, was compared to the COD reported by the vital registry system. RESULTS: Overall agreement between the reviewer and original COD at the ICD-10 chapter block was 69.2%, with a weighted kappa of 0.62. Agreement varied greatly by ICD-10 chapter. Mutual misclassification among common co-morbidities,such as diabetes mellitus and circulatory disease, minimized the net change in the mortality fraction assigned to each ICD-10 chapter after physician review. CONCLUSIONS: The ICD-10 chapter level underlying COD codes can be used to estimate disease burden in the population. Caution is recommended for use of vital registry statistics in Hermosillo for individual level or disease-specific analyses.

Optimizing medical resources for spaceflight using the integrated medical model.

INTRODUCTION: Efficient allocation of medical resources for spaceflight is important for crew health. The Integrated Medical Model (IMM) was developed to estimate medical event occurrences, mitigation, and resource requirements. An optimization module was created for IMM that uses a systematic process of elimination and preservation to maximize crew health outcomes subject to resource constraints. METHODS: A maximum medical kit is identified and resources are eliminated according to their relative impact on outcomes of interest. Additional steps allow opportunities for resources to be added back into the medical kit if possible. The effectiveness of the module is demonstrated under six alternative mission profiles by optimizing the medical kit to maximize the expected Crew Health Index (CHI), and comparisons are made with minimum and maximum kits. RESULTS: The optimum and maximum kits had similar expected CHI, but CHI was more variable for the optimum kit. The maximum kit resulted in the best outcomes, but required at least 13.7 times the mass of the optimum kit and 26.6 times the volume. The largest difference in mean CHI between the optimum and maximum kits occurred for four crewmembers on a 180-d mission (91.1% vs. 95.4%). CONCLUSIONS: The optimization module may be used as an objective tool to assist with the efficient allocation of medical resources for spaceflight. The module provides a flexible algorithm that may be used in conjunction with the IMM model to assist in medical kit requirements and design.

Clinical Features and Outcomes of Very-Early-Onset Inflammatory Bowel Disease in Brazilian Children.

We report on 20 Brazilian children under 6 years of age with very-early-onset inflammatory bowel disease naive to treatment. The clinical, laboratory, and histopathologic findings at diagnosis and outcomes were reviewed: 13 had ulcerative colitis (UC) and 7 had Crohn disease (CD). The final diagnostic pattern was as follows: 4 children had neonatal-onset (1 UC and 3 CD), 8 had infantile subtype (4 UC and 4 CD), and 8 had UC beyond the neonatal and infantile period. Both forms of inflammatory bowel disease were severe and extensive at diagnosis, with a high prevalence of bloody diarrhea, reflecting the colonic location of the disease. UC was predominantly pancolonic, CD was isolated in the colon and associated with perianal disease. Children with CD were younger than those with UC, were significantly more nutritionally impaired, and had more complications. This study shows that very-early-onset inflammatory bowel disease has an aggressive clinical course with 2 distinct phenotypes, UC and CD, with differences in severity, clinical behavior, and inflammatory pattern but with a preponderance of colonic involvement in both types.