Prevalence of cocaine and derivatives in blood and urine samples of trauma patients and correlation with injury severity: a prospective observational study.

PURPOSE: The abuse of cocaine and its derivatives presents a likely risk factor for injury. Trauma incurred by cocaine and derivative abusers may be more severe than that incurred by non-users. OBJECTIVES: To ascertain the presence of cocaine and its derivatives in trauma patients and to correlate RTS (Revised Trauma Score) and ISS (Injury Severity Score) with the presence of cocaine and its derivatives in blood and urine samples. METHODS: All trauma victims treated in an emergency unit between November 11, 2012 and September 15, 2013 were included in the study. Blood and urine samples were collected on admission to hospital. RTS and ISS scores were then compared with the presence or absence of cocaine and its derivatives in the samples. The associations between RTS < 7.84 and ISS > 16 and the independent variables were evaluated by the gross odds ratio values, determined by univariate logistic regression. Multivariate analysis was performed using multivariate logistic regression. RESULTS: Of 453 patients (83.7% male) included in the study, 28.6% presented ISS > 16 and 33.6% presented RTS < 7.84. A total of 435 samples were collected, and 86 (19.8%) provided positive samples for cocaine, 48 (11%) for crack and 69 (15.9%) for cocaethylene. Compared to other patients, drug users showed a greater probability of RTS < 7.84 (2.18 times greater) and a greater probability of ISS > 16 (1.76 times greater). CONCLUSION: For the trauma patients included in our study, the use of cocaine and its derivatives was shown to be associated with more severe traumas, as demonstrated by their RTS and ISS scores.

Occupational and environmental human lead exposure in Brazil.

The purpose of this paper is to present a review of data on assessment of exposure and adverse effects due to environmental and occupational lead exposure in Brazil. Epidemiological investigations on children lead exposure around industrial and mining areas have shown that lead contamination is an actual source of concern. Lead in gasoline has been phasing out since the 1980s, and it is now completely discontinued. The last lead mining and lead refining plant was closed in 1995, leaving residual environmental lead contamination which has recently been investigated using a multidisciplinary approach. Moreover, there are hundreds of small battery recycling plants and secondary smelting facilities all over the country, which produce focal urban areas of lead contamination. Current regulatory limits for workplace lead exposure have shown to be inadequate as safety limits according to a few studies carried out lately.

Diagnostic investigation of ventilator-associated pneumonia using bronchoalveolar lavage: comparative study with a postmortem lung biopsy

The purpose of the present study was to validate the quantitative culture and cellularity of bronchoalveolar lavage (BAL) for the diagnosis of ventilator-associated pneumonia (VAP). A prospective validation test trial was carried out between 1992 and 1997 in a general adult intensive care unit of a teaching hospital. Thirty-seven patients on mechanical ventilation with suspected VAP who died at most three days after a BAL diagnostic procedure were submitted to a postmortem lung biopsy. BAL effluent was submitted to Gram staining, quantitative culture and cellularity count. Postmortem lung tissue quantitative culture and histopathological findings were considered to be the gold standard exams for VAP diagnosis. According to these criteria, 20 patients (54 percent) were diagnosed as having VAP and 17 (46 percent) as not having the condition. Quantitative culture of BAL effluent showed 90 percent sensitivity (18/20), 94.1 percent specificity (16/17), 94.7 percent positive predictive value and 88.8 percent negative predictive value. Fever and leukocytosis were useless for VAP diagnosis. Gram staining of BAL effluent was negative in 94.1 percent of the patients without VAP (16/17). Regarding the total cellularity of BAL, a cut-off point of 400,000 cells/ml showed a specificity of 94.1 percent (16/17), and a cut-off point of 50 percent of BAL neutrophils showed a sensitivity of 90 percent (19/20). In conclusion, BAL quantitative culture, Gram staining and cellularity might be useful in the diagnostic investigation of VAP

Diagnostic investigation of ventilator-associated pneumonia using bronchoalveolar lavage: comparative study with a postmortem lung biopsy.

The purpose of the present study was to validate the quantitative culture and cellularity of bronchoalveolar lavage (BAL) for the diagnosis of ventilator-associated pneumonia (VAP). A prospective validation test trial was carried out between 1992 and 1997 in a general adult intensive care unit of a teaching hospital. Thirty-seven patients on mechanical ventilation with suspected VAP who died at most three days after a BAL diagnostic procedure were submitted to a postmortem lung biopsy. BAL effluent was submitted to Gram staining, quantitative culture and cellularity count. Postmortem lung tissue quantitative culture and histopathological findings were considered to be the gold standard exams for VAP diagnosis. According to these criteria, 20 patients (54%) were diagnosed as having VAP and 17 (46%) as not having the condition. Quantitative culture of BAL effluent showed 90% sensitivity (18/20), 94.1% specificity (16/17), 94.7% positive predictive value and 88.8% negative predictive value. Fever and leukocytosis were useless for VAP diagnosis. Gram staining of BAL effluent was negative in 94.1% of the patients without VAP (16/17). Regarding the total cellularity of BAL, a cut-off point of 400,000 cells/ml showed a specificity of 94.1% (16/17), and a cut-off point of 50% of BAL neutrophils showed a sensitivity of 90% (19/20). In conclusion, BAL quantitative culture, Gram staining and cellularity might be useful in the diagnostic investigation of VAP.

Abnormal antioxidant system in erythrocytes of mercury-exposed workers.

To investigate the effects of chronic exposure to mercury we studied the red cell antioxidant system in mercury-exposed workers through the evaluation of reduced glutathione, catalase and superoxide dismutase systems. Of these workers, some were being exposed at the time and had presented urinary mercury levels considered safe for occupational exposure for at least 3 months prior to the initiation of this study, and others had been on leave for at least 6 months because of intoxication symptoms. Reduced glutathione levels were lower and catalase activity was higher in the workers which were still being exposed, compared to those on leave and controls. No differences were observed between the workers on leave and controls.

Mesotelioma maligno de pleura com associaçäo etiológica a asbesto: a propósito de três casos clínicos / Malign mesothelioma of pleura with etiological association to asbestos: apropos of 3 clinical cases

O mesotelioma maligno de pleura (MM) é tumor de ocorrência rara e nosso meio e tem-se mostrado, quando em elevada incidência, relacionado à exposiçäo pregressa a asbesto ou amianto nas séries descritas em outros países. OBJETIVO. A partir de casos clínicos atendidos no Hospital de Clínicas da UNICAMP, procurou-se evidenciar tal associaçäo epidemiológica, visando alertar profissionais médicos quanto à possível elevaçäo da incidência de tal tumor nesta década e, futuramente, por características próprias da história natural desse tipo de tumor. MÉTODOS. Säo descritos três casos de MM de pleura ocorridos na regiäo de Campinas, SP, num período de dois anos, dos pontos de vista clínico, laboratoriais complementares e anatomopatológico, incluindo minuciosa investigaçäo anamnésica ocupacional e ambiental. RESULTADOS. Todos os casos foram confirmados do ponto de vista anatomopatológico, incluindo microscopia eletrônica, como casos de MM. Os três casos mostraram relaçäo epidemiológica, comprovada por meio de história ocupacional, com exposiçäo a asbesto no passado. Um dos casos teve exposiçäo ocupacional pregressa de curta duraçäo (cerca de um ano); outro teve exposiçäo doméstica a partir de asbesto trazido do ambiente de trabalho por seu pai, durante sua infância, e o terceiro caso com contaminaçäo ocupacional indireta. CONCLUSÃO. A ocorrência de MM de pleura relacionada à exposiçäo a asbesto, no passado, parece ser realidade em nosso meio, como mostram estes três casos clínicos. Destaca-se a necessidade da anamnese ocupacional e ambiental detalhadas na abordagem desses casos, alertando-se para maior atençäo no diagnóstico dos tumores primários da pleura e do peritônio, nos próximos anos, em funçäo de provável aparecimento de novos casos relacionados a exposiçäo a asbesto pregressa, tendo em vista o intervalo de tempo entre o início da manipulaçäo do asbesto em nosso país e o aparecimento destes primeiros casos coincidir com o tempo de latência médio esperado para a ocorrência de MM. Destacam-se, ainda, as necessidades de definiçäo precisa de critérios diagnósticos, para esse tipo de tumor, e criaçäo de registro centralizado de casos.

[Malignant mesothelioma of the pleura with etiological association to asbestos: report of 3 clinical cases]. / Mesotelioma maligno de pleura com associação etiológica a asbesto: a propósito de três casos clínicos.

UNLABELLED: Diffuse Malign Mesotheliomas (DMM) has a low background prevalence. High incidences of this tumor have been related to asbestos exposure in the past. PURPOSE: To describe and discuss three clinical cases treated in our hospital, in which precise histopathologic diagnosis was made, and detailed occupational and environmental histories were taken, trying to identify in their past some kind of asbestos exposure. METHODS: Three cases of DMM are described. Diagnosis was confirmed by histochemical analysis and electronmicroscopy. Detailed occupational and environmental histories were taken from subjects and their families, searching for past contact with asbestos. RESULTS: The cases were diagnosed in a short period of time (two years), in a region of the country where many asbestos cement plants are located since the mid sixties. Skillful histological procedures were used. From these cases we found out that one had a twelve months period of exposure, 24 years before, in one of those plants. Another patient had an exposure for three years, as a bystander, in the same plant (also 24 years before) and a third patient was contaminated by asbestos brought home by his father in the 1950s (latency period of 30 years). All cases were histochemically studied and diagnosis confirmed by the presence of microvilli at electronmicroscopic examination. CONCLUSIONS: These three cases seem to confirm the existence of the epidemiologic association with asbestos exposure in our country. Definition of diagnosis criteria, centralization of cases registry and the necessity of more attention to this kind of asbestos related disease are discussed and stressed, as many new cases like those described are thought to occur in the near future, as the latency period of the disease seems to match with that of industrial asbestos manipulation in Brazil.