RESUMO
BACKGROUND: In pandemics such as COVID-19, shortages of personal protective equipment are common. One solution may be to decontaminate equipment such as facemasks for reuse. AIM: To collect and synthesize existing information on decontamination of N95 filtering facepiece respirators (FFRs) using microwave and heat-based treatments, with special attention to impacts on mask function (aerosol penetration, airflow resistance), fit, and physical traits. METHODS: A systematic review (PROSPERO CRD42020177036) of literature available from Medline, Embase, Global Health, and other sources was conducted. Records were screened independently by two reviewers, and data was extracted from studies that reported on effects of microwave- or heat-based decontamination on N95 FFR performance, fit, physical traits, and/or reductions in microbial load. FINDINGS: Thirteen studies were included that used dry/moist microwave irradiation, heat, or autoclaving. All treatment types reduced pathogen load by a log10 reduction factor of at least three when applied for sufficient duration (>30 s microwave, >60 min dry heat), with most studies assessing viral pathogens. Mask function (aerosol penetration <5% and airflow resistance <25 mmH2O) was preserved after all treatments except autoclaving. Fit was maintained for most N95 models, though all treatment types caused observable physical damage to at least one model. CONCLUSIONS: Microwave irradiation and heat may be safe and effective viral decontamination options for N95 FFR reuse during critical shortages. The evidence does not support autoclaving or high-heat (>90°C) approaches. Physical degradation may be an issue for certain mask models, and more real-world evidence on fit is needed.
Assuntos
Infecções por Coronavirus/prevenção & controle , Descontaminação/normas , Reutilização de Equipamento/normas , Guias como Assunto , Temperatura Alta , Dispositivos de Proteção Respiratória/virologia , Raios Ultravioleta , HumanosRESUMO
Inadequate supply of filtering facepiece respirators (FFRs) for healthcare workers during a pandemic such as the novel coronavirus outbreak (SARS-CoV-2) is a serious public health issue. The aim of this study was to synthesize existing data on the effectiveness of ultraviolet germicidal irradiation (UVGI) for N95 FFR decontamination. A systematic review (PROSPERO CRD42020176156) was conducted on UVGI in N95 FFRs using Embase, Medline, Global Health, Google Scholar, WHO feed, and MedRxiv. Two reviewers independently determined eligibility and extracted predefined variables. Original research reporting on function, decontamination, or mask fit following UVGI were included. Thirteen studies were identified, comprising 54 UVGI intervention arms and 58 N95 models. FFRs consistently maintained certification standards following UVGI. Aerosol penetration averaged 1.19% (0.70-2.48%) and 1.14% (0.57-2.63%) for control and UVGI arms, respectively. Airflow resistance for the control arms averaged 9.79 mm H2O (7.97-11.70 mm H2O) vs 9.85 mm H2O (8.33-11.44 mm H2O) for UVGI arms. UVGI protocols employing a cumulative dose >20,000 J/m2 resulted in a 2-log reduction in viral load. A >3-log reduction was observed in seven UVGI arms using >40,000 J/m2. Impact of UVGI on fit was evaluated in two studies (16,200; 32,400 J/m2) and no evidence of compromise was found. Our findings suggest that further work in this area (or translation to a clinical setting) should use a cumulative UV-C dose of 40,000 J/m2 or greater, and confirm appropriate mask fit following decontamination.
Assuntos
Infecções por Coronavirus/prevenção & controle , Desinfecção/normas , Reutilização de Equipamento/normas , Guias como Assunto , Máscaras/normas , Exposição Ocupacional/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Raios Ultravioleta , Betacoronavirus , COVID-19 , Eficiência , Humanos , SARS-CoV-2 , Segurança/normasRESUMO
Insulin and insulin-like growth factor-1 signaling have fundamental roles in energy metabolism, growth and development. Recent research suggests hyperactive insulin receptor (IR) and hyperinsulinemia are cancer risk factors. However, the mechanisms that account for the link between the hyperactive insulin signaling and cancer risk are not well understood. Here we show that an insulin-like signaling inhibits the DAF-18/(phosphatase and tensin homolog) PTEN tumour suppressor in Caenorhabditis elegans and that this regulation is conserved in human breast cancer cells. We show that inhibiting the IR increases PTEN protein levels, while increasing insulin signaling decreases PTEN protein levels. Our results show that the kinase region of IRß subunit physically binds to PTEN and phosphorylates on Y27 and Y174. Our genetic results also show that DAF-2/IR negatively regulates DAF-18/PTEN during C. elegans axon guidance. As PTEN is an important tumour suppressor, our results therefore suggest a possible mechanism for increased cancer risk observed in hyperinsulinemia and hyperactive IR individuals.
Assuntos
Insulina/metabolismo , PTEN Fosfo-Hidrolase/metabolismo , Receptor de Insulina/metabolismo , Animais , Animais Geneticamente Modificados , Axônios/metabolismo , Caenorhabditis elegans/genética , Caenorhabditis elegans/metabolismo , Proteínas de Caenorhabditis elegans/agonistas , Proteínas de Caenorhabditis elegans/genética , Proteínas de Caenorhabditis elegans/metabolismo , Linhagem Celular , Expressão Gênica , Humanos , Insulina/farmacologia , Insulinas , Mucosa Intestinal/metabolismo , Modelos Biológicos , Mutação , Neurônios/metabolismo , PTEN Fosfo-Hidrolase/genética , Ligação Proteica , Receptor de Insulina/agonistas , Receptor de Insulina/genéticaAssuntos
Gravidez Ectópica/cirurgia , Adulto , Feminino , Humanos , Laparoscopia , Gravidez , Resultado da Gravidez , Salpingostomia/métodos , Útero/cirurgiaRESUMO
Lactic acidosis B is a rare metabolic complication of malignancy. It usually is associated with advanced and extensive metastatic disease. The authors report a case in which lactic acidosis was the presenting feature of a previously undiagnosed case of metastatic breast cancer in a pregnant woman and that resolved with successful antineoplastic treatment. The authors review the likely cause and management of the condition.
Assuntos
Acidose Láctica/etiologia , Adenocarcinoma/complicações , Neoplasias da Mama/complicações , Complicações na Gravidez/metabolismo , Acidose Láctica/diagnóstico , Adenocarcinoma/secundário , Adulto , Feminino , Humanos , Gravidez , Complicações Neoplásicas na Gravidez/metabolismo , Terceiro Trimestre da GravidezAssuntos
Complicações Cardiovasculares na Gravidez , Hemorragia Uterina , Feminino , Humanos , Mola Hidatiforme/complicações , Gravidez , Complicações Cardiovasculares na Gravidez/etiologia , Complicações Cardiovasculares na Gravidez/terapia , Gravidez Ectópica/complicações , Cuidado Pré-Natal , Hemorragia Uterina/etiologia , Hemorragia Uterina/terapia , Neoplasias Uterinas/complicaçõesRESUMO
Pituitary glands of pro-oestrous and oestrous rats were perifused in series with isolated ovarian follicles and the luteinizing hormone (LH) and follicle-stimulating hormone (FSH) responses to gonadotropin-releasing hormone (GnRH) were measured. Pituitary glands from pro-oestrous rats, perifused with the effluent medium from isolated preovulatory follicles, showed a significant reduction in the self-priming effect of GnRH as observed from the typical biphasic LH response to a continuous GnRH challenge. The initial FSH response to GnRH was also reduced. A similar trend was seen in the LH responses of pituitary glands from oestrous rats but results were not significant; there was no parallel reduction in FSH release. It is unlikely that the attenuation of GnRH self-priming was due to the steroids released by the isolated follicles. LH responses of pro-oestrous pituitaries, perifused with medium containing 200 pg oestradiol/ml, 5 ng progesterone/ml or 200 pg testosterone/ml were similar to paired controls as were the responses when all three steroids were added to the perifusing media at identical concentrations. Furthermore, when steroids were charcoal extracted from the effluent medium of perifused isolated follicles the biological activity of this medium in attenuating GnRH self-priming was not destroyed. Finally, the effects of purified bovine inhibin and steroid-free human follicular fluid (hFF) on LH responses were compared. Purified inhibin at a concentration of 20 or 50 ng/ml perifusing medium had no effect on GnRH-stimulated LH release although GnRH-stimulated FSH secretion was significantly reduced toward the end of an extended perifusing period.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Fatores Biológicos/fisiologia , Líquido Folicular/fisiologia , Adeno-Hipófise/metabolismo , Hormônios Liberadores de Hormônios Hipofisários/fisiologia , Animais , Estro/metabolismo , Feminino , Hormônio Foliculoestimulante/metabolismo , Técnicas In Vitro , Hormônio Luteinizante/metabolismo , Folículo Ovariano/metabolismo , Perfusão , Radioimunoensaio , Ratos , Ratos EndogâmicosAssuntos
Algoritmos , Hemorragia/etiologia , Doenças Vaginais/etiologia , Hiperplasia Endometrial/complicações , Feminino , Hemorragia/diagnóstico , Humanos , Micoses/complicações , Doenças do Colo do Útero/complicações , Doenças Uterinas/complicações , Doenças Vaginais/diagnóstico , Doenças da Vulva/complicaçõesRESUMO
A randomly controlled trial was performed on 41 women having gynaecological surgery in which the team of surgeons and nurses wore or did not wear masks. After major abdominal surgery, 3 of 5 patients in the unmasked group developed wound infections whereas no infection was observed in the 4 patients of the masked group. A greater number of Streptococci were also found by settle-plates on the operating table in the unmasked group. No infection was recorded after minor or vaginal surgery.
Assuntos
Doenças dos Genitais Femininos/cirurgia , Máscaras , Salas Cirúrgicas , Infecção da Ferida Cirúrgica/prevenção & controle , Abdome/microbiologia , Abdome/cirurgia , Microbiologia do Ar , Ensaios Clínicos como Assunto , Microbiologia Ambiental , Contaminação de Equipamentos , Feminino , Humanos , Período Intraoperatório , Distribuição Aleatória , Streptococcus/isolamento & purificação , Vagina/cirurgiaAssuntos
Peso ao Nascer , Recém-Nascido Prematuro , Estatura , Anticoncepcionais Orais , Dieta , Emprego , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Trabalho de Parto Induzido , Masculino , Idade Materna , Trabalho de Parto Prematuro/etiologia , Paridade , Gravidez , Complicações na Gravidez , Complicações Infecciosas na Gravidez , Gravidez Múltipla , Grupos Raciais , Fumar , Classe SocialRESUMO
In a population of 16333 singleton births born in one week of April, 1970, 4.4% failed to establish regular respiration within 3 min of birth. A follow-up at 5 years of age collected medical, educational and sociological information on 79.6% of the survivors of the cohort identified by the birth survey. Data have been analysed to investigate the relationships between the delay in the onset of regular respiration and possible risk factors identifiable prior to or at the time of birth. Complex statistical analysis employing linear modelling techniques showed that the delay in the onset of respiration was primarily related to: null and high parity; antepartum haemorrhage (especially placenta praevia); pre-eclampsia; breech delivery; Caesarian section and low birthweight. There was no association with maternal smoking during pregnancy or with social class. These conclusions are reasonably consistent with those drawn from other studies using alternative measures of asphyxia.
Assuntos
Transtornos Respiratórios/congênito , Pré-Escolar , Feminino , Seguimentos , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Trabalho de Parto , Masculino , Idade Materna , Paridade , Gravidez , Efeitos Tardios da Exposição Pré-Natal , Risco , Fatores Sexuais , Fumar , Classe SocialRESUMO
The recovery of gases used for insufflation at gynaecological laparoscopy was investigated in 163 women who were randomly allocated to receive insufflation with nitrous oxide or carbon dioxide, the two most commonly used gases. No difference was detected and since nitrous oxide has dangerous side effects, the use of carbon dioxide is recommended. Methods of enhancing the recovery of gas were then investigated in a further 207 women, treatment being allocated in a random fashion. No merit was found in the use of these techniques and they have been abandoned.
Assuntos
Dióxido de Carbono , Laparoscopia/métodos , Óxido Nitroso , Feminino , Humanos , Postura , Pressão , Distribuição AleatóriaRESUMO
The 16 989 singleton births in one week of March, 1958, studied by the British Perinatal Mortality Survey, were subjected to an analysis of covariance, which showed that major factors associated with birthweight of the infant were: maternal height, history of smoking in pregnancy, parity and history of pre-eclampsia during the pregnancy. The same analysis was repeated on the data collected on 16792 singletons born 12 years later in one week of April, 1970 and studied by the British Births Survey. In spite of major changes in obstetric practice and in the maternal population, the same factors were shown to be highly significant and the magnitude of the associations had changed little.