The effectiveness and biosafety of diatrizoate contrast media in complicated cholelithiasis.

Adverse reactions after intravascular administration of iodine-based contrast media are well-known. Nevertheless the same type of contrast media is also used for endoscopic retrograde cholangiopancreatography and systemic absorption of contrast media after mentioned procedure routinely occurs, not much is known about effects of widely used diatrizoates (Triombrast) on the hepato-pancreato-biliary system in case of cholelithiasis treatment. AIM: The aim of the present study was to determine the effectiveness and biosafety of diatrizoate contrast media in terms of complicated cholelithiasis healing using conventional and improved surgery treatment protocols based on set of biochemical markers. MATERIALS AND METHODS: The paper presents materials of clinical observation and biochemical analysis of 122 patients have been diagnosed with gallstone disease complicated by choledocholithiasis and cholangitis and biliary pancreatitis. Biochemical liver tests before and after surgery treatment using conventional and improved protocols were determined. RESULTS: Biochemical manifestations of hepatocellular injury included exceeded activity of γ-glutamyltranspeptidase and aminotrasferases as well as level of liver fatty acid-binding protein and bilirubin which were different between groups of patients with cholelithiasis who suffered from concomitant cholangitis and pancreatitis. Proposed management algorithm for patients with gallstone disease with concomitant cholangitis and pancreatitis links to get rid of endoscopic retrograde cholangiography with contrast agent from the conventional surgery treatment protocols because its most obvious downside. CONCLUSIONS: Patients with gallstone diseases revealed significant biochemical changes that should be successfully resolved after surgery treatment without endoscopic retrograde cholangio- pancreatography with contrast media because its hepatotoxic effect.

Efficient, biosafe and tissue adhesive hemostatic cotton gauze with controlled balance of hydrophilicity and hydrophobicity.

Cotton gauze is a widely used topical hemostatic material for bleeding control, but its high blood absorption capacity tends to cause extra blood loss. Therefore, development of rapid hemostatic cotton gauze with less blood loss is of great significance. Here, we develop an efficient hemostatic cotton gauze whose surface is slightly modified with a catechol compound which features a flexible long hydrophobic alkyl chain terminated with a catechol group. Its hemostatic performance in animal injuries is superior to standard cotton gauze and Combat GauzeTM. Its biosafety is similar to cotton gauze and rebleeding hardly occurs when the gauze is removed. Here, we show its hemostatic capability is attributable to the rapid formation of big and thick primary erythrocyte clots, due to its effective controlling of blood movement through blocking effect from tissue adhesion by catechol, blood wicking in cotton, and the hydrophobic effect from long alkyl chains.

Factores que intervienen en la aplicación de medidas de bioseguridad del profesional de enfermería / Factors Associated with the Application of Biosafety Measures Taken by Nursing Professionals

Introducción: Las medidas de bioseguridad son normas preventivas que debe aplicar el personal de salud para evitar el contagio por la exposición de agentes infecciosos que pueden provocar daño. Objetivo: Determinar factores que intervienen en la aplicación de medidas de bioseguridad del profesional de enfermería. Métodos: Estudio cuantitativo, descriptivo de corte transversal. La población fue de 30 profesionales de enfermería que laboran en un Centro Quirúrgico de un Hospital de Lima, específicamente en el Hospital Nacional Dos de Mayo de Lima, Perú, meses de marzo a julio del 2019. La técnica utilizada fue la encuesta y el instrumento, un cuestionario estructurado. Para el cálculo de la confiabilidad estadística la prueba Alpha de Cronbach, juicio de expertos y "r" de Pearson. Resultados: En referencia a los factores que intervienen en la aplicación de las medidas de bioseguridad del profesional de enfermería, 56,70 por ciento presentaron factores desfavorables y 43,30 por ciento, factores favorables. En cuanto a los factores personales, 66,70 por ciento presentaron factores desfavorables y 33,30 por ciento, factores favorables; y con respecto a los factores institucionales, 53,30 por ciento presentaron factores favorables y 46,70 por ciento factores desfavorables. Conclusiones: Los factores desfavorables que intervinieron en la aplicación de las medidas de bioseguridad en el profesional de enfermería fueron la edad adulta joven, sin estudios de especialidad y no tener capacitación en bioseguridad; y los factores favorables, en minoría, fueron contar con oficina de epidemiología, supervisión permanente en la aplicación de medidas de bioseguridad y disponer de ambientes exento de riesgos(AU)

Introduction: Biosafety measures are preventive standards that the health personnel must apply to avoid contagion due to exposure to infectious agents that can cause harm. Objective: To determine factors that intervene in the application of biosafety measures by the nursing professional. Methods: Quantitative, descriptive and cross-sectional study. The study population consisted of 30 nursing professionals who work in a Surgical Center at Dos de Mayo National Hospital in Lima, Peru, from March to July 2019. The technique used was the survey, and the instrument, a structured questionnaire. For the calculation of statistical reliability, Cronbach's alpha test, expert criteria and Pearson's "r" were used. Results: Regarding the factors involved in the application of biosafety measures by the nursing professional, 56.70 percent presented unfavorable factors and 43.30 percent, favorable factors. Regarding personal factors, 66.70 percent presented unfavorable factors, and 33.30 percent, favorable factors; and with regard to institutional factors, 53.30 percent presented favorable factors, and 46.70 percent, unfavorable factors. Conclusions: The unfavorable factors that intervened in the application of biosafety measures by the nursing professional were young adulthood, without specialty studies, and not having training in biosafety. The favorable factors, in a minority, were having an epidemiology office, permanent supervision in the application of biosafety measures, and having risk-free settings(AU)

Neoplasia de próstata en trabajadores expuestos al cadmio y/o sus compuestos: revisión sistemática / Prostatic Neoplasm in Workers Exposed to Cadmium and/or its Compounds: Systematic Review

INTRODUCCIÓN: La neoplasia de próstata es la enfermedad maligna más común de los países desarrollados y la segunda causa de muerte a nivel mundial. Objetivos: Revisar la literatura científica existente sobre la aparición de neoplasias de próstata asociada a la exposición laboral al cadmio y/o sus compuestos. MÉTODOS: Revisión sistemática de la literatura científica recogida en las bases de datos bibliográficas MEDLINE (vía PubMed), The Cochrane Library, Scopus y Web of Science. Los términos utilizados, como descriptores y texto libre en título y resumen, fueron: «Cadmium», «Cadmium Compounds», «Cadmium Radioisotopes», «Cadmium Isotopes», «Cadmium Chloride», «Cadmium Poisoning», «Itai Itai», «Prostatic Neoplasms», «Prostatic Neoplasm», «Prostate Neoplasm», «Prostate Cancer», «Cancer of the Prostate», «Prostatic Cancer», «Cancer of Prostate» y «Occupational Exposure». Se utilizaron los filtros (límites) «humanos» y «adultos» (19+ años). RESULTADOS: Se recuperaron 114 referencias, de las que se pudieron obtener a texto completo 14 artículos tras aplicar los criterios de inclusión y exclusión. En ellos se describe la asociación entre exposición laboral al cadmio y el desarrollo de neoplasia de próstata. CONCLUSIONES: A pesar de obtener unos resultados que evalúan el desarrollo de neoplasia de próstata tras la exposición al cadmio o a sus compuestos, no existe suficiente evidencia que demuestre su efecto carcinogénico en el ámbito laboral, por lo que serían necesarios nuevos estudios que aporten evidencia en relación a este tema

INTRODUCTION: Prostate neoplasm is the most common malignant disease in developing countries and the second cause of death worldwide. OBJECTIVES: To review the existing scientific literature on the appearance of prostate neoplasms associated with occupational exposure to cadmium and/or its compounds. Methods: Systematic review of the scientific literature collected in the MEDLINE bibliographic databases (via PubMed), The Cochrane Library, Scopus and Web of Science. The terms used, as descriptors and free text in title and summary, were: «Cadmium», «Cadmium Compounds», «Cadmium Radioisotopes», «Cadmium Isotopes», «Cadmium Chloride», «Cadmium Poisoning», «Itai Itai», «Prostatic Neoplasms», «Prostatic Neoplasm», «Prostate Neoplasm», «Prostate Cancer», «Cancer of the Prostate», «Prostatic Cancer», «Cancer of Prostate» and «Occupational Exposure». The filters (limits) «humans» and «adults» (19+ years) were considered. RESULTS: 114 references were retrieved, 14 articles of them in full text after applying the inclusion and exclusion criteria, in which the association between occupational exposure to cadmium and the development of prostate neoplasm is explained. CONCLUSIONS: Despite the results obtained that evaluate the development of prostate cancer after exposure to cadmium or its compounds, not enough evidence to demonstrate its carcinogenic effect in the workplace has been found, so new studies that provide evidence in relation to this topic should be carried out

Motivações para mudança nas ações dos profissionais de enfermagem após exposição acidental a material biológico / Motivos para el cambio en las acciones de profesionales de enfermería después de exposición accidental a material biológico / Motivations for changing the actions of nursing professionals after accidental exposure to biological material

Objetivos: identificar motivações para mudança nas ações dos profissionais, após acidente ocupacional e discutir essas mudanças no processo de trabalho na perspectiva da saúde do trabalhador. Método: Estudo descritivo, com abordagem qualitativa, com profissionais de enfermagem com histórico de acidentes de trabalho com exposição a materiais biológicos. Para análise dos dados utilizou-se a análise temático categorial. Resultados: A vivência do acidente de trabalho mostrou-se determinante para modificação de práticas profissionais, motivados por medos relacionados ao risco de infecção pós-exposição; entendimento do risco; orientação recebidas pós acidente; conhecimento quanto ao diagnóstico do paciente. Conclusão: As modificações relatadas pelos profissionais se mostraram repercussões positivas no processo de trabalho, porém, foram motivadas por sentimentos negativos experimentados após o acidente. Ficando clara a necessidade de orientação dos profissionais sobre promoção a saúde e prevenção dos acidentes de trabalho.

Objetivos: identificar motivaciones para el cambio en las acciones de los profesionales, después de accidente ocupacional y discutir estos cambios en el proceso de trabajo en la perspectiva de la salud del trabajador. Método: Estudio descriptivo, con abordaje cualitativo, con profesionales de enfermería con historial de accidentes de trabajo con exposición a materiales biológicos. Para el análisis de los datos se utilizó el análisis temático categorial. Resultados: La vivencia del accidente de trabajo se mostró determinante para la modificación de prácticas profesionales, motivadas por miedos relacionados con el riesgo de infección postexposición; Entendimiento del riesgo; Orientación recibida después del accidente; En el diagnóstico del paciente. Conclusión: Las modificaciones relatadas por los profesionales se mostraron repercusiones positivas en el proceso de trabajo, pero fueron motivadas por sentimientos negativos experimentados después del accidente. En el caso de los profesionales de la salud, la salud y la prevención de accidentes de trabajo.

Objectives: to identify motivations for change in the actions of professionals after occupational accident and to discuss these changes in the work process from a worker’s health perspective. Method: Descriptive study, with a qualitative approach, with nursing professionals with a history of work accidents with exposure to biological materials. For the analysis of the data the categorical thematic analysis was used. Results: The experience of the work-related accident was determinant for the modification of professional practices, motivated by fears related to the risk of post-exposure infection; Understanding of risk; Orientation received after accident; Knowledge of the patient’s diagnosis. Conclusion: The modifications reported by the professionals showed positive repercussions in the work process, however, they were motivated by negative feelings experienced after the accident. The need for professional guidance on health promotion and prevention of occupational accidents is clear.

Fatores associados ao uso de equipamentos de proteção individual por profissionais de saúde acidentados com material biológico no Estado do Maranhão / Factors associated with use of personal protective equipment by healthcare professionals who suffered accidents with biological materials in the State of Maranhão

Contexto: Os profissionais da área de saúde estão expostos ao risco de acidentes de trabalho; por isso, equipamentos de proteção individual (EPIs) atuam como barreira e promovem proteção sempre que haja possibilidade de exposição ao material biológico. Objetivo: Analisar os fatores associados e determinar a frequência de adesão ao uso de EPI por profissionais de saúde que sofreram acidentes ocupacionais com material biológico no Estado do Maranhão. Métodos: Realizou-se um estudo epidemiológico, transversal, tipo analítico baseado em dados secundários do Sistema de Informação de Agravos de Notificação (SINAN) entre os profissionais de saúde acidentados com material biológico no período de 2010 a 2015. Primeiramente, foi realizada a análise não ajustada; na segunda fase, foi adotada a análise ajustada do tipo hierarquizada, tendo como variável resposta a adesão ao uso de EPI. Foram consideradas associadas à variável resposta aquelas que apresentaram p<0,05. Resultados: A frequência de utilização de EPI foi de 41% e, ao final da análise hierarquizada, mantiveram-se associados a não utilização de EPI: ter 12 anos ou menos de estudo; trabalhar na capital/região metropolitana; sofrer exposição percutânea, por sangue, por agulha e por descarte inadequado de perfurocortantes. Conclusão: A frequência de adesão ao uso de EPI foi relativamente baixa entre os profissionais de saúde que sofreram acidentes no Estado do Maranhão. Os profissionais com 12 anos ou menos de estudo, não utilizando EPI e que realizaram descarte inadequado de materiais perfurocortantes podem estar contribuindo para a ocorrência de acidentes ocupacionais nas instituições de saúde.

Background: Health professionals are at high risk for work accidents; within this context, personal protective equipment (PPE) acts as a barrier and affords protection in any situation of potential exposure to biological materials. Objective: To analyze associated factors and determine the frequency of adherence to use of PPE by health professionals who suffered occupational needle stick injuries in the State of Maranhão. Methods: An epidemiological, cross-sectional, analytical study based on secondary data from the Information System on Notifying Diseases (SINAN) was performed with health professionals who suffered needle stick injuries from 2010 to 2015. Unadjusted analysis was performed first, and hierarchical adjusted analysis in a second stage, with adherence to use of PPE as response variable. Only variables with p < 0.05 were considered to exhibit association with the response variable. Results: The frequency of use of PPE was 41%; at the end of hierarchical analysis, not using PPE remained associated with: having 12 or less years schooling; working in the capital/metropolitan region; and percutaneous exposure to blood by means of needles or improper disposal of sharps. Conclusion: The frequency of adherence to PPE was relatively low among health professionals who suffered accidents in the State of Maranhão. Twelve years or less of schooling, not using PPE and improper disposal of sharps might contribute to the occurrence of occupational accidents at health institutions.

Abordaje de la evaluación económica de dispositivos de bioseguridad desde la gestión sanitaria y la perspectiva social / Approach to the economic evaluation of biosafety devices from health-management and social perspective

No disponible

The extent of environmental and body contamination through aerosols by hydro-surgical debridement in the lumbar spine.

INTRODUCTION: Surgical site infections occur in 1-6% of spinal surgeries. Effective treatment includes early diagnosis, parenteral antibiotics and early surgical debridement of the wound surface. MATERIALS AND METHODS: On a human cadaver, we executed a complete hydro-surgery debridement including a full surgical setup such as draping. The irrigation fluid was artificially contaminated with Staphylococcus aureus (ATCC 6538). Surveillance cultures were used to detect environmental and body contamination of the surgical team. RESULTS: For both test setups, environmental contamination was observed in an area of 6 × 8 m. Both test setups caused contamination of all personnel present during the procedure and of the whole operating theatre. However, the concentration of contamination for the surgical staff and the environment was lower when an additional disposable draping device was used. CONCLUSIONS: The study showed that during hydro-surgery debridement, contaminated aerosols spread over the whole surgical room and contaminate the theatre and all personnel.

Evaluación de la percepción de riesgo en el personal de enfermeraí en la atención de pacientes sospechosos de riesgo biológico IV / Evaluation of the perception of risk in the nursing staff in care of patients with suspected biological hazard

Introducción. El personal sanitario es una población especialmente vulnerable a los riesgos derivados del ejercicio de su profesión. La complejidad que tiene la atención de los pacientes con virus Ébola lleva al estudio de la percepción de riesgo de este colectivo. Objetivo. Conocer la percepción de riesgo en el personal de enfermería que atendió a los pacientes con sospecha de Fiebre Hemorrágica Virus Ébola (FHVE). Material y métodos. Estudio transversal realizado en el Hospital Clínic de Barcelona. Se incluyeron 19 profesionales de enfermería que atendieron directamente a pacientes con sospecha de FHVE. Los datos se recogieron mediante un cuestionario de evaluación dimensional del riesgo percibido junto a variables sociodemográficas y un posterior análisis estadístico. Resultados. Un 68 % del personal de enfermería refirió tener un nivel de conocimiento elevado del riesgo asociado al factor de estudio. Un 42 % determinó que había una posibilidad muy alta de experimentar un daño. Un 63 % apreció que las consecuencias más nocivas se experimentarían a corto plazo y, finalmente, un 48 % valoró que había un riesgo muy alto de accidente o enfermedad asociado al factor de estudio, frente a un 5 % que lo valoró muy bajo. Conclusiones. Las respuestas obtenidas ponían de manifiesto que los profesionales de enfermería poseían un nivel de conocimiento muy alto sobre el riesgo asociado al factor de estudio, y que el temor emocional era también muy elevado (AU)

Introduction. Healthcare personnel is especially vulnerable to the risks derived from their job. The complexity that has the care of patients with Ebola justifies the study of the perception of risk of such professionals. Objective. To know the perception of risk in the nursing staff that takes care of patients suspected of suffering the Ebola virus. Material and methods. Transversal study carried out in the Hospital Clínic of Barcelona. 19 professionals of nursing staff that attended suspected Ebola patients were included in the study. The data was collected through a questionnaire of dimensional evaluation of the perceived risk along with sociodemographic variables and a subsequent statistics analysis. Results. A percentage of 68 % of the nursing staff refereed having a high level of knowledge of the risk associated with the factor of this study. A percentage of 42 % determined that there was a very high possibility of being harmed. A percentage of 63 % considered that the most harmful consequences would appear in short term, and finally a percentage of 48 % considered that there was a very high risk of accident or illness associated to the factor of this study, whereas a percentage of 5 % considered the risk to be very low. Conclusions. The answers obtained showed not only that nursing staff had a very high level of knowledge regarding the risk associated to the factor of this study, but also that the emotional fear was very high (AU)

Acidente de trabalho com material perfurocortante envolvendo profissionais e estudantes da área da saúde em hospital de referência / Work-related accident with material-cutting drill involving students and health professionals in hospital reference

Contexto: Acidente de trabalho por instrumento perfurocortante é considerado extremamente perigoso por ser capaz de transmitir patógenos e expor às várias doenças. Os profissionais da saúde realizam atividades que exigem aproximação física com o paciente, manipulam instrumentos capazes de provocar esse tipo de acidente, implicando em consequências e afetando-os diretamente nos aspectos físico e psicológico e, eventualmente, repercutindo nas relações familiares e sociais. Objetivo: Identificar o perfil dos profissionais envolvidos em acidentes com instrumentos perfurocortantes em hospital referência no interior do Tocantins Método: Estudo retrospectivo com coleta de dados no Serviço de Vigilância Epidemiológico do hospital, a partir do início de notificação obrigatória de janeiro de 2009 a janeiro de 2011. Resultado: Dentre 114 vítimas notificadas, 34 (30%) eram homens e 80 (70%) mulheres, com média de idade de 31,7 anos (21±57). Quanto ao grau de escolaridade, 58 (50,8%) tinham o 2° grau completo; os técnicos de enfermagem foram os mais acometidos (n=56; 49%). Em relação ao material orgânico, o sangue foi o mais prevalente (77%). Os acidentes ocorreram principalmente durante procedimento cirúrgico (n=40; 35%) e a agulha com lúmen foi o principal agente (54,4%). Setenta e oito por cento dos profissionais não usavam equipamentos de proteção individual (EPI). Conclusão: O número de agravos reafirma que as estratégias de prevenção de acidentes com material perfurocortante ainda são incipientes. Inserir segurança do trabalho com disciplina na grade curricular das diversas especialidades na área da saúde pode contribuir para a redução dos agravos.

Context: Accident at work by perforating cutting instrument is considered extremely dangerous since it is able to transmit pathogens and expose to various diseases. Health professionals perform activities that require physical proximity to the patient, manipulate instruments capable of causing this type of accident, resulting in consequences and directly affecting them in physical and psychological aspects and, eventually, impacting on family and social relationships. Objective: To identify the profile of the professionals involved in accidents with perforating cutting instruments in reference hospital in the countryside of the Brazilian state of Tocantins. Methods: Retrospective study with data collection at the Department of Epidemiological Surveillance of the hospital, from the beginning of the mandatory notification from January 2009 to January 2011. Results: Among 114 reported victims, 34 (30%) were men and 80 (70%) women with a mean age of 31.7 years (21±57). As the level of education, 58 (50.8%) had high schools diplomas; nursing staff were the most affected (n=56; 49%). Regarding the organic material, blood was most prevalent (77%). Accidents occurred mainly during surgery (n=40; 35%) and the needle with lumen was the primary agent (54.4%). Seventy eight percent of professionals did not use personal protective equipment. Conclusion: The number of injuries reaffirms that the accident prevention strategies with perforating cutting materials are still incipient. Enter security of working with discipline in the curriculum of various specialties in health can contribute to the reduction of injuries.

Short-term effects of airborne ragweed pollen on clinical symptoms of hay fever in a panel of 30 patients

Objectives: Ragweed, Ambrosia artemisiifolia , is a highly allergenic annual herbaceous plant that is spreading quickly across the globe. Few studies have investigated the relationship between ragweed pollen counts and hay fever symptoms. We investigate the dose-response relationship between ragweed exposure in patients sensitized to ragweed and daily hay fever symptoms. Method: A panel study was conducted among 31 adult patients sensitized to A artemisiifolia in France and Switzerland. Rhinitis, conjunctivitis, and bronchial symptoms were recorded daily, as well as daily pollen counts of ragweed, air pollutants, and meteorological data over 2 successive years. Data were analyzed with generalized estimating equation models to quantify effects of ragweed pollen whilst controlling for confounders. Results: The relationship between ragweed pollen and the percentage of patients with nasal, ocular, and bronchial symptoms was linear. For every increase of 10 grains/m 3 , the odds ratio (OR) (95% confidence interval) for nasal symptoms was, in 2009, 1.18 [1.04-1.35] on weekdays and 1.43 [1.16-1.75] at weekends, and in 2010, 1.04 [1.00-1.07] on weekdays and 1.25 [1.06-1.46] at weekends. The OR for ocular symptoms was 1.32 [1.16-1.56] in 2009 and 1.05 [1.02-1.07] in 2010. Finally, the OR for bronchial symptoms was 1.14 [1.03- 1.25] in 2009 and 1.03 [0.97-1.08] in 2010. Conclusion: There is a statistically significant linear relationship between ragweed pollen counts and hay fever symptoms. Our study shows that nasal symptoms differ on weekdays and at weekends (AU)

Objetivos: La Ambrosia artemisiifolia es una planta herbácea, altamente alergénica, que tiende a extenderse mundialmente muy rápidamente. Muy pocos estudios han investigado la relación de los contajes de polen de ambrosia con la intensidad de los síntomas. En este trabajo hemos documentado la relación dosis/respuesta entre la exposición a ambrosia, en pacientes sensibilizados a este polen, y la intensidad de su sintomatología Métodos: En el estudio se incluyeron 31 pacientes residentes en Francia o Suiza y sensibilizados a Ambrosia artemisiifolia . Durante dos años consecutivos, se registraron diariamente los síntomas oculares, nasales y bronquiales de los pacientes, los niveles de polen de ambrosía, los niveles de contaminantes ambientales junto con los datos. El análisis de los datos se realizó mediante la construcción de modelos de ecuaciones de estimación generalizada, de forma que se pudiera cuantificar los efectos del polen de ambrosia y controlando las variables de confusión. Resultados: La relación entre los recuentos de polen de ambrosía y el porcentaje de pacientes con síntomas nasales, oculares y bronquiales fue linear. Para cada incremento de 10 granos/m 3 , el OR para los síntomas nasales, en el año 2009, fue 1.18 [1.04-1.35] durante los días entre semana, y 1.43 [1.16-1.75] durante el fin de semana, y en 2010, 1.04 [1.00-1.07] durante los días entre semana y 1.25 [1.06-1.46] durante el fin de semana; el OR para los síntomas oculares fue de 1.32 [1.16-1.56] en el 2009 y 1.05 [1.02-1.07] en el 2010; el OR para los síntomas bronquiales fue 1.14 [1.03-1.25] en 2009 y 1.03 [0.97-1.08] en 2010. Conclusión: Hemos demostrado una relación lineal significativa entre los recuentos de polen de ambrosía y los síntomas de la polinosis en los pacientes sensibilizados. Nuestro estudio también demostró que el nivel de molestias difiere entre los días entre semana comparados con los del fin de semana (AU)

Exposure-dose-response of Tellina deltoidalis to metal-contaminated estuarine sediments: 1. Cadmium spiked sediments.

Cadmium is a ubiquitous environmental metal contaminant with an affinity for biological membranes; it can enter cells by facilitated transport and it binds therein to various biomolecules and affects membrane system function. The relationship between cadmium exposure, dose and response was investigated in the benthic, deposit feeding, marine bivalve Tellina deltoidalis, using 28 day microcosm spiked cadmium exposures. Tissue cadmium reached steady state with the exposure concentration. Half the accumulated cadmium was detoxified and with increased exposure more was converted into metal rich granules. Most biologically active cadmium was in the mitochondrial fraction, with up to 7320-fold cadmium increases in exposed organisms. Cadmium exposed T. deltoidalis generally had reduced glutathione peroxidase enzyme activity. An increase in total glutathione concentrations, due to a build up of oxidised glutathione, was indicated by the reduced to oxidised glutathione ratio. All cadmium exposed T. deltoidalis had reduced total antioxidant capacity that corresponded with increased lipid peroxidation, lysosomal destabilisation and micronuclei frequency. Clear exposure-dose-response relationships have been demonstrated for T. deltoidalis exposed to cadmium-spiked sediments, supporting this organism's suitability for laboratory or in situ evaluation of sediment cadmium toxicity.

Frecuencia de accidentes en la práctica odontológica y conductas frente a la exposición a productos biológicos potencialmente infecciosos / Frequency of accidents in dental practice and behavior from exposure to potentially infectious biological products

El odontólogo, como profesional de la salud, en su ambiente laboral se ve expuesto a sufrir accidentes y enfermedades debido a que están en contacto con sangre y fluídos orgánicos potencialmente infecciosos. Ante la concurrencia de un accidente en la práctica odontológica es fundamental conocer los procedimientos adecuados para prevenir diferentes enfermedades transmitidas por los agentes patógenos contenidos en los materiales biológicos. El objetivo del estudio fue determinar la frecuencia de accidentes laborales y la conducta adoptada una vez ocurrido el accidente en odontólogos egresados en el Paraguay. Fue aplicado un cuestionario de 18 preguntas a 180 profesionales. El 67,8% afirmó haber sufrido algún tipo de accidente, de los cuales el tipo percutáneo fue el más frecuente (92,6%), seguido por salpicadura de fluídos o sangre en la mucosa ocular. En el momento del accidente el 84% sabía cómo actuar; la conducta adoptada con mayor frecuencia (76,2%) fue el lavado con abundante agua o suero seguido de la desinfección con antiséptico de la zona afectada (72,1%). El 37,7% recibió asistencia médica luego del accidente. Con la metodología aplicada se concluye que existe una alta ocurrencia de accidentes ocupacional en odontólogos y que diversas son las conductas adoptadas por los mismos, la cual no siempre son las correctas; refleja la necesidad de informar y concienciar acerca de dichos eventos por las potenciales consecuencias que suelen tener.

Estudiantes de enfermería. Prevención de riesgos biológicos / Updated review on the prevention of biological hazards in the nursing students

Si la realización de las prácticas es algo importante en todas las titulaciones, en Enfermería resulta fundamental y tiene un gran impacto educativo. Durante este período los alumnos, además de poner en práctica los conocimientos teóricos, toman contacto con la realidad, donde se exponen a una serie de peligros inherentes a dicha profesión. A este hecho hay que añadir varios factores que agravan la situación: la inexperiencia como profesionales, la aparición de cierto grado de estrés provocado por las situaciones variables y de incertidumbre que los rodean, y la no contemplación de este colectivo por parte de la Ley de Prevención de Riesgos Laborales. Todo ello hace al alumnado más vulnerable frente a los riesgos(AU)

If the carrying out a practices is something extremely important in all degree studies, in the case of nursing this is something even more fundamental and of great educational impact. During that period, students not only put their knowledge and theory into practice, they get in touch with reality and they also expose themselves to a series of risks inherent to our profession. In addition to that, one has to take into account the appearance of various factors that aggravate their susceptibility; their inexperience as professionals, their exposure to some degree of stress due to the variable conditions and uncertainties in their environment, the lack of coverage under the PRL law, makes this group more vulnerable to the risks(AU)

Resultados de un programa de prevención de exposiciones accidentales a fluidos biológicos en personal sanitario basado en la mejora del grado de cumplimiento de las precauciones estándar / Results of a program of prevention of accidental exposure to biological fluids in healthcare workers based on the improvement of the compliance of Standard Precautions

Objetivo: Evaluar un programa de prevención de exposiciones accidentales a fluidos biológicos basado en la mejora del grado de cumplimiento (GC) de las Precauciones Estándar (PE). Material y métodos: Intervenciones: primera (realización sesiones de actualización y reparto de trípticos informativos), y segunda (reparto de trípticos). Indicadores: Nivel de Conocimientos (NC), medido con un cuestionario de cinco preguntas, se consideró inadecuado cuando se fallaban tres o más preguntas; GC de PE medido en cuatro áreas (Higiene Manos -HM-, utilización de guantes -UG-, utilización adecuada métodos barrera -UAMB- y manejo adecuado objetos cortantes -MAOC-; Incidencia de inoculaciones y de exposiciones de mucosas a fluidos corporales. Resultados. La frecuencia de cuestionarios inadecuados paso del 54,6% al 23,3%(<0.001). La frecuencia HM pasó del 53,5% al 58,2%(<0,01), la UG del 78,7% al 84,6%(0,058), el UAMB del 53,8% al 55.5%(N.S.) y el MAOC del 52,9% al 54,0%(N.S.). La Incidencia inoculaciones paso del 5,53% al 4,98%(N.S.) y las exposiciones de mucosas del 0,95% al 0,81%(N.S.). Conclusiones: El programa ha mejorado los conocimientos del personal sobre PE, y el GC de PE y ha disminuido la incidencia exposiciones accidentales a fluidos biológicos aunque no de manera estadísticamente significativa (AU)

Introduction: The aim is to evaluate a program of prevention of accidental exposure to biological fluids based on the improvement of the compliance to Standard Precautions (SP). Methods: Interventions: first (update sessions and distributing pamphlets), and second (distributing pamphlets). Indicators: Level of knowledge (LK), measured with a 5-item questionnaire, with three or more incorrect answers considered inadequate; Compliance to SP measured in four areas (Hand Hygiene Hands -HH-, utilization of gloves - GU-, suitable utilization methods barrier - SUMB - and suitable managing cutting objects - SMCO-; Incident of percutaneus injuries and of exposure of mucous to corporal fluids. Results: The frequency of inadequate questionnaires I happen from 54,6 % to 23,3 % (<0.001). The frequency HH happened from 53,5 % to 58,2 % (<0,01), the GU of 78,7 % to 84,6 % (0,058), the SUMB of 53,8 % to 55.5 % (N.S.) and the SMCO of 52,9 % to 54,0 % (N.S.). The Incident percutaneus injuries from 5,53 % to 4,98 % (N.S.) and the exposure of mucous from 0,95 % to 0,81 % (N.S.). Conclusion: The program has improved in the knowledge of the personnel on SP, and has improved SP compliance and the Incident has diminished accidental exhibitions to biological fluids though not in a statistically significant way (AU)

Estado da arte da brucelose em humanos / The current state of brucellosis in humans

A brucelose, doença infecto-contagiosa causada por bactérias do gênero Brucella, tem chamado a atenção dos sistemas de saúde em todo o mundo por provocar enfermidades de caráter ocupacional e por ser considerada pela Organização Mundial da Saúde como doença emergente e agente potencial para bioterrorismo. O Brasil ainda não possui uma rede estruturada na saúde pública para diagnóstico da brucelose em humanos. O presente trabalho objetiva realizar uma atualização sobre os principais aspectos que envolvem esta doença. Para este fim, uma revisão bibliográfica sistematizada foi realizada. Foram revisados aspectos etiológicos, clínicos, epidemiológicos e diagnósticos, dentre outros, com o intuito de atualizar os profissionais e pesquisadores da área. Encontraram-se 31 artigos, dos quais 28 foram utilizados. Constata-se, pela revisão, que muitos dos aspectos da patogenia, profilaxia, diagnóstico e terapia da doença ainda não estão completamente compreendidos, porém progresso substancial tem sido alcançado no entendimento da base molecular da genética da Brucella e da patogênese da infecção. Conclui-se afirmando a importância da padronização diagnóstica da doença, pois é com base nos dados fornecidos pelo diagnóstico que se poderá instituir medidas de vigilância.

Brucellosis, an infectious disease caused by bacteria of the genus Brucella, has drawn the attention of healthcare providers worldwide because it causes occupational diseases and is regarded as an emerging disease and a potential agent for bioterrorism by the World Health Organization. Brazil does not have a structured public health network for brucellosis diagnosis in humans. This work aims to provide an update on its main aspects of this disease. A systematic literature review was conducted for this purpose. Etiological, clinical, epidemiological and diagnostic aspects were reviewed, among others, in order to update professionals and researchers in the field. A total of 31 articles were found, of which 28 were used. This review shows that many aspects of pathogenesis, prevention, diagnosis and therapy of the disease are not yet fully understood, but substantial progress has been made in understanding the molecular basis of Brucella genetics and the pathogenesis of infection. We conclude by stating the importance of standardizing the diagnostic procedures of the disease because surveillance measures are imposed based on data provided by these diagnoses.

El humo quirúrgico: riesgos y medidas preventivas / Surgical smoke: risks and preventive measures

La aplicación de las tecnologías avanzadas a la medicina ha supuesto el incremento de algunos factores de riesgo en el personal sanitario. Uno de ellos podría ser el humo quirúrgico producido por instrumentos electroquirúrgicos, ultrasonidos o láser. La voz de alarma acerca de un posible perjuicio para la salud de los trabajadores de quirófano se basa fundamentalmente en los componentes detectados hasta la fecha y los experimentos realizados en el laboratorio. No obstante, hay que tener precaución al extrapolar los resultados de los estudios in vitro a la práctica clínica diaria y, hasta la fecha, no hay evidencias suficientes del efecto perjudicial de la exposición crónica a éste en los estudios poblacionales publicados. Los organismos responsables de velar por la salud de los trabajadores en distintos países no han emitido todavía normas para el tratamiento y la evacuación del humo quirúrgico generado en intervenciones tanto por laparotomía como por laparoscopia. En este artículo pretendemos ofrecer una visión de las consecuencias que el humo quirúrgico tiene para la salud y las medidas preventivas que se pueden adoptar (AU)

The application of the advanced technologies in medicine has led to the appearance of new risk factors for health personnel. One of these could be the surgical smoke produced by electrosurgical instruments, ultrasounds or laser. However, there is still insufficient evidence in the published population studies on the detrimental effects of chronic exposure to surgical smoke. The main concern on the possible damage to the health of operating room staff is mainly based on the components currently detected until the date and laboratory experiments. Caution must also be used when extrapolating the results of in vitro studies to daily clinical practice. The organisations responsible for protecting the health of the workers in different countries have still not issued guidelines for the treatment and removal of the surgical smoke generated in both open and laparoscopic procedures. In this article we try to present a view of the consequences that surgical smoke has on health and the preventive measures that can be adopted (AU)

Evaluación higiénica de riesgos biológicos del trabajo en estabulario de un centro de investigación sanitaria / Biological risk assessment in animal facilities ofa sanitary investigation centre

Objetivo: El propósito del presente trabajo es evaluar los riesgos biológicos a los que están expuestos los trabajadores del estabulario de la Unidad de Investigación Sanitaria con el fin de determinar la necesidad de adoptar medidas preventivas que permitan controlar el riesgo, determinar dichas medidas y conocer la aplicabilidad de la metodología elegida en el caso específico del trabajo con animales. Metodología: Se utilizó la metodología de evaluación BIOGAVAL propuesta por el Gabinete de Seguridad e Higiene en el Trabajo de Valencia para la evaluación del riesgo biológico existente en los puestos de técnico de animalario y veterinario. El método seleccionado requiere, para la determinación del nivel de riesgo, la identificación de los microorganismos involucrados, el daño a la salud, las vías de transmisión, la posibilidad de vacunación y el porcentaje de personal vacunado o las medidas higiénicas existentes en el momento de llevar a cabo la evaluación. Resultados: Los resultados de la evaluación de los puestos de trabajo indican la necesidad de medidas preventivas, en especial encaminadas al control de Leptospira y Brucella. Una vez adoptadas las medidas de prevención se observa que el nivel de riesgo de todos los agentes se sitúa en valores inferiores a los límites de exposición biológica establecidos por el método. Se constata la falta de datos determinantes para la valoración numérica del riesgo relativo a algunos agentes identificados. Se considera que los niveles de riesgo emanados del método pueden ser superiores a los reales al no contabilizarse en el "Formulario de medidas higiénicas adoptadas" aquellas medidas realizadas sobre los propios animales. Conclusiones: La metodología de evaluación prueba ser un método ágil, ordenado y relativamente sencillo para la determinación del riesgo biológico al que están expuestos los trabajadores. El método de evaluación BIOGAVAL supone una herramienta muy práctica a la hora de sistematizar evaluaciones de elevada complejidad dada por su característica de indeterminación de presencia de los agentes biológicos, si bien su aplicación se ve drásticamente mermada debido a la ausencia de datos estadísticos fiables sobre variables determinantes como duración de incapacidades temporales o tasas de incidencias para muchos agentes biológicos. El método proporciona orientación sobre el tipo de medidas preventivas a adoptar. Por otro lado, se propone una ampliación en el "Formulario de Medidas Higiénicas Adoptadas" con la intención de recoger el hecho característico del trabajo con animales

Aims: The purpose of this study is to assess the biological risks to which workers in the animal facilities of the Health Research Unit are exposed in order to determine the need for preventive measures to control risk, determine those measures and test methodology chosen in the specific case of working with animals. Methods: BIOGAVAL evaluation methodology proposed by Office of Security and Hygiene in the Work of Valencia was used to evaluate the technician and veterinarian biological risks. The chosen methodology needs, for the determination of the risk level, identification of the involved microorganisms, damage to the health, routes of transmission, possibility of vaccination and percentage of vaccinated personnel and the hygienic existing measures in the moment to carry out the evaluation. Results: The results show the need of preventive measures, especially directed to the control of Leptospira and Brucella. Once adopted the measures, the risk level for all agents places in values lower than the level established by the method. It is stated the lack of determinant information for the numerical risk evaluation relative to some identified agents. The levels of risk came from the method could be superior to the real ones as in the «Form of hygienic adopted measures» there are not considered those measures realized on the proper animals. Conclusions: The methodology of evaluation proves to be an agile, orderly and relatively simple method for the determination of the biological risk to which the workers are exposed. The method of evaluation BIOGAVAL is a practical tool as systematized evaluations of high complexity, due to its characteristic uncertainty on the presence of the biological agents, though its application results drastically reduced due to the absence of statistical trustworthy information on determinant variables as duration of temporary disabilities or rates of incidents for some biological agents. The method provides orientation on the type of preventive measures to adopt. It is proposed an extension in the «Form of Hygienic Adopted Measures» to take into account the fact of the working with animals

The effect of microbiological containment systems on dexterity.

Microbiology laboratories use containment equipment such as safety cabinets and isolators or respiratory protective equipment to protect workers against aerosol infection hazards. There is a perception among microbiologists that the use of containment equipment reduces dexterity to a point where the risks associated with using sharps are increased. Thus, in a situation where it is essential to use sharps, the use of respiratory protection is frequently the favored method of operator protection. Using three methods of manual dexterity testing, the effect of latex gloves, a positive pressure respirator, and three forms of containment equipment, (a Class II safety cabinet, a half suit, and a flexible film isolator) were tested against performance in these tests using bare hands in 10 subjects. The study was extended to additionally assess Class III cabinets using 20 subjects. With the exception of latex gloves, the personal protective equipment and containment equipment all had a statistically significant detrimental effect on manual dexterity compared with working solely with bare hands. The use of containment systems, especially barrier containment systems such as Class III cabinets and isolators, significantly reduces dexterity and may increase the chance of accidents. The use of positive pressure respirators with double gloves also affects dexterity but to a lesser extent. The use of sharps should be minimized within containment equipment. Risk assessment may be required to address the comparative risk of aerosol and needlestick infection with different agents to choose the most appropriate containment systems.