Hemodialysis vascular access in elderly patients: A comprehensive review.

The number of elderly patients initiating hemodialysis (HD) increased considerably over the past decade. Arteriovenous fistulas (AVFs) are the preferred vascular access (VA) type in most HD patients. Choice of VA for older hemodialysis patients presents a challenge. The higher incidence of comorbidities, longer AVF maturation times, risk of primary failure, risk of patency loss, and shorter life expectancy are important factors to consider. In this review we provide a comprehensive analysis on maturation rates, primary failure, patency, and mortality regarding vascular access in patients older than 75 years of age.

Chemical profiling of Cannabis varieties cultivated for medical purposes in southeastern Brazil.

Cannabis cultivation for medical purposes in Brazil has been increased in the last years. While cannabis crops are prohibited, hundreds patients have been granted with judicial authorizations and there is little information about the cultivation conditions, yields and chemical profiles of the plants. Cannabis plants contain hundreds of compounds, with cannabinoids and terpenes the main drivers of their toxicological and pharmacological properties. Besides the cannabinoids, terpene contents are useful for the chemotaxonomic classification of different varieties, and their role in forensic analyses should be further delineated. The present study monitored cannabis crops of fifteen participants who were granted special licenses by the Brazilian Courts in Rio de Janeiro and São Paulo. The cultivation conditions were monitored and five cannabinoids (tetrahydrocannabinol acid-THCA, tetrahydrocannabinol-THC, cannabidiolic acid-CBDA, cannabidiol-CBD and cannabinol-CBN) and nineteen terpenes were quantified in cannabis flowers. The total grow cycle of thirty-five cannabis plants ranged from 10 to 24 weeks. The dry flower yields ranged 22-90 g per plant. Most cannabis specimens were CBD-rich varieties (CBD levels from 1.6% to 16.7%, and THC levels from 0.0% to 2.6%, n = 22) used to treat epileptic patients. The THC-rich varieties contained CBD levels ranging from 0.03% to 0.8%, and THC levels from 0.7% to 20.1%, n = 11. Fewer of the samples contained THC:CBD ratios of approximately 1:1 (CBD levels of 3.3-3.8% and THC levels of 2.2-3.7%, n = 2). The most abundant terpenes in the cannabis flowers were beta-caryophyllene, alpha-humulene, guaiol and alpha-bisabolol. CBD-rich varieties showed significant higher levels of beta-caryophyllene and alpha-humulene in comparison with THC-rich varieties. Overall, the study herein provides data concerning medical cannabis crops grown in a region of Brazil that not only guide individual medical cannabis cultivation methods but also aid forensic analyses.

Inorganic element profile of medicinal Cannabis extracts consumed by pediatric patients

Abstract The increasing number of reports of web-based experiences on the success of Cannabis-based therapies in controlling seizures in children suffering from refractory epilepsy have led to efforts by governments and associations to a recent change in legislation. The Brazilian Health Regulatory Agency (ANVISA) allowed the import of Cannabis extracts in 2015 and the registration of the first industrialized drug in 2017. In 2019, ANVISA approved procedures for the granting of a Sanitary Authorization for manufacturing and imports, establishing marketing requirements, prescribing, dispensing, monitoring and surveillance of cannabis products for medicinal purposes. Similar to other consumer products of health concern, is necessary to ensure the quality and health safety of these products worldwide. The aim of the present study to evaluate the presence of As, Cd, Pb, Ni, Cu, Co, Cr and Mn present in Cannabis extracts and resins used in the treatment of pediatric patients with neurological diseases. Samples (48 national and 24 imported) were analyzed by Inductively Coupled Plasma Mass Spectrometry - ICP-MS. The imported extracts presented more homogeneous inorganic element values, while national extracts showed varied levels, thus indicating the highest health risk.

Renal transplantation in Birt-Hogg-Dubé syndrome: should we?

BACKGROUND: Birt-Hogg-Dubé (BHD) Syndrome is a rare genodermatosis caused by a mutation on folliculin gene, with a strong link to renal cancer. To date few patients with such condition have reached dialysis stage, as nephron-sparing surgery is usually possible at the time of diagnosis. To our best knowledge no patient with BHD syndrome has been submitted to renal transplantation. CASE PRESENTATION: We report the case of a woman diagnosed with multifocal bilateral renal cell carcinoma that underwent bilateral radical nephrectomy and was started on a regular hemodialysis program at the age of 29. While on hemodialysis program she was diagnosed clinically with BHD syndrome and molecular testing confirmed an heterozygous mutation on FLCN gene. The patient has been kept on surveillance program for 2 years with no clinical complications from the genetic syndrome and in complete remission from renal cancer. Though there has not been any report of a patient with BHD being transplanted, risks and benefits for this patient were weighted. She has been considered apt by the transplant team and is currently waitlisted for cadaveric renal transplantation. DISCUSSION: It is a matter of discussion which should be cancer-free period for anephric patients with an inherited cancer syndrome to be candidates for renal transplant. So far BHD syndrome has not been causally associated with any other neoplastic disorder elsewhere. Accepting cancer biology is very complex and knowledge of the behaviour of this genetic syndrome is limited to a few cases reported worldwide, the authors believe that renal transplantation is the best treatment option for this young patient. The choice of post transplantation immunosuppression is debatable, but considering experience in other inherited cancer syndromes a maintenance scheme with mTOR inhibitor will be favoured.

Occupational exposure to airborne lead in Brazilian police officers.

Shooting with lead-containing ammunition in indoor firing ranges is a known source of lead exposure in adults. Police officers may be at risk of lead intoxication when regular training shooting exercises are yearly mandatory to law enforcement officers. Effects on health must be documented, even when low-level elemental (inorganic) lead exposure is detected. Forty police officers (nineteen cadets and twenty-one instructors) responded to a questionnaire about health, shooting habits, and potential lead exposure before a training curse. Blood samples were collected and analyzed for blood lead level (BLL) before and after a three days training curse. The mean BLL for the instructors' group was 5.5 µg/dL ± 0.6. The mean BLL for the cadets' group before the training was 3.3 µg/dL ± 0.15 and after the training the main BLL was 18.2 µg/d L± 1.5. Samples were analyzed by Inductively Coupled Plasma Mass Spectrometer (ICP-MS). All the participants in the training curse had significantly increased BLL (mean increment about 15 µg/dL) after the three days indoor shooting season. In conclusion, occupational lead exposure in indoor firing ranges is a source of lead exposure in Brazilian police officers, and appears to be a health risk, especially when heavy weapons with lead-containing ammunition are used in indoor environments during the firing training seasons.

Health-seeking patterns among fatally ill Capeverdian women.

The circumstances of 94 deaths among females aged 15-49 years in Cape Verde were investigated to assess their access to effective care. Persons associated with the deceased women were interviewed (verbal autopsy) to explore contributing causes of death, perceived illnesses and treatment efforts. The certainty of diagnosis and avoidability of the fatal outcome were assessed by a panel ofexperts. A model of health care accessibility is elaborated to identity restricting (delay) factors. Deliberate avoidance of modern medical care and reliance on traditional medicine were major delay factors, while unawareness of the severity of symptoms and affordability limits were minor delay factors in this population. A detailed sorting of cases by health care level is used to identify the effectiveness of diagnosing, referral and care provided. Since a high proportion of avoidable deaths occurred in hospital, the quality of care may have been sub-optimal.

Escorregamento epifisário proximal do fêmur: tratamento mediante fixação "in situ" com um único parafuso canulado / Slipped capital femoral epiphysis

No Departamento de Ortopedia e Traumatologia da Santa Casa de Misericórdia de São Paulo - Pavilhão "Fernandinho Simonsen", no período de 1989 a 1999, foram tratados 218 pacientes, portadores do escorregamento epifisário proximal do fêmur, mediante a fixação in situ com um único parafuso canulado. Desse total, foram selecionados ao acaso os prontuários de 40 pacientes, sendo 20 de cada sexo. No momento do diagnóstico, a média de idade dos pacientes do sexo masculino foi de 12,7 anos, enquanto que nos do feminino foi de 11,9 anos. O fechamento da placa epifisária (epifisiodese) proximal do fêmur foi obtido em todos os casos e com tempo médio de 14,05 meses após a fixação. O objetivo do presente estudo é a análise epidemiológica e radiográfica retrospectiva nesta amostragem de 40 pacientes assim tratados, bem como suas complicações, avaliadas exclusivamente do ponto de vista radiográfico.

Conocimiento, creencias y actitudes del VIH/SIDA: estudio en población abierta / Knowledge, beliefs and attitudes of the HIV/BEEN: study in open population

Se realizo un estudio sobre conocimientos, actitudes y creencias sobre el vih/sida. El muestreo utilizado fue aleatorio. Se aplicaron encuestas de forma individual y con carácter anónimo.Se obtuvieron 14 conclusiones entre las que se destaca que la población estudiada conoce que la principal vía de transmisión son las relaciones sexuales con riesgo

Vigilancia de la rabia en murciélagos en la prov. Ciego de Avila

Se analiza la investigación de rabia en muerciélagos en la provicia de Ciego de Avila, Cuba, en el período de 1987 a 1992. Se estudiaron 2987 muestras por el laboratorio nacional de referencia de la República de Cuba, realizándose a cada caso las técnicas de coloración en busca de los corpúsculos de negri, anticuerpos fluorescentes y prueba biológica. Se confirmaron 3 casos en la etapa para el 0.1 porciento de positividad. Se describen los tres casos notificados en murciélagos. (AU)

Análisis de la letalidad por leptospirosis en la provincia Ciego de Avila, Cuba 1980-1992

Se realiza un estudio de la letalidad por letospirosis en la provincia de Ciego de Avila de 1980 a 1992. En la etapa se notifican 8 fallecidos, lo que representa una baja letalidad; se analiza el perfeccionamiento ocurrido con la vigilancia epidemiológica de la enfermedad, ya que a partir de 1983 el 83 por ciento de los fallecidos se les planteó como diagnóstico presuntivo la identidad. Todas las defunciones se presentaron en casos ictéricos. Los síntomas y signos más frecuentes fueron fiebre, ictericia, hepatomegalia y disuria. Al 50 por ciento de los casos se les realizó el diagnóstico en fase de leptospiruria y al otro 50 por ciento en la leptospiremia. 5 de los 8 fallecidos eran mayores de 50 años

Efectividad de la educación para la salud en la vigilancia de la rabia en mangos / taEffectiveness of health education in thsurveillance of rabies in angooses

Se instrumenta un programa de educación sanitaria sobre el papel de la mangosta como reservorio de rabia a partir de 1983, en la provincia Ciego de Avila. En el presente estudio se compara el número de muestras enviadas de mangostas, y los casos positivos de rabia en los períodos de 1977 a 1982 y de 1983 a 1988. En el primer período Ciego de Avila sólo estudió el 2,5

del total de muestras del país, mientras que en el segundo investigó el 30,8

del total de la república, lo que demuestra la efectividad del programa educativo ejecutado. La totalidad de rabia en mangosta varió del 1,8

del total al 47

. Se analizan las muestras investigadas de otras especies en la provincia Ciego de Avila, y los casos positivos de rabia

Efectividad de la educación para la salud en la vigilancia de la rabia en mangosta / Effectiveness of health education in the surveillance of rabies in mangooses

Se instrumenta un programa de educación sanitaria sobre el papel de la mangosta como reservorio de rabia a partir de 1983, en la provincia Ciego de Avila. En el presente estudio se compara el número de muestras enviadas de mangostas, y los casos positivos de rabia en los períodos de 1977 a 1982 y de 1983 a 1988. En el primer período Ciego de Avila sólo estudió el 2,5 %del total de muestras del país, mientras que en el segundo investigó el 30,8 %del total de la república, lo que demuestra la efectividad del programa educativo ejecutado. La totalidad de rabia en mangosta varió del 1,8 %del total al 47 %. Se analizan las muestras investigadas de otras especies en la provincia Ciego de Avila, y los casos positivos de rabia

Características del hábito de fumar entre profesionales y técnicos de la salud de la provincia Ciego de Avila, 1989 / Characteristics of soking habit among health professional and technicians in Ciego de Avila Province, 1989

Se realizó una encuesta anónima a 1 295 profesionales y técnicos de la salud de la provincia Ciego de Avila sobre algunas características del hábito de fumar entre ellos; esta muestra representó el 35,6

del universo a estudiar, se concluyó que el 58,66

son o fueron fumadores, predominando el sexo femenino; la mayor intensidad está entre los médicos y en el sexo masculino, comenzando mayormente en las edades de 15 a 20 años. La Educación para la Salud fue a criterio de los encuestados la medida más eficaz para disminuir este dañino hábito

Características del hábito de fumar entre profesionales y técnicos de la salud de la provincia Ciego de Avila, 1989 / Characteristics of smoking habit among health professional and technicians in Ciego de Avila Province, 1989

Se realizó una encuesta anónima a 1 295 profesionales y técnicos de la salud de la provincia Ciego de Avila sobre algunas características del hábito de fumar entre ellos; esta muestra representó el 35,6% del universo a estudiar, se concluyó que el 58,66% son o fueron fumadores, predominando el sexo femenino; la mayor intensidad está entre los médicos y en el sexo masculino, comenzando mayormente en las edades de 15 a 20 años. La Educación para la Salud fue a criterio de los encuestados la medida más eficaz para disminuir este dañino hábito