Prenatal Exposure to Mercury, Manganese, and Lead and Adverse Birth Outcomes in Suriname: A Population-Based Birth Cohort Study.

Globally, adverse birth outcomes are increasingly linked to prenatal exposure to environmental contaminants, such as mercury, manganese, and lead. This study aims to assess an association between prenatal exposure to mercury, manganese, and lead and the occurrence of adverse birth outcomes in 380 pregnant women in Suriname. The numbers of stillbirths, preterm births, low birth weights, and low Apgar scores were determined, as well as blood levels of mercury, manganese, lead, and relevant covariates. Descriptive statistics were calculated using frequency distributions. The associations between mercury, manganese, and lead blood levels, on the one hand, and adverse birth outcomes, on the other hand, were explored using contingency tables, tested with the χ2-test (Fisher's exact test), and expressed with a p value. Multivariate logistic regression models were computed to explore independent associations and expressed as (adjusted) odds ratios (aOR) with 95% confidence intervals (CI). The findings of this study indicate no statistically significant relationship between blood mercury, manganese, or lead levels and stillbirth, preterm birth, low birth weight, and low Apgar score. However, the covariate diabetes mellitus (aOR 5.58, 95% CI (1.38-22.53)) was independently associated with preterm birth and the covariate hypertension (aOR 2.72, 95% CI (1.081-6.86)) with low birth weight. Nevertheless, the observed high proportions of pregnant women with blood levels of mercury, manganese, and lead above the reference levels values of public health concern warrants environmental health research on risk factors for adverse birth outcomes to develop public health policy interventions to protect pregnant Surinamese women and their newborns from potential long-term effects.

Goatkids fed diets containing castor cake detoxified: II. Nitrogen balance, hepatic and renalfunction

The aim of this study was to evaluate the influence of completely replacing soybean meal (SM) with castor cake detoxified (DCC) with two alkaline products on the nitrogen balance and hepatic and renal function in goat kids. Goatkids of two breeds, Saanen and Anglo Nubian, with an initial body weight of 16.2 ± 0.67 kg, and confined during the growth phase, were used. The treatments consisted of three diets: one based on SM and the other two based on castor cake detoxified with Ca(OH)2or NaOH. Twenty-four goats kids were distributed in a completelyrandomized design using a 3 x 2 factorial scheme (diet x breed) with four replicates per combination. The experimental period lasted for 270 days. Consumed nitrogen, fecal nitrogen, urinary nitrogen, retained nitrogen, and nitrogen balance were influenced(p < 0.05) by diets. There was significant effect of diets (p < 0.05) on creatinine, direct bilirubin, urea, alanine aminotransferase, aspartate aminotransferase and gamma-glutamyltransferase blood levels, however without any negative changes involving renal or hepatic dysfunction. Inclusion of castor cake in the diet of goats kids in confinement is an attractive option, considering that goats kids use does not cause hepatic and renal alterations, suggesting that SM can be completely replaced. NaOH DCC stands in the substitution of soybean meal, because in spite of decreasing the consumption of nitrogen provides the same retention of soybean meal.(AU)

Rol de los péptidos natriuréticos en insuficiencia cardíaca: El fino equilibrio entre la medicina de precisión y la optimización de los recursos

La insuficiencia cardíaca constituye la fase final de la mayoría de las patologías cardiovasculares. Si bien el interrogatorio, el conocimiento de los antecedentes personales y familiares del paciente, sumados al examen físico detallado, contribuyen en sobremanera al diagnóstico; muchas veces el diagnóstico diferencial del síndrome de insuficiencia cardíaca no nos permite diferenciar entre los cuadros compensados de aquellos portadores de insuficiencia cardíaca en las primeras fases de la descompensación o nos llevan a la duda entre diagnósticos diferenciales. La falta de disponibilidad de camas de hospitalización, problemas de cobertura médica o incluso problemas sociales o psicológicos, obligan muchas veces a la determinación de altas precoces con el riesgo presente de descompensaciones e internaciones reiteradas. Evitar descompensaciones frecuentes es el trabajo silencioso que debe realizar el médico para tratar de detectar precozmente con la finalidad de enlentecer o detener el progreso de la enfermedad cardiovascular, evitando estudios e internaciones costosas. Entre el armamento necesario para cumplir con esta finalidad se encuentra el dosaje de péptidos natriuréticos. La presente revisión trata de resumir los datos disponibles que valoran el control de los niveles de péptidos natriuréticos en nuestra asistencia de los pacientes con insuficiencia cardíaca.

Heart failure constitutes the final stage of most cardiovascular diseases. Although the questioning, the knowledge of the patient s personal and family history, added to the detailed physical examination, greatly contribute to the diagnosis; Many times the differential diagnosis of heart failure syndrome does not allow us to differentiate between the compensated conditions of those with heart failure in the early stages of decompensation or leads us to doubt between differential diagnoses. The lack of availability of hospital beds, problems of medical coverage or even social or psychological problems, often force the determination of early discharges with the present risk of decompensation and repeated hospitalizations. Avoiding frequent decompensations is the silent work that the physician must do to try to detect it early in order to slow down or stop the progress of cardiovascular disease, avoiding expensive studies and hospitalizations. Among the weapons necessary to fulfill this purpose is the dosage of natriuretic peptides. This review attempts to summarize the available data that assess the control of natriuretic peptide levels in our care of patients with heart failure.

A insuficiência cardíaca constitui o estágio final da maioria das doenças cardiovasculares. Apesar do questionamento, o conhecimento da história pessoal e familiar do paciente, somado ao exame físico detalhado, contribuem muito para o diagnóstico; Muitas vezes, o diagnóstico diferencial da síndrome da insuficiência cardíaca não nos permite diferenciar as condições compensadas dos portadores de insuficiência cardíaca nos estágios iniciais de descompensação ou nos leva à dúvida entre os diagnósticos diferenciais. A falta de disponibilidade de leitos hospitalares, problemas de cobertura médica ou mesmo problemas sociais ou psicológicos, muitas vezes obrigam à determinação de altas precoces com o risco atual de descompensação e hospitalizações repetidas. Evitar descompensações frequentes é o trabalho silencioso que o médico deve fazer para tentar detectá-la precocemente, a fim de retardar ou interromper o progresso das doenças cardiovasculares, evitando estudos e internações dispendiosas. Entre as armas necessárias para cumprir esse propósito está a dosagem de peptídeos natriuréticos. Esta revisão tenta resumir os dados disponíveis que avaliam o controle dos níveis de peptídeo natriurético em nosso tratamento de pacientes com insuficiência cardíaca.

Anemia and Cognitive Performance in the ELSA-Brasil Cohort Baseline.

OBJECTIVE: The association between cognitive performance and hemoglobin concentration has long been a topic of debate, but few data for middle-aged persons have been explored. The authors examined the association between anemia and cognitive performance at baseline assessment in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), a multicenter cohort study of individuals from six Brazilian cities. METHODS: A total of 13,624 participants (mean age=51.6 years [SD=9.0]) were included in this cross-sectional study. Cognitive performance was evaluated by using standardized scores for verbal learning, late recall, word recognition, a semantic verbal fluency test, and the Trail-Making Test, Part B (TMT-B). The association between anemia and cognitive performance was examined by using linear regression models adjusted for sociodemographic characteristics and cardiovascular risk factors. RESULTS: Anemia was diagnosed in 713 (5.2%) participants. No association was found between anemia and worse cognitive performance for the main models. Global cognitive scores were similar between participants with and without anemia in adjusted models for the entire sample (ß=-0.004; 95% CI=-0.052, 0.044) or for men (ß=0.047; 95% CI=-0.053, 0.146) and women (ß=-0.015; 95% CI=-0.070, 0.040) separately. In addition, hemoglobin levels (in quintile groups) were not associated with global cognitive scores. Similarly, no significant associations with anemia or hemoglobin levels were observed when each cognitive performance test was evaluated separately. CONCLUSIONS: Anemia and hemoglobin levels were not associated with worse cognitive performance in this large cohort.

Strangers headed to a strange land? A pilot study of using a transition coordinator to improve transfer from pediatric to adult services.

OBJECTIVE: To compare the impact of a transition coordinator on outcomes for pediatric liver transplant recipients vs a historical comparison group. STUDY DESIGN: To examine the utility of a transition coordinator, medication adherence, as measured by SDs of tacrolimus blood levels (Tacrolimus SD), was compared between the "transition coordinator group" (20 transplant recipients transferred between 2007 and 2012) and comparison group for 1 year before and after transfer. Measures of health care management, quality of life, and acceptability were administered to the transition coordinator group as well. RESULTS: A repeated measures ANOVA was used to compare adherence values between the transition coordinator group and the comparison group. During the year before transfer, for the transition coordinator group, Tacrolimus SD was 1.98 (SD = 1.05) vs 3.25 (SD = 1.19) for comparison patients, F(1,25) = 4.77, P = .04. After transfer, levels remained stable for the transition coordinator group, Tacrolimus SD = 1.88 (SD = 1.57), but increased for comparison patients, Tacrolimus SD = 4.36 (SD = 0.99), F(1,25) = 6.99, P = .01. Psychosocial outcomes remained stable during the transfer period and acceptability was high. CONCLUSIONS: Our findings, although limited by a small sample size, suggest that a transition coordinator is a promising method to improve this process.

Influência da saturação venosa central de oxigênio na mortalidade hospitalar de pacientes cirúrgicos / Influence of central venous oxygen saturation on in-hospital mortality of surgical patients / Influencia de la saturación venosa central de oxígeno en la mortalidad hospitalaria de pacientes quirúrgicos

RESUMO JUSTIFICATIVA E OBJETIVOS: Saturação venosa central de oxigênio (SvcO2) baixa indica desequilíbrio entre oferta e consumo de oxigênio celular e, consequentemente, pior prognóstico em pacientes graves. No entanto, ainda não está claro qual o valor desse marcador em pacientes cirúrgicos. O objetivo deste estudo foi avaliar se SvcO2 baixa no perioperatório determina pior prognóstico. MÉTODO: Estudo observacional, durante 6 meses, em um hospital terciário. Foram incluídos pacientes que necessitassem de pós-operatório em terapia intensiva (UTI) com idade > 18 anos, submetidos a cirurgias de grande porte. Pacientes com cirurgias paliativas e pacientes com insuficiên cia cardíaca grave foram excluídos. Valores de SvcO2 foram mensurados antes da cirurgia, durante o procedimento e após a cirurgia na UTI. RESULTADOS: Foram incluídos 66 pacientes e não sobreviveram 25,8 por cento. Os valores médios de SvcO2 dos pacientes foram maiores no intraoperatório, 84,7 ± 8,3 por cento, do que no pré-operatório e UTI, respectivamente 74,1 ± 7,6 por cento e 76,0 ± 10,5 por cento (p = 0,0001). Porém, somente os valores de SvcO2 no pré-operatório dos pacientes não sobreviventes foram significativamente mais baixos que os sobreviventes. Pela regressão logística SvcO2 pré-operatória, OR = 0,85 (IC 95 por cento 0,74-0,98) p = 0,02 foi fator independente de mortalidade hospitalar. Pacientes com SvcO2 < 70 por cento no pré-operatório apresentaram maior necessidade de transfusão sanguínea (80,0 por cento versus 37,0 por cento p = 0,001) e reposição volêmica no intraoperatório 8.000,0 (6.500,0 - 9.225,0) mL versus 6.000,0 (4.500,0 - 8.500,0) mL p = 0,04), com maiores chances de complicações pós-operatórias (75 por cento versus 45,7 por cento p = 0,02) e maior tempo de internação na UTI 4,0 (2,0-5,0) dias versus 3,0 (1,7 - 4,0) dias p = 0,02. CONCLUSÕES: Os valores de SvcO2 no intraoperatório são maiores que os do pré- e pós-operatório. Contudo, a SvcO2 baixa no pré-operatório determina pior prognóstico.

BACKGROUND AND OBJECTIVES: Low central venous oxygen saturation (ScvO2) indicates an imbalance between cellular oxygen supply and consumption and, consequently, worse prognosis for critical patients. However, it is not clear what the value of this marker in surgical patients. The objective of the present study was to evaluate whether low perioperative ScvO2 determines a worse prognosis. METHODS: This is a 6-month observational study carried on in a tertiary hospital. Patients who needed to be in the intensive care unit (ICU) postoperatively, with age > 18 years, who underwent large surgeries, were included. Patients who underwent palliative surgeries and those with severe heart failure were excluded. Levels of ScvO2 were measured before the surgery, during the procedure, and after the surgery in the ICU. RESULTS: Sixty-six patients were included in this study, but 25.8 percent of them did not survive. Mean ScvO2 levels were higher intraoperatively, 84.7 ± 8.3 percent, than preoperatively and in the ICU, 74.1 ± 7.6 percent and 76.0 ± 10.5 percent (p = 0.0001), respectively. However, only preoperative SvcO2 levels of non-surviving patients were significantly lower than those who survived. By logistic regression, preoperative ScvO2, OR = 0.85 (95 percent CI 0.74-0.98) (p = 0.02), was an independent factor of in-hospital mortality. Patients with preoperative ScvO2 < 70 percent had greater need of intraoperative blood transfusion (80.0 percent versus 37.0 percent, p = 0.001) and volume replacement, 8,000.0 (6,500.0-9,225.0) mL versus 6,000.0 (4,500.0-8,500.0) mL (p = 0.04), with greater chances of postoperative complications (75 percent versus 45.7 percent, p = 0.02) and longer time in the ICU, 4.0 (20.0-5.0) days versus 3.0 (1.7-4.0) days (p = 0.02). CONCLUSIONS: Intraoperative ScvO2 levels are higher than those both in the pre- and postoperative period. However, low preoperative ScvO2 determines worse prognosis.

JUSTIFICATIVA Y OBJETIVOS: La saturación venosa central de oxígeno (SvcO2) baja indica un desequilibrio entre la oferta y el consumo de oxígeno celular y como consecuencia, un peor pronóstico para los pacientes graves. Sin embargo, todavía no está claro cuál es el valor de ese marcador en pacientes quirúrgicos. El objetivo de este estudio fue evaluar si la SvcO2 baja en el perioperatorio determina un peor pronóstico. MÉTODO: Estudio observacional durante 6 meses, realizado en un tercer hospital. Fueron incluidos pacientes que necesitasen postoperatorio en cuidados intensivos (UCI), con edad > 18 años, sometidos a cirugías de gran porte. Los pacientes con cirugías paliativas y pacientes con insuficiencia cardíaca grave quedaron fuera del estudio. Los valores de SvcO2 se midieron antes de la cirugía, durante el procedimiento y después de la operación en la UCI. RESULTADOS: Se incluyeron 66 pacientes de los cuales un 25,8 por ciento no sobrevivieron. Los valores promedios de SvcO2 de los pacientes fueron mayores en el intraoperatorio, 84,7 ± 8,3 por ciento, que en el preoperatorio y UCI, respectivamente 74,1 ± 7,6 por ciento y 76,0 ± 10,5 por ciento (p = 0,0001). Sin embargo, solamente los valores de SvcO2 en el preoperatorio de los pacientes no sobrevivientes fueron significativamente más bajos que los sobrevivientes. La regresión logística SvcO2 preoperatoria, OR = 0,85 (IC 95 por ciento 0,74-0,98) (p = 0,02), fue un factor independiente de mortalidad hospitalaria. Los pacientes con SvcO2 < 70 por ciento en el preoperatorio, presentaron una mayor necesidad de transfusión sanguínea (80,0 por ciento versus 37,0 por ciento p = 0,001) y reposición volémica en el intraoperatorio 8000,0 (6500,0 - 9225,0) mL versus 6000,0 (4500,0 - 8500,0) mL p = 0,04), con mayores chances de complicaciones postoperatorias (75 por ciento versus 45,7 por ciento p = 0,02) y un mayor tiempo de ingreso en la UCI 4,0(2,0-5,0) días versus 3,0 (1,7 - 4,0) días p = 0,02. CONCLUSIONES: Los valores de SvcO2 en el intraoperatorio son mayores que los del pre y del postoperatorio. Sin embargo, la SvcO2 baja en el preoperatorio es determinante para un peor pronóstico.

Factores asociados a los niveles de plomo en sangre en residentes de la ciudad de México / Risk factors for high levels of lead in the blood of México City inhabitants

Se efectuó un estudio exploratorio para identificar los factores de riesgo que se asocian a la exposición al plomo ambiental en una población residente de la ciudad de México, no expuesta ocupacionalmente. Se midieron los niveles de plomo en sangre a trescientos trabajadores del área administrativa del Instituto de Seguridad Social al Servicio de los Trabajadores del Estado (ISSSTE), por medio de espectrofotometría de absorción atómica y se les aplicó un cuestionario con las principales variables que potencialmente modifican la exposición al plomo. El análisis estadístico se efectuó a través de análisis de varianza, regresión múltiple y regresión logística. Los resultados mostraron efectos significativos en relación al sexo, zona de residencia, horas utilizadas en transporte, consumo cotidiano de chiles enlatados y uso de utensilios de barro vidriado

Níveis de dieldrin em sangue de aplicadores de aldrin na região de São José do Rio Preto, São Paulo / Dieldrin levels in blood of workers applying aldrin,in Sao Jose do Rio Preto, Sao Paulo

Foram determinados os níveis de dieldrin no sangue de 18 lavradores profissionalmente expostos ao aldrin, tendo sido encontrados valores muito elevados (média = 0,49 fLgjml; desvio padrão 0,36 ppm), acima dos citados na literatura em casos de intoxicação. Não pôde ser detectada correlação entre o nível sanguíneo de dieldrin e o tempo de exposição ao aldri n, o intervalo entre a exposição e a coleta do sangue, a quantidade do composto empregado ou a natureza da exposição. O grau de contaminação detectado, decorrente principalmente da manipulação imprudente do pesticida, enfatiza a necessidade de medidas mais efetivas na conscientização dos aplicadores de aldrin com relação ao risco assumido, e de fiscalização pelos órgãos responsáveis (AU).