Piperacillin-tazobactam anaphylaxis: a rare cause of occupational disease.

Summary: Piperacillin is a beta-lactam antibiotic of penicillin family. Some penicillins were report-ed as occupational diseases cause, but piperacillin anaphylaxis with occupational sensi-tization is rare. We describe the case of a female nurse with recurrent anaphylaxis in last few months without apparent cause, only in work environment. Latex allergy was excluded after negative latex glove provocation. Later during diagnostic workup, the patient reported a similar reaction minutes after piperacillin preparation. She denied any previous antibiotic therapeutic exposure. Skin prick tests (SPT) to beta-lactams were positive to piperacillin, penicillin G and major and minor determinants. SPT to cefuroxime was negative but intradermic test was positive. The patient has indication for beta-lactams eviction and for adrenaline auto-injector kit. No further reactions occurred after patient's transfer to another department with minimum possible exposure. Allergic risk prevention is essential and must be rapidly implemented to avoid incapacitating occupational diseases development.

Radial scar of the breast: Is it possible to avoid surgery?

INTRODUCTION: Breast radial scar (RS) management remains controversial. The need for surgical excision is supported by the concern of an associated high-grade lesion missed in the biopsy. The aim of this study was to assess histologic upgrade rate after a percutaneous biopsy, to determine if vacuum assisted biopsy prevents the need for subsequent RS surgical resection and to evaluate the upgrade risk factors. PATIENTS AND METHODS: This was a uni-institutional retrospective study of consecutive patients with RS histologically diagnosed from January 2010 to December 2015. RESULTS: A total of 113 cases of RS were diagnosed. We verify that there was a histologic upgrade in 22 (19.5%) cases. The upgrade risk factors were the type of biopsy performed, the presence of atypia, the presence of calcifications and the number of fragments obtained in the biopsy (p < 0.05). The biopsy type was vacuum assisted in 25 (22.1%). The upgrade rate in the vacuum assisted biopsy group was 4.0%, whereas in the standard core needle biopsy group was 23,9% (p = 0.041). DISCUSSION AND CONCLUSION: We demonstrated that the risk of upgrade after a RS diagnosis depends on the type of biopsy performed, the presence of atypia, the presence of calcifications and the number of fragments obtained. When a standard core biopsy is performed the risk of upgrade and malignancy is not negligible, and surgery is indicated. When the biopsy is vacuum assisted, the risk of upgrade and malignancy is significantly decreased and so the indication for excisional biopsy seems not to be so imperative.

Efeitos da ocratoxina no desempenho do camarão-branco-do-pacífico (Litopenaeus vannamei, Bonne) / The effects of ochratoxina in performance pacific white shrimp (Litopenaeus vannamei Bonne)

A ocratoxina é um dos maiores grupos de micotoxinas; são metabólitos secundários produzidos principalmente por fungos dos gêneros Aspergillus e Penicillium. Possui propriedades tóxicas e nefrotóxicas, está relacionada à nefropatia endêmica dos Bálcãs, a tumores do trato urinário e foi classificada pela Agência Internacional de Pesquisa do Câncer (IARC) como pertencente ao grupo 2B, por ser possivelmente carcinogênica para humanos. O objetivo do presente estudo foi avaliar os efeitos da ocratoxina A (OTA) no desempenho do camarão-branco-do-pacífico (Litopenaues vannamei). O experimento foi feito simulando o manejo produtivo de uma fazenda de camarão marinho do litoral localizada em Luís Correia, Piauí. Foram utilizados cinco tratamentos com diferentes níveis de micotoxinas: T1- 100µg/kg de OTA; T2- 500µg/kg de OTA; T3- 1000µg/kg de OTA; T4- 100µg/kg de OTA e 500µg/kg afatoxina B1 e T5 - 0,0µg/kg de OTA. A produção de OTA foi realizada por meio da fermentação do milho, utilizando-se a cepa de Aspergillus ochraceus. Rações comerciais foram contaminadas com os núcleos de milho. A detecção e a quantificação de OTA dos núcleos, das rações comerciais e dos tecidos do camarão (cefalotórax e abdome) foram realizadas por cromatografia líquida de alta eficiência (CLAE). Para simular o sistema de criação da fazenda, os animais foram cultivados por um período de oito semanas, sendo 20 animais por caixa, recebendo alimentação duas vezes por dia. O menor ganho de peso observado foi no T2 e no T4 e os maiores ganhos de peso foram obtidos no T1 e no T5, que também apresentaram a melhor conversão alimentar. Após 56 dias de experimento, foi detectada OTA residual nas amostras de abdome apenas nos camarões do T1. Logo, camarões alimentados com rações contaminadas com OTA têm seu desempenho produtivo comprometido, o que gera impactos econômicos negativos para a indústria carcinicultora, além de ser um risco à saúde do consumidor, devido aos resíduos em sua musculatura.(AU)

Ochratoxin A is the second largest group of mycotoxins. It is a secondary metabolite produced mainly by fungi of the genera Aspergillus and Penicillium, and has toxic and nephrotoxic properties that are associated with the Balkan endemic nephropathy and urinary tract tumors. The International Agency for Research on Cancer (IARC) classifies it as group 2B: possibly carcinogenic to humans. The aim of this study was to evaluate the effects of ochratoxin A (OTA) on the performance of the Pacific white shrimp (Litopenaues vannamei). The experiment simulated the productive management of a shrimp farm located on the marine coast of Luis Correia, Piauí State. Five treatments with different levels of mycotoxins were used: T1- 100µg/kg of OTA; T2- 500µg/kg of OTA; T3 - 1000µg/kg of OTA; T4- 100µg/kg of OTA and 500µg/kg afatoxina B1 and T5 - 0.0µg/kg of OTA. OTA was produced by fermenting corn, using the Aspergillus ochraceus strain. Commercial feeds were contaminated with the corn kernels. OTA in the kernels, commercial feeds and shrimp tissues (cephalothorax and abdomen) were detected and quantified via high performance liquid chromatography (HPLC). To simulate the farming system, totaling 20 animals per box. The animals were fed twice a day and raised under these conditions for eight weeks. The shrimp gained weight during the weeks of the test, when subjected to different OTA treatments. The lowest weight gain was observed in T2 and T4 and the highest weight gains were in T1 and T5, which also presented the best feed conversion ratio. After 56 days, residual OTA was detected in samples of shrimp abdomen only in T1. Therefore, the productive performance of shrimp that are fed with OTA-contaminated feed is compromised, which has a negative economic impact on the shrimp industry, and is a health risk to consumers due to residues in the muscles.(AU)

Airways changes related to air pollution exposure in wheezing children.

In this study, we aimed to evaluate the relationship between individual total exposure to air pollution and airway changes in a group of 51 wheezing children. Respiratory status was assessed four times (January 2006, June 2006, January 2007 and June 2007) during a 1-week period through a standardised questionnaire, spirometry, exhaled nitric oxide fraction and pH in exhaled breath condensate (EBC). Concentrations of particles with a 50% cut-off aerodynamic diameter of 10 µm (PM(10)), O(3), NO(2) and volatile organic compounds were estimated through direct measurements with an ad hoc device or air pollution modelling in the children's schools and at their homes in the same 4 weeks of the study. For each child, total exposure to the different air pollutants was estimated as a function of pollutant concentrations and daily activity patterns. Increasing total exposure to PM(10), NO(2), benzene, toluene and ethylbenzene was significantly associated with a decrease of forced expiratory volume in 1 s (FEV(1)) and with an increase of change in FEV(1). Increasing exposure to NO(2) and benzene was also related to a significant decrease of FEV(1)/forced vital capacity. Increasing exposure to PM(10), NO(2), benzene and ethylbenzene was associated with acidity of EBC. This study suggests an association in wheezing children between airway changes and total exposure to air pollutants, as estimated by taking into account the concentration in the various microenvironments attended by the children.

Immunocharacterization of the DNA puff BhC4-1 protein of Bradysia hygida (Diptera: Sciaridae).

The DNA puff BhC4-1 gene is amplified and highly expressed in the salivary gland of Bradysia hygida late larvae. Using affinity-purified polyclonal antibodies we have identified the product of the BhC4-1 gene as a 43 kDa polypeptide which is present in extracts of salivary glands from late fourth instar larvae and in the corresponding gland secretion, but not in glands from earlier stages. We also demonstrate that this protein is produced mainly in the S1 and S3 regions of the salivary gland, where BhC4-1 amplification levels are more pronounced and larger amounts of mRNA are produced. By immunoelectron microscopy the BhC4-1 protein was detected in secretory granules of the S1 and S3 regions, and localized in fibrous structures present in the saliva.

Proteolytic activity in infected and noninfected insect cells: degradation of HIV-1 Pr55gag particles.

In this work the proteolytic activity in the supernatant and inside insect cells in culture was evaluated for different multiplicities of infection (MOI) and times of infection (TOI). Several methods to detect proteolytic activity in insect cells were tested and that using fluorescein thiocyanite-casein as a substrate was chosen. It was observed that infection caused not only a reduction in the concentration of proteases by decreasing their synthesis but also an inhibition of the intracellular proteolytic activity by increasing the intracellular ATP level (measured by in vivo nuclear magnetic resonance, NMR). The maximum proteolytic activity in the supernatant was observed at 72 hpi except when the cells were infected in the late exponential growth phase or with very low MOI, yielding a nonsynchronous infection. The proteolytic degradation of Pr55gag particles was studied during culture and after harvest. In this particular case it was concluded that the supernatant should be stored at low temperature or quickly purified, since the degradation after 24 h is only 3% at 4 degrees C while at 27 degrees C this value rises to 23%. There is a complex relationship between MOI, TOI, proteolytic activity, and product titer and quality. Thus, the optimal conditions for each case will be a compromise between the final product titer, the desired product quality, and operational issues like process time and capacity, requiring proper integration between bioreaction and downstream processing.

Traumatic vascular lesions associated with fractures and dislocations.

From May 1977 to January 1983, 270 patients with traumatic vascular lesions were treated in our Service. Among these, 27 presented associated fractures and/or dislocations. A high index of suspicion, the early recognition of the presence of vascular injury by thorough clinical evaluation, routine use of the Doppler flowmeter and broad indication of preoperative angiography resulted in prompt repair of these lesions in the majority of cases. Early exploration, wide fasciotomies, use of temporary intraluminal shunts during the bone fixation procedures (usually by internal plates), definitive venous and arterial repair after limb stabilization was achieved and frequent use of intraoperative angiography were the predominant factors in the treatment and outcome in these complex injuries. All eight limbs with closed fractures and/or dislocations were preserved, as well as 17 of 19 (89%) of the limbs with open or exposed skeletal injuries, resulting in a limb salvage rate of 92.6%.

Lesöes vasculares traumáticas: associadas com fraturas e luxaçöes / Traumatic vascular lesions: associated with fractures and dislocations

De maio de 1977 a abril de 1984, 310 pacientes com lesöes vasculares traumáticas foram tratados por nosso grupo. Destes, 37 apresentavam fraturas e/ou lesöes associadas. Um elevado índice de suspeiçäo, o reconhecimento precoce da presença de uma lesäo vascular por exame clínico apurado, o uso rotineiro do Doppler ultra-som e a ampla indicaçäo de angiografia pré-operatória resultaram em reparo precoce destas lesöes, na maioria dos casos. Os fatores predominantes para o êxito do tratamento destas lesöes complexas foram: exploraçäo cirúrgica imediata, fasciotomias extensas, uso de "shunt" temporário intraluminar durante a fixaçäo óssea (geralmente empregando placas e parafusos internos), reparo arterial e venoso definitivo após a estabilizaçäo do membro e o uso freqüente de angiografias peroperatórias. Foram preservados oito membros com fraturas e/ou lesöes fechadas, bem como 26 de 29 dos membros com lesöes ósseas abertas ou expostas, resultando na manutençäo de 91,8% do total das extremidades tratadas

A anestesia no Sarah- Instituto Nacional de Medicina do Aparelho Locomotor: visita pre-anestesica. / The anesthesia in Sarah-Instituto Nacional de Medicina do aparelho locomototor: pre-anesthesic visit

A participacao do anestesiologista no conhecimento da problematica do paciente cirurgico tem sido nossa preocupacao constante. Desde julho de 1978, criou-se a reavaliacao conjunta dos pacientes cirurgicos, na semana anterior a data prevista da cirurgia, da qual participam anestesiologistas, cirurgioes e colegas consultores Os pacientes sao entrevistados pelos anestesiologistas, seus prontuarios sao revistos, faz-se um exame clinico dirigido e discutem-se os problemas pertinentes com os cirurgioes ou consultores e os pacientes recebem a orientacao final. De 866 pacientes que foram vistos, 49 pacientes foram medicados, para reavaliacao na internacao. 36 cirurgias foram suspensas pelos anestesiologistas, por apresentarem diversas patologias. Dois pacientes foram internados para tratamento clinico hospitalar. Esta experiencia trouxe diversas contribuicoes: uma melhor avaliacao dos pacientes, evitou-se a marcacao de cirurgia sem adequado preparo; racionalizando-se o uso do centro cirurgico, melhora-se a possibilidade da aceitacao das tecnicas regionais em pacientes pediatricos e melhora-se tambem o relacionamento cirurgiao -anestesiologista, contribuindo para a unidade de pensamento e de conduta dos proprios anestesiologistas