A Global Review of the Perioperative Care of Patients With Aneurysmal Subarachnoid Hemorrhage Undergoing Microsurgical Repair of Ruptured Intracerebral Aneurysm.

INTRODUCTION: To describe the perioperative care of patients with aneurysmal subarachnoid hemorrhage (aSAH) who undergo microsurgical repair of a ruptured intracerebral aneurysm. METHODS: An English language survey examined 138 areas of the perioperative care of patients with aSAH. Reported practices were categorized as those reported by <20%, 21% to 40%, 41% to 60%, 61% to 80%, and 81% to 100% of participating hospitals. Data were stratified by Worldbank country income level (high-income or low/middle-income). Variation between country-income groups and between countries was presented as an intracluster correlation coefficient (ICC) and 95% confidence interval (CI). RESULTS: Forty-eight hospitals representing 14 countries participated in the survey (response rate 64%); 33 (69%) hospitals admitted ≥60 aSAH patients per year. Clinical practices reported by 81 to 100% of the hospitals included placement of an arterial catheter, preinduction blood type/cross match, use of neuromuscular blockade during induction of general anesthesia, delivering 6 to 8 mL/kg tidal volume, and checking hemoglobin and electrolyte panels. Reported use of intraoperative neurophysiological monitoring was 25% (41% in high-income and 10% in low/middle-income countries), with variation between Worldbank country-income group (ICC 0.15, 95% CI 0.02-2.76) and between countries (ICC 0.44, 95% CI 0.00-0.68). The use of induced hypothermia for neuroprotection was low (2%). Before aneurysm securement, variable in blood pressure targets was reported; systolic blood pressure 90 to 120 mm Hg (30%), 90 to 140 mm Hg (21%), and 90 to 160 mmHg (5%). Induced hypertension during temporary clipping was reported by 37% of hospitals (37% each in high and low/middle-income countries). CONCLUSIONS: This global survey identifies differences in reported practices during the perioperative management of patients with aSAH.

Improved Spatial Memory And Neuroinflammatory Profile Changes in Aged Rats Submitted to Photobiomodulation Therapy.

Recent evidences have shown the therapeutic potential of transcranial photobiomodulation on traumatic brain injury and Alzheimer's disease. Despite the promising benefits in the brain, little is known about the laser's effects in the absence of pathological conditions. We submitted young (4 months old) and aged (20 months old) rats to transcranial low-level laser and evaluated their exploratory activity and habituation in open field, anxiety in elevated plus maze, spatial memory in Barnes maze, and aversive memory in a step-down inhibitory avoidance task. Additionally, the levels of a panel of inflammatory cytokines and chemokines were quantified in two different brain regions: the cerebral cortex and the hippocampus. Young and aged rats submitted to transcranial laser exhibited better cognitive performance in Barnes maze than did control rats. Transcranial laser therapy decreased cortical levels of GM-CSF, IL-10, MCP-1, LIX, and TNFα in young rats and IL-5 in aged rats. High levels of IL-6, IL-10, and TNF-alpha were found in the cerebral cortex of aged rats submitted to transcranial laser. In the hippocampus, a decrease in IP-10 and fractalkine levels was observed in the aged rats from the laser group when compared to the aged rats from the control group. Our data indicate that transcranial photobiomodulation improves spatial learning and memory and alters the neuroinflammatory profile of young and aged rats' brains.

Adolescents Emotional State and Behavioral and Dietary Habit Changes during Isolation Due to the COVID-19 Pandemic.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) was recognized as a pandemic by the World Health Organization on March 11, 2020. As an infectious disease with no specific treatment, several measures have been established to minimize the outbreak of this disease, including social isolation. OBJECTIVE: To evaluate the behavior of adolescents during the isolation period. METHODS: This is a cross-sectional descriptive study conducted at the Adolescent Health Studies Center. Data were obtained from a questionnaire prepared on Google Forms, sent by a multiplatform instant messaging application, and analyzed using the Stata 14 software. RESULTS: A total of 208 adolescents with a mean age of 15.3 years (SD ± 1.8) answered the questionnaire, 57.7% were female. About 93.3% of adolescents said they were in isolation with a changed routine, 67.3% increased their food consumption, 86.5% were inactive, and 58.7% reported screen time over 8 h/d. There was an association between anxiety and increased food consumption (odds ratio: 3.9; CI 95% 2-7.5; p = 0.00), sleeping difficulty (odds ratio: 3.6; CI 95% 1.9-6.8; p = 0.00), and conflicting family relationship (odds ratio: 5.7; CI 95% 1.6-7.8; p = 0.01). CONCLUSION: The study revealed that social isolation due to an infectious disease was associated with several effects on the behavior and eating behavior of adolescents, which need to be acknowledged to encourage them to lead a healthy lifestyle after the COVID-19 confinement.

Quality of life of Brazilian industrial workers: a review article.

Workers in general have their quality of life affected; however, in the industrial setting, they are exposed to poor and unhealthy conditions in their workplaces and to different occupational hazards depending on their role, sector of activity, and climatic conditions. This study aimed to analyze the quality of life of Brazilian industrial workers. This is an integrative review. The PICo strategy was used to prepare the research question, and each letter represents one component of the question - population (P), workers; interest (I), quality of life; and context (Co), Brazilian industry. The search and selection process was conducted in the Scientific Electronic Library Online (SciELO) and PubMed databases. The search was conducted from August to September 2019, and studies published in the past 10 years were selected. In most workers, work-related QL deficits were identified mainly in the domains of general health and vitality in the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and of social relationships and environment in the World Health Organization Quality of Life short version (WHOQOL-Bref). The factors that represented risks for quality of life included exposure to noise in the workplace, repetitive strain injury/work-related musculoskeletal disorders, occupational low back pain, occupational stress, and work-related fatigue. Few studies assessing quality of life of industrial workers were found. The reviewed studies showed that quality of life deficits are related to vitality, physical functioning, general health, environment, and psychological health of these workers.

Frequencies of CD39, IVS1-1, IVS1-6 and IVS1-110 mutations in beta-thalassemia carriers and their influence on hematimetric indices / Frequências de mutações CD39, IVS1-1, IVS1-6 e IVS1-110 em portadores de betatalassemia e suas influências nos valores hematimétricos

ABSTRACT Introduction: Beta-thalassemia is caused by a deficient synthesis of the ß-chain of hemoglobin, which leads to a chronic, microcytic and hypochromic anemia. More than 200 mutations have already been associated with this type of thalassemia, and their frequencies may vary according to the population. Objectives: The objectives of this study were to determine the frequencies of CD39, IVS1-1, IVS1-6 and IVS1-110 mutations in people with beta-thalassemia from the city of Franca, São Paulo, and to evaluate the influence of the genotypes on hematological alterations. Methods: Venous blood samples were collected from 25 volunteers previously diagnosed with beta-thalassemia. Complete blood counts (CBC) were performed, and the identification of the mutations was carried out using the polymerase chain reaction (PCR). Results: The CD39 mutation was found in 11 (44%) individuals, followed by IVS1-6 (9; 36%) and IVS1-110 (4; 16%). One patient (4%) did not present any of these mutations. IVS1-6 mutation was inversely correlated to red cell distribution width (RDW) (rs = -0.44; p = 0.034), and CD39 was correlated to lower mean corpuscular volume (MCV) (rs = -0.44; p = 0.034). Multivariable linear regression models showed that the CD39 mutation carriers have lower levels for hemoglobin (ß = -0.61; p = 0.044) and hematocrit (ß = -2.1; p = 0.018). Conclusion: The results showed a high frequency of the CD39 mutation in the city of Franca, and the correlations observed between the presence of CD39 mutation and the hematological alterations suggest a genotype influence on the phenotype of beta-thalassemia, which would contribute to the clinical variations of this hemoglobinopathy.

RESUMO Introdução: A betatalassemia é causada pela síntese deficiente da cadeia ß da hemoglobina, o que leva à ocorrência das anemias crônica, microcítica e hipocrômica. Mais de 200 mutações já foram associadas a esse tipo de talassemia, mesmo que diferentes populações apresentem frequências variadas para cada uma delas. Objetivos: Os objetivos deste estudo foram determinar as frequências das mutações CD39, IVS1-1, IVS1-6 e IVS1-110 em indivíduos betatalassêmicos da cidade de Franca, São Paulo, e avaliar a influência dos genótipos sobre alterações hematológicas. Métodos: Amostras de sangue venoso foram coletadas de 25 voluntários previamente diagnosticados com betatalassemia. Foram realizados hemogramas completos, e a identificação das mutações foi feita utilizando a técnica de reação em cadeia da polimerase (PCR). Resultados: A mutação CD39 foi encontrada em 44% dos indivíduos, seguida por IVS1-6 (36%) e IVS1-110 (16%). Um paciente (4%) não apresentou nenhuma das mutações. A mutação IVS1-6 correlacionou-se inversamente ao red cell distribution width (RDW) (rs = -0,44; p = 0,034), enquanto a presença da mutação CD39 mostrou-se correlacionada a menores valores de volume corpuscular médio (VCM) (rs = -0,44; p = 0,034). Modelos de regressão linear multivariados mostraram que os portadores da mutação CD39 possuem menores valores de hemoglobina (ß = -0,61; p = 0,044) e hematócrito (ß = -2,1; p = 0,018). Conclusão: Os resultados mostraram alta frequência da mutação CD39 na cidade de Franca, e as correlações observadas entre a presença da mutação CD39 e as alterações hematológicas sugerem influência do genótipo sobre o fenótipo da betatalassemia, o que poderia contribuir para as variações clínicas dessa hemoglobinopatia.

l-Amino acid oxidase isolated from calloselasma rhodostoma snake venom induces cytotoxicity and apoptosis in JAK2V617F-positive cell lines

BACKGROUND: Myeloproliferative neoplasms are Philadelphia chromosome-negative diseases characterized by hyperproliferation of mature myeloid cells, associated or not with the Janus kinase 2 tyrosine kinase mutation, JAK2V617F. As there is no curative therapy, researchers have been investigating new drugs to treat myeloproliferative neoplasms, including l-amino acid oxidase from Calloselasma rhodostoma snake venom (CR-LAAO), which is a toxin capable of eliciting apoptosis in several tumor cell lines. OBJECTIVE: To evaluate the effects of l-amino acid oxidase from C. rhodostoma snake venom in the apoptotic machinery of JAK2-mutated cell lines. METHODS: The HEL 92.1.7 and SET-2 cell lines were cultured with l-amino acid oxidase and catalase for 12 h at 37 °C in 5% carbon dioxide. The cell viability was assessed by the multi-table tournament method, the level of apoptosis was measured by flow cytometry, and the expression of cysteine-dependent aspartate-specific proteases and cleaved Poly(ADP-ribose) polymerase were analyzed by Western blotting. RESULTS: l-Amino acid oxidase from C. rhodostoma snake venom was cytotoxic to HEL 92.1.7 and SET-2 cells (50% inhibitory concentration = 0.15 µg/mL and 1.5 µg/mL, respectively) and induced apoptosis in a concentration-dependent manner. Cell treatment with catalase mitigated the l-amino acid oxidase toxicity, indicating that hydrogen peroxide is a key component of its cytotoxic effect.The activated caspases 3 and 8 expression and cleaved PARP in HEL 92.1.7 and SET-2 cells confirmed the apoptosis activation by CR-LAAO. CONCLUSIONS: l-Amino acid oxidase from C. rhodostoma snake venom is a potential antineoplastic agent against HEL 92.1.7 and SET-2 JAK2V617F-positive cells as it activates the extrinsic apoptosis pathway.

l-Amino acid oxidase isolated from Calloselasma rhodostoma snake venom induces cytotoxicity and apoptosis in JAK2V617F-positive cell lines.

BACKGROUND: Myeloproliferative neoplasms are Philadelphia chromosome-negative diseases characterized by hyperproliferation of mature myeloid cells, associated or not with the Janus kinase 2 tyrosine kinase mutation, JAK2V617F. As there is no curative therapy, researchers have been investigating new drugs to treat myeloproliferative neoplasms, including l-amino acid oxidase from Calloselasma rhodostoma snake venom (CR-LAAO), which is a toxin capable of eliciting apoptosis in several tumor cell lines. OBJECTIVE: To evaluate the effects of l-amino acid oxidase from C. rhodostoma snake venom in the apoptotic machinery of JAK2-mutated cell lines. METHODS: The HEL 92.1.7 and SET-2 cell lines were cultured with l-amino acid oxidase and catalase for 12h at 37°C in 5% carbon dioxide. The cell viability was assessed by the multi-table tournament method, the level of apoptosis was measured by flow cytometry, and the expression of cysteine-dependent aspartate-specific proteases and cleaved Poly(ADP-ribose) polymerase were analyzed by Western blotting. RESULTS: l-Amino acid oxidase from C. rhodostoma snake venom was cytotoxic to HEL 92.1.7 and SET-2 cells (50% inhibitory concentration=0.15µg/mL and 1.5µg/mL, respectively) and induced apoptosis in a concentration-dependent manner. Cell treatment with catalase mitigated the l-amino acid oxidase toxicity, indicating that hydrogen peroxide is a key component of its cytotoxic effect.The activated caspases 3 and 8 expression and cleaved PARP in HEL 92.1.7 and SET-2 cells confirmed the apoptosis activation by CR-LAAO. CONCLUSIONS: l-Amino acid oxidase from C. rhodostoma snake venom is a potential antineoplastic agent against HEL 92.1.7 and SET-2 JAK2V617F-positive cells as it activates the extrinsic apoptosis pathway.

Prevalence of hemoglobinopathies in school children: the importance of using confirmatory methods / Prevalência das hemoglobinopatias em crianças em idade escolar: a importância do uso de métodos de confirmação

The hemoglobinopathies are included among the most common genetic diseases in the world. In Brazil, hemoglobinopathies are related to the diversity of racial backgrounds and the degree of interbreeding. The study focused on the prevalence of hemoglobinopathies using conventional and confirmatory laboratory tests in children from public schools in Ribeirão Preto-SP. The study involved the participation of 427 children between six and nine years of age. Hematologic evaluation, hemoglobin electrophoresis on cellulose acetate at alkaline pH, quantification of hemoglobin fractions by high performance liquid chromatography (HPLC) and detection of -α^3.7 deletion for α thalassemia by polymerase chain reaction were performed. The results of hemoglobin electrophoresis on cellulose acetate and HPLC of the children studied showed the presence of 30 children (7%) with hemoglobinopathies. Eleven children presented results indicating suspicion of S/β-thalassemia; their parents and/or siblings were evaluated and confirmed the presence of only Hb S. The analysis of deletion -α^3.7to characterize α-thalassemias sampling performed on 207 participants identified 26 children (12.6%) with deletion -α^3.7. Thus, 54 (12.6%) of the children studied present this genetic alteration. For the detection of α-thalassemias it is necessary to use confirmatory methods such as molecular analysis and evaluation of family members in doubtful cases to facilitate genetic counseling in families, in which deletion -α^3.7 is more frequent in Brazil...

As hemoglobinopatias estão incluídas nas doenças genéticas mais comuns no mundo. No Brasil, as hemoglobinopatias são relatadas pela diversidade racial e o grau de miscigenação. O estudo focou a prevalência das hemoglobinopatias usando métodos laboratoriais convencionais como a eletroforese de hemoglobina em acetato de celulose em pH alcalino e confirmatório por reação em cadeia de polimerase (PCR) em crianças de escolas públicas de Ribeirão Preto-SP. O estudo envolveu a participação de 427 crianças entre 6-9 anos de idade. Determinaram-se os valores hematológicos, efetuou-se eletroforese de hemoglobina em acetato de celulose em pH alcalino, quantificação das frações de hemoglobina por HPLC e a detecção da deleção -α^3,7 pela PCR. Os resultados da eletroforese de hemoglobina em acetato de celulose e do HPLC, nas crianças estudadas, mostraram a presença de 30 crianças (7%) com hemoglobinopatias. Onze crianças apresentaram resultado indicando a suspeita de S/β-talassemia; seus pais e/ou irmãos confirmaram a presença de apenas a Hb S. A análise da deleção -α^3,7, uma das alterações que estão presentes na α-talassemia, realizada em 207 participantes, identificou 26 crianças (12,6%) com a deleção -α^3,7. Dessa forma, 54 (12,6%) das crianças estudadas apresentam hemoglobinopatias. Para a deleção da α-talassemias é necessário utilizar métodos confirmatórios como as análises moleculares e avaliação de membros da família, em casos duvidosos, facilitando o aconselhamento genético nas famílias, sendo a deleção -α^3,7 mais frequente no Brasil...

Fatores associados ao excesso de peso e ao índice de massa corporal em três escolas de Itaúna ? MG / Factors associated with overweight and body mass index in three schools of Itaúna ? MG

Objetivo: verificar a prevalência e os fatores associados ao excesso de peso e ao índice de massa corporal (IMC) de escolares. Métodos: trata-se de estudo transversal, epidemiológico, no qual foram avaliadas 60 crianças de seis a 10 anos de idade, de três escolas públicas de Itaúna-MG. Elas foram classificadas quanto ao IMC/idade e seus pais responderam a questionário para obtenção de dados demográficos, história familiar e pregressa, estilo de vida e frequência alimentar semiquantitativo. Os dados foram avaliados com auxílio dos softwares Excel e SPSS. Foram usados testes estatísticos de regressão logística múltipla e linear múltipla. Resultados: a prevalência de excesso de peso, eutrofia e baixo peso identificada pelo IMC/idade foi de 21,6% (p=13), 76,7% (p=46) e 1,7% (p=1), respectivamente. O excesso de peso foi independentemente associado à obesidade materna (p=0,004). Foi encontrada associaçãodireta entre IMC e obesidade materna (p=0,02), ingestão de pães (p=0,03) e salgadinhos tipo chips (p=0,08) e associação inversa entre IMC e ingestão de iogurte (p=0,007) e sorvete (p=0,09). Conclusão: a prevalência de excesso de peso encontrada na população estudada foi alta, demonstrando a importância de mais atenção a esse aspecto, uma vez que ele pode estar associado a fatores potencialmente modificáveis, como os dietéticos.

Objective: to verify the prevalence and factors associated with overweight and body mass index (BMI) in schoolchildren. Methods: this was a cross sectional epidemiological study in which 60 children from six to 10 years of age were evaluated in three public schools of Itaúna-MG. They were classified by BMI/age, and their parents answered a questionnaire about demographic data, medical and family history, lifestyle, and semi quantitative food frequency. The data were evaluated with the aid of the Excel and SPSS software. Statistical tests for logistic and linear multiple regressions were used. Results: the prevalence of overweight, eutrophy, and low weight, identified by BMI/age, amounted to 21.6% (p = 13),76.7% (p = 46), and 1.7% (p = 1), respectively. Overweight was independently associated with maternal obesity (p = 0.004). A direct association was found between BMI and maternal obesity (p = 0.02), intake of breads (p = 0.03) and snacks such as chips (p = 0.08), and an inverse association was observed between BMI and yogurt (p = 0.007) and ice cream (p = 0.09) intake. Conclusion: the prevalence of overweight found in the studied population was high demonstrating the importance of more attention to this aspect because it can be associated with potentially modifiable factors, such as dietetics.

Caffeine in the treatment of pain.

BACKGROUND AND OBJECTIVES: Caffeine is a widely used substance with effects on several systems, presenting characteristic of pharmacokinetic and pharmacodynamic which cause interactions with several drugs. This study's objective is to review the effects caused by caffeine. CONTENT: This review assesses the caffeine pharmacology, its action mechanisms, indications, contraindications, doses, interactions and adverse effects. CONCLUSIONS: There are insufficient double-blind randomized controlled studies that assess the analgesic effect of caffeine on several painful syndromes. Patients presenting chronic pain need caution when it comes to tolerance development, abstinence and drug interaction from chronic caffeine use.

Cafeína para o tratamento de dor / Caffeine in the treatment of pain / Cafeína para el tratamiento del dolor

JUSTIFICATIVA E OBJETIVOS: A cafeína é uma substância amplamente consumida com efeitos em diversos sistemas e que apresenta farmacocinética e farmacodinâmica características, causando interações com diversos medicamentos. O objetivo deste estudo é fazer uma revisão sobre os efeitos da cafeína. CONTEÚDO: Nesta revisão, são abordados a farmacologia da cafeína, os mecanismos de ação, as indicações, as contraindicações, as doses, as interações e os efeitos adversos. CONCLUSÕES: Faltam estudos controlados, randomizados e duplos-cegos para avaliar a eficácia analgésica da cafeína nas diversas síndromes dolorosas. Em pacientes com dor crônica, é necessário ter cautela em relação ao desenvolvimento de tolerância, abstinência e interação medicamentosa no uso crônico de cafeína.

BACKGROUND AND OBJECTIVES: Caffeine is a widely used substance with effects on several systems, presenting characteristic of pharmacokinetic and pharmacodynamic which cause interactions with several drugs. This study's objective is to review the effects caused by caffeine. CONTENT: This review assesses the caffeine pharmacology, its action mechanisms, indications, contraindications, doses, interactions and adverse effects. CONCLUSIONS: There are insufficient double-blind randomized controlled studies that assess the analgesic effect of caffeine on several painful syndromes. Patients presenting chronic pain need caution when it comes to tolerance development, abstinence and drug interaction from chronic caffeine use.

JUSTIFICATIVA Y OBJETIVOS: La cafeína es una sustancia extensamente consumida que posee efectos en diversos sistemas y que presenta una farmacocinética y una farmacodinámica características, causando interacciones con diversos medicamentos. El objetivo de este estudio es hacer una revisión sobre los efectos de la cafeína. CONTENIDO: En esta revisión, abordamos la farmacología de la cafeína, los mecanismos de acción, las indicaciones, las contraindicaciones, las dosis, las interacciones y los efectos adversos. CONCLUSIONES: Faltan estudios controlados, randomizados y doble ciegos para evaluar la eficacia analgésica de la cafeína en los diversos síndromes dolorosos. En los pacientes con dolor crónico, se hace necesario un cuidado especial con relación al desarrollo de la tolerancia, abstinencia y de la interacción medicamentosa en el uso crónico de la cafeína.

WBC count and functional changes induced by co-administration of clofazimine and clarithromycin, in single and multiple doses, in Wistar rats

Clofazimine and clarithromycin are used to treat leprosy and infections caused by Mycobacterium avium complex. Little data on the toxicity of co-administration of these two drugs are available. Here we evaluated the potential adverse effects of polytherapy with these two drugs in male Wistar rats by determining WBCs counts and other blood cell counts, neutrophilic phagocytosis, and burst oxidative, by flow cytometry. We observed an increase in WBCs, in multiple-dose regimens, and in polymorphonuclear cells, in both single- clarithromycin only and multiple dose regimens. We also observed a reduction in mononuclear cell counts in single and multiple doses. The drugs seem to reverse the mononuclear and polymorphonuclear cell ratio. An increase in oxidative burst was observed in animals treated with the drugs administered either individually or combined. In conclusion, clofazimine and clarithromycin change WBCs counts. Our results may contribute for a better understanding of the mechanisms related to the effects of co-administrating the two drugs.

Clofazimina e laritromicina são utilizadas no tratamento da hanseníase e em infecções causadas pelo complexo Mycobacterium avium. Devido à escassez de dados sobre a toxicidade de esquemas terapêuticos que associam estes fármacos, este estudo teve por objetivo avaliar os efeitos adversos desta terapia, em ratos machos Wistar, por meio da determinação da contagem global e específica de leucócitos e ensaios de fagocitose e burst oxidativo de neutrófilos por citometria de fluxo. Houve aumento do número de leucócitos (dose múltipla) e de células polimorfonucleares (doses única e múltipla) nos grupos tratados com claritromicina em monoterapia ou associada à clofazimina e redução das células mononucleares, em doses única e múltipla, nos mesmos grupos. Os fármacos parecem inverter a proporção entre células mono e polimorfonucleares. Observou-se aumento do burst oxidativo nos animais tratados com os fármacos isolados ou associados. Concluindo, clofazimina e claritromicina provocam alterações leucocitárias e os resultados podem contribuir para melhor entendimento dos mecanismos relacionados aos efeitos da administração dos fármacos em associação.

Whole blood, serum, and saliva lead concentrations in 6- to 8-year-old children.

With increasing evidence of adverse health effects of lower lead levels (below 10microg/dL in whole blood), studies on novel internal dose biomarkers are needed. This study aimed at: (1) assessing the lead exposure by measuring this element in whole blood (Pb-blood), serum (Pb-serum), and 3 different types of saliva: whole (Pb-whole-saliva), submandibular/sublingual (Pb-sub-saliva) and parotid saliva (Pb-parotid-saliva); (2) correlating Pb-blood with Pb-serum; and (3) relating Pb-blood and Pb-serum with the lead found in the different salivas. The study population included 444 children aged 6 to 8 years attending 4 government schools in the district of Campos Eliseos, in Ribeirao Preto, Sao Paulo State, Brazil. Whole blood, serum, parotid, submandibular/sublingual ("sub-saliva"), and whole saliva were collected in trace element-free tubes. Lead concentrations were determined by inductively coupled plasma-mass spectrometry (ICP-MS). Median Pb-blood and Pb-serum were 2.1microg/dL and 0.4microg/L, respectively. Ten percent of the children had Pb-blood between 4.0 and 9.4microg/dL. Boys showed higher Pb-blood than girls (2.3 vs. 2.0microg/dL, p<0.0003). Lead concentrations in whole, sub, and parotid saliva were 1.7, 1.4, and 1.3microg/L, respectively. No significant correlations were found between Pb-blood and Pb-serum, between Pb-blood and lead in the 3 different salivas, or between Pb-serum and Pb-whole-saliva or Pb-sub-saliva. However, there was a weak statistically significant correlation between Pb-serum and Pb-parotid-saliva. In conclusion, the mean Pb-blood concentration was 2.4microg/dL, with 10% of the children exhibiting Pb-blood between 4.0 and 9.4microg/dL. Boys presented higher Pb-blood. Results suggest that Pb-blood has no correlation with Pb-serum or lead in the 3 different salivas collected here. A weak but statistically significant correlation between Pb-serum and Pb-parotid-saliva was found. Our results also point to the need for carrying out more studies on sources of exposure and lead levels in children in Brazil.

Chumbo e anemia / Lead and anemia

O plumbismo é um problema de saúde pública, afetando o desenvolvimento das crianças. O sistema hematológico é um alvo importante da toxicidade do chumbo, comprometendo a síntese do heme e consequentemente causando anemia. Os efeitos sobre o ácido δ-amino levulínico de hidratase (ALAD)são mais marcantes provocando o acúmulo de ácido δ-amino levulínico (ALA) e o aumento do ácido gama aminobutírico (GABA) no sistema nervoso central. A intoxicação do chumbo afeta também a síntese das cadeias globulínicas α e β, o que contribui para o desenvolvimento da anemia. A anemia não é uma manifestação precoce do plumbismo, sendo evidente quando os níveis de chumbo estão elevados por períodos prolongados. A anemia geralmente é anemia hipocrômica normocítica, embora microcitose seja comumente observada, com presença de pontilhado basófilo nos eritrócitos. Recentemente, foi observada maior susceptibilidade ao plumbismo em crianças com deficiência de ferro, sendo sugerido que o ferro é capaz de competir com o chumbo inibindo sua ligação com a proteína transportadora DMT1 (Divalent Metal Transporter1). Na coexistência de deficiência de ferro e intoxicação por chumbo, a anemia é mais severa, com acentuado grau de microcitose e hipocromia, sendo recomendado suplementação de ferro para crianças com risco de intoxicação por chumbo.

The plumbism is a public health problem, affecting the development the children. The hematologic system is a target important from lead poisoning, engaging the heme synthesis causing anemia. The effects above the δ-aminolevulinate acid dehidrathase (ALAD) are very marking causing the accumulationof δ-aminolevulinic acid (ALA) and the increase of γ-acid aminobutyric (GABA) in the nervous system central. The exacerbate lead toxicity demonstrated affect also the synthesis the globulins chains α and β, the one to contributory about to the development from anemia. The anemia isn’t a manifestation precocious of the plumbism, being clear when the levels of lead elevated for prolonged periods. The anemia generally is hypochromic normocytic, the microcytosis may be commonly observed, with presence of basophilic stippling in the erythocytes. Recently, was observed greater susceptibility the plumbism in the children with iron deficiency, being suggested by what the iron is capable of competed with the lead, inhibiting the binding with the transport protein DMT1 (Divalent Metal Transporter 1). In the co-existence of iron deficiency and lead poisoning, the anemia is very severe, with accented degree of microcytosis and hypochromia, being recommended iron supplementation to children with risk of lead poisoning.

Dexmedetomidine for awake craniotomy without laryngeal mask.

OBJECTIVE: This paper reports the use of dexmedetomidine in three epileptic patients with cavernous angiomas that underwent awake surgery in order to map their speech areas. METHOD: Loading dose of dexmedetomidine varied from 1 microg/Kg/h to 3 microg/Kg/h over 20 minutes and maintenance dose from 0.4 microg/Kg/h to 0.8 microg/Kg/h. RESULTS: There was no occurrence of hemodynamic instability, convulsions or respiratory depression. Patients tolerated well the procedure. CONCLUSION: Dexmedetomidine was useful for awake craniotomy as it decreased patients level of consciousness but did not produce agitation. Laryngeal mask was not necessary to keep air ventilation.

Os princípios da Lei Complementar 141/2012

Aborda os princípios básicos da Lei Complementar n. 141/2012, que trata acerca dos valores mínimos aplicados em serviços públicos de saúde. Material produzido para utilização no curso "Responsabilidades gestoras no último ano de mandato" ofertado pela Universidade Aberta do Sistema Único de Saúde (UNA-SUS).

Lei Complementar 141/2012 [Despesas com ações e serviços públicos de saúde]

Baseado na Lei Complementar 141/2012, elenca os critérios utilizados para a transferência de valores pela União aos Estados, Distrito Federal e municípios para o investimento em saúde pública. Trata, também, da transparência quanto às contas da saúde, bem como sua fiscalização. Material produzido para utilização no curso "Responsabilidades gestoras no último ano de mandato" fornecido pela Universidade Aberta do Sistema Único de Saúde (UNA-SUS).

Lei Complementar 141/2012 [Despesas com Ações e Serviços Públicos de Saúde: artigo 3º da Lei 141]

Discorre sobre as ações que são consideradas como despesas em serviços públicos de saúde, sob enfoque do artigo 3º da Lei Complementar 141. Material produzido para utilização no curso "Responsabilidades gestoras no último ano de mandato" fornecido pela Universidade Aberta do Sistema Único de Saúde (UNA-SUS).

Lei Complementar 141/2012 [Despesas não consideradas como gastos em ações e serviços públicos de saúde : artigo 4º da Lei 141]

Elenca as atividades que não são consideradas despesas com ações e serviços públicos de saúde, sob enfoque do artigo 4º da Lei Complementar 141. Material produzido para utilização no curso "Responsabilidades gestoras no último ano de mandato" fornecido pela Universidade Aberta do Sistema Único de Saúde (UNA-SUS).

Lei Complementar 141/2012 [Publicidade e participação social na fiscalização das despesas em saúde]

Dispõe sobre os procedimentos e mecanismos utilizados para a fiscalização dos recursos aplicados na saúde pública. Material produzido para utilização no curso "Responsabilidades gestoras no último ano de mandato" fornecido pela Universidade Aberta do Sistema Único de Saúde (UNA-SUS).