Rastreamento da hipersensibilidade metálica pelos profissionais e estudantes de saúde na prática clínico-cirúrgica / Seguimiento de la hipersensibilidad metálica por profesionales y estudiantes de salud en la práctica clínico-quirúrgica / Screening of metallic hypersensitivity by health professionals and students in clinical-surgical practice

Objetivo: investigar o rastreamento da hipersensibilidade metálica realizada pelos profissionais e estudantes de saúde durante a prática clínico-cirúrgico. Método: estudo exploratório-descritivo realizado com 228 profissionais e estudantes da área da saúde, por meio de questionário eletrônico semiestruturado, aplicado durante abril e maio de 2021, analisado por meio da estatística descritiva e da frequência de palavras. Resultados: 11,0% dos participantes realizaram a investigação sobre a hipersensibilidade metálica. 67,1% declararam que muito provavelmente poderiam incluir essa temática durante a triagem em seus atendimentos. Falta de conhecimento sobre alergia a metais e causas multifatoriais durante a prática clínico-cirúrgica foram citadas como barreiras para a implementação do rastreamento da hipersensibilidade metálica. Conclusão: pouco se evidencia o rastreamento da hipersensibilidade metálica em pacientes durante a prática clínico-cirúrgica dos profissionais e estudantes de saúde.

Objetivo: investigar el rastreo de la hipersensibilidad metálica realizada por los profesionales y estudiantes de salud durante la práctica clínico-quirúrgica. Método: estudio exploratorio-descriptivo realizado con 228 profesionales y estudiantes del área de la salud, por medio de cuestionario electrónico semiestructurado, aplicado durante abril y mayo de 2021, analizado por medio de la estadística descriptiva y de la frecuencia de palabras. Resultados: 11,0% de los participantes realizaron la investigación sobre la hipersensibilidad metálica. El 67,1% declaró que muy probablemente podrían incluir esa temática durante la selección en sus atenciones. La falta de conocimientos sobre la alergia a los metales y las causas multifactoriales durante la práctica clínico-quirúrgica se citaron como barreras para la implementación del seguimiento de la hipersensibilidad metálica. Conclusión: poco se evidencia el rastreo de la hipersensibilidad metálica en pacientes durante la práctica clínico-quirúrgica de los profesionales y estudiantes de salud.

Objective to investigate the screening of metallic hypersensitivity performed by health professionals and students during clinical-surgical practice. Method: an exploratory-descriptive study conducted with 228 health professionals and students, through a semi-structured electronic questionnaire, applied during April and May 2021, analyzed through descriptive statistics and the frequency of words. Results: 11.0% of participants conducted research on metallic hypersensitivity. 67.1% stated that they could very likely include this theme during screening in their care. Lack of knowledge about metal allergy and multifactorial causes during clinical-surgical practice were cited as barriers to the implementation of metallic hypersensitivity screening. Conclusion: there is little evidence of metallic hypersensitivity screening in patients during the clinical-surgical practice of health professionals and students.

Efeitos tóxicos à saúde humana e ao ambiente causados pelo derramamento de rejeitos de minério da barragem de Fundão / Toxic effects to human health and the environment caused by the spillage of ore tailings from the Fundão dam

Objetivo: analisar as evidências científicas existentes até o presente momento que descrevem os efeitos tóxicos causados à saúde humana e ao ambiente, devido à liberação dos rejeitos de minério, decorrentes do rompimento da barragem de Fundão em Mariana - MG. Métodos: a revisão narrativa da literatura baseou-se na busca de artigos em quatro bases de dados: PubMed, SciELO, Science Direct e LILACS, utilizando os descritores "Dam", "Fundão" e "Mariana" junto com o operador booleano "AND". Resultados: trinta e quatro das oitenta e cinco publicações encontradas atenderam aos critérios de inclusão e foram utilizadas para compor a presente revisão. Foram observados os seguintes efeitos tóxicos: contaminação da água e do solo, principalmente, por metais pesados, potencial genotóxico, citotóxico e mutagênico da água, diminuição da diversidade microbiana, contaminação de peixes, perda da vegetação e prejuízos ao metabolismo de crescimento de plantas. Entre esses metais, foi relatado aumento na concentração de ferro, manganês, cobre, cádmio, chumbo, arsênio, cromo, magnésio, alumínio, mercúrio, cobalto, bário, níquel e selênio. Além disso, o desastre promoveu o aumento no número de casos de doenças humanas, como dengue, doenças respiratórias, dermatológicas, intestinais, psicológicas e comportamentais. Conclusão: todas as evidências científicas expostas na presente revisão sugerem que houve a contaminação ambiental, bem como da população local, por agentes tóxicos presentes nos rejeitos de minério, em especial metais pesados, liberados após o rompimento da barragem de Fundão. Assim, torna-se essencial a realização de mais estudos que visem esclarecer os efeitos tóxicos crônicos decorrentes dos rejeitos de minério liberados ao ambiente.

Objective: to analyze the scientific evidence existing to date that describes the toxic effects caused to human and the environmental health, due to the release of ore tailings, resulting from the rupture of the Fundão dam in Mariana-MG. Methods: the narrative literature review was based on a search for articles in four databases: PubMed, SciELO, Science Direct and LILACS, using the descriptors "Dam", "Fundão" and "Mariana" together with the Boolean operator "AND". Results: thirty-four, of the eighty-five publications found, met the inclusion criteria and were used to compose the present review. The following toxic effects were observed: contamination of water and soil mainly by heavy metals, genotoxic, cytotoxic and mutagenic potential of water, decrease in microbial diversity, contamination of fish, loss of vegetation, and impairment of plant growth metabolism. Among these metals, increased concentrations of iron, manganese, copper, cadmium, lead, arsenic, chromium, magnesium, aluminum, mercury, cobalt, barium, nickel and selenium were reported. In addition, the disaster promoted an increase in the number of cases of human diseases, such as dengue, respiratory, dermatological, intestinal, psychological and behavioral diseases. Conclusion: all the scientific evidence exposed in the present review that there was environmental contamination, as well as of the local population, by toxic agents present in the ore tailings, especially heavy metals, released after the collapse of the Fundão dam. Thus, further studies aimed at clarifying the chronic toxic effects resulting from the ore tailings released into the environment are essential.

Chronic kidney disease of non-traditional origin in Mesoamerica: a disease primarily driven by occupational heat stress

[ABSTRACT]. The death toll of the epidemic of chronic kidney disease of nontraditional origin (CKDnt) in Mesoamerica runs into the tens of thousands, affecting mostly young men. There is no consensus on the etiology. Anecdotal evidence from the 1990s pointed to work in sugarcane; pesticides and heat stress were suspected. Subsequent population-based surveys supported an occupational origin with overall high male-female ratios in high-risk lowlands, but small sex differences within occupational categories, and low prevalence in non-workers. CKDnt was reported in sugarcane and other high-intensity agriculture, and in non-agricultural occupations with heavy manual labor in hot environments, but not among subsistence farmers. Recent studies with stronger designs have shown cross-shift changes in kidney function and hydration biomarkers and cross-harvest kidney function declines related to heat and workload. The implementation of a water-rest-shade intervention midharvest in El Salvador appeared to halt declining kidney function among cane cutters. In Nicaragua a water-rest-shade program appeared sufficient to prevent kidney damage among cane workers with low-moderate workload but not among cutters with heaviest workload. Studies on pesticides and infectious risk factors have been largely negative. Non-occupational risk factors do not explain the observed epidemiologic patterns. In conclusion, work is the main driver of the CKDnt epidemic in Mesoamerica, with occupational heat stress being the single uniting factor shown to lead to kidney dysfunction in affected populations. Sugarcane cutters with extreme heat stress could be viewed as a sentinel occupational population. Occupational heat stress prevention is critical, even more so in view of climate change.

[RESUMEN]. La mortalidad por la epidemia de enfermedad renal crónica de origen no tradicional (ERCnt) en Mesoamérica asciende a decenas de miles de personas, principalmente hombres jóvenes. No existe consenso sobre su etiología. En la década de 1990, informes anecdóticos apuntaban como factor de riesgo al trabajo en plantaciones de caña de azúcar; se consideró como posibles causantes a los plaguicidas y el estrés térmico. Estudios de prevalencia de base poblacional subsiguientes apoyaron un origen ocupacional, con una proporción elevada de hombres respecto de las mujeres en las tierras bajas donde el riesgo era elevado, pero con pequeñas diferencias de sexo dentro de las categorías ocupacionales y baja prevalencia en el ámbito no laboral. Se reportó ERCnt en los trabajadores de la caña de azúcar y otros cultivos con alta exigencia física y en ocupaciones no agrícolas que implican trabajo manual intenso en ambientes calurosos, pero no entre los agricultores de subsistencia. Estudios recientes con diseños más sólidos han demostrado cambios en la función renal y en los biomarcadores de hidratación en el curso de los turnos laborales, y disminución de la función renal relacionada con el calor y la carga de trabajo en el curso de la cosecha. La implementación de una intervención basada en la provisión de agua, descanso y sombra a mitad de la cosecha en El Salvador detuvo la disminución de la función renal en los cortadores de caña. En Nicaragua, un programa de provisión de agua, descanso y sombra evitó la lesión renal en los trabajadores de la caña con una carga de trabajo baja y moderada, pero no entre los cortadores, quienes tienen la mayor carga de trabajo. Los estudios sobre plaguicidas y factores de riesgo infecciosos han sido en gran medida negativos. Los factores de riesgo no ocupacionales no explican los patrones epidemiológicos observados. En conclusión, el trabajo es el principal desencadenante de la epidemia de ERCnt en Mesoamérica, y el estrés térmico ocupacional es el único factor que consistentemente conduce a la disfunción renal en las poblaciones afectadas. Los cortadores que trabajan en los ingenios azucareros y están expuestos a un estrés térmico extremo podrían ser considerados una población ocupacional centinela. La prevención del estrés térmico ocupacional es crítica, más aún si se consideran los efectos del cambio climático.

[RESUMO]. A mortalidade devida à epidemia de doença renal crônica de origem não tradicional (DRCnt) na Mesoamérica atinge dezenas de milhares de pessoas, principalmente homens jovens. Não há consenso sobre a sua etiologia. Na década de 1990, informações empíricas apontavam o trabalho em plantações de cana de açúcar como um fator de risco; pesticidas e estresse térmico também eram considerados causas possíveis. As pesquisas populacionais subsequentes sustentam uma origem ocupacional da doença, com uma elevada proporção de homens quando comparados à de mulheres, em areas de baixa altitude, onde o risco da doença é mais elevado, mas com pequenas diferenças de gênero quando se consideram as categorias ocupacionais e baixa prevalência no ambiente não-ocupacional. A DRCnt foi identificada em trabalhadores agrícolas da cana de açúcar e de outras culturas que exigem trabalho físico de alta intensidade e em ocupações não agrícolas envolvendo um trabalho manual intenso em ambientes quentes, mas não entre os agricultores de subsistência. Estudos recentes com desenhos mais robustos demonstraram mudanças na função renal e nos biomarcadores de hidratação ao longo dos turnos de trabalho, e diminuição da função renal relacionada à exposição ao calor e à carga de trabalho ao longo da colheita. A implementação de uma intervenção de água-descanso-sombra durante a colheita em El Salvador interrompeu o declínio da função renal em cortadores de cana. Na Nicarágua, intervenções água-descanso-sombra parecem ter sido suficientes para evitar lesões renais em trabalhadores canavieiros com cargas de trabalho baixa e moderada, mas não entre os cortadores de cana que têm carga de trabalho mais pesada. Estudos sobre exposição a pesticidas e a fatores de risco de origem infecciosa têm sido largamente negativos. Os fatores de risco não-ocupacionais não explicam os padrões epidemiológicos observados. Em conclusão, ocupação é o principal desencadeador da epidemia de DRCnt na Mesoamérica, e o estresse térmico ocupacional é o único fator comprovado que leva à disfunção renal nas populações afetadas. Os cortadores de cana que trabalham em engenhos de açúcar e expostos a um estresse térmico extremo podem ser considerados uma população ocupacional sentinela. A prevenção do estresse térmico ocupacional é crítica, especialmente considerando os efeitos das mudanças climáticas.

Renal damage associated with heavy metals: review work / Daño renal asociado a metales pesados: trabajo de revisión

Abstract Catheter-associated infection is an entity with multiple complications, a condition that alters the quality of life of all patients Chronic kidney disease (CKD) represents an important health problem in the entire global population, where knowledge of the environmental factors associated with this disease is currently essential for its prevention. Several heavy metals are recognized, including Cadmium (Cd), Lead (Pb), Arsenic (As) and Mercury (Hg), which are clearly associated with renal damage and progression of CKD. Studies in animals and humans primarily demonstrate a clear association between exposure to these metals and the presence of chronic renal damage, where the pathophysiology of each of these metals is important in understanding the mechanism of renal damage. The present review aims to analyze the pathophysiology and clinical manifestations of the nephrotoxicity associated with these metals, as well as the different studies in both humans and animals that have been performed.

Resumen La enfermedad renal crónica (ERC) representa un importante problema de salud en todo el globo. Actualmente, es esencial para su prevención el conocimiento de los factores ambientales asociados con la enfermedad. Se reconocen diversos metales pesados, entre los que destacan el cadmio (Cd), plomo (Pb), arsénico (As) y mercurio (Hg), que están claramente asociados con la lesión renal y la progresión de la ERC. Estudios en animales y humanos demuestran, principalmente, una clara asociación entre la exposición a estos metales y la presencia de daño renal crónico, donde la fisiopatologia de cada uno de ellos es importante para entender el mecanismo de daño renal. La presente revisión tiene como objetivo analizar, tanto la fisiopatología y manifestaciones clínicas de la nefrotoxicidad asociada a dichos metales, como los diferentes estudios que se han realizado en humanos y animales.

Impact of free thyroxine levels and other clinical factors on bare metal stent restenosis

ABSTRACT Objective Thyroid hormones have both direct and indirect effects on thermogenesis such as modulating vascular smooth muscle cell proliferation. However, the influence of more subtle changes in thyroid hormones on coronary atherosclerosis remains a matter of speculation. Smooth muscle cells play a crucial role in the pathogenesis of in-stent restenosis (ISR). However, the relationship between free thyroxine (fT4) and ISR has not been studied. In the present study, we aimed to assess the role of preprocedural serum fT4 level on the development of ISR in patients undergoing coronary bare metal stent (BMS) implantation. Materials and methods We enrolled and analyzed clinical, biochemical, and angiographic data from 705 consecutive patients without a history of primary thyroid disease [mean age 60.3 ± 9.3 years, 505 (72%) male]; all patients had undergone BMS implantation and further control coronary angiography owing to stable or unstable angina pectoris. Patients were divided into 3 tertiles based on preprocedural serum fT4 levels. Results ISR was observed in 53 (23%) patients in the lowest tertile, 82 (35%) patients in the second tertile, and 107 (46%) patients in the highest fT4 tertile (p < 0.001). Using multiple logistic regression analysis, five characteristics emerged as independent predictors of ISR: diabetes mellitus, smoking, HDL-cholesterol, stent length, and preprocedural serum fT4 level. In receiver operating characteristics curve analysis, fT4 level > 1.23 mg/dL had 70% sensitivity and 73% specificity (AUC: 0.75, p < 0.001) in predicting ISR. Conclusion Higher preprocedural serum fT4 is a powerful and independent predictor of BMS restenosis in patients with stable and unstable angina pectoris.

Brachiopods, sipunculans, enteropneusts and metals from two estuarine tidal flats, Pacific, Costa Rica / Braquiópodos, sipuncúlidos, enteropneustos y metales en dos planicies estuarinas de marea, Pacífico, Costa Rica

Abstract:Reports on the abundances and on metal concentrations in intertidal estuarine invertebrates from the Eastern Tropical Pacific are rare. Thus, the objectives of this report are to make accessible data on the abundances (1984-1987, 49 dates; 2013, 12 dates) of sipunculans, brachiopods and hemichordates from a sand-mud flat; and on trace metals (1996, 2000) and abundances (2015, 3 dates) of sipunculans and brachiopods at a sand flat in the Gulf of Nicoya estuary (10o N-85o W). Cores (17.7 cm2) were collected at the sand-mud flat, and quadrats (0.2 m2) at the sand flat. The flats contrasted in their sand (65 % vs 90 %) and silt+clay (31.5 % vs 5.6 %) contents. At the sand-mud flat (1984-87: 1.83 m2) the sipunculans were represented by 13 individuals, the brachiopods by 129 and the acorn worms by 185, with estimated maximum densities of: 5.7, 29, and 40 ind./m2, respectively. Trace metal (Fe, Mn, Ni, Cr, Cd, Zn, and Pb) analysis (Atomic Absorption Spectrometry) were conducted in specimens of Sipunculus nudus (Sipuncula) and Glottidia audebarti (Brachiopoda). Maximum mean concentrations in S. nudus were: For non-depurated worms, Fe (16.0 mg/g dw) > Mn (165 µg/g dw) > Zn (81 µg/g dw) > Cu (26 µg/g dw) > Cr (11 µg/g dw) > Ni (10.4 µg/g dw) > Pb (9.3 µg/g dw) > Cd (1.2 µg/g dw). For 72 hour depurated worms: Fe (5.0 mg/g dw) > Mn (61 µg/g dw) > Zn (39 µg/g dw) > Cu (24 µg/g dw) > Ni (8.4 µg/g dw) > Pb (2.7 µg/g dw) > Cd (0.62 µg/g dw). For G. audebarti: Fe (1.6 mg/g dw-soft parts) > Zn (123.5 µg/g dw-soft parts) > Cu (31.4 µg/g dw-pedicles) > Pb (21.0 µg/g dw-shells) > Cd (5.2 µg/g dw-soft parts) > Cr (4.7 µg/g dw-shells). For sediments; Fe (46 mg/g dw) > Mn (41.3 µg/g dw) > Zn (63 µg/g dw) > Cu (36.2 µg/g dw) > Cr (31.5 µg/g dw) > Pb (21.1 µg/g dw) > Ni (16.1 µg/g dw) > Cd (1.1 µg/g dw). These concentrations were expected for a nonindustrialized estuary. At the sand flat (Area sampled: 10.6 m2 ) 76 individuals of G. audebarti, 112 of G. albida, and 366 of S. nudus were collected in 2015, with estimated maximum densities of: 7.1, 10.5, and 31 ind./m2, respectively. Densities of G. audebarti and G. albida were relatively low, while those of S. nudus were relatively high when compared with other reports. The shell lenght of G. audebarti ranged from 9.0 mm to 38.0 mm and from 6.0 mm to 29.0 mm for G. albida. These ranges were within those found for these lingulides elsewhere. The mean length of S. nudus was 41 mm and the maximum weight was 1.6 g, which are small. No brachiopods were found at the sand-mud flat in 2013, nor enteropneusts at the sand flat in 2015. G. audebarti had a relatively stable presence, while G. albida almost vanished from the samples at the end of 2015. The spatial distributions of the three invertebrates were found aggregated at both intertidal flats. Strong ENSO warming events during 1983 and 2015, and red tides in 1985 may have influenced the abundances. Rev. Biol. Trop. 64 (3): 1311-1331. Epub 2016 September 01.

ResumenSon raros los reportes sobre las abundancias y concentraciones de metales en invertebrados estuarinos de la zona de entre-mareas del Pacífico Este Tropical. Los objetivos de este informe son el hacer accesibles datos sobre las abundancias (1984-1987, 49 fechas; 2013, 12 fechas) de sipuncúlidos, braquiópodos y hemicordados en una planicie arenoso-fangosa y sobre metales traza (1996, 2000) y abundancias (2015, 3 fechas) de sipuncúlidos y braquiópodos en una planicie arenosa en el estuario del Golfo de Nicoya (10o N-85o W). Barrenos (17.7 cm2) fueron recolectados en la planicie arenoso-fangosa y cuadrantes (0.2 m2) en la arenosa. Las planicies contrastaron en sus contenidos de arena (65 % vs 90 %) y de limo + arcilla (31.5 % vs 5.6 %). En la planicie arenoso-fangosa (1984-87: 1.83 m2) los sipuncúlidos estuvieron representados por 13 individuos, los braquiópodos por 129 y los hemicordados enteropneustos por 185, con densidades estimadas de: 5.7, 29, y 40 ind. /m2, respectivamente. Análisis de metales traza (Fe, Mn, Ni, Cr, Cd, Zn, y Pb) por Espectrometría de Absorción Atómica (AAS) fueron hechos en especímenes de Sipunculus nudus (Sipuncula) y Glottidia audebarti (Brachiopoda). Concentraciones máximas promedio en S. nudus fueron: para gusanos no-depurados, Fe (16.0 mg/g dw) > Mn (165 µg/g dw) > Zn (81 µg/g dw) > Cu (26 µg/g dw) > Cr (11 µg/g dw) > Ni (10.4 µg/g dw) > Pb (9.3 µg/g dw) > Cd (1.2 µg/g dw). Para gusanos depurados por 72 horas: Fe (5.0 mg/g dw) > Mn (61 µg/g dw) > Zn (39 µg/g dw) > Cu (24 µg/g dw) > Ni (8.4 µg/g dw) > Pb (2.7 µg/g dw) > Cd (0.62 µg/g dw). Para G. audebarti: Fe (1.6 mg/g dw-partes suaves) > Zn (123.5 µg/g dw-partes suaves) > Cu (31.4 µg/g dwpedículos) > Pb (21.0 µg/g dw-conchas) > Cd (5.2 µg/g dw-partes suaves) > Cr (4.7 µg/g dw-conchas). Para sedimentos; Fe (46 mg/g dw) > Mn (41.3 µg/g dw) > Zn (63 µg/g dw) > Cu (36.2 µg/g dw) > Cr (31.5 µg/g dw) > Pb (21.1 µg/g dw) > Ni (16.1 µg/g dw) > Cd (1.1 µg/g dw). Estas concentraciones fueron esperables para un estuario no industrializado. En la planicie arenosa (Area muestreada: 10.6 m2) 76 individuos de G. audebarti, 112 de G. albida y 366 de S. nudus fueron recolectados en el 2015, con densidades estimadas de: 7.1, 10.5, y 31 ind. /m2, respectivamente. Densidades de G. audebarti y G. albida fueron relativamente bajas, mientras que las de S. nudus fueron relativamente altas cuando se les comparó con otros reportes. La longitud de la concha de G. audebarti varió entre 9.0 mm y 38.0 mm y entre 6.0 mm a 29.0 mm la de G. albida. Estos ámbitos estuvieron dentro de los encontrados para estos lingúlidos en otros sitios. La longitud promedio de S. nudus fue 41 mm y el peso máximo fue de 1.6 g que son pequeños. En la planicie arenoso-fangosa no se encontró braquiópodos en el 2013, ni enteropneustos en la planicie arenosa en el 2015. G. audebarti tuvo una presencia relativamente estable, mientras que G. albida casi desapareció de las muestras al final del 2015. La distribución espacial de las tres especies fue de tipo agregado en ambas planicies. Fuertes eventos ENSO durante 1983 y 2015, así como mareas rojas en 1985, pueden haber influenciado las abundancias.

A Single-Institution Experience with Metallic Ureteral Stents: A Cost-Effective Method of Managing Deficiencies in Ureteral Drainage

IntroductionThe limitations of traditional ureteral stents in patients with deficiencies in ureteral drainage have resulted in frequent stent exchanges. The implementation of metallic stents was introduced to improve the patency rates of patients with chronic upper urinary tract obstruction, obviating the need for frequent stent exchanges. We report our clinical experiences with the use of metallic ureteral stents in the management of poor ureteral drainage.Materials and MethodsFifty patients underwent metallic ureteral stent placement from 2009 to 2012. Stent failure was defined as an unplanned stent exchange, need for nephrostomy tube placement, increasing hydronephrosis with stent in place, or an elevation in serum creatinine. Stent life was analyzed using the Kaplan-Meier methodology, as this was a time dependent continuous variable. A cost analysis was similarly conducted.ResultsA total of 97 metallic stents were placed among our cohort of patients: 63 in cases of malignant obstruction, 33 in the setting of cutaneous ureterostomies, and 1 in an ileal conduit urinary diversion. Overall, stent failure occurred in 8.2% of the stents placed. Median stent life was 288.4 days (95% CI: 277.4-321.2 days). The estimated annual cost for traditional polymer stents (exchanged every 90 days) was $9,648-$13,128, while the estimated cost for metallic stents was $4,211-$5,313.ConclusionOur results indicate that metallic ureteral stent placement is a technically feasible procedure with minimal complications and is well tolerated among patients. Metallic stents can be left in situ for longer durations and provide a significant financial benefit when compared to traditional polymer stents.

Afectaciones a la salud por efecto de metales tóxicos en la población de Xochitlán, Hidalgo, México / Affectations of health by toxic metals in population of Xochitlán, Hidalgo, Mexico

Determinar niveles de bioacumulación de metales (Cd, Cr, Pb y Al) en tejidos y fluidos corporales de los habitantes de Xochitlán, Estado de Hidalgo, ha sido el objetivo de este estudio. Con vistas a realizar valoraciones de riesgo y probables daños a la salud de sus pobladores, se inició el estudio con una caracterización sociodemográfica, con pobladores de entre seis y 90 años de edad. Como criterio de exclusión se consideró: malformaciones congénitas, padecimientos inmunosupresivos y menos de cinco años de residencia en la localidad. Se presentó una pirámide poblacional invertida; de un total de 1947 habitantes, la población de entre 10 y 19 años ocupa el centro de la pirámide, que adelgaza en los extremos de la vida (5 > X > 60 años). Se ha propuesto una metodología, combinada con los lineamientos establecidos por la Agencia Para Sustancias Tóxicas y Registro de Enfermedades (ATSDR 2000) y la Agencia de Protección Ambiental de Estados Unidos (U.S. EPA 2005) y adicionando un instrumento de encuesta (anamnesis clínica) para la caracterización de individuos y poblaciones con amplio enfoque clínico. De la interrelación de concentraciones de metales en fluidos y tejidos con aspectos de riesgos ambientales, se podrá decantar un diagnóstico situacional actual, retrospectivo y una visión a futuro sobre el comportamiento de la contaminación y su impacto en factores de salud. La bioacumulación de metales evaluados estuvo presente entodos los fluidos y tejidos de los pobladores seleccionados de entre seis y 90 años de edad. Se ha encontrado relación entre estos resultados y los de estudios previos de acumulación de metales en aguas, suelos y cultivos.

To determine levels of metal bio accumulation (Cd, Cr, Pb and Al) in weaves and corporal fluids of the inhabitants of Xochitlán, Hidalgo, has been the objective of this study. With a view to realising valuations of risk and probable damages to the health of its settlers, the study with a sociodemographic characterization began, with settlers between six and 90 years of age. As exclusion criterion were considered, congenital malformations, immuno suppressive sufferings and less than five years of residence in the locality. An inverted population pyramid appeared; of a total of 1947 inhabitants, the population between 10 and 19 years occupies the center of the pyramid, that thins in the ends of the life (5> X> 60 years). A methodology, combined with the established by the ATSDR and the EPA has seted out and adding an instrument of survey (clinical anamnesis) for the characterization of individuals and populations with ample clinical approach. Of the interrelation of flowed and woven metal concentrations in, with aspects of environmental risks it will be possible to be poured off a present, retrospective situational diagnosis and a vision to future, on the behavior of the contamination and its impact in health factors. The evaluated metal bio accumulation was present in all the fluids and weaves of the settlers selected between six and 90 years of age. One has been a relation between these results and those of previous studies of metal accumulation in waters, grounds and cultures.

Clinical variables related with in-stent restenosis late regression after bare metal coronary stenting

In-stent restenosis (ISR) has an incidence between 20% and 30% using bare metal stents. ISR late regression phenomenon (ISRLR) has been previously described, but clinical variables related with this phenomenon remain unclear. The aim of the study was to identify the variables related with ISRLR. METHODS: We identified from our data base 30 patients between November 1995 and September 2002 that fulfilled the following criteria: 1) Documented ISR at follow-up angiography (CA-1); 2) treated medically; and 3) Referred for a second follow-up angiography (CA-2). at least 3 months after CA-1. ISRLR was defined as a > 0.2 mm increase in MLD between CA-1 and CA-2, calculated as the 2-fold of our inter-observer variability. ISR late progression was defined as a > 0.2 mm decrease in minimum lumen diameter (MLD) between CA-1 and CA-2. RESULTS: At the time of CA-2 only 2 patients (6.7%) had symptoms related with the previously stented vessel. We found a mean MLD of 1.03+/-0.34 mm and 1.54+/-0.48 mm at CA-1 and CA-2 respectively (AMLD = 0.51 +/-0.34 mm; p < 0.001). Twenty four patients (80.0%) had ISRLR. Two variables were related to the presence or absence ISRLR: Current smoking at the time of coronary stenting (70.8% vs 20.0% respectively, p = 0.026) and acute coronary syndrome as clinical indication for coronary stenting (and 83.5% vs 40.0% respectively, p = 0.029). CONCLUSION: ISRLR is a frequent phenomenon in patients with ISR treated medically, probably contributing to the benign long-term clinical outcome that has been previously described in patients with asymptomatic or mildly symptomatic ISR. Current smoking at the time of coronary stenting and acute coronary syndrome as clinical indication for coronary stenting are associated with this phenomenon.

Avaliaçäo da exposiçäo profissional a fumos metálicos em operaçöes de solda / Evaluation of the ocupational exposure to metallic fumes in welding

Foi realizada amostragem de fumos metálicos na zona respiratória de quatro de soldadores e em um grupo de prensistas näo expostos a fumos metálicos. As concentraçöes de metais obtidas foram comparadas com os limites de tolerância propostos pela American Conference of Governmental Industrial Hygienists - ACGIH - e adaptados à nossa jornada de trabalho. As concentraçöes encontradas estäo próximas dos limites de tolerância, sendo enfatizada e discutida a dificuldade de decidir se estäo acima ou abaixo do limite. O nível de exposiçäo é comparado com os níveis de metais no sangue e na urina encontrados abaixo dos limites de tolerância biológica. Säo evidenciadas a necessidade de se amostrar o ar dentro do elmo, próximo ao nariz do soldador, e a impraticabilidade de um limite de tolerância gravimétrico único para a presente situaçäo

Lesoes produzidas por agentes quimicos nas industrias de galvanoplastia. / Injuries due to chemical agents in galvanoplastic industries

O presente artigo apresenta uma descricao das caracteristicas de alguns quimicos, que se constituem nas materias-primas utilizadas nos processos de galvanoplastia, relacionando-os aos seus provaveis efeitos toxicos produzidos no organismo humano