RESUMO
In situ tender X-ray absorption near-edge structure (XANES) spectroscopy at the P K-edge was utilized to investigate the oxidation mechanism of aqueous H3PO3 on Pt electrodes under various conditions relevant to high-temperature polymer electrolyte membrane fuel cell (HT-PEMFC) applications. XANES and electrochemical analysis were conducted under different tender X-ray irradiation doses, revealing that intense radiation induces the oxidation of aqueous H3PO3 via H2O yielding H3PO4 and H2. A broadly applicable experimental procedure was successfully developed to suppress these undesirable radiation-induced effects, enabling a more accurate determination of the aqueous H3PO3 oxidation mechanism. In situ XANES studies of aqueous 5 mol dm-3 H3PO3 on electrodes with varying Pt availability and surface roughness reveal that Pt catalyzes the oxidation of aqueous H3PO3 to H3PO4. This oxidation is enhanced upon applying a positive potential to the Pt electrode or raising the electrolyte temperature, the latter being corroborated by complementary ion-exchange chromatography measurements. Notably, all of these oxidation processes involve reactions with H2O, as further supported by XANES measurements of aqueous H3PO3 of different concentrations, showing a more pronounced oxidation in electrolytes with a higher H2O content. The significant role of water in the oxidation of H3PO3 to H3PO4 supports the reaction mechanisms proposed for various chemical processes observed in this work and provides valuable insights into potential strategies to mitigate Pt catalyst poisoning by H3PO3 during HT-PEMFC operation.
RESUMO
Humanitarian crises can occur in places affected by chemical, physical, biological, and social threats, especially when these threats interact with each other and cause a syndemic. In order to avoid crises in these places, it is necessary to introduce mitigation measures that we have framed as "humanitarian scenarios". Due to their nature, implementation of these interventions requires the creation of multidisciplinary operational groups with a work strategy that integrates them into the affected community. In the case of the child population, the operational group was called the 'childhood risks in contaminated places' (CRCP) unit; contaminated places meaning localities impacted by chemical, physical, or biological threats. The strategy has six phases: (i) planning the survey and site visit; (ii) community involvement in identifying threats, vulnerabilities, and routes of exposure (the path of pollutants from their source to the receiving population), and in preparing joint work for the subsequent phases; iii) prioritization of risks identified through environmental monitoring and use of biomarkers of exposure and effects; iv) risk prevention through the creation of various 'capacities and alternatives for the prevention of syndemic threats'; (v) advocacy to implement these capacities and alternatives through risk communication and local training; and (vi) protection through measures that include telehealth, social progress, and innovation to improve health coverage. The strategy has been implemented in different contexts, and in some of them it has been enriched by analysis of respect for human rights.
Crises humanitárias podem ocorrer em locais afetados por ameaças químicas, físicas, biológicas e sociais, principalmente quando essas ameaças interagem entre si e causam uma sindemia. Para evitar as crises, é necessário introduzir nesses locais medidas de mitigação que enquadramos no termo "cenários humanitários". Por sua natureza, a implementação de tais ações de intervenção exige a formação de grupos operacionais multidisciplinares e de uma estratégia de trabalho que permita integrá-los à comunidade afetada. No caso da população infantil, o grupo operacional recebeu o nome de Unidade de Riscos Infantis em Áreas Contaminadas (na sigla em espanhol, RISC), ou seja, em locais impactados por ameaças químicas, físicas ou biológicas. A estratégia consiste nas seis fases a seguir: i) planejamento para o estudo e visita ao local; ii) participação da comunidade para identificar ameaças, vulnerabilidades e rotas de exposição (caminho que os contaminantes devem seguir desde a sua fonte até a população receptora), bem como para o trabalho conjunto nas fases seguintes; iii) priorização dos riscos identificados por meio do monitoramento ambiental e uso de biomarcadores de exposição e efeitos; iv) prevenção de riscos por meio da criação de diversas capacidades e alternativas para a prevenção diante de ameaças sindêmicas (CAPAS); v) promoção da implantação das CAPAS por meio da comunicação de riscos e capacitação local; e vi) proteção com medidas que incluem propostas de telessaúde, progresso social e inovação para melhorar a cobertura de saúde. A estratégia foi aplicada em diferentes contextos, em alguns dos quais foi enriquecida com uma análise do respeito pelos direitos humanos.
RESUMO
The adsorption of OH on Pt(111) in alkaline solution has been investigated by a method that combines density functional theory, molecular dynamics, and quantum statistical mechanics. In particular, we have calculated the free energy surface for the reaction. A physisorbed hydroxide ion in a metastable state and a stable adsorbed uncharged OH group are observed. The energy of activation at equilibrium is comparatively low, so that the reaction is fast.
RESUMO
The oxidation of the aqueous H3PO3 in contact with Pt was investigated for a fundamental understanding of the Pt/aqueous H3PO3 interaction with the goal of providing a comprehensive basis for the further optimization of high-temperature polymer electrolyte membrane fuel cells (HT-PEMFCs). Ion-exchange chromatography (IEC) experiments suggested that in ambient conditions, Pt catalyzes H3PO3 oxidation to H3PO4 with H2O. X-ray photoelectron spectroscopy (XPS) on different substrates, including Au and Pt, previously treated in H3PO3 solutions was conducted to determine the catalytic abilities of selected metals toward H3PO3 oxidation. In situ ambient pressure hard X-ray photoelectron spectroscopy (AP-HAXPES) combined with the "dip-and-pull" method was performed to investigate the state of H3PO3 at the Pt|H3PO3 interface and in the bulk solution. It was shown that whereas H3PO3 remains stable in the bulk solution, the catalyzed oxidation of H3PO3 by H2O to H3PO4 accompanied by H2 generation occurs in contact with the Pt surface. This catalytic process likely involves H3PO3 adsorption at the Pt surface in a highly reactive pyramidal tautomeric configuration.
RESUMO
In patients with chronic Chagas' cardiomyopathy, there are forms of the disease that affect the electrical conduction system almost exclusively. The most common disorders include right bundle branch block alone or in association with left anterior fascicular block. We present an unusual case of a patient with Chagas' cardiomyopathy in association with a preexcitation syndrome.
Assuntos
Feixe Acessório Atrioventricular/diagnóstico , Feixe Acessório Atrioventricular/cirurgia , Ablação por Cateter/métodos , Doença de Chagas/diagnóstico , Doença de Chagas/cirurgia , Síndromes de Pré-Excitação/diagnóstico , Síndromes de Pré-Excitação/cirurgia , Feixe Acessório Atrioventricular/complicações , Doença de Chagas/complicações , Diagnóstico Diferencial , Eletrocardiografia/métodos , Humanos , Achados Incidentais , Masculino , Pessoa de Meia-Idade , Síndromes de Pré-Excitação/etiologiaRESUMO
BACKGROUND: Chagas' disease is an endemic disease in most Latin American countries. The cardiomyopathy associated with this condition often requires permanent pacing due to bradycardia. The aim of this study was to compare the indications for pacemaker implantation, intraoperative measurements, and long-term follow-up of patients with Chagas' cardiomyopathy (ChCM) and ischemic cardiomyopathy (ICM) referred for pacemaker implantation. METHODS: Retrospective study including consecutive patients with ChCM (Group 1) and ICM (Group 2), who underwent pacemaker implantation in a single center. RESULTS: We analyzed 360 patients. Patients in Group 1 were younger (66.29 ± 7.01 vs 75.3 ± 7.11 years; P = 0.0001) and more often male (72% vs 60%; P = 0.05). Sinus node dysfunction (SND) was more prevalent in Group 1 (70% vs 52%; P = 0.03). Atrioventricular block was less prevalent in Group 1 (30% vs 48%; P = 0.04). No significant differences were found with respect to left ventricular ejection fraction (54.2 ± 9.1 vs 53.4 ± 8.2%; P = NS) and baseline QRS duration (119 ± 34 vs 108 ± 29 ms; P = NS). Right bundle branch block was more frequent in Group 1 (44% vs 12%; P = 0.0001), and left bundle branch block in Group 2 (6% vs 22%; P = 0.0001). Implantation time was longer in Group 1 (39 ± 19 vs 29 ± 13 minutes; P = 0.001) and was with higher atrial and ventricular pacing thresholds (1.4 ± 0.8 vs 1.0 ± 0.5 V; P = 0.001 and 1.2 ± 0.8 vs 0.6 ± 0.8 V; P = 0.001, respectively). During a follow-up of 42.8 ± 13.6 months, Group 1 had a higher incidence of new atrial fibrillation (34% vs 25.5%; P = 0.001), and there was a nonsignificant trend toward more displacements of the ventricular lead (6% vs 3.5%; P = 0.3). There were no deaths during the follow-up. CONCLUSIONS: ChCM patients receiving pacemakers are younger and more frequently have SND compared to those with ICM. Pacemaker implant is longer in patients with ChCM disease and is with higher pacing thresholds. The incidence of new atrial fibrillation during the follow-up is significantly higher in patients with ChCM.
Assuntos
Estimulação Cardíaca Artificial/métodos , Doenças Cardiovasculares/parasitologia , Doenças Cardiovasculares/terapia , Doença de Chagas/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença de Chagas/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do TratamentoRESUMO
AIMS: The aim of this study was to report the short- and long-term results of slow pathway radiofrequency (RF) ablation in patients with atrioventricular (AV) nodal reentrant tachycardia (AVNRT) using a simplified approach (2 catheters and short applications of RF). MATERIALS AND METHODS: This was a retrospective study that included consecutive patients with AVNRT. We used an anatomical approach with only 2 catheters. Decremental AV nodal conduction and atrial-His conduction interval jump were measured. To detect the onset of the QRS, we used surface lead II. During the stimulation protocol, we performed S2-QRS and S3-QRS measurements. An increase in the S3-QRS3 interval of 50 milliseconds or greater in response to a decrease in the S2-QRS2 coupling interval of 10 milliseconds was defined as a discontinuous AV nodal function curve and taken as evidence of dual antegrade AV pathways. Atrioventricular nodal reentrant tachycardia was demonstrated by the presence of dual AV nodal physiology, atrial echoes, and tachycardia induction with a 1:1 AV relationship and a VA interval of less than 70 milliseconds. Short RF applications (10-15 seconds) were delivered at an intermediate point between the posteroseptal and medioseptal regions of the Koch triangle. The applications were considered effective when junctional rhythm appeared. The end point was the demonstration of slow pathway modification without AVNRT induction. RESULTS: Three hundred forty-four patients (age, 49.22 ± 17.47 years; 254 were female) were included. Discontinuous AV nodal function curves were found in 271 patients (78.77%), and short-term success was achieved in all patients. The anterograde jump in AV nodal conduction was abolished after RF in 222 patients (81.91%), and discontinuous AV nodal conduction and single AV nodal echo beats persisted in 49 cases (18%). The mean number of RF application was 7.79 ± 2.23, the mean number of effective applications was 4.63 ± 0.62, and the mean RF application time was 54.92 ± 8.03 seconds. The total procedure and fluoroscopy time was 29.45 ± 9.6 and 10.87 ± 2.36 minutes, respectively. After the procedure, all patients were followed up for a mean of 46.44 ± 18.89 months, and 7 patients (2%) presented AVNRT recurrences. Complications were observed in 4 patients (1.16%); no permanent AV block was observed. CONCLUSION: In this study, slow pathway RF ablation using a simplified approach technique is an effective and safe approach for the treatment of AVNRT.
Assuntos
Ablação por Cateter/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Taquicardia por Reentrada no Nó Atrioventricular/epidemiologia , Taquicardia por Reentrada no Nó Atrioventricular/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Argentina/epidemiologia , Ablação por Cateter/métodos , Criança , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prevalência , Medição de Risco , Fatores de Risco , Taquicardia por Reentrada no Nó Atrioventricular/diagnóstico , Resultado do Tratamento , Adulto JovemRESUMO
Brugada syndrome is a clinical-electrocardiographic entity predisposing to malignant ventricular arrhythmias. The typical arrhythmia is polymorphic ventricular tachycardia, which can potentially degenerate to ventricular fibrillation. Monomorphic ventricular tachycardia is uncommon. Our group is reporting the case of a 39-year-old man with known Brugada syndrome who developed ventricular flutter while febrile. Fever has previously been shown to unmask Brugada changes and to induce ventricular arrhythmias. The appearance of monomorphic ventricular tachycardia potentially attributable to sodium-channel dysfunction further confounds the mechanism of arrhythmogenesis in Brugada syndrome. This curious occurrence further underlines the likely complex nature of arrhythmogenesis in Brugada syndrome.
Assuntos
Síndrome de Brugada/complicações , Síndrome de Brugada/diagnóstico , Eletrocardiografia/métodos , Febre/complicações , Febre/diagnóstico , Flutter Ventricular/diagnóstico , Adulto , Humanos , Masculino , Flutter Ventricular/etiologiaRESUMO
Catecholaminergic polymorphic ventricular tachycardia is a familial cardiac arrhythmia that is related to RYR2 or CASQ2 gene mutation. It occurs in patients with structurally normal heart and causes exercise-emotion triggered syncope and sudden cardiac death. We present a 13 year-old girl with recurrent episodes of exercise-related syncope and prior history of sudden death in a first degree relative.
RESUMO
Atrial Fibrillation (AF) is the most important risk factor for stroke and thromboembolic events (TE). The aims of this study were to determine the prevalence of AF among patients with permanent pacemakers (PPM), the percentage of anticoagulated patients and the prevalence on TE in this population. The secondary purpose was to determine the "level of knowledge" about indications of anticoagulation for AF patients. This was a descriptive and retrospective study on a consecutive series of patients referred for PPM implantation. Cardiovascular risk factors, indications for pacing, prior history of AF, TE and anticoagulation indication were analyzed. In order to determine possible causes for not indicating anticoagulation, an electronic survey was sent to all doctors that usually refer patients for PPM implant and follow-up to our clinic. Among 934 patients, 26% (244) presented AF of which 34% were anticoagulated. 77.3% presented a CHADS2 score of > or = 2 while only 2% had absolute contraindication for anticoagulation. The prevalence of TE was 9%. More than 60% of the doctors answered the survey. More than 40% acknowledged the CHADS, score but only 33% were able to recognize all variables included in the score and 23% were able to determine when to indicate anticoagulation properly. A low anticoagulation rate was detected among patients with AF and PPM with a high prevalence of TE and stroke. An extremely low adherence to international guidelines was detected among doctors that usually deal with this sort of patients.
Assuntos
Anticoagulantes/uso terapêutico , Fibrilação Atrial/epidemiologia , Marca-Passo Artificial , Padrões de Prática Médica/estatística & dados numéricos , Trombofilia/tratamento farmacológico , Administração Oral , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/administração & dosagem , Fibrilação Atrial/complicações , Fibrilação Atrial/terapia , Contraindicações , Coleta de Dados , Uso de Medicamentos , Eletrocardiografia , Feminino , Fidelidade a Diretrizes , Humanos , Masculino , Guias de Prática Clínica como Assunto , Prevalência , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Tromboembolia/epidemiologia , Tromboembolia/etiologia , Trombofilia/etiologiaRESUMO
Systemic sclerosis is a complex disease that affects the connective tissue, the vascular system and the immune system. It typically produces skin and organ fibrosis. Cardiac bundle branch blocks and fascicular blocks occur in 25-75% of the cases and were found to be independent predictors of mortality. Second and third degree atrioventricular block are very rare. We present the case of a 47 year-old female with diagnosis of systemic sclerosis, presented with syncope secondary to complete atrioventricular block requiring permanent pacemaker implantation.
Assuntos
Bloqueio Atrioventricular/etiologia , Escleroderma Sistêmico/complicações , Síncope/etiologia , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
Propafenone, a Class IC antiarrhythmic drug, is an orally active sodium channel-blocking agent. It is effective in supraventricular tachyarrhythmias and is particularly useful in converting atrial fibrillation to sinus rhythm. In therapeutic doses, it may cause non-cardiac and cardiac toxicity, including proarrhythmia.
RESUMO
The title compounds exhibit a K2NiF4-type layered perovskite structure; they are based on the La1.2Sr0.8InO4+δ oxide, which was found to exhibit excellent features as fast oxide-ion conductor via an interstitial oxygen mechanism. These new Ba-containing materials were designed to present a more open framework to enhance oxygen conduction. The citrate-nitrate soft-chemistry technique was used to synthesize such structural perovskite-type materials, followed by annealing in air at moderate temperatures (1150 °C). The subtleties of their crystal structures were investigated from neutron powder diffraction (NPD) data. They crystallize in the orthorhombic Pbca space group. Interstitial O3 oxygen atoms were identified by difference Fourier maps in the NaCl layer of the K2NiF4 structure. At variance with the parent compound, conspicuous oxygen vacancies were found at the O2-type oxygen atoms for x = 0.2, corresponding to the axial positions of the InO6 octahedra. The short O2-O3 distances and the absence of steric impediments suggest a dual oxygen-interstitial mechanism for oxide-ion conduction in these materials. Conductivity measurements show that the activation energy values are comparable to those typical of ionic conductors working by simple vacancy mechanisms (~1 eV). The increment of the total conductivity for x = 0.2 can be due to the mixed mechanism driving both oxygen vacancies and interstitials, which is original for these potential electrolytes for solid-oxide fuel cells.
Assuntos
Estimulação Cardíaca Artificial , Bloqueio Cardíaco/etiologia , Bloqueio Cardíaco/prevenção & controle , Traumatismos da Medula Espinal/complicações , Fraturas da Coluna Vertebral/complicações , Síncope/etiologia , Síncope/prevenção & controle , Adulto , Bloqueio Cardíaco/diagnóstico , Humanos , Masculino , Traumatismos da Medula Espinal/diagnóstico , Fraturas da Coluna Vertebral/diagnóstico , Síncope/diagnóstico , Resultado do TratamentoRESUMO
[RESUMEN]. Las crisis humanitarias pueden presentarse en sitios afectados por amenazas químicas, físicas, biológicas y sociales, sobre todo cuando estas amenazas interaccionan entre sí y causan una sindemia. A fin de evitar las crisis, en estos sitios se hace necesario introducir medidas de mitigación que hemos enmarcado bajo el término de “escenarios humanitarios”. Debido a su naturaleza, la implementación de dichas acciones de intervención requiere de la conformación de grupos operativos multidisciplinarios y de una estrategia de trabajo que permita integrarlos con la comunidad afectada. En el caso de la población infantil, el grupo ope- rativo recibió el nombre de unidad de riesgos infantiles en sitios contaminados (RISC), es decir, en localidades impactadas por amenazas químicas, físicas o biológicas. La estrategia consta de las siguientes seis fases: i) planificación para el estudio y la visita al sitio; ii) participación de la comunidad para identificar amena- zas, vulnerabilidades y rutas de exposición (el camino que deben seguir los contaminantes desde su fuente hasta la población receptora), así como para el trabajo conjunto en las siguientes fases; iii) priorización de riesgos identificados mediante el monitoreo ambiental y uso de biomarcadores de exposición y efectos; iv) prevención de riesgos a través de la creación de diversas capacidades y alternativas para la prevención ante amenazas sindémicas (CAPAS); v) promoción para implementar las CAPAS mediante la comunicación de riesgos y la capacitación local; y vi) protección con medidas que incluyen propuestas de telesalud, progreso social e innovación para mejorar la cobertura sanitaria. La estrategia ha sido aplicada en diferentes contextos, en algunos de los cuales, ha sido enriquecida con el análisis del respeto de los derechos humanos.
[ABSTRACT]. Humanitarian crises can occur in places affected by chemical, physical, biological, and social threats, espe- cially when these threats interact with each other and cause a syndemic. In order to avoid crises in these places, it is necessary to introduce mitigation measures that we have framed as "humanitarian scenarios". Due to their nature, implementation of these interventions requires the creation of multidisciplinary operational groups with a work strategy that integrates them into the affected community. In the case of the child popula- tion, the operational group was called the ‘childhood risks in contaminated places’ (CRCP) unit; contaminated places meaning localities impacted by chemical, physical, or biological threats. The strategy has six phases: (i) planning the survey and site visit; (ii) community involvement in identifying threats, vulnerabilities, and routes of exposure (the path of pollutants from their source to the receiving population), and in preparing joint work for the subsequent phases; iii) prioritization of risks identified through environmental monitoring and use of bio- markers of exposure and effects; iv) risk prevention through the creation of various ‘capacities and alternatives for the prevention of syndemic threats’; (v) advocacy to implement these capacities and alternatives through risk communication and local training; and (vi) protection through measures that include telehealth, social pro- gress, and innovation to improve health coverage. The strategy has been implemented in different contexts, and in some of them it has been enriched by analysis of respect for human rights.
[RESUMO]. Crises humanitárias podem ocorrer em locais afetados por ameaças químicas, físicas, biológicas e sociais, principalmente quando essas ameaças interagem entre si e causam uma sindemia. Para evitar as crises, é necessário introduzir nesses locais medidas de mitigação que enquadramos no termo “cenários huma- nitários”. Por sua natureza, a implementação de tais ações de intervenção exige a formação de grupos operacionais multidisciplinares e de uma estratégia de trabalho que permita integrá-los à comunidade afe- tada. No caso da população infantil, o grupo operacional recebeu o nome de Unidade de Riscos Infantis em Áreas Contaminadas (na sigla em espanhol, RISC), ou seja, em locais impactados por ameaças químicas, físicas ou biológicas. A estratégia consiste nas seis fases a seguir: i) planejamento para o estudo e visita ao local; ii) participação da comunidade para identificar ameaças, vulnerabilidades e rotas de exposição (caminho que os contaminantes devem seguir desde a sua fonte até a população receptora), bem como para o trabalho conjunto nas fases seguintes; iii) priorização dos riscos identificados por meio do monitoramento ambiental e uso de biomarcadores de exposição e efeitos; iv) prevenção de riscos por meio da criação de diversas capacidades e alternativas para a prevenção diante de ameaças sindêmicas (CAPAS); v) promoção da implantação das CAPAS por meio da comunicação de riscos e capacitação local; e vi) proteção com medi- das que incluem propostas de telessaúde, progresso social e inovação para melhorar a cobertura de saúde. A estratégia foi aplicada em diferentes contextos, em alguns dos quais foi enriquecida com uma análise do respeito pelos direitos humanos.
Assuntos
Saúde da Criança , Contaminação Química , Medição de Risco , Direito à Saúde , Vulnerabilidade Social , Saúde da Criança , Poluição do Ar , Direito à Saúde , Vulnerabilidade Social , Saúde da Criança , Poluição do Ar , Medição de Risco , Direito à Saúde , Vulnerabilidade SocialRESUMO
RESUMEN Las crisis humanitarias pueden presentarse en sitios afectados por amenazas químicas, físicas, biológicas y sociales, sobre todo cuando estas amenazas interaccionan entre sí y causan una sindemia. A fin de evitar las crisis, en estos sitios se hace necesario introducir medidas de mitigación que hemos enmarcado bajo el término de "escenarios humanitarios". Debido a su naturaleza, la implementación de dichas acciones de intervención requiere de la conformación de grupos operativos multidisciplinarios y de una estrategia de trabajo que permita integrarlos con la comunidad afectada. En el caso de la población infantil, el grupo operativo recibió el nombre de unidad de riesgos infantiles en sitios contaminados (RISC), es decir, en localidades impactadas por amenazas químicas, físicas o biológicas. La estrategia consta de las siguientes seis fases: i) planificación para el estudio y la visita al sitio; ii) participación de la comunidad para identificar amenazas, vulnerabilidades y rutas de exposición (el camino que deben seguir los contaminantes desde su fuente hasta la población receptora), así como para el trabajo conjunto en las siguientes fases; iii) priorización de riesgos identificados mediante el monitoreo ambiental y uso de biomarcadores de exposición y efectos; iv) prevención de riesgos a través de la creación de diversas capacidades y alternativas para la prevención ante amenazas sindémicas (CAPAS); v) promoción para implementar las CAPAS mediante la comunicación de riesgos y la capacitación local; y vi) protección con medidas que incluyen propuestas de telesalud, progreso social e innovación para mejorar la cobertura sanitaria. La estrategia ha sido aplicada en diferentes contextos, en algunos de los cuales, ha sido enriquecida con el análisis del respeto de los derechos humanos.
ABSTRACT Humanitarian crises can occur in places affected by chemical, physical, biological, and social threats, especially when these threats interact with each other and cause a syndemic. In order to avoid crises in these places, it is necessary to introduce mitigation measures that we have framed as "humanitarian scenarios". Due to their nature, implementation of these interventions requires the creation of multidisciplinary operational groups with a work strategy that integrates them into the affected community. In the case of the child population, the operational group was called the 'childhood risks in contaminated places' (CRCP) unit; contaminated places meaning localities impacted by chemical, physical, or biological threats. The strategy has six phases: (i) planning the survey and site visit; (ii) community involvement in identifying threats, vulnerabilities, and routes of exposure (the path of pollutants from their source to the receiving population), and in preparing joint work for the subsequent phases; iii) prioritization of risks identified through environmental monitoring and use of biomarkers of exposure and effects; iv) risk prevention through the creation of various 'capacities and alternatives for the prevention of syndemic threats'; (v) advocacy to implement these capacities and alternatives through risk communication and local training; and (vi) protection through measures that include telehealth, social progress, and innovation to improve health coverage. The strategy has been implemented in different contexts, and in some of them it has been enriched by analysis of respect for human rights.
RESUMO Crises humanitárias podem ocorrer em locais afetados por ameaças químicas, físicas, biológicas e sociais, principalmente quando essas ameaças interagem entre si e causam uma sindemia. Para evitar as crises, é necessário introduzir nesses locais medidas de mitigação que enquadramos no termo "cenários humanitários". Por sua natureza, a implementação de tais ações de intervenção exige a formação de grupos operacionais multidisciplinares e de uma estratégia de trabalho que permita integrá-los à comunidade afetada. No caso da população infantil, o grupo operacional recebeu o nome de Unidade de Riscos Infantis em Áreas Contaminadas (na sigla em espanhol, RISC), ou seja, em locais impactados por ameaças químicas, físicas ou biológicas. A estratégia consiste nas seis fases a seguir: i) planejamento para o estudo e visita ao local; ii) participação da comunidade para identificar ameaças, vulnerabilidades e rotas de exposição (caminho que os contaminantes devem seguir desde a sua fonte até a população receptora), bem como para o trabalho conjunto nas fases seguintes; iii) priorização dos riscos identificados por meio do monitoramento ambiental e uso de biomarcadores de exposição e efeitos; iv) prevenção de riscos por meio da criação de diversas capacidades e alternativas para a prevenção diante de ameaças sindêmicas (CAPAS); v) promoção da implantação das CAPAS por meio da comunicação de riscos e capacitação local; e vi) proteção com medidas que incluem propostas de telessaúde, progresso social e inovação para melhorar a cobertura de saúde. A estratégia foi aplicada em diferentes contextos, em alguns dos quais foi enriquecida com uma análise do respeito pelos direitos humanos.
Assuntos
Humanos , Criança , Socorro em Desastres , Proteção da Criança , Vulnerabilidade a Desastres , Poluentes Ambientais , Sindemia , Direito à SaúdeRESUMO
El intervalo QT representa la actividad eléctrica ventricular, tanto la despolarización como la repolarización. Definimos como intervalo QT prolongado a una medida del QT corregido > 450 ms en varones y > 470 ms en mujeres. Se diferencian 2 grandes grupos dentro del síndrome del QT prolongado: el congénito, asociado con mutaciones en determinados genes, y la variante adquirida. El síndrome de QT prolongado es un conjunto de entidades infrecuentes que se manifiestan en el ECG por la prolongación del intervalo QT y la predisposición a la taquicardia ventricular polimórfica. Una de las principales etiologías del síndrome de QT congénito adquirido es el uso de fármacos prolongadores del intervalo QT. En la actualidad la lista de fármacos que pueden prolongarlo a dosis terapéuticas es amplia y está en continuo crecimiento. La prolongación del intervalo QT puede predisponer a la aparición de taquicardia ventricular polimórfica grave denominada torcida de puntas (TdP), cuya aparición no es muy frecuente, pero es causa de muerte súbita. En el presente reporte presentamos un caso de desarrollo de torcida de puntas debido a uso de amitriptilina
Assuntos
Síndrome do QT LongoRESUMO
In this paper, our group reports the use of a new framework in sites contaminated with mercury. This is significant because under the Minamata Convention on Mercury each Party shall endeavor to develop appropriate strategies for identifying and assessing sites contaminated by mercury or mercury compounds. This new approach, the "CHILD" framework has five steps: i) Community-based risk characterization; ii) Habilitation; iii) Intervention; iv) Laws and Regulation; and v) Development. We are using this framework in three mercury artisanal mining sites, and preliminary results are depicted in this report.
Assuntos
Exposição Ambiental , Monitoramento Ambiental/métodos , Poluentes Ambientais/análise , Mercúrio/análise , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mineração , Exposição Ocupacional , Adulto JovemRESUMO
An 18- year old woman with hypertrophic cardiomyopathy, aborted sudden cardiac death and implanted with an implantable cardioverter defibrillator (ICD), developed progressive fragmentation of her surface 12-lead electrocardiogram (ECG). During the follow-up, she presented with multiple appropriate ICD discharges. Here, we discuss the possible association between surface fragmented ECG and the risk of ventricular arrhythmias in patients with hypertrophic cardiomyopathy.