Anamnesis ambiental como parte de la consulta pediátrica: estudio piloto / Environmental history-taking as part of pediatric consultations: a pilot study

Introducción. La salud ambiental infantil es la rama de la pediatría que estudia la influencia del medioambiente en la salud y la enfermedad de los niños. Las exposiciones ambientales globales representan una seria amenaza para la salud, lo que justifica una mayor investigación y acción. Objetivo. Evaluar la salud ambiental de una muestra de niños que viven en áreas urbanas y rurales de la ciudad de Uruguaiana, Brasil. Población y métodos. Se incluyeron padres/tutores (n = 714) de niños atendidos en el Policlínico Infantil de la Ciudad de Uruguaiana de enero a octubre de 2021, que respondieron la anamnesis ambiental en pediatría (Sociedad Brasileña de Pediatría). Los datos obtenidos se analizaron según la residencia en zona urbana o rural, o el ingreso familiar. Resultados. Al comparar los habitantes de la zona urbana (n = 660) con los de la zona rural (n = 54), verificamos que entre los de la zona rural fue significativamente mayor la actividad con productos químicos (15 % vs. 32,7 %; p = 0,004), vivir cerca de plantación (7,5 % vs. 74,5 %; p <0,001) o con fuente de contaminación (4,8 % vs. 32,7 %; p <0,001), tener perro (62 % vs. 87,3 %; p <0,001), usar plaguicidas (0,6 % vs. 32,7 %; p <0,001) y exposición a contaminación química (2,6 % vs. 18,2 %; p <0,001). En el área urbana predominó la exposición al tránsito de vehículos cerca de la vivienda (85 % vs. 48,1 %; p <0,001), renta media inferior a 3 salarios mínimos (90 %) y baja escolaridad. Conclusión. Realizar la anamnesis ambiental es fundamental para la detección de amenazas ambientales presentes en los lugares donde los niños y adolescentes viven, aprenden, juegan y estudian.

Introduction. Children's environmental health studies the influence of the environment on health and disease in children. Global environmental exposures pose a serious threat to health, warranting further research and action. Objective. To assess the environmental health of a sample of children living in urban and rural areas in Uruguaiana, Brazil. Population and methods. We included parents/legal guardians (n = 714) of children seen at Policlinica Infantil de Uruguaiana between January and October 2021, who completed the environmental history- taking in pediatrics (Brazilian Society of Pediatrics). Collected data were analyzed based on place of residence (urban or rural) or household income. Results. The comparison between inhabitants of the urban area (n = 660) and the rural area (n = 54) established that, among those living in the rural area, activity with chemical substances (15% versus 32.7%; p = 0.004), living near a plantation (7.5% versus 74.5%; p < 0.001) or near a source of contamination (4.8% versus 32.7%; p < 0.001), having a dog (62% versus 87.3%; p < 0.001), using pesticides (0.6% versus 32.7%; p < 0.001), and exposure to chemical contamination (2.6% versus 18.2%; p < 0.001) were significantly higher. In the urban area, exposure to vehicle traffic near the house (85% versus 48.1%; p < 0.001), an average income below 3 minimum wages (90%), and a low level of education predominated. Conclusion. Environmental history-taking is critical for the detection of environmental threats present in the areas where children and adolescents live, learn, play, and study

Consultas por enfermedades respiratorias agudas en la población pediátrica y su relación con el material particulado atmosférico en Bahía Blanca: un estudio ecológico / Consultations for acute respiratory diseases in the pediatric population and their relationship with atmospheric particulate matter in Bahía Blanca: an ecological study

Introducción. El material particulado (PM) es uno de los contaminantes del aire que mayor implicación tienen en la aparición o exacerbación de cuadros respiratorios en niños. Objetivo. Describir las características de las consultas por enfermedades respiratorias agudas en menores de 15 años, los niveles de PM en el aire, y analizar la asociación existente entre ellos en un sector de Bahía Blanca entre abril de 2019 y marzo de 2020. Población y métodos. Estudio ecológico de series temporales y grupos múltiples. Análisis descriptivo de consultas totales, por área, diagnóstico, y del PM. Modelo de correlación y regresión lineal generalizado para determinar la relación entre las variables. Se utilizó el programa SPSS®. Resultados. Se recopilaron 4787 consultas. Un 38,6 % (1846) correspondieron a rinitis y un 21,1 % (1011) a broncoespasmo. El PM de 10 nm (PM10) superó su valor límite el 31 % (115) de los días de estudio y el de 2,5 nm (PM2,5) un 3 % (8). Un aumento del 10 % del PM2,5 demostró incrementos de 1,3 % en las consultas totales; el incremento llegó al 2,1 % en el área más cercana al sector industrial (p <0,05). En esta última, el aumento del 10 % de los valores de PM10 se asoció al aumento del 1,8 % de las consultas (p <0,05). Conclusión. Se demostró asociación positiva entre las consultas por enfermedad respiratoria aguda y los niveles de PM del aire, sobre todo con el PM2,5 y en el área más cercana al sector industrial.

Introduction. Particulate matter (PM) is one of the air pollutants most involved in the onset or exacerbation of respiratory conditions in children. Objective. To describe the characteristics of consultations for acute respiratory diseases in children younger than 15 years and the levels of PM in the air and to analyze their association in a sector of Bahía Blanca between April 2019 and March 2020. Population and methods. Ecological, time-series study with multiple groups. Descriptive analysis of total number of consultations, by area, diagnosis, and PM. Generalized linear correlation and regression model to determine the relationship among variables. The SPSS® software was used. Results. Data from 4787 consultations were collected. Of these, 38.6% (1846) were related to rhinitis and 21.1% (1011), to bronchospasm. PM of 10 nm (PM10) exceeded its limit value on 31% (115) of the study days, and PM of 2.5 nm (PM2.5), on 3% (8). A 10% increase in PM2.5 showed increases of 1.3% in total consultations; the increase reached 2.1% in the area closest to the industrial sector (p < 0.05). In the latter, a 10% increase in PM10 was associated with an increase of 1.8% in consultations (p < 0.05). Conclusion. A positive association was evidenced between consultations for acute respiratory diseases and PM levels in the air, especially with PM2.5 and in the area closest to the industrial sector.

Chronic consumption of contaminated feed with 2 4 dichlorophenoxyacetic acid (2 4 D) herbicide in rodents: effects on male reproductive health / Consumo crônico de ração contaminada com herbicida ácido 2 4 di clorofenoxiacético (2 4 D) em roedores: efeitos na saúde reprodutiva masculina

Introduction: The herbicide 2,4-dichlorophenoxyacetic acid (2,4-D) is one of the most widely used pesticides in the world. There is evidence that this herbicide can induce deleterious effects in non-target organisms, including impairment of reproduction function. Objective: The aim of this study was to evaluate the reproductive effects of the chronic consumption of contaminated feed with 2,4-D in rats using food environmental spraying simulation. Methods: Animals orally exposed received nebulized chow with 2,4-D solution in different concentrations for 180 days: 0 (control - CG), 20.69 (LCG), 34.63 (MCG), or 51.66 ppm day−1 (HCG). Results: Sperm quality was impaired to 2,4-D. The percentage of sperm with progressive movement, number of sperm in the testis and daily sperm production were decreased in all exposed groups to the herbicide compared to CG. Sperm counts in the caput/corpus and cauda epididymis were reduced in MCG and HCG, and sperm transit time was delayed in the epididymis of LCG. There was a negative impact on sperm morphology and plasma membrane integrity in MCG and HCG, respectively. Germ cell exfoliation within the lumen of the seminiferous tubules and epithelial vacuolization in epididymis were found in the HCG. Conclusion: This is the first study to describe the negative impact on male reproductive morphophysiology after chronic exposure to 2,4-D using food nebulization in environmentally relevant concentrations, based on agronomic use of the herbicide. The reproductive injuries identified raise concerns about the impacts of wide population exposure to 2,4-D (AU).

Introdução: O herbicida 2,4- ácido diclorofenoxiacético (2,4-D) é um dos agrotóxicos mais utilizados no mundo. Há evidências de que este herbicida pode induzir efeitos deletérios em organismos não-alvo, incluindo prejuízo na função reprodutiva. Objetivo: O objetivo deste estudo foi avaliar os efeitos reprodutivos do consumo crônico de ração contaminada com 2,4-D em ratos, utilizando simulação de pulverização ambiental de alimentos. Métodos: Animais expostos oralmente receberam ração nebulizada com solução de 2,4-D em diferentes concentrações por 180 dias: 0 (controle - GC), 20,69 (LCG), 34,63 (MCG) ou 51,66 ppm dia−1 (HCG). Resultados: A qualidade espermática foi prejudicada pelo 2,4-D. A porcentagem de espermatozoides com movimento progressivo, número de espermatozoides no testículo e produção diária de espermatozoides foram menores em todos os grupos expostos ao herbicida, quando comparados ao GC. A contagem de espermatozoides na cabeça/corpo e cauda do epidídimo foi reduzida em MCG e HCG, e o tempo de trânsito espermático atrasou no epidídimo em LCG. Houve impacto negativo na morfologia espermática e na integridade da membrana plasmática em MCG e HCG, respectivamente. Esfoliação de células germinativas no lúmen dos túbulos seminíferos e vacuolização epitelial no epidídimo foram encontradas em HCG. Conclusão: Este é o primeiro estudo a descrever o impacto negativo na morfofisiologia reprodutiva masculina após exposição crônica ao 2,4-D, utilizando nebulização de alimentos em concentrações ambientalmente relevantes, com base no uso agronômico do herbicida. As lesões reprodutivas identificadas levantam preocupações sobre os impactos da ampla exposição da população ao 2,4-D (AU).

Heavy metal exposure and renal impairment: A systematic review of observational studies

Background: Environmental exposure to toxins has been strongly implicated in its multi-faceted etiology of chronic kidney disease, a serious public health problem affecting individuals, families, and communities. There is a need to synthesize available studies on the effect of heavy metal exposure on renal function, considering the rising global burden of kidney disease. The objective of this study is to determine the association between exposure to heavy metals and renal disease. Methods: The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) were used to conduct the review. A comprehensive independent search, title, abstract, and full-text screening of available literature on Google Scholar, PubMed, and OAREScience was done between March 2021 and May 2021. The criteria for study inclusion were full-text articles published in English language in the last 20 years (2001-2020), and observational primary human studies reporting the association between heavy metal exposure and renal disease. The Newcastle-Ottawa Quality Assessment Scale was used to assess the quality of the included studies. Results: A total of 552 studies were identified following the search from the different databases. A total of 13 studies were finally included in the review. Heavy metals implicated in the studies include cadmium, lead, mercury, and arsenic, with ten studies showing environmental exposure as the primary source. Ten (10) studies showed an association between heavy metal exposure and renal impairment (p<0.05) while only 3 studies reported no association. Conclusion: Environmental monitoring is needed to stem the tide of heavy metal exposure in view of the growing burden of chronic kidney disease.

Occupational health and safety challenges among artisanal and small-scale diamond miners in Kimberley, South Africa

Background: Artisanal and small-scale mining (ASM) is a laborious process often executed with rudimentary low-technology mining equipment. It exposes miners to a myriad of occupational hazards, which may increase health and safety disparities between them and formally employed mine workers. Objectives: The objectives of the study were to identify workplace hazards and the associated risks; and to assess the effects of mining activities on the health and environment of artisanal diamond miners in Kimberley, Northern Cape province. Methods: This was an interdisciplinary observational ethnographic study. A workplace assessment was undertaken at seven sites in Kimberley. Participants were conveniently selected; snowballing was used to recruit additional participants. Field notes were recorded from observations. Interview questions included those about the duration of artisanal mining, and the risks faced in the workplace. Data collection included photographic documentation. An inductive and deductive process was used to analyse the data and thematic analysis was conducted. Results: The observed occupational hazards included physical (ultraviolet radiation exposure, injuries due to trauma), respiratory (silica dust exposure), biomechanical (heavy lifting, repetitive movement), and psychological (work-related stress, anxiety) hazards. There was a paucity of access to, and use of, personal protective equipment (PPE). Workers improvised ways to protect themselves, e.g. by using cloths as masks. There was no recourse to formal occupational health services and social safety networks. Conclusion: Occupational health and safety challenges included physical, biomechanical, respiratory, and psychosocial hazards. The mining activities had a detrimental impact on the environment.

Characteristics and Differences of Household Fine Particulate Matter Pollution Caused by Fuel Burning in Urban and Rural Areas in China / 中国医学科学院学报

Objective To explore the overall level,distribution characteristics,and differences in household fine particulate matter (PM2.5) pollution caused by fuel burning in urban and rural areas in China. Methods The relevant articles published from 1991 to 2021 were retrieved and included in this study.The data including the average concentration of household PM2.5 and urban and rural areas were extracted,and the stoves and fuel types were reclassified.The average concentration of PM2.5 in different areas was calculated and analyzed by nonparametric test. Results The average household PM2.5 concentration in China was (178.81±249.91) μg/m3.The mean household PM2.5 concentration was higher in rural areas than in urban areas[(206.08±279.40) μg/m3 vs. (110.63±131.16) μg/m3;Z=-5.45,P<0.001] and higher in northern areas than in southern areas[(224.27±301.66) μg/m3 vs.(130.11±140.61) μg/m3;Z=-2.38,P=0.017].The north-south difference in household PM2.5 concentration was more significant in rural areas than in urban areas[(324.19±367.94) μg/m3 vs.(141.20±151.05) μg/m3,χ2=-5.06,P<0.001].The PM2.5 pollution level showed differences between urban and rural households using different fuel types (χ2=92.85,P<0.001),stove types (χ2=74.42,P<0.001),and whether they were heating (Z=-4.43,P<0.001).Specifically,rural households mainly used solid fuels (manure,charcoal,coal) and traditional or improved stoves,while urban households mainly used clean fuels (gas) and clean stoves.The PM2.5 concentrations in heated households were higher than those in non-heated households in both rural and urban areas (Z=-4.43,P<0.001). Conclusions The household PM2.5 pollution caused by fuel combustion in China remains a high level.The PM2.5 concentration shows a significant difference between urban and rural households,and the PM2.5 pollution is more serious in rural households.The difference in the household PM2.5 concentration between urban and rural areas is more significant in northern China.PM2.5 pollution in the households using solid fuel,traditional stoves,and heating is serious,and thus targeted measures should be taken to control PM2.5 pollution in these households.

Environmental exposure to perchlorate, nitrate, and thiocyanate in relation to chronic kidney disease in the general US population, NHANES 2005-2016 / 中华医学杂志(英文版)

BACKGROUND@#Few studies have explored the impact of perchlorate, nitrate, and thiocyanate (PNT) on kidney function. This study aimed to evaluate the association of urinary levels of PNT with renal function as well as the prevalence of chronic kidney disease (CKD) among the general population in the United States.@*METHODS@#This analysis included data from 13,373 adults (≥20 years) from the National Health and Nutrition Examination Survey 2005 to 2016. We used multivariable linear and logistic regression, to explore the associations of urinary PNT with kidney function. Restricted cubic splines were used to assess the potentially non-linear relationships between PNT exposure and outcomes.@*RESULTS@#After traditional creatinine adjustment, perchlorate (P-traditional) was positively associated with estimated glomerular filtration rate (eGFR) (adjusted β: 2.75; 95% confidence interval [CI]: 2.25 to 3.26; P  < 0.001), and negatively associated with urinary albumin-to-creatinine ratio (ACR) (adjusted β: -0.05; 95% CI: -0.07 to -0.02; P  = 0.001) in adjusted models. After both traditional and covariate-adjusted creatinine adjustment, urinary nitrate and thiocyanate were positively associated with eGFR (all P values <0.05), and negatively associated with ACR (all P values <0.05); higher nitrate or thiocyanate was associated with a lower risk of CKD (all P values <0.001). Moreover, there were L-shaped non-linear associations between nitrate, thiocyanate, and outcomes. In the adjusted models, for quartiles of PNT, statistically significant dose-response associations were observed in most relationships. Most results were consistent in the stratified and sensitivity analyses.@*CONCLUSIONS@#Exposures to PNT might be associated with kidney function, indicating a potential beneficial effect of environmental PNT exposure (especially nitrate and thiocyanate) on the human kidney.

Ambient Fine Particulate Matter Exposure and Blood Pressure: Evidence from a Large Chinese Multiple Follow-Up Study / 生物医学与环境科学（英文）

OBJECTIVE@#This study aimed to investigate the association of ambient PM2.5 exposure with blood pressure (BP) at the population level in China.@*METHODS@#A total of 14,080 participants who had at least two valid blood pressure records were selected from the China Health and Retirement Longitudinal Survey during 2011-2015. Their long-term PM2.5 exposure was assessed at the geographical level, on the basis of a regular 0.1° × 0.1° grid over China. A mixed-effects regression model was used to assess associations.@*RESULTS@#Each decrease of 10 μg/m3 in the 1 year-mean PM2.5 concentration (FPM1Y) was associated with a decrease of 1.24 [95% confidence interval (CI): 0.84-1.64] mmHg systolic BP (SBP) and 0.50 (95% CI: 0.25-0.75) mmHg diastolic BP (DBP), respectively. A robust association was observed between the long-term decrease in PM2.5 and decreased BP in the middle-aged and older population. Using a generalized additive mixed model, we further found that SBP increased nonlinearly overall with FPM1Y but in an approximately linear range when the FPM1Y concentration was < 70 µg/m3; In contrast, DBP increased approximately linearly without a clear threshold.@*CONCLUSION@#Efficient control of PM2.5 air pollution may promote vascular health in China. Our study provides robust scientific support for making the related air pollution control policies.

Ambient fine particulate matter and cardiopulmonary health risks in China / 中华医学杂志(英文版)

In China, the level of ambient fine particulate matter (PM 2.5 ) pollution far exceeds the air quality standards recommended by the World Health Organization. Moreover, the health effects of PM 2.5 exposure have become a major public health issue. More than half of PM 2.5 -related excess deaths are caused by cardiopulmonary disease, which has become a major health risk associated with PM 2.5 pollution. In this review, we discussed the latest epidemiological advances relating to the health effects of PM 2.5 on cardiopulmonary diseases in China, including studies relating to the effects of PM 2.5 on mortality, morbidity, and risk factors for cardiovascular and respiratory diseases. These data provided important evidence to highlight the cardiopulmonary risk associated with PM 2.5 across the world. In the future, further studies need to be carried out to investigate the specific relationship between the constituents and sources of PM 2.5 and cardiopulmonary disease. These studies provided scientific evidence for precise reduction measurement of pollution sources and public health risks. It is also necessary to identify effective biomarkers and elucidate the biological mechanisms and pathways involved; this may help us to take steps to reduce PM 2.5 pollution and reduce the incidence of cardiopulmonary disease.

Concentrações de metais em poeira depositada em casas de trabalhadores informais e domiciliares da cadeia produtiva de joias e bijuterias de Limeira, SP: avaliação de risco à saúde infantil / Metal concentrations in dust deposited in the homes of informal and home-based workers in the jewelry and fashion jewelry production of Limeira, SP: risk assessment for children's health

Introdução: O trabalho informal é acompanhado de diversas particularidades, além do manuseio de produtos químicos sem equipamentos adequados, pode acontecer a exposição passiva de familiares ou amigos próximos, como por exemplo as crianças. Na cidade de Limeira, no interior de São Paulo, há a produção informal de joias e bijuterias, envolvendo atividades que vão desde a montagem de peças até a solda. Objetivos: este estudo avaliou a exposição de crianças à poeiras contendo metais, nas residências de trabalhadores informais e domiciliares da cadeia produtiva de joias e bijuterias de Limeira. Método: foram coletadas amostras de poeira com lenços eletrostáticos em 21 domicílios do grupo exposto e 23 do grupo controle e determinados os Elementos Potencialmente Tóxicos (EPT) Cr, Sn, Mn, Ni, Cu, Zn, Cd, Pb e As, nos ambientes. As análises foram realizadas no Instituto de Pesquisas Tecnológicas do Estado de São Paulo (IPT), por ICP-MS. Também, foram cedidos os resultados das concentrações de EPT no sangue de uma subamostra de crianças, presentes na população de estudo, pela coordenadora do projeto (KPKO). Resultados: As concentrações de Cr, Mn, Ni, Cu, Zn, As, Cd e Sn na poeira doméstica foram significativamente maiores no grupo exposto (<0,05), assim como as concentrações de Pb e Cd no sangue das crianças do grupo exposto (<0,05). As concentrações de EPT na poeira doméstica e no sangue das crianças apresentaram correlação moderada para Cr (Coeficiente de Correlação de Spearman (Rho) 0,40), Zn (Rho -0,43) e As (Rho 0,40), e uma forte correlação para Cd (Rho 0,80) (p <0,05). Conclusões: Os resultados do estudo apontaram riscos para a exposição infantil ao Cd, As e Cr durante a produção informal e doméstica de joias e bijuterias, salientando a importância de proteger a saúde infantil através da promoção de ações de segurança. Adicionalmente, os lenços eletrostáticos se mostraram ferramentas de baixo custo e eficazes para avaliação da exposição a EPT.

Introduction: Informal work is followed by several particularities, besides the handling of chemicals without proper equipment, there may happen the passive exposure of family members or close friends, such as children. In the city of Limeira, in the interior of São Paulo, there is informal jewelry production, involving activities ranging from assembling pieces to welding. Objectives: This study evaluated the exposure of children to dust containing metals in the homes of informal and home-based workers in the jewelry production industry in Limeira. Method: dust samples were collected with electrostatic cloths from 21 households in the exposed group and 23 in the control group, and the Potentially Toxic Elements (PTE) Cr, Sn, Mn, Ni, Cu, Zn, Cd, Pb, and As were determined in the environments. The analyses were carried out at the Technological Research Institute of the State of São Paulo (IPT), by ICP-MS. Also, the results of PTE concentrations in the blood of a subsample of children, present in the study population, were provided by the project coordinator (KPKO). Results: Concentrations of Cr, Mn, Ni, Cu, Zn, As, Cd and Sn in household dust were significantly higher in the exposed group (<0.05), as were concentrations of Pb and Cd in the blood of children in the exposed group (<0.05). PTE concentrations in house dust and children's blood showed moderate correlation for Cr (Spearman's Correlation Coefficient (Rho) 0.40), Zn (Rho -0.43) and As (Rho 0.40), and a strong correlation for Cd (Rho 0.80) (p <0.05). Conclusions: The results of the study indicated risks for children's exposure to Cd, As and Cr during informal, domestic jewelry production, highlighting the importance of protecting children's health by promoting safety actions. Additionally, electrostatic cloths proved to be low-cost and effective tools for assessing exposure to PTE.

Exposición a material particulado y su relación con el cáncer de mama. Mecanismos fisiopatológicos / Exposure to particulate matter and its association to breast cancer. Pathophysiological mechanisms

Introducción. El cáncer de mama es el tipo de cáncer que genera más muertes en mujeres en el mundo. Aunque se reconoce el aporte de factores genéticos, hormonales y de estilos de vida como sus principales causas, las hipótesis que señalan que la contaminación del ambiente juega un papel importante en su desarrollo, han tomado mucha fuerza en los últimos años. Estas hipótesis surgen debido a que el aumento en la incidencia del cáncer de mama coincide con procesos de industrialización, además de mayor presencia en regiones urbanas y con altos niveles de contaminación. El objetivo de este artículo fue consolidar información sobre los mecanismos fisiopatológicos que puedan explicar la relación entre cáncer de mama y la contaminación por material particulado. Metodología. Se realizó una búsqueda de literatura en PubMed, Google Académico y Epistemonikos para documentos publicados sobre el tema desde enero de 2016 hasta el 3 de agosto de 2022. Resultados. Se encontró que algunos de los mecanismos que podrían explicar dicha relación incluyen: alteraciones endocrinas que favorecen cambios hormonales, induciendo el crecimiento mamario; cambios en las características histológicas del tejido normal, como involución reducida de unidades lobulares ductales terminales; formación de aductos de hidrocarburos aromáticos policíclicos-ácido desoxirribonucleico (HAP-ADN), con mutación específica del gen TP53; activación de la proliferación en la línea celular MCF-7; y, alteraciones en la metilación del ADN. Conclusión. Si bien órganos distales como la mama no son la primera entrada de los contaminantes ambientales al cuerpo, estos sí pueden verse afectados tras la exposición a largo plazo, a través de diferentes mecanismos de disrupción endocrina y daño al ADN principalmente

Breast cancer is the type of cancer that causes the most deaths in women worldwide. Although the contribution of genetic, hormonal and lifestyle factors are recognized as its main causes, the hypotheses that indicate that environmental pollution has an important role in its development have taken on great strength during the last years. These hypotheses are based on the increase in the incidence of breast cancer that coincides with industrialization processes, in addition to its greater presence in urban regions with high levels of pollution. The aim of this study was to consolidate information on the pathophysiological mechanisms that can explain the relationship between breast cancer and air pollution by particulate matter. Methodology. A literature search was carried out in PubMed, Google Scholar and Epistemonikos for documents published on this topic from January 2016 until August 3rd 2022. Results. Some of the mechanisms that could explain this association include endocrine alterations that favor hormonal changes, inducing breast growth; changes in the histological characteristics of normal tissue such as reduced involution of terminal duct lobular units; formation of polycyclic aromatic hydrocarbons-deoxyribonucleic acid (PAH-DNA) adducts, with specific mutation of the TP53 gene; an increase in cell proliferation in the MCF-7 cell line; and alterations in DNA methylation. Conclusion. Although distal organs such as the breast are not the entry site of environmental pollutants into the body, they can be affected after prolonged exposure, mainly through different mechanisms of endocrine disruption and DNA damage

Riesgo biológico en el personal de enfermería de la Unidad de Cuidados Intensivos del Hospital Alberto Sabogal Sologuren / Biological risk in the nursing staff of the Intensive Care Unit of the Alberto Sabogal Sologuren Hospital

Según la Organización Internacional del Trabajo (OIT) se estima que 2,34 millones de personas mueren cada año a causa de accidentes y enfermedades relacionados con el trabajo. Entre las áreas hospitalarias, la unidad de cuidados intensivos (UCI) es considerada como la más tensa, traumática y agresiva, que ha pesar de la pesada rutina de trabajo, los peligros a la que el personal de enfermería (enfermeros, técnicos y asistentes) está continuamente expuesto. No sólo el medio ambiente es insalubre, sino que dada la ocurrencia frecuente de situaciones de emergencia y la alta concentración de pacientes en estado crítico que se someten a cambios en su estado de salud. El personal de enfermería la UCI tienen un mayor riesgo relacionado con los peligros biológicos, ya que están expuestos a organismos infecciosos durante los procedimientos invasivos y no invasivos. En ese sentido, este trabajo busca indagar sobre percepción acerca de la exposición a los riesgos biológicos para las enfermeras que laboran en la UCI en el Hospital Alberto Sabogal Sologuren, Perú. Los resultados llevados con las trabajadoras de la salud de Unidad de Cuidados Intensivos en el Hospital Alberto Sabogal indicaron que en general, las enfermeras de ese centro asistencial hacen uso de buenas prácticas de riesgo, siendo el de mayor prevalecencia (71%) el relacionado con los principios de bioseguridad, y siendo el de menor cuidado (37%), el referente al lavado de las manos antes y después de tener contacto con los pacientes. Es preocupante, que un porcentaje bajo de enfermeras, entre un 5 y 22% respondieron algunas veces a las prácticas de riesgo, siendo un factor importante de contaminación o peligro con su salud(AU)

According to the International Labor Organization (ILO), an estimated 2.34 million people die each year from work-related accidents and diseases. Among the hospital areas, the intensive care unit (ICU) is considered the most tense, traumatic and aggressive, which has despite the heavy work routine, the dangers to which the nursing staff (nurses, technicians and assistants) They are continually exposed. Not only is the environment unhealthy, but given the frequent occurrence of emergency situations and the high concentration of critically ill patients undergoing changes in their health status. ICU nursing staff are at increased risk related to biohazards, as they are exposed to infectious organisms during invasive and non-invasive procedures. In this sense, this work seeks to investigate the perception of exposure to biological risks for nurses who work in the ICU at the Alberto Sabogal Sologuren Hospital, Peru. The results carried out with the health workers of the Intensive Care Unit at the Alberto Sabogal Hospital indicated that in general, the nurses of this care center make use of good risk practices, with the highest prevalence (71%) being related to the principles of biosafety, and being the least careful (37%), the reference to washing hands before and after having contact with patients. It is worrisome that a low percentage of nurses, between 5 and 22% sometimes responded to risk practices, being an important factor of contamination or danger to their health(AU)

Dinámica de la transmisión de SARS-CoV-2 en centros educativos en un prestador de salud privado en Uruguay / Transmission dynamics of SARS-CoV-2 in schools assisted by one health service provider in Uruguay / Dinâmica da transmissão do SARS-CoV-2 em centros educacionais para o caso dum provedor de saúde privado no Uruguai

Introducción: en Uruguay se registró entre diciembre de 2020 y marzo de 2021 un aumento sostenido en la transmisión comunitaria del virus SARS-CoV-2, llegando a un índice de Harvard IP7 de 24,07. Considerando las consecuencias negativas del cierre escolar y que, a diferencia de los adultos, los niños son menos vulnerables y transmiten menos la infección, a pesar del contexto epidemiológico se decidió retomar la presencialidad parcial en centros educativos. Resulta necesario analizar las características de la transmisión en dichos centros para evaluar el impacto de las medidas de mitigación. Objetivo: describir las características de la transmisión de la infección por SARS-CoV-2 en una serie de niños asistidos en un prestador privado de salud con exposición de riesgo en centros educativos. Metodología: estudio descriptivo y retrospectivo de los menores de 15 años con infección por SARS-CoV-2 con exposición de riesgo en centros educativos asistidos en marzo de 2021. Se describieron variables clínicas (edad, sexo, manifestaciones clínicas, evolución), características de la exposición (caso índice, cumplimiento de medidas de distanciamiento físico, uso de mascarilla) y casos secundarios. La fuente de datos fue la historia clínica complementada con encuesta telefónica a madre, padre y/o tutor. Resultados: presentaron exposición de riesgo en centros educativos 198 de los 804 menores de 15 años con infección por SARS-CoV-2 (24,6%). Media edad 8 años, 51% de sexo femenino. Fueron asintomáticos 53% y presentaron síntomas leves 47%. Ninguno requirió hospitalización ni presentó complicaciones post infecciosas al momento de la comunicación. El caso índice fue un adulto en 64% y un niño en 36%. Refirieron haber cumplido medidas de distanciamiento físico 45% y uso de mascarilla 60%. En el 45% se produjeron casos secundarios en el hogar, uno de ellos falleció (65 años, diabetes mellitus tipo 2). Conclusiones: en este escenario con elevados índices de circulación comunitaria, más de la cuarta parte de los niños de esta serie adquirieron la infección en un centro educativo, mayoritariamente a partir de un adulto. Si bien la mayoría de los niños fueron asintomáticos o desarrollaron formas leves de la enfermedad, una proporción importante continuó la cadena de transmisión y generó casos secundarios intradomiciliarios. Es posible que el incumplimiento de las medidas de distanciamiento físico y en el uso de mascarilla sumado a la circulación de la VOC gamma (P1) en etapas tempranas de la campaña de vacunación, expliquen estos hallazgos. El análisis de la dinámica de la transmisión resulta imprescindible para optimizar las medidas de mitigación de la pandemia.

Introduction: in Uruguay, between December 2020 and March 2021, there was a steady increase in community transmission of the SARS-CoV-2 virus when it reached a Harvard IP7 index of 24.07. Considering the negative consequences of closing down schools and the fact that, unlike adults, children are less vulnerable and transmit the infection less, it was decided to resume partial school attendance, despite the epidemiological situation. It is necessary to analyze the characteristics of the transmission in these centers to evaluate the impact of the mitigation measures. Objective: describe the characteristics of the transmission of SARS CoV-2 infection in several children at risk of exposure at their schools and assisted by a private health provider. Methodology: descriptive, retrospective study of children under 15 years of age with SARS-CoV-2 infection at risk exposure at educational centers in March 2021. Clinical variables (age, sex, clinical manifestations, evolution), characteristics of exposure (index case, compliance with physical distancing measures, wear of face masks) and secondary cases. The data source was health medical records and a supplementary telephone survey to the mother, father and/or guardian. Results: 198 of the 804 children under 15 years of age with SARS-CoV-2 infection (24.6%) presented risk exposure at their educational centers. Average age 8 years, 51% female. 53% were asymptomatic and 47% had mild symptoms. None required hospitalization or presented post-infectious complications at the time of communication. The index case was an adult in 64% and a child in 36%. They reported having complied with physical distance restrictions 45% and use of a mask 60%. In 45% secondary cases occurred at home, one of them died (65 years old, type 2 diabetes mellitus). Conclusions: in this scenario with high rates of community circulation, more than a quarter of the children in this series acquired the infection in an educational center, mostly from an adult. Although most of the children were asymptomatic or developed mild forms of the disease, a significant proportion continued the chain of transmission and generated secondary intradomiciliary cases. It is possible that lack of compliance with physical distancing protocols and with the use of the mask, added to the circulation of gamma VOC (P1) in the early stages of the vaccination campaign and can explain these findings. Analysis of the transmission dynamics is essential to optimize pandemic mitigation measures.

Introdução: no Uruguai, entre dezembro de 2020 e março de 2021, houve um aumento gradativo da transmissão comunitária do vírus SARS-CoV-2, atingindo um índice Harvard IP7 de 24,07. Considerando as consequências negativas do encerramento das escolas e que, ao contrário dos adultos, as crianças são menos vulneráveis e transmitem menos a infecção, apesar do contexto epidemiológico, decidiu-se retomar a presença parcial nos centros educativos. É necessário analisar as características da transmissão nesses centros para avaliar o impacto das medidas de mitigação. Objetivo: descrever as características da transmissão da infecção por SARS CoV-2 em uma série de crianças atendidas numa assistência privada de saúde com exposição de risco em centros educacionais. Metodologia: estudo descritivo, retrospectivo de crianças menores de 15 anos de idade com infecção por SARS-CoV-2 com exposição de risco em centros educacionais atendidos em março de 2021. Variáveis clínicas (idade, sexo, manifestações clínicas, evolução), características da exposição (caso índice), cumprimento das medidas de distanciamento físico, uso de máscara) e casos secundários. A fonte de dados foi a história clínica complementada por uma enquete telefônica à mãe, pai e/ou responsável. Resultados: 198 das 804 crianças menores de 15 anos com infecção por SARS-CoV-2 (24,6%) apresentaram exposição de risco em centros educacionais. Idade média 8 anos, 51% do sexo feminino. 53% eram assintomáticas e 47% apresentavam sintomas leves. Nenhuma delas precisou de internação ou apresentou complicações pós-infecciosas no momento da comunicação. O caso índice foi um adulto em 64% e uma criança em 36%. Relataram ter cumprido as medidas de distanciamento físico 45% e uso de máscara 60%. Em 45% dos casos secundários ocorreram em casa, um deles faleceu (65 anos, diabetes mellitus tipo 2). Conclusões: neste cenário com altas taxas de circulação comunitária, mais de um quarto das crianças desta série adquiriram a infecção em um centro educacional, principalmente de um adulto. Embora a maioria das crianças fosse assintomática ou desenvolvesse formas leves da doença, uma proporção significativa continuou a cadeia de transmissão e gerou casos secundários intradomiciliares. É possível que a falta de cumprimento das medidas de distanciamento físico e do uso de máscara, somados à circulação de VOC gama (P1) nas fases iniciais da campanha de vacinação, expliquem esses achados. A análise da dinâmica de transmissão é essencial para otimizar as medidas de mitigação da pandemia.

Consultorio de Salud Ambiental en un Hospital Privado de Comunidad de la Ciudad de Buenos Aires / Environmental Health consulting office in a Private Community Hospital of the Buenos Aires City

En los últimos años surge el concepto de Una Sola Salud que reconoce la interdependencia sistémica al observar que los cambios en la salud humana se expresan de manera sincrónica e indivisible de la salud del ambiente. Nuevas enfermedades y daños crónicos inespecíficos ocurren a la par de la pérdida de biodiversidad y vitalidad. En las últimas décadas venimos observando el surgimiento de "adaptaciones sistémicas" que requieren un abordaje desde la clínica y la toxicología a nivel individual y desde la epidemiología de la complejidad a nivel poblacional. Luego de un largo recorrido de investigaciones, el Hospital Italiano formalizó el consultorio de Salud Ambiental con la intención de brindar respuesta a la demanda de pacientes que atribuyen síntomas y signos a la polución ambiental. (AU)

In recent years, the concept of One Health has emerged, recognizing the systemic interdependence and the changes in human health that are expressed synchronously and indivisible from the environment. New diseases and nonspecific chronic damage are occuring in parallel with the loss of biodiversity and vitality.In recent decades we have observed the appearance of "systemic adaptations" that require a clinical and toxicological approach at the individual level, and address the population level from an epidemiological and complexity science paradigm. After many years of research, the Hospital Italiano de Buenos Aires formalized the Environmental Health consulting office and the measurement of glyphosate levels, giving answer to the demand of patients who associate their signs and symptoms to environmental pollution. (AU)

Exposición ambiental a plomo y biomarcadores de estrés oxidativo en niños sanos de La Plata, Argentina / Environmental exposure to lead and oxidative stress biomarkers among healthy children in La Plata, Argentina

Introducción. La exposición ambiental a plomo (Pb) aún constituye un problema de salud pública, particularmente para los niños. El estrés oxidativo podría representar un mecanismo primario asociado a su toxicidad. El objetivo del presente estudio fue determinar los niveles de Pb en sangre (Pb-S) en niños de 1 a 6 años de La Plata y alrededores con exposición ambiental, y su relación con biomarcadores de estrés oxidativo. Población y métodos. Estudio analítico de corte transversal. Se evaluaron niños clínicamente sanos de 1 a 6 años. Se determinaron los niveles de Pb-S, las actividades de enzimas antioxidantes y el grado de peroxidación lipídica. Se utilizó el paquete estadístico R versión 3.5.1. Resultados. Participaron 131 niños, mediana de edad 2,33 años. La media geométrica de los niveles de Pb-S fue 1,90 µg/dL; el 32 % presentó plombemias cuantificables y el 3 %, niveles ≥5 µg/dL (referencia internacional). Al comparar los biomarcadores de estrés oxidativo según los niveles de Pb-S, solo se observó diferencia significativa entre las medianas de las sustancias reactivas al ácido tiobarbitúrico (TBARS): 12,0 versus 10,0 nmol MDA/mL plasma; p = 0,02. Asimismo, la correlación entre las plombemias y las TBARS fue positiva (r = 0,24; p = 0,012). Conclusiones. La mayoría de los niños mostraron niveles de Pb-S menores a los límites recomendados por agencias internacionales, que si bien, no producen alteraciones en la actividad de enzimas antioxidantes, sí inducen peroxidación lipídica. Estos resultados reflejan la utilidad de este biomarcador como una herramienta diagnóstica temprana para evaluar los efectos subtóxicos del Pb.

Introduction. Environmental exposure to lead is still a major public health problem, especially in children. Oxidative stress may be a primary mechanism associated with toxicity. Theobjective of this study was to measure blood lead levels (BLLs) in children aged 1 to 6 years expos to lead in La Plata and suburban areas and their relation to oxidative stress biomarkers. Population and methods. Cross-sectional,analytical study. Clinically healthy children aged1 to 6 years were analyzed. BLLs, antioxidant enzyme activity, and extent of lipid peroxidation were measured. The statistical softwarepackage R, version 3.5.1, was used. Results. A total of 131 children participated; their median age was 2.33 years. The geometric mean of BLLs was 1.90 µg/dL; 32% showed a measurable BLL and 3%, BLLs ≥ 5 µg/dL (international reference). The comparison ofoxidative stress biomarkers based on BLshowed a significant difference in median thiobarbituric acid reactive substances (TBARS):12.0 versus 10.0 nmol MDA/mL of plasma;p = 0.02. In addition, the correlation between BLLs and TBARS was positive (r = 0.24; p = 0.012 Conclusions. Most children had a BLL below the limit recommended by international agencies; although such BLLs do not affantioxidant enzyme activity, they can induce lipid peroxidation. These results demonstrate theusefulness of this biomarker as an early diagnosistool to assess subtoxic lead effects.

Carboxyhemoglobinemia as a laboratory finding in an outpatient

Resumen El monóxido de carbono (CO) es un gas producido principalmente por combustión incompleta de hidrocarburos. La intoxicación por exposición ambiental puede presentarse con síntomas inespecíficos y constituye la causa más importante de aumento de carboxihemoglobina (COHb). Su nivel en sangre depende de la duración de la exposición, la ventilación minuto y las concentraciones de CO y oxígeno en el ambiente. La elevada toxicidad radica en la hipoxia tisular que se genera. Se presenta el caso de un paciente masculino, 73 años, en seguimiento en el hospital por neumonía intersticial no específica como patología de base. En un control de laboratorio se encontró 11,9% de COHb, sin exposición a tabaco. No utilizaba calefacción a gas sino un panel cerámico eléctrico, recientemente pintado con esmalte sintético. La suspensión del uso del panel normalizó la COHb. El CO, producto de descomposición térmica del esmalte sintético, explica la causa de la intoxicación.

Abstract Carbon monoxide (CO) is a gas produced mainly by incomplete combustion of hydrocarbons. Poisoning from environmental exposure can present with nonspecific symptoms and is the most important cause of increased carboxyhemoglobin (COHb). Its blood level depends on the duration of exposure, minute ventilation, and the concentrations of CO and oxygen in the environment. The high toxicity lies in the tissue hypoxia that is generated. The case of a male patient, 73 years old, under follow-up in the hospital for non-specific interstitial pneumonia as the underlying pathology was presented. In a laboratory control, COHb 11,9% was found. There was no exposure to tobacco and there was no use of gas heating but of an electric ceramic panel, recently painted with synthetic enamel type paint. The suspension of the use of the panel normalised the COHb. The CO product of thermal decomposition of synthetic enamel explains the cause of poisoning.

Resumo O monóxido de carbono (CO) é um gás produzido principalmente pela combustão incompleta de hidrocarbonetos. A intoxicação por exposição ambiental pode se apresentar com sintomas inespecíficos e é a causa mais importante de aumento da carboxihemoglobina (COHb). Seu nível em sangue depende do tempo de exposição, da ventilação minuto e das concentrações de CO e oxigênio no ambiente. A alta toxicidade está na hipóxia tecidual gerada. Apresentamos o caso de um paciente do sexo masculino, 73 anos, em acompanhamento hospitalar por pneumonia intersticial inespecífica como patologia de bas. Em um controle laboratorial, achou-se 11,9% de COHb, sem exposição ao tabaco. Não utilizava aquecimento a gás e sim um painel elétrico cerâmico, recentemente pintado com esmalte sintético. A suspensão do uso do painel normalizou o COHb. O CO produto da decomposição térmica do esmalte sintético explica a causa da intoxicação.

Lessons from COVID-19 pandemic: teaching midwifery at the national level in Sierra Leone in the pandemic and post pandemic

The contents of this article are drawn from personal experiences and National response by the Ministry of Health and Sanitation during the COVID-19 pandemic in the midst of teaching in a midwifery training school. Teaching Midwifery in COVID-19 Pandemic and Post Pandemic periods impacted on the way student midwives were taught. Contextual issues are highlighted during the COVID-19 Pandemic in the Midwifery Education profession. But more speciacally, the impact of Covid-19 on midwifery education basically around the way students were taught, classroom spacing rearrangement and institutionalizing national protocols and guidelines on prevention of COVID-19 spread among staff and students.

Relation entre exposition professionnelle des manipulateurs de déchets d'équipements électriques et électroniques et problèmes respiratoires à Bamako en 2019 / Relationship between occupational exposure of waste electrical and electronic equipment handlers and respiratory problems in Bamako in 2019

Introduction: les déchets d'équipements électriques et électroniques (D3E), avec leurs enjeux sanitaires et environnementaux, sont devenus un problème de santé publique exposant les travailleurs aux composés d'éléments toxiques responsables de (2ème expertise) troubles respiratoires. Objectif: Etudier la relation entre l'exposition professionnelle aux D3E et la survenue des problèmes respiratoires à Bamako en 2019. Matériel et Méthodes : Il s'agissait d'une étude transversale, analytique de 6 mois, menée dans la ville de Bamako en 2019 et concernait 159 manipulateurs de D3E. Les données ont été collectées sur tablette et les analyses univariées et multivariées réalisées sur SPSS version 22 au seuil de significativité de 0,05 avec présentation des Odds Ratio (OR) et leurs intervalles de confiance à 95% (OR[IC95%]). Résultats : La prévalence en général des troubles respiratoires était de 67,3% chez les manipulateurs des D3E. On notait que le retrait du revêtement des fils électroniques (OR[IC95%] =25,93[2,30;291,53]), la perte de poids récente en dehors d'un régime (OR[IC95%] =7,43[1,68;32,85]) et la rareté de lavage des mains avec du savon après les toilettes (OR[IC95%] =11,50[2,07;63,89]) représentaient un risque plus élevé de problèmes respiratoires. Conclusion :Ces résultats montrent que les manipulateurs de D3E ont beaucoup de comportement à risque des problèmes respiratoires. Cette étude pourrait servir à la mise en œuvre de stratégies visant à réduire l'impact des D3E

Introduction: waste electrical and electronic equipment (WEEE), with its health and environmental issues, has become a public health problem exposing workers to toxic compounds causing respiratory problems. Objective: To study the relationship between professional exposure to WEEE and the occurrence of respiratory problems in Bamako in 2019. Material and Methods: This was a 6-month cross-sectional, analytical study carried out in the city of Bamako in 2019 and involved 159 WEEE manipulators. Data were collected using a tablet (2). Univariate and multivariate analyzes were performed using SPSS version 22 with the significance level of 0.05. Odds Ratio (OR) were presented with their 95% confident interval (OR [95%CI]). Results: The overall prevalence of respiratory disorders was 67.3% among WEEE handlers. It was noted that the removal of the coating of electronic wires (OR [95%CI] =25.93[2.30;291.53]), recent weight loss outside of a diet (OR [95% CI] =7,43[1.68;32.85]) and the infrequent hand washing with soap after the toilet (OR [95% CI] =11.50[2.07; 63.89]) represented a higher risk of (2) breathing problems. Conclusion: These results show that D3E handlers have a lot of risky behavior for respiratory problems. This study could be used to implement strategies to reduce the impact of D3E

Carcinome épidermoïde conjonctival invasif: à propos de 2 cas / Invasive squamous cell carcinoma: about 2 cases

Les tumeurs conjonctivales sont fréquentes dans les zones tropicales,où l'exposition aux rayons ultraviolets est forte et quasi permanente. Les tumeurs malignes sont assez rares et la plus représentée est le carcinome épidermoïde de la conjonctive.Nous rapportons deux cas de carcinome épidermoïde invasif de la conjonctive reçus dans le service d'ophtalmologie de l'hôpital Sominé Dolo de Mopti au Mali. Il s'agissait de deux patientes de 25 et 51 ans, vivant en zone rurale et désertique exposées aux rayons solaires et à la poussière. Elles présentaient une masse développée dans l'aire de la fente palpébrale, envahissant la cornée et empêchant l'occlusion palpébrale. La masse était en relief, multi lobulée, bien circonscrite, de couleur blanc nacré et d'aspect papillomateux avec une dilatation des vaisseaux nourriciers. Une exérèse chirurgicale large à 4 - 5 mm des berges de tissu sain a été réalisée avec examen anatomopathologique de la pièce qui a confirmé un carcinome épidermoïde différencié mature et invasif de la conjonctive. Le bilan d'extension et la sérologie HIV étaient négatifs. L'évolution était favorable à moyen terme sans récidive

Conjunctival tumors are common in tropical areas, where exposure to ultraviolet radiation is high and almost permanent. Malignant tumors are quite rare and the most represented is conjunctival squamous cell carcinoma. We report two cases of invasive squamous cell carcinoma of the conjunctiva received in the ophthalmology department of the Sominé Dolo hospital in Mopti, Mali. The patients were 25 and 51 years old, living in a rural desert area exposed to sunlight and dust. They presented with a mass developed in the area of the palpebral fissure, invading the cornea and preventing palpebral occlusion. The mass was raised, multi-lobulated, well circumscribed, pearly white in color and papillomatous in appearance with dilation of the feeder vessels. A wide surgical excision at 4 - 5 mm from the healthy tissue edges was performed with anatomopathological examination of the specimen, which confirmed a mature and invasive differentiated squamous cell carcinoma of the conjunctiva. The extension workup and HIV serology were negative. The evolution was favorable in the medium term without recurrence