Análise espaço-temporal do efeito da poluição do ar na saúde de crianças / Análisis espacio-temporal del efecto de la contaminación del aire en la salud de los niños / Space-time analysis of the effect of air pollution on children's health

O objetivo foi investigar a associação de curto prazo entre a poluição do ar e atendimentos em emergências por doenças respiratórias, em crianças de 0 a 6 anos. Estudo ecológico, espacial e temporal realizado na Região Metropolitana da Grande Vitoria, Espírito Santo, Brasil. Utilizou-se o modelo aditivo generalizado (MAG) de regressão de Poisson, com a variável dependente o número diário de atendimentos por doenças respiratórias, e as variáveis independentes, concentrações diárias dos poluentes atmosféricos (MP10, SO2, NO2, O3 e CO), temperatura, umidade e precipitação pluviométrica. Por meio das médias diárias das concentrações, foram feitas estimativas para toda a região e análises in loco com a consideração de crianças residentes no entorno de 2km de oito estações de monitoramento da qualidade do ar. O incremento de 10μg/m3 nos níveis de concentração dos poluentes atmosféricos aumentou o risco de atendimento em emergência por doença respiratória. Na região geral, para o MP10, o aumento foi de 2,43%, 2,73% e 3,29% nos acumulados de 5, 6 e 7 dias, respectivamente. Para o SO2, o acréscimo foi de 4,47% no dia da exposição, 5,26% dois dias após, 6,47%, 8,8%, 8,76% e 7,09% nos acumulados de 2, 3, 4 e 5 dias, respectivamente. O CO apresentou associação significativa para residentes no entorno de duas estações, e o O3 somente em uma. Mesmo dentro dos limites estabelecidos pela Organização Mundial da Saúde, os poluentes MP10, SO2, NO2 e O3 estão associados ao maior risco para atendimento por doenças respiratórias em crianças de 0 a 6 anos, e alguns efeitos só foram identificados nas localidades desagregadas por região, isto é, in loco, o que possibilita captar maior variabilidade dos dados.

El objetivo fue investigar la asociación de corto plazo entre la contaminación del aire y la atención en urgencias por enfermedades respiratorias, en niños de 0 a 6 años. Estudio ecológico, espacial y temporal realizado en la Región Metropolitana de la Grande Vitória, Espírito Santo, Brasil. Se utilizó el modelo aditivo generalizado (MAG) de regresión de Poisson, con la variable dependiente que es el número diario de consultas por enfermedades respiratorias, y las variables independientes: concentraciones diarias de los contaminantes atmosféricos (MP10, SO2, NO2, O3 y CO), temperatura, humedad y precipitación pluviométrica. Mediante las medias diarias de las concentraciones, se realizaron estimativas para toda la región y análisis in loco, considerando a niños residentes en un entorno de 2km con 8 estaciones de monitoreo de la calidad del aire. El incremento de 10μg/m3 en los niveles de concentración de los contaminantes atmosféricos aumentó el riesgo de atención en urgencias por enfermedad respiratoria. En la región como un todo, en el caso del MP10, el aumento fue de 2,43%, 2,73% y 3,29% en los acumulados de 5, 6 y 7 días, respectivamente. En el SO2, el incremento fue de 4,47% durante el día de la exposición, 5,26% dos días después, 6,47%, 8,8%, 8,76% y 7,09% en los acumulados de 2, 3, 4 y 5 días, respectivamente. El CO presentó asociación significativa para residentes alrededor de dos estaciones, y el O3 solamente en una. Incluso dentro de los límites establecidos por la Organización Mundial de la Salud, los contaminantes MP10, SO2, NO2 y O3 están asociados a un mayor riesgo en relación con la atención por enfermedades respiratorias en niños de 0 a 6 años, y algunos efectos sólo se identificaron en las localidades desagregadas por región, esto es, in loco, lo que posibilita captar una mayor variabilidad de los datos.

The study aimed to investigate the short-term association between air pollution and emergency treatments for respiratory diseases in children 0 to 6 years of age. This was an ecological space-time study in Greater Metropolitan Vitória, Espírito Santo State, Brazil. A Poisson regression general additive model (GAM) used the number of daily treatments for respiratory diseases as the dependent variable, and the independent variables were daily concentrations of air pollutants (PM10, SO2, NO2, O3, and CO), temperature, humidity, and precipitation. Average daily concentrations were used to make estimates for the entire metropolitan area and in loco analyses considering children residing in a 2km radius around 8 air quality monitoring stations. An increase of 10μg/m3 in the concentration of air pollutants increased the risk of emergency treatment for respiratory disease. In the overall area, for PM10, the increase was 2.43%, 2.73%, and 3.29% in the cumulative values at 5, 6, and 7 days, respectively. For SO2, the increase was 4.47% on the day of exposure, 5.26% two days later, and 6.47%, 8.8%, 8.76%, and 7.09% for the cumulative values at days 2, 3, 4, and 5 days, respectively. CO showed a significant association for residents around two stations, and O3 for only one. Even within the limits set by the World Health Organization, the pollutants PM10, SO2, NO2, and O3 are associated with increased risk of treatment for respiratory diseases in children 0 to 6 years of age, and some effects were only identified when disaggregating by neighborhood, i.e., in loco, which allows capturing greater variation in the data.

The effect of passive exposure to tobacco smoke on perioperative respiratory complications and the duration of recovery / O efeito da exposição passiva à fumaça de tabaco em complicações respiratórias no perioperatório e a duração da recuperação

Abstract Background: The incidence of perioperative respiratory complications and postoperative care unit recovery time investigated in patients with passive tobacco smoke exposure according to the degree of exposure. Methods: Total 270 patients ranging in age from 18 to 60 years with the ASA physical status I or II exposed and not exposed to passive tobacco smoke received general anesthesia for various elective surgical operations evaluated for the study. Patients divided into two groups as exposed and non-exposed to passive tobacco smoke, those exposed to passive smoke are also divided into two groups according to the degree of exposure. Patients taken to the postoperative care unit (PACU) at the end of the operation and monitorized until Modified Aldrete's Scores became 9 and more. Respiratory complications evaluated and recorded in intraoperative and postoperative period. Results: A total of 251 patients were enrolled; 63 (25.1%) patients had airway complications, 11 (4.4%) had complications intraoperatively and 52 (20.7%) patients had complications postoperatively. There has been found significant relation with passive tobacco smoke exposure and high incidences of perioperative and postoperative respiratory complications. The risk of cough, desaturation and hypersecretion complications were found to be increased depending on the degree of exposure. There was significant relation between the degree of passive smoke exposure and the duration of PACU stay. Conclusion: Passive tobacco smoke exposed general anesthesia receiving patients also regarding to the degree of exposure having high rates of perioperative respiratory complications and prolongation of PACU stays when compared with unexposed patients.

Resumo Justificativa: A incidência de complicações respiratórias no perioperatório e o tempo em sala de recuperação pós-anestesia no pós-operatório em pacientes com exposição passiva à fumaça de tabaco foram avaliados de acordo com o grau de exposição. Métodos: Foram avaliados 270 pacientes entre 18-60 anos, estado físico ASA I ou II, passivamente expostos e não expostos à fumaça de tabaco, submetidos à anestesia geral para vários procedimentos cirúrgicos eletivos. Os pacientes foram divididos em dois grupos: passivamente expostos e não expostos à fumaça de tabaco. Aqueles com exposição passiva à fumaça também foram divididos em dois grupos de acordo com o grau de exposição. Os pacientes enviados à sala de recuperação pós-anestesia (SRPA) no fim da cirurgia foram monitorados até atingir 9 ou mais no escore modificado de Aldrete. As complicações respiratórias foram avaliadas e registradas nos períodos intraoperatório e pós-operatório. Resultados: Foram incluídos 251 pacientes, dos quais 63 (25,1%) apresentaram complicações respiratórias, 11 (4,4%) complicações no intraoperatório e 52 (20,7%) complicações no pós-operatório. Houve relação significativa entre a exposição passiva à fumaça de tabaco e a alta incidência de complicações respiratórias no perioperatório e pós-operatório. O risco de complicação como tosse, dessaturação e hipersecreção aumentou de acordo com o grau de exposição. Houve relação significativa entre o grau de exposição passiva à fumaça e o tempo de permanência em SRPA. Conclusão: Os pacientes com exposição passiva à fumaça de tabaco apresentaram altas taxas de complicações respiratórias no perioperatório e prolongamento da permanência em SRPA, em comparação com os pacientes não expostos.

Fatores associados aos óbitos entre homens envenenados por carbamato ("chumbinho") / Factores de muertes de hombres envenenados por carbamato ("chumbinho") / Factors associated with the deaths of men poisoned by carbamato ("chumbinho")

RESUMO Objetivo Determinar os fatores associados aos óbitos em vítimas de envenenamento por carbamato (“chumbinho”). Método Estudo retrospectivo, epidemiológico tipo caso-controle, baseado nas fichas de notificação de intoxicação do centro de controle de intoxicações localizado na região metropolitana do Rio de Janeiro. Foram utilizadas 24 fichas de notificação de intoxicações de homens dos 20 aos 59 anos com história de envenenamento por carbamato entre 2005 e 2009. As fichas foram sorteadas aleatoriamente, respeitando-se a razão de 1:3 (um caso para três controles). A faixa etária variou de 23 a 58 anos; a média 43,83 anos. Resultados Os sintomas mais recorrentes foram: miose (OR = 1.0; IC 95%: 0,27 – 3,69. p= 1.0), sialorreia (OR = 0,83; IC 95%: 0,22 – 3,12. p= 0,78), dispneia (OR = 0,66; IC 95%: 0.14 – 3,03. p= 0,59). Conclusão Os óbitos apresentaram associação com sialorreia, miose e dispneia e uma forte associação com estertores pulmonares, broncoespasmos e os roncos pulmonares.

RESUMEN Objetivo Determinar los factores asociados a la muerte en las víctimas de envenenamiento por carbamato (“Chumbinho”). Método Estudio retrospectivo, epidemiológico de caso y control sobre el envenenamiento en los formularios de notificación un centro de control de envenenamiento localizado en la región metropolitana de Río de Janeiro. Utilizamos 24 formularios de notificación de envenenamiento en hombres de 20 a 59 años con intoxicación por el carbamato de 2005 a 2009. Los registros fueron seleccionados al azar, respetando la proporción de 1:3 (un caso y tres controles). El rango de edad fue de 23 a 58 años, promedio de 43,83 años. Resultados Los síntomas más frecuentes fueron miosis (OR = 1,0; IC del 95%: 0,27 a 3,69 p = 1.0.), Babeo (OR = 0,83, IC 95% 0,22-3,12 p. = 0,78), disnea (OR = 0,66; IC del 95%: 0:14 - 3.03 p = 0.59). Conclusión Las muertes se asociaron con babeo, miosis y disnea, y una fuerte asociación con estertores pulmonares, broncoespasmo y el ronquido pulmonar.

ABSTRACT Objective To determine the factors associated with death in poisoning victims by carbamate (“Chumbinho”). Method Retrospective study, epidemiological case-control based on poisoning reporting forms, a poison control center located in the metropolitan region of Rio de Janeiro. We used 24 notification forms of poisoning in men aged 20 to 59 years with poisoning by carbamate history from 2005 to 2009. The records were randomly selected, respecting the ratio 1:3 (a case to three controls). The age range was 23-58 years, average 43.83 years. Results The most frequent symptoms were myosis (OR=1.0; 95% CI: 0.27 to 3.69 p=1.0.), drooling (OR=0.83; 95% CI. 0.22 to 3.12 p=0.78), and dyspnea (OR=0.66; 95% CI: 0:14-3.03 p=0.59). Conclusion The deaths were associated with drooling, miosis and dyspnea and a strong association with pulmonary rales, bronchospasm and pulmonary snoring.

The carbon dioxide challenge test in panic disorder: a systematic review of preclinical and clinical research

This systematic review assesses the current state of clinical and preclinical research on panic disorder (PD) in which the carbon dioxide (CO2) challenge was used as a trigger for panic attacks (PAs). A total of 95 articles published from 1984 to 2012 were selected for inclusion. Some hypotheses for PD evolved greatly due to the reproducibility of PAs in a controlled environment using the safe and noninvasive CO2 test. The 35% CO2 protocol was the method chosen by the majority of studies. Results of the test report specific sensitivity to hypercapnia in PD patients of the respiratory PD subtype. The CO2 challenge helped assess the antipanic effects of medication and non-pharmaceutical approaches such as physical exercise and cognitive behavioral therapy. The test was also used in studies about the genetic component of PD, in which twins and relatives of PD patients were analyzed.

Enfermedad y síntomas respiratorios en niños de cinco municipios carboníferos del Cesar, Colombia / PM10 exposure-related respiratory symptoms and disease in children living in and near five coal-mining areas in the Cesar department of Colombia

Objetivos Establecer la prevalencia de síntomas respiratorios y enfermedad respiratoria en niños menores de 12 años de municipios de influencia de la zona carbonífera del departamento del Cesar y posibles factores asociados. Métodos Estudio transversal en 1 627 niños menores de 10 años habitantes de municipios carboneros del Cesar expuestos a diferentes niveles de MP10 en los años 2008-2010, en quienes se midieron enfermedades y síntomas respiratorios relacionados con exposición a PM10, buscando asociación con diferentes zonas de exposición al material particulado. Resultados Niños de corregimientos próximos a depósitos mineros y de corregimientos con tráfico tuvieron mayor proporción de casos probables de asma; mientras que los del corregimiento con tráfico se ausentaron más días por enfermedad respiratoria aguda; se encontró mayor frecuencia de síntomas respiratorios en niños expuestos al humo de cigarrillo o de leña intramurales, niños de viviendas con paredes de bareque o adobe, tenencia de animales, presencia de humedad en las viviendas, vehículos de carga a menos de 100 m de la vivienda; vivir en zonas con tráfico aumentó el riesgo de presentar síntomas respiratorios, enfermedad respiratoria aguda y ausentismo escolar. Discusión Todos los efectos estudiados estuvieron asociados a condiciones intramurales, factores del entorno cercano o individuales, coincidiendo con lo encontrado en estudios similares de salud y contaminación del aire. Se sugiere la creación de estrategias y políticas regionales para el control y monitoreo de la calidad del aire y la salud de los habitantes del departamento del Cesar.

Objectives Establishing the prevalence of respiratory symptoms and disease in children aged less than 12 years-old living within the Cesar department's coal-mining area and possible associated factors. Methods This was a cross-sectional study of 1,627 children aged less than 10 years-old living in and near coal-mining areas in the Cesar department who were exposed to different levels of PM10 from 2008-2010; their PM10 exposure-related symptoms and respiratory diseases were measured, seeking an association with living in areas exposed to particulate material. Results Children living in areas close to coal-mining activity which also had high traffic volume had a higher rate of probable cases of asthma; those living in areas with traffic (not no coal-mining) were absent from school for more days due to acute respiratory disease. Respiratory symptoms were most commonly found in children experiencing living conditions which exposed them to cigarette or firewood smoke indoors, living in houses made with wattle and daub or adobe walls, living where animals were kept, living in damp housing and diesel-powered dump trucks operating within 100 m or less of their housing. Living in areas having high traffic volume increased the risk of respiratory symptoms, acute respiratory disease and being absent from school. Discussion All the effects studied were associated with intramural conditions, individual factors or those associated with the immediate surroundings thereby coinciding with results found in similar studies regarding air pollution and health. It is thus suggested that regional strategies and policy be created for controlling and monitoring the air quality and health of people living in the Cesar department.

A genetic effect of IL-5 receptor alpha polymorphism in patients with aspirin-exacerbated respiratory disease

Persistent eosinophil activation in both the upper and lower airway mucosa is a central feature of aspirin-exacerbated respiratory disease (AERD). Eosinophil activation and survival are profoundly influenced by interleukin 5 (IL-5) and its receptor, IL-5R. In patients susceptible to allergic disorders, IL-5 receptor alpha (IL5RA) polymorphisms have been reported; however, an association with AERD remains unclear. We hypothesize that IL5RA polymorphisms may contribute to eosinophil activation in AERD patients. We recruited 139 AERD patients, 171 aspirin-tolerant asthma patients and 160 normal controls. IL5RA polymorphisms (-5993G>A, -5567C>G and -5091G>A) were genotyped and functional activity of polymorphism was assessed by luciferase reporter assay and electrophoretic mobility shift assay (EMSA). There was no significant difference in the genotype frequency of the three polymorphisms among the three groups. AERD patients carrying the AA genotype at -5993G>A had a significantly higher presence of serum-specific immunoglobulin E (IgE) to staphylococcal enterotoxin A (P=0.008) than those with the GG/GA genotype. In vitro, the -5993A allele had a higher promoter activity compared with the -5993G allele in human mast cell (HMC-1; P=0.030) and human promyelocytic leukemia (HL-60; P=0.013) cells. In EMSA, a -5993A probe produced a specific shifted band than the -5993G had. These findings suggest that a functional polymorphism in IL5RA may contribute to eosinophil and mast cell activation along with specific IgE responses to staphylococcal enterotoxin A in AERD patients.

Successful treatment of retinoic acid syndrome with dexamethasone: a case report.

Retinoic acid syndrome (RAS) is the clinical syndrome that occurs after treatment of acute promyelocytic leukemia with all-trans-retinoic acid (ATRA). The patients experience fever, dyspnea, hypotension, respiratory distress, edema and weight gain. Chest x-ray will show pulmonary infiltrates and pleuropericardial effusion. The onset of this syndrome is usually 5-21 days after ATRA treatment when white blood cell counts are rising more than 10,000/cu.mm. The authors have reported a case of RAS. The patient was a 29-year-old man who had been working in a battery manufacturing factory for 7 years. He presented with easily bruising for one month. The initial blood test showed hematocrit of 36.2%, white blood cells count of 3,200/cu.mm with 28% neutrophils, 20% lymphocytes, 2% eosinophils and 50% promyelocytes and platelet of 20,000/cu.mm. Peripheral blood smear revealed numerous fragmented red blood cells. Bone marrow examination showed hypercellularity with abnormal promyelocytes of 95% and bone marrow cytogenetics was translocation of chromosome 15 and 17 [t (15;17)(q22;q12)]. The diagnosis was acute promyelocytic leukemia and the patient was treated with ATRA 45 mg/m2/day per oral starting on day 1 and intravenous idarubicin 10 mg/n2 on day 4, 5 and 6. On day 13, he had a body temperature of 39 degrees C and a dry cough. The white blood cells were rising to 7,400/cu.mm with 16% neutrophils. On day 18, he had oliguria, high grade fever, hypotension, cough with chest pain and white blood cells rose to 21,300/cu.mm with 65% neutrophils and rising of blood urea nitrogen and creatinine. Chest x-ray showed enlarged cardiac shadow with pleural effusion. Echocardiogram revealed moderate amount of pericardial effusion. The diagnosis of RAS was made and ATRA was withdrawn. Intravenous dexamethasone 4 mg every 6 hours and hemodialysis was started. The patient's symptoms improved dramatically and bone marrow examination was in complete remission. He was subsequently given cytarabine and idarubicin as consolidation. This patient had clinical manifestation consistent with RAS, which improved after prompt treatment.

Some consequences of ozone exposure on health

The reaction of ozone with polyunsaturated fatty acids from the surfactant factor and pulmonary epithelial cells produces different reaction products which can cross the alveolar-capillary barrier and reach distant structures. Although only a few papers claim extrapulmonary changes in animals exposed to this gas, some neurological deficits, such as complaints of fatigue, lethargy, headache in humans, as well as significant disarrangements in the sleep pattern related to biochemical changes int he brain have referred to in animals exposed to ozone. In the present review, the molecular configuration and the reaction of ozone at different lung levels are related to impairment at the respiratory and blood systems, in order to elucidate the mechanisms by which this gas or its reaction products, such as free radicals, prostaglandins and others can cross the alveolar-capillary and hemato-encephalic barriers, and to explain those neurological effects