Comprehensive evaluation of abattoirs with no Hazard Analysis Critical Control Point plan in Tucumán,Argentina / Evaluación integral de frigoríficos sin un plan de análisis de peligros y puntos críticos de control en Tucumán, Argentina

Abstract This work focused on the comprehensive study of two provincial transit abattoirs inTucumán, Argentina, with no Hazard Analysis Critical Control Point (HACCP) plan. Visits (n = 20)were conducted between 2016 and 2018 during the operational and post-operational processes.Risk was estimated and the bacteriological analysis of carcass and environmental samples wasperformed. Risk estimation showed the predominance of high risk in both abattoirs. The maindeviations from the HACCP plan were: deficient building conditions, deficient workflow, lack of sectorization of changing rooms and bathrooms, lack of implementation of Standardized Sanitary Operational Procedures, and no food safety training of workers. The counts of indi-cator microorganisms from both abattoirs were not significant. Salmonella spp. was isolated from 7.5% carcass and 7.3% environmental samples. The Salmonella serovars identified were Cerro, Corvallis, Havana and Agona. Shiga toxin (stx) genes were detected in 24.4% carcass and 30.9% environmental samples. The isolates were characterized as Escherichia coli O8:H7/stx1, O116:H49/stx2 and O136:H40/stx2. Based on these results, it would be possible to implement an improvement plan in Tucumán abattoirs together with the local health authorities. Still, the need to work jointly with the sanitary authority in search of a unique sanitary standard for Argentina remains unaddressed.

Resumen Este trabajo se centró en el estudio integral de dos frigoríficos de tránsito provincial en Tucumán, Argentina, carentes de un plan de análisis de peligros y puntos críticos de control (HACCP, por sus siglas en inglés). Las visitas (n = 20) se realizaron entre 2016 y 2018 durante los procesos operativos y posoperativos. Se realizó la estimación del riesgo y el análisis bacteriológico de medias reses y muestras ambientales. La estimación del riesgo demostró un predominio de riesgo alto en ambos frigoríficos. Las principales desviaciones del plan HACCP fueron las deficientes condiciones edilicias, un inadecuado flujo de trabajo, la falta de sectorización de vestuarios y banños, una implementación nula de procedimientos operativos estandarizados de saneamiento y una insuficiente capacitación en seguridad alimentaria de los operarios. Los recuentos de microorganismos indicadores de ambos frigoríficos no presentaron diferencias significativas. Salmonella spp. se aisló del 7,5% de muestras de medias reses y del 7,3% de muestras ambientales. Se identificaron las siguientes serovariedades de Salmonella: Cerro, Corvallis, Havana y Agona. Se detectaron genes de toxina Shiga (sfx) en el 24,4% de las muestras de medias reses y en el 30,9% de las muestras ambientales. Los aislamientos se caracterizaron como Escherichia coli O8:H7/sfx1, O116:H49/sfx2 y O136:H40/sfx2. Teniendo en cuenta estos resultados, sería posible implementar un plan de mejoramiento en frigoríficos de Tucumán conjuntamente con las autoridades locales de salud. Aun así, sigue sin abordarse la necesidad de trabajar en vinculación con las autoridades sanitarias en la búsqueda de una norma integrada única para Argentina.

Síndrome metabólico y su correlación con ecuaciones de predicción del riesgo global de enfermedad cardiovascular / Metabolic Syndrome and its Correlation with Prediction Equations of Global Risk for Cardiovascular Disease

Introducción: El síndrome metabólico constituye un hito en la investigación de evaluar mejor y de manera óptima el riesgo de enfermedad cardiovascular aterosclerótica. Objetivo: Analizar la correlación entre la capacidad predictiva del riesgo global de enfermedad cardiovascular aterosclerótica del síndrome metabólico y las tablas de riesgo: Framingham Risk Score, la tabla de la OMS/ISH y las de Gaziano, la ecuación PROCAM y el algoritmo QRISK2. Métodos: Se realizó una revisión documental, para lo cual se empleó la bibliografía nacional e internacional, especialmente la publicada en los últimos 5 años. Se utilizó el motor de búsqueda Google Académico y se consultaron artículos de libre acceso en las bases de datos Pubmed y SciELO desde marzo 2020 hasta el mes de enero 2021. Se emplearon como palabras clave: síndrome metabólico, riesgo cardiovascular global, método de estimación de riesgo y sus equivalentes en inglés. Las unidades de análisis fueron artículos originales, de revisión, incluyendo revisiones sistemáticas publicadas en los idiomas español e inglés. Fueron seleccionados 38 artículos (23 en idioma español, 15 en inglés) y 31 (81,5 por ciento) corresponden a los últimos 5 años. Conclusiones: El síndrome metabólico y los sistemas de estimación del riesgo global de enfermedad cardiovascular aterosclerótica no deben ser utilizados como equivalentes a causa de que su concordancia, en sentido general, es muy cuestionable. No obstante, se puede considerar como una herramienta útil en prevención primaria de la enfermedad cardiovascular aterosclerótica, siempre y cuando no sustituyan el juicio clínico y se contemplen todas las excepciones y precauciones posibles en el momento de su aplicación(AU)

Introduction: Metabolic syndrome is a milestone within the research to assess better and optimally the risk of atherosclerotic cardiovascular disease. Objective: To analyze the correlation between the predictive capacity for the global risk of atherosclerotic cardiovascular disease of metabolic syndrome and the risk tables: Framingham Risk Score, the WHO/ISH and Gaziano tables, the PROCAM equation, and the QRISK2 algorithm. Methods: A documentary review was carried out, using national and international literature, especially published within the last five years. The Google Scholar search engine was used and open-access articles were consulted in the Pubmed and SciELO databases, from March 2020 to January 2021. The keywords used were síndrome metabólico [metabolic syndrome], riesgo cardiovascular global [global cardiovascular risk], método de estimación de riesgo [risk estimation method] and their English equivalents. The units of analysis were original review articles, including systematic reviews published in Spanish and English. Thirty-eight articles were selected (23 in Spanish and fifteen in English), 31 (81.5 percent) of which correspond to the last five years. Conclusions: Metabolic syndrome and global risk estimation systems for atherosclerotic cardiovascular disease should not be used as equivalents because their concordance, in general, is very questionable. Nevertheless, they can be considered a useful tool in the primary prevention of atherosclerotic cardiovascular disease, as long as they do not replace clinical judgment and all possible exceptions or precautions are considered at the time of their application(AU)

Neoplasia intraepitelial escamosa cervical: abordagem por estimativas de risco / Cervical squamous intraepithelial neoplasia: risk estimation approach

As neoplasias intraepiteliais cervicais representam a fase pré-tumoral da neoplasia invasiva do colo uterino; são identificadas por citologia e testes de DNA-HPV e conduzidas por intervenções ambulatoriais. A perspectiva de estimativas de risco, para abordagem de tais lesões, constitui uma verdadeira mudança de paradigma, tendo em vista que as recomendações serão baseadas em riscos, não em resultados.(AU)

Cervical intraepithelial neoplasms represent the pre-tumor phase of invasive cervical cancer; identified by cytology, HPV-DNA testing and conducted by outpatient interventions. The perspective of risk estimates, to address such injuries, constitutes a true paradigm shift, considering that recomendations will be based on risks, not results.(AU)

Histerectomia radical após parto cesáreo por adenocarcinoma de colo uterino: relato de caso / Radical hysterectomy after c-section in cervical adenocarcinoma: a case report

Mundialmente, o câncer de colo uterino ocupa o quarto lugar das neoplasias em mulheres, porém, nos países em desenvolvimento, as taxas de incidência superam de forma impactante os casos de países desenvolvidos. Apesar de ser um evento incomum durante a gestação, é cada vez mais observado, o que talvez possa ser atribuído às gestações programadas em idades mais avançadas. O caso descrito refere-se a uma paciente de 32 anos de idade, diagnosticada no terceiro trimestre da gestação com adenocarcinoma de origem endocervical com estadiamento anatomopatológico final (FIGO 2018) 1B2. Ela foi submetida à abordagem cirúrgica como tratamento inicial. Foi adotada como conduta a resolução da gestação, com boa vitalidade fetal, ao final da 34ª semana, após corticoterapia para maturação pulmonar fetal. Foi realizado parto cesariano seguido de histerectomia radical tipo C1 na classificação de Querleu e Morrow associado a linfadenectomia pélvica, no mesmo ato operatório.(AU)

Worldwide, cervical cancer ranks fourth in female cancers, but when assessing data from developing countries, incidence rates are significantly higher than in developed countries. Although it is an uncommon event during pregnancy, it is increasingly observed, which may perhaps be justified due to pregnancies postponed at older ages. The case described relates to a 32-year-old woman diagnosed in the third trimester of pregnancy with endocervical adenocarcinoma, whose final anatomopathological staging (FIGO 2018) was IB2. The same was submitted to the surgical approach as an initial treatment. It was adopted as a conduct, the resolution of pregnancy, with good fetal viability, at the end of the 34th week, after corticosteroid therapy for fetal lung maturation. The patient underwent cesarean section followed by radical type C1 hysterectomy in the classification of Querleu and Morrow associated with pelvic lymphadenectomy in the same surgery.(AU)

Assessment Of 10-Year Risk Of Developing A Major Cardiovascular Event In Patients Attending A Hospital For The Treatment Of Other Disorders

Objective: To assess the individual’s predicted risk of developing a CVD event in 10 y using risk scores among persons with other disorders/diseases. Methods: This is a cross-sectional observational study conducted for a period of 6 mo among 283 subjects. Total risk was estimated individually by using Framingham Risk Scoring Algorithm and ASCVD risk estimator. Results: According to Framingham Risk score the prevalence of low risk (<10%) identified as 67.84% (192), followed by intermediate risk (10%-19%), 19.08% (54), and high risk (≥20%) 13.07% (37). By using ASCVD Risk estimator, risk has reported in our study population was low risk (<5%) is 48.76% (138), borderline risk (5-7.4%) is 13.07% (37), intermediate risk (7.5-19.9%) is about 25.09% (71), high risk (>20%) is about 13.07% (37). Conclusion: In this study burden of CVD risk was relatively low, which was estimated by both the Framingham scale and ASCVD Risk estimator. Risk scoring of individuals helps us to identify the patients at high risk of CV diseases and also helps in providing management strategies.

Determination of the spatial susceptibility to Yellow Fever using a multicriteria analysis

BACKGROUND The outbreak of sylvatic Yellow Fever (SYF) in humans during 2016-2017 in Brazil is one of the greatest in the history of the disease. The occurrence of the disease in areas with low vaccination coverage favoured the dissemination of the disease; therefore, it is necessary to identify the areas vulnerability to the YF virus (YFV) to assist in the adoption of preventive measures. OBJECTIVE To correlate the physical-environmental elements associated with the occurrence of SYF in humans via a multicriteria analysis. METHODS For the multicriteria analysis, preponderant elements related to SYF occurrences, including soil usage and coverage, temperature, precipitation, altitude, mosquito transmitters, and non-human primate occurrence areas, were considered. The results were validated by assessing the correlation between the incidence of SYF and the vulnerable areas identified in the multicriteria analysis. RESULTS Two regions with different vulnerability to the occurrence of the disease were identified in the multicriteria analysis, with emphasis on the southern areas of the state of São Paulo northeast areas of Minas Gerais, and the entire states of Rio de Janeiro and Espírito Santo. The map of SYF vulnerability obtained in the multicriteria analysis coincides with the areas in which cases of the disease have been recorded. The regions that presented the greatest suitability were in fact the municipalities with the highest incidence. MAIN CONCLUSIONS The multicriteria analysis revealed that the elements that were used are suited for and consistent in the prediction of the areas that are vulnerable to SYF. The results obtained indicate the proximity of the areas that are most vulnerable to the disease to densely populated areas where an Aedes aegypti infestation was observed, which confers a high risk of re-urbanisation of YF.

Estimation of cardiovascular risk and detection of subclinical carotid atheromatosis in patients with diabetes without a history of cardiovascular disease

ABSTRACT Objectives Cardiovascular risk estimated by several scores in patients with diabetes mellitus without a cardiovascular disease history and the association with carotid atherosclerotic plaque (CAP) were the aims of this study. Materials and methods Cardiovascular risk was calculate using United Kingdom Prospective Diabetes Study (UKPDS) risk engine, Framingham risk score for cardiovascular (FSCV) and coronary disease (FSCD), and the new score (NS) proposed by the 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol. Ultrasound was used to assess CAP occurrence. A receiver operating characteristic (ROC) analysis was performed. Results One hundred seventy patients (mean age 61.4 ± 11 years, 58.8% men) were included. Average FSCV, FSCD and NS values were 33.6% ± 21%, 20.6% ± 12% and 24.8% ± 18%, respectively. According to the UKPDS score, average risk of coronary disease and stroke were 22.1% ± 16% and 14.3% ± 19% respectively. Comparing the risks estimated by the different scores a significant correlation was found. The prevalence of CAP was 51%, in patients with the higher scores this prevalence was increased. ROC analysis showed a good discrimination power between subjects with or without CAP. Conclusion The cardiovascular risk estimated was high but heterogenic. The prevalence of CAP increased according to the strata of risk. Understanding the relationship between CAP and scores could improve the risk estimation in subjects with diabetes.

Application of different cardiac assessment systems in pregnant women with congenital heart disease / 实用医学杂志

Objective To compare the application of Goldman , CARPREG and ZAHARA in predicting cardiac outcomes in pregnant women with congenital heart disease. Methods A retrospective analysis of 144 pregnant women with CHD , enrolled in The Third Affiliated Hospital of Guangzhou Medical University between Jan 1992 and June 2015 was conducted. The mortality and the incidence of cardiac events were counted by three risk estimation methods. The sensitivity and calibration of three systems were compared by using Hosmer-Lemeshow goodness of-fit analysis and Aera Under Curve (AUC). Results In terms of mortality rates, the sensitivity of CARPREG was higher than that of Goldman (AUC:0.874 and 0.889 respectively;P = 0.568 >0.05);. In terms of the incidence of cardiac events, the sensitivity of ZAHARA was higher than that of Goldman (AUC:0.912 and 0.773 respectively;P = 0.063 > 0.05); Conclusions All 3 risk estimation methods have good performance in sensitivity of predicting the incidence of cardiac events and mortality in pregnant women with CHD. The ZAHARA has a better calibration in predicting the incidence of cardiac events , and we recommend ZAHARA as the first choice of evaluation system for this kind of patients.

A public health risk assessment for yellow fever vaccination: a model exemplified by an outbreak in the state of São Paulo, Brazil

We propose a method to analyse the 2009 outbreak in the region of Botucatu in the state of São Paulo (SP), Brazil, when 28 yellow fever (YF) cases were confirmed, including 11 deaths. At the time of the outbreak, the Secretary of Health of the State of São Paulo vaccinated one million people, causing the death of five individuals, an unprecedented number of YF vaccine-induced fatalities. We apply a mathematical model described previously to optimise the proportion of people who should be vaccinated to minimise the total number of deaths. The model was used to calculate the optimum proportion that should be vaccinated in the remaining, vaccine-free regions of SP, considering the risk of vaccine-induced fatalities and the risk of YF outbreaks in these regions.

Hepatitis B virus and hepatocellular carcinoma: antiviral therapy and risk estimation / 国际外科学杂志

The incidence of hepatocellular carcinoma is increasing year by year all over the world.Hepatoma has become one of the main causes of cancer-related death.For many years,studies found the chronic hepatitis B virus infection is the leading cause of hepatocellular carcinoma,and antiviral therapy for hepatitis B virus could obviously reduce the incidence of hepatoma and prevent recurrence after hepatectomy.Making appropriate risk estimation in patients with chronic hepatitis B and providing patients with high risk the effective medical intervention can help to prevent the occurrence and delay the development of hepatocellular carcinoma.

The risk of acquiring the new influenza A(H1N1) for Brazilian travelers to Chile, Argentina and the USA

We estimate the risk of acquiring the new influenza A(H1N1) for Brazilian travelers to Chile, Argentina and the USA. This is done by a mathematical model that quantifies the intensity of transmission of the new virus in those countries and the probability that one individual has of acquiring the influenza depending on the date of arrival and time spent in the area. The maximum estimated risk reached 7.5 cases per 10,000 visitors to Chile, 17 cases per 10,000 travelers to Argentina and 23 cases per 10,000 travelers to the USA. The estimated number of imported cases until 27 July is 57 ± 9 from Chile, 136 ± 27 from the USA and 301 ± 21 from Argentina, which are in accord with the official figures. Estimating the number of imported cases was particularly important for the moment of the disease introduction into this country, but it will certainly be important again as a tool to calculate the number of future imported cases from northern countries in our next inter-epidemic season, were imported cases can constitute again the majority of the new influenza burden to the Brazilian health services.

Survey on basic data of risk estimation of lung cancer among non-uranium miners in China / 中华放射医学与防护杂志

Objective To investigate the basic data of risk estimation of lung cancer among non-uranium miners in China.Methods 2836 workers from 24 mines in 9 provinces/regions were face-to-face interviewed to collect information including age at exposure,exposure duration,cigarette smoking among others.Results Age of the investigated non-uranium miners ranged from 17 to 72(36.9±8.0)years.The miners received low and poor education,3% of them were illiterate,58% with primary and middle school education,only 7% with junior college and higher education.Seventy-five percent of the uranium miners are migrant rural workers.Ethnic minority miners accoungted for 16% of all the investigated miners.Among the migrant rural workers age at initial exposure was estimated to be 29.6±8.0 years.By the time of the investigation,46.7% of the miners had worked in the mine for five years and longer,working years in the mine was 6.7±6.8 years with a median of 4.1years.3.4% of the non-uranium miners began the initial radon exposure in mines before their 18 years of old.17.5% of the investigated miners reported working more than 8 h every working day.Among the males,58.0% were current smokers with a median of 16 cigarettes per day.Age to begin the cigarette smoking was 20 years on average.Current smoking rate was age-dependent,the rate as high as 69.2% for the males aged 15-19 years.Current smoking rate was significantly statistically lower in coal mines than that in other mines,49.0% vs 62.5%.Compared with other miners,more frequent mechanical ventilations were reported by coal miners,Conclusions In China non-uranium mines,75% were migrant rural workers,by the time of the investigation about half of them had worked in the mines for at least five years.Non-uranium miners began their mining at 30 years on average,with a very small percentage of 3%,exposed to the mining radon before their 18 years.Current cigarette smoking rate in non-uranium male miners was the same as the general male population in China.

Gastric Impedance Signal Analysis Based on Wavelet Transform and Stein Unbiased Risk Estimation Rule / 医疗卫生装备

Objecive To discuss a denoise method of gastric impedance signal based on wavelet transform and Stein Unbiased Risk Estimation rule.Methods Firstly,the signal was decomposed by Multi-resolution Analysis(MRA).Secondly,the signal was denoised by Stein Unbiased Risk Estimation rule,whose threshold was adaptive.Results The experimentation results demonstrated that breathing and blood flowing impedance interference could be cancelled effectively by using this method.Conclusion Wavelet analysis provides a new method for further study of gastric motility signal parameter extraction.