El rol del laboratorio en los hallazgos de intoxicación y exposición a monóxido de carbono / The role of the laboratory in findings of carbon monoxide poisoning and exposure

El monóxido de carbono es un gas altamente tóxico que se origina principalmente por la combustión incompleta de combustibles fósiles. La intoxicación presenta síntomas inespecíficos que solapan otras patologías y por lo tanto es indispensable la confirmación mediante la medición de la carboxihemoglobina en sangre. El laboratorio incorporó la determinación en el informe del estado ácido base a partir de octubre del 2018, debido a que previamente el médico debía solicitarla frente a la sospecha de una intoxicación. El objetivo del trabajo fue evaluar si esta medida implementada por el laboratorio contribuyó a mejorar el diagnóstico de intoxicación por CO, analizar las características de los pacientes con COHb mayor o igual a 5% y definir un valor de reporte inmediato para la COHb. El 46% de los casos con COHb mayor o igual a 5% no se relacionaban con una intoxicación y/o exposición a CO. De los casos de intoxicación se encontró que el 77% fueron diagnosticados a partir de la sospecha médica y un 23% por hallazgo del laboratorio. Se concluyó que es de mucha utilidad el rol del laboratorio en detectar aquellos casos que no fueron evidentes clínicamente. Existen ciertas patologías como las oncológicas o la enfermedad de Wilson donde se vieron valores elevados de COHb sin presentar intoxicación y se definió finalmente, como valor de reporte inmediato 7% para la COHb. (AU)

Carbon monoxide is a highly toxic gas that originates mainly from incomplete combustion of fossil fuels. Intoxication causes nonspecific symptoms that overlap with other conditions and, therefore, confirmation by measuring blood carboxyhemoglobin is essential. The laboratory incorporated the measurement in the acid-base status report as of October 2018, as it was previously required to be requested by the physician in case of suspected intoxication. The aim of this study was to evaluate whether this measure implemented by the laboratory contributed to the improvement of the diagnosis of CO intoxication, to analyze the characteristics of patients with COHb greater than or equal to 5% and to define an immediate reporting value for COHb. Overall, 46% of the cases with COHb greater than or equal to 5% were not related to CO poisoning and/or exposure. Of the cases of intoxication, 77% were diagnosed based on medical suspicion and 23% on laboratory findings. It was concluded that the laboratory has a useful role in detecting cases that were not clinically evident. There are certain diseases including different types of cancer or Wilson's disease where elevated COHb values were seen without intoxication and finally, 7% for COHb was defined as the immediate reporting value (AU)

Ammonia levels during broiler rearing cycle

The evaluated ammonia volatilization rates and its association with humidity, temperature, and pH in broiler litter in conventional and dark house rearing systems. Evaluations were performed at 0.01, 1.00, and 1.50 m high, using a completely randomized design, at a weekly frequency for 12 weeks­from the sanitary void to the end of the 42-day cycle. Litter temperature had no significant difference for different types of house. Humidity and pH levels varied according to houses and evaluation periods. No ammonia volatilization was detected during initial periods. However, up from the 21st day of rearing, rates started to increase, showing higher concentrations at 0.01 m height. At 1.00 and 1.50 m, values around 20 mL·m­3, were obtained and considered an acceptable exposure level for the broilers and employees directly working in this sector. Yet, broiler breeders should target lower levels due to environmental impacts.

Efeitos da exposição a poluentes do ar na saúde das crianças de Cuiabá, Mato Grosso, Brasil / Efectos de la exposición a contaminantes del aire en la salud de los niños de Cuiabá, Mato Grosso, Brasil / Effects of exposure to air pollutants on children's health in Cuiabá, Mato Grosso State, Brazil

Exposição a poluentes do ar, que costumam ser quantificados por agências ambientais que não estão presentes em todos os estados, pode estar associada a internações por doenças respiratórias de crianças. Foi desenvolvido um estudo ecológico de séries temporais com dados referentes às internações por algumas doenças respiratórias de crianças menores de dez anos de idade, em 2012, na cidade de Cuiabá, Mato Grosso, Brasil. Os níveis médios de material particulado fino (PM2,5) foram estimados por modelo matemático, os dados de temperatura mínima e umidade relativa do ar foram obtidos do Instituto Nacional de Meteorologia, e número de focos de queimadas do Sistema de Informações Ambientais. A abordagem estatística utilizou o modelo aditivo generalizado da regressão de Poisson com defasagens de 0 a 7 dias. Foram estimados os custos financeiros e aumentos do número de internações decorrentes de elevações de PM2,5. Foram 565 internações (média de 1,54/dia; DP = 1,52) e concentração de PM2,5 de 15,7µg/m3 (DP = 3,2). Foram encontradas associações entre exposição e internações no segundo semestre, nos lags 2 e 3, e quando analisado o ano todo, no lag 2. Uma elevação de 5µg/m3 do PM2,5 implicou o aumento de 89 internações e custos acima dos R$ 95 mil para o Sistema Único de Saúde. Dados estimados por modelo matemático podem ser utilizados em locais onde não há monitoramento de poluentes.

La exposición a contaminantes del aire, que suelen ser cuantificados por agencias ambientales que no están presentes en todos los estados, puede estar asociada a internamientos por enfermedades respiratorias de niños. Se desarrolló un estudio ecológico de series temporales con datos referentes a los internamientos por algunas enfermedades respiratorias de niños menores de 10 años de edad, en 2012, en la ciudad de Cuiabá, Mato Grosso, Brasil. Los niveles medios de material particulado fino (PM2,5) se estimaron mediante un modelo matemático, los datos de temperatura mínima y humedad relativa del aire se obtuvieron del Instituto Nacional de Meteorología, y el número de focos de incendios del Sistema de Información Ambiental. El enfoque estadístico usó el modelo aditivo generalizado de la regresión de Poisson con desfases de 0 a 7 días. Se estimaron los costes financieros y aumentos del número de internamientos derivados de elevaciones de PM2,5. Fueron 565 internamientos (media de 1,54/día; DE = 1,52) y concentración de PM2,5 de 15,7µg/m3 (DE = 3,2). Se encontraron asociaciones entre exposición e internamientos en el segundo semestre, en los lags 2 y 3, y cuando se analizó todo el año, en el lag 2. Una elevación de 5µg/m3 del PM2,5 implicó el aumento de 89 internamientos y costes por encima de los BRL 95 mil para el Sistema Único de Salud. Los datos estimados por el modelo matemático pueden ser utilizados en lugares, donde no existe un monitoreo de contaminantes.

Exposure to air pollutants, usually measured by environmental agencies that are not present in all states, may be associated with respiratory admissions in children. An ecological time series study was conducted with data on hospitalizations due to selected respiratory diseases in children under 10 years of age in 2012 in the city of Cuiabá, Mato Grosso State, Brazil. Mean levels of fine particulate matter (PM2.5) were estimated with a mathematical model, data on low temperatures and relative humidity were obtained from the Brazilian National Institute of Meteorology, and the numbers of brush burnings were obtained from the Environmental Information System. The statistical approach used the Poisson regression generalized additive model with lags of 0 to 7 days. The financial costs and increases in hospitalizations due to increments in PM2.5 were estimated. There were 565 hospitalizations (mean 1.54 admissions/day; SD = 1.52), and mean PM2.5 concentration was 15.7µg/m3 (SD = 3.2). Associations were observed between exposure and hospitalizations in the second semester at lags 2 and 3, and at lag 2 when the entire year was analyzed. An increment of 5µg/m3 in PM2.5 was associated with an increase of 89 hospitalizations and costs exceeding BRL 95,000 (≈ USD 38,000) for the Brazilian Unified National Health System. Data estimated by mathematical models can be used in locations where pollutants are not monitored.

Riesgos hacia los trabajadores y comunidad por liberaciones accidentales de gases densos peligrosos en la ciudad de Los Ángeles (Chile) / Risks to workers and the community for accidental releases of hazardous dense gases in Los Angeles city (Chile)

Se evaluaron riesgos hacia los trabajadores y comunidad por posibles liberaciones accidentales de gases densos peligrosos, desde fuentes de uso y almacenamiento, dentro del radio urbano de Los Ángeles (Chile). Se obtuvo información desde organizaciones públicas, privadas y por trabajo de campo para determinar la ubicación de las fuentes, especificaciones y cantidades de gases. Se consideraron comercializadoras de gases industriales e instalaciones de GLP con estanques mayores o iguales a 2 m³. Se aplicaron las metodologías de evaluación de riesgos de la NTP N° 937 del INSHT (España) y del Programa APELL del PNUMA Los gases identificados en las comercializadoras fueron Ar, CO2, N2O y C2H2. Del análisis utilizando la metodología NTP N° 937 se obtuvo, para los trabajadores evaluados en locales de venta de gases industriales, un nivel de riesgo a priori bajo y una prioridad de acción clase 3 y, en las instalaciones de GLP de distribución masiva, se obtuvo un riesgo moderado con prioridad de acción clase 2. El análisis con metodología APELL arroja que las instalaciones de gas licuado, frente a una fuga de gas, tendrían para la comunidad nivel de consecuencias limitadas, graves y muy graves en el 67, 29 y 3,8% de los casos, respectivamente.

Risks to workers and the community were evaluated for possible accidental releases of hazardous dense gases from sources use and storage, within the urban area in Los Angeles (Chile). Information was obtained from public and private organizations and the field-work to determine the location of the sources, specifications and quantities of gases. Gases trading industries and installations of LPG tanks greater than or equal to 2m³ were considered. Methodologies for risk assessment of the NTP N°937 INSHT (Spain) and UNEP APELL program were applied. The identified gases in the trading industries were Ar, CO2, N2O and C2H2. From the analysis which used the methodology NTP No. 937, for workers evaluated in stores selling industrial gases, a low priori risk level was obtained and a priority for action class 3. In the LPG installations of mass distribution, a moderate risk with priority action class 2 was obtained. The APELL methodology analysis reveals that the liquefied gas installations, in case of gas leaking, would have limited, serious and very serious consequences for the community in 67%, 29% and 3,8% of cases respectively.

Exposición ambiental al mercurio y valores en orina de los habitantes de la comunidad Boca de Yaracuy: ubicada en la costa centro-norte de Venezuela / Enviromental expossure to mercury and urine values in inhabitants from Boca de Yaracuy community in the Venezuela north central coast

El objetivo de esta investigación fue relacionar la concentración de mercurio urinario de 100 residentes de la comunidad Boca de Yaracuy (zona costera del Estado Carabobo-Venezuela) con los niveles mercuriales encontrados en pescado, agua y sedimento provenientes del Caño El Alpargatón. Durante el estudio fueron captados 4 peces, 2 muestras de agua y tres de sedimento y analizadas por absorción atómica. La media de los niveles de mercurio en la orina de los individuos analizados fue de 3,62 ± 1,09 µg/g creatinina, ubicandose por debajo del valor límites establecido por la Agencia para sustancias tóxicas y registro de enfermedades, Conferencia americana de higienistas industriales gubernamentales y la Organización Mundial de la Salud, además de las Gacetas oficiales venezolanas N° 5382 y 5021. En las muestras ambientales provenientes del Caño. El Alpargatón, no se encontraron niveles elevados de mercurio, así como ausencia de intoxicación por mercurio en sus habitantes. Se requieren de nuevas investigaciones que abarquen un mayor número de elementos que faciliten un mejor abordaje de la contaminación mercurial.

The aim study was to relate the concentration of urinary mercury than 100 residents of the Community Boca Yaracuy (Carabobo state coastal-Venezuela) with mercury levels found in fish, water and sediment from the Caño Alpargatón. During the study were caught 4 fish, 2 samples of water and three samples of sedimentand, analyzed by atomic absorption. The average mercury levels in urine of individuals analyzed was 3,62 ± 1.09 mg/g creatinine, ranking below the limits set by the Agency for toxic substance and disease registry, American conference of gubernamental industrial hygienists, the World Health Organization and the Venezuela Official Gazettes N°5382 and 5021. In environmental samples from the Caño Alpargaton not were found elevanted levels of mercury and mercury poisoning absence of its inhabitants. Further investigations are needed to cover a larger number of elements to be a better approach to mercury pollution.

Air pollution and cardiovascular hospital admissions in a medium-sized city in São Paulo State, Brazil

The objective of the present study was to estimate the contribution of environmental pollutants to hospital admissions for cardiovascular disease. A time series ecological study was conducted on subjects aged over 60 years and living in São José dos Campos, Brazil, with a population near 700,000 inhabitants. Hospital admission data of public health patients (SUS) were obtained from DATASUS for the period between January 1, 2004 and December 31, 2006, according to the ICD-10 diagnoses I20 to I22 and I24. Particulate matter with less than 10 µm in aerodynamic diameter, sulfur dioxide and ozone were the pollutants examined, and the control variables were mean temperature and relative humidity. Data on pollutants were obtained from the São Paulo State Sanitary Agency. The generalized linear model Poisson regression with lags of up to 5 days was used. There were 1303 hospital admissions during the period. Exposure to particulate matter was significantly associated with hospitalization for cardiovascular disease 3 days after exposure (RR = 1.006; 95 percentCI = 1.000 to 1.010) and an increase of 16 µg/m³ was associated with a 10 percent increase in risk of hospitalization; other pollutants were not associated with hospitalization. Thus, it was possible to identify the role of exposure to particulate matter as an environmental pollutant in hospitalization for cardiovascular disease in a medium-sized city inSoutheastern Brazil.

Association of beta2-Adrenergic Receptor Polymorphism with Work-Related Symptoms in Workers Exposed to Wheat Flour

PURPOSE: Our previous study indicated that the presence of wheat-specific IgG1 and IgG4 antibodies was associated with work-related symptoms in workers exposed to wheat flour. We performed this study to investigate the genetic polymorphisms of beta2-adrenergic receptors and wheat-specific antibodies in association with the clinical parameters of baker's asthma. MATERIALS AND METHODS: In total, 379 subjects working in a single industrial bakery were enrolled in this study. The skin prick test was performed with common inhalant allergens and wheat flour extract. The presence of serum- specific IgE, IgG1, and IgG4 antibodies to wheat flour were determined by ELISA. Whole blood samples were obtained for genotype analysis. Subjects were genotyped with regard to five candidate single nucleotide polymorphisms (SNPs) of the beta2-adrenergic receptor gene (ADRB2; -47 T>C, 46 A>G, 79 C>G, 252 G>A, and 523 C>A) using a single-base extension method. RESULTS: No significant associations were observed between the genotype/allele frequencies of any of the SNPs tested and any clinical parameters. The haplotype of ADRB2 (GAA composed of 46 A>G, 252 G>A, and 523 C>A) was significantly associated with work-related symptoms (pG and haplotype [GAA] of ADRB2, the prevalence rates of wheat-specific IgG1 antibodies and lower respiratory symptoms increased significantly with exposure intensity (both p<0.05). CONCLUSION: The findings of the present study suggest that ADRB2 genetic polymorphism may contribute to the development of work-related symptoms in workers exposed to wheat flour, which can lead to baker's asthma.

Polycyclic aromatic hydrocarbons in ambient air at Agra: distribution and toxicity assessment.

Polycyclic Aromatic Hydrocarbons (PAHs) are a class of organic pollutants that are commonly found in the environment, largely due to combustion or processing of hydrocarbon fuels. PAHs are considered highly toxic for human beings and several of these compounds are carcinogenic, mutagenic and teratogenic. Human exposure to PAHs occurs principally by direct inhalation, ingestion or dermal contact as a result of the widespread presence and persistence of PAHs in the urban environment. With increasing awareness that PAHs are known and suspected carcinogens, this study was undertaken to monitor PAH compounds in Total Suspended Particulate Matter (TSPM) at the industrial site--Nunhai, Agra. For this purpose, TSPM samples were collected on glass fibre filter papers (EPM 2000) using High Volume Sampler (HVS 430) at Nunhai, Agra. 16 EPA priority PAH compounds were analyzed by a Gas Chromatograph equipped with FID detector. PAHs having high molecular weight, i.e., BghiP, BbF, DbA, BaA, BaP and IP, were the most abundant with concentrations ranging between 0.026 to 0.56 ng m(-3). The calculated mean TPAH value was 0.32 ng m(-3). The probably carcinogenic and possibly carcinogenic PAH as classified by International Agency for Research on Cancer (IARC) accounted for 42% and 38% respectively of the total PAH. The health risk associated with inhalatory exposure to PAHs was assessed on the basis of Benzo(a)pyrene concentration in air and Toxic Equivalency Factor (TEF) for individual PAH. In the present study, BaP concentrations ranged from 0.005 to 0.23 ng m(-3) with a mean value of 0.04 ng m(-3). Carcinogenic potencies for DbA and BaP in PAH mixtures based on TEF concept were 45% and 39% respectively. This underlines the importance of DbA and BaPas a surrogate compound of a PAH mixture in our environment in assessing human health risk.

Exposición involuntaria al humo de tabaco en lugares públicos de la Ciudad de México / Involuntary exposure to tobacco smoke in public places in Mexico City

OBJETIVO: La legislación mexicana considera como espacios libres de humo de tabaco a muchos lugares públicos. Sin embargo, no existen evaluaciones de la exposición a humo de tabaco ambiental que permitan medir el cumplimiento de las leyes ni identificar espacios de oportunidad para el control de la exposición. El presente estudio tiene como objetivo cuantificar los niveles de nicotina ambiental en lugares públicos de la Ciudad de México. MATERIAL Y MÉTODOS: Utilizando un protocolo común a otros países de América Latina, durante marzo de 2004 se colocaron monitores de difusión pasiva de nicotina en un hospital, dos escuelas, un edificio de oficinas públicas, un aeropuerto, siete restaurantes y tres bares de la Ciudad de México. Los monitores fueron analizados en la Universidad Johns Hopkins, donde la nicotina fue extraída y cuantificada usando cromatografía de gases con detección selectiva de nitrógeno. La concentración mediana de nicotina ambiental fue estimada por tipo de lugar y por área de restricción para fumar. RESULTADOS: Se detectó nicotina ambiental en todos los lugares públicos. Las mayores concentraciones se observaron en bares (6.01 µg/m³), restaurantes (0.69 µg/m³), aeropuerto (0.21 µg/m³) y oficinas públicas (0.10 æg/m³). Los grados de exposición fueron similares a los observados en otras ciudades de América Latina. CONCLUSIONES: Las concentraciones de nicotina en el aeropuerto y las oficinas públicas reflejan la falta de cumplimiento con la legislación vigente en México. Las concentraciones de nicotina registradas en bares y restaurantes evidencian la necesidad de impulsar medidas legislativas que establezcan a estos sitios como lugares públicos y de trabajo libres de humo de tabaco.

OBJECTIVE: Mexican legislation considers many public places as smoke-free spaces. However, no environmental tobacco smoke exposure assessment studies exist to evaluate compliance with governmental regulations and to identify opportunities for tobacco control. The main objective of this study is to quantify airborne nicotine concentrations in public places in Mexico City. MATERIAL AND METHODS: During March 2004, nicotine passive monitors were allocated in a hospital, two schools, a public office building, an airport, seven restaurants, and three bars following a common protocol applied in other Latin American countries. Monitors were analyzed at the Johns Hopkins University, extracting the nicotine and quantifying it using nitrogen selective gas chromatography. Median concentrations of environmental nicotine were estimated by type of place and smoking restriction. RESULTS: Airborne nicotine was detected in all public places. The highest concentrations were observed in bars (6.01 µg/m³), restaurants (0.69 µg/m³), airport (0.21 µg/m³), and public offices (0.10 µg/m³). Nicotine exposure concentrations are similar to those previously observed in other capital cities of Latin America. CONCLUSIONS: Nicotine levels in the airport and public offices reflect the lack of compliance with mandatory non-smoking official regulations in Mexico. High nicotine concentrations in bars and restaurants provide evidence for the need to advance smoke-free legislative action in these public and work places.

Exposición al humo de tabaco en hogares de la Ciudad de México: análisis de nicotina ambiental y en cabello de niños y mujeres / Environmental tobacco smoke exposure in homes of Mexico City: analysis of environmental samples and children and women hair

OBJETIVO: En México no se han efectuado evaluaciones de la exposición al humo de tabaco ambiental en los hogares ni en sus habitantes. El objetivo de este estudio es cuantificar los niveles de nicotina ambiental en hogares de la Ciudad de México, evaluando simultáneamente los niveles de nicotina en el cabello de niños y mujeres. MATERIAL Y MÉTODOS: En julio de 2005 se seleccionaron 41 hogares de la Ciudad de México a conveniencia, 20 por ciento sin fumadores y 80 por ciento con fumadores. Se colocaron monitores pasivos de nicotina en los hogares por una semana y se obtuvieron muestras de cabello de mujeres no fumadoras y niños para cuantificar nicotina. Las muestras fueron enviadas a la Universidad Johns Hopkins, donde la nicotina se extrajo y analizó con cromatografía de gases. De manera adicional, se aplicaron encuestas de opinión y conductas relacionadas con el humo de tabaco ambiental. RESULTADOS: Las concentraciones de nicotina ambiental tuvieron una mediana de 0.08 æg/m³ (RIC 0.01-0.64), en el cabello de los niños 0.05 ng/mg (RIC 0.05-0.29) y en el cabello de las mujeres 0.05 ng/mg (RIC 0.05-0.19). Las concentraciones de nicotina ambiental y en el cabello de los niños mostraron una correlación alta (rS=0.49), y se incrementó con el número de fumadores en el hogar. La mayoría de los encuestados apoya las medidas de control del humo de tabaco ambiental. CONCLUSIONES: Se observaron grados particularmente altos de exposición en niños atribuibles a la presencia de nicotina ambiental en el hogar. Deben implementarse acciones preventivas integrales para eliminar el tabaquismo activo y evitar el consumo de tabaco en el hogar.

OBJECTIVE: In Mexico no evaluation of environmental tobacco smoke exposure in homes or habitants has been conducted. The objective of this study is to quantify environmental nicotine in Mexico City homes, simultaneously evaluating nicotine levels in children and women. MATERIAL AND METHODS: In July 2005 a convenience sample of 41 homes was selected, 20 percent without smokers, 80 percent with smokers. Nicotine passive monitors were allocated in homes for one week, obtaining samples of hair from inhabitant non-smoking women and children. Samples were taken to the Johns Hopkins University where nicotine was extracted and analyzed using gas chromatography. A survey of opinions and behaviors related to environmental tobacco smoke was conducted. RESULTS: Environmental nicotine concentrations had a median of 0.08 µg/m3 (IQR 0.01-0.64), in children's hair 0.05 ng/mg (IQR 0.05-0.29), and in women's hair 0.05 ng/mg (IQR 0.05-0.19). Environmental nicotine concentrations and in childrenÆs hair were highly correlated (rS=0.49), and increased with the number of smokers at home. The majority of adults surveyed showed support towards measures of environmental tobacco smoke control. CONCLUSIONS: Homes are important spaces of exposure to environmental tobacco smoke. Particularly high levels of exposure were observed in children's hair, attributable to the presence of environmental nicotine at home. Integral preventive activities to eliminate active smoking and to avoid tobacco consumption at home are required.