Relationship between flame retardants and respiratory health- A systematic review and meta-analysis of observational studies.

Chronic respiratory diseases are a dealing cause of death and disability worldwide. Their prevalence is steadily increasing and the exposure to environmental contaminants, including Flame Retardants (FRs), is being considered as a possible risk factor. Despite the widespread and continuous exposure to FRs, the role of these contaminants in chronic respiratory diseases is yet not clear. This study aims to systematically review the association between the exposure to FRs and chronic respiratory diseases. Searches were performed using the Cochrane Library, MEDLINE, EMBASE, PUBMED, SCOPUS, ISI Web of Science (Science and Social Science Index), WHO Global Health Library and CINAHL EBSCO. Among the initial 353 articles found, only 9 fulfilled the inclusion criteria and were included. No statistically significant increase in the risk for chronic respiratory diseases with exposure to FRs was found and therefore there is not enough evidence to support that FRs pose a significantly higher risk for the development or worsening of respiratory diseases. However, a non-significant trend for potential hazard was found for asthma and rhinitis/rhinoconjunctivitis, particularly considering urinary organophosphate esters (OPEs) including TNBP, TPHP, TCEP and TCIPP congeners/compounds. Most studies showed a predominance of moderate risk of bias, therefore the global strength of the evidence is low. The limitations of the studies here reviewed, and the potential hazardous effects herein identified highlights the need for good quality large-scale cohort studies in which biomarkers of exposure should be quantified in biological samples.

Responses of benthic macroinvertebrate communities to a Bti-based insecticide in artificial microcosm streams.

Bioinsecticides based on the bacterium Bacillus thuringiensis subsp. israelensis (Bti) are increasingly being applied directly into aquatic compartments to control nuisance mosquitoes and blackflies and are generally considered environmentally friendly alternatives to synthetic insecticides. Bti-based insecticides are considered highly selective, being Diptera-specific, and supposedly decompose rapidly in the environment. Nevertheless, their safety to non-target species and freshwater ecosystems has been questioned by recent studies, which in fact document possible indirect effects in aquatic food webs such as the decrease of prey availability to predators. This work aimed to evaluate the potential effects of a Bti-based insecticide (VectoBac® 12AS) on a freshwater macroinvertebrate community and on stream ecological functions by using artificial microcosm streams. Artificial microcosm streams were colonized with a macroinvertebrate community plus periphyton collected in a stream together with Alnus glutinosa leaf packs. They were exposed for 7 days to different Bti treatments (0, 12, 120, 1200 µg/L), which are within the recommended concentrations of application in aquatic compartments for blackfly and mosquito control. Besides invertebrate community structure and abundance, effects were evaluated regarding leaf decomposition and primary production as measures of ecosystem functioning. Community structure was significantly altered in all Bti treatments after 7 days of exposure, mostly due to a decline in chironomids, followed by oligochaetes, which both belong to the deposit-feeders' functional group. Direct effects on oligochaetes are surprising and require further research. Also, reductions of leaf decomposition due to Bti-induced sublethal effects on shredders (reduced feeding) or mortality of chironomids (that can also feed on coarse organic matter) observed in our study, represent potential indirect effects of Bti in aquatic ecosystems. Our short-exposure experiment evidenced some negative effects on stream benthic invertebrate communities and on ecosystem functioning that must be considered whenever Bti is used in water bodies for blackfly or mosquito control programs.

Neurofibromatosis-associated pulmonary hypertension: an ominous duo.

The authors report a rare clinical case of a patient with neurofibromatosis type 1 (NF1) complicated by pulmonary hypertension (PH), which presents with rapid progression. An exhaustive investigation was performed to identify the main aetiology of the PH. It was concluded that the PH could be associated with NF1, and so belonged in group 5 of the clinical classification of PH. In general, such patients have a poor long-term prognosis due to the inexistence of proven, effective treatment. Further studies are needed to better understand the mechanisms of NF1-associated PH.

Marfan syndrome revisited: From genetics to the clinic. / Síndrome de Marfan revisitada ­ da genética à clínica.

Marfan syndrome is an autosomal dominant connective tissue disease with an estimated incidence of 1 in 5000 individuals. In 90% of cases it is caused by mutations in the gene for fibrillin-1, the main constituent of extracellular microfibrils. Studies on animal models of Marfan syndrome have revealed that fibrillin-1 mutations interfere with local TGF-ß signaling, in addition to impairing tissue integrity. The cardinal features involve the cardiovascular, ocular and skeletal systems. The diagnosis of Marfan syndrome is made according to the revised Ghent nosology. Early identification and appropriate management are critical for patients with Marfan syndrome, who are prone to the life-threatening cardiovascular complications of aortic aneurysms and aortic dissection. The standard treatment includes prophylactic beta-blockers in order to slow down dilation of the ascending aorta, and prophylactic aortic surgery. The success of current medical and surgical treatment of aortic disease in Marfan syndrome has substantially improved mean life expectancy, extending it above 72 years. This review aims to provide an overview of this hereditary disorder.

Cinco casos de aplasia cutis congénita / Five cases of aplasia cutis congénita

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Grã-parentalidade: revisão integrativa da literatura / Grandparenthood: integrative review of literature / Gran-paternidad: revisión integrativa de la literatura

O nascimento de uma criança implica a transição para a parentalidade que ocorre, simultaneamente, com a transição para a grã-parentalidade. Neste artigo, procedeu-se a uma revisão integrativa da literatura existente em bases eletrônicas de dados, com vista a responder à questão: "Como é vivida a transição para a grã-parentalidade?" A grã-parentalidade pode ser identificada como: uma transição; um processo adaptativo; a procura do sentido de vida; uma oportunidade de crescimento pessoal; um evento normativo.

The birth of a child brings the transition to parenthood occurs and, simultaneously, the grandparents start on a new transition, the transition to grandparenthood. To systematize the state of art, it was done a integrative review of literature, in electronic databases in order to answer the question "How is experienced the transition to the Grand-parenting?". The grandparenthood can be seen as a transition or as an adaptive process; the search for the meaning of life; opportunity for personal growth; normative event.

El nacimiento de un niño implica la transición a la paternidad que se produce simultáneamente con la transición a la Gran-paternidad. En este artículo, se procedió a una revisión integradora de la literatura, en bases de datos electrónicas, con el fin de responder a la pregunta: "¿Cómo vivió la transición a la Gran-paternidad?". La Gran-paternidad puede ser vista como una transición o como un proceso de adaptación; la búsqueda del sentido de la vida; una oportunidad para el crecimiento personal; un evento normativo.

Levels of TBT and other selected organotin compounds in duplicate diet samples.

Organotin compounds (OTs) are ubiquitous contaminants with a broad range of applications ranging from biocides and pesticides to catalysts for the production of polyurethane foams and silicones. The deleterious effects of some OTs (particularly tributyltin - TBT) upon wildlife and experimental animals are well documented and include endocrine disruption, immunotoxicity, neurotoxicity, genotoxicity and metabolic dysfunction in which obesity is included. However, virtually no data on the current human exposure levels is available. In order to bridge this gap, we quantified for the first time the levels of OTs in duplicate diet samples from members of the University of Aveiro in Portugal. OTs were detected in 32% of the 28 diet samples analyzed, at relatively low levels. TBT and monobutyltin were detected only in two samples and dibutyltin was detectable in three samples. Dioctyltin was quantified in four samples and monooctyltin in three samples. Phenyltins were below the detection limit in all the diet samples analyzed. Overall, for the vast majority of the samples (89%), the estimated daily intakes (EDI) of organotins through food were much lower than the established tolerable daily intakes (TDI). Hence, for the majority of the participants the risk associated with food ingestion is low.

Lead in duplicate diet samples from an academic community.

Lead is a naturally occurring element that with the advent of the industrial era became a serious environmental and public health issue. Leaded gasoline, lead based paints, use of lead in plumbing and water pipes, ceramics with lead-containing glazes and tobacco smoke are potential sources of lead exposure for humans. Despite these multiple sources, food is still considered the most important one for the general non-smoking population. Hence, in the present study, the dietary intake of lead was determined in duplicate diet samples provided by 30 participants working or studying at University of Aveiro, Portugal. Pb was detected in all the analysed samples with values ranging between 0.009 and 0.10mgkg-1 ww which correspond to estimated daily intakes between 0.22 and 3.5µgkg-bw-1day-1. Risk estimations disclose that at least 3.3% and 26.7% of the participants might suffer cardiovascular and nephrotoxic effects, respectively.

Brominated flame retardants and organochlorine compounds in duplicate diet samples from a Portuguese academic community.

Concentrations of persistent organic pollutants (POPs), including polybrominated diphenyl ethers (PBDEs), hexabromocyclododecanes (HBCDDs), polychlorinated biphenyls (PCBs), hexachlorocyclohexane isomers (HCHs), hexachlorobenzene (HCB), chlordane compounds (CHLs) and dichlorodiphenyltrichloroethane and its metabolites (DDTs), were measured in duplicate diet samples from 21 volunteers at a Portuguese academic community (University of Aveiro). Overall, the levels of the target compounds were low, with detection frequencies varying widely depending on the compounds and with brominated flame retardants (BFRs) registering the lowest detection frequencies. Among PCB congeners, nondioxin-like PCBs were predominant and detected in the majority of the samples. Organochlorine pesticides were also detected in the majority of the samples, with 100% detection for DDTs and HCHs. Estimated daily intakes (EDIs) were calculated using lower and upper bound estimations, and in both cases values were far below the currently established tolerable daily intakes for PCBs and OCs and the reference doses for PBDEs and HBCDDs.

Brominated, chlorinated and phosphate organic contaminants in house dust from Portugal.

House dust is an important matrix to evaluate the human exposure to a large number of contaminants including organochlorine compounds and flame retardants. In this study, we measured the levels of polybrominated diphenyl ethers (PBDEs), hexabromocyclododecanes (HBCDDs), 1,2-bis(2,4,6-tribromophenoxy) ethane (BTBPE), decabromodiphenyl ethane (DBDPE), polychlorinated biphenyls (PCBs) and several organophosphorus flames retardants (PFRs) in 28 house dust samples collected between 2010 and 2011 in two Portuguese cities, Aveiro and Coimbra. Among the measured compounds, PFRs, particularly tris(2-ethylhexyl) phosphate (TEHP), triphenyl phosphate (TPHP), 2-ethylhexyl diphenyl phosphate (EHDPP) and tris(methylphenyl) phosphate (TMPP), were the dominant group (median: 3200ngg(-1)). PBDE levels were the second highest (median: 340ngg(-1)) with great predominance of BDE 209 (median 270ngg(-1)), followed by HBCDDs (median: 150ngg(-1)), DBDPE (54ngg(-1)), PCBs (median: 6.3ngg(-1)) and BTBPE (median: 1.2ngg(-1)). Estimated daily intakes (EDIs) via dust ingestion showed a higher intake of PFRs (median: 4.6ngkg-bw(-1)day); however for all contaminants the EDIs were much lower than the established reference dose (RfD) values. Therefore, the studied population is exposed to non-hazardous levels of the target compounds when considering the exposure through house dust ingestion.

Epidemiological profile and postoperative complications of women undergoing gynecological surgery in a reference center in the northern brazilian legal amazon / Perfil epidemiológico e complicações pós-operatórias das mulheres submetidas à cirurgia ginecológica em centro de referência do extremo setentrional da amazônia legal brasileira

Objective: To evaluate the epidemiological profile and the operative complications of patients undergoing gynecological operations for benign diseases in a tertiary public hospital in the state of Roraima, Brazil. Methods: We conducted a retrospective survey through the analysis of 518 records of patients submitted to gynecological operations between January and June 2012. We included the three major operations during this period (n = 175): hysterectomy, colpoperineoplasty and suburethral sling placement. We excluded 236 cases of tubal ligation and 25 cases where it was not possible to access to medical records. Results: The mean age was 47.6 years; the education level of most patients was completed junior high (36.6%); 77% were from the State capital, 47.4% were in stable relationships and 26.3% were housewives. The majority of patients had given birth three or more times (86.6%), with previous vaginal delivery in 50.2%, and cesarean delivery, 21%. The main diagnostic indications for surgical treatment were uterine myoma (46.3%), urinary incontinence (27.4%) and genital dystopias (17.7%). We found three cases (1.7%) of high-grade intraepithelial lesions on Pap smear. The most common procedure was total hysterectomy (19.8%), 15.5% vaginally. The most common complication was wound infection (2.2%). Conclusion: Women undergoing gynecological operations due to benign disease had a mean age of 47 years, most had levels of basic education, came from the capital, were in stable relationships, predominantly housewives, multiparous and showed low operative complication rates.

Objetivo: avaliar o perfil epidemiológico e as complicações operatórias das pacientes submetidas à operações ginecológicas realizadas devido à presença de doenças benignas em um hospital público terciário no Estado de Roraima, Brasil. Métodos: foi realizado um levantamento retrospectivo, por meio da análise de prontuários de 518 pacientes submetidas à operações ginecológicas entre os meses de janeiro e junho de 2012. Foram incluídas as três principais operações realizadas nesse período (n=175): histerectomia, colpoperineoplastia e colocação de sling suburetral. Foram excluídos 236 casos de laqueadura tubária e 25 casos em que não foi possível acesso ao prontuário médico. Resultados: A média etária foi 47,6 anos, predominaram pacientes com ensino fundamental (36,6%), provenientes da capital (77%), com relações estáveis (47,4%) e ocupação prevalente "do lar" (26,3%). As pacientes, em sua maioria, tinham antecedentes três ou mais partos (86,6%), com via vaginal prévia em 50,2% e parto cesáreo prévio em 21%. Os principais diagnósticos indicativos de tratamento cirúrgico foram: mioma uterino (46,3%), incontinência urinária de esforço (27,4%) e distopias genitais (17,7%). Foram encontrados três casos (1,7%) de lesões intraepiteliais de alto grau na colpocitologia oncótica. A operação mais realizada foi a histerectomia total (19,8%), sendo 15,5% por via vaginal. A complicação mais frequente foi a infecção de ferida operatória (2,2%). Conclusão: as mulheres submetidas às operações ginecológicas devido à doenças benignas apresentavam média etária de 47 anos, a maioria tinha nível de escolaridade fundamental, eram provenientes da capital, tinham união estável, eram predominantemente do lar, multíparas e apresentaram taxas de complicações operatórias baixas.

Epidemiological profile and postoperative complications of women undergoing gynecological surgery in a reference center in the northern Brazilian legal Amazon.

OBJECTIVE: To evaluate the epidemiological profile and the operative complications of patients undergoing gynecological operations for benign diseases in a tertiary public hospital in the state of Roraima, Brazil. METHODS: We conducted a retrospective survey through the analysis of 518 records of patients submitted to gynecological operations between January and June 2012. We included the three major operations during this period (n = 175): hysterectomy, colpoperineoplasty and suburethral sling placement. We excluded 236 cases of tubal ligation and 25 cases where it was not possible to access to medical records. RESULTS: The mean age was 47.6 years; the education level of most patients was completed junior high (36.6%); 77% were from the State capital, 47.4% were in stable relationships and 26.3% were housewives. The majority of patients had given birth three or more times (86.6%), with previous vaginal delivery in 50.2%, and cesarean delivery, 21%. The main diagnostic indications for surgical treatment were uterine myoma (46.3%), urinary incontinence (27.4%) and genital dystopias (17.7%). We found three cases (1.7%) of high-grade intraepithelial lesions on Pap smear. The most common procedure was total hysterectomy (19.8%), 15.5% vaginally. The most common complication was wound infection (2.2%). CONCLUSION: Women undergoing gynecological operations due to benign disease had a mean age of 47 years, most had levels of basic education, came from the capital, were in stable relationships, predominantly housewives, multiparous and showed low operative complication rates.

From sub cellular to community level: toxicity of glutaraldehyde to several aquatic organisms.

The biocide glutaraldehyde (GA) is widely used as a disinfectant and sterilizing agent against bacteria and virus in hospital and veterinary facilities. GA or its metabolites may reach aquatic ecosystems due to incomplete or inadequate treatment of wastewaters. Data about GA effects at lethal and a sub lethal level to non-target organisms is needed so that a risk assessment to aquatic ecosystems can be done. Thus, in this work a battery of toxicity tests with primary producers, primary consumers and secondary consumers were performed and a species sensitive distribution (SSD) for GA was built. Moreover, effects on biomarkers (catalase, lactate dehydrogenase, glutathione-S-transferase, and cholinesterase) were measured in Danio rerio embryos and adults. Primary consumers (Thamnocephalus platyurus 24h - EC50=3.6 mg/l; Daphnia magna 48 h - EC50=6.6 mg/l) and D. rerio adults (96 h - LC50=5.5mg/l) were slightly more sensitive to GA than D. rerio embryos (96 h - LC50=22.2mg/l) and primary producers (Lemna minor 168 h - EC50=73.8 mg/l; Pseudokirchneriella subcapitata 72h - EC50=12.3mg/l; Chlamydomonas reinhardtii 72 h - EC50=14.6 mg/l; Chlorella vulgaris 72 h - EC50=31.3mg/l). However, no significant differences between the trophic levels were found and general HC5 and HC50 values of 0.6 and 11.4 mg/l were respectively estimated. Despite the low GA toxicity to D. rerio embryos, hatching delay and malformations were found (96 h - EC50=11.9 mg/l). For biomarkers, an inhibition of lactate dehydrogenase activity was observed in embryos whereas an inhibition in catalase, lactate dehydrogenase and glutathione-S-transferase activities was observed in adults. Thus, GA is moderately toxic (doses>1mg/l) to aquatic organisms, independently of the trophic level. However, considering the varied range of effects depending on the life stage and organism tested and relatively low HC5 value of 0.6 mg/l, mesocosm and chronic toxicity tests seem to be the next step in direction of more realistic scenarios of GA risk assessment in aquatic ecosystems.

Eventos adversos a medicamentos em hospital terciario: estudo piloto com rastreadores / Eventos adversos a medicamentos en hospital terciario: estudio piloto con rastreadores / Adverse drug events in hospital: pilot study with trigger tool

OBJETIVO : Estimar a frequência e caracterizar os eventos adversos a medicamentos em hospital de cuidados terciários. MÉTODOS : Revisão retrospectiva de 128 prontuários de hospital do Rio de Janeiro, em 2007, representando 2.092 pacientes. A ferramenta utilizada foi uma lista de rastreadores, como antídotos, análises laboratoriais com resultados anormais, suspensão brusca de medicação e outros. Foi extraída amostra aleatória simples daqueles pacientes com 15 anos ou mais de idade. Foram excluídos pacientes oncológicos e da obstetrícia, e os internados por menos de 48 horas ou na emergência. Os pacientes com e sem eventos adversos a medicamentos foram comparados quanto a características sociais, demográficas e de doenças, para testar as diferenças entre os grupos. RESULTADOS : Cerca de 70,0% dos prontuários apresentaram no mínimo um rastreador. A capacidade dos rastreadores de identificar eventos adversos a medicamentos foi 14,4%. A incidência de eventos adversos a medicamentos foi 26,6/100 pacientes. Foram identificados um ou mais eventos em 15,6% dos pacientes. O tempo mediano de permanência hospitalar foi 35,2 dias para os pacientes com eventos adversos a medicamentos e 10,7 dias para os demais (p < 0,01). As classes de medicamentos mais envolvidos foram as que atuam sobre o aparelho cardiovascular e sobre o sistema nervoso, e os do trato digestivo e metabolismo. Os fármacos mais imputados foram: tramadol, dipirona, glibenclamida e furosemida. Do total de eventos, 82,0% contribuíram ou provocaram danos temporários ao paciente e demandaram intervenção, e 6,0% podem ter contribuído para o óbito do paciente. Estima-se que o hospital apresente, anualmente, 131 eventos de sonolência e lipotimia, 33 quedas e 33 hemorragias potencialmente associados aos medicamentos. CONCLUSÕES ...

OBJETIVO : Estimar la frecuencia y caracterizar los eventos adversos a medicamentos en hospital de cuidados terciarios. MÉTODOS : Revisión retrospectiva de 128 prontuarios de hospital de Rio de Janeiro, Brasil, en 2007, representando 2.092 pacientes. La herramienta utilizada fue una lista de rastreadores, como antídotos, análisis de laboratorio con resultados anormales, suspensión brusca de medicación y otros. Se extrajo muestra aleatoria simple de los pacientes con 15 años o más de edad. Se excluyeron pacientes oncológicos y de obstetricia, y los internados por menos de 48 horas o en la emergencia. Los pacientes con y sin eventos adversos a medicamentos fueron comparados con respecto a las características sociales, demográficas y de enfermedades, para evaluar las diferencias entre los grupos. RESULTADOS : Cerca de 70,0% de los prontuarios presentaron por lo menos un rastreador. La capacidad de los rastreadores para identificar eventos adversos a medicamentos fue de 14,4%. La incidencia fue 26,6/100 pacientes. Se identificaron uno o más eventos adversos a medicamentos en 15,6% de los pacientes. El tiempo mediano de permanencia hospitalaria fue de 35,2 días para los pacientes con eventos adversos a medicamentos y 10,7 días para los demás (p<0,01). Las clases de medicamentos más involucrados fueron los que actúan sobre los sistemas cardiovascular y nervioso y los del tracto digestivo y metabolismo. Los fármacos más imputados fueron: tramadol, dipirona, glibenclamida y furosemida. Del total de eventos, 82,0% contribuyeron o provocaron daños temporales en el paciente y demandaron intervención y 6,0% pueden haber contribuido en el óbito del paciente. Se estima que el hospital presente, anualmente, 131 eventos de somnolencia y lipotimia, 33 caídas y 33 hemorragias potencialmente asociados a los medicamentos. CONCLUSIONES ...

OBJECTIVE : To estimate the frequency of and to characterize the adverse drug events at a terciary care hospital. METHODS : A retrospective review was carried out of 128 medical records from a hospital in Rio de Janeiro in 2007, representing 2,092 patients. The instrument used was a list of triggers, such as antidotes, abnormal laboratory analysis results and sudden suspension of treatment, among others. A simple random sample of patients aged 15 and over was extracted. Oncologic and obstetric patients were excluded as were those hospitalized for less than 48 hours or in the emergency room. Social and demographic characteristics and those of the disease of patients who underwent adverse events were compared with those of patients who did not in order to test for differences between the groups. RESULTS : Around 70.0% of the medical records assessed showed at least one trigger. Adverse drug events triggers had an overall positive predictive value of 14.4%. The incidence of adverse drug events was 26.6 per 100 patients and 15.6% patients suffered one or more event. The median length of stay for patients suffering an adverse drug event was 35.2 days as against 10.7 days for those who did not (p < 0.01). The pharmacological classes most commonly associated with an adverse drug event were related to the cardiovascular system, nervous system and alimentary tract and metabolism. The most common active substances associated with an adverse drug event were tramadol, dypirone, glibenclamide and furosemide. Over 80.0% of events provoked or contributed to temporary harm to the patient and required intervention and 6.0% may have contributed to the death of the patient. It was estimated that in the hospital, 131 events involving drowsiness or fainting 33 involving falls, and 33 episodes of hemorrhage related to adverse drug effects occur annually. CONCLUSIONS : Almost one-sixth of in-patients (16,0%) suffered an adverse drug event. The instrument ...