Harm from Residential Indoor Air Contaminants.

This study presents a health-centered approach to quantify and compare the chronic harm caused by indoor air contaminants using disability-adjusted life-year (DALY). The aim is to understand the chronic harm caused by airborne contaminants in dwellings and identify the most harmful. Epidemiological and toxicological evidence of population morbidity and mortality is used to determine harm intensities, a metric of chronic harm per unit of contaminant concentration. Uncertainty is evaluated in the concentrations of 45 indoor air contaminants commonly found in dwellings. Chronic harm is estimated from the harm intensities and the concentrations. The most harmful contaminants in dwellings are PM2.5, PM10-2.5, NO2, formaldehyde, radon, and O3, accounting for over 99% of total median harm of 2200 DALYs/105 person/year. The chronic harm caused by all airborne contaminants in dwellings accounts for 7% of the total global burden from all diseases.

Manejo farmacológico del episodio depresivo bipolar en adolescentes: actualización bibliográfica / Pharmacological management of bipolar depressive episode in adolescents: bibliographic update

El manejo farmacológico del episodio depresivo en contexto del trastorno bipolar constituye un desafío para el clínico tanto en psiquiatría adultos como infantoadolescente. El presente trabajo tiene por objetivo actualizar y sintetizar la evidencia disponible respecto al manejo farmacológico para la depresión bipolar en población pediátrica. Metodología: Se realizó una búsqueda de las publicaciones de los últimos 5 años en bases de datos. Resultados: La evidencia muestra como primera línea el uso de antipsicóticos de segunda generación por sobre los estabilizadores del ánimo en este grupo etario; demostrando lurasidona y lanzapina/fluoxetina eficacia similares. Lurasidona es una opción con mejor perfil de seguridad por asociarse a menos efectos adversos y mejor adherencia. El uso de antidepresivos debe considerarse dentro de los pasos iniciales del manejo, asociado a un antipsicótico de segunda generación. Conclusiones: Se destaca la importancia de la sospecha, evaluación y diagnóstico adecuado para guiar la decisión de manejo integral. A pesar de los riesgos y consideraciones existentes, es importante considerar el uso en primera línea de antipsicóticos de segunda generación y de antidepresivos en el manejo de un cuadro depresivo en contexto de la enfermedad bipolar. La escasez de estudios en el tratamiento farmacológico de la depresión bipolar en general y especialmente en población pediátrica limita la generalización y extrapolación de los resultados a la realidad local.

The pharmacological management of the depressive episode in the context of bipolar disorder constitutes a challenge for the clinician both in adult and child-adolescent population. The objective of this paper is to update and synthesize the available evidence regarding the pharmacological management of bipolar depression in the pediatric population. Methodology: A search of the publications of the last 5 years in databases was carried out. Results: The evidence shows the use of second generation antipsychotics over mood stabilizers as the first line in this age group; demonstrating similar efficacy. Results: The evidence shows the use of second generation antipsychotics over mood stabilizers as the first line in this age group; demonstrating similar efficacy lurasidone and lanzapine/fluoxetine. Lurasidone is an option with a better safety profile as it is associated with fewer adverse effects and better adherence. The use of antidepressants should be considered within the initial steps of management, associated with a second generation antipsychotic. Conclusions: The importance of suspicion, evaluation and adequate diagnosis to guide the decision of comprehensive management is highlighted. Despite the existing risks and considerations, it is important to consider the first-line use of second-generation antipsychotics and antidepressants in the management of a depressive episode in the context of bipolar illness. The scarcity of studies on the pharmacological treatment of bipolar depression in general and especially in the pediatric population limits the generalization and extrapolation of the results to the local reality.

PM2.5 exceedances and source appointment as inputs for an early warning system.

Between June 2018 and April 2019, a sampling campaign was carried out to collect PM2.5, monitoring meteorological parameters and anthropogenic events in the Sartenejas Valley, Venezuela. We develop a logistic model for PM2.5 exceedances (≥ 12.5 µg m-3). Source appointment was done using elemental composition and morphology of PM by scanning electron microscopy coupled with energy dispersive spectroscopy (SEM-EDS). A proposal of an early warning system (EWS) for PM pollution episodes is presented. The logistic model has a holistic success rate of 94%, with forest fires and motor vehicle flows as significant variables. Source appointment analysis by occurrence of events showed that samples with higher concentrations of PM had carbon-rich particles and traces of K associated with biomass burning, as well as aluminosilicates and metallic elements associated with resuspension of soil dust by motor-vehicles. Quantitative source appointment analysis showed that soil dust, garbage burning/marine aerosols and wildfires are three majority sources of PM. An EWS for PM pollution episodes around the Sartenejas Valley is proposed considering the variables and elements mentioned.