Long-term commuting times and air quality relationship to COVID-19 in São Paulo.

The Coronavirus Disease 2019 (COVID-19) epidemic is an unprecedented global health crisis and the effects may be related to environmental and socio-economic factors. In São Paulo, Brazil, the first death occurred in March 2020 and since then the numbers have grown to 175 new deaths per day in April 2021, positioning the city as the epicenter of the number of cases and deaths in Brazil. São Paulo is one of the largest cities in the world with more than 12 million inhabitants, a fleet of about 8 million vehicles and frequent pollutant concentrations above recommended values. Social inequalities are evident in the municipality, similarly to other cities in the world. This paper focuses on transportation activities related to air pollution and associated with cardiovascular and respiratory diseases especially on people who developed comorbidities during their whole life. This study relates travel trip data to air quality analysis and expanded to COVID-19 disease. This work studied the relationship of deaths in São Paulo due to COVID-19 with demographic density, with family income, with the use of public transport and with atmospheric pollution for the period between March 17th, 2020 and April 29th, 2021. The main results showed that generally passenger kilometers traveled, commuting times and air quality related diseases increase with residential distance from the city center, and thus, with decreasing residential density. PM2.5 concentrations are positively correlated with COVID-19 deaths, regions with high urban densities have higher numbers of deaths and long-distance frequent trips can contribute to spread of the disease.

Impact of shoulder rotation on neck-shaft angle: A clinical study.

BACKGROUND: Two recent experimental studies evaluated the influence of shoulder rotation on neck-shaft angle, with conflicting results. However, there have been no clinical studies of whether this angle varies in different shoulder positions. The present study aimed to determine whether shoulder rotation affects neck-shaft angle on standard radiographs in patients with complaints of shoulder pain. HYPOTHESIS: Shoulder rotation does not affect neck-shaft angle. MATERIALS AND METHODS: A prospective study was conducted in selected patients with shoulder pain. Three true anterior-posterior radiographic views were obtained: in neutral rotation, 30° external rotation, and internal rotation with patient's arm in a sling. The X-rays were evaluated by three shoulder and elbow surgeons. Inter- and intra-observer reliability was evaluated by intraclass correlation coefficient (ICC). RESULTS: Neck-shaft angle on true AP view did not differ between neutral rotation and 30° external rotation: 132±6° and 130±9°, respectively (P>0.999). In internal rotation with the hand resting on the abdomen, neck-shaft angle was 145±6°: i.e., significantly different (P<0.001) to the other two positions. Intra- and inter-observer correlation demonstrated excellent reliability. CONCLUSIONS: Radiographic neck-shaft angle was significantly different in internal rotation with the patient's arm in a sling, compared with views in neutral or 30° external rotation. Intra- and inter-observer correlation showed excellent reliability. LEVEL OF EVIDENCE: II, comparative prospective study.

Predicting difficult laryngoscopy using ultrasound measurement of distance from skin to epiglottis.

BACKGROUND: Unpredicted difficult intubation can have severe consequences, and it is a significant source of morbidity and mortality. Although recent studies indicate that specific ultrasonography (US) measurements may be predictors of difficult laryngoscopy, their use is still limited, and its quantification is missing. The purpose of this prospective observational study is to evaluate the use of US-measured distance from skin to epiglottis (DSE) for difficult laryngoscopy prediction. METHODS: In a double-blind study, standard preintubation, screening tests, and DSE were obtained from 74 adult patients requiring endotracheal intubation. The relationship between difficult laryngoscopy and DSE was evaluated using a t test. A comparative analysis of its predictive performance with common clinical preintubation screening tests was performed using bootstrapping. RESULTS: We found that increasing DSE is strongly associated with difficult laryngoscopy (P < .001, 2-sided t test). We showed that a cutoff value of 27.5 mm was able to predict difficult laryngoscopy with an accuracy of 74.3%, a sensitivity of 64.7%, and a specificity of 77.1%. CONCLUSIONS: Our work demonstrates that the DSE can be effectively used to predict difficult laryngoscopy. Moreover, combining DSE with the modified Mallampati score in a decision tree significantly improves the predictive power over either test alone.

Osteoid osteoma of the glenoid: Arthroscopic treatment.

Osteoid osteoma is a benign tumor that is rarely found in the scapula. We report a clinical case involving a 36-year-old female patient who suffered from progressive pain in her right shoulder for 1 year. This patient was initially diagnosed with impingement syndrome and was treated unsuccessfully with medication and physical therapy for approximately 2 months. Based on imaging exams, a juxta-articular osteoid osteoma of the glenoid was identified. The patient underwent a shoulder arthroscopy that included tumor removal and treatment of the resulting chondral lesion. At 6-, 12- and 36-month assessments, the patient was asymptomatic, with a normal range of motion and experienced a pain intensity corresponding to 0 points on the Visual Analog Scale (VAS) and 35 points on the University of California, Los Angeles (UCLA) Scale. A postoperative MRI indicated the absence of any residual tumor tissue or inflammatory signs. We believe that the approach described in this paper allows juxta-articular osteoid osteomas to be accessed in a minimally invasive manner and permits not only adequate resection but also the treatment of chondral lesions that could remain after tumor resection.

Large-scale whole genome sequencing of M. tuberculosis provides insights into transmission in a high prevalence area.

To improve understanding of the factors influencing tuberculosis transmission and the role of pathogen variation, we sequenced all available specimens from patients diagnosed over 15 years in a whole district in Malawi. Mycobacterium tuberculosis lineages were assigned and transmission networks constructed, allowing ≤10 single nucleotide polymorphisms (SNPs) difference. We defined disease as due to recent infection if the network-determined source was within 5 years, and assessed transmissibility from forward transmissions resulting in disease. High-quality sequences were available for 1687 disease episodes (72% of all culture-positive episodes): 66% of patients linked to at least one other patient. The between-patient mutation rate was 0.26 SNPs/year (95% CI 0.21-0.31). We showed striking differences by lineage in the proportion of disease due to recent transmission and in transmissibility (highest for lineage-2 and lowest for lineage-1) that were not confounded by immigration, HIV status or drug resistance. Transmissions resulting in disease decreased markedly over time.

Assessment of the function and resistance of sternoclavicular ligaments: A biomechanical study in cadavers.

BACKGROUND: Few biomechanical studies have assessed the resistance of the ligamentous structures of the sternoclavicular joint, and none have reproduced the physiological movements of the joint. Determining the structures that are injured in sternoclavicular dislocations is important for the surgical planning of acute or chronic ligament reconstruction. METHODS: Forty-eight joints from 24 human cadavers were studied, and they were divided into 4 groups of 12 joints each (retraction, protraction, depression and elevation). Biomechanical testing assessed primary and secondary failures. The mechanical resistance parameters between movements that occurred on the same plane (depression versus elevation, protraction versus retraction) were compared. RESULTS: The posterior sternoclavicular ligament was the most injured structure during the protraction test, but it was not injured during retraction. The anterior sternoclavicular ligament was the most affected structure during retraction and depression. The costoclavicular ligament was the most affected structure during elevation. Joint resistance was significantly greater during protraction movements when compared to retraction (P<0.05). CONCLUSION: The anterior sternoclavicular ligament was the most affected structure during retraction and depression movements. During protraction, lesions of the posterior sternoclavicular ligament were most frequent during elevation, and the costoclavicular ligament was the most frequently injured ligament. The resistance of the sternoclavicular joint was significantly greater during protraction movement when compared to retraction. LEVEL OF EVIDENCE: IV, basic science, biomechanics, cadaver model.

Treatment of anaemia with erythropoiesis-stimulating agents in patients with chronic kidney disease does not lower mortality and may increase cardiovascular risk: a meta-analysis.

BACKGROUND/AIMS: Interpretation of the results of earlier meta-analyses in chronic kidney disease (CKD) patients on the impact of anaemia treatment with erythropoiesis-stimulating agents (ESAs) on clinical outcomes has been hampered by the inclusion of small trials and trials of short duration. We re-evaluated the benefits and harms of treating anaemia, including only relevant clinical trials. METHODS: We conducted a systematic review and meta-analysis of randomised controlled trials performed in adults with CKD which allocated patients to different doses of ESAs, and we compared the effect of these interventions on vascular access thrombosis, stroke, risk of end-stage renal disease (ESRD) and all-cause mortality. Additional inclusion criteria were studies with a duration of at least 1 year and enrolling more than 500 participants. RESULTS: Five trials (7,902 participants) met the inclusion criteria and were included in the meta-analysis. The number of patients enrolled in each trial ranged from 596 to 4,038. The mean/median duration of follow-up ranged from 14 to 36 months. A higher haemoglobin target was associated with increased risk of vascular access thrombosis (RR 1.343; 95% CI 1.162-1.554; p = 0.0005) and stroke (RR 1.735; 95% CI 1.323-2.275; p = 0.0005), and no effect on risk of ESRD (RR 1.089; 95% CI 0.986-1.203; p = 0.094) or all-cause mortality (RR 1.148; 95% CI 0.977-1.350; p = 0.093). CONCLUSION: In CKD patients, treatment of anaemia with ESAs targeting a higher haemoglobin value does not lower mortality or reduce the risk of ESRD, and may increase cardiovascular risk.

Co-administration of ondansetron decreases the analgesic efficacy of tramadol in humans.

Tramadol, a central analgesic acting on serotonin neurotransmission, is often co-used with ondansetron, a 5-HT(3) antagonist, for the management of postoperative pain to decrease nausea and vomiting. The aim of the study is to test the hypothesis that this drug combination raises tramadol requirement by patient-controlled analgesia (PCA). Forty patients undergoing hernioplasty or thyroidectomy were enrolled in a randomized, controlled study and allocated to receive ondansetron 4 mg i.v. (n = 20) or saline (n = 20). At 0, 1, 2, 4 and 24 h of PCA, tramadol consumption was evaluated. Tramadol consumption (mg × kg(-1) × h(-1)) was higher in the ondansetron group at the 2-hour time point compared to the control group (0.24 ± 0.1 vs. 0.17 ± 0.16; p = 0.01). Our study suggests that ondansetron acutely reduces the analgesic efficacy of tramadol.

[Dioxins and furans: origins and risks]. / Dioxinas e furanos: origens e riscos.

A bibliographic review is presented with the objective of describing the origin and the risks to the public health of dioxins and furans and getting familiar with some research areas about these compounds. The review has considered 16 selected references covering a period of approximately twelve years (1986 to 1997). The main conclusions were: a) These compounds are from nonnatural origin, considered highly toxic, extremely persistent in the environment, and they have been detected in all environmental matrices like: soil, sediments, air, water, animals and plants; b) emissions of these compounds to the atmosphere come primarily from combustion processes; c) atmospheric dispersion, deposition and subsequent accumulation in the food chain seem to be the major exposure pathway to the general population; d) due to their lipophilic characteristic and persistence in the environment, these compounds accumulate in adipose tissues, being food of animal origin those which present higher concentrations; e) in Brazil, the few studies conducted, with the measurement of concentrations of these compounds in the environment have showed levels comparable to those obtained in Germany. The authors recommend the development of further studies about these compounds in Brazil, specially about their accumulation in food and in human tissue

[Clinical picture of Hartnup disease. Without urine amino acids or any other identified metabolic disorder (a new entity)]. / Quadro clínico de doença de Hartnup. Sem aminoaciduria ou outra alteração metabólica identificada (entidade Nova).

Harthnup disease clinical picture without aminoaciduria or other identified metabolic disturb (New entity?). The authors present a patient with clinical picture superposed to the Hartnup disease's, a rare, autosomic and recessive metabolic disturbance, characterized by typical aminoaciduria consequent to tryptophan and other neutral aminoacids defective transport by jejunal mucous membrane and renal tubules, clinically expressed by photosensitive pellagra-like dermatitis, mental retardation and intermittent cerebellar ataxia. The laboratorial results did not confirm Hartnup aminoaciduria nor other identified metabolic change that justify his clinical manifestations.

The effects of milling on diameters and lengths of fibrous glass and chrysotile asbestos fibers.

An investigation on the ffects of milling on diameters and lengths of fibrous glass and chrysotile asbestos was performed. A wool type fibrous glass and chrysotile asbestos were ball milled, one at a time, for selected periods of time. After each milling time a sample was taken by using a special technique to obtain representative samples. The samples from all milling times were analyzed by phase contrast microscopy with a Zeiss phase contrast objective at a total magnification of 625 X. Selected samples were observed and photographed in a Phillips EM 200 electron miscroscope. The results of examination by phase contrast microscopy showed that milling had no significant effect on diameters of fibrous glass fibers, but reduced the lengths of these fibers and reduced both diameters and lengths of chrysotile asbestos...