Sal rosa do Himalaia: determinação do teor de iodo, pesquisa de corantes e avaliação da rotulagem / Himalayan pink salt: iodine, colorants research and labeling evaluation

Introdução: O sal rosa do Himalaia tem se destacado no mercado brasileiro por sua coloração atrativa, além dos apelos ao consumidor que o destacam como um produto "mais natural" e com grande diversidade de minerais por ser um sal de rocha. O teor de iodo no sal rosa consumido no país ainda é pouco discutido, mas vital para manter sob controle os distúrbios por deficiência de iodo (DDI).  Objetivo: Avaliar amostras de sal rosa do Himalaia quanto aos teores de iodo, à presença de corantes e à rotulagem. Método: Foram analisadas 71 amostras em 13 cidades do estado de São Paulo para determinação de iodo adicionado na forma de iodato, prova qualitativa para corantes artificiais e avaliação da rotulagem com base na legislação brasileira. Resultados: Um elevado índice de  insatisfatoriedade dos teores de iodo foi encontrado (56%) e um percentual ainda maior nos sais comercializados a granel (74%). Verificou-se que, dentre as amostras insatisfatórias, o maior percentual de inadequação (28%) foi a ausência de iodo, colocando a população consumidora deste produto em risco para as DDI. A irregularidade de rotulagem mais encontrada foi a ausência da declaração da adição de iodo (46%), com contradições entre a declaração no rótulo e a efetiva presença avaliada analiticamente. Foram verificadas expressões de qualidade não previstas (27%) ou superlativas (14%), assim como alegações não comprovadas por estudos científicos, como a redução de 60% de sódio e a presença de 84 minerais. Nenhuma amostra apresentou adição de corante. Conclusões: O sal rosa do Himalaia analisado apresentou irregularidades importantes para a saúde da população, em especial quanto ao teor de iodo, mas também não conformidades de rotulagem que comprometem o acesso à informação correta sobre o produto.

Introduction: Himalayan pink salt has stood out in the Brazilian market for its attractive colors, in addition to appeals to the consumer that highlight it as a "more natural" product and with a great diversity of minerals as it is a rock salt. The iodine content in pink salt consumed in the country is still little discussed, but vital to keep Iodine Deficiency Disorders (DDIs) under control. Objective: Evaluate Himalayan pink salt samples for iodine contents, presence of artificial colorants and labeling. Method: Seventy-one samples from thirteen cities of the São Paulo State were analyzed for determination of iodine added as iodate, qualitative testing colorants, and labeling evaluation based on Brazilian legislation. Results: A high rate of unsatisfactory iodine content was found (56%), even higher in salts sold in bulk (74%). It was found that among the unsatisfactory samples, the highest percentage of inadequacy (28%) was the absence of iodine, exposing the consumers of this product at risk for DDIs. The most frequent labeling irregularity was the absence of iodine declaration (46%), with contradictions between label declaration and effective presence evaluated analytically. Unforeseen (27%) or superlative (14%) quality expressions were verified, as well as claims not supported by scientific studies, such as 60% reduction in sodium and presence of 84 minerals. No sample showed colorants addition. Conclusions: Himalayan pink salt samples analyzed showed important irregularities for health of the population, especially regarding the iodine content, but also labeling inaccuracies that compromise access to correct information about the product.

Post-varicella arterial ischemic stroke in children and neurocognitive performance: a 4-year follow-up study.

OBJECTIVE: To analyze data from children who were previously healthy and presented with post-varicella arterial ischemic stroke upon arrival when admitted to the emergency room, with focus on the clinical/laboratory aspects, and neurocognitive performance after four-year follow-up. METHODS: Seven children presenting with arterial ischemic stroke after varicella were evaluated at pediatric emergency services in the city of São Paulo (SP), Brazil. Ischemic stroke was determined by magnetic resonance imaging/magnetic resonance angiography in a topography compatible with the areas supplied by the middle cerebral or internal carotid arteries. IgG-class antibodies against varicella zoster virus and varicella-zoster virus DNA by polymerase chain reaction in cerebrospinal fluid were tested. Patients with prothrombotic conditions were excluded. The Pediatric Stroke Outcome Measure was applied upon admission and 4-years after the stroke. RESULTS: All patients (age range: 1.3 to 4 years) included presented chickenpox 5.1 (±3.5) months before. All patients had analysis of anti-varicella-zoster-virus-IgG in cerebrospinal fluid, but only three (43%) had a positive result. Of the patients 43% had no vascular lesions identified in magnetic resonance angiography. All patients showed improvement in their sequela scores. After 4 years, five patients displayed good evolution in the Pediatric Stroke Outcome Measure, and only one patient presented with a score of 2 in the sensorimotor and cognition areas. No recurrence of arterial ischemic stroke was observed. CONCLUSION: We reinforced the non-progressive course of post-varicella arterial ischemic stroke after 4-year follow-up. The presence of varicella-zoster-virus-DNA detected by polymerase chain reaction, and/or intrathecal IgG antibody against varicella zoster virus, and angiopathy location in magnetic resonance angiography were not determining for the diagnosis. Invasive tests, with low sensitivity, should be well considered in the diagnosis of post-varicella arterial ischemic stroke.

Small is beautiful: climate-change science as if people mattered.

There is a widely accepted gap between the production and use of climate information. It is also widely accepted that at least part of the reason for this situation lies in the challenge of bridging between what may be characterized as ''top-down'' approaches to climate information on the global scale, and local decision contexts, which necessarily take a ''bottom-up'' perspective, in which climate change is just one factor among many to consider. We here reflect on the insights provided in a different context-that of economics-by E.F. Schumacher in his celebrated book Small is Beautiful (1973), to see what light they might shed on this challenge, with a focus on climate-change science for adaptation. Schumacher asked how economics might look if it was structured "as if people mattered". We ask the same question of climate-change science, and find many parallels. One is the need to grapple with the complexity of local situations, which can be addressed by expressing climate knowledge in a conditional form. A second is the importance of simplicity when dealing with deep uncertainty, which can be addressed through the use of physical climate storylines. A third is the need to empower local communities to make sense of their own situation, which can be addressed by developing ''intermediate technologies'' that build trust and transparency. Much of climate-change science is necessarily big science. We argue that in order to make climate information useable for adaptation, it is also necessary to discover the beauty of smallness.

Post-varicella arterial ischemic stroke in children and neurocognitive performance: a 4-year follow-up study

ABSTRACT Objective To analyze data from children who were previously healthy and presented with post-varicella arterial ischemic stroke upon arrival when admitted to the emergency room, with focus on the clinical/laboratory aspects, and neurocognitive performance after four-year follow-up. Methods Seven children presenting with arterial ischemic stroke after varicella were evaluated at pediatric emergency services in the city of São Paulo (SP), Brazil. Ischemic stroke was determined by magnetic resonance imaging/magnetic resonance angiography in a topography compatible with the areas supplied by the middle cerebral or internal carotid arteries. IgG-class antibodies against varicella zoster virus and varicella-zoster virus DNA by polymerase chain reaction in cerebrospinal fluid were tested. Patients with prothrombotic conditions were excluded. The Pediatric Stroke Outcome Measure was applied upon admission and 4-years after the stroke. Results All patients (age range: 1.3 to 4 years) included presented chickenpox 5.1 (±3.5) months before. All patients had analysis of anti-varicella-zoster-virus-IgG in cerebrospinal fluid, but only three (43%) had a positive result. Of the patients 43% had no vascular lesions identified in magnetic resonance angiography. All patients showed improvement in their sequela scores. After 4 years, five patients displayed good evolution in the Pediatric Stroke Outcome Measure, and only one patient presented with a score of 2 in the sensorimotor and cognition areas. No recurrence of arterial ischemic stroke was observed. Conclusion We reinforced the non-progressive course of post-varicella arterial ischemic stroke after 4-year follow-up. The presence of varicella-zoster-virus-DNA detected by polymerase chain reaction, and/or intrathecal IgG antibody against varicella zoster virus, and angiopathy location in magnetic resonance angiography were not determining for the diagnosis. Invasive tests, with low sensitivity, should be well considered in the diagnosis of post-varicella arterial ischemic stroke.

CCL3, CCL5, IL-15, IL-1Ra and VEGF compose a reliable algorithm to discriminate classes of adverse events following 17DD-YF primary vaccination according to cause-specific definitions.

In the present study, a range of serum biomarkers were quantified in suspected cases of adverse events following YF immunization (YEL-AEFI) to propose a reliable laboratorial algorithm to discriminate confirmed YEL-AEFI ("A1" class) from cases with other illnesses ("C" class). Our findings demonstrated that increased levels of CXCL8, CCL2, CXCL10, IL-1ß, IL-6 and TNF-α were observed in YEL-AEFI ("A1" and "C" classes) as compared to primary vaccines without YEL-AEFI [PV(day 3-28)] and reference range (RR) controls. Notably, increased levels of CCL3, CCL4, CCL2, CCL5, IL-1ß, IL-15, IL-1Ra and G-CSF were found in "A1" as compared to "C" class. Venn diagrams analysis allowed the pre-selection of biomarkers for further analysis of performance indices. Data demonstrated that CCL3, CCL5, IL-15 and IL-1Ra presented high global accuracy (AUC = 1.00) to discriminate "A1" from "C". Decision tree was proposed with a reliable algorithm to discriminate YEL-AEFI cases according to cause-specific definitions with outstanding overall accuracy (91%). CCL3, CCL5, IL-15 and IL-1Ra appears as root attributes to identify "A1" followed by VEGF as branch nodes to discriminate Wild Type YFV infection ("C(WT-YFV)") from cases with other illnesses ("C*"). Together, these results demonstrated the applicability of serum biomarker measurements as putative parameters towards the establishment of accurate laboratorial tools for complementary differential diagnosis of YEL-AEFI cases.

Multisystem inflammatory syndrome associated with COVID-19 from the pediatric emergency physician's point of view.

OBJECTIVE: Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease (COVID-19) is a rare and challenging diagnosis requiring early treatment. The diagnostic criteria involve clinical, laboratory, and complementary tests. This review aims to draw pediatrician attention to this diagnosis, suggesting early treatment strategies, and proposing a pediatric emergency care flowchart. SOURCES: The PubMed/MEDLINE/WHO COVID-19 databases were reviewed for original and review articles, systematic reviews, meta-analyses, case series, and recommendations from medical societies and health organizations published through July 3, 2020. The reference lists of the selected articles were manually searched to identify any additional articles. SUMMARY OF THE FINDINGS: COVID-19 infection is less severe in children than in adults, but can present as MIS-C, even in patients without comorbidities. There is evidence of an exacerbated inflammatory response with potential systemic injury, and it may present with aspects similar to those of Kawasaki disease, toxic shock syndrome, and macrophage activation syndrome. MIS-C can develop weeks after COVID-19 infection, suggesting an immunomediated cause. The most frequent clinical manifestations include fever, gastrointestinal symptoms, rash, mucous membrane changes, and cardiac dysfunction. Elevated inflammatory markers, lymphopenia, and coagulopathy are common laboratory findings. Supportive treatment and early immunomodulation can control the intense inflammatory response and reduce complications and mortality. CONCLUSIONS: MIS-C associated with COVID-19 is serious, rare, and potentially fatal. The emergency department pediatrician must recognize and treat it early using immunomodulatory strategies to reduce systemic injury. Further studies are needed to identify the disease pathogenesis and establish the most appropriate treatment.

Differences in children and adolescents with SARS-CoV-2 infection: a cohort study in a Brazilian tertiary referral hospital

OBJECTIVES: To compare demographic/clinical/laboratory/treatments and outcomes among children and adolescents with laboratory-confirmed coronavirus disease 2019 (COVID-19). METHODS: This was a cross-sectional study that included patients diagnosed with pediatric COVID-19 (aged <18 years) between April 11, 2020 and April 22, 2021. During this period, 102/5,951 (1.7%) of all admissions occurred in neonates, children, and adolescents. Furthermore, 3,962 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detection samples were processed in patients aged <18 years, and laboratory-confirmed COVID-19 occurred in 155 (4%) inpatients and outpatients. Six/155 pediatric patients were excluded from the study. Therefore, the final group included 149 children and adolescents (n=97 inpatients and 52 outpatients) with positive SARS-CoV-2 results. RESULTS: The frequencies of sore throat, anosmia, dysgeusia, headache, myalgia, nausea, lymphopenia, pre-existing chronic conditions, immunosuppressive conditions, and autoimmune diseases were significantly reduced in children and adolescents (p<0.05). Likewise, the frequencies of enoxaparin use (p=0.037), current immunosuppressant use (p=0.008), vasoactive agents (p=0.045), arterial hypotension (p<0.001), and shock (p=0.024) were significantly lower in children than in adolescents. Logistic regression analysis showed that adolescents with laboratory-confirmed COVID-19 had increased odds ratios (ORs) for sore throat (OR 13.054; 95% confidence interval [CI] 2.750-61.977; p=0.001), nausea (OR 8.875; 95% CI 1.660-47.446; p=0.011), and lymphopenia (OR 3.575; 95% CI 1.355-9.430; p=0.010), but also had less hospitalizations (OR 0.355; 95% CI 0.138-0.916; p=0.032). The additional logistic regression analysis on patients with preexisting chronic conditions (n=108) showed that death as an outcome was significantly associated with pediatric severe acute respiratory syndrome (SARS) (OR 22.300; 95% CI 2.341-212.421; p=0.007) and multisystem inflammatory syndrome in children (MIS-C) (OR 11.261; 95% CI 1.189-106. 581; p=0.035). CONCLUSIONS: Half of the laboratory-confirmed COVID-19 cases occurred in adolescents. Individuals belonging to this age group had an acute systemic involvement of SARS-CoV-2 infection. Pediatric SARS and MIS-C were the most important factors associated with the mortality rate in pediatric chronic conditions with COVID-19.

Isolamento e identificação microscópica de elementos histológicos vegetais: contribuições para o controle de qualidade e segurança dos alimentos / Isolation and microscopic identification of vegetable histological elements: contributions to quality control and food safety

A microscopia alimentar atua no controle da qualidade e identidade dos alimentos utilizando recursos microscópicos para a identificação de elementos histológicos vegetais e de matérias estranhas. O objetivo do estudo foi apresentar as principais contribuições da análise microscópica de isolamento e identificação de elementos histológicos vegetais na vigilância dos alimentos analisados no Instituto Adolfo Lutz Central (IAL), de 2016 a 2020. Os dados das análises realizadas no período do estudo foram tabulados para categorização e avaliação dos resultados. Foram analisadas 4.189 amostras de alimentos e água, sendo 1.096 para pesquisa e identificação de elementos histológicos vegetais, com maior demanda para as análises de controle. As categorias de alimentos mais analisadas foram as misturas para o preparo de alimentos e alimentos prontos para consumo; café, cevada, chá, erva-mate e produtos solúveis; e os suplementos alimentares. Dentre as amostras analisadas, 5% não estavam de acordo com a rotulagem, principalmente devido à adição de ingrediente, com destaque para os açúcares e produtos para adoçar; as especiarias, temperos, molhos; e os suplementos alimentares. Por meio da análise microscópica foram verificadas adulterações em diversas categorias de produtos, demonstrando a sua contribuição às ações de vigilância na prevenção de fraudes e na segurança dos alimentos. (AU)

Food microscopy acts to control the quality and identity of foods using microscopic resources to identify vegetable histological elements and foreign matter.The aim of the study was to present the main contributions from microscopic analysis on isolation and identification of vegetable histological elements in the surveillance of foods analyzed at the Instituto Adolfo Lutz Central (IAL) from 2016 to 2020. Data from the analysis performed during the studied period were tabulated for categorization and further evaluation. Altogether, 4.189 food and water samples were analyzed and 1.096 samples underwent research and identification of vegetable histological elements, with greater demand for the control analysis.The most analyzed food categories were mixtures for food preparation and ready-to-eat foods; coffee, barley, tea, yerba mate and soluble products; and food supplements. Among the analyzed samples, 5% were not in accordance with the labeling, mainly due to the addition of an ingredient, especially sugars and sweetening products; spices, seasonings, sauces; and food supplements. Through microscopic analysis, adulterations were found in several categories of products, demonstrating its relevance to surveillance actions in fraud prevention and food safety. (AU)

Drivers and impacts of the most extreme marine heatwaves events.

Prolonged high-temperature extreme events in the ocean, marine heatwaves, can have severe and long-lasting impacts on marine ecosystems, fisheries and associated services. This study applies a marine heatwave framework to analyse a global sea surface temperature product and identify the most extreme events, based on their intensity, duration and spatial extent. Many of these events have yet to be described in terms of their physical attributes, generation mechanisms, or ecological impacts. Our synthesis identifies commonalities between marine heatwave characteristics and seasonality, links to the El Niño-Southern Oscillation, triggering processes and impacts on ocean productivity. The most intense events preferentially occur in summer, when climatological oceanic mixed layers are shallow and winds are weak, but at a time preceding climatological maximum sea surface temperatures. Most subtropical extreme marine heatwaves were triggered by persistent atmospheric high-pressure systems and anomalously weak wind speeds, associated with increased insolation, and reduced ocean heat losses. Furthermore, the most extreme events tended to coincide with reduced chlorophyll-a concentration at low and mid-latitudes. Understanding the importance of the oceanic background state, local and remote drivers and the ocean productivity response from past events are critical steps toward improving predictions of future marine heatwaves and their impacts.

Association of lifestyle factors with semen quality: A pilot study conducted in men from the Portuguese Trás-os-Montes and Alto Douro region followed in fertility support consultations.

A cross-sectional pilot study was conducted in men followed in fertility consultations, from the portuguese Trás-os-Montes and Alto Douro region, in order to associate several lifestyle factors with the spermatic parameters. Of a total of 522 men, 373 were compared based on the occupational exposure to harmful factors, smoking habits and practice of physical exercise per week, and the other 149 men according to their body mass index (normal weight vs. overweight vs. obesity). In the absence of harmful occupational factors, physical exercise seems to be associated with sperm quality improvement, whether individuals smoke or not. When exposed to harmful environments, non-smokers that practice physical exercise more than two times per week tended to present the best vitality, normal morphology and sperm concentration (p > .05). However, if they smoke, physical exercise seems not enough to enhance the spermatic parameters. The BMI correlated negatively with the spermatic quality, especially with sperm concentration (p < .05). Concerning men that did not present lifestyle risks associated, the motility, midpiece and tail abnormalities, and teratozoospermia index were significantly worse on obese individuals comparing to overweight men (p < .05). Thus, patients should also be recommended to control their weight and to have a BMI under 30 kg/m2 .

Macrophage profile and homing into breast milk in response to ongoing respiratory infections in the nursing infant.

Studies have shown that immune components of human milk can be changed during an infection in the nursing infant. Macrophages are abundant in human milk and they are classified into inflammatory (CD16-) and noninflammatory (CD16+) subsets. This study investigated CD16+ and CD16- macrophage homing into breast milk in response to ongoing infections in nursing infants. Peripheral blood and mature milk were collected from 33 healthy mothers of nursing infants with respiratory infections (Group I) and from 26 healthy mothers of healthy nursing infants (Group H). Blood and milk total, CD16- and CD16+ monocyte (Mo)/macrophage (Mφ) subsets, respectively, and CCR2 and CX3CR1 expression and cytokine levels were analyzed by flow cytometry. CCL2 and CX3CL1 were quantified by ELISA and cytokines by flow cytometry in serum and milk. There was an increase of total and CD16+ Mφ, and, also a decrease of CD16- Mφ frequencies in maternal milk from Group I compared to Group H, but absolute numbers analyses showed higher numbers of all subpopulations of milk Mφ in Group I compared to Group H. Higher numbers of CX3CR1+CD16+ and double-staining of CCR2 and CX3CR1 in both CD16+ and CD16- cells were observed in milk during infant infection, which weren't observed in the blood. CCR2 expression was hardly found in milk CD16- Mφ in both groups. CCL2 and CX3CL1 were both higher in milk than in blood from both groups, but Group I showed higher levels of these chemokines in milk than Group H. Breast milk showed higher IL-6 and IL-8 concentrations than serum, and infant infection caused an increase in these cytokines only in milk. Our findings suggest that milk Mφ profiles are different from blood Mo, and the ongoing infection in the nursing infant could change milk Mφ to a more anti-inflammatory profile compared to that in the healthy group, possibly as an additional strategy of infant protection.

Peixe bonito assado: um caso de surto de intoxicação por histamina / Roasted bonito fish: a case of histamine poisoning outbreak

Introdução: A ingestão de altos teores de histamina, cuja formação em peixes está associada à manutenção de peixes escombrídeos em temperaturas inadequadas, geralmente acima dos 4,4 °C, pode levar a um quadro de intoxicação alimentar, conhecido como escombrotoxicose. Objetivo: Relatar surto de escombrotoxicose em pessoas de uma família da cidade de Campinas, SP- Brasil; avaliar os fatores que foram determinantes para sua ocorrência; relatar os passos da investigação epidemiológica; e quantificar o teor de histamina na amostra incriminada. Metodologia: Foram realizadas investigações epidemiológica e sanitária. Foi coletada a sobra do pescado consumido pelos comensais e analisados os parâmetros microbiológicos e os teores de histamina por UHPLC. Resultados e Discussão: Os dados epidemiológicos obtidos da entrevista com os comensais demonstraram associação dos sintomas à intoxicação química, e confirmado pela análise do alimento, que apresentou a concentração de 6407,9 mg/kg de histamina. A inspeção sanitária, realizada no supermercado onde o peixe foi adquirido, indicou ausência de controle de temperatura na ilha de distribuição do pescado. Conclusões: A presente investigação epidemiológica e sanitária concluiu tratar-se de um surto de intoxicação por histamina, no qual uma família de quatro pessoas foi acometida. Com esta investigação, houve a implantação, por parte do supermercado, de controles mais rigorosos da temperatura do pescado, melhoria de sua conservação no gelo e aumento de sua quantidade, na ilha de exposição(AU)

Introduction: Intake of the high levels of histamine, whose production in fishes is associated with the maintenance of scombrid fish at inappropriate temperatures, usually above 4.4 °C; and it may lead to the food poisoning known as scombrotoxicosis. Objective: To report an outbreak of escombrotoxicosis in the members of a family from the city of Campinas, SP-Brazil. Also, to evaluate the factors which were determinant for its occurrence, to report the steps of the epidemiological investigation, and to quantify the histamine content in the incriminated sample. Methodology: Epidemiological and sanitary analyses were performed. The leftovers of the fishes consumed by the guests were collected, and they were analyzed regarding to the microbiological parameters and the histamine levels by means of UHPLC. Results and Discussion: The epidemiological data collected during interviewing the guests indicated an associating between the symptoms and the chemical poisoning, which was confirmed by analyzing the food. And this assay detected the concentrations of 6407.9 mg/kg of histamine. The health inspection carried out at the market, wherein the fish was bought, indicated the absence of temperature control in the distribution of the fish. Conclusions: The present epidemiological and sanitary investigation concluded that it was a case of histamine poisoning outbreak. Owing to this investigation, the supermarket established the more stringent controls of the temperature for preserving the fish, improving their placement in ices and also increasing their quantities(AU)

Passagem de plantão como ferramenta de gestão parasegurança do paciente / MEDICAL SHIFTS PASSAGE AS A MANAGEMENT TOOL FOR PATIENT SAFETY

Objetivo: compreender o processo de passagem de plantão do enfermeiro eelaborar uma ferramenta para viabilizar cientificamente tal contexto. Método: estudo deabordagem qualitativa, descritivo, realizado com 18 enfermeiros, por entrevistassemiestruturada analisadas por meio da Análise de Conteúdo, de setembro a dezembro de2016. Para a elaboração do instrumento, foram utilizadas a observação participante e oMétodo do Arco de Maguerez. Resultados: identificou-se que a passagem de plantãoapresenta caráter empírico, evidenciando a ausência de ferramenta científica que qualifiqueeste processo, fragilizando a segurança dos pacientes. Foram detectados nós críticos como: olocal da passagem de plantão, interrupções e excesso de comunicação, dessa forma, elaborouseum instrumento em formato de checklist embasado no modelo Situation, Background,Assessment, Recommendation – SBAR de comunicação. Considerações finais: evidencia-seque é possível eliminar o caráter empírico da passagem de plantão utilizando a ferramentaSBAR, favorecendo a segurança dos pacientes.

Objective: to understand the nurses' shift process and to develop a tool toscientifically enable such context. Method: a qualitative, descriptive study, carried out with18 nurses, through semi-structured interviews analyzed by the Content Analysis, fromSeptember to December 2016. For the instrument elaboration, participant observation andthe Method of the Arch of Maguerez were used. Results: it was identified that the passage ofthe shift is empirical, evidencing the absence of a scientific tool that qualifies this process,which weakens patient safety. Critical nodes were detected, such as: the location of the shift,interruptions and over-communication, thus, an instrument was developed as a checklistformat based on the Situation, Background, Assessment, Recommendation - SBAR model ofcommunication. Final considerations: it is evident that it is possible to eliminate theempirical character of the shift by using the SBAR tool, which benefits patient safety.

Objetivo: comprender el proceso de pasaje de guardia del enfermero y elaboraruna herramienta para basar científicamente tal contexto. Método: Estudio de perspectivacualitativa, descriptiva, realizado con 18 enfermeros, por medio de entrevistassemiestructuradas analizadas a partir del Análisis de Contenido, entre septiembre ydiciembre de 2016. Para la elaboración del instrumento, se utilizó la observaciónparticipante y el Método del Arco de Maguerez. Resultados: se identificó que el pasaje de laguardia presenta carácter empírico, lo que evidencia la ausencia de una herramientacientífica que califique ese proceso, debilitando la seguridad de los pacientes. Se detectónudos críticos como: el lugar de pasaje de guardia, interrupciones y exceso de comunicación,a partir de esas constataciones, se elaboró un instrumento en formato de checklist basado enel modelo Situation, Background, Assessment, Recommendation - SBAR de comunicación.Consideraciones finales: se evidencia que es posible eliminar el carácter empírico del pasajede guardia utilizando la herramienta SBAR, favoreciendo la seguridad de los pacientes.

The N-butyl-N-4-hydroxybutyl Nitrosamine Mouse Urinary Bladder Cancer Model.

Urinary bladder cancer (UBC) is a common and complex malignancy, with a multifactorial etiology, like environmental factors, such as cigarette smoking, occupational exposure, and genetic factors.UBC exhibits considerable genotypic and phenotypic heterogeneity. Among all UBC lesions, urothelial carcinoma is the most frequently observed histological type. Despite all the developments made in urologic oncology field, therapeutic options remain inadequate. There is urgency for the identification and development of new antineoplastic drugs to replace or improve current protocols and in vivo models have been proven to be essential for this step. There are different animal models of UBC: Spontaneous and experimentally induced models (genetically engineered, transplantable-xenograft and syngeneic animals- and chemically induced models). N-butyl-N(4-hydroxybutil)nitrosamine (BBN) is the most suitable reagent to generate chemically induced in vivo models of UBC and to study bladder carcinogenesis. BBN has proven, over the years, to be very realistic and reliable. It is bladder specific, and induces high tumor incidence.

Implementation of Humane Endpoints in a Urinary Bladder Carcinogenesis Study in Rats.

BACKGROUND/AIM: This study aimed to evaluate the utility of several biological parameters for the prediction of tumor development and animal welfare in a rat model of urinary bladder cancer. MATERIALS AND METHODS: The control group (n=9) received tap water while the test group (n=12) received the carcinogen N-butyl-N-(4-hydroxybutyl) nitrosamine (BBN) in drinking water. A score sheet with biological variables was used to monitor animals' welfare. Body weight, food and drink consumption and rectal temperature were measured weekly. Blood and urine samples were collected. RESULTS: Animals from the control group exhibited a slightly higher body weight and body weight gain. The final urine volume was higher in BBN group (p<0.05). All animals from the BBN group exhibited macroscopic hematuria at 35th week. Four animals were anemic in the last week of the experiment. CONCLUSION: The routine control of hematuria was a useful non-invasive biomarker of disease progression that may be used as a potential earlier humane endpoint. Animals did not show clinical signs of suffering that justified their sacrifice before the end of the study.

Synergistic Effect of Carboplatin and Piroxicam on Two Bladder Cancer Cell Lines.

BACKGROUND/AIM: This study aimed to evaluate the in vitro efficacy of carboplatin and piroxicam, both in isolation and combined, against T24 and 5637 human urinary bladder cancer cell lines. MATERIALS AND METHODS: Cell viability, drug interaction, cell morphology, cell proliferation, apoptosis and autophagy were analyzed after 72 h of drug exposure. Statistical analysis was performed and values of p<0.05 were considered statistically significant. RESULTS: Drug exposure in combination led to a significant reduction of cell viability comparatively to single-drug exposure. These combinations resulted in a synergistic interaction in the T24 (combination index for 50% effect (CI50)=0.65) and 5637 (CI50=0.17) cell lines. Notable increase of morphological alterations, a marked decrease of Ki-67 expression, a considerable enhancement of autophagic vacuoles and a minimal effect on apoptosis was observed in both cell lines treated with combined drugs. CONCLUSION: Data showed that in vitro combination of carboplatin and piroxicam produced a more potent antiproliferative effect when compared to single drugs.

Altered expression of CKs 14/20 is an early event in a rat model of multistep bladder carcinogenesis.

Cytokeratins (CKs) 14 and 20 are promising markers for diagnosing urothelial lesions and for studying their prognosis and histogenesis. This work aimed to study the immunohistochemical staining patterns of CK14/20 during multistep carcinogenesis leading to papillary bladder cancer in a rat model. Thirty female Fischer 344 rats were divided into three groups: group 1 (control); group 2, which received N-butyl-N-(4-hydroxybutyl)nitrosamine (BBN) for 20 weeks plus 1 week without treatment; and group 3, which received BBN for 20 weeks plus 8 weeks without treatment. Bladder lesions were classified histologically. CK14 and CK20 immunostaining was assessed according to its distribution and intensity. In control animals, 0-25% of basal cells and umbrella cells stained positive for CK14 and CK20 respectively. On groups 2 and 3, nodular hyperplastic lesions showed normal CK20 and moderately increased CK14 staining (26-50% of cells). Dysplasia, squamous metaplasia, papilloma, papillary tumours of low malignant potential and low- and high-grade papillary carcinomas showed increased CK14 and CK20 immunostaining in all epithelial layers. Altered CK14 and CK20 expression is an early event in urothelial carcinogenesis and is present in a wide spectrum of urothelial superficial neoplastic and preneoplastic lesions.

Programa de Ensaio de Proficiência para iodo em sal refinado organizado pelo Instituto Adolfo Lutz - São Paulo, 2014 / Proficiency Testing Program for iodine in refined salt organized by Adolfo Lutz Institute - São Paulo, 2014

Este trabalho apresenta as etapas do Programa de Ensaio de Proficiência (PEP) para determinar iodo em sal refinado, organizado pelo Instituto Adolfo Lutz, no ano de 2014, em São Paulo, com o objetivo de oferecer uma ferramenta metrológica para avaliar o desempenho dos laboratórios participantes, principalmente, daqueles que subsidiam o Programa Nacional de Monitoramento de Iodo em Sal. O sal refinado iodado preparado para realização do PEP, foi considerado suficientemente homogêneo e estável para condução do programa. Dentre os 34 laboratórios participantes, 27 (79%) apresentaram desempenho satisfatório, 3 (9%) apresentaram desempenho questionável e 4 (12%) apresentaram desempenho insatisfatório, revelando a necessidade de ações corretivas, de forma a identificar e corrigir os problemas que possam ter interferido nos resultados. Considera-se que a oferta de Programas de Ensaio de Proficiência para iodo em sal deve ser realizada com maior frequência, contribuindo para a melhoria contínua dos procedimentos de medição, visando a confiabilidade metrológica. Espera-se, com este tipo de ação, aumentar a segurança da população quanto à ingestão adequada de iodo...

Teor de iodo no sal para consumo humano: monitoramento no Estado de São Paulo no período de 1999 a 2014 / Iodine content in salt for human consumption: monitoring in São Paulo state from 1999 to 2014

O presente trabalho teve como objetivos quantificar e monitorar os teores de iodo em 681 amostras de sal para consumo humano de 72 diferentes marcas, comercializadas no Estado de São Paulo, ao longo de 15 anos, no período de 1999 a 2014, a fim de verificar o cumprimento da legislação vigente quanto à obrigatoriedade da iodação do sal e estimar o impacto do seu consumo para a população. Verificou-se que das 681 amostras, 624 (91,6%) apresentaram-se satisfatórias e 57 (8,4%) insatisfatórias, demonstrando a alta porcentagem de cumprimento à legislação pelas indústrias salineiras. No entanto, pode-se constatar que o valor da mediana de iodo no sal vem declinando com as mudanças das legislações no Brasil e nos últimos dois anos tem sido de 27 mg/kg. Considerando o consumo médio de sal, segundo dados das Pesquisas de Orçamentos Familiares (POF – 2002/2003 e 2008/2009), de 10,1 g/dia, estima-se assim que ainda esteja ocorrendo ingestão excessiva de iodo pela população...