Exposición laboral a ruido en personal de servicio en ambulancias médica / Workplace noise exposure of personal emergency medical

Se determinó el nivel de exposición laboral a ruido en los trabajadores de las ambulancias de emergencias médicas que utilizan sistema sonoro a partir de la percepción de exposición y efectos al ruido, los elementos de organización del trabajo, evaluación ambiental y dosimetría personal realizada durante horario laboral, los días de mayor atención asistencial y tipo de emergencia. La investigación fue de tipo descriptiva de campo, exploratoria. Con una muestra de 21,4% (30 trabajadores) integrada por médicos, paramédicos y conductores. Criterios de inclusión: trabajadores fijos con antigüedad mayor de 1 año. Se obtuvo los siguientes resultados: promedio de antigüedad laboral 7 años. El 59,6% percibe que su trabajo está bastante o muy afectado por el ruido, 63,3% no refirió deterioro auditivo, 93% no consultó ni se realizó control audiométrico; 16,6% refirió tinnitus. Sólo, 24,5% de las actividades de emergencias se realizan con sistema sonoro y menor a 2 horas por turno. Se registró nivel elevado de ruido en la cabina anterior con ventanas cerradas en una ambulancia (Leq 95,5 dBA); sin embargo, la dosimetría personal reportó un Leq de 80,4 dBA con dosis de 11%; valores que no exceden los niveles técnicos de referencia (85 dbA). Hay percepción de exposición laboral a ruido, que no superan los niveles técnicos de referencia de acuerdo a la norma venezolana. Se recomienda la reubicación inmediata de la fuente sonora en la unidad que presentó nivel superior a 85 dBAy la realización de examen audiológico para verificar la ausencia de lesión y generar tranquilidad en los trabajadores(AU)

We measured occupational exposure to noise among emergency ambulance workers, based on their perception of exposure and noise effects, work organization elements, environmental assessment and personal dosimetry over a work shift, during peak activity and by type of emergency. This was a cross-sectional study conducted in a sample of 21.4%of the workforce(30 workers), and included physicians, paramedics and drivers, with a permanent contract and more than one year on the job. Results: the average seniority was seven years; 59.6% perceived their work to be affected or very affected by noise, 63.3% did not report hearing loss, 93% had not sought medical attention nor undergone an audiometry, and 16.6% reported tinnitus. Only 24.5% of emergency activities are performed with the siren on and forless than 2 hours per shift. The highest noise levels were measured in the driver’s cabin with windows closed( ceiling level,95.5dBA). However, personal dosimetry measurements showeda time-weighted average of 80.4 dBA at a dose of 11%; these values do not exceed the permissible exposure level of 85 dbA. Emergency medical personnel perceive exposure to noise in their jobs; however, the Venezuelan permissible occupational exposure limit is not exceeded. We recommend the immediate relocation of the sound source in the unit that had a level above 85 dBA and audiometric evaluation of workers to verify the absence of injury and generate peace of mind(AU)

Herpes simplex encephalitis is linked with selective mitochondrial damage; a post-mortem and in vitro study.

Herpes simplex virus type-1 (HSV-1) encephalitis (HSE) is the most commonly diagnosed cause of viral encephalitis in western countries. Despite antiviral treatment, HSE remains a devastating disease with high morbidity and mortality. Improved understanding of pathogenesis may lead to more effective therapies. Mitochondrial damage has been reported during HSV infection in vitro. However, whether it occurs in the human brain and whether this contributes to the pathogenesis has not been fully explored. Minocycline, an antibiotic, has been reported to protect mitochondria and limit brain damage. Minocycline has not been studied in HSV infection. In the first genome-wide transcriptomic study of post-mortem human HSE brain tissue, we demonstrated a highly preferential reduction in mitochondrial genome (MtDNA) encoded transcripts in HSE cases (n = 3) compared to controls (n = 5). Brain tissue exhibited a significant inverse correlation for immunostaining between cytochrome c oxidase subunit 1 (CO1), a MtDNA encoded enzyme subunit, and HSV-1; with lower abundance for mitochondrial protein in regions where HSV-1 was abundant. Preferential loss of mitochondrial function, among MtDNA encoded components, was confirmed using an in vitro primary human astrocyte HSV-1 infection model. Dysfunction of cytochrome c oxidase (CO), a mitochondrial enzyme composed predominantly of MtDNA encoded subunits, preceded that of succinate dehydrogenase (composed entirely of nuclear encoded subunits). Minocycline treated astrocytes exhibited higher CO1 transcript abundance, sustained CO activity and cell viability compared to non-treated astrocytes. Based on observations from HSE patient tissue, this study highlights mitochondrial damage as a critical and early event during HSV-1 infection. We demonstrate minocycline preserves mitochondrial function and cell viability during HSV-1 infection. Minocycline, and mitochondrial protection, offers a novel adjunctive therapeutic approach for limiting brain cell damage and potentially improving outcome among HSE patients.

El índice tobillo-brazo como predictor de mortalidad vascular / Ankle brachial index as indicator for vascular mortality

El índice tobillo-brazo (ITB) es un parámetro que muestra la relación entre la tensión arterial sistólica de la extremidad superior y la extremidad inferior. Este indicador, ampliamente estudiado y presente en la bibliografía, se ha mostrado como excelente predictor de mortalidad tanto vascular como por causas generales cuando presenta valores fuera del rango establecido como normal (0,90-1,30). En dichas situaciones la utilidad del ITB reside en detectar precozmente la existencia de enfermedad arterial periférica (EAP) durante su fase asintomática y servir como parámetro de corte para el establecimiento de medidas preventivas más contundentes antes de que el daño vascular existente se haga sintomático. Para el profesional de enfermería este parámetro constituye una potente herramienta de valoración, objetiva y cuantitativa, que permite seleccionar aquellos pacientes en los que es preciso potenciar al máximo los cuidados preventivos (AU)

The ankle-brachial index (ABI) is a simple test showing the relationship between systolic blood pressure in the upper and the lower limbs. This parameter widely studied in literature has been reported as an excellent vascular and all-cause death predictor when exceeds the normal values (0.90-1.30). In such situation the ABI can early detect periferic arterial disease (PAD) in asymptomatic phase and be a cutoff parameter to consider more aggressive preventive interventions before the existing vascular damage becomes symptomatic. This test is a powerful assessment tool for nurses to select those patients needing to maximize preventive cares. The nursing staff training for ABI measurement, the provision of suitable equipment by the Health Institutions and the development of reliable and more simple measurement methods are key issues that would facilitate its routinely and systematically use to improve the preventive strategy in vascular diseases (AU)