Chronostratigraphy elucidates environmental changes in lacustrine sedimentation rates and metal accumulation.

All changes taking place in a watershed have repercussions on lacustrine environments, being these, the sink of all activities occurring in the basin. Lake Titicaca, the world's highest and navigable lake, is not unfamiliar with these phenomena that can alter the sedimentation dynamics and metal accumulation. This study aimed to identify temporal trends of sedimentation rates by employing a geochronological analysis (210Pb, 137Cs) and to propose metal background values in Puno Bay, as well as to identify metal concentrations (As, Ba, Ca, Cr, Cu, K, Mg, Mo, Ni, Pb, Zn) in the projected timeline to propose, for the first time, background values in Puno Bay. Two sediment cores were collected from the outer and inner bays. Sediment rate (SR) was calculated through the excess of 210Pb (210Pbxs) applying the Constant Flux Constant Sedimentation (CFCS) model. Results show that SR in the outer bay was 0.48 ± 0.08 cm a-1 and for the inner bay was 0.64 ± 0.07 cm a-1. Sediment quality guidelines (SQGs) did not indicate toxicity was likely to occur, except for As. However, enrichment factors (EFs) indicated that all metal accumulation is geogenic. Climatic factors had a marked influence on sedimentation rates for the outer bay, and in the case of the inner bay, it was a sum of climatic and human-based factors.

The Inflammatory Biomarkers Behavior Profile of Patients Following Elective Degenerative Spine Surgery and Differences Compared to Those Coursing With a Postoperative Spinal Infection: Protocol for a Systematic Review.

BACKGROUND: The incidence of postoperative spinal infection (PSI) ranges from 0% to 10%, with devastating effects on the patient prognosis because of higher morbidity while increasing costs to the health care system. PSIs are elusive and difficult to diagnose, especially in the early postoperative state, because of confusing clinical symptoms, rise in serum biomarkers, or imaging studies. Current research on diagnosis has focused on serum biomarkers; nevertheless, most series rely on retrospective cohorts where biomarkers are studied individually and at different time points. OBJECTIVE: This paper presents the protocol for a systematic review that aims to determine the inflammatory biomarker behavior profile of patients following elective degenerative spine surgery and their differences compared to those coursing with PSIs. METHODS: The proposed systematic review will follow the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. This protocol was registered at PROSPERO on January 19, 2022. We will include studies related to biomarkers in adult patients operated on for degenerative spinal diseases and those developing PSIs. The following information will be extracted from the papers: (1) study title; (2) study author; (3) year; (4) evidence level; (5) research type; (6) diagnosis group (elective postoperative degenerative disease or PSI); (7a) region (cervical, thoracic, lumbosacral, and coccygeal); (7b) type of infection by anatomical or radiological site; (8) surgery type (including instrumentation or not); (9) number of cases; (10) mean age or individual age; (11) individual serum biomarker values from the preoperative state up to 90 days postoperative for both groups, including (10a) interleukin-6, (10b) presepsin, (10c) erythrocyte sedimentation rate, (10d) leukocyte count, (10e) neutrophil count, (10f) C-reactive protein, (10g) serum amyloid, (10h) white cell count, (10i) albumin, (10j) prealbumin, (10k) procalcitonin, (10l) retinol-associated protein, and (10m) Dickkopf-1; (11) postoperative days at symptoms or diagnosis; (12) type of organism; (13) day of starting antibiotics; (14) duration of treatment; and (15) any biases (including comorbidities, especially those affecting immunological status). All data on biomarkers will be presented graphically over time. RESULTS: No ethical approval will be required, as this review is based on published data and does not involve interaction with human participants. The search for this systematic review commenced in February 2021, and we expect to publish the findings in mid-2023. CONCLUSIONS: This study will provide the behavior profile of biomarkers for PSI and patients following elective surgery for degenerative spinal diseases from the preoperative period up to 90 days postoperative, providing cutoff values on the day of diagnosis. This research will provide clinicians with highly trustable cutoff reference values for PSI diagnosis. Finally, we expect to provide a basis for future research on biomarkers that help diagnose more accurately and in a timely manner in the early stages of illness, ultimately impacting the patient's physical and mental health, and reducing the disease burden. TRIAL REGISTRATION: PROSPERO CRD42022304645; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=304645. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/41555.

In-hospital mortality and severe outcomes after hospital discharge due to COVID-19: A prospective multicenter study from Brazil.

Background: We evaluated in-hospital mortality and outcomes incidence after hospital discharge due to COVID-19 in a Brazilian multicenter cohort. Methods: This prospective multicenter study (RECOVER-SUS, NCT04807699) included COVID-19 patients hospitalized in public tertiary hospitals in Brazil from June 2020 to March 2021. Clinical assessment and blood samples were performed at hospital admission, with post-hospital discharge remote visits. Hospitalized participants were followed-up until March 31, 2021. The outcomes were in-hospital mortality and incidence of rehospitalization or death after hospital discharge. Kaplan-Meier curves and Cox proportional-hazard models were performed. Findings: 1589 participants [54.5% male, age=62 (IQR 50-70) years; BMI=28.4 (IQR,24.9-32.9) Kg/m² and 51.9% with diabetes] were included. A total of 429 individuals [27.0% (95%CI,24.8-29.2)] died during hospitalization (median time 14 (IQR,9-24) days). Older age [vs<40 years; age=60-69 years-aHR=1.89 (95%CI,1.08-3.32); age=70-79 years-aHR=2.52 (95%CI,1.42-4.45); age≥80-aHR=2.90 (95%CI 1.54-5.47)]; noninvasive or mechanical ventilation at admission [vs facial-mask or none; aHR=1.69 (95%CI 1.30-2.19)]; SAPS-III score≥57 [vs<57; aHR=1.47 (95%CI 1.13-1.92)] and SOFA score≥10 [vs <10; aHR=1.51 (95%CI 1.08-2.10)] were independently associated with in-hospital mortality. A total of 65 individuals [6.7% (95%CI 5.3-8.4)] had a rehospitalization or death [rate=323 (95%CI 250-417) per 1000 person-years] in a median time of 52 (range 1-280) days post-hospital discharge. Age ≥ 60 years [vs <60, aHR=2.13 (95%CI 1.15-3.94)] and SAPS-III ≥57 at admission [vs <57, aHR=2.37 (95%CI 1.22-4.59)] were independently associated with rehospitalization or death after hospital discharge. Interpretation: High in-hospital mortality rates due to COVID-19 were observed and elderly people remained at high risk of rehospitalization and death after hospital discharge. Funding: Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) and Programa INOVA-FIOCRUZ.

Geochemistry and sedimentary photopigments as proxies to reconstruct past environmental changes in a subtropical reservoir.

Sediment cores were used to establish past environmental impacts associated with eutrophication, erosion and metal contamination in the subtropical Atibainha reservoir (São Paulo State, Brazil). We hypothesize that: (1) the levels of nutrients, determined by a spectrophotometric method, reflect the contributions of these elements over time and (2) changes in sedimentation rates, determined by 210Pb geochronology, and metal flows, determined by ICP-AEOS, are related to anthropic activities. Stratigraphic changes in the analysed variables were used to divide the sediment cores into three intervals, according to PCA and cluster analysis (Euclidian distances, Ward's method). Interval I, composed by the period prior to operation of the reservoir, was influenced by organic matter levels. Interval II, between 1967 and 1993 (PC2: 14.94% of the total variability), a period of minor impacts, was mainly influenced by Mn (eigenvalue of 0.71) and Zn (0.74). Interval III, which included sediment deposited between 1993 and 2015 (PC1: 60.28% of the total variability), was influenced by the highest levels of the pigments lutein (0.86), zeaxanthin (0.90) and fucoxanthin (0.65), together with total nitrogen (0.78) and sedimentation rate (0.91), suggesting changes in the phytoplankton community composition probably associated to the intensification of eutrophication and erosion processes. Despite the limitations of applying paleolimnological techniques in reservoirs and the use of pigments as proxies in regions with higher temperatures, it was observed that the anoxic conditions and the aphotic environment in the hypolimnion acted to preserve pigments associated with the groups Chlorophyta (lutein), Cyanobacteria (zeaxanthin) and Bacillariophyta (fucoxanthin). The isolated analysis of nutrients was not sufficient to make conclusive inferences regarding the eutrophication history, since the levels of TP tended to decrease over time, in contrast to an increase in the levels of TN. Despite intensification of eutrophication and erosion, associated to anthropic activities, no signs of metal contamination were recorded.

Comparison between DAS28-ESR and DAS28- CRPus for patients with rheumatoid arthritis: application in a population of southern Brazil

Abstract The Disease Activity Score 28 (DAS28) shows discrepancies when using erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) scores to assess rheumatoid arthritis (RA). This study aimed to verify the agreement between the DAS28-CRP and DAS28-ESR scores in patients with RA from the south of Brazil. A unicentric cross-sectional study was performed (n = 56). The diagnosis of the patients followed the American College of Rheumatology/ European League Against Rheumatism criteria, and their DAS28 were calculated. The DAS28- ESR score was higher than the DAS28-CRP (DAS28-ESR mean 4.8±1.6; DAS28-CRP mean 4.3±1.4) for 83.9% of the patients. The DAS28-CRP and DAS28-ESR scores showed a very strong correlation (Pearson's coefficient = 0.922; P<0.0001, 95% CI +0.87 to +0.95, statistical power 100%). Spearman's correlation coefficient (0.49; P=0.0001, 95% CI +0.25 to +0.67, statistical power 47.54%) showed a moderate correlation between the unique components of the DAS28 formulas. There was agreement between the tests in only 36 of the patients (64.29%). Among the discordant categories, DAS28-ESR overestimated the classification in 16 patients (28.5%). The Kappa coefficient between the categories was 0.465 (SE 0.084, 95% CI +0.301 to +0.630), showing a moderate degree of agreement between the instruments. Although the DAS28-ESR and DAS28-CRP were highly correlated, they differed significantly in terms of patient categorization and should not be used interchangeably

Sedimentation rates by the 210Pb chronological method in Itanhaém river watershed, southeast Brazil.

The historical variation of sedimentation rate was investigated in five cores collected from the Itanhaém watershed main rivers, the second largest coastal watershed of the São Paulo state, Brazil, using the lead-210 radioisotope as a geochronometer. The main characteristics of the rivers' waters and sediments were determined in order to support the geochronological analysis results and associate sediments with possible source areas. In this context, the fluvial waters' general classification indicated the facies sulfated or chlorinated sodium in the winter and summer seasons, except for the Branco river waters in summer, which were classified as calcium or magnesium bicarbonate. A longitudinal salinity gradient was found in the downstream river courses, under greater marine influence, with the ions Cl-, Na+, SO42+, Mg2+, Ca2+, and K+ being most common in the waters. Silica is the predominant constituent in the sediment cores and is inversely related to the organic matter (OM) presence. Inverse correlations were also found between silica and other constituents. The watershed sedimentation rates were determined in the range of 0.31 up to 3.97 g/cm2/year and 0.30 up to 3.40 cm/year, highlighting the core extracted from Branco river, which showed the highest sedimentation rate. The profiles corresponding to Preto and Aguapeú rivers presented discontinuities in the sedimentation rates. The discontinuities were dated and would probably be related to the anthropic activities, which intensified in the municipality of Itanhaém around the middle of the twentieth century.

Polymyalgia rheumatica: A case series from Colombia and analysis of Latin America.

OBJECTIVE: Polymyalgia rheumatica (PMR) is the most common inflammatory disease in patients over 50 years. Information about the disease in Latin America (LATAM) is scarce. We aimed to evaluate a group of Colombian patients with PMR and to conduct a systematic review of PMR in LATAM. METHODS: A multicentric retrospective study was performed. Medical records of 256 PMR patients were evaluated. Patients were divided into two groups, those fulfilling the 2012 European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) classification criteria for PMR and those who did not (i.e., clinical diagnosis). A systematic literature review and meta regression was performed comparing Colombian vs LATAM patients. RESULTS: From 256 patients, 145 (56.6%) fulfilled the 2012 EULAR/ACR criteria, and 111 (43.3%) were classified by clinical diagnosis. Inflammatory bilateral shoulder pain, pelvic girdle aching, morning stiffness >45 min, elevated erythrocyte sedimentation rate (ESR), and C-reactive protein (CPR), and Methotrexate (MTX) prescription were more common in the 2012 EULAR/ACR group. None of the included patients presented overt polyautoimmunity (PolyA), whereas up to 24% exhibited latent PolyA. In addition, these patients showed high frequency of malignancy (7.59%). In the meta regression analysis, Colombian patients exhibited lower ESR levels, and were less likely to develop giant cell arteritis (GCA) as compared to the rest of LATAM data. CONCLUSION: Patients with PMR in LATAM exhibit similar phenotypes from other cohorts worldwide. Malignancy, GCA and latent PolyA should be considered in the routine clinical follow-up of patients with PMR.

Paracoccidioidomycosis due to P lutzii: The importance of neutrophil/lymphocyte ratio in the symptomatic and asymptomatic phases in severe cases.

BACKGROUND: PCM is a neglected systemic mycosis endemic in Brazil. The middle-west region of Brazil has shown the highest number of PCM by Paracoccidioides lutzii (P lutzii) cases. Differentiating cases of severe PCM from non-severe ones should be a concern at the bedside. Diagnosis of severe PCM by P lutzii is based on the subjectivity of clinical manifestations, which can result in a delay in starting its treatment and, consequently evolution to severe sequelae. There is not laboratory biomarker available to support the early diagnosis of severe PCM that is feasible for all the realities that coexist in Brazil. OBJECTIVES: The aim of this study was to investigate the usefulness of laboratory biomarkers as erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and neutrophil/lymphocyte ratio (NLR) in the diagnosis of severe PCM. PATIENTS/METHODS: ESR, CRP and NLR were analysed for 44 patients with PCM by P lutzii and a Receiver Operation Characteristic (ROC) curve were generated to identify the NLR cut-off point and point out the presence of severe PCM. RESULTS: Sixteen (36.4%) had severe PCM and 28 (63.6%) had non-severe PCM. The mean NLR was higher and statistically significant among patients with severe PCM than among those with non-severe PCM. The area under the ROC curve was 0.859 for the diagnosis of severe PCM. The cut-off point for NLR for the diagnosis of severe PCM was 3.318 (sensitivity of 100%, specificity of 77%). CONCLUSIONS: According to results, it is plausible to conclude that NLR represents a potential biomarker for the diagnosis of severe PCM.

Variation in Inflammatory Biomarkers Among Demographic Groups Significantly Affects Their Accuracy in Diagnosing Periprosthetic Joint Infection.

BACKGROUND: Diagnosis of periprosthetic joint infection (PJI) is a multistep process that involves performing various tests including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). The latter two tests, despite being used at all times for PJI diagnosis, are known to be nonspecific and substantially affected by demographic characteristics, including age, gender, race, and body mass index. It is unknown how these variations affect the diagnostic utility of serological markers for PJI. METHODS: Institutional databases were queried to identify patients undergoing revision arthroplasty between 2010 and 2018, in whom preoperative serum ESR and CRP was performed. Patient demographics were collected, and patients were cross-referenced with an internal database to determine their infection status. Analyses were performed to determine how ESR and CRP varied with respect to demographic factors, including age, gender, race, and infection status. Given that patient infection status was known at the time of revision, conclusions were drawn about the effect of these variations in inflammatory markers on the diagnostic utility of ESR and CRP. RESULTS: The value of ESR increased by age was higher in females and African American race. No significant differences were observed in the value of CRP among the demographic factors, although a slight positive trend was observed with respect to age. The variation in inflammatory markers significantly affected the sensitivity, specificity, and accuracy of ESR and CRP for PJI diagnosis. CONCLUSION: Understanding how the accuracy of diagnostic tests varies with respect to demographic factors can help physicians avoid subjecting patients to unnecessary additional testing and reach more accurate diagnoses of PJI.

Negative association between 25-hydroxyvitamin D and inflammatory markers in rheumatologic diseases / Asociación negativa entre 25-hidroxi vitamina D y los marcadores inflamatorios en enfermedades reumatológicas

Objective: The main purpose of this study was to evaluate serum 25-hydroxyvitamin D (25OHD) levels and its association with in"ammatory markers in patients with rheumatologic diseases (RD). Methods: A cross-sectional study in 154 women with RD (rheumatoid arthritis, spondyloarthritis and other connective tissue diseases) and 112 healthy individuals as a control group (CG) was carried out. Results: No differences in serum and urine calcium, serum phosphate, and urinary deoxypyridinoline were found. RD group had lower 25OHD and higher PTH compared to CG. RD group had higher C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) compared to CG. The overall mean level of 25OHD (ng/ml) was 26.3±12.0 in the CG and 19.4±6.8 in the RD group (p<0.0001). Moreover, CG had lower percentage of individuals with 25OHD de!ciency compared to RD (29.9% vs 53.2%). The femoral neck BMD was signi!cantly lower in postmenopausal RD women compared to CG. 25OHD levels signi!cantly correlated with ESR and CRP as in"ammatory markers. Age, BMI, presence of RD, and CRP were signi!cantly and negatively associated with 25OHD levels through linear regression analysis. According to univariate logistic regression analysis for 25OHD deficiency (<20 ng/ml), a significant and negative association with BMI, presence of RD, ESR and CRP were found. Conclusion: Patients with RD had lower 25OHD levels than controls and the presence of a RD increases by 2.66 the risk of vitamin D de!ciency. In addition, 25OHD has a negative correlation with ESR and CRP as in"ammatory markers. (AU)

Objetivo El objetivo principal de este estudio fue evaluar los niveles séricos de 25-hidroxivitamina D (25OHD) y su asociación con marcadores inflamatorios en enfermedades reumatológicas. Materiales y métodos: Se realizó un estudio transversal en 154 mujeres con enfermedades reumatológicas (artritis reumatoide, espondiloartritis y otras enfermedades del tejido conectivo) y 112 individuos sanos como grupo control (GC). Resultados: No se encontraron diferencias en el calcio sérico y urinario, el fosfato sérico y la desoxipiridinolina urinaria entre el GC y los sujetos con enfermedades reumatológicas. El grupo de pacientes con enfermedades reumatológicas tenía 25OHD más bajo y PTH más alto en comparación con el GC. Asimismo, el grupo de individuos con enfermedades reumatológicas tenía proteína C reactiva (PCR) y velocidad de eritrosedimentación (VES) más altas en comparación con el GC. El nivel de 25OHD (ng/ml) fue 26,3±12,0 en el GC y 19,4±6,8 en el grupo con enfermedades reumatológicas (p<0,0001). Además, el GC presentó un porcentaje menor de deficiencia de 25OHD en comparación con el grupo con enfermedades reumatológicas (29,9% vs 53,2%). La DMO del cuello femoral fue significativamente menor en las mujeres posmenopáusicas con enfermedades reumatológicas en comparación con el GC. La 25OHD correlacionó significativamente con la VES y la PCR como marcadores inflamatorios. El análisis de regresión lineal mostró que la edad, el IMC, la presencia de una enfermedad reumatológica y la PCR se asociaron significativa y negativamente con los niveles de 25OHD. Mientras que el análisis de regresión logística univariada mostró que la deficiencia de 25OHD (<20 ng/ml), se asoció significativa y negativamente con el IMC, la presencia de una enfermedad reumatológica, la VES y los niveles de PCR. Conclusiones: Los pacientes con enfermedades reumatológicas tenían niveles de 25OHD más bajos que los controles y la presencia de una enfermedad reumatológica aumenta en 2.66 el riesgo de deficiencia de vitamina D. Además, la 25OHD mostró correlación negativa con la VES y la PCR como marcadores inflamatorios. (AU)

¿Son válidos los métodos manuales modificados para determinar la Velocidad de Eritrosedimentación Globular (VSG) en laboratorios clínicos? / Are modified manual methods valid to establish Erythrocyte Sedimentation Rate (ESR) in clinical laboratories? / Os métodos manuais modificados são válidos para determinar a velocidade de hemossedimentação(VHS) nos laboratórios clínicos?

Resumen Se evaluó estadísticamente la validez de cuatro métodos para determinar la Velocidad de Eritrosedimentación Globular (VSG) alternos al de Westergren, el que se tomó como "gold standard". Los métodos evaluados fueron Wintrobe (WB), Wintrobe inclinado (WI) a 45° y dos micrométodos capilares, uno vertical (MM) y otro inclinado a 45° (MMI). Se procesaron 419 muestras por los cinco métodos. Se evaluó la concordancia (C), la sensibilidad (S), especificidad (E), valor predictivo positivo (VPP) y valor predictivo negativo (VPN). Los resultados de S, E, VPP, VPN y C fueron: 93,8%, 93,6, 98,8%, 72,8% y 71% en el de WB; 86,3%, 85,7%, 97,2%, 52,4% y 54% en el de WI; 94,6%, 66,6%, 94,1%, 71,4% y 54% para MM y 91,9%, 72,4%, 94,8%, 60,8% y 55% para MMI. El índice kappa mostró una concordancia "buena" entre el método de Westergren y el método de Wintrobe y "moderada" con los métodos de WBI, MM y MMI. Los resultados del presente estudio muestran que el método de Wintrobe es confiable para su uso en el laboratorio clínico comparado con el de Westergreen.

Abstract Four methods were statistically evaluated for their validity to determine the alternative Erythrocyte sedimentation rate to that of Westergren, which was taken as the "gold standard". The methods evaluated were Wintrobe (WB), Wintrobe inclined (WI) at 45° and two capillary micromethods, one vertical (MM) and one inclined at 45° (MMI). A total of 419 samples were processed by the five methods. Concordance (C), sensitivity (S), specificity (E), positive predictive value (PPV) and negative predictive value (NPV) were evaluated. The results for S, E, PPV, NPV and C were: 93.8%, 93.6, 98.8%, 72.8% and 71% for WB; 86.3%, 85.7%, 97.2%, 52.4% and 54% for WI; 94.6%, 66.6%, 94.1%, 71.4% and 54% for MM and 91.9%, 72.4%, 94.8%, 60.8% and 55% for MMI. The kappa index showed "good" agreement between the Westergren method and the Wintrobe method and "moderate" agreement with the WBI, MM and MMI methods. The results of the present study show that the Wintrobe method is reliable for use in the clinical laboratory compared to the Westergren method.

Resumo Neste trabalho, foi avaliada estatisticamente a validez de quatro métodos para determinar a Velocidade de Eritrosedimentação Globular (VSG) alternos ao Westergren, que foi considerado como o "Método Padrão". Os métodos avaliados foram Wintrobe (WB), Wintrobe inclinado a 45° (WI) e dois micro-métodos capilares, um vertical (MM) e outro inclinado a 45° (MMI). 419 amostras foram processadas pelos cinco métodos. Envalou-se a concordância (C), sensibilidade (S), especificidade (E), assim como os valores preditivos positivos (VPP) e negativos (VPN). Os resultados de S, E, VPN e VPP foram: 93.8%, 93.6%, 98.8%, 72.8% e 71% com o WB; 86.3%, 85.7%, 97.2%, 52.4% e 54% com o WI; 94.6%, 66.6%, 94.1%, 71.4% e 54% para MM e 91.9%, 72.4%, 94.8%, 60.8% e 55% para o MMI. O índice kappa apresentou "boa" concordância entre os métodos de Westergren e Wintrobe, enquanto teve concordância "moderada" com os métodos WBI, MMe MMI. Os resultados deste estudo revelaram que o método de Wintrobe é confiável para seu uso no laboratório clínico comparado com o método de Westergren.

Historical records of mercury deposition in dated sediment cores reveal the impacts of the legacy and present-day human activities in Todos os Santos Bay, Northeast Brazil.

We determined depth profiles of total mercury (T-Hg) in six 210Pb-dated sediment cores from Todos os Santos Bay to reconstruct the history of anthropogenic Hg accumulation. We also assessed superficial sediments samples from five estuaries. T-Hg concentrations (5-3500 µg kg-1) presented a large spatial and temporal variability. T-Hg concentrations in Ribeira Bay increased up to 200-fold along time, whereas the fluxes of T-Hg are substantially higher (up to 10,000 fold) than present-day wet deposition for industrialized areas. Sedimentary records indicate that a chlor-alkali plant has been the main source of Hg pollution until the present, although the T-Hg records suggest that harbor, shrimp farming, and oil refinery activities, besides Hg atmospheric depositions, are important across the bay. Sediments in the Ribeira Bay act as an important Hg sink. If sediments are eroded or disturbed, they may release Hg, thus posing a serious risk to wildlife and ecosystem health. CAPSULE: Sedimentary cores provide data on preindustrial levels and also anthropogenic fluxes of Hg for the appraisal of the magnitude, processes and potential risks of the contamination.

Assessment of a coastal lagoon metal distribution through natural and anthropogenic processes (SE, Brazil).

The present study intends to assess the metal pollution of a eutrophic coastal lagoon, analyzing the long-term and actual metal content in surface sediments, suspended particles, aquatic macrophyte and fish species, and the loads emitted from natural processes and anthropogenic sources, including the relative emission of domestic untreated sewage. Distribution indicated contamination of suspended particles with Cd and the predominance of Pb in the bioavailable form in surface sediments which may explain Cd and Pb contamination in fish. Domestic untreated sewage was an important source of Cu and due to the lagoon's management, this source may be increasing the metal content in the lagoon's surface sediments. Soil loss, atmospheric deposition and solid waste disposal also contributed to metal inputs to the lagoon. Extensive contamination has been prevented by the lagoon's management such as sandbar opening. Metal retention within the watershed soils reduce the effective metal transference and lagoon pollution.

Caracterización y asociación clínico bacteriológica en la espondilodiscitis piógena / Bacteriological-clinical association and characterization in Pyogenic Spondylodiscitis

Resumen: Objetivo: Determinar la asociación entre las características clínicas y estudios de laboratorio con el tipo de microorganismo aislado en hemocultivos de pacientes con espondilodiscitis piógena. Material y métodos: Es un estudio transversal analítico, se revisaron expedientes clínicos de pacientes con espondilodiscitis piógena desde Enero de 2013 hasta Enero de 2017. Se realizó análisis descriptivo univariado usando frecuencias y porcentajes para variables cualitativas, medidas de tendencia central y dispersión para las cuantitativas. Análisis bivariado mediante prueba de χ2 o test exacto de Fisher. Análisis de variables cuantitativas mediante t Student o U de Mann-Whitney. Se usó coeficiente de correlación de Spearman. Considerando significancia estadística p < 0.05. Resultados: Se obtuvo una muestra de 34 pacientes, 20 (58%) fueron mujeres, mediana (Me) de edad 60 años (52-66). Se aisló en hemocultivos, bacterias Gram positivas 11 (32.4%) y Gram negativas 23 (67.6%). El microorganismo aislado más frecuente fue Escherichia coli 12 (35.3%). Los pacientes con espondilodiscitis por Gram negativas presentaron dolor leve y velocidad de sedimentación globular (VSG) Me 26 mm/hra P (18-36), los pacientes con espondilodiscitis por Gram positivas presentaron dolor severo y VSG Me 38 mm/h P (34-40) (p = 0.000 y 0.028, respectivamente). La VSG y dolor en el grupo de pacientes con espondilodiscitis por bacterias Gram negativas tuvo un coeficiente de correlación de Spearman moderado 0.418, (p = 0.047); en el grupo de Gram positivas, un coeficiente de correlación de Spearman bajo 0.228, (p = 0.507). Conclusión: Existe una asociación clínica y estadística de manera significativa entre los tipos de microorganismo aislado en hemocultivo, la intensidad del dolor valorado en escala visual análoga (EVA) y los niveles de VSG.

Abstract: Objective: Determine the association between clinical characteristics and laboratory studies with the type of isolated microorganism in blood cultures of patients with Pyogenic Spondylodiscitis. Material and methods: It is a cross-analytical study, clinical records of patients with Pyogenic Spondylodiscitis were reviewed from January 2013 to January 2017. Univariate descriptive analysis was performed using frequencies and percentages for qualitative variables, central trend measures and dispersion for quantitative ones. Bivariate analysis by testing of χ2 or Fisher's exact test. Analysis of quantitative variables using T Student or Mann-Whitney U. Spearman's correlation coefficient was used. Considering statistical significance p < 0.05. Results: A sample of 34 patients was obtained, 20 (58%) were women, median (Me) of age 60 years (52-66). Was isolated into blood cultures, Gram-positive bacteria 11 (32.4%) gram negatives 23 (67.6%). The microorganism most common isolate was Escherichia coli 12 (35.3%). Patients with Gram-negative spondylodiscitis had mild pain and globular sedimentation rate (VSG) Me 26 mm/hra P (18-36), patients with Gram-positive spondylodyscitis had severe pain and VSG Me 38 mm/h P (34-40) (p= 0.000 and 0.028, respectively). VSG and pain in the group of patients with gram-negative bacteria spondylodiscitis had a moderate Spearman correlation coefficient of 0.418, (p = 0.047); in the Gram positives group, a low correlation coefficient of Spearman 0.228, (p = 0.507). Conclusion: There is a clinical and statistical association significant between types of isolated microorganism in blood culture, pain intensity valued on analog visual scale (EVA) and VSG levels.

Evaluación de reactantes de fase aguda como predictores de bacteriemia en niños con fiebre, leucemia aguda y linfoma / Evaluation of acute-phase reactants as predictors of bacteremia in children with fever, acute leukemia, and lymphoma

Introducción: Para predecir una infección en estadios tempranos en niños con cáncer se han evaluado marcadores como ESD, PCR y PCT. Objetivo: evaluar la precisión diagnóstica para bacteriemia de estos marcadores al ingreso en niños con fiebre y leucemia aguda (LA) o linfoma (L) internados entre 2013-2016. Métodos: estudio analítico retrospectivo. Revisión de historias clínicas. Se calcularon sensibilidad, especificidad, valor predictivo positivo, valor predictivo negativo y área bajo la curva ROC para cada marcador en MedCalc® V16.8.4. Se obtuvo autorización del Comité de Ética. Resultados:en total se internaron 31 niños con diagnóstico de LA y L, 19 presentaron fiebre y 12 no. Hubo 40 episodios de fiebre clasificados en 4 grupos: bacteriemia 14 (35%), infección documentada microbiológicamente 5 (12.5%), infección documentada clínicamente 2 (5%) y fiebre de origen desconocido 19 (47.5%). Los niveles de PCT fueron mayores en el grupo de bacteriemia registrando un valor promedio de 1,17ng/ mL (p: 0.045). El área bajo la curva ROC entre el grupo con y sin bacteriemia fue de 0.50 para ESD, 0.65 para PCR y 0.83 para PCT con S de 77.78%, E de 66.67%, VPP de 50% y VPN de 92.86%. Discusión: la PCT mostró ser el más eficaz que ESD y PCR para predecir bacteriemia. se deben realizar investigaciones con biomarcadores con el objeto de disminuir el uso inadecuado de antibióticos en pacientes con fiebre secundaria a enfermedad y acortar los tiempos de tratamiento en pacientes con infecciones adecuadamente resueltas mejorando ampliamente la calidad de vida en niños con cáncer (AU)

Introduction: To predict infection in early stages in children with cancer, markers such as ESR, CRP, and PCT have been evaluated. Objective: To evaluate the diagnostic precision for bacteremia of these markers on admission of children with fever and acute leukemia (AL) or lymphoma (L) admitted between 2013- 2016. Methods: A retrospective analytical study. Review of the clinical records. Sensitivity, specificity, positive predictive value, negative predictive value, and area under the ROC curve were calculated for each marker in MedCalc® V16.8.4. The study was approved by the Ethics Committee. Results: Overall, 31 children with AL and L were admitted, 19 of whom presented with fever and 12 did not. There were 40 episodes of fever classified into 4 groups: bacteremia 14 (35%), microbiologically documented infection 5 (12.5%), clinically documented infection 2 (5%), and fever of unknown etiology 19 (47.5%). PCT levels were higher in the group with bacteremia with a mean value of 1.17ng/mL (p:0.045). The area under the ROC curve between the groups with and without bacteremia was 0.50 for ESR, 0.65 for CRP, and 0.83 for PCT with a sensitivity of 77.78%, specificity of 66.67%, PPV of 50%, and NPV of 92.86%. Discussion: PCT showed a greater efficacy than ESD and CRP to predict bacteremia. Research on biomarkers should be conducted to reduce the inadequate use of antibiotics in patients with fever secondary to disease and to shorten treatment times in patients with adequately resolved infections, thereby improving quality of life in children with cancer (AU)

[Bacteriological-clinical association and characterization in Pyogenic Spondylodiscitis]. / Caracterización y asociación clínico bacteriológica en la espondilodiscitis piógena.

OBJECTIVE: Determine the association between clinical characteristics and laboratory studies with the type of isolated microorganism in blood cultures of patients with Pyogenic Spondylodiscitis. MATERIAL AND METHODS: It is a cross-analytical study, clinical records of patients with Pyogenic Spondylodiscitis were reviewed from January 2013 to January 2017. Univariate descriptive analysis was performed using frequencies and percentages for qualitative variables, central trend measures and dispersion for quantitative ones. Bivariate analysis by testing of 2 or Fishers exact test. Analysis of quantitative variables using T Student or Mann-Whitney U. Spearmans correlation coefficient was used. Considering statistical significance p 0.05. RESULTS: A sample of 34 patients was obtained, 20 (58%) were women, median (Me) of age 60 years (52-66). Was isolated into blood cultures, Gram-positive bacteria 11 (32.4%) gram negatives 23 (67.6%). The microorganism most common isolate was Escherichia coli 12 (35.3%). Patients with Gram-negative spondylodiscitis had mild pain and globular sedimentation rate (VSG) Me 26 mm/hra P (18-36), patients with Gram-positive spondylodyscitis had severe pain and VSG Me 38 mm/h P (34-40) (p= 0.000 and 0.028, respectively). VSG and pain in the group of patients with gram-negative bacteria spondylodiscitis had a moderate Spearman correlation coefficient of 0.418, (p = 0.047); in the Gram positives group, a low correlation coefficient of Spearman 0.228, (p = 0.507). CONCLUSION: There is a clinical and statistical association significant between types of isolated microorganism in blood culture, pain intensity valued on analog visual scale (EVA) and VSG levels.

OBJETIVO: Determinar la asociación entre las características clínicas y estudios de laboratorio con el tipo de microorganismo aislado en hemocultivos de pacientes con espondilodiscitis piógena. MATERIAL Y MÉTODOS: Es un estudio transversal analítico, se revisaron expedientes clínicos de pacientes con espondilodiscitis piógena desde Enero de 2013 hasta Enero de 2017. Se realizó análisis descriptivo univariado usando frecuencias y porcentajes para variables cualitativas, medidas de tendencia central y dispersión para las cuantitativas. Análisis bivariado mediante prueba de 2 o test exacto de Fisher. Análisis de variables cuantitativas mediante t Student o U de Mann-Whitney. Se usó coeficiente de correlación de Spearman. Considerando significancia estadística p 0.05. RESULTADOS: Se obtuvo una muestra de 34 pacientes, 20 (58%) fueron mujeres, mediana (Me) de edad 60 años (52-66). Se aisló en hemocultivos, bacterias Gram positivas 11 (32.4%) y Gram negativas 23 (67.6%). El microorganismo aislado más frecuente fue Escherichia coli 12 (35.3%). Los pacientes con espondilodiscitis por Gram negativas presentaron dolor leve y velocidad de sedimentación globular (VSG) Me 26 mm/hra P (18-36), los pacientes con espondilodiscitis por Gram positivas presentaron dolor severo y VSG Me 38 mm/h P (34-40) (p = 0.000 y 0.028, respectivamente). La VSG y dolor en el grupo de pacientes con espondilodiscitis por bacterias Gram negativas tuvo un coeficiente de correlación de Spearman moderado 0.418, (p = 0.047); en el grupo de Gram positivas, un coeficiente de correlación de Spearman bajo 0.228, (p = 0.507). ­. CONCLUSIÓN: Existe una asociación clínica y estadística de manera significativa entre los tipos de microorganismo aislado en hemocultivo, la intensidad del dolor valorado en escala visual análoga (EVA) y los niveles de VSG.

A 210Pb chronological study in sediments from poços de caldas alkaline massif (PCAM), Brazil.

The Constant Flux and Constant Sedimentation (CF:CS) of supported/excess 210Pb model was successfully used to study sediment profiles from Antas stream, located in the region of Poços de Caldas city, Minas Gerais State, Brazil. Historical changes in the region were tracked from evaluating the sedimentation rate by the 210Pb method. In that site, Osamu Utsumi mine was the first mining-industrial complex for the production of concentrated uranium in Brazil. Four sediment testimonies were sampled along Antas stream in order to determine sedimentation rates using 210Pb as geochronometer. 210Pb and 238U activity concentrations were determined in sediment samples by alpha spectrometry, allowing to find the excess 210Pb present in the sediments. Additionally, the main oxides, organic matter, particles size and water composition were determined in order to assist the results interpretation from radionuclides data. The results allowed find one (profile PKS-4) or two (profiles PKS-1, PKS-2 and PKS-3) sedimentation rates, probably due to changes in the sediments input regime in the region. The sedimentation rates were in the range between 0.26 and 0.94 g/cm2.year, corresponding to the interval of linear sedimentation rate of 0.21 - 0.92 cm/year. The deposition year in the bottom of PKS-4 profile as estimated from the sedimentation rate coincided with the construction year of Bortolan dam (1956). Large touristic interventions carried out at Poços de Caldas city from 1920s coupled to unbridled urbanization, industrialization and demographic growth there in the second half of the twentieth century possibly caused the changes found in the sedimentation rates.

Invasive fungal infections in Colombian patients with systemic lupus erythematosus.

Introduction Systemic lupus erythematosus is an autoimmune disease with multi-organ involvement. Complications, such as invasive fungal infections usually occur in patients with a greater severity of the disease. Objective The objective of this study was to determine the prevalence and risk variables associated with invasive fungal infections in a Colombian systemic lupus erythematosus population. Materials and methods A cross-sectional, retrospective study that evaluated patients with systemic lupus erythematosus for six years. The primary outcome was invasive fungal infection. Descriptive, group comparison and bivariate analysis was performed using Stata 12.0 software. Results Two hundred patients were included in this study; 84.5% of the patients were women and the median age was 36 years; 68% of the subjects had haematological complications; 53.3% had nephropathy; 45% had pneumopathy and 28% had pericardial impairment; 7.5% of patients had invasive fungal infections and the most frequently isolated fungus was Candida albicans. Pericardial disease, cyclophosphamide use, high disease activity, elevated ESR, C3 hypocomplementemia, anaemia and lymphopenia had a significant association with invasive fungal infection ( P < 0.05). Conclusions We describe for the first time the prevalence of invasive fungal infection in a Colombian population with systemic lupus erythematosus, which was higher than that reported in other latitudes. In this population the increase in disease activity, the presence of pericardial impairment and laboratory alterations (anaemia, lymphopenia, increased ESR and C3 hypocomplementemia) are associated with a greater possibility of invasive fungal infections. Regarding the use of drugs, unlike other studies, in the Colombian population an association was found only with the previous administration of cyclophosphamide. In addition, patients with invasive fungal infections and systemic lupus erythematosus had a higher prevalence of mortality and hospital readmission compared with patients with systemic lupus erythematosus without invasive fungal infection.

Geochemical behavior, environmental availability, and reconstruction of historical trends of Cu, Pb, and Zn in sediment cores of the Cananéia-Iguape coastal system, Southeastern Brazil.

The Cananéia-Iguape system is located in a coastal region of southeastern Brazil, recognized by UNESCO as an Atlantic Forest Biosphere Reserve. This system has suffered substantial environmental impacts due to the opening of an artificial channel and by past intensive mining activities. In this paper was performed the sequential chemical extraction of Cu, Pb, and Zn, on previously described sediment cores, and the statistical treatment of the data, allowing to estimate the remobilization geochemical behavior, the available content and the trend of accumulation between 1926 and 2008. The maximum available level (sum of all mobile fraction) were, in mgkg-1, 18.74 for Cu, 177.55 for Pb and 123.03 for Zn. Considering its environmental availability, Pb remains a concern in the system. It was possible to recognize the anthropic contribution of Pb, being the mining activities considered the only potential source of this metal in the region.

Could C-reactive protein and erythrocyte sedimentation rate support monitoring of dermatomyositis and polymyositis activity? / É possível supor que a proteína c reativa e a hemossedimentação possam ser usadas para monitorar a atividade da dermatomiosite e da polimiosite?

OBJECTIVES: To evaluate serum levels of C-reactive protein and erythrocyte sedimentation rates in patients with untreated newly diagnosed dermatomyositis or polymyositis and their correlation with clinical and laboratory parameters. METHODS: A cross-sectional study including 48 consecutive patients with untreated newly diagnosed dermatomyositis and polymyositis reviewed between 2002 and 2015 was conducted. Fifty healthy subjects were enrolled as controls. RESULTS: Patients with dermatomyositis and polymyositis had higher levels of C-reactive protein and erythrocyte sedimentation rate than healthy controls, but these values were not associated with clinical or laboratory parameters of disease activity either for dermatomyositis or for polymyositis. Additionally, erythrocyte sedimentation rate values correlated with pulmonary involvement as evidenced through computer tomography imaging (OR 1.15; 95%CI 1.01-1.31) only in patients with polymyositis. CONCLUSIONS: Although elevated, C-reactive protein and erythrocyte sedimentation rate are not sensitive parameters for measuring clinical and laboratory activity of dermatomyositis nor for polymiositis. However, erythrocyte sedimentation rate may be a valid parameter for screening pulmonary involvement, particularly in patients with polymyositis.

OBJETIVOS: Avaliar os níveis séricos da proteína C reativa (PCR) e da velocidade de hemossedimentação (VHS) em pacientes recém-diagnosticados com dermatomiosite (DM) e polimiosite (PM), sem tratamento prévio, correlacionando-os com parâmetros clínico-laboratoriais. MÉTODOS: Estudo transversal que incluiu 48 pacientes consecutivos com DM e PM (critérios de Bohan e Peter) recém-diagnosticados, sem tratamento medicamentoso, no período de 2002 a 2015. Foram incluídos 50 indivíduos saudáveis como grupo controle. RESULTADOS: Os pacientes apresentaram níveis mais elevados de VHS e PCR comparativamente aos controles saudáveis. Estes valores, porém, não se correlacionaram com os parâmetros clínicos e laboratoriais da atividade da doença (DM e PM). Somente em pacientes com PM a VHS apresentou relação com acometimento pulmonar na tomografia computadorizada [OR 1,15 (IC 95% 1,01-1,31)]. CONCLUSÕES: Apesar de aumentadas, a PCR e a VHS não são parâmetros sensíveis para a mensuração da atividade clínica e laboratorial de DM e PM., No entanto, a VHS pode ter validade no rastreio do acometimento pulmonar, particularmente em pacientes com PM.