Pneumoencéfalo intraventricular após perfuração acidental de dura-máter. Relato de caso

BACKGROUND AND OBJECTIVES: The loss of resistance to air to identify the epidural space is widely used. However, the accidental perforation of the dura mater is one of the possible complications of this procedure, with an estimated incidence between 1% and 2%. The objective of this report was to describe the case of a patient with intraventricular pneumocephalus after the accidental perforation of the dura mater using the loss of resistance with air technique. CASE REPORT: Female patient, 26 years old, 75 kg, 1.67 m, physical status ASA I, with a 38-week pregnancy, was referred to the obstetric service for a cesarean section. Venipuncture was performed after placement of the monitoring. The patient was placed in a sitting position for administration of the epidural anesthesia. During the identification of the epidural space with the loss of resistance with air technique, an accidental perforation of the dura mater was diagnosed by observing free flow of CSF through the needle. The technique was modified to epidural anesthesia and anesthetics were administered by the needle placed in the subarachnoid space. In the first 24 hours, the patient developed headache and she was treated with caffeine, dypirone, hydration, hydrocortisone, and bed rest; despite those measures, the patient's symptoms worsened and evolved to headache in decubitus. A CT scan of the head showed the presence of pneumocephalus. After evaluation by a specialist, the patient remained under observation, with progressive improvement of the symptoms and was discharged from the hospital in the fifth day, without complications. CONCLUSIONS: Pneumocephalus after accidental perforation of the dura mater presented headache with the characteristics of headache secondary to loss of CSF, but with spontaneous resolution after the air was absorbed. Invasive measures, such as epidural blood patch, were not necessary. © Sociedade Brasileira de Anestesiologia, 2006.

Evaluating quality of life in mercury intoxicated people in urban-industrial environments through short-form 36 application

Context and objective: Records of contact with mercury (Hg) exist for more than 3500 years and several problems related to the use of this element can be noticed. Considering inexistence of current reports about it, quality of life perception evaluation was studied in people chronically intoxicated by mercury in an industrial environment. Design and setting: This is a cross-sectional descriptive observational study. Information from 47 urban-industrial workers from lamps manufacturing in São Paulo, clinically diagnosed as intoxicated by mercury and currently followed by the Occupational Health Service of Faculdade de Medicine da Universidade de São Paulo, with average age of 41.7 years old, was considered. Methods: SF36 questionnaire application was performed, with inferences tested by χ-square proof, by Spearman linear correlation and Mann-Whitney non-parametric test, adopting p < 0.05 as significant level. Results: In the eight domains, observed medians are 40% for physical functioning; 0 for physical function; 30% for body pain; 30% for general health; 22.2% for vitality; 50% for social functioning; 0 for emotional role and 36% for mental health. Correlation between age and SF36 domains does not reveal statistical significance, except for physical functioning, indicating that lower scores presented by older people in this domain are not followed by changes on other ones. Conclusions: Values obtained in people chronically intoxicated by mercury are actually lower, in the motor and mental scope components. Some instruments domains are higher for men than for women. Older ages are inversely associated to good performance in physical function domain. © Copyright Moreira Jr. Editora. Todos os direitos reservados.

Espectro de agentes etiológicos associados a surtos de doenças transmitidas por alimentos em núcleos receptores turísticos de três regiões geográficas do Estado de São Paulo

Foodborne and waterborne diseases are spread by the consumption of food or water contaminated with bacteria and/or their toxins, viruses, parasites or chemicals. The aim of the research reported here was to establish the spectrum of etiologic agents of foodborne outbreaks at 15 tourist resorts in three geographic regions of the State of Sao Paulo (Brazil). The study was based on the cases reported to the Epidemic Surveillance Center (CVE) of the Public Health Authority of the State of São Paulo (SES), from 2002 to 2005. The tourist centers were chosen at random in three regions of the state (Capital, Interior and Coast) and offered the following attractions: events, agribusiness, cultural history, shopping, town center, gastronomy, health and leisure, sun and sea. Among the bacteria, the results showed that Salmonella spp. were most frequently associated with outbreaks, followed by Shigella spp., enterotoxigenic Escherichia coli, Staphylococcus aureus, Clostridium perfringens, Bacillus cereus and Campylobacter spp. Viruses (Rotavirus and Hepatitis A) played a part in many of the cases, while the frequency of parasites and worm infestations was low in the foodborne disease outbreaks at these resorts. The mixed foods (rice, beans, liver, potatoes, barbecue, juice), fish and poultry were the three commonest vehicles implicated in the outbreaks.

Potencial tóxico dos alginatos para uso odontológico

Alginate or irreversible hydrocolloid is one the most accepted and frequently employed impression materials in dental practice. Substances like zinc, cadmium, lead silicate and fluorides, which are included in several alginate brands with the aim of improving their physical, chemical and mechanical properties, are a source of serious concern as regards their toxicity. Some brands of alginate have been reported to contain potentially toxic fluorides and metals such as cadmium, lead and zinc silicates, either singly or combined. Consequently, special care should be taken while preparing of these materials. It is necessary to monitor potentially toxic chemicals and metals in the alginates continually to avoid contamination of dental professionals and patients. In this review, alginates used in dentistry are analyzed for potential toxicity.

Mercury, copper, and zinc concentrations in extracted human teeth

Amalgam has been used as a filling material for over 150 years. Mercury, copper, and zinc are present in restoration. The aim of this study was to compare mercury, copper, and zinc concentrations in extracted human teeth with amalgam restorations and teeth without restorations. Thirty-two teeth, 15 restored with dental amalgam and 17 without restorations, were chemically analyzed in an Optima 3300 DV (Perkin Elmer) plasma emission spectrometer. Mercury, copper, and zinc were found in human teeth regardless of the presence of amalgam restorations. The highest mercury concentrations were found in the coronary portions of the teeth with amalgam restorations. Copper concentrations were very high. Zinc concentrations in the teeth without restoration were lower than those seen in the coronary portion of the teeth with restorations. © 2009 Heldref Publications.

Intoxicação por chumbo em um cão - relato de caso

The present study reports the occurrence of lead poisoning in a male, 2 year-old mongrel dog attended at UNESP Botucatu Veterinary Hospital. The animal was brought to the hospital with claim of gastrointestinal and nervous disturbs for 10 days, worsening in the last 24 hours. After unsuccessfully attempts to control status epileticus, the animal died. Hematological evaluation revealed significant rubricytosis and basophilic stippling, highly suggestive of lead poisoning. Serum lead concentration confirmed toxic levels of this element. Necropsy evidenced the presence of foreign bodies in stomach (one stone and two metallic objects) and, microscopically, characteristic inclusions in renal parenchyma. Fragments obtained from liver and kidneys revealed lead concentrations of 0, 8 μg/g and 25 μg/g, respectively, which in association to clinical signs of saturnism, determined the diagnosis of lead poisoning.

Dessecação de Crotalaria juncea no outono

The objective of this study was to evaluate the effect of glyphosate applied alone and in mixtures with 2.4-D or metsulfuron methyl in the desiccation of mature plants of Crotalaria juncea during the fall season, in a field crop. Two experiments were carried out using a randomized experimental block design, in a 4 × 3 factorial scheme, with four replications. Treatments in the first experiment were formed by four doses (0.00, 0.54, 1.08 and 1.62 kg ha -1) of glyphosate, associated with three doses (0.00, 0.806 and 1.209 kg ha -1) of 2 , 4-D. In the second experiment the same doses of glyphosate were studied associated with three doses (0.0 4.0 and 8.0 g ha -1) of metsulfuron-methyl. Visual evaluations of plant poisoning, score number of plants with regrowth and dry matter of plants were determined. It was concluded that glyphosate applied alone or in association with 2.4-D or metsulfuron-methyl, regardless of the applied doses, was ineffective in the desiccation of mature plants of Crotalaria juncea.

Ligature of external carotid artery as an optional technique in a patient with von Willebrand disease

The von Willebrand disease (vWD) is a hereditary coagulopathy. There is no gender predilection. Clinically characterized by mucocutaneous bleeding, especially nose bleeding, menorrhagia and bleeding after trauma. This article reports a case of a 52-year-old Caucasian male patient with vWD, who presented with extensive bleeding in the tongue after a lacerating injury caused by accidental biting, and describes some clinical, pathological and treatment aspects of vWD. After repeated attempts to suture the wound and replace clotting factors, a decision was made to perform the ligature of the external carotid artery ipsilateral to the injury. There was favorable resolution of the case, with a good aspect of the scar 2 months after ligation. This case reinforces that it is extremely important to make a thorough review of medical history of all patients, searching for possible bleeding disorders or previous family history.

Noninvasive aspergillosis as a maxillary antrolith: report of a rare case.

Maxillary antrolithiasis is characterized by masses of tissue of endogenous or exogenous origin that calcify within the maxillary sinuses. Aspergillosis is a fungal disease in which the maxillary sinus is a primary site of infection. Aspergillosis mycetoma, its noninvasive form, is the most prevalent modality of the disease in the maxillary sinuses. In approximately half of the cases reported in the literature, calcification of the fungal mycelia, which later became antroliths, was verified. This article reports a rare case of the accidental discovery of a maxillary antrolith associated with noninvasive aspergillosis in an immunocompetent and asymptomatic 56-year-old woman. The diagnosis and therapeutic procedures used in treating the patient are discussed as well as the probable iatrogenic origin of the fungal pathology.

Complete denture wearing and fractures among edentulous patients treated in university clinics

Objective: The prevalence of wearing and fracture of complete dentures was evaluated among edentulous patients treated in two dental schools in Brazil. Background: Acceptance and wearing of complete dentures are related to adaptive behaviour of edentulous patients. However, one reason that could interfere with the wearing dentures is their potential to fracture, which is still a common complication in denture rehabilitation practice. Material and methods: Two hundred and twenty-four edentulous patients rehabilitated with complete dentures from 2000 to 2005 in Araçatuba and Araraquara Dental School, University of State of São Paulo, were assessed in 2006 and 2007 to answer a questionnaire about wearing and fracture of their dentures. Statistical analysis were performed using Epi Info software and chi-squared test to compare maxillary and mandibular data (α = 0.05). Results: Almost 26% of the patients did not wear their dentures, and among the remainder, the majority wore the maxillary denture. About 30% of the dentures were fractured, with higher prevalence in the maxillary arch (p = 0.003). Conclusions: Discontinuation of wearing dentures was quite high, especially considering the treatment which was carried out in university clinics. Prevalence of fractures was also high, greater for the maxillary denture, and was one of the main reasons for non-wearing of complete dentures. © 2011 The Gerodontology Society and John Wiley & Sons A/S.

Detection of enterotoxin A in coagulase-negative staphylococci isolated from nutrition students

Background: Staphylococcus is a clinically important genus because of its capacity to produce enterotoxins and to cause food poisoning. Staphylococci are the most frequent microorganisms of the skin and mucosal microbiota, with an estimated 20 to 40% of individuals carrying these bacteria on their hands or nose. Since nutrition professionals are involved in the handling and preparation of foods and are possible carriers of these bacteria, the objective of this study was to investigate the presence of Staphylococcus on the hands and in the nasal fossae of undergraduate nutrition students and to determine the enterotoxigenic capacity of these microorganisms. Methods and Findings: A total of 201 strains were isolated from the hands and nose of 61 nutrition students. Of these, 180 (89.5%) were identified as coagulasenegative staphylococci and 21 (10.5%) as S. aureus. Thirty-seven (18.4%) Staphylococcus isolates were producers of enterotoxin A. Toxin production was detected in 5 (19%) of the S. aureus isolates and in 31 (17.2%) of the coagulase-negative staphylococci. Conclusions: This study demonstrated a large number of enterotoxin-producing staphylococci on the hands and nose of nutrition students and professionals involved in the handling and preparations of foods. These findings indicate the need for adequate hygiene measures to prevent food poisoning. © iMedPub.

Electrocatalytic activity under oscillatory regime: The electro-oxidation of formic acid on ordered Pt3Sn intermetallic phase

Despite the considerable progress in the understanding of the mechanistic aspects of the oscillatory electro-oxidation of C1 molecules, there are apparently no systematic studies concerning the impact of surface modifiers on the oscillation dynamics. Herein we communicate on the oscillatory electro-oxidation of formic acid on ordered Pt3Sn intermetallic phase, and compare the results with those obtained on a polycrystalline platinum electrode. Overall, the obtained results were very reproducible, robust and allowed a detailed analysis on the correlation between the catalytic activity and the oscillation dynamics. The presence of Sn in the intermetallic electrode promotes drastic effects on the oscillatory dynamics. The decrease in the mean electrode potential and in the oscillation frequency, as well as the pronounced increase in the number oscillations (and also in the oscillation time), was discussed in connection with the substantial catalytic enhancement of the Pt3Sn towards the electro-oxidation of formic acid. The self-organized potential oscillations were used to probe the electrocatalytic activity of the Pt3Sn electrode and compare it with that for polycrystalline Pt. The presence of Sn resulted in a significant decrease (2-11 times, depending on the applied current) of the rate of surface poisoning. © 2012 Elsevier B.V.

Altering the adsorptive and electronic properties of Pt through poly(vinyl alcohol) adsorption

In the present paper we investigated the effect of adsorbed PVA on Pt electrodes on classic electrochemical processes such as hydrogen UPD, oxygen reduction and CO electro-oxidation. Upon adsorption PVA blocks roughly 50% of the hydrogen sites and can not be removed from the Pt surface through cycling in the potential range of 0.05-1.0 V vs. RHE. Potentiodynamic experiments under controlled hydrodynamic conditions provided by rotating disk electrode experiments showed a negative impact of the adsorbed PVA on the oxygen reduction reaction (ORR). Cyclic-voltammetry results revealed that not even CO was able to remove PVA from the Pt surface. Regarding the oxidation of CO, the adsorbed polymer positively shifted the CO oxidation peak potential, therefore higher potentials are required to free the Pt surface from CO poisoning. In situ Fourier transform infrared spectroscopy evidenced that the presence of PVA shifted the linearly bound CO frequency toward higher wavenumbers, a process found to be independent of the Pt surface orientation. In situ electrochemical X-ray absorption spectroscopy results showed that PVA also impacted the electronic properties of platinum by decreasing the occupancy of the Pt conducting 5d band. Our findings clearly support the efforts toward understanding the nature of the interaction between polymers and metallic surfaces as well as the impact on technological applications (e.g. in PEMFCs). © 2013 Elsevier Ltd. All rights reserved.

The role of mitochondria and biotransformation in abamectin-induced cytotoxicity in isolated rat hepatocytes

Abamectin (ABA), which belongs to the family of avermectins, is used as a parasiticide; however, ABA poisoning can impair liver function. In a previous study using isolated rat liver mitochondria, we observed that ABA inhibited the activity of adenine nucleotide translocator and FoF1-ATPase. The aim of this study was to characterize the mechanism of ABA toxicity in isolated rat hepatocytes and to evaluate whether this effect is dependent on its metabolism. The toxicity of ABA was assessed by monitoring oxygen consumption and mitochondrial membrane potential, intracellular ATP concentration, cell viability, intracellular Ca2+ homeostasis, release of cytochrome c, caspase 3 activity and necrotic cell death. ABA reduces cellular respiration in cells energized with glutamate and malate or succinate. The hepatocytes that were previously incubated with proadifen, a cytochrome P450 inhibitor, are more sensitive to the compound as observed by a rapid decrease in the mitochondrial membrane potential accompanied by reductions in ATP concentration and cell viability and a disruption of intracellular Ca2+ homeostasis followed by necrosis. Our results indicate that ABA biotransformation reduces its toxicity, and its toxic action is related to the inhibition of mitochondrial activity, which leads to decreased synthesis of ATP followed by cell death. © 2012 Elsevier Ltd.

Hepatoencephalopathy syndrome due to Cassia occidentalis (Leguminosae, Caesalpinioideae) seed ingestion in horses

Cassia occidentalis is a bush from the Leguminosae family, subfamily Caesalpinoideae, and is a toxic plant of veterinary interest due to the occasional contamination of animal rations. This report describes the clinical and histopathological findings of an outbreak of C.occidentalis poisoning in horses. Twenty mares were poisoned after consuming ground corn contaminated with 8% of C.occidentalis seeds. Of the 20 animals affected, 12 died: 8 mares were found dead, 2 died 6h after the onset of clinical signs compatible with hepatic encephalopathy and the 2 other animals were subjected to euthanasia 12h after the onset of the clinical signs. The remaining 8 mares presented with mild depression and decreased appetite, but improved with treatment and no clinical sequelae were observed. In 6 animals that underwent a necropsy, an enhanced hepatic lobular pattern was noted and within the large intestine, a large number of seeds were consistently observed. Hepatocellular pericentrolobular necrosis and cerebral oedema were the main histological findings. In one mare, there was mild multifocal semimembranosus rhabdomyocytic necrosis and haemorrhage. Seeds collected from intestinal contents and sifted from the culpable feedstuff were planted. Examination of the leaves, flowers, fruits and seeds of the resultant plants identified C.occidentalis. Horses poisoned by C.occidentalis seeds demonstrate clinical signs associated with hepatoencephalopathy and frequently die suddenly. Lesions primarily involve the liver and secondarily, the central nervous system. Cassia occidentalis poisoning should be considered a differential diagnosis in horses with hepatoencephalopathy and special caution should be taken with horse rations to avoid contamination with seeds of this toxic plant. © 2012 EVJ Ltd.