Avaliação da qualidade de vida e dos sintomas de stress em mulheres menopausadas com disfunção da articulação temporomandibular

Universidade Estadual de Campinas . Faculdade de Educação Física

Desidratação e recomendações para a reposição hídrica em crianças fisicamente ativas

OBJETIVO: A prática de exercícios físicos, devido à produção inerente de calor, pode conduzir à desidratação. A maioria dos estudos que abordam os riscos da desidratação e fornecem recomendações de reposição hídrica é direcionada a indivíduos adultos residentes em regiões de clima temperado, porém, em regiões tropicais, pouco é conhecido sobre as necessidades de reposição hídrica em crianças fisicamente ativas. Esta revisão discute as recomendações para esta população e estabelece os riscos da prática esportiva em ambiente de clima tropical. FONTES DE DADOS: Análise sistemática com levantamento da literatura nacional (SciELO) e internacional (Medline) de artigos publicados entre 1972 e 2009, com os seguintes descritores isolados ou em combinação: hidratação, crianças, desidratação e reposição hídrica. Foram selecionados artigos publicados nas línguas portuguesa e inglesa. SÍNTESES DE DADOS: Observou-se que há riscos de desidratação e possível desenvolvimento de um quadro de hipertermia principalmente se as crianças são submetidas a condições climáticas desfavoráveis sem reposição hídrica adequada. O principal fator desencadeante da hipertermia é a menor adaptação das crianças aos extremos de temperatura, em comparação aos adultos, por possuírem área maior de superfície corporal e capacidade menor de termorregulação por evaporação. CONCLUSÕES: Conhecidos os fatores intervenientes da desidratação, a melhor recomendação, perante uma condição climática sabidamente desfavorável, é estabelecer um plano impositivo de hidratação com bebida com sabor e acréscimo de carboidratos e sódio, evitando-se uma perda hídrica significativa, diminuição da performance e, principalmente, com o objetivo de reduzir os riscos à saúde impostos pela hipertermia e desidratação a crianças fisicamente ativas.

Is sympathectomy at T4 level better than at T3 level for treating palmar hyperhidrosis?

Purpose: We compared the results from a video-assisted thoracoscopic sympathectomy (VTS) at the T4 denervation level with those from a VTS at the T3 level for the treatment of palmar hyperhydrosis (PH). Methods: Seventy patients with PH were prospectively followed for VTS at the T3 or T4 denervation levels for 6 months. The end points of this study were: absence of PH, compensatory hyperhydrosis (CH), and quality-of-life assessment. Results: Sixty-seven patients reported a complete resolution of PH after surgery. One failure occurred in the T3 group and 2 in the T4 group. When anhydrosis was obtained, we noticed totally dry hands in 26 patients in the T3 group and 6 patients in the T4 group. The other 27 patients in the T4 group and 8 in the T3 group maintained a small level of sweating and were also considered to be therapeutic successes. At 6 months, 25 patients in the T4 group had some degree of CH (71.42%) and all patients in the T3 group (100%), though the T4 group had a lower degree of severity of CH at the 6-month follow-up (P < 0.05). After the operation, quality of life was improved similarly in both groups. Conclusions: VTS at either the T3 or T4 level provides an effective treatment for PH. VTS at the T4 level is associated with a less severe form of CH. Despite the occurrence of CH, patients' quality of life is significantly improved following VTS at the T3 or T4 levels. For this reason, the T4 resection can now be used as a treatment for PH.

The Society of Thoracic Surgeons Expert Consensus for the Surgical Treatment of Hyperhidrosis

Significant controversies surround the optimal treatment of primary hyperhidrosis of the hands, axillae, feet, and face. The world`s literature on hyperhidrosis from 1991 to 2009 was obtained through PubMed. There were 1,097 published articles, of which 102 were clinical trials. Twelve were randomized clinical trials and 90 were nonrandomized comparative studies. After review and discussion by task force members of The Society of Thoracic Surgeons` General Thoracic Workforce, expert consensus was reached from which specific treatment strategies are suggested. These studies suggest that primary hyperhidrosis of the extremities, axillae or face is best treated by endoscopic thoracic sympathectomy (ETS). Interruption of the sympathetic chain can be achieved either by electrocautery or clipping. An international nomenclature should be adopted that refers to the rib levels (R) instead of the vertebral level at which the nerve is interrupted, and how the chain is interrupted, along with systematic pre and postoperative assessments of sweating pattern, intensity and quality-of-life. The recent body of literature suggests that the highest success rates occur when interruption is performed at the top of R3 or the top of R4 for palmar-only hyperhidrosis. R4 may offer a lower incidence of compensatory hyperhidrosis but moister hands. For palmar and axillary, palmar, axillary and pedal and for axillary-only hyperhidrosis interruptions at R4 and R5 are recommended. The top of R3 is best for craniofacial hyperhidrosis. (Ann Thorac Surg 2011;91:1642-8) (C) 2011 by The Society of Thoracic Surgeons

Thermoregulatory Efficiency is Increased after Heat Acclimation in Tropical Natives

To evaluate the effects of heat acclimation on sweat rate redistribution and thermodynamic parameters, 9 tropical native volunteers were submitted to 11 days of exercise-heat exposures (40 +/- 0 degrees C and 45.1 +/- 0.2% relative humidity). Sudomotor function was evaluated by measuring total and local (forehead, chest, arm, forearm, and thigh) sweat rates, local sweat sodium concentration, and mean skin and rectal temperatures. We also calculated heat production (H), heat storage (S), heat exchange by radiation (R) and by convection (C), evaporated sweat (E(sw)), sweating efficiency (eta(sw)), skin wettedness (w(sk)), and the ratio between the heat storage and the sum of heat production and heat gains by radiation and convection (S/(H+R+C)). The heat acclimation increased the whole-body sweat rate and reduced the mean skin temperature. There were changes in the local sweat rate patterns: on the arm, forearm, and thigh it increased significantly from day 1 to day 11 (all p<0.05) and the sweat rates from the forehead and the chest showed a small nonsignificant increase (p=0.34 and 0.17, respectively). The relative increase of local sweat rates on day 11 was not different among the sites; however, when comparing the limbs (arm, forearm, and thigh) with the trunk (forehead and chest), there was a significant higher increase in the limbs (32 +/- 5%) in comparison to the trunk (11 +/- 2%, p=0.001). After the heat acclimation period we observed higher w(sk) and E(sw) and reduced S/(H+R+C), meaning greater thermoregulatory efficiency. The increase in the limb sweat rate, but not the increase in the trunk sweat rate, correlated with the increased w(sk), E(sw), and reduced S/(H+R+C) (p<0.05 to all). Altogether, it can be concluded that heat acclimation increased the limbs` sweat rates in tropical natives and that this increase led to increased loss of heat through evaporation of sweat and this higher sweat evaporation was related to higher thermoregulatory efficiency. J Physiol Anthropol 29(1): 1-12, 2010 http://www.jstage.jst.go.jp/browse/jpa2 [DOI: 10.2114/jpa2.29.1]

Differences in thermoregulatory ability between slick-haired and wild-type lactating Holstein cows in response to acute heat stress

Animals inheriting the slick hair gene have a short, sleek, and sometimes glossy coat. The objective of the present study was to determine whether slick-haired Holstein cows regulate body temperature more effectively than wild-type Holstein cows when exposed to an acute increase in heat stress. Lactating slick cows (n = 10) and wild-type cows (n = 10) were placed for 10 h in an indoor environment with a solid roof, fans, and evaporative cooling or in an outdoor environment with shade cloth and no fans or evaporative cooling. Cows were exposed to both environments in a single reversal design. Vaginal temperature, respiration rate, surface temperature, and sweating rate were measured at 1200, 1500, 1800, and 2100 h (replicate 1) or 1200 and 1500 h (replicate 2), and blood samples were collected for plasma cortisol concentration. Cows in the outdoor environment had higher vaginal and surface temperatures, respiration rates, and sweating rates than cows in the indoor environment. In both environments, slick-haired cows had lower vaginal temperatures (indoor: 39.0 vs. 39.4 degrees C; outdoor 39.6 vs. 40.2 degrees C; SEM = 0.07) and respiration rate (indoor: 67 vs. 79 breaths/min; outdoor 97 vs. 107 breaths/min; SEM = 5.5) than wild-type cows and greater sweating rates in unclipped areas of skin (indoor: 57 vs. 43 g.h(-1)/m(2); outdoor 82 vs. 61 g.h(-1)/m(2); SEM = 8). Clipping the hair at the site of sweating measurement eliminated the difference between slick-haired and wild-type cows. Results indicate that slick-haired Holstein cows can regulate body temperature more effectively than wild-type cows during heat stress. One reason slick-haired animals are better able to regulate body temperature is increased sweating rate.

Physiological responses to the menstrual cycle - Implications for the development of heat illness in female athletes

Fluctuations in estrogen and progesterone during the menstrual cycle can cause changes in body systems other than the reproductive system. For example, progesterone is involved in the regulation of fluid balance in the renal tubules and innervation of the diaphragm via the phrenic nerve. However, few significant changes in the responses of the cardiovascular and respiratory systems, blood lactate, bodyweight, performance and ratings of perceived exertion are evident across the cycle. Nevertheless, substantial evidence exists to suggest that increased progesterone levels during the luteal phase cause increases in both core and skin temperatures and alter the temperature at which sweating begins during exposure to both ambient and hot environments. As heat illness is characterised by a significant increase in body temperature, it is feasible that an additional increase in core temperature during the luteal phase could place females at an increased risk of developing heat illness during this time. In addition, it is often argued that physiological gender differences such as oxygen consumption, percentage body fat and surface area-to-mass ratio place females at a higher risk of heat illness than males. This review examines various physiological responses to heat exposure during the menstrual cycle at rest and during exercise, and considers whether such changes increase the risk of heat illness in female athletes during a particular phase of the menstrual cycle.

Jungle yellow fever: clinical and laboratorial sudies emphasizing viremia on a human case

The authors report the clinical, laboratorial and epidemiological aspects of a human case of jungle yellow fever. The patient suffered from fever, chills, sweating, headaches, backaches, myalgia, epigastric pains, nausea, vomiting, diarrhea and prostration. He was unvaccinated and had been working in areas where cases of jungle yellow fever had been confirmed. Investigations concerning the yellow fever virus were performed. Blood samples were collected on several days in the course of the illness. Three of these samples (those obtained on days 5,7 and 10) were inoculated into suckling mice in attempt to isolate virus and to titrate the viremia level. Serological surveys were carried out by using the IgM Antibodies Capture Enzyme Linked Immunosorbent Assay (MAC-ELISA), Complement Fixation (CF), Hemagglulinalion Inhibition (HI) and Neutralization (N) tests. The yellow fever virus, recovered from the two first samples and the virus titration, showed high level of viremia. After that, specific antibodies appeared in all samples. The interval between the end of the viremia and the appearance of the antibodies was associated with the worsening of clinical symptoms, including bleeding of the mucous membrane. One must be aware of the risk of having a urban epidemics in areas where Aedes aegypti is found in high infestation indexes.

Exposição a fungos dos trabalhadores dos ginásios com piscina

RESUMO - Os trabalhadores dos ginásios com piscinas apresentam maior prevalência de lesões fúngicas, como a Tinea pedis e a onicomicose, devido às características intrínsecas da sua actividade profissional, pois apresentam mais horas por dia de exposição à contaminação fúngica das superfícies. Esta situação verifica-se não só por serem os que mais frequentam os locais possíveis de estarem contaminados, como é o caso de balneários, vestiários e zona envolvente às piscinas, mas também porque algumas das actividades desenvolvidas são realizadas com os pés descalços. Além disso, a utilização de roupa sintética e de calçado ocluso, que retêm a sudação excessiva, favorece o desenvolvimento fúngico. Constituiu objectivo deste trabalho conhecer o risco de infecção e/ou lesão (Tinea pedis e onicomicose) nos trabalhadores dos ginásios com piscina e a sua eventual relação com a exposição à contaminação fúngica (ar e superfícies) dos locais de trabalho. Foram descritas as variáveis ambientais e biológicas que influenciam a infecção e/ou lesão fúngica em ambiente profissional e exploradas eventuais associações entre essas mesmas variáveis. Foram também conhecidas as diferenças da contaminação fúngica das superfícies entre as duas principais estações do ano (Verão e Inverno) e entre antes e depois da lavagem e desinfecção. O estudo realizado possui uma componente transversal, em que se pretendeu descrever os fenómenos ambientais e biológicos da contaminação fúngica em ambiente profissional e explorar eventuais associações entre variáveis; uma componente longitudinal, em que foram conhecidas as diferenças sazonais da contaminação fúngica das superfícies; e, ainda, uma componente quase experimental, em que foi analisada a distribuição fúngica nas superfícies antes e depois da lavagem e desinfecção. Na vertente transversal foi considerada uma amostra de 10 ginásios com piscina e outra amostra de, pelo menos, 10 profissionais de cada estabelecimento, perfazendo um total de 124 trabalhadores (75 Homens - 60,48% e 49 Mulheres - 39,52%). Foram realizadas 258 colheitas biológicas aos pés dos trabalhadores, efectuada a avaliação ambiental da contaminação fúngica dos estabelecimentos através de 50 colheitas de amostras de ar e 120 colheitas de amostras de superfícies (60 antes e 60 depois da lavagem e desinfecção) e efectuados os respectivos processamento laboratorial e identificação fúngica. Foram também avaliadas as variáveis ambientais temperatura, humidade relativa e velocidade do ar, preenchidas 10 grelhas de observação, com o objectivo de efectuar o registo de informação sobre as variáveis que xx influenciam a exposição ocupacional às espécies fúngicas e, ainda, completadas 124 grelhas de observação inerentes à colheita de material biológico, de modo a realizar o registo dos profissionais com lesão e outras informações pertinentes para a análise laboratorial. Todos os 124 trabalhadores responderam a um questionário, em simultâneo à realização das colheitas biológicas, de modo a conhecer algumas das variáveis individuais e profissionais com pertinência para o presente estudo. Num dos estabelecimentos, foram também estudadas as diferenças da contaminação fúngica das superfícies entre antes e depois da lavagem e desinfecção e, ainda, entre as duas estações do ano (Verão e Inverno). Nesse estabelecimento, foram realizadas 36 colheitas de superfícies antes e 36 colheitas depois da lavagem e desinfecção, em 6 dias diferentes da semana, durante 6 semanas sequenciais em cada estação do ano, completando um total de 72 colheitas de superfícies. Foi ainda criado e aplicado um método para estabelecer um padrão de exposição profissional a fungos nas superfícies, de modo a permitir definir níveis semi-quantitativos de estimação do risco de infecção fúngica dos trabalhadores dos ginásios com piscinas. Para o critério da Gravidade, considerou-se que a gravidade da contaminação e, consequentemente, da possível lesão, está intimamente relacionada com a espécie fúngica envolvida. Foram calculadas as médias da contaminação fúngica por cada estabelecimento antes da lavagem e desinfecção, de modo a estabelecer os níveis de Frequência e, em relação à Exposição, foram estabelecidos intervalos para agrupar as horas semanais de trabalho. Dos 124 trabalhadores que participaram no estudo, 58 (46,8%) possuíam lesões visíveis. Nesses 58, as Leveduras foram as mais isoladas (41,4%), seguidas dos Dermatófitos (24,1%) e de Fungos Filamentosos Não Dermatófitos (6,9%). Candida parapsilosis e Rhodotorula sp. foram as Leveduras mais frequentemente isoladas (20,2%); no caso dos Dermatófitos, Trichophyton rubrum foi a espécie mais frequente (55,5%) e, relativamente aos Fungos Filamentosos Não Dermatófitos, Penicillium sp. foi o mais isolado (15,6%), seguido do género Fusarium (12,5%). No que concerne à contaminação fúngica das superfícies, 37 fungos filamentosos foram isolados. Fusarium foi o género mais frequente, antes e depois da lavagem e desinfecção (19,1% - 17,2%). Em relação aos fungos leveduriformes, 12 leveduras diferentes foram identificadas, tendo sido os géneros Cryptococcus (40,6%) e Candida (49,3%) os mais frequentes antes e depois da lavagem e desinfecção, respectivamente. Em relação à contaminação fúngica do ar, foram identificados 25 fungos filamentosos diferentes, em que os 3 géneros mais frequentemente isolados foram Cladosporium (36,6%), Penicillium (19,0%) e Aspergillus (10,2%). Relativamente às leveduras, foi identificado o género xxi Rhodotorula (87,5%) e as espécies Trichosporon mucoides e Cryptococcus unigutulattus (12,5%). Verificou-se associação, ao nível de significância de 5%, entre lesão visível e horas semanais e entre lesão visível e tempo de profissão, comprovando a influência da duração da exposição ao factor de risco (contaminação fúngica do ambiente profissional), para a presença de lesão visível nos trabalhadores expostos (Tinea pedis e onicomicose), ficando demonstrada a relação entre a exposição ao factor de risco em estudo – exposição profissional a fungos – com os efeitos para a saúde. As variáveis ambientais avaliadas (temperatura, humidade relativa e velocidade do ar) não influenciaram a contaminação fúngica do ar e das superfícies, não tendo sido evidenciada nenhuma relação estatisticamente significativa (p>0,05). Contudo, verificou-se influência do número de ocupantes que frequentaram cada um dos estabelecimentos nas médias das unidades formadoras de colónias por metro quadrado nas superfícies antes da lavagem e desinfecção. Não se verificou correlação entre os resultados quantitativos da contaminação fúngica do ar e a das superfícies dos 10 estabelecimentos monitorizados. No entanto, verificaram-se diferenças significativas, ao nível de significância de 10%, entre a contaminação fúngica das superfícies e a contaminação fúngica do ar (p<0,1), tendo-se constatado que apesar de 50% dos valores mais baixos terem sido superiores na contaminação fúngica do ar, a contaminação fúngica das superfícies apresentou-se com maior variabilidade quantitativa. Em relação às diferenças significativas na contaminação fúngica das superfícies nos 10 estabelecimentos entre antes e depois da lavagem e desinfecção, apenas se verificou redução significativa (p<0,05) da contaminação fúngica depois da lavagem e desinfecção nos balneários e vestiários masculinos em relação aos fungos leveduriformes. No estabelecimento seleccionado, verificou-se que a relação entre a contaminação fúngica e a temperatura e humidade relativa não foi significativa (p>0,05) em ambas as estações do ano e também não se constatou influência dos ocupantes nos valores médios das unidades formadoras de colónias por metro quadrado das superfícies antes da lavagem e desinfecção em ambas as estações de ano. Em quase todas as situações em que se verificaram diferenças significativas entre as duas estações do ano, verificou-se um aumento das unidades formadoras de colónias por metro quadrado no Inverno, com excepção do total das unidades formadoras de colónias por metro quadrado antes da lavagem e desinfecção nos balneários e vestiários masculinos em que se verificou aumento no Verão. Constatou-se também que apenas ocorreu redução da xxii contaminação fúngica depois da lavagem e desinfecção nas escadas de acesso no Inverno e nos balneários e vestiários masculinos no Verão. Com a aplicação do método para estabelecer um padrão de exposição profissional a fungos nas superfícies obteve-se, nos 10 estabelecimentos, com Nível de Risco Mínimo 65 locais (54,2%), com Nível de Risco Médio 23 locais (19,2%) e com Nível de Risco Elevado 32 locais (26,6%). Próximo do jacuzzi e junto ao tanque foram os locais com mais classificações de Nível de Risco Elevado. No estabelecimento seleccionado verificou-se que, no Verão, depois da lavagem e desinfecção, ocorreu um maior número de locais classificados no Nível de Risco Elevado e, no Inverno, constatou-se a situação inversa, tendo sido observado maior número de locais com Nível de Risco Elevado antes da lavagem e desinfecção. Junto ao tanque e nas escadas de acesso à zona envolvente ao jacuzzi e tanque foram os locais com mais classificações de Nível de Risco Elevado, no Verão e no Inverno. Foram isolados nas superfícies fungos comuns aos isolados nos trabalhadores. Antes da lavagem e desinfecção, 30,3% dos fungos foram isolados nas superfícies e nos trabalhadores e depois desses procedimentos 45,5% dos fungos foram também isolados comummente. As Leveduras foram as mais isoladas comummente e as que se verificaram mais frequentes antes e depois da lavagem e desinfecção da superfícies e, também, nos resultados das colheitas biológicas realizadas aos trabalhadores, foram o género Rhodotorula e a espécie Candida parapsilosis, permitindo confirmar que a infecção fúngica dos trabalhadores está relacionada com a contaminação fúngica das superfícies. Concluiu-se que é necessária a intervenção em Saúde Ocupacional no âmbito da vigilância ambiental e da vigilância da saúde, com o intuito de diminuir a prevalência das infecções fúngicas. Para a prossecução desse objectivo, sugere-se a implementação de medidas preventivas, nomeadamente: o controlo da contaminação fúngica das superfícies mediante procedimentos de lavagem e desinfecção eficazes, de modo a minimizar a contaminação fúngica das superfícies; a identificação precoce da infecção através da realização de colheitas biológicas periódicas aos trabalhadores, inseridas num protocolo de vigilância da saúde; e, ainda, a sensibilização para a aplicação de medidas de higiene pessoal e o tratamento das patologias. A aplicação do método criado para estabelecer um padrão de exposição profissional a fungos nas superfícies servirá não só para a estimação do risco de infecção fúngica dos trabalhadores de ginásios com piscinas, mas também para facilitar o estabelecimento de valores fúngicos de referência, a implementação de medidas correctivas adequadas e imediatas e, ainda, a prevenção de infecções fúngicas, não só nos ginásios com piscina, mas também noutros contextos profissionais. ------------ SUMMARY - Gyms with swimming pools workers have higher prevalence of fungal injuries, such as Tinea pedis and onychomycosis. This is due to their work intrinsic characteristics, since they have more hours per day of exposure to surfaces fungal contamination. This occurs not only because they attend sites most likely to be contaminated, such as showers, changing rooms and pool surrounding area, but also because some of the activities are done barefoot. Furthermore, synthetic clothing and occluded footwear use, which retain the excessive sweating, promotes fungal development. The aim of this study was to know gymnasiums with swimming pool workers infection and/or injury (Tinea pedis and onychomycosis) risk, and its possible relationship with exposure to workplace fungal contamination (air and surfaces). This study describes environmental and biological variables that influence infection and/or fungal injury in a professional setting and explored possible associations between these variables. Differences in surfaces fungal contamination between the two main seasons (summer and winter), as well between before and after cleaning and disinfection were known. It was developed a study with an cross-sectional perspective, that aimed to describe the biological and environmental phenomena of fungal contamination in a professional environment and explore possible associations between variables; an longitudinal perspective in which were known surfaces fungal contamination seasonal differences; and also with an almost experimental perspective that analyzed surfaces fungal distribution before and after cleaning and disinfection. The cross-sectional perspective comprised 10 gyms with swimming pool sample, and another sample of, at least, 10 professionals in each establishment totalling 124 workers (75 men – 60,48%, and 49 women – 39,52%). Were performed 258 biological samples at workers feet, environmental fungal contamination evaluation from the establishments through 50 air samples and 120 surfaces samples (60 before and 60 after cleaning and disinfection) and conducted their laboratory processing and fungal identification. Were also evaluated environmental variables, such as temperature, relative humidity and air velocity completed 10 observation grids, in order to obtain data about variables that affect occupational exposure to fungal species, and also completed 124 observation grids inherent to biological material collection, in order to know the professionals with injury and other relevant information for laboratory analysis. All 124 workers answered to a questionnaire at the same time that occur biological samples collection, in order to xxv obtain information about some of the individual and professional variables with relevance to this study. In one of the establishments were also studied differences concerning surfaces fungal contamination between before and after cleaning and disinfection, and also between two main seasons (summer and winter). In this setting, there were performed 36 surfaces samples before and 36 surfaces samples after cleaning and disinfection on 6 different week days for 6 sequential weeks in each season, totalling 72 surfaces samples. It was also created and implemented a method to establish a pattern for surfaces fungal occupational exposure, in order to help define semi-quantitative levels estimation to fungal infection risk in gyms with swimming pools workers. For Gravity criterion it was considered that contamination severity and, thus, the possible injury are closely related to implicate fungal species. Was calculated fungal contamination average by each establishment prior cleaning and disinfection, in order to establish Frequency levels. Regarding Exposure, were established weekly hours group intervals spent in professional activity. From the 124 professionals tested, 58 (46,8%) had visible injuries. In the 58 workers, Yeasts were the most isolated (41,4%), followed by Dermatophytes (24,1%) and Other Filamentous Fungi Besides Dermatophytes (6,9%). Candida parapsilosis and Rhodotorula sp. were the most frequently isolated Yeasts (20,2% for each), from Dermatophytes, Trichophyton rubrum was the most frequently isolated species (55,5%) and from Other Filamentous Fungi Besides Dermatophytes, Penicillium sp. was the most frequent (15,6%), followed by Fusarium genera (12,5%). Regarding surfaces fungal contamination, 37 filamentous fungi were isolated. Fusarium genera was the most frequent, before and after cleaning and disinfection (19,1% - 17,2%). Considering yeasts, 12 different yeasts were identified, being Cryptococcus (40,6%) and Candida (49,3%) genera the more frequent before and after cleaning and disinfection, respectively. In relation to air fungal contamination, 25 different filamentous fungi were identified and the 3 most frequently isolated genera were Cladosporium (36,6%), Penicillium (19,0%) and Aspergillus (10,2%). For yeasts, were identified Rhodotorula genera (87,5%), and also the species Trichosporon mucoides and Cryptococcus unigutulattus (12,5%). Was found association with 5% significance level, between visible injury and weekly hours and between visible injury and occupation time, confirming exposure duration influence to risk factor (work environment fungal contamination) for the visible injury presence in exposed workers (Tinea pedis and onychomycosis), being confirmed the relation between the study exposure risk - occupational exposure to fungi - with health effects. xxvi Environmental variables evaluated (temperature, relative humidity and air velocity) did not affect air and surfaces fungal contamination and wasn’t found no statistically significant relation (p>0,05). However, there was evidence that occupant’s number influence surfaces colony forming units mean per square meter before cleaning and disinfection. There was no correlation between quantitative data from air fungal contamination and surfaces fungal contamination from the 10 establishments monitored. However, there were significant differences with 10% significance level, between surfaces and air fungal contamination (p<0,1), and despite 50% of the lowest rates were higher in air fungal contamination, it was found that surfaces fungal contamination had more quantitative variability. Regarding differences from the 10 establishments surfaces fungal contamination, between before and after cleaning and disinfection, there was only a significant reduction (p<0,05) in fungal contamination after cleaning and disinfection in male changing rooms for yeasts. In the selected establishment, it was found that relation between fungal contamination and temperature and relative humidity was not significant (p>0,05) in both seasons, and also there wasn’t no influence observed from occupants in surfaces colony forming units mean per square meters before cleaning and disinfection in both seasons. In almost all situations where significant differences between the two seasons were shown, there was a colony-forming units per square meter increase in winter. There was an exception in total colony forming units per square meter before cleaning and disinfection in male changing room’s exception, where there was an increase in summer. Furthermore, was found that only occur a reduction in fungal contamination after cleaning and disinfection, on access stairs in winter, as well as in male changing rooms in summer. With application from the method to establish pattern for surfaces fungal occupational exposure, it was obtained, in the 10 establishments, 65 sites with Low Risk Level (54,2%), 23 sites with Average Risk Level (19,2%) and 32 sites with High Risk Level (26,6%). Near swimming pool and jacuzzi were the places with more High Risk Level classifications. In the selected establishment, was found that in the summer, after cleaning and disinfection, there were a greater number of sites classified as High Risk Level, and in winter it was found the opposite situation, being noted more places with High Risk Level before cleaning and disinfection. Next to swimming pool and access stairs to swimming pool and jacuzzi were the places with more High Risk Level classifications in Summer and Winter. Were isolated common fungi in surfaces and in workers. Prior to cleaning and disinfection 30,3% of fungi were isolated on surfaces and workers, and after 45,5% of fungi were also xxvii commonly isolated. The Yeasts were the most commonly isolated and the most frequent before and after surfaces cleaning and disinfection, and also in workers biological samples, were Rhodotorula genera and Candida parapsilosis, allowing confirming that workers fungal infection is related with surfaces fungal contamination. It was concluded that Occupational Health intervention it is necessary, in environmental monitoring and health surveillance perspective, in order to reduce fungal infections prevalence. To achieve this objective, preventive measures implementation it’s recommended, including: surfaces fungal contamination control, through effective cleaning and disinfecting in order to minimize surfaces fungal contamination; early infection identification by performing periodic biological sampling from workers, included in a health surveillance protocol; and also personal hygiene and diseases treatment awareness. Application of the created method to establish pattern for surfaces fungal occupational exposure, will be useful not only for estimating workers from gymnasiums with swimming pools fungal infection risk, but also to facilitate fungal reference values stipulation, effective and corrective measures implementation, and also, fungal infections prevention, not only in gymnasiums with swimming pool, but also in other professional settings.----------------- RÉSUMÉ - Les travailleurs des gymnases avec des piscines présentent souvent des infections fongiques, telles que Tinea pedis et aussi des onychomycoses, dues à leur activité professionnel, parce qu’ils restent plus longtemps tout prés des surfaces avec une certaine contamination fongique. Toute cette situation est due non seulement parce qu’ils sont ceux qui fréquentent plus souvent les places plus contaminées: des balnéaires, des vestiaires et des zones autour des piscines, mais aussi ils réalisent des activités aux pieds nus ou avec des chaussures très fermés et encore quelques fois avec des vêtements synthétiques. Tout cela emmène à une grande sudation ce qui aidera au développement fongique. Un objective de ce travaille a été connaître le risque d’infection et/ou présence de lésion (Tinea pedis et des onychomycoses) dans les travailleurs des gymnases avec des piscines et leur éventuel rapport avec l’exposition à la contamination fongique (de l’air et des surfaces) dans leurs locaux de travaille. On a décrit aussi des variables d’environnement et biologiques qui ont une certaine influence dans les infections fongiques dans tout l’environnement professionnel et aussi approfondir des éventuels associations entre ces même variables. On a encore reconnu des différences de la contamination fongique avant et après des lavages et désinfection de ces surfaces. Aussi on a trouvé des différences de contamination en Été et en Hiver. Cet étude a un composante transversale, en visant la description des phénomènes de contamination fongique biologique et de l'environnement dans un environnement professionnel et l’étude des associations possibles entre les variables; une composante longitudinale dans laquelle ils étaient connus comme des variations saisonnières de la contamination fongique des surfaces, et même; un quasi-composante expérimentale, où elle a examiné la répartition des champignons surfaces avant et après le lavage et la désinfection. Dans la composante transversale on été considérés 1 échantillons de 10 gymnases avec des piscines et un autre échantillon de au moins 10 professionnels de chaque établissement dans un total 124 travailleurs (75 hommes - 60,48% et 49 femmes - 39,52%). On a réalisé 258 prélèvements aux pieds des travailleurs et on a effectué en simultané la validation par contamination fongique de l’environnement par 50 prélèvements de l’air et par 120 prélèvements de surfaces (60 avant et 60 après des lavages et des désinfections) et on a effectué leur traitement en laboratoire et l’identification fongique. On a fait aussi l’évaluation des variables de l’environnement, la température, l’humidité relative et la vitesse de l’air. On a remplie 10 tableaux xxix d’observation, avec l’objective d’obtenir des informations sur les variables qu’influenceront l’exposition occupationnel aux souches fongiques, et encore 124 tableaux d’observation liée au prélèvement du matériel biologique, pour réaliser le registre des professionnels avec des lésions et des autres informations pertinentes pour une analyse laboratoire. Tous ces 124 travailleurs ont rempli un questionnaire au même temps que les prélèvements biologiques, afin de connaître quelques variables individuels et professionnels importants pour cet étude. Dans un des établissements on a aussi étudié les différences fongiques des surfaces parmi avant et après les lavages et de la désinfection et encore parmi l’Été et l’Hiver. Dans ce même établissement on a réalisé 36 prélèvements des surfaces avant et 36 après des lavages et de la désinfection, pendant 6 jours différents de la semaine, pendant 6 semaines en chaque saison de l’année, dans un total de 72 prélèvements des surfaces. On a encore crié et appliqué une méthode pour établir un standard d’exposition professionnelle au fungi sur les surfaces, afin de permettre la définition des niveaux semi quantitative d’estimation des risques d’infection fongique des travailleurs des gymnases avec des piscines. Pour le critère de Gravité, il a été considéré que la gravité de la contamination, et donc les possibles dommages, est étroitement liée aux espèces fongiques impliquées. Nous avons calculé la moyenne de la contamination fongique par chaque établissement avant le lavage et la désinfection afin d'établir les niveaux de Fréquence et, par rapport à l'Exposition, ont été crées pour regrouper les intervalles d'heures hebdomadaires consacrées à l'activité professionnelle en question. Sur les 124 travailleurs qui ont participé à l'étude, 58 (46,8%) avaient des lésions visibles. Parmi ces 58, les Levures ont été les plus isolées (41,4%), suivis par des Dermatophytes (24,1%) et des Filamenteux Non Dermatophytes (6,9%). Candida parapsilosis and Rhodotorula sp. ont été les Levures les plus fréquemment isolées (20,2%); dans le cas des Dermatophytes, Trichophyton rubrum est le plus fréquent (55,5%) et pour les Filamenteux Non Dermatophytes, Penicillium sp. a été le plus isolé (15,6%), suivi par Fusarium sp. (12,5%). En ce qui concerne la contamination fongique des surfaces, 37 champignons filamenteux ont été isolés. Le genre Fusarium est le plus fréquent avant et après le lavage et la désinfection (19,1% - 17,2%). Pour la levure, 12 levures différentes ont été identifiées, ayant été Cryptococcus sp. (40,6%) et Candida sp. (49,3%) les plus fréquents avant et après le lavage et la désinfection, respectivement. En ce qui concerne la contamination fongique de l'air, on a identifié 25 différents champignons filamenteux, où les 3 genres les plus fréquemment isolés étaient Cladosporium (36,6%), Penicillium (19,0%) et Aspergillus (10,2%). Pour les levures, il a été identifié le genre xxx Rhodotorula (87,5%) et les espèces Trichosporon mucoides et Cryptococcus unigutulattus (12,5%). On a vérifié une association, au niveau de signification de 5%, entre les lésions visibles et les heures hebdomadaires et entre les lésions visibles et la durée d’occupation, ce qui confirme l'influence de la durée de l'exposition aux facteurs de risque (contamination fongique dans le milieu de travail) pour la présence des lésions visibles chez les travailleurs exposés (Tinea pedis et onychomycose), en démontrant une relation entre l'exposition au facteur de risque dans ces études - l'exposition professionnelle aux champignons - avec les effets sur la santé. Les variables environnementales évalué (température, humidité relative et la vitesse de l'air) ne modifient pas la contamination fongique de l'air et des surfaces; donc, n'a pas été démontré aucune relation statistiquement significative (p>0,05). Cependant, il y a une influence du nombre d'occupants qui ont participé à chacun des établissements en moyenne des unités formant colonie par mètre carré sur la surface avant le lavage et la désinfection. Il n'y avait pas de corrélation entre les résultats quantitatifs de la contamination fongique de l'air et des surfaces des 10 établissements surveillés, cependant il existe des différences importantes, au niveau de signification de 10% entre la contamination fongique des surfaces et de la contamination fongique de l'air (p <0,1), on a constaté que malgré 50% des niveaux les plus bas étaient plus élevés dans la contamination fongique de l'air, la contamination fongique des surfaces présentée une plus grande variabilité quantitativement. En ce qui concerne les différences de la contamination fongique des surfaces dans les 10 établissements entre avant et après le lavage et la désinfection, il y avait seulement une réduction significative (p<0,05) de la contamination fongique après le lavage et la désinfection dans les balnéaires et vestiaires pour les hommes par rapport aux levures. Lors de l'établissement choisi, on a constaté que le rapport entre la contamination fongique et la température et l'humidité relative n'était pas significatif (p>0,05) dans les deux saisons et aussi on n’a pas observé l'influence des occupants en moyenne des unités formant colonie par mètres carrés de surfaces avant le lavage et la désinfection dans les deux saisons de l'année. Dans presque toutes les situations ou on a vérifié des différences significatives entre les deux saisons, il ya eu une augmentation des unités formant des colonies par mètre carré en Hiver, à l'exception du total des unités formant des colonies par mètre carré avant le lavage et désinfection dans les balnéaires et vestiaires des hommes où il y a eu une augmentation en Été. On a également été constaté que seulement a eu une réduction de la contamination des xxxi champignons après la désinfection de l'escalier d'accès en Hiver et dans les balnéaires et vestiaires des hommes en Été. Avec la méthode pour établir standard d’exposition professionnelle au fungi sur les surfaces on a obtenu dans les 10 établissements, avec le Niveau de Risque Faible de 65 places (54,2%), avec le Niveau de Risque Moyen 23 places (19,2%) et 32 places avec le Niveau de Risque Élevé (26,6%). Près du jacuzzi et près de la piscine sont les lieux avec des plus évaluations de Niveau de Risque Élevé. Lors de l'établissement choisi, il a été constaté que, dans l'Été, après le lavage et la désinfection, un plus grand nombre de places évaluées comme présentant un Niveau de Risque Élevé et en Hiver on a constaté la situation inverse avec de nombreux points de Niveau de Risque Élevé avant le lavage et la désinfection. A côté de la piscine et les escaliers ont été les lieux avec plus grands classifications de Niveau de Risque Élevé en Été et en Hiver. On a isolé, chez les travailleurs, des champignons communs aux isolés sur les surfaces. Avant le lavage et la désinfection, 30,3% des champignons ont été isolés sur les travailleurs et sur les surfaces et, après ces procédures, 45,5% des champignons ont été isolés fréquemment. Les levures les plus souvent isolées et les plus fréquentes avant et après le lavage et la désinfection des surfaces, et aussi dans les résultats d'échantillons biologiques prélevés sur les travailleurs, étaient du genre Rhodotorula et les espèces de Candida parapsilosis, ce qui permet confirmer que l'infection fongique des travailleurs est liée à la contamination fongique des surfaces. On a conclu qu’il est nécessaire l'intervention en Santé Occupationnelle sous la surveillance de l'environnement et sous la surveillance de la santé, afin de réduire la prévalence des infections fongiques. Pour atteindre cet objectif, nous suggérons la mise en oeuvre de mesures préventives, y compris: le contrôle de la contamination fongique des surfaces par des méthodes de lavage et de désinfection afin de minimiser la contamination fongique des surfaces, l'identification précoce de l'infection avec des prélèvements biologiques périodiques, notamment un protocole pour la surveillance de la santé, et aussi la conscience du sens de l'hygiène personnelle et le traitement des pathologies. La méthode mise en place pour l’établissement d’un standard d’exposition professionnelle au fungi sur les surfaces, servira à estimer non seulement le risque d'infection fongique des travailleurs dans les gymnases avec des piscines, mais aussi pour faciliter l'établissement de valeurs de référence de champignons, l'application des mesures correctives immédiates et appropriées, et aussi la prévention des infections fongiques, non seulement dans les gymnases avec piscine, mais aussi dans d'autres contextes professionnels.

Description of an injury in a human caused by a false tocandira (Dinoponera gigantea, Perty, 1833) with a revision on folkloric, pharmacological and clinical aspects of the giant ants of the genera Paraponera and Dinoponera (sub-family Ponerinae)

The authors observed an injury caused by the sting of a false tocandira ant in the hand of an amateur fisherman and they describe the clinical findings and the evolution of the envenoming, which presented an acute and violent pain, cold sweating, nausea, a vomiting episode, malaise, tachycardia and left axillary's lymphadenopathy. About three hours after the accident, still feeling intense pain in the place of the sting, he presented an episode of great amount of blood in the feces with no history of digestive, hematological or vascular problems. The intense pain decreased after eight hours, but the place stayed moderately painful for about 24 hours. In that moment, he presented small grade of local edema and erythema. The authors still present the folkloric, pharmacological and clinical aspects related to the tocandiras stings, a very interesting family of ants, which presents the largest and more venomous ants of the world.

Serological and parasitological study and report of the first case of human babesiosis in Colombia

A study on the presence of Babesia in humans was performed in Puerto Berrío (Latitude 6.50deg. Longitude: -74.38deg. River: Magdalena. Area: 74.410km², Colombia-South America). Indirect immunofluorescence, thin and thick blood smears were used to study 194 individuals. Patients were grouped according to their risk-factors for Babesia infection: (group 1) individuals with fever, chills, sweating and other malaria-type symptoms; (group 2) symptomatic and asymptomatic individuals from local cattle ranches, which were enrolled in an active form, and (group 3) workers from the local slaughterhouse. Seven individuals were serologically positive for Babesia: Three individuals presented IgM antibodies against B. bovis, while one had IgG against this species; one individual had IgM against B. bigemina, another had IgG and a third both IgM and IgG against this species. Only one individual was parasitologically positive for Babesiaand serologically positive for Babesia bovis (IgM 1:64)

Significant correction of disease after postnatal administration of recombinant ectodysplasin A in canine X-linked ectodermal dysplasia.

Patients with defective ectodysplasin A (EDA) are affected by X-linked hypohidrotic ectodermal dysplasia (XLHED), a condition characterized by sparse hair, inability to sweat, decreased lacrimation, frequent pulmonary infections, and missing and malformed teeth. The canine model of XLHED was used to study the developmental impact of EDA on secondary dentition, since dogs have an entirely brachyodont, diphyodont dentition similar to that in humans, as opposed to mice, which have only permanent teeth (monophyodont dentition), some of which are very different (aradicular hypsodont) than brachyodont human teeth. Also, clinical signs in humans and dogs with XLHED are virtually identical, whereas several are missing in the murine equivalent. In our model, the genetically missing EDA was compensated for by postnatal intravenous administration of soluble recombinant EDA. Untreated XLHED dogs have an incomplete set of conically shaped teeth similar to those seen in human patients with XLHED. After treatment with EDA, significant normalization of adult teeth was achieved in four of five XLHED dogs. Moreover, treatment restored normal lacrimation and resistance to eye and airway infections and improved sweating ability. These results not only provide proof of concept for a potential treatment of this orphan disease but also demonstrate an essential role of EDA in the development of secondary dentition.

Acute hypersensitivity pneumonitis in a paint quality controller : a case report

Introduction: Isocyanates are sensitizing chemicals used in various industries such as polyurethane foam production or paint-related purposes. Acting as haptens recognized by T-lymphocytes, they can cause allergic asthma and rarely hypersensitivity pneumonitis (HP). We aim to present a case report of acute HP due to hexamethylene diisocyanate (HDI) in a paint quality controller, a profession not generally considered at a high risk for work-related Isocyanates exposure. Case report: A 30-yr-old otherwise healthy female, light smoker working as a paint quality controller developed shortness of breath, malaise, sweating and chills at workplace six hours after handling a HDI-based hardener. Upon admission to emergency department, symptoms had progressed to severe respiratory failure. HR computer tomography (HRCT) showed bilateral ground-glass attenuation without pleural effusion. Rapid clinical and radiological improvement occurred under facial oxygen supply and systemic steroid therapy. Occupational medicine investigations revealed regular handling of HDI using latex gloves without respiratory protection. Assessment at workplace showed insufficient air renewal (1.5 times per hour), inadequate local aspiration and HDI exposure at levels of 1-4.25 ppb/m3 (Swiss Occupation Exposure Limit 5 ppb/m3). Biological monitoring after identical work procedure executed by a co-worker showed HDI exposure (5.1 micrograms hexamethylene diamine/g creatinine). Resumption of work was disadvised because of the life-threatening event. Discussion: The diagnosis of occupational HP is highly supported by classical findings on imagery and typical symptoms occurring within approved latency interval, associated with rapid clinical improvement. Although neither broncho-alveolar lavage nor specific IgG diagnosis (en route) were performed during the acute episode, various blood tests managed to rule out evidence of an infection or autoimmune disease. Other causes of HP seem unlikely as the patient did not have any recurrence of symptoms since absence from work. Workplace evaluation provided significant information on HDI exposure and allowed substantial recommendations to diminish Isocyanate exposure for the 20 still healthy laboratory co-workers. Although the entryways (air or skin) and precise mechanism of toxicity remain unclear, the present case clearly shows that Isocyanates may trigger acute HP in susceptible workers in a profession not generally considered at a high risk.

TB Factsheet

What is TB (tuberculosis)? TB is a serious but curable infectious disease. It usually affects the lungs but it can affect other parts of the body. What are the symptoms? Any of the following symptoms may occur: . Cough . Phlegm . High temperature . Sweating at night . Weight loss . Fatigue / general tiredness . Swollen glands If you are concerned that you might have TB, or develop any of these symptoms, please visit your family doctor for advice. How do you catch TB? It is usually spread through the air from someone with the infectious type of TB. The germ gets into the air when that person coughs, sneezes or spits. Who can get TB? Anyone can get TB but it is difficult to catch. It mainly depends on the amount of time that is spent in contact with someone with infectious TB. What if I have been in close contact with someone with infectious TB? If you are identified as a contact at risk from TB then you will be invited for screening. Initial screening consists of a skin test to determine if your immune system recognises TB. The skin test is called the Mantoux test, the result of which needs to be read 48 hours later. People who have a positive skin test and / or evidence of TB infection found on chest X-ray, or who are unwell will be investigated further by a specialist doctor and may be treated with a course of anti-TB medication. How is TB treated? TB is curable. Treatment consists of a long course of different types of specialist antibiotics. What happens next? If you have been identified as a close contact of the case, you will be invited for screening by the accompanying letter. Otherwise, you will have received a general information letter, and have not been identified as requiring screening at this time.

TB Factsheet

What is TB (tuberculosis)? TB is a serious but curable infectious disease. It usually affects the lungs but it can affect other parts of the body. What are the symptoms? Any of the following symptoms may occur: ��. Cough ��. Phlegm ��. High temperature ��. Sweating at night ��. Weight loss ��. Fatigue / general tiredness ��. Swollen glands If you are concerned that you might have TB, or develop any of these symptoms, please visit your family doctor for advice. How do you catch TB? It is usually spread through the air from someone with the infectious type of TB.