Probabilistic assessment of risk from the exposure to mercury in artisanal gold mining communities in Colombia

Colombia is one the largest per capita mercury polluters as a consequence of its artisanal gold mining operations, which are steadily increasing following the rising price of this metal. Compared to gravimetric separation methods and cyanidation, the concentration of gold using Hg amalgams presents several advantages: the process is less time-consuming and minimizes gold losses, and Hg is easily transported and inexpensive relative to the selling price of gold. Very often, mercury amalgamation is carried out on site by unprotected workers. During this operation large amounts of mercury are discharged to the environment and eventually reach the fresh water bodies in the vicinity where it is subjected to methylation. Additionally, as gold is released from the amalgam by heating on open charcoal furnaces in small workshops, mercury vapors are emitted and inhaled by the artisanal smelters and the general population

Caracterización del hormigón en relación a la difusión de gases y su correlación con el radón

Radon gas (Rn) is a natural radioactive gas present in some soils and able to penetrate buildings through the building envelope in contact with the soil. Radon can accumulate within buildings and consequently be inhaled by their occupants. Because it is a radioactive gas, its disintegration process produces alpha particles that, in contact with the lung epithelia, can produce alterations potentially giving rise to cancer. Many international organizations related to health protection, such as WHO, confirm this causality. One way to avoid the accumulation of radon in buildings is to use the building envelope as a radon barrier. The extent to which concrete provides such a barrier is described by its radon diffusion coefficient (DRn), a parameter closely related to porosity (ɛ) and tortuosity factor (τ). The measurement of the radon diffusion coefficient presents challenges, due to the absence of standard procedures, the requirement to establish adequate airtightness in testing apparatus (referred to here as the diffusion cell), and due to the fact that measurement has to be carried out in an environment certified for use of radon calibrated sources. In addition to this calibrated radon sources are costly. The measurement of the diffusion coefficient for non-radioactive gas is less complex, but nevertheless retains a degree of difficulty due to the need to provide reliably airtight apparatus for all tests. Other parameters that can characterize and describe the process of gas transport through concrete include the permeability coefficient (K) and the electrical resistivity (ρe), both of which can be measured relatively easily with standardized procedure. The use of these parameters would simplify the characterization of concrete behaviour as a radon barrier. Although earlier studies exist, describing correlation among these parameters, there is, as has been observed in the literature, little common ground between the various research efforts. For precisely this reason, prior to any attempt to measure radon diffusion, it was deemed necessary to carry out further research in this area, as a foundation to the current work, to explore potential relationships among the following parameters: porosity-tortuosity, oxygen diffusion coefficient, permeability coefficient and resistivity. Permeability coefficient measurement (m2) presents a more straightforward challenge than diffusion coefficient measurement. Some authors identify a relationship between both coefficients, including Gaber (1988), who proposes: k= a•Dn Equation 1 Where: a=A/(8ΠD020), A = sample cross-section, D020 = diffusion coefficient in air (m2/s). Other studies (Klink et al. 1999, Gaber and Schlattner 1997, Gräf and Grube et al. 1986), experimentally relate both coefficients of different types of concrete confirming that this relationship exists, as represented by the simplified expression: k≈Dn Equation 2 In each particular study a different value for n was established, varying from 1.3 to 2.5, but this requires determination of a value for n in a more general way because these proposed models cannot estimate diffusion coefficient. If diffusion coefficient has to be measured to be able to establish n, these relationships are not interesting. The measurement of electric resistivity is easier than diffusion coefficient measurement. Correlation between the parameters can be established via Einstein´s law that relates movement of electrical charges to media conductivity according to the expression: D_e=k/ρ Equation 3 Where: De = diffusion coefficient (cm2/s), K = constant, ρ = electric resistivity (Ω•cm). The tortuosity factor is used to represent the uneven geometry of concrete pores, which are described as being not straight, but tortuous. This factor was first introduced in the literature to relate global porosity with fluid transport in a porous media, and can be formulated in a number of different ways. For example, it can take the form of equation 4 (Mason y Malinauskas), which combines molecular and Knudsen diffusion using the tortuosity factor: D=ε^τ (3/2r √(πM/8RT+1/D_0 ))^(-1) Equation 4 Where: r = medium radius obtained from MIP (µm), M = gas molecular mass, R = ideal gases constant, T = temperature (K), D0 = coefficient diffusion in the air (m2/s). Few studies provide any insight as to how to obtain the tortuosity factor. The work of Andrade (2012) is exceptional in this sense, as it outlines how the tortuosity factor can be deduced from pore size distribution (from MIP) from the equation: ∅_th=∅_0•ε^(-τ). Equation 5 Where: Øth = threshold diameter (µm), Ø0 = minimum diameter (µm), ɛ = global porosity, τ = tortuosity factor. Alternatively, the following equation may be used to obtain the tortuosity factor: DO2=D0*ɛτ Equation 6 Where: DO2 = oxygen diffusion coefficient obtained experimentally (m2/s), DO20 = oxygen diffusion coefficient in the air (m2/s). This equation has been inferred from Archie´s law ρ_e=〖a•ρ〗_0•ɛ^(-m) and from the Einstein law mentioned above, using the values of oxygen diffusion coefficient obtained experimentally. The principal objective of the current study was to establish correlations between the different parameters that characterize gas transport through concrete. The achievement of this goal will facilitate the assessment of the useful life of concrete, as well as open the door to the pro-active planning for the use of concrete as a radon barrier. Two further objectives were formulated within the current study: 1.- To develop a method for measurement of gas coefficient diffusion in concrete. 2.- To model an analytic estimation of radon diffusion coefficient from parameters related to concrete porosity and tortuosity factor. In order to assess the possible correlations, parameters have been measured using the standardized procedures or purpose-built in the laboratory for the study of equations 1, 2 y 3. To measure the gas diffusion coefficient, a diffusion cell was designed and manufactured, with the design evolving over several cycles of research, leading ultimately to a unit that is reliably air tight. The analytic estimation of the radon diffusion coefficient DRn in concrete is based on concrete global porosity (ɛ), whose values may be experimentally obtained from a mercury intrusion porosimetry test (MIP), and from its tortuosity factor (τ), derived using the relations expressed in equations 5 y 6. The conclusions of the study are: Several models based on regressions, for concrete with a relative humidity of 50%, have been proposed to obtain the diffusion coefficient following the equations K=Dn, K=a*Dn y D=n/ρe. The final of these three relations is the one with the determination coefficient closest to a value of 1: D=(19,997*LNɛ+59,354)/ρe Equation 7 The values of the obtained oxygen diffusion coefficient adjust quite well to those experimentally measured. The proposed method for the measurement of the gas coefficient diffusion is considered to be adequate. The values obtained for the oxygen diffusion coefficient are within the range of those proposed by the literature (10-7 a 10-8 m2/s), and are consistent with the other studied parameters. Tortuosity factors obtained using pore distribution and the expression Ø=Ø0*ɛ-τ are inferior to those from resistivity ρ=ρ0*ɛ-τ. The closest relationship to it is the one with porosity of pore diameter 1 µm (τ=2,07), being 7,21% inferior. Tortuosity factors obtained from the expression DO2=D0*ɛτ are similar to those from resistivity: for global tortuosity τ=2,26 and for the rest of porosities τ=0,7. Estimated radon diffusion coefficients are within the range of those consulted in literature (10-8 a 10-10 m2/s).ABSTRACT El gas radón (Rn) es un gas natural radioactivo presente en algunos terrenos que puede penetrar en los edificios a través de los cerramientos en contacto con el mismo. En los espacios interiores se puede acumular y ser inhalado por las personas. Al ser un gas radioactivo, en su proceso de desintegración emite partículas alfa que, al entrar en contacto con el epitelio pulmonar, pueden producir alteraciones del mismo causando cáncer. Muchos organismos internacionales relacionados con la protección de la salud, como es la OMS, confirman esta causalidad. Una de las formas de evitar que el radón penetre en los edificios es utilizando las propiedades de barrera frente al radón de su propia envolvente en contacto con el terreno. La principal característica del hormigón que confiere la propiedad de barrera frente al radón cuando conforma esta envolvente es su permeabilidad que se puede caracterizar mediante su coeficiente de difusión (DRn). El coeficiente de difusión de un gas en el hormigón es un parámetro que está muy relacionado con su porosidad (ɛ) y su tortuosidad (τ). La medida del coeficiente de difusión del radón resulta bastante complicada debido a que el procedimiento no está normalizado, a que es necesario asegurar una estanquidad a la celda de medida de la difusión y a que la medida tiene que ser realizada en un laboratorio cualificado para el uso de fuentes de radón calibradas, que además son muy caras. La medida del coeficiente de difusión de gases no radioactivos es menos compleja, pero sigue teniendo un alto grado de dificultad puesto que tampoco está normalizada, y se sigue teniendo el problema de lograr una estanqueidad adecuada de la celda de difusión. Otros parámetros que pueden caracterizar el proceso son el coeficiente de permeabilidad (K) y la resistividad eléctrica (ρe), que son más fáciles de determinar mediante ensayos que sí están normalizados. El uso de estos parámetros facilitaría la caracterización del hormigón como barrera frente al radón, pero aunque existen algunos estudios que proponen correlaciones entre estos parámetros, en general existe divergencias entre los investigadores, como se ha podido comprobar en la revisión bibliográfica realizada. Por ello, antes de tratar de medir la difusión del radón se ha considerado necesario realizar más estudios que puedan clarificar las posibles relaciones entre los parámetros: porosidad-tortuosidad, coeficiente de difusión del oxígeno, coeficiente de permeabilidad y resistividad. La medida del coeficiente de permeabilidad (m2) es más sencilla que el de difusión. Hay autores que relacionan el coeficiente de permeabilidad con el de difusión. Gaber (1988) propone la siguiente relación: k= a•Dn Ecuación 1 En donde: a=A/(8ΠD020), A = sección de la muestra, D020 = coeficiente de difusión en el aire (m2/s). Otros estudios (Klink et al. 1999, Gaber y Schlattner 1997, Gräf y Grube et al. 1986) relacionan de forma experimental los coeficientes de difusión de radón y de permeabilidad de distintos hormigones confirmando que existe una relación entre ambos parámetros, utilizando la expresión simplificada: k≈Dn Ecuación 2 En cada estudio concreto se han encontrado distintos valores para n que van desde 1,3 a 2,5 lo que lleva a la necesidad de determinar n porque no hay métodos que eviten la determinación del coeficiente de difusión. Si se mide la difusión ya deja de ser de interés la medida indirecta a través de la permeabilidad. La medida de la resistividad eléctrica es muchísimo más sencilla que la de la difusión. La relación entre ambos parámetros se puede establecer a través de una de las leyes de Einstein que relaciona el movimiento de cargas eléctricas con la conductividad del medio según la siguiente expresión: D_e=k/ρ_e Ecuación 3 En donde: De = coeficiente de difusión (cm2/s), K = constante, ρe = resistividad eléctrica (Ω•cm). El factor de tortuosidad es un factor de forma que representa la irregular geometría de los poros del hormigón, al no ser rectos sino tener una forma tortuosa. Este factor se introduce en la literatura para relacionar la porosidad total con el transporte de un fluido en un medio poroso y se puede formular de distintas formas. Por ejemplo se destaca la ecuación 4 (Mason y Malinauskas) que combina la difusión molecular y la de Knudsen utilizando el factor de tortuosidad: D=ε^τ (3/2r √(πM/8RT+1/D_0 ))^(-1) Ecuación 4 En donde: r = radio medio obtenido del MIP (µm), M = peso molecular del gas, R = constante de los gases ideales, T = temperatura (K), D0 = coeficiente de difusión de un gas en el aire (m2/s). No hay muchos estudios que proporcionen una forma de obtener este factor de tortuosidad. Destaca el estudio de Andrade (2012) en el que deduce el factor de tortuosidad de la distribución del tamaño de poros (curva de porosidad por intrusión de mercurio) a partir de la ecuación: ∅_th=∅_0•ε^(-τ) Ecuación 5 En donde: Øth = diámetro umbral (µm), Ø0 = diámetro mínimo (µm), ɛ = porosidad global, τ = factor de tortuosidad. Por otro lado, se podría utilizar también para obtener el factor de tortuosidad la relación: DO2=D0*-τ Ecuación 6 En donde: DO2 = coeficiente de difusión del oxígeno experimental (m2/s), DO20 = coeficiente de difusión del oxígeno en el aire (m2/s). Esta ecuación está inferida de la ley de Archie ρ_e=〖a•ρ〗_0•ɛ^(-m) y la de Einstein mencionada anteriormente, utilizando valores del coeficiente de difusión del oxígeno DO2 obtenidos experimentalmente. El objetivo fundamental de la tesis es encontrar correlaciones entre los distintos parámetros que caracterizan el transporte de gases a través del hormigón. La consecución de este objetivo facilitará la evaluación de la vida útil del hormigón así como otras posibilidades, como la evaluación del hormigón como elemento que pueda ser utilizado en la construcción de nuevos edificios como barrera frente al gas radón presente en el terreno. Se plantean también los siguientes objetivos parciales en la tesis: 1.- Elaborar una metodología para la medida del coeficiente de difusión de los gases en el hormigón. 2.- Plantear una estimación analítica del coeficiente de difusión del radón a partir de parámetros relacionados con su porosidad y su factor de tortuosidad. Para el estudio de las correlaciones posibles, se han medido los parámetros con los procedimientos normalizados o puestos a punto en el propio Instituto, y se han estudiado las reflejadas en las ecuaciones 1, 2 y 3. Para la medida del coeficiente de difusión de gases se ha fabricado una celda que ha exigido una gran variedad de detalles experimentales con el fin de hacerla estanca. Para la estimación analítica del coeficiente de difusión del radón DRn en el hormigón se ha partido de su porosidad global (ɛ), que se obtiene experimentalmente del ensayo de porosimetría por intrusión de mercurio (MIP), y de su factor de tortuosidad (τ), que se ha obtenido a partir de las relaciones reflejadas en las ecuaciones 5 y 6. Las principales conclusiones obtenidas son las siguientes: Se proponen modelos basados en regresiones, para un acondicionamiento con humedad relativa de 50%, para obtener el coeficiente de difusión del oxígeno según las relaciones: K=Dn, K=a*Dn y D=n/ρe. La propuesta para esta última relación es la que tiene un mejor ajuste con R2=0,999: D=(19,997*LNɛ+59,354)/ρe Ecuación 7 Los valores del coeficiente de difusión del oxígeno así estimados se ajustan a los obtenidos experimentalmente. Se considera adecuado el método propuesto de medida del coeficiente de difusión para gases. Los resultados obtenidos para el coeficiente de difusión del oxígeno se encuentran dentro del rango de los consultados en la literatura (10-7 a 10-8 m2/s) y son coherentes con el resto de parámetros estudiados. Los resultados de los factores de tortuosidad obtenidos de la relación Ø=Ø0*ɛ-τ son inferiores a la de la resistividad (ρ=ρ0*ɛ-τ). La relación que más se ajusta a ésta, siendo un 7,21% inferior, es la de la porosidad correspondiente al diámetro 1 µm con τ=2,07. Los resultados de los factores de tortuosidad obtenidos de la relación DO2=D0*ɛτ son similares a la de la resistividad: para la porosidad global τ=2,26 y para el resto de porosidades τ=0,7. Los coeficientes de difusión de radón estimados mediante estos factores de tortuosidad están dentro del rango de los consultados en la literatura (10-8 a 10-10 m2/s).

Neuroimaging evidence implicating cerebellum in the experience of hypercapnia and hunger for air

Recent neuroimaging and neurological data implicate cerebellum in nonmotor sensory, cognitive, vegetative, and affective functions. The present study assessed cerebellar responses when the urge to breathe is stimulated by inhaled CO2. Ventilation changes follow arterial blood partial pressure CO2 changes sensed by the medullary ventral respiratory group (VRG) and hypothalamus, entraining changes in midbrain, pons, thalamus, limbic, paralimbic, and insular regions. Nearly all these areas are known to connect anatomically with the cerebellum. Using positron emission tomography, we measured regional brain blood flow during acute CO2-induced breathlessness in humans. Separable physiological and subjective effects (air hunger) were assessed by comparisons with various respiratory control conditions. The conjoint physiological effects of hypercapnia and the consequent air hunger produced strong bilateral, near-midline activations of the cerebellum in anterior quadrangular, central, and lingula lobules, and in many areas of posterior quadrangular, tonsil, biventer, declive, and inferior semilunar lobules. The primal emotion of air hunger, dissociated from hypercapnia, activated midline regions of the central lobule. The distributed activity across the cerebellum is similar to that for thirst, hunger, and their satiation. Four possible interpretations of cerebellar function(s) here are that: it subserves implicit intentions to access air; it provides predictive internal models about the consequences of CO2 inhalation; it modulates emotional responses; and that while some cerebellar regions monitor sensory acquisition in the VRG (CO2 concentration), others influence VRG to adjust respiratory rate to optimize partial pressure CO2, and others still monitor and optimize the acquisition of other sensory data in service of air hunger aroused vigilance.

Phenotypic and physiologic characterization of transgenic mice expressing interleukin 4 in the lung: lymphocytic and eosinophilic inflammation without airway hyperreactivity.

To investigate the contribution of interleukin-4 (IL-4) to airway inflammation in vivo and to explore directly its relationship to airway reactivity, we created transgenic mice in which the murine cDNA for IL-4 was regulated by the rat Clara cell 10 protein promoter. Expression was detected only in the lung and not in thymus, heart, liver, spleen, kidney, or uterus. The expression of IL-4 elicited hypertrophy of epithelial cells of the trachea, bronchi, and bronchioles. Hypertrophy is due, at least in part, to the accumulation of mucus glycoprotein. Histologic examination of parenchyma revealed multinucleated macrophages and occasional islands of cells consisting largely of eosinophils or lymphocytes. Analysis of lung lavage fluid revealed the presence of a leukocytic infiltrate consisting of lymphocytes, neutrophils and eosinophils. Mice expressing IL-4 had greater baseline airway resistance but did not demonstrate hyperreactivity to methacholine. Thus, the expression of IL-4 selectively within the lung elicits an inflammatory response characterized by epithelial cell hypertrophy, and the accumulation of macrophages, lymphocytes, eosinophils, and neutrophils without resulting in an alteration in airway reactivity to inhaled methacholine.

Eosinophil recruitment into the respiratory epithelium following antigenic challenge in hyper-IgE mice is accompanied by interleukin 5-dependent bronchial hyperresponsiveness.

A murine model for antigen-induced bronchial hyperreactivity (BHR) and airway eosinophilia, two hallmarks of asthma, was developed using ovalbumin-immunized mice, which produce large amounts of IgE (named BP2, "Bons Producteurs 2," for High Line of Selection 2). A single intranasal ovalbumin challenge failed to modify the bronchial responses, despite the intense eosinophil recruitment into the bronchoalveolar lavage fluid and airways. When mice were challenged twice a day for 2 days or once a day for 10 days, BHR in response to i.v. 5-hydroxytryptamine or to inhaled methacholine was induced in BP2 mice but not in BALB/c mice. Histological examination showed that eosinophils reached the respiratory epithelium after multiple ovalbumin challenges in BP2 mice but remained in the bronchial submucosa in BALB/c mice. Total IgE titers in serum were augmented significantly with immunization in both strains, but much more so in BP2 mice. Interleukin 5 (IL-5) titers in serum and bronchoalveolar lavage fluid of BP2 mice were augmented by the antigenic provocation, and a specific anti-IL5 neutralizing antibody suppressed altogether airway eosinophilia and BHR, indicating a participation of IL-5 in its development. Our results indicate that the recruitment of eosinophils to the airways alone does not induce BHR in mice and that the selective effect on BP2 mice is related to their increased IgE titers associated with antigen-driven eosinophil migration to the epithelium, following formation and secretion of IL-5.

Continuous nitric oxide synthesis by inducible nitric oxide synthase in normal human airway epithelium in vivo.

Nitric oxide (NO) is an important mediator of inflammatory responses in the lung and a key regulator of bronchomotor tone. An airway NO synthase (NOS; EC 1.14.13.39) has been proposed as a source of endogenous NO in the lung but has not been clearly defined. Through molecular cloning, we conclusively demonstrate that NO synthesis in normal human airways is due to the continuous expression of the inducible NOS (iNOS) isoform in airway epithelial cells. Although iNOS mRNA expression is abundant in airway epithelial cells, expression is not detected in other pulmonary cell types, indicating that airway epithelial cells are unique in the continuous pattern of iNOS expression in the lung. In situ analysis reveals all airway epithelial cell types express iNOS. However, removal of epithelial cells from the in vivo airway environment leads to rapid loss of iNOS expression, which suggests expression is dependent upon conditions and/or factors present in the airway. Quantitation of NOS activity in epithelial cell lysates indicates nanomolar levels of NO synthesis occur in vivo. Remarkably, the high-level iNOS expression is constant in airway epithelium of normal individuals over time. However, expression is strikingly decreased by inhaled corticosteroids and beta-adrenergic agonists, medications commonly used in treatment of inflammatory airway diseases. Based upon these findings, we propose that respiratory epithelial cells are key inflammatory cells in the airway, functioning in host defense and potentially playing a role in airway inflammation.

Efeitos da hiperprolactinemia sobre a inflamação alérgica pulmonar em ratos Wistar

Objetivo: Foi investigada a hipótese da hiperprolactinemia modular a resposta inflamatória alérgica pulmonar em ratos machos e em fêmas lactantes sem tratamento de domperidona. Métodos: Em ratos machos, a hiperprolactinemia foi de curta duração (5 dias) induzida pela domperidona (5,1 mg.kg-1 por dia, i.p). A resposta alérgica foi gerada por sensibilização e desafios inalatórios com ovoalbumina. Foi feita contagem de leucócitos totais e diferenciados do lavado bronco alveolar (BAL), lavado medular femoral (BFL) e sangue; a percentagem de produção de muco e colageno no pulmão, níveis de corticosterona e prolactina e citocinas TNF-α, IL-4, IL-6, IL-10, em explantes de pulmão e IFNg no BAL, foram medidos. Pela citometria foram avaliadaos os receptores de prolactina; Resultados: Hiperprolactinemia de curta duração feita antes do desafio inalatório disminuiu a resposta alérgica pulmonar na contagem de leucócitos no lavado broncoalveolar. Esse tratamento reduziu a celularidade no BFL e a percentagem de muco e aumentou a expressão de citocinas IL-4, IL-6, IL-10, TNFα e da expressão do IFNg. Níveis altos de prolactina diminuiram o número de eosinófilos ao pulmão no BAL. Pela citometria revelou-se que além de ter menor número de granulócitos migrados ao pulmão, estes apresentaram maior expressão do número de receptores por granulócito para prolactina no grupo tratado com domperidona. Alterações similares foram reveladas em fêmeas lactantes como foi a diminuição nos leucócitos do BAL, e no número de células do BFL. O tratamento profilático diminuiu a resposta alérgica tanto no grupo hiperprolactinêmico como no grupo veículo. O tratamento feito após o desafio inalatório não evidenciou alterações relevantes nas variáveis medidas. Conclusões: A hiperprolactinemia de curta duração, feita após a sensibilização e antes da inalação diminui a resposta inflamatória no pulmão em ratos. Os resultados deste estudo demonstram que a hiperprolactinemia induzida antes do desafio antigênico diminue a inflamação alérgica pulmonar. Assim, é provável que a prolactina endógena tenha um papel relevante como um imunomodulador da asma. Este estudo aponta a possibilidade futura do uso da domperidona para pacientes asmáticos. Durante a primavera muitas espécies de mamíferos têm seus filhotes e ocorre abundância de fatores alergenos no ar. Logo, um fator endógeno que favoreça a proteção de fêmeas durante a lactação, tal como a hiperprolactinemia, tem elevado valor adaptativo

Estudo com radioaerossol de DTPA Tecnécio-99m em pacientes portadores de pneumopatia por amiodarona

Com o objetivo de se avaliar a importância do \"clearance\" do dietilenotriamino-pentacetato marcado com Tecnécio 99m (DTPA-Tecnécio-99m) em portadores de pneumopatia por amiodarona foram estudados 40 indivíduos, em quatro grupos. Grupo I: 10 voluntários normais, assintomáticos e não fumantes (8 homens e 2 mulheres), com média de idade de 56,80 anos. Grupo II: 10 voluntários normais, assintomáticos e fumantes (6 homens e 4 mulheres ), com média de idade de 27,50 anos. Grupo III: 10 pacientes não fumantes ( 4 homens e 5 mulheres ), com média de idade de 52,90 anos. Todos faziam uso crônico de amiodarona por via oral. Grupo IV: 10 pacientes portadores de pneumopatia por amiodarona, quatro ex-fumantes, dois fumantes e quatro não fumantes ( 8 homens e 2 mulheres) com média de idade de 52,90 anos. Todos faziam uso de amiodarona por via oral e nenhum fumou nas 4 semanas que precederam o estudo. Após espirometria que constou do registro da curva volume-tempo, todos inalaram 4 ml de solução salina contendo 740 MBq de DTPA Tecnécio-99m, durante cinco minutos. Através de uma c~mara de cintilação computadorizada foram obtidas imagens pulmonares, definindo-se 9 áreas de interesse. Para cada região escolhida foi determinada uma curva de \"clearance\" extraindo-se o valor de meia-vida biológica em minu- tos ( T 1/2 ) e a taxa percentual de \" clearance\" alvéolo capilar do radioaerossol por minuto (K%/min). Observamos que, das variáveis espirométricas consideradas, a capacidade vital forçada (CVF) e o volume expiratório forçado no 1 segundo (VEF1) mostraram diferenças significantes entre os grupos I e IV. A contagem total de radioatividade de ambos os pulmões não mostrou relação com a CVF e o VEF1. O \" clearance \" pulmonar do DTPA Tecnécio-99m foi maior nos grupos 11 e IV, porém não permitindo sua diferenciação. Estes resultados permitem concluir: Os pacientes portadores de pneumonite por amiodaro- na apresentam\" clearance \" alvéolo-capilar de DTPA Tecnécio-99m significativamente maior que os indivíduos do grupo de normais não fumantes. Este fato também se verificou em relação aos pacientes em uso crônico de amiodarona mas sem evidências de pneumopatia. Não é possível diferenciar os fumantes dos portadores de pneumonite por amiodarona através da análise da integridade da barreira alvéolo-epitelial com DTPA Tecnécio-99m. Comparativamente, o estudo da integridade alvéolo-epitelial pelo \"clearance\" pulmonar de DTPA Tecnécio-99m é mais sensível que a espirometria na avaliação da pneumonite por amiodarona, permitindo diferenciar estes pacientes dos que fazem uso crônico da droga

Fatores de bioconcentração e disponibilidade de bário, cádmio, cobre, níquel e zinco em solos e em culturas de interesse agronômico

Os elementos potencialmente tóxicos (EPTs) estão presentes nos solos em concentrações dependentes do material de origem e das ações antrópicas. A adição de EPTs ao solo pelas atividades antrópicas pode ocasionar risco à saúde humana, já que estes elementos podem ser acumulados no organismo por meio do contato dérmico com o solo, da inalação de partículas em suspensão, de ingestão de solo e de alimentos contaminados. A contaminação dos alimentos ocorre pelo cultivo em áreas com alta biodisponibilidade de EPTs, e nessa condição ocorre absorção e translocação para a parte aérea, com possível acúmulo dos metais nas porções comestíveis, como raízes, frutos e grãos. A biodisponibilidade dos EPTs é regulada pelas características químicas dos elementos e por atributos do solo, como a CTC, o pH e a matéria orgânica (MO). Sintomas de toxicidade e alterações morfológicas e fisiológicas podem aparecer dependendo da absorção e da movimentação dos EPTs nas plantas. Objetivou-se neste trabalho avaliar o efeito da adição de bário (Ba), de cádmio (Cd), de cobre (Cu), de níquel (Ni) e de zinco (Zn) em amostras de um Neossolo Quartzarênico e um Latossolo Vermelho distrófico, sob duas condições de saturação por bases (30% e 50 ou 70%, dependendo da cultura), no cultivo de arroz (Oryza sativa), alface (Lactuca sativa), girassol (Helianthus annuus) e tomate (Solanum lycopersicum). Os EPTs nos solos foram extraídos com EPA 3051a, Água Régia, DTPA, Mehlich 1, Mehlich 3, HNO3 (0,43 mol L-1) e CaCl2 (0,01 mol L-1), e seus teores correlacionados com os presentes nas raízes, na parte aérea, nos frutos e com a quantidade acumulada pelas plantas. Os fatores de bioconcentração (FBC) e de transferência (FT) foram calculados para as culturas. O índice SPAD (Soil Plant Analysis Development - Chlorophyll Meter) foi determinado na fase vegetativa da alface, do arroz e do girassol, enquanto a atividade fotossintética foi determinada pelo IRGA (Infrared gas analyzer). Os maiores teores de EPTs foram observados nas plantas cultivadas no Neossolo. As quantidades de Cu, Ni e Zn acumuladas nas plantas apresentaram correlação positiva com os teores extraídos pelo EPA 3051a e pela Água Régia. Os teores extraídos com HNO3 (0,43 mol L-1) apresentaram elevada correlação positiva com os teores reativos extraídos com DTPA e com Mehlich 3, e também com as quantidades de EPTs acumuladas pelas plantas. Os FBCs foram mais altos nos solos com baixa CTC, baixos teores de MO e baixos valores de pH. O arroz apresentou a menor translocação de Cd do sistema radicular para os grãos. O Cu, o Ni e o Zn causaram alterações no desenvolvimento da alface e do girassol, e diminuíram a transpiração e a condutância estomática da alface. O arroz apresentou a menor absorção de EPTs e a maior tolerância ao Ba, ao Cd, ao Ni e ao Zn, no entanto, as plantas apresentaram maiores condutividade estomática e transpiração.

Thermogravimetric analysis of the pyrolysis of several materials used in the preparation of commercial cigarettes

Comunicación presentada en forma de póster en el "12th Mediterranean Congress of Chemical Engineering", Barcelona (Spain), November 15-18, 2011

Sildenafil na hipertensão pulmonar persistente do recém-nascido associada a hérnia diafragmática congénita

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

COPD: A stepwise or a hit hard approach?

Current guidelines differ slightly on the recommendations for treatment of Chronic Obstructive Pulmonary Disease (COPD) patients, and although there are some undisputed recommendations, there is still debate regarding the management of COPD. One of the hindrances to deciding which therapeutic approach to choose is late diagnosis or misdiagnosis of COPD. After a proper diagnosis is achieved and severity assessed, the choice between a stepwise or "hit hard" approach has to be made. For GOLD A patients the stepwise approach is recommended, whilst for B, C and D patients this remains debatable. Moreover, in patients for whom inhaled corticosteroids (ICS) are recommended, a step-up or "hit hard" approach with triple therapy will depend on the patient's characteristics and, for patients who are being over-treated with ICS, ICS withdrawal should be performed, in order to optimize therapy and reduce excessive medications. This paper discusses and proposes stepwise, "hit hard", step-up and ICS withdrawal therapeutic approaches for COPD patients based on their GOLD group. We conclude that all approaches have benefits, and only a careful patient selection will determine which approach is better, and which patients will benefit the most from each approach.

Cardiovascular implications of exposure to traffic air pollution during exercise

Regular aerobic exercise is recommended by physicians to improve health and longevity. However, individuals exercising in urban regions are often in contact with air pollution, which includes particles and gases associated with respiratory disease and cancer. We describe the recent evidence on the cardiovascular effects of air pollution, and the implications of exercising in polluted environments, with a view to informing clinicians and other health professionals. There is now strong evidence that fine and ultra fine particulate matter present in air pollution increases cardiovascular morbidity and mortality. The main mechanisms of disease appear to be related to an increase in the pathogenic processes associated with atherosclerosis. People exercising in environments pervaded by air contaminants are probably at increased risk, due to an exercise-induced amplification in respiratory uptake, lung deposition and toxicity of inhaled pollutants. We make evidence-based recommendations for minimizing exposure to air-borne toxins while exercising, and suggest that this advice be passed on to patients where appropriate.

Misleading high tobramycin plasma concentrations can be caused by skin contamination of fingerprick blood following inhalation of nebulized tobramycin (TOBI (R)) - A short report

We observed unexpected high plasma concentrations of tobrarriycin (48.5 and 28.1 mg/L) in fingerprick blood samples after the nebulization of tobramycin solution for inhalation (tobramycin 300 mg/5 mL, TOBI(R)) by 2 young children aged 3 years. To investigate whether dermal contamination could be the source of error, 3 adult volunteers were present during another nebulization by a third child (age 2 years). The volunteers had exposure to tobramycin by handling the nebulizer or the nebule and also by inhalation from holding the child and being in close proximity while TOBI(R) was being administered. Five blood samples by fingerprick and 2 by venipuncture were collected and assayed for tobramycin concentration. On each occasion the site was swabbed with alcohol wipes to mimic standard patient sampling methods. One site was resampled after cleaning of hands with 2% chlorhexidine gluconate and water. Tobramycin concentrations from venipuncture 1-2 hours after nebulization were all < 0.2 mg/L except for 1 result of 1.2 mg/L. The tobramycin concentrations from fingerpricks before hand washing varied between 6.8 and 172 mg/L, and after hand washing between 0.3 and 17.6 mg/L. Contamination of fingers with tobramycin is likely to have caused the error in the 2 initial cases and did cause misleadingly elevated levels in the adult volunteers. We caution that therapeutic drug monitoring of nebulized tobramycin should not be done by fingerprick sampling, and care should be taken to avoid contamination of the venipuncture site.

Aminoglycoside-induced changes in the renal handling of cations in the Fischer 344 rat

Disturbances of cation homeostasis, particularly hypomagnesaemia, are a frequent consequence of treatment with aminoglycoside antibiotics. These disturbances are thought to result from renal wasting of cations and administration of gentamicin to rats has been shown to produce hypercalciuria and hypermagnesiuria. The aims of this study were to attempt to elucidate these responses in anaesthetised rats infused with gentamicin and to use this model to investigate the mechanisms of these effects. Fischer 344 rats were anaesthetised and surgically prepared for clearance experiments. Infusion of gentamicin in isotonic saline increased urinary output of calcium and magnesium while sodium and potassium output were unaffected. These elevations in calcium and magnesium excretion were explained by reduced tubular reabsorption of these cations. Both the hypercalciuric and hypermagnesiuric responses to gentamicin were extremely rapid and were sustained during drug infusion; when gentamicin infusion ceased both responses were rapidly reversible. Infusion of another aminoglycoside, tobramycin, produced very similar effects to gentamicin. The hypercalciuria and hypermagnesiuria caused by gentimicin infusion were unaffected by parathyroidectomy. The peak increases in calcium and magnesium output brought about by infusion of gentamicin with frusemide were not significantly different to the increases produced by frusemide alone. The site at which gentamicin interferes with calcium and magnesium reabsorption cannot be firmly deduced from these results. However, the known close association between calcium and sodium reabsorption in the proximal tubule implies that gentamicin is unlikely to change proximal calcium reabsorption without a similar change in proximal sodium reabsorption. The similarity between the hypercalciuric and hypermagnesiuric effects of frusemide alone and the effects of frusemide infused simultaneously with gentamicin suggests that gentamicin may act at the same site as the diuretic, the thick ascending limb of the loop of Henle.