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Cançado JED, Saldiva PHN, Pereira LAA, Lara LBLS, Artaxo P, Martinelli LA, Arbex MA, Zanobetti A, Braga ALF. The impact of sugar cane-burning emissions on the respiratory system of children and the elderly. ENVIRONMENTAL HEALTH PERSPECTIVES 2006; 114:725-9. [PMID: 16675427 PMCID: PMC1459926 DOI: 10.1289/ehp.8485] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
We analyzed the influence of emissions from burning sugar cane on the respiratory system during almost 1 year in the city of Piracicaba in southeast Brazil. From April 1997 through March 1998, samples of inhalable particles were collected, separated into fine and coarse particulate mode, and analyzed for black carbon and tracer elements. At the same time, we examined daily records of children (<13 years of age) and elderly people (>64 years of age) admitted to the hospital because of respiratory diseases. Generalized linear models were adopted with natural cubic splines to control for season and linear terms to control for weather. Analyses were carried out for the entire period, as well as for burning and nonburning periods. Additional models were built using three factors obtained from factor analysis instead of particles or tracer elements. Increases of 10.2 microg/m3 in particles<or=2.5 microm/m3 aerodynamic diameter (PM2.5) and 42.9 microg/m3 in PM10 were associated with increases of 21.4% [95% confidence interval (CI), 4.3-38.5] and 31.03% (95% CI, 1.25-60.21) in child and elderly respiratory hospital admissions, respectively. When we compared periods, the effects during the burning period were much higher than the effects during nonburning period. Elements generated from sugar cane burning (factor 1) were those most associated with both child and elderly respiratory admissions. Our results show the adverse impact of sugar cane burning emissions on the health of the population, reinforcing the need for public efforts to reduce and eventually eliminate this source of air pollution.
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Bernardi FDC, Saldiva PHN, Mauad T. Histological examination has a major impact on macroscopic necropsy diagnoses. J Clin Pathol 2006; 58:1261-4. [PMID: 16311344 PMCID: PMC1770793 DOI: 10.1136/jcp.2005.027953] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Necropsy is the gold standard for clinicopathological discrepancy studies and epidemiological surveys. Inadequate sampling or lack of tissue may hamper the final interpretation and quality of the necropsy. AIM To compare the histological and gross necropsy diagnoses of different organs. METHODS A retrospective comparison of the provisional reports (gross findings only) and the final reports (after histological examination) of the necropsies performed at the department of pathology of the Hospital das Clínicas, Sao Paulo University, Brazil, a large tertiary care complex, in 2001. The total number of diagnoses listed for the lungs, heart, liver, pancreas, kidneys, and spleen were calculated. Findings were categorised into concordant/refined diagnosis, discordant/additional diagnosis, histology needed, and inconclusive. RESULTS Three hundred and seventy one postmortem reports were analysed. There were 214 men and 157 women, with a mean age of 50.3 years, ranging from 1 to 92. The lung received the highest number (954) and the pancreas the lowest number (390) of diagnoses. The highest frequencies of discrepancies between the gross and microscopic findings were found in the lung and the liver: 38.7% and 35.1%, respectively. The brain had the lowest frequency of discrepancies. In a small number of cases, the final diagnosis could only be achieved through microscopic analysis, with the highest frequency being found in the kidneys (8.5%). CONCLUSIONS Histological analysis has a major impact on previously performed gross diagnosis at necropsy, especially in the lungs, liver, and kidneys. Adequate sampling and histological analysis are important for necropsy quality.
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Costa CLB, Spilborghs GMGT, Martins MA, Saldiva PHN, Mauad T. Nitric Acid-Induced Bronchiolitis in Rats Mimics Childhood Bronchiolitis obliterans. Respiration 2005; 72:642-9. [PMID: 16106109 DOI: 10.1159/000087363] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2004] [Accepted: 11/17/2004] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Childhood bronchiolitis obliterans (CBO) is an infrequent but severe disease, characterized by persistent obstructive respiratory symptoms after an acute episode of bronchiolitis. Its etiology is mostly postviral, especially in developing countries. Pathologically, CBO is characterized as constrictive-type BO. The pathogenesis of this disease is poorly understood and there is no specific treatment. Animal models could help to better understand the sequence of events culminating in bronchiolar obliteration and serve as basis for experimental therapeutic research. OBJECTIVES In this study, we adapted the nitric acid (NA) technique to develop a suitable model to study CBO in rats. METHODS We have intratracheally instilled 0.5% NA or saline and studied the histological lesions on days 2, 7, 14 and 30. NA-instilled animals developed a sequence of bronchiolar lesions that included necrotizing bronchiolitis, proliferative (PROL) bronchiolar lesions and constrictive (CONS) bronchiolar lesions with bronchiectasis, mucostasis and macrophagic accumulation. RESULTS The frequency of PROL lesions decreased and that of the CONS lesions increased, with a statistically significant difference at the sacrifice days, except for day 7 (PROL vs. CONS lesions day 2: p = 0.001; PROL vs. CONS lesions day 7: p = 0.38; PROL vs. CONS lesions day 14: p < 0.001; PROL vs. CONS lesions day 30: p < 0.001). CONCLUSIONS We conclude that this model presents histological similarities with the histological picture of CBO, being suitable for further developmental and therapeutic experimental research in this field.
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de Magalhães Simões S, dos Santos MA, da Silva Oliveira M, Fontes ES, Fernezlian S, Garippo AL, Castro I, Castro FFM, de Arruda Martins M, Saldiva PHN, Mauad T, Dolhnikoff M. Inflammatory cell mapping of the respiratory tract in fatal asthma. Clin Exp Allergy 2005; 35:602-11. [PMID: 15898982 DOI: 10.1111/j.1365-2222.2005.02235.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The site and distribution of inflammation in the airways of asthmatic patients has been largely investigated. Inflammatory cells are distributed in both large and small airways in asthma. It has been demonstrated that distal lung inflammation in asthma may significantly contribute to the pathophysiology of the disease. The upper airways have also been implicated in the overall asthmatic inflammation. Although it is now accepted that lung inflammation is not restricted to the intrapulmonary airways in asthma, little is known about cell distribution in the other lung compartments and their relation to the intrapulmonary airways. OBJECTIVE We aimed to map the inflammatory process in fatal asthma (FA), from the upper airways to the lung parenchyma. METHODS Eosinophil, neutrophil, mast cell and lymphocyte content were determined in nasal mucosa, the trachea, intrapulmonary airways and parenchyma (peribronchiolar and distal) of 20 patients with FA and 10 controls. RESULTS Eosinophil content was higher in all studied areas in FA compared with controls (P<0.02). Mast cell content was higher in the outer area of larger airways, small membranous bronchioles and in peribronchiolar parenchyma of FA compared with controls (P<0.04). CD3+, CD4+and CD20+cells showed increased content in FA intrapulmonary airways compared with controls (P<0.05). There was a positive correlation between CD4+cell content in nasal mucosa and larger airways in asthmatics. Increased neutrophil content was observed only in peribronchiolar parenchyma of FA (P=0.028). CONCLUSION Eosinophils present a widespread distribution within the respiratory tract in FA, from the nasal mucosa to the distal lung. The outer wall of small membranous bronchioles is the main site of inflammatory changes in FA. There is a localized distribution of alveolar inflammation at the peribronchiolar region for mast cells and neutrophils. Our findings provide further evidence of the importance of the lung periphery in the pathophysiology of FA.
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Fló C, Lopes FDTQS, Kasahara DI, Silva ACD, Jesus RCC, Rivero DHRF, Saldiva PHN, Martins MA, Jacob-Filho W. Effects of exercise training on papain-induced pulmonary emphysema in Wistar rats. J Appl Physiol (1985) 2005; 100:281-5. [PMID: 16141386 DOI: 10.1152/japplphysiol.00024.2005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The purpose of the present study was to evaluate the role of exercise training on the development of papain-induced emphysema in rats. Our hypothesis was that the increase in pulmonary tissue stretching associated with exercise could increase the severity of a protease-induced emphysema. Wistar rats were randomly assigned to four groups (n = 10 for each group) that received, respectively, intratracheal infusion of papain (6 mg in 1 ml of 0.9% NaCl) or vehicle and were submitted or not to a protocol of exercise on a treadmill. Rats exercised at 13.3 m/min, 6 days/wk, for 9 wk (increasing exercise time, from 10 to 35 min). We measured respiratory system elastance and resistance, the size and weight of the heart, and pulmonary mean linear intercept (Lm). After 9 wk of exercise training, there were no differences in respiratory system resistance and elastance values among the four experimental groups. Volume of the heart was significantly greater in rats submitted to exercise training (P = 0.007) compared with sedentary rats due to increases in volumes of both right and left cardiac chambers. Lm was significantly greater in rats that received papain compared with saline-infused rats (P = 0.025). Surprisingly, this was true, even though there was no significant decrease in elastance, possibly due to connective tissue remodeling. However, Lm was significantly greater in papain + exercise rats compared with rats that received papain and were not submitted to exercise. We conclude that exercise training can increase alveolar damage induced by papain infusion.
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Rangel ALCA, Coletta RD, Almeida OP, Graner E, Lucena A, Saldiva PHN, Vargas PA. Parotid mycobacteriosis is frequently caused by Mycobacterium tuberculosis in advanced AIDS. J Oral Pathol Med 2005; 34:407-12. [PMID: 16011609 DOI: 10.1111/j.1600-0714.2005.00331.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Tuberculosis is one of the leading infectious diseases in the world, with more than 2 million new cases annually. It is one of the main causes of death of human immunodeficiency virus (HIV)-positive patients, involving multiple organs and particularly the lungs. Nevertheless there are few consistent studies about tuberculosis involving the parotid of HIV patients. The objective of this work was to describe the histological and immunohistochemical characteristics of 10 cases of mycobacteriosis involving the parotid of autopsied patients with advanced acquired immunodeficiency syndrome (AIDS), including identification of the Mycobacterium species. METHODS Detection of 'M. tuberculosis complex' was performed by polymerase chain reaction (PCR) and ligase chain reaction (LCR) and Mycobacterium avium by PCR. RESULTS All cases showed involvement of intraparotid lymph nodes, but the glandular parenchyma was affected in only three cases. Most of the cases (80%) presented a chronic non-caseating granulomatous inflammation, and in two cases predominated foamy macrophages, full of bacteria, and no granuloma formation. In areas of mycobacteriosis, macrophages predominated followed by TCD8, B and TCD4 lymphocytes. All cases were infected by Mycobacterium genus and 'M. tuberculosis complex' was detected in five cases by LCR and in eight by PCR, while M. avium was positive in one case only, which was also positive for M. tuberculosis. CONCLUSIONS Parotid mycobacteriosis in advanced AIDS is characterized by intraparotid lymph node non-caseating inflammatory granulomatous lesion, caused mainly by M. tuberculosis.
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Negri EM, Omar ED, Mori SS, Rodrigues NRD, Barbas CSV, Saldiva PHN, Dolhnikoff M. A simple method for the differential characterization of alveoli and alveolar ducts in injured lungs. Histol Histopathol 2005; 20:449-54. [PMID: 15736049 DOI: 10.14670/hh-20.449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
RATIONALE AND HYPOTHESIS Previous studies evaluating the histoarchitecture of distal airspaces have been shown to be limited by the difficulty in adequately differentiating alveoli and alveolar ducts. This limitation has been specially noticed in studies addressing lung recruitment and in situations of diffuse alveolar damage (DAD), where generic nominations for distal airspaces had to be created, such as "peripheral airspaces" (PAS) and "large-volume gas-exchanging airspaces" (LVGEA). Elastic stains have been largely used to describe normal lung structures. Weigert's resorcin-fuchsin staining (WRF) demarcates the thickened free portions of the ductal septum facilitating its recognition. We hypothesized that this staining could help in differentiating alveoli from alveolar ducts in distorted lung parenchyma. MATERIAL AND METHODS Samples of control lungs and of DAD lungs induced by mechanical ventilation (VILI) were stained with hematoxylin-eosin (HE) and with WRF. Using morphometry we assessed the volume proportion of alveoli, alveolar ducts and LVGEA in control and VILI lungs. RESULTS WRF stained VILI lungs showed a significant decrease in the volume proportion of LVGEA and alveoli and a significant increase in the volume proportion of alveolar ducts when compared to HE stained samples. CONCLUSION We conclude that WRF staining is useful to distinguish alveolar ducts from alveoli in a DAD model, and suggest that it should be routinely used when morphometric studies of lung parenchyma are performed.
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Carvalho-Oliveira R, Saiki M, Pires-Neto RC, Lorenzi-Filho G, Macchione M, Saldiva PHN. Anti-oxidants reduce the acute adverse effects of residual oil fly ash on the frog palate mucociliary epithelium. ENVIRONMENTAL RESEARCH 2005; 98:349-54. [PMID: 15910789 DOI: 10.1016/j.envres.2004.10.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2004] [Revised: 10/06/2004] [Accepted: 10/14/2004] [Indexed: 05/02/2023]
Abstract
There is evidence indicating that oxidants play a pivotal role in determining air pollution-dependent lung injury. In the present study we explored the role of oxidants present in ambient particles in causing damage to the mucociliary epithelium. We explored the protective effects of pretreatment with three substances (n-propyl gallate, DL-alpha-tocopherol acetate, and EDTA) on the frog palate exposed to residual oil fly ash (ROFA). The parameters analyzed were mucociliary transport (MCT) and ciliary beating frequency (CBF) after 0, 10, 20, 30, 60, and 120 min of exposure. MCT was decreased significantly by ROFA (P < 0.001), with a significant interaction effect (P = 0.02) between the duration of exposure and treatment with antioxidants. The inhibitory effects on MCT of the substances tested were significantly different (P = 0.002); vitamin E was similar to control (Ringer) and different from all other groups. CBF showed no significant effect of duration of exposure (P = 0.465), but a significant interaction between duration of exposure and treatments was observed (P = 0.011). Significant differences were detected among treatments (P < 0.001), with ROFA and n-propyl gallate at concentrations of 50 microM presenting a short-lived increase in CBF, which was not observed in the remaining groups. The results showed that both MCT and CBF were affected within a short period (100 min) of exposure to ROFA and that the presence of antioxidant substances, such as vitamin E (4 mg/mL) and n-propyl gallate (300 microM), protected against the mucociliary impairment induced by ROFA on the frog palate.
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Carvalho-Oliveira R, Pozo RMK, Lobo DJA, Lichtenfels AJFC, Martins-Junior HA, Bustilho JOWV, Saiki M, Sato IM, Saldiva PHN. Diesel emissions significantly influence composition and mutagenicity of ambient particles: a case study in São Paulo, Brazil. ENVIRONMENTAL RESEARCH 2005; 98:1-7. [PMID: 15721877 DOI: 10.1016/j.envres.2004.05.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2004] [Revised: 04/28/2004] [Accepted: 05/04/2004] [Indexed: 05/24/2023]
Abstract
In 2003, a bus strike paralyzed the fleet of buses in Sao Paulo, Brazil during 3 days, from 6 to 8 of April, the complete interruption of services being achieved on the 7th. We evaluated the effect of the absence of this source of pollution on the composition, mutagenicity, and toxicity of the fine particulate material collected during this period. Particles were sampled in glass fiber filters on days 7 and 15 of April of 2003 (strike and nonstrike days, respectively), using a high-volume sampler. Trace element determinations (As, Br, Co, Cl, Fe, La, Mn, Sb, Sc, and Th) of particulate material samples were carried out by neutron activation analysis. Sulfur determination was done by X-ray fluorescence analysis. The ratio between nonstrike/strike concentrations of hydrocarbons associated with automotive emissions (benzene, toluene, ethyl-benzene, and xylenes; BTEX) was determined by gas chromatography/mass spectrometry. Mutagenesis of testing solutions was determined by means of the Tradescantia micronucleus assay in early tetrads of Tradescantia pallida. The inhibition of mitosis of the cells of the primary meristema of the root tips of Allium cepa was used as an index of the toxicity. Fine particle trace element contents were lower during the strike. The concentrations of sulfur and BTEX were 50% and 39.3% lower, respectively, on the strike day. A significant (P=0.038) reduction of micronuclei induced by fine particles sampled during the strike was observed. No effect of the strike on toxicity was detected. These results indicate that a program aiming to reduce emissions of the bus fleet in our town may impact positively the air quality by reducing the mutagenic potential of ambient particles.
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Gonçalves FLT, Carvalho LMV, Conde FC, Latorre MRDO, Saldiva PHN, Braga ALF. The effects of air pollution and meteorological parameters on respiratory morbidity during the summer in São Paulo City. ENVIRONMENT INTERNATIONAL 2005; 31:343-349. [PMID: 15734187 DOI: 10.1016/j.envint.2004.08.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2004] [Accepted: 08/12/2004] [Indexed: 05/24/2023]
Abstract
Effects of meteorological variables and air pollutants on child respiratory morbidity are investigated during two consecutive summers (December-March 1992/1993 and 1993/1994) at the Metropolitan Area of São Paulo (MASP), Brazil. The MASP, with almost 17 million inhabitants, is considered the most populous region in South America. Due to warmer temperatures, increased rainfall and consequent low levels of air pollutants during the summer compared to winter, less attention has been paid to epidemiological studies during this season, especially in tropical urban areas such as São Paulo. In the present work, principal component analysis (PCA) is applied to medical end environmental data to identify patterns relating child morbidity, meteorological variables and air pollutants during the summer. The following pollutant concentrations are examined: SO2, inhalable particulate matter (PM10), and O3. The meteorological variables investigated are air temperature, water vapor (water vapor density) and solar radiation. Although low correlation between respiratory morbidity and environmental variables are, in general, observed for the entire dataset, the PCA method indicates that child morbidity is positively associated with O3 for the 1992/1993 summer. This pattern is identified in the third principal component (PC3), which explains about 19% of the total variance of all data in this summer. However, the 1993/1994 summer shows a more complex association between both groups, suggesting stronger ties with meteorological variables. Marked changes in synoptic conditions from the end of January to end of March of the 1993/1994 summer seem to have played an important role in modulating respiratory morbidity. A detailed examination of meteorological conditions in that period indicates that prefrontal (postfrontal), hot (cold) and dry (wet) days favored the observed decrease (increase) of respiratory morbidity.
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Algranti E, Handar AM, Dumortier P, Mendonça EMC, Rodrigues GL, Santos AMA, Mauad T, Dolhnikoff M, De Vuyst P, Saldiva PHN, Bussacos MA. Pneumoconiosis after sericite inhalation. Occup Environ Med 2005; 62:e2. [PMID: 15723874 PMCID: PMC1740979 DOI: 10.1136/oem.2003.012609] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Between 1997 and 1999 three sericite plant workers in Parana, Brazil, were diagnosed with pneumoconiosis. AIMS To investigate and describe the radiological, clinical, and pathological changes in miners and millers exposed to sericite dust with mineralogical characteristics of inhaled dust. METHODS The working premises were visited to examine the sericite processing and to classify the jobs according to make qualitative evaluation. Respirable dust was collected and the amount of crystalline silica and particle size distribution were measured. Forty four workers were examined by a standard questionnaire for respiratory symptoms, spirometry, and chest x ray. Material from an open lung biopsy was reviewed for histopathological and mineralogical analysis, together with sericite samples from the work site to compare the mineral characteristics in lung lesions and work area. RESULTS Respirable dust contained 4.5-10.0% crystalline silica. Particle size distribution showed a heavy burden of very fine particles (23-55%) with a mean diameter of <0.5 microm. Mean age of sericite miners was 41.0 (11.9) and mean number of years of exposure was 13.5 (10.1). In 52.3% of workers (23/44), chest radiographs presented a median category of 1/0 or above, and 18.2% (8/44) had a reduced FEV1. There was a significant association between exposure indices and x ray category. Histological studies of the lung biopsy showed lesions compatible with mixed dust fibrosis with no silicotic nodules. x Ray diffraction analysis of the lung dust residue and the bulk samples collected from work area showed similar mineralogical characteristics. Muscovite and kaolinite were the major mineral particle inclusions in the lung. CONCLUSION Exposure to fine sericite particles is associated with the development of functional and radiological changes in workers inducing mixed dust lesions, which are distinct histologically from silicosis.
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Abstract
OBJECTIVE This study describes the involvement and the histological alterations found in the tongues of 92 autopsied patients who died with AIDS. MATERIALS AND METHODS Sex, age, CD4 cell count and clinical history were obtained from the files of 92 patients who died with AIDS. All the tongues were examined for macroscopical alterations and stained using H&E, Gomori-Grocott, Ziehl-Neelsen, PAS, Brow-Hopps and Mucicarmine. Histological autopsy findings were grouped based on a protocol that was designed following the World Health Organization recommendations. RESULTS The mean age of the patients who died of AIDS and CD4 cell count were 36 years and 82 cells microL(-1), respectively. Histological alterations of the tongues were found in 75% of the cadavers. The most common lesions were hairy leukoplakia (HL) (42 cases), candidosis (31 cases) and non-specific chronic glossitis (29 cases), followed by concomitant lesions (28 cases), non-specific chronic ulceration (17 cases), melanotic pigmentation (13 cases), herpes simplex (10 cases), lymphoepithelial cysts (two cases), cryptococcosis (two cases), mycobacteriosis (one case), histoplasmosis (one case), cytomegalovirus infection (one case) and non-Hodgkin Lymphoma (one case). HL with oral candidosis (n = 13) were the most common concomitant lesions. CONCLUSION These findings indicate that the tongue is a favorite site to occurrence of reactive, infectious and concurrent lesions in the end-stage of AIDS patients.
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Farhat SCL, Paulo RLP, Shimoda TM, Conceição GMS, Lin CA, Braga ALF, Warth MPN, Saldiva PHN. Effect of air pollution on pediatric respiratory emergency room visits and hospital admissions. Braz J Med Biol Res 2005; 38:227-35. [PMID: 15785834 DOI: 10.1590/s0100-879x2005000200011] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In order to assess the effect of air pollution on pediatric respiratory morbidity, we carried out a time series study using daily levels of PM10, SO2, NO2, ozone, and CO and daily numbers of pediatric respiratory emergency room visits and hospital admissions at the Children's Institute of the University of Sao Paulo Medical School, from August 1996 to August 1997. In this period there were 43,635 hospital emergency room visits, 4534 of which were due to lower respiratory tract disease. The total number of hospital admissions was 6785, 1021 of which were due to lower respiratory tract infectious and/or obstructive diseases. The three health end-points under investigation were the daily number of emergency room visits due to lower respiratory tract diseases, hospital admissions due to pneumonia, and hospital admissions due to asthma or bronchiolitis. Generalized additive Poisson regression models were fitted, controlling for smooth functions of time, temperature and humidity, and an indicator of weekdays. NO2 was positively associated with all outcomes. Interquartile range increases (65.04 microg/m3) in NO2 moving averages were associated with an 18.4% increase (95% confidence interval, 95% CI = 12.5-24.3) in emergency room visits due to lower respiratory tract diseases (4-day moving average), a 17.6% increase (95% CI = 3.3-32.7) in hospital admissions due to pneumonia or bronchopneumonia (3-day moving average), and a 31.4% increase (95% CI = 7.2-55.7) in hospital admissions due to asthma or bronchiolitis (2-day moving average). The study showed that air pollution considerably affects children's respiratory morbidity, deserving attention from the health authorities.
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Albertini-Yagi CS, Oliveira RC, Vieira JE, Negri EM, de Oliveira LR, Saldiva PHN, Lorenzi-Filho G. Sputum induction as a research tool for the study of human respiratory mucus. Respir Physiol Neurobiol 2005; 145:101-10. [PMID: 15652792 DOI: 10.1016/j.resp.2004.08.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2004] [Indexed: 10/26/2022]
Abstract
The study objectives were to compare in vitro transportability and physical properties of respiratory mucus, obtained invasively by direct collection (DC) right after endotracheal intubation and non-invasively by sputum induction with 3% hypertonic saline solution inhalation (SI) 24 h before the anesthesia. Twenty-two patients with no pulmonary disease scheduled for elective abdominal surgical procedures were studied. The parameters analyzed and the main results are as follows. (1) Transportability by cilia (MCT), SI was higher than DC (0.94+/-0.25 and 0.62+/-0.25; P<0.001). There was a significant correlation between the two methods and DC could be estimated by: DC=0.21+(0.44 SI) (r=0.44; P<0.001). (2) Transportability by cough (CC), SI was higher than DC (68.23+/-32.1 and 33.58+/-19.04 mm; P=0.002). (3) Contact angle (CA), SI was lower than DC (10+/-3 degrees and 22+/-14 degrees ; P=0.025). (4) Rheological properties (no significant difference obtained between SI and DC). These results indicated that SI changes mucus physical properties and transportability in non-expectorators.
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Guimarães ET, Macchione M, Lobo DJA, Domingos M, Saldiva PHN. Evaluation of the mutagenic potential of urban air pollution in São Paulo, Southeastern Brazil, using the Tradescantia stamen-hair assay. ENVIRONMENTAL TOXICOLOGY 2004; 19:578-584. [PMID: 15526269 DOI: 10.1002/tox.20065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
We used a short-term bioassay--the Tradescantia stamen-hair assay (TSH)--to evaluate the toxicity of ambient particles with an aerodynamic diameter less than 10 microm sampled in the metropolitan region of São Paulo, Brazil. Two exposure locations were selected: downtown São Paulo and Caucaia do Alto (mean PM10 levels of 64 and 14 microg/m3, respectively). The experiment was conducted July 11-August 15, 2002, and toxicity was assessed with the Tradescantia stamen-hair assay (TSH) employing clone KU-20 of Tradescantia. Four experimental groups were defined: inflorescences collected from plants cultivated in Caucaia, inflorescences collected from plants cultivated in São Paulo (to establish the baseline level of mutations in stamen hairs at both sites), inflorescences collected from plants cultivated in Caucaia and brought to São Paulo and maintained in chambers that received ambient air, and inflorescences collected from plants cultivated in Caucaia and brought to São Paulo and maintained in chambers that received air passed through a particle filter. The frequency of mutations observed in Caucaia was significantly lower than that in the remaining groups. Flower cuttings brought from Caucaia and receiving ambient air of São Paulo showed a rate of mutations similar to that of plants cultivated in São Paulo. Filtering particles from the air reduced the rate of mutation but not sufficiently to reach the level of that in Caucaia. The frequency of mutations observed in São Paulo was significantly associated with PM10 levels on the fifth day before the opening of the flowers (r = 0.47, p = 0.025). Our results indicate that urban particles play a significant role in the development of pollution-dependent mutations.
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Freitas C, Bremner SA, Gouveia N, Pereira LAA, Saldiva PHN. Internações e óbitos e sua relação com a poluição atmosférica em São Paulo, 1993 a 1997. Rev Saude Publica 2004; 38:751-7. [PMID: 15608891 DOI: 10.1590/s0034-89102004000600001] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Investigar efeitos de curto prazo da poluição atmosférica na morbidade respiratória de menores de 15 anos e na mortalidade de idosos. MÉTODOS: O estudo foi realizado na cidade de São Paulo, Brasil. Foram analisadas as contagens diárias de admissões hospitalares, de menores de 15 anos e de mortes de idosos (>64 anos) no período de 1993 a 1997, em relação às variações diárias de poluentes atmosféricos (PM10, CO, O3). Foi utilizada para análise a regressão de Poisson em modelos aditivos generalizados. Os modelos foram ajustados para efeitos da tendência temporal, sazonalidade, dias da semana, fatores meteorológicos e autocorrelação. RESULTADOS: Variações do 10° ao 90° percentil dos poluentes foi significativamente associada com o aumento de admissões por doenças respiratórias em menores de 15 anos para PM10 (%RR=10,0), CO (%RR=6,1) e O3 (%RR=2,5). Associação similar foi encontrada para mortalidade em idosos e PM10 (%RR=8,1) e CO (%RR=7,9). CONCLUSÕES: Os resultados encontrados são coerentes com os estudos que apontam associação entre variações de curto prazo dos poluentes atmosféricos e incremento na morbidade e mortalidade nos grandes centros urbanos.
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117
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Nakagawa NK, Donato-Júnior F, Kondo CS, King M, Auler-Júnior JOC, Saldiva PHN, Lorenzi-Filho G. Effects of acute hypovolaemia by furosemide on tracheal transepithelial potential difference and mucus in dogs. Eur Respir J 2004; 24:805-10. [PMID: 15516676 DOI: 10.1183/09031936.04.10021704] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Furosemide is a potent diuretic that affects water transfer across the respiratory epithelium, which is closely related to the transepithelial potential difference (PD). Water is a critical factor that determines mucus transport; an important lung defence mechanism that removes particles and microorganisms from the respiratory system. The aim of the present study was to investigate the acute effects of furosemide and hypovolaemia on tracheal PD and mucus properties. A total of 36 male mixed-breed dogs were submitted to anaesthesia, mechanical ventilation and haemodynamic monitoring. They were randomly assigned to three groups consisting of: a control group, a furosemide (40 mg i.v.) + hypovolaemia group, and a furosemide (40 mg i.v.) + volume replacement group. Tracheal PD and mucus samples were collected at time 0, 1 and 2 h after intervention. Mucus properties were analysed by means of a magnetic microrheometer and in vitro mucociliary transportability on the frog palate. Compared to controls, furosemide decreased PD to intermediate values, and only significantly when associated with hypovolaemia (-13+/-5 and -8+/-2 mV, time 0 and 2 h, respectively). In addition to the direct effect of furosemide, these results indicate that hypovolaemia also affects ion transport in the tracheal membrane. Furosemide and hypovolemia have no acute effects on respiratory mucus properties.
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118
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Ferreira CM, Lombardi JV, Machado-Neto JG, Bueno-Guimarães HM, Soares SRC, Saldiva PHN. Effects of copper oxychloride in Rana catesbeiana tadpoles: toxicological and bioaccumulative aspects. BULLETIN OF ENVIRONMENTAL CONTAMINATION AND TOXICOLOGY 2004; 73:465-470. [PMID: 15386166 DOI: 10.1007/s00128-004-0452-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
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119
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Guedes JRP, Ferreira CM, Guimarães HMB, Saldiva PHN, Capelozzi VL. Homeopathically prepared dilution of Rana catesbeiana thyroid glands modifies its rate of metamorphosis. HOMEOPATHY 2004; 93:132-7. [PMID: 15287432 DOI: 10.1016/j.homp.2004.04.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
One strand of research on the scientific basis of homeopathy is based on inversion effects of dilutions and the biophysical properties of information transfer. A model developed by Endler, was the basis for the study of the influence of high-diluted solution (1:1026 part by weight) of thyroid glands on the rate of metamorphosis of the frog Rana catesbeiana from the no legged to four-legged stage. The glands were obtained from tadpoles and prepared according by (dilution and succussion). Similar pure hydroalcoholic solution (unsuccussed) was used as control. In order to identify significant differences in the frequencies of four-legged tadpoles, in homeopathic and control group, we used a chi-square goodness-of-fit test (P<0.01) and the cumulative risk for metamorphosis by Cox's Proportional Hazards model (P<0.05). The number of animals that reached the four-legged stage is generally smaller in the treated group, than in the hydroalcoholic control group. It was postulated that thyroid hormones transmitted information' specific to the molecules used to prepare the solution, even though the molarity was beyond Avogadro's number.
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120
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Costa MBG, Siqueira SAC, Saldiva PHN, Rabe KF, Mauad T. Histologic patterns of lung infiltration of B-cell, T-cell, and Hodgkin lymphomas. Am J Clin Pathol 2004; 121:718-26. [PMID: 15151212 DOI: 10.1309/r4br-rady-f20k-49he] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022] Open
Abstract
Secondary lung infiltration by lymphomas occurs frequently. To our knowledge, however, no recent studies have attempted to discriminate histologic patterns of lung infiltration in the lymphoma subtypes. We retrospectively evaluated the frequency of lung infiltration and the respective infiltration patterns by lymphomas at autopsy, during an 11-year period. Lymphomas were classified according to the 2001 World Health Organization Classification of hematologic malignancies in B-cell, T-cell, and Hodgkin lymphomas (HLs). In 21,157 autopsies, 414 reports with lymphoma diagnosis were reviewed histologically, and 85 showed lung infiltration (20.5%). We studied 14 HLs, 43 B-cell lymphomas, and 20 T-cell lymphomas. Five infiltration patterns were identified: peribronchial-perivascular, nodular alveolar, interstitial, and pleural. Approximately half of the lymphomas had more than 1 infiltration pattern (mean, 1.7); peribronchial-perivascular and pleural were the most frequent. The frequency of nodular infiltration was larger in HL than in B-cell lymphomas. T-cell lymphomas had a larger frequency of the interstitial infiltration pattern compared with B-cell lymphomas. Recognizing the frequency and patterns of lung infiltration in the light of a more recent classification is certainly useful for physicians dealing with lymphoma diagnostic procedures, such as radiologists and pathologists.
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121
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Mauad T, Silva LFF, Santos MA, Grinberg L, Bernardi FDC, Martins MA, Saldiva PHN, Dolhnikoff M. Abnormal alveolar attachments with decreased elastic fiber content in distal lung in fatal asthma. Am J Respir Crit Care Med 2004; 170:857-62. [PMID: 15151920 DOI: 10.1164/rccm.200403-305oc] [Citation(s) in RCA: 157] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Small airway disease is thought to contribute significantly to functional impairment caused by asthma. Functional evidence of airway-parenchyma uncoupling in asthma, such as loss of deep breath bronchodilator effect in bronchoconstrictive episodes and enhanced airway closure, has been previously demonstrated. Elastic fibers are essential to maintain adequate elastic recoil of the lungs. In this study, we hypothesized that alveolar attachments could be abnormal and that elastic fibers could be damaged in the distal lungs of patients with fatal asthma. For this purpose, we measured the number of abnormal alveolar attachments and quantified the content of elastic fibers in the adventitial layer of small airways and in the peribronchial and distal alveolar septa of 15 patients who died of asthma (FA) and 9 control subjects (CTRL). Our data (geometric mean [range]) showed an increased proportion of abnormal alveolar attachments per centimeter of basement membrane perimeter in fatal asthma (FA, 0.18 [0.03-4.00]; CTRL, 0.00 [0.00-0.12]; p < 0.001) and decreased elastic fiber content in the small airway adventitial layer (FA, 4.08 [2.22-11.46] microm; CTRL, 6.79 [5.62-10.0] microm; p = 0.01) and in the peribronchial alveoli (FA, 1.08 [0.46-1.91] microm; CTRL, 1.81 [1.22-1.74] microm; p = 0.003), but not in the distal alveoli. We propose that structural alterations at the peribronchiolar level might contribute to the pathogenesis of some functional abnormalities observed in patients with severe asthma.
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Egito EST, Aiello VD, Bosisio IBJ, Lichtenfels AJ, Horta ALM, Saldiva PHN, Capelozzi VL. Vascular remodeling process in reversibility of pulmonary arterial hypertension secondary to congenital heart disease. Pathol Res Pract 2004; 199:521-32. [PMID: 14533936 DOI: 10.1078/0344-0338-00457] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Pulmonary vascular remodeling process was analyzed using morphometry in lung biopsy specimens taken from 26 children, aged 6 to 160 months, who had congenital heart disease and significant pulmonary arterial hypertension. Reparative surgery was performed in 22 patients and palliative surgery was performed in four patients. One patient expired postoperatively and four others after hospital discharge. Vascular remodeling examination revealed a characteristic pathological picture: pronounced medial thickening with increased collagen content (fibrosis), without significant arterial intimal proliferation. At a mean follow-up of 44 months, 72% of the survivors were asymptomatic with no medication. Diagnosed by echocardiogram, 22% of these patients were shown to have pulmonary arterial hypertension. The characteristic pathological features described above occurred in 38% of the patients who either expired or had pulmonary hypertension postoperatively. These findings were an aid to identifying a high risk group in which the outcome does not meet expectations for the classical grade I and II changes. We concluded that the presence of isolated medial thickening does not ensure either survival or a normal postoperative pulmonary arterial pressure at late follow-up and that the collagen content can be a better reference for good outcome. Early intracardiac repair is recommended before the development of significant medial fibrosis.
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MESH Headings
- Adolescent
- Cardiac Surgical Procedures/mortality
- Child
- Child, Preschool
- Collagen/metabolism
- Extracellular Matrix/metabolism
- Female
- Heart Defects, Congenital/complications
- Heart Defects, Congenital/physiopathology
- Heart Defects, Congenital/surgery
- Humans
- Hypertension, Pulmonary/etiology
- Hypertension, Pulmonary/physiopathology
- Hypertension, Pulmonary/surgery
- Infant
- Male
- Muscle, Smooth, Vascular/metabolism
- Muscle, Smooth, Vascular/pathology
- Pulmonary Artery/metabolism
- Pulmonary Artery/pathology
- Pulmonary Artery/physiopathology
- Recovery of Function
- Retrospective Studies
- Tunica Media/metabolism
- Tunica Media/pathology
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Medeiros N, Rivero DHRF, Kasahara DI, Saiki M, Godleski JJ, Koutrakis P, Capelozzi VL, Saldiva PHN, Antonangelo L. Acute pulmonary and hematological effects of two types of particle surrogates are influenced by their elemental composition. ENVIRONMENTAL RESEARCH 2004; 95:62-70. [PMID: 15068931 DOI: 10.1016/j.envres.2003.07.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2002] [Revised: 07/11/2003] [Accepted: 07/16/2003] [Indexed: 05/24/2023]
Abstract
Several epidemiological studies have consistently demonstrated significant associations between ambient levels of particulate matter and lung injury and cardiovascular events with increased morbidity and mortality. Particle surrogates (PS), such as residual oil fly ash (ROFA), have been widely used in experimental studies aimed at characterizing the mechanisms of particle toxicity. Since PS composition varies depending on its source, studies with different types of PS may provide clues about the relative toxicity of the components generated by high-temperature combustion process. In this work, we have studied the effects of nasal instillation of increasing doses of different PS in mice: saline, carbon, and two types of particle surrogates. PS type A (PSA) was the ROFA collected from the waste incinerator of our university hospital; PS type B (PSB) was collected from the electrostatic precipitator of a large steel company and thus had an elevated metal content. After 24h, we analyzed hematological parameters, fibrinogen, bronchoalveolar lavage, bone marrow, and pulmonary histology. Nasal instillation of the two types of PS-induced leucopenia. PSB elicited a greater elevation of plasma fibrinogen levels. Bone marrow and pulmonary inflammatory changes were more intense for PSA. We concluded that the PS composition modulates acute inflammatory changes more significantly than the mass for these two types of PS.
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Lin CA, Pereira LAA, Nishioka DC, Conceição GMS, Braga ALF, Saldiva PHN. Air pollution and neonatal deaths in São Paulo, Brazil. Braz J Med Biol Res 2004; 37:765-70. [PMID: 15107940 DOI: 10.1590/s0100-879x2004000500019] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Air pollution has been associated with health effects on different age groups. The present study was designed to assess the impact of daily changes in air pollutants (NO2, SO2, CO, O3, and particle matter (PM10)) on total number of daily neonatal deaths (those that occur between the first and the 28th days of life) in São Paulo, from January 1998 to December 2000, since adverse outcomes such as neonatal deaths associated with air pollution in Brazil have not been evaluated before. Generalized additive Poisson regression models were used and nonparametric smooth functions (loess) were adopted to control long-term trend, temperature, humidity, and short-term trends. A linear term was used for holidays. The association between air pollutants and neonatal deaths showed a short time lag. Interquartile range increases in PM10 (23.3 microg/m(3)) and SO2 (9.2 microg/m(3)) were associated with increases of 4% (95% CI, 2-6) and 6% (95% CI, 4-8), respectively. Instead of adopting a two-pollutant model we created an index to represent PM10 and SO2 effects. For an interquartile range increase in the index an increase of 6.3% (95% CI, 6.1-6.5) in neonatal deaths was observed. These results agree with previous studies performed by our group showing the deleterious effects of air pollutants during the perinatal period. The method reported here represents an alternative approach to analyze the relationship between highly correlated pollutants and public health problems, reinforcing the idea of the synergic effects of air pollutants in public health.
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125
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Martins MCH, Fatigati FL, Véspoli TC, Martins LC, Pereira LAA, Martins MA, Saldiva PHN, Braga ALF. Influence of socioeconomic conditions on air pollution adverse health effects in elderly people: an analysis of six regions in São Paulo, Brazil. J Epidemiol Community Health 2004; 58:41-6. [PMID: 14684725 PMCID: PMC1757032 DOI: 10.1136/jech.58.1.41] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
STUDY OBJECTIVE To evaluate if the effects of particulate matter (PM(10)) on respiratory mortality of elderly people are affected by socioeconomic status. DESIGN Time series studies. The daily number of elderly respiratory deaths were modelled in generalised linear Poisson regression models controlling for long term trend, weather, and day of the week, from January 1997 to December 1999, in six different regions of São Paulo City, Brazil. The regions were defined according to the proximity of air pollution monitoring stations. Three socioeconomic indicators were used: college education, monthly income, and housing. MAIN RESULTS For a 10 micro g/m(3) increase in PM(10), the percentage increase in respiratory mortality varied from 1.4% (95% CI 5.9 to 8.7) to 14.2% (95% CI 0.4 to 28.0). The overall percentage increase in the six regions was 5.4% (95% CI 2.3 to 8.6). The effect of PM(10) was negatively correlated with both percentage of people with college education and high family income, and it was positively associated with the percentage of people living in slums. CONCLUSIONS These results suggest that socioeconomic deprivation represents an effect modifier of the association between air pollution and respiratory deaths.
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