The Fate of Atrazine in Tropical Environments: Photolysis, Acute Toxicity and Endocrine Disruptor Potential

Triazine herbicides are widely used both in Brazil and internationally and are frequently detected in natural environments and drinking water. This study assesses atrazine degradation through solar radiation under tropical conditions and determines the toxicity of the intermediates. Atrazine degradation is tested through ultrapure water, humic acid solution and natural water experiments, with exposure to sunlight to simulate a natural environment. A yeast estrogen screen (YES) assay and Artemia salina test are carried out during the abiotic degradation. The atrazine degradation depends on the radiation intensity, since the experiments conducted in the summer reached 50% after ca. 17 days. No significant variations in this herbicide concentration are observed after 90 days of exposure in the fall. Atrazine degradation is observed only in humic acid and is responsible for indirect photolysis. Intermediates, namely, desethylatrazine (DEA) and deisopropylatrazine (DIA), are identified and quantified at the μg L–1 level. Thus, with the degradation of atrazine in water, the medium toxicity may decrease, since DEA and DIA have mean effective concentrations that kill 50% of Artemia salina (EC50) similars to atrazine (13 mg L–1). No estrogenic activity in the YES is detected for atrazine and its metabolites. These findings evidence that radiation intensity and organic substances in tropical countries influence the half-life of pesticides in aquatic environments.

BENEFITS OF OZONE THERAPY IN THE TREATMENT OF FOOT ULCERS IN PEOPLE WITH DIABETES MELLITUS

Objective: To identify the benefits of ozone therapy in the treatment of foot ulcers in people with diabetes mellitus. Method: Literature review carried out in the CINAHL, Cochrane Library, LILACS, PUBMED, SciELO, SCOPUS and Web of Science databases in the period between April and May 2020. In each database, the controlled descriptors were delimited in the Science Descriptors of Health and Medical Subject Headings, keywords defined: Ozone (Ozone), Diabetic Foot (Diabetic foot), with the help of the Boolean operator AND. Results: 14 primary studies were selected. Most studies have level II evidence, published in English, in different journals, from different parts of the world. 15 benefits of ozone therapy for the treatment of foot ulcers were identified, with a predominance of increased granulation tissue and intensification in the progress of tissue repair. Conclusion: The use of ozone therapy has shown several benefits in the progress in tissue repair of foot ulcers in people with diabetes, increased granulation tissue, promoted antiseptic and bactericidal activities, preventing oxidative stress.

BENEFÍCIOS DA OZONIOTERAPIA NO TRATAMENTO DE ÚLCERAS NOS PÉS EM PESSOAS COM DIABETES MELLITUS

Objetivo:Identificar os benefícios da ozonioterapia no tratamento de úlceras nos pés de pessoas com diabetes mellitus. Métodos: Revisão de literatura realizada nas bases de dados CINAHL, CochraneLibrary, LILACS, PUBMED, SciELO, SCOPUS e Web of Science, no período de abril a maio de 2020. Em cada base de dados, os descritores controlados foram delimitados nos Descritores em Ciências da Saúde e Medical Subject Headings, definidas as palavras-chaves: Ozônio (Ozone) e Pé Diabético (Diabeticfoot), com auxílio do operador booleano AND. Resultados:Houve a seleção de 14 estudos primários. A maioria dos estudos possui nível II de evidência, publicados em inglês, em distintos periódicos, oriundos de diversas partes do mundo. Foram identificados 15 benefícios da ozonioterapia para o tratamento de úlceras nos pés, com predomínio de aumento do tecido de granulação e intensificação no progresso do reparo tecidual. Conclusão: O uso da ozonioterapia apresentou diversos benefícios no progresso do reparo tecidual de úlceras nos pés em pessoas com diabetes, aumentando o tecido de granulação, promovendo atividades antissépticas e bactericidas e prevenindo o estresse oxidativo.

Can dynamic ultrasonography replace urodynamics in the follow-up of patients with myelomeningocele? A prospective concurrent study

AIMS

To evaluate the accuracy of dynamic ultrasonography (DUS), as a feasible alternative diagnostic method to identify detrusor overactivity (DO) in patients with neurogenic bladder.

METHODS

We performed concurrent analysis of 81 pairs of urodynamic study (UDS) and DUS, in 63 patients with myelomeningocele (MMC), from June 2014 to February 2017. The assessment focused on bladder behavior during the filling phase, DO evaluation, DO with leakage, compliance, and maximum cystometric capacity (MCC).

RESULTS

Patient age ranged from 3 months to 34 years (median, 84 months); 47.6% were male. Overall, 9.5% of patients had chronic kidney disease, 20.6% had recurrent urinary tract infection, 19.05% had vesicoureteral reflux, and 69.8% had constipation. Anticholinergic therapy was used by 41.3% of patients. DO was observed in 45.67% of patients and DO with leakage in 42.6%. Mean bladder compliance was 10.39 mL/cmH₂ O and normal MCC was 56.79%. DUS had 91.89% sensitivity in identifying DO, 88.64% specificity, 87.18% positive predictive value, 92.86% negative predictive value, and 90.12% accuracy, with a kappa coefficient of 0.8 (P < 0.001).

CONCLUSION

MMC follow-up is essential because urinary parameters can change during patient growth. The standard examination is invasive and has related complications, making noninvasive evaluation a desirable alternative, like DUS. Our data suggest that DO and MCC can be evaluated using DUS in patients with MMC. UDS should be performed in patients with abnormal findings on ultrasound evaluation or those with worsening of urinary tract function.

Predictive variables affecting transfusion requirements in orthotopic liver transplantation

INTRODUCTION AND AIMS

Adult orthotopic liver transplantation (OLT) is associated with considerable blood product requirements. The aim of this study was to assess the ability of preoperative information to predict intraoperative red blood cell (RBC) transfusion requirements among adult liver recipients.

METHODS

Preoperative variables with previously demonstrated relationships to intraoperative RBC transfusion were identified from the literature: sex, age, pathology, prothrombin time (PT), factor V, hemoglobin (Hb), and platelet count (plt). These variables were then retrospectively collected from 758 consecutive adult patients undergoing OLT from 1997 to 2007. Relationships between these variables and intraoperative blood transfusion requirements were examined by both univariate analysis and multiple linear regression analysis.

RESULTS

Univariate analysis confirmed significant associations between RBC transfusion and PT, factor V, Hb, Plt, pathology, and age (P values all < .001). However, stepwise backward multivariate analysis excluded variables Plt and factor V from the multiple regression linear model. The variables included in the final predictive model were PT, Hb, age, and pathology. Patients suffering from liver carcinoma required more blood products than those suffering from other pathologies. Yet, the overall predictive power of the final model was limited (R(2) = .308; adjusted R(2) = .30).

CONCLUSION

Preoperative variables have limited predictive power for intraoperative RBC transfusion requirements even when significant statistical associations exist, identifying only a small portion of the observed total transfusion variability. Preoperative PT, Hb, age, and liver pathology seem to be the most significant predictive factors but other factors like severity of liver disease, surgical technique, medical experience in liver transplantation, and other noncontrollable human variables may play important roles to determine the final transfusion requirements.

Autologous blood donation in cardiac patients

Despite the advantages of autologous blood transfusion, doubt still remains about its safety in cardiac patients. We report our experience with 439 cardiac patients who donated a total of 1692 units of blood before coronary, valvular, or congenital cardiac operations. During the collections, patients were continuously monitored with ECG, blood pressure, and heart rate. In 22 collections we observed vasovagal reactions, which represents an incidence of 1.3% of the total number of collections. The patients recovered quickly and only in 3 cases was volume replacement with saline needed. There were no other complications which could be related to the preoperative autologous donation program. We feel that, with careful selection of the patients and of the circumstances surrounding the collection of blood, autologous blood donation in cardiac patients is a safe and beneficial experience.