Browsing by Autor "J. Barral"

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Genotoxic damage among Bolivian farmers exposed to a complex mixture of pesticides
(Elsevier BV, 2018) Jessika Barrón Cuenca; Noemí Tirado; J. Barral; Pablo Almaraz; Ulla Stenius; Marika Berglund; Kristian Dreij
Genotoxic damage in a Bolivian agricultural population exposed to a mixture of pesticides
(Wolters Kluwer, 2019) John H. Barron; Noemí Tirado; J. Barral; Christian Lindh; Ulla Stenius; Marika Berglund; Kristian Dreij
TPS 792: Occupational health 2, Exhibition Hall, Ground floor, August 27, 2019, 3:00 PM - 4:30 PM Pesticides are well-known chemicals that can increase the risk to develop cancer by induction of DNA damage and oxidative stress, especially in populations with chronic exposure. Bolivian farmers have been increasing their use of pesticides during the last decades to increase their production and economy. Chronic exposure to these chemicals, their combined effects and genetic polymorphisms can increase the risk of genotoxic damage, mutagenicity and development of chronic diseases. A cross-sectional study in 297 volunteers from three different Bolivian agricultural communities was conducted. Exposure and handling of pesticides were assessed by a questionnaire and urinary pesticide metabolite analysis. Genotoxic effects were evaluated in collected blood samples by Micronucleus and Comet assay. Frequency of glutathione transferase (GST) null genotypes (GSTM1 and GSTT1) was determined to evaluate the impact on DNA damage levels. The results showed that only 17% of the farmers used recommended protection equipment. In agreement, they were highly exposed to chlorpyrifos, pyrethroids and 2,4-D, and men generally more highly compared to women. Higher frequency of micronuclei (MN) was found in women compared to men (4.52 vs 3.55, p<0.05). Farmers active >8 years had higher frequency of MN compared to farmers active <8 years (4.23 vs 2.94, p<0.05). Surprisingly, a null GST genotype (GSTM1 and GSTT1: 84% and 24% null, respectively) was associated with lower levels of DNA damage. High levels of exposure to tebuconazole, 2,4-D or cyfluthrin was associated with high levels of DNA strand breaks (p<0.05-0.01). After adjustment for confounding factors (e.g. gender, age, GST genotype), a significant increased risk of DNA strand breaks was found for exposure to 2,4-D (OR=1.9, CI=1.0-3.8, p=0.049). In conclusion, agricultural Bolivian population, especially men are highly exposed to mixtures of pesticides causing genotoxic effects in lymphocytes and which constitutes an increased risk of developing cancer in the future.
Increased levels of genotoxic damage in a Bolivian agricultural population exposed to mixtures of pesticides
(Elsevier BV, 2019) Jessika Barrón Cuenca; Noemí Tirado; J. Barral; Imran Ali; Michael Levi; Ulla Stenius; Marika Berglund; Kristian Dreij
During the past decades, farmers in low to middle-income countries have increased their use of pesticides, and thereby the risk of being exposed to potentially genotoxic chemicals that can cause adverse health effects. Here, the aim was to investigate the correlation between exposure to pesticides and genotoxic damage in a Bolivian agricultural population. Genotoxic effects were assessed in peripheral blood samples by comet and micronucleus (MN) assays, and exposure levels by measurements of 10 urinary pesticide metabolites. Genetic susceptibility was assessed by determination of null frequency of GSTM1 and GSTT1 genotypes. The results showed higher MN frequency in women and farmers active ≥8 years compared to their counterpart (P < 0.05). In addition, age, GST genotype, alcohol consumption, and type of water source influenced levels of genotoxic damage. Individuals with high exposure to tebuconazole, 2,4-D, or cyfluthrin displayed increased levels of genotoxic damage (P < 0.05-0.001). Logistic regression was conducted to evaluate associations between pesticide exposure and risk of genotoxic damage. After adjustment for confounders, a significant increased risk of DNA strand breaks was found for high exposure to 2,4-D, odds ratio (OR) = 1.99 (P < 0.05). In contrast, high exposure to pyrethroids was associated with a reduced risk of DNA strand breaks, OR = 0.49 (P < 0.05). It was also found that high exposure to certain mixtures of pesticides (containing mainly 2,4-D or cyfluthrin) was significantly associated with increased level and risk of genotoxic damage (P < 0.05). In conclusion, our data show that high exposure levels to some pesticides is associated with an increased risk of genotoxic damage among Bolivian farmers, suggesting that their use should be better controlled or limited.
OP021 Topic: AS14–Infections: Sepsis and Septic Shock/Antimicrobial Stewardship/Tropical and Parasite Infections/Other: VALIDATION AND APPLICABILITY OF THE PHOENIX SEPSIS SCORE IN LOW-RESOURCE SETTINGS
(Lippincott Williams & Wilkins, 2024) Raúl Olmos; Nicola Casson; Willmer E. Diaz Villalobos; V.H. Urquieta Clavel; Mercedes Ortiz; I. Ribera Murguia; C. Mendoza Montoya; Carolina Auza; Matthew Lanza; J. Barral
Aims & Objectives: Sepsis and Septic Shock are leading death causes, sepsis diagnosis criteria evolved since 2005 and recently the Phoenix Sepsis Score (PSS) was proposed. Our study pretends to validate and evaluate the applicability of the score in a resource-limited setting. Methods: An observational, multicentric, and retrospective study was performed in 14 hospitals in Bolivia, enrolling septic children added in 2023 and a statistical analysis was carried out to describe its application and validate the new sepsis criteria. Results: 274 patients were enrolled, with an admission diagnosis of sepsis (22,6%), septic shock (63,5%), and 13,9% cases later ruled out; a mortality rate of 29% for sepsis and 36,8% for septic shock was observed. PSS show increased sensitivity (91,1%), specificity (83.7%), and an AUROC of 0.537; better than SIRS (AUROC 0.486; sensitivity 71.1% and specificity 73.9%) and SOFA (AUROC 0.460; sensitivity 58.9% and specificity 66.8%). All the PSS criteria are routinely performed (>83,2% of patients), except Fibrinogen (19,8%) and D-Dimer; the coefficient of Cronbach’s alpha of 0,715 showed acceptable reliability, but some variations in oxygen levels due to the high-altitude geography of hospitals modified the reliability test, reducing to 0.589 the coefficient of Cronbach’s alpha in hospitals above 4000 m.a.s.l.Conclusions: The PSS is applicable in low resource settings, the limited availability of fibrinogen and D-dimer tests does not change the overall reliability of the score, which is acceptable. The high altitude of some hospitals reduces the reliability of PSS, therefore further studies are required to evaluate the correct adaptation of the PSS to high-altitude environments. Keywords: septic shock, Bolivia, Critical care, Children, Sepsis
PP329 Topic: AS09–Global Health/Resource Limited Setting/Health Inequalities/Impact of Global Warming/Other: ADHERENCE TO PEDIATRIC SEPSIS TREATMENT RECOMMENDATIONS IN A LOW-INCOME COUNTRY
(Lippincott Williams & Wilkins, 2024) Raúl Olmos; Nils Cassón; Willmer E. Diaz Villalobos; V.H. Urquieta Clavel; Mercedes Ortiz; I. Rivera Murguia; C. Mendoza Montoya; Carolina Auza; Matthew Lanza; J. Barral
Aims & Objectives: Sepsis in low-income countries is one of the most important morbidity and mortality issues in hospitals with limited resources. Our objective was to obtain data on the epidemiology and mortality of sepsis and septic shock (SS), and to assess adherence to practice guidelines (CPGs) for the management in the first hour Methods: A multicenter, retrospective, descriptive cohort study was carried out that included 14 PICU patients in Bolivia between January and December 2023. The diagnosis of sepsis and SSc shock was made based on Sepsis–3 criteria, assessing time (minutes) of the start of the following items: 1) Placement of the first vascular access within the first 5 minutes, 2) Infusion of liquids within 30 minutes, 3) Start of antibiotics within 60 minutes, and 4) Start of Vasoactives within 60 minutes, finally overall adherence and/or compliance with the recommendations of the Surviving Sepsis campaign (SSC) was evaluated in addition to overall mortality. Results: 268 patients with sepsis and SS were included, 63% of patients obtained vascular access in the first 5 minutes but only 49% started fluid infusion within the first 30 minutes, 66% started antibiotics and vasoactive drugs in the first 60 minutes, 34.8% mortality was obtained in SS and 33% overall mortality in sepsis, Adherence to all treatment goals was achieved in 18%, associated with lower mortality rates (26% vs 38%; p =0.004)Conclusions: Low adherence to the guidelines and high mortality rates were found in the PICUs of a low-income country; prospective further studies are needed to evaluate improvement interventions. Keywords: Critical care, Children, septic shock, Bolivia, Sepsis