RESUMO
BACKGROUND: Patients with a history of anaphylaxis are at risk of future anaphylactic reactions. Thus, secondary prevention measures are recommended for these patients to prevent or attenuate the next reaction. METHODS: Data from the Anaphylaxis Registry were analyzed to identify secondary prevention measures offered to patients who experienced anaphylaxis. Our analysis included 7788 cases from 10 European countries and Brazil. RESULTS: The secondary prevention measures offered varied across the elicitors. A remarkable discrepancy was observed between prevention measures offered in specialized allergy centers (84% of patients were prescribed adrenaline autoinjectors following EAACI guidelines) and outside the centers: Here, EAACI guideline adherence was only 37%. In the multivariate analysis, the elicitor of the reaction, age of the patient, mastocytosis as comorbidity, severity of the reaction, and reimbursement/availability of the autoinjector influence physician's decision to prescribe one. CONCLUSIONS: Based on the low implementation of guidelines concerning secondary prevention measures outside of specialized allergy centers, our findings highlight the importance of these specialized centers and the requirement of better education for primary healthcare and emergency physicians.
Assuntos
Anafilaxia , Prevenção Secundária , Anafilaxia/epidemiologia , Anafilaxia/etiologia , Anafilaxia/prevenção & controle , Brasil , Epinefrina , Europa (Continente)/epidemiologia , Humanos , Sistema de RegistrosRESUMO
The nano-mineralogy, petrology, and chemistry of coal gasification products have not been studied as extensively as the products of the more widely used pulverized-coal combustion. The solid residues from the gasification of a low- to medium-sulfur, inertinite-rich, volatile A bituminous coal, and a high sulfur, vitrinite-rich, volatile C bituminous coal were investigated. Multifaceted chemical characterization by XRD, Raman spectroscopy, petrology, FE-SEM/EDS, and HR-TEM/SEAD/FFT/EDS provided an in-depth understanding of coal gasification ash-forming processes. The petrology of the residues generally reflected the rank and maceral composition of the feed coals, with the higher rank, high-inertinite coal having anisotropic carbons and inertinite in the residue, and the lower rank coal-derived residue containing isotropic carbons. The feed coal chemistry determines the mineralogy of the non-glass, non-carbon portions of the residues, with the proportions of CaCO3 versus Al2O3 determining the tendency towards the neoformation of anorthite versus mullite, respectively. Electron beam studies showed the presence of a number of potentially hazardous elements in nanoparticles. Some of the neoformed ultra-fine/nano-minerals found in the coal ashes are the same as those commonly associated with oxidation/transformation of sulfides and sulfates.