Estudio de metales urinarios y plomo en sangre: parámetros poblacionales en Antofagasta, 2018 / Urinary heavy metals and blood lead levels among residents of Antofagasta, Chile

Background: The presence of toxic metals in human populations is strongly associated with chronic diseases. Aim: To determine levels of lead, chromium, cadmium, mercury and inorganic arsenic (AsIn) in the general population aged over 5 years in Antofagasta, Chile. Material and Methods: People living in Urban Antofagasta for at least five years were considered eligible. Biological samples were obtained to measure heavy metals. Results: One thousand two hundred three participants with a median age of 43 years (656 women) were studied. Their mean time of residence in the city was 30 years, and 52% smoked. Eight percent of the adult population and 12% of children had AsIn values above 35 µg/L, while 75% of the population had levels below 21.9 µg/L. The other metals were below the risk levels defined by the health authority (10 µg/L for chromium, 10 µg/L for mercury, 2 µg/L for cadmium, 5 and 10 μg/dL for blood lead for children and adults, respectively). The factors associated with high levels of AsIn in adults were male sex, living more than 200 meters from monitoring points, and low schooling. In children, the associated variables were high intake of seafood products and having a caregiver with less than 8 years of schooling. Contrary to expectations, the greatest risk of presenting altered levels of the metals occurred in the population living more than 500 meters from the identified risk sources (90% of the population). Conclusions: The findings of this study suggest that all potential sources of exposure to AsIn should be evaluated, and surveillance actions should be established to reduce involuntary exposure to this metalloid.

Nombres populares y clasificación de las drogas de abuso ilícitas en Chile / Popular names and classification of illicit drugs commonly used in Chile

Background The consumption of illicit drugs in Chile has increased over the years generating abuse and dependence problems and becoming a public health problem. Aim To build and disseminate a figure in which health personnel can quickly visualize illicit drugs and their common names, and thus be able to associate them with the effects and risks that are expected in the patient. Material and Methods A bibliographic review and compilation of information obtained from dealers and drug abusers. Results A figure and a table were developed. The former illustrates the classification and common names of drugs, while the second indicates the mechanisms of action and effects expected in the body according to each drug of abuse. Conclusions Illicit drugs have several popular names and various mechanisms of action. When confronting drug consumption this information is crucial to provide an adequate treatment and withdrawal management. However, it is important to keep in mind that this work only represents a management guide and that treatment should always focus on the condition and clinical manifestations of the patient.

Hiponatremia grave secundaria a la exposición a veneno de Phyllomedusa Bicolor (Rana Kambó): caso clínico / Severe hyponatremia secondary to Phyllomedusa bicolor (Kambó frog) poisoning: report of one case

Phyllomedusa bicolor or Kambo is a frog that lives in the Amazon rainforest. It can release through its skin a substance used in healing rituals that are common among South-American tribes, as well as in urban people of America and Europe. We report a 41-year-old female patient who, during a healing ritual consumed ayahuasca (a drink obtained from the mixture of Banisteriopsis caapi, Psychotria viridis and Mimosa hostilis) and 12 hours later received the poison of Kambo Frog (Phyllomedusa bicolor) on superficial right shoulder skin burns. The ritual included a minimum of six-liter water intake over a few hours period. She evolved with clouding of sensorium, motor agitation, frequent vomiting, and generalized tonic-clonic seizures. She presented lethargic to the emergency room, with a weak pupillary light reflex, generalized stiffness, moving all four limbs. Laboratory showed severe hyponatremia (120 mEq/L) and a creatine kinase level of 8,479 UI/L, that increased 107,216 IU/L within few days. An admission CT Brain scan was normal. The toxicological screening did not identify the presence of other substances. During hospitalization the patient developed severe psychomotor agitation controlled by a dexmedetomidine infusion, hyponatremia, low plasma osmolality (248 mOsm/kg), and disproportionately high urinary osmolality (448 mOsm/kg), suggestive of inappropriate antidiuretic hormone secretion syndrome (SIADH). With correction of hyponatremia, the patient gradually recovered consciousness. Rhabdomyolysis was assumed to be secondary to seizure and managed by volume and bicarbonate infusions with a positive response.

Caracterización de las exposiciones a plaguicidas entre los años 2006 y 2013 reportadas al Centro de Información Toxicológica de la Pontificia Universidad Católica de Chile / Characterization of pesticide exposures reported between 2006 and 2013 to a poison information center in Chile

Background: Pesticides are widely used to increase crop yields and vector control. However, both acute and chronic exposure have health consequences. There is paucity of information about the global occurrence of pesticide poisonings. Aim: To characterize the reports of pesticide exposures received by a University Poison Information Center. Material and Methods: All pesticide exposures reported in Chile between 2006 and 2013 were analyzed. A data-collection sheet provided by the International Programme on Chemical Safety of the World Health Organization, was used to collect information. Results: In the study period, 13,181 reports were analyzed. The main age groups exposed were preschoolers and adults. Sixty one percent of exposures occurred accidentally and 24.8% were suicide attempts. Exposures to acetylcholinesterase inhibitors was reported in 29.3% of cases, to superwarfarin rodenticides in 28.5% and to pyrethroids in 24.0%. An increased risk of suicide attempts with pesticides was observed among women, when compared with men (odds ratio: 1.5; 95% confidence intervals: 1.4-1.6; p < 0.001). The risk was higher among teenage girls. Conclusions: The amount of cases under acetyl cholinesterase inhibitor exposure, the most toxic pesticides currently in use should be highlighted. Workers should be educated and all cases should be reported to take actions aiming at reducing these events.

Exposición a agentes de riesgo biológico en trabajadores chilenos: Reporte del Centro de Información Toxicológica de la Pontificia Universidad Católica de Chile (CITUC) / Exposure to occupational biological risks: Experience of a toxicology information center

Background: Exposure to Biological Agents during work is an emergent type of occupational risk. Aim: To characterize occupational biological risk exposure among Chilean workers which have been registered by the Toxicology Information Center, between January 2006 and December 2009. Material and Methods: All incoming calls reporting exposure to biological agents during the studied period were analyzed. The information obtained from the caller was registered using the Communication Record Instrument of the WHO International Programme on Chemical Safety (IPCS INTOX). Results: In the studied period, 77 calls were received. The mean age of exposed patients was 35 ± 15 years and 57% of them were females. The most common involved agents were vaccines for veterinary use (42%) followed by Loxosceles laeta bites in 16%. The main routes of exposure were injections, cuts and needle stick injuries in 39% and stings and bites in 38%. The highest exposure rates were observed in Southern Chile due to self-inoculation of veterinary vaccines used in the salmon industry (22.7/100.000 actual workers). Fifty-eight percent of calls were from health care workers, and 51% of them were from health care facilities. Sixty percent of exposures occurred during summer and spring. There was a fourfold higher risk of calls involving women exposed to bites or stings (odds ratio (OR) 4.5 (CI95 1.5-13.9, p < 0.01). Men had a fourfold higher risk of being exposed to vaccines or medications for veterinary use (OR 4.2, CI95 1.4-12.6 p < 0.01). Conclusions: Most calls involving an exposure to a biological agent were caused by self-inoculation of veterinary medications.

Caracterización de la ingestión por sobredosis de paracetamol: Reporte de un centro de información toxicológica chileno / Characterization of paracetamol overdose: Report of a poison information center in Chile

Background: Paracetamol (acetaminophen) is an analgesic and antipyretic drug widely used across the world. Its ingestion is one of the most common causes of drug overdose. In the United States is the first cause of acute hepatitis in adults. Aim: To describe the epidemiological profile of paracetamol overdose in Chile. Material and Methods: Cross sectional retrospective study that included all the phone call inquiries received at the Poison Control Center of the Pontificia Universidad Catolica de Chile (CITUC) during 2009. Results: Nine hundred fifty nine inquiries involving acute paracetamol exposures were received. Women represented a 63.1% of the cases. Half of the cases were suicide attempts, of which 74.8% were women. Accidental exposures occurred mainly in children. In 29.3% of the patients, the exposure was considered to involve a hepatotoxic dose. Women had 2.7 times the risk of men to ingest a toxic dose of paracetamol with suicidal purpose (Odds ratio (OR) = 2.7; 95% confidence interval (Cl): 2.1-3.6; p < 0.001). Adolescents had 3.4 times the risk of the general consultants (OR: 3.4; 95% Cl: 2.4-4.7; p < 0.001). Conclusions: Paracetamol overdose is common in Chile. Authorities should carry out preventive measures. Antidotes and the capacity to measure plasma levels of paracetamol should be available in healthcare centers.

Comparación de la biodisponibilidad y la farmacocinética entre dos formulaciones de tabletas de metforminade 850 mg en voluntarios colombianos sanos / Bioavalaibility and pharmacokinetic comparison of two formulations of metformin 850 mg tablets in healthy Colombian volunteers

Purpose: The aim of this study was to compare the bioavailability of two formulations of metformin 850 mg tablets: Glucophage® from Merck Santè laboratories (reference product) and Metformin from Winthrop Pharmaceuticals de Colombia SA (test product) in healthy Colombian volunteers.Methods: A random, double blind, two-period, two-week wash out period, crossover study was performed in 24 healthy male and female volunteers for a single 850-mg dose of metformin tablets administrated with 240 ml of water after 12 hours of fasting. Once the drug was administrated, blood samples were collected before and within 24 hour, and plasma metformin concentration was determined by using a validated HPLC method. Pharmacokinetic parameters such as Cmax, AUC0-96h, AUC0-∞, and Tmax were determined. The formulations were considered bioequivalent if the logarithmic mean ratios of ln-transformed Cmax and AUC0-∞ values were within the equivalence range of 80%-125%.Results: ANOVA analysis of the ln-transformed Cmax and AUC0-∞ indicated that none of the effects examined (formulation, period, within and between-subjet variances and carry over) was statistically significant. The mean (±SD) of Cmax 1217.38 (± 251.72) ng/ml vs. 1305.25 (± 301.06) ng/ml, AUC0-96h 1363.49 (± 315.51) ng.h/ml vs. 1584.82 (± 368.75) ng.h/ml, AUC0-∞, 7155.75 (± 1440.74) ng.h/ml vs. 7777.08 (± 1896.49) ng.h/ml, and Tmax 2.57 (± 0.93) h vs. 2.22 (± 0.94) h were obtained with test and reference formulations, respectively. These pharmacokinetic parameters presented differences with the results from other published papers. The 90% confidence interval of the logarithmic ratio of AUC0-∞ and Cmax was within the range of 80-125%.Conclusions: In this study in healthy Colombian volunteers, a single 850-mg dose of metformin tablet test formulation met the criteria for bioequivalence to the reference formulation based on pharmacokinetic parameters AUC0-∞ and Cmax.

Objetivo: El objetivo de este estudio es comparar la bioequivalencia de dos formulaciones de tabletas de metformina de 850 mg: Glucophage® del Laboratorio Merck Santè (producto de referencia) y metformina de Laboratorios Winthrop Pharmaceuticals de Colombia SA (producto de prueba), en voluntarios colombianos sanos.Métodos: Se realizó un estudio aleatorizado, doble ciego, cruzado, en dos períodos y con un tiempo de lavado de dos semanas, en 24 voluntarios sanos, hombres y mujeres, que recibieron una dosis única de metformina de 850 mg, con 240 ml de agua, después de 12 horas de ayuno. Luego de la administración del medicamento, se recolectaron muestras de sangre durante 24 horas y las concentraciones plasmáticas de metformina se determinaron con un método de HPLC validado. Se calcularon los parámetros farmacocinéticos: Cmax, AUC0-96h, AUC0-∞, y Tmax. Las formulaciones se consideraron bioequivalentes si la relación de la media transformada a ln de Cmax y AUC0-∞ estaba dentro del rango de bioequivalencia de 80% a 125%.Resultados: El Anova de los datos transformados a ln de Cmax y AUC0-∞ indicaron que ninguno de los efectos analizados (formulación, período, variación intra e intersujetos y arrastre) fueron estadísticamente significativos. La media (±SD) de los parámetros obtenidos para los productos de prueba y de referencia, respectivamente, fueron: Cmax 1217.38 (± 251.72) ng/ml vs. 1305.25 (± 301.06) ng/ml, AUC0-96h 1363.49 (± 315.51) ng.h/ml vs. 1584.82 (± 368.75) ng.h/ml, AUC0-∞, 7155.75 (± 1440.74) ng.h/ml vs. 7777.08 (± 1896.49) ng.h/ml, and Tmax 2.57 (± 0.93) h vs. 2.22 (± 0.94) h. El intervalo de confianza de la relación logarítmica del AUC0∞ y Cmax se encontró dentro del rango de 80% a 125%.

Evaluación de u test alternativo para el diagnstico de crecimiento auricular en base a la morfología de las ondas f en la fibrilación auricular / Evaluation of an alternative test for the diagnosis of atrial growth based on the morphology of the waves f in the atrial fibrillation

La fibrilación auricular, una arritmia frecuente, muestra en el ECG la sustitución de las ondas p por ondas f, algunas de mayor amplitud. Estas últimas se asocian a crecimiento auricular (factor predictivo en el manejo de FA); cuando no se dispone de eco-cardiógrafo en emergencias, es necesario un método diagnóstico alternativo para el crecimiento auricular en pacientes inestables; Proponemos como test diagnóstico: Crecimiento auricular (>40mm)>>0nda f gruesa (>0,1mV)". Nuestro estudio analítico toma como universo a pacientes atendidos por el servicio de cardiología del HCV de Cochabamba-Bolivia de 2005 a 2009, 1000 pacientes de forma aleatoria simple, muestra de 150 pacientes. La tasa de prevalencia de FA 15%(IC95%:13;17); sexo predominante masculino, 54,7%(RR=1(X2=0 y valor de p >0,05-No significativo)); edad con rango de 17-81 años, mediana de 53 años ((IC95%:50;56)(RIC = 21 años)); Clasificando se encontró onda f gruesa en 65%(IC95%:57;73) y crecimiento auricular izquierdo en 88%(IC95%:83;93); La correlación Crecimiento auricular>>Onda f gruesa encontrada dio un OR=1,5; ó 0,5 veces más posibilidad de presentar onda f gruesa en crecimiento auricular. Se encontró cardiomiopatía chagásica y reumática asociados, representando el 65%. Validez interna del test: S=66%; E=44%; VPP=90% y VPN = 15%, la capacidad para determinar crecimiento auricular con el test positivo (S) es baja, aceptable, pero la probabilidad de tener test positivo en crecimiento auricular (VPP) es muy alta; validez externa: Índice kappa = 0,6-Reproductibilidad inter-observador moderada, comparada con la eco-cardiografía. Se obtuvo mayor aplicación en cardiopatía chagásica (S=70%, E=57%, VPP=94%).

The atrial fibrillation (FA), a frequent arrhythmia, the ECG replaces the waves p with waves f, some of them, these last ones associate to atrial growth (factor predictive in the handling of AF); The Clinical Hospital Viedma (CHV), departmental center of reference, it doesn't have echo-cardiograph in emergencies, is necessary a new alternative diagnosis method for the atrial growth in unstable patient; We propose a diagnosis test: "atrial growth (>40mm) >>Wave thick f (>0,1mV)". Our descriptive-analytic and traversal study, taking of the universe, patients assisted by the cardiology service in the HCV of Cochabamba-Bolivia from 2005 to 2009 (4700-patient), a sample of 1000 patients, a simple aleatory way, we work with 150 patients (representative). Results: rate of prevalence of AF, 15%(IC95%:13;17); Masculine predominant sex, 54,7%(RR=1(X2=0 and value of p >0,05-no significant)); Age with 17-81 year-old range, mediana=53 anos(CI95%:50;56) and journey intercuartil (IQR)=21 years; Classifying was thick wave f in 65%(CI95%:57;73) and atrial left growth in 88%(IC95%:83;93); The correlation atrial growth>>Wave thick f", we obtained a OR=1,5; or 0,5 times more possibility to present wave thick f in atrial growth. We find Chagas myocardiophaty and pathologies rheumatic associates, both 65%; Internal validity of the test: S=66%; E=44%; PPV=90% and PNV=15%, the capacity to determine atrial growth with the positive test (S) it is acceptable, but the probability of having positive test in atrial growth (PPV) it is very high; External validity: Index kappa = moderated 0,6-Reproductibilidad inter-observer, compared with the echo-cardiography. Bigger application was obtained in Chagas myocardiopathy (S=70%, E=57%, PPV=94%).

La importancia de la salud ambiental y el alcance de las unidades de pediatría ambiental / The relevance of environmental health and the scope of pediatric environmental health specialty units

In the last decades there has been an important decrease in infant mobidity and mortality, but these achievements are not equally distributed across thewhole population. Children are one of the most susceptible groups due to their unique vulnerabilities to environmental factors. Unhealthy environments, indoor pollution, poor drainage, inadequate waste disposal, and many others, are significant environmental risk factors to children. Currently, Chile is experiencing an advanced demographical transition, asituation that requires a precise approach to guarantee that the population has an adequate health status. It is important to take care of children, since their present health status will condition their health as adults. Pediatric Environmental Health Specialty Units are structures specialized in pediatric conditions related to the environment, formed by aninterdisciplinary and highly specialized team. These centers provide assistance, information and treatment, promote research, educate health care providers or the public, and report problems to authorities. Health authorities should emphasize the importance of having a safe environment for children and encourage efforts to reduce exposure to environmental hazards promoting healthy behaviors, education and awareness at all levels of society.

Epidemiología de las intoxicaciones: análisis de las llamadas efectuadas durante el año 2007 al Centro de Información Toxicológica (CITUC) de la Pontificia Universidad Católica de Chile / Epidemiology of intoxications: analysis of calls made during 2007 to the Toxicology Information Center (CITUC) of the Catholic University of Chile

Objetivo: Describir y caracterizar la epidemiología de las consultas por intoxicaciones al Centro de Información Toxicológica de la Universidad Católica (CITUC) y conocer las variaciones epidemiológicas producidas entre los años 2004 y 2007. Método: Se realizó un estudio retrospectivo, observacional y descriptivo de las llamadas registradas por el Centro durante el periodo del año 2007. Se analizaron las siguientes variables: número total de llamadas, lugar de las llamadas, circunstancias de la exposición, tipo y números de agentes involucrados, vías de exposición, tiempo desde la exposición, características demográficas y las indicaciones y tratamientos recomendados. Resultados: Se registraron 30.171 llamadas. El 45 por ciento de las consultas provenían del hogar y el 52,5 por ciento de las instalaciones de salud. El 67,2 por ciento de las consultas fueron exposiciones accidentales y el 29,2 por ciento fueron intencionales. Los Medicamentos se presentaron en un 57,1 por ciento de las llamadas, seguidos por los Productos de uso doméstico (16,5 por ciento), Productos de uso industrial (4,7 por ciento), y Pesticidas (5,8 por ciento). La ingestión fue la vía de exposición que se predominó en un 76,6 por ciento del total de casos. El 23,3 por ciento del total de las llamadas, se realizaron dentro de la primera hora post-exposición. Las intoxicaciones en niños menores de 14 años correspondieron al 50 por ciento de las llamadas. Respecto al año 2004 aumentó la proporción de llamadas procedentes del hogar y el porcentaje de intoxicaciones intencionales. Conclusiones: Los medicamentos constituyen el principal agente de intoxicación. La principal vía de exposición es la ingesta y el principal grupo de población afectado son los niños menores de 14 años. Estos son indicadores evidentes y claros de la necesidad imperante de desarrollar campañas publicitarias preventivas e informativas, avaladas por el Ministerio de Salud, respecto al correcto almacenamiento...

Objective: To describe the epidemiological features of the intoxication cases reported to CITUC and the variations produced between 2004 and 2007. Method: A retrospective and descriptive study of the calls registered at the Center during 2007. The following data were analyzed: number and place of the calls; circunstances of exposure; type and number of agents involved; routes of exposure; time since exposure; sex and age of the subjects, and treatment and advice offered. Findings: 30.171 calls were received, 45 percent from the home and 52,5 percent from Health Care Service; 67,2 percent were accidents and 29,2 percent were intentional exposures. The agents were: medicines (57,1 percent); cleaning products (16,5 percent) pesticides (5,8 percent); other chemical and industrial products (4,7 percent). The exposure route was oral in 76,6 percent of cases; 48 percent of calls occurred within one hour of exposure. Children under six were the main group involved. Conclusion: The evidence substantiates a need for prevention campaigns, sponsored by the Health Ministry, about the correct storage of medicines and the appropiate management of poisoning at home. Child-resistant containers and education are two essential elements for prevention of pediatric intoxications.

Tóxicos al alcance de los niños / Household hazardous

Existen productos frecuentes de uso doméstico y plantas ornamentales en nuestros jardines con gran poder toxigénico que son importantes de conocer.

Intoxicación por rodenticidas anticoagulantes / Poisoning by anticoagulant rodenticides

El Centro de Información Toxicológica de la Universidad Católica (CITUC) recibe llamados telefónicos de todo Chile en relación a intoxicaciones. Este artículo realiza una revisión de los llamados recibidos durante 2007 y específicamente los relacionados a intoxicación con rodenticidas, sustancia importante por la gravedad de sus consecuencias.

Evaluación del efecto de cuatro polimorfismos en el gen del receptor adrenérgico beta - 2 en el parto pretérmino / Role of four polymorphisms of the beta - 2 adrenergic receptor gen in patients with preterm delivery

Objetivo: Determinar si los polimorfismos de nucleótido único encontrados en la secuencia del receptor β-2 adrenérgico β2AR) se asocian con el parto pretérmino espontáneo. Método: Se realizó un estudio de casos y controles no pareado en el que se determinaron y compararon las frecuencias alélicas, genotípicas y haplotípicas de cuatro polimorfismos, -47 C/T, -20 C/T, Arg16Gly y Gln27Glu del gen del β2AR, entre 35 mujeres con parto pretérmino (casos) y 105 mujeres con parto a término (controles). El estudio se hizo con pacientes de tres instituciones hospitalarias de la ciudad de Medellín, Colombia. Se aisló el ADN genómico de sangre periférica, se amplificó el segmento del gen mediante la reacción en cadena de la polimerasa (PCR) y se determinaron los polimorfismos por secuenciación directa. Resultados: No se encontraron diferencias significativas de las frecuencias alélicas de los loci polimórficos -47 C/T, -20 C/T, Arg16Gly y Gln27Glu entre el grupo de casos (21.5%, 21.5%, 51.5% y 21.5%, respectivamente) y los controles (21.5%, 21.5%, 57% y 21.5%, respectivamente (p>0.05). Las frecuencias genotípicas también fueron similares entre las pacientes con parto pretérmino y las de parto a término (p>0.05 para todos los genotipos). De los 16 posibles haplotipos, resultantes de la combinación entre los distintos alelos, sólo se presentaron tres en toda la población de estudio (CCGG, TTGC, TTAC). Las frecuencias haplotípicas tampoco tuvieron diferencias significativas entre los grupos comparados (p>0.05). Conclusión: No se observó una asociación entre el parto pretérmino y cualquiera de los polimorfismos o sus haplotipos. Estos resultados no apoyan una participación de los polimorfismos del β2AR en el trabajo de parto pretérmino espontßneo en estas pacientes.

Objective: To determine whether single nucleotide polymorphisms found in the sequence of the β-2 (β2AR) adrenergic receptor are associated with spontaneous preterm delivery. Method: A case-control study in which the allelic, genotype, and haplotype frequencies of four polymorphisms, -47 C/T, -20 C/T, Arg16Gly, and Gln27Glu of the β2AR gene, were determined and compared between 35 women with preterm delivery (cases) and 105 women with term delivery (controls). The study was performed with patients of three hospitals in the city of Medellín, Colombia. The genomic DNA of peripheral blood was isolated, the segment of the gene was amplified by means of the chain reaction of polymerase (PCR), and the polymorphisms were determined by direct sequence method. Results: No significant differences for the allelic frequencies were found for polymorphic loci -47 C/T, -20 C/T, Arg16Gly, and Gln27Glu between the cases group (21.5%, 21.5%, 51.5% and 21.5%, respectively) and controls (21.5%, 21.5%, 57% and 21.5%, respectively; p>0.05). The genotype frequencies were also similar between patients with preterm delivery and those with term delivery (p>0.05 for all the genotypes). Only three of the 16 possible haplotypes (CCGG, TTGC, and TTAC), from the combination between the different alleles, appeared in the participants of this study. The haplotype frequencies were not significantly different between the compared groups either (p>0.05). Conclusion: No association was observed between preterm delivery and any of the polymorphisms or its haplotypes. These results do not support a role of the polymorphisms of the β2AR in spontaneous preterm delivery for these patients.

Caracterización clínico-epidemiológica telefónica de la mordedura por araña de rincón, en un centro de información toxicológica de Chile, durante el año 2005 / Prevalence and epidemiology of Loxosceles laeta bite. Analysis of consultations to a poison control center

Background: Loxoscelism is caused by the bite of spider Loxosceles laeta. It can cause a cutaneous or systemic syndrome. Aim: To determine the epidemiol¢gica! and clinical features of patients bitten by the Chilean recluse spider (Loxosceles laeta). Material and Methods: All communications received at a telephonic orientation center for intoxications during 2005 were analyzed, selecting those who involved patients with symptoms that suggested loxoscelism (i.e., pain, burning sensation, blue area, hematuria, fever or myalgia). These were derived to the emergency room for confirmation of the diagnosis. Forty-eight hours after the initial communication, patients were contacted by phone to find out about the definitive diagnosis. The variables analyzed were: gender, age, geographical location, time since exposure, part of the body involved, clinical signs and definitive diagnosis. Results: Of 2,831 telephonic consultations with suspected loxoscelism, the diagnosis was confirmed in 287. All of these patients had cutaneous loxoscelism and only 7.3 percent of them developed visceral loxoscelism. Fifty six percent of patients with loxoscelism presented two or more clinical signs. The most common were a blue area, pain and a burning sensation, in 69 percent, 58 percent and 38 percent of patients, respectively. Fifty-one percent of patients developed signs within the first 12 hours. All patients with visceral syndrome presented with hemoglobinuria. No cases of loxoscelism were registered in areas located southern than the Xth region of Chile. There were no fatalities attributed to loxoscelism. Conclusions: Most cases of loxoscelism of this series were cutaneous. The population must be educated about the clinical signs of spider bite to seek early and adequate medical treatment.

Intoxicación por antidepresivos tricíclicos en pediatría / Tricyclic antidepressant poisoning in children

Los medicamentos antidepresivos son recetados con frecuencia en adultos y lamentablemente están al alcance de los niños en muchos domicilios, lo que tiene como consecuencia el riesgo de intoxicación accidental o con fines suicidas. Se decriben en este artículo los graves efectos de la intoxicación por antidepresivos tricíclicos.

Epidemiología de las intoxicaciones que generaron llamadas durante el año 2004 al Centro de Información Toxicológica (CITUC) de la Pontificia Universidad Católica de Chile: Región Metropolitana / Epidemiology of intoxication cases that originated calls to the Toxicology Information Centre (CITUC) of the Catholic University of Chile: Metropolitan Region, 2004

Objetivo: Describir y caracterizar la epidemiología de las consultas por intoxicaciones, reportados al Centro de Información Toxicológica de la Universidad Católica (CITUC). Método: Se realizó un estudio retrospectivo y descriptivo de las llamadas registradas por el centro durante el período del año 2004. Se analizarán los siguientes datos: número total de llamadas, lugar de la llamada, circunstancias de la exposición, tipo y nº de agentes involucrados, vías de exposición, tiempo desde la exposición, sexo y edad de los pacientes, y las indicaciones y tratamientos recomendados. Resultados: Se registraron 22.168 llamadas. El 52,5 por ciento de las consultas provenían del hogar y el 40,2 por ciento de los Servicios de Urgencia. El 71,6 por ciento de las consultas eran exposiciones accidentales y el 19,8 por ciento fueron intencionales. Los medicamentos se presentaron en un 53,6 por ciento de las llamadas, seguidos por los Productos de Aseo (13,7 por ciento), Productos industriales y Químicos (10,2 por ciento), y Pesticidas (7,1 por ciento). El 92,5 por ciento de las exposiciones eran con un agente tóxico. La ingestión fue la vía de exposición que se registró en un 82 por ciento. El 44,6 por ciento del total de las llamadas, se realizaron dentro de la primera hora post-exposición. Las intoxicaciones en niños menores de 6 años correspondieron al 47,9 por ciento de las llamadas. Conclusiones: Los medicamentos constituyen el principal agente de intoxicación. La principal vía de exposición es la ingesta y que el principal grupo de población afectado son los niños menores de 6 años. Estos son indicadores evidentes y claros de la necesidad imperante de desarrollar campañas publicitarias preventivas e informativas, avaladas por el Ministerio de Salud, respecto al correcto almacenaje de los medicamentos y el manejo de las intoxicaciones en el hogar. La introducción del envase resistente a niños y la educación constituyen dos piezas fundamentales en la prevención de las intoxicaciones pediátricas.

Intoxicación por clobutinol y oxolamina / Poisoning for clobutinol and oxolamine

El objetivo de este artículo es revisar los efectos y rasgos tóxicos descritos en la literatura y establecer un manejo clínico adecuado y específico para la intoxicación con estos medicamentos.