Intoxicação em crianças no estado do Paraná, Brasil / Child Intoxication in the State of Paraná, Brazil

As intoxicações configuram-se como problema de saúde pública em âmbito mundial. No Brasil, estima-se que 33% dos casos de intoxicação medicamentosa pertençam ao grupo de crianças menores de nove anos de idade. Analisar as notificações compulsórias por intoxicação em crianças de zero a nove anos no Estado do Paraná, entre os anos de 2016 e 2020. Por meio de um estudo epidemiológico, descritivo com abordagem quantitativa, referente aos casos de notificação por intoxicação em crianças no Estado do Paraná, no período de 2016 a 2020. Realizado análise descritiva e distribuição espacial dos dados. Por se tratar de dados secundários o estudo dispensou apreciação ética. Foram notificados 8.595 casos de intoxicação em crianças no período em estudo. Houve predominância da faixa etária de 1 a 4 anos (73,5 %), sexo masculino (54,9%) e da cor branca (73,1%). Os agentes tóxicos mais frequentes foram os medicamentos (45%) e os produtos de uso domiciliar (20,5%). Quanto ao tipo de exposição foi a aguda-repetida (93,6%), em que o desfecho foi cura sem sequela (94,8%). Os casos de intoxicações estão relacionados às crianças nas fases iniciais de vida, destacando que muitos acidentes podem ser evitados por meio de boas práticas de armazenamento de produtos.

Intoxications constitute a worldwide public health issue. In Brazil, it is estimated that 33% of drug intoxication cases belong to children under nine years of age. This study aimed to analyze compulsory notifications of intoxication in children aged zero to nine years in the State of Paraná between the years 2016 and 2020. Using an epidemiological, descriptive study with a quantitative approach, the cases of notification due to child intoxication in the State of Paraná were examined from 2016 to 2020. Descriptive analysis and spatial distribution of the data were performed. As the study involved secondary data, ethical approval was not required. A total of 8,595 cases of child intoxication were reported during the study period. The age group of 1 to 4 years predominated (73.5%), as well as male gender (54.9%) and white ethnicity (73.1%). The most frequent toxic agents were medications (45%) and household products (20.5%). Regarding the type of exposure, acute-repeated exposure (93.6%) was the most common, with an outcome of cure without sequelae (94.8%). Cases of intoxication are linked to children in the early stages of life, emphasizing that many accidents can be prevented through proper product storage practices.

Causas de ataxia aguda en un hospital de tercer nivel de complejidad / Causes of acute ataxia at a tertiary level hospital

La ataxia es una alteración de la coordinación motora voluntaria y del control postural. Es una entidad poco frecuente en la infancia, siendo la principal causa de ataxia aguda descripta en la bibliografía, de origen inmunológico (post infecciosa), seguida de las intoxicaciones. Para el diagnóstico es fundamental una anamnesis detallada, cronología de los síntomas, antecedentes infecciosos o de contacto con sustancias tóxicas y un examen neurológico completo. El objetivo de nuestro estudio fue analizar retrospectivamente la causa de ataxia aguda como signo neurológico predominante en pacientes que consultaron en el Hospital Juan P. Garrahan. Diseño: Se trata de un estudio descriptivo, observacional, retrospectivo y de corte transversal. Población: niños de 1 a 18 años, con o sin patología previa conocida, que consultaron al servicio de emergencias del hospital por ataxia entre enero de 2013 y octubre de 2018. Método: recolección y análisis de historias clínicas comprendidas en esa fecha, con alteración en la marcha como síntoma de consulta. Resultados: de un total de 237 pacientes, la causa más frecuente de ataxia aguda fue la inmunológica (incluyendo en este grupo a las postinfecciosas y a las no asociadas a infección). Conclusión: En nuestro hospital con tercer nivel de atención, la causa más frecuente de ataxia aguda fue la inmunológica. En segundo lugar, las intoxicaciones y, en tercer lugar, las enfermedades neurológicas. (AU)

Ataxia is a disorder of voluntary motor coordination and postural control, which is rare in childhood. The main cause of acute ataxia described in the literature is immune-mediated inflammation (postinfectious), followed by intoxication. A detailed anamnesis, chronology of symptoms, history of infection or contact with toxic substances, and a complete neurological examination are essential in the diagnostic work-up. The aim of our study was to retrospectively analyze the cause of acute ataxia as a predominant neurological sign in patients who consulted at Hospital Juan P. Garrahan. Study design: A descriptive, observational, retrospective, cross-sectional study was conducted. Study population: children aged 1 to 18 years, with or without known previous disease, who presented to the hospital emergency department for ataxia between January 2013 and October 2018. Method: collection and analysis of medical records from that period of patients with gait disturbance as the reason for consultation. Results: out of a total of 237 patients, the most frequent cause of acute ataxia was immune-mediated inflammation (both post-infectious and noninfectious). Conclusion: In our tertiary care hospital, the most frequent cause of acute ataxia was immune-mediated inflammation. The second most frequent cause was intoxication and the third neurological diseases (AU)

Intoxicações de mercúrio e chumbo com maior prevalência em crianças e trabalhadores no Paraná / Intoxications by mercury and lead with higher prevalence in children and workers in Paraná

Resumo Introdução A intoxicação exógena é um importante problema de saúde pública no Brasil. Objetivo Analisar os casos de intoxicação por metais na população do estado do Paraná e estimar a taxa de prevalência, bem como os fatores associados. Método Foi realizado um estudo descritivo com base nas intoxicações notificadas no período de 2007 a 2015. Resultados foram identificados 117 casos de intoxicação por metais e estimada uma prevalência de 1,2 caso por milhão de habitantes, com predomínio de casos no macrorregional norte da saúde. Com relação aos agentes tóxicos, mercúrio (41%) e chumbo (40,2%) foram confirmados como os mais frequentes. Dentre esses casos, houve predomínio do sexo masculino (57,3%), na faixa etária de 20 a 59 anos (55,6%), seguido da faixa etária de 1 a 4 anos (28,2%). Além disso, a residência e o local de trabalho foram destacados como locais de maior exposição, sendo relatados como acidentais em 70,1% dos casos, dos quais 41,9% necessitaram de cuidados hospitalares, 91% evoluíram para cura e houve um óbito. Conclusão A intoxicação por metais tem afetado principalmente crianças e trabalhadores, sugerindo medidas educativas e preventivas.

Abstract Background Exogenous intoxication is an important public health problem in Brazil. Objective Analyze cases of metal poisoning in the population of Paraná state and estimate the prevalence rate, as well as the associated factors. Method A descriptive study based on intoxications that were reported from 2007 to 2015 was performed. Results 117 cases of metal poisoning were identified and a prevalence rate of 1.2 cases per million inhabitants was estimated, with a predominance of cases on the northern health macro-regional complex. With respect to toxic agents, mercury (41%) and lead (40.2%) were confirmed as the most frequent ones. Among these cases, there was a predominance of males (57.3%), aged between 20 and 59 years old (55.6%), followed by the age group from 1 to 4 years old (28.2%). In addition, the residence and work place were highlighted as places of greatest exposure, being reported as accidental one in 70.1% of the cases, of which 41.9% required hospital cares, 91% evolved to cure and there was one death. Conclusion The metal poisoning has affected mainly children and workers, suggesting educational and preventive measures.

Morbilidad por intoxicaciones exógenas en un hospital pediátrico de Santiago de Cuba / Morbidity due to exogenous intoxications in a pediatric hospital from Santiago de Cuba

Introducción: Las intoxicaciones por accidentes constituyen causas crecientes de morbilidad, hospitalización, invalidez e incluso mortalidad. Objetivo: Describir aspectos clínicos y epidemiológicos en niños y adolescentes con intoxicaciones agudas. Métodos: Se realizó un estudio observacional, descriptivo y prospectivo en niños y adolescentes ingresados por intoxicación exógena en los servicios de Atención Continuada a pacientes en estado grave y de Misceláneas del Hospital Infantil Docente Sur Dr. Antonio María Béguez César de Santiago de Cuba, de enero del 2016 a igual mes del 2018. Resultados: Las intoxicaciones presentaron una elevada incidencia en el grupo etario de 15-18 años (61,7 %) y en el sexo femenino (85,1 %); la mayoría se produjo de modo voluntario (85,1 %), principalmente en el hogar (84,1 %) y con predominio de los medicamentos como agente causal (86,9 %). La evolución clínica resultó ser satisfactoria en 68,2 % de los pacientes; en el resto no fue así debido a la aparición de complicaciones, sobre todo de gastritis medicamentosa (30,8 %). Conclusiones: Las intoxicaciones en la infancia y la adolescencia son una causa importante de morbilidad luego de las infecciones respiratorias, y constituyen un motivo usual de urgencia médica en los hospitales pediátricos.

Introduction: Poisonings due to accidents are increasing causes of morbidity, hospitalization, disability and even mortality. Objective: To describe the clinical and epidemiological aspects in children with acute intoxications. Method: An observational, descriptive and prospective study was carried out in children and adolescent patients admitted with the diagnosis of exogenous intoxication in the services of Continuous Care to severely ill and Miscellaneous patients from Dr. Antonio María Béguez César Southern Pediatric Teaching Hospital, in Santiago de Cuba from January, 2016 to January, 2018. Results: Poisoning had a high incidence in the 15 - 18 years group (61,7 %) and in the female sex (85,1 %); most of them took place voluntarily (85,1 %), mainly at home (84,1 %) and with predominance of drugs as causal agent (86,9 %). Clinical course was satisfactory in 68,2 % of the patients; it was not the same in the rest due to the emergence of complications, above all due to drug gastritis (30,8 %) Conclusions: Poisoning in childhood and adolescence is an important cause of morbidity, after the respiratory infections, and constitute an usual reason of medical emergencies in pediatric hospitals.

Relación de intencionalidad en pacientes con intoxicaciones agudas por plaguicidas en un hospital de Ibagué-Colombia / Acute pesticide poisoning and its relationship with intentionality in patients from a hospital in Ibague-Colombia

Resumen Introducción: La intoxicación aguda por plaguicidas, asociada al suicidio, es un problema de salud pública cuyo estudio es primordial por los organismos estatales. Objetivo: Establecer la relación de intencionalidad en pacientes con intoxicación aguda por plaguicidas, junto a la descripción de algunas características sociodemográficas y de exposición registrados en un hospital de Ibagué desde 2013 a 2016. Materiales y métodos: Se realizó un estudio observacional descriptivo de corte transversal retrospectivo en 137 registros notificados con intoxicación aguda por plaguicida según los códigos del CIE 10. Desarrollo de análisis estadístico descriptivo y estratificado para encontrar la asociación de características con la intencionalidad de la intoxicación. Resultados: El 50% de los casos correspondían a personas menores de 20 años; el 79,6% de las intoxicaciones tenían fines suicidas y se observó que el 45% realizaron un intento de suicidio previo; un nivel educativo alto correspondió a un bajo riesgo de envenenamiento intencional [OR=0,05; IC95% (0,01-0,56); p=0,01]. Conclusiones: Es necesaria la cooperación entre las autoridades en salud e instituciones públicas para implementar medidas de control y demás estrategias que prevengan las intoxicaciones con plaguicidas, particularmente la exposición voluntaria asociada al suicidio, fenómeno creciente en esta ciudad.

Abstract Introduction: Acute pesticide poisoning associated with suicide is a public health problem that requires special attention by state agencies. Objective: To establish the relationship of patient's intent with acute pesticide poisoning and describe some sociodemographic and exposure characteristics registered by a hospital in Ibagué (Colombia), from 2013 to 2016. Materials and methods: A retrospective, cross-sectional, descriptive, observational study was conducted on 137 reports of acute pesticide poisoning that were registered according to ICD 10 codes. A descriptive and stratified statistical analysis was applied to establish the association between characteristics of poisoning intentionality. Results: 50% of the cases corresponded to people who were under 20 years of age. 79.6% of the poisonings were due to suicide attempt and 45% had had a previous attempt. A high educational level corresponded to a lower risk of intentional poisoning [OR=0.05; IC95% (0.01-0.56); p=0.01]. Conclusions: Cooperation between health care authorities and public institutions is necessary to implement measures and strategies in order to prevent acute pesticide poisoning events, especially those associated with suicide attempts, the frequency of which is growing in this city.

Profile of intoxications served at the 24-hour emergency service unit

Intoxications represent a serious public health problem. According to the World Health Organization, 193,000 deaths per year are caused by unintended intoxications worldwide. This study aims to know the profile of intoxications at the 24-hour Emergency Service Unit in Divinópolis, in the state of Minas Gerais. This is a descriptive study in which the study population chosen were all patients treated for intoxications in the period from 2017 to 2018, registered in the health service; 421 cases of intoxications were recorded. The female gender was the most prevalent, and the age group with the most cases was 21 to 30 years. The main circumstance found was attempted suicide (83.1%), and the main causative agent was drugs (76.5%), with benzodiazepines being the main class responsible for intoxications. The most used treatment was gastric lavage and activated charcoal. This study demonstrates that knowledge about the city's intoxication profile is important for the development of treatment and patient management methods to better suit the demands of the municipality.

Métodos y sustancias empleados en la conducta suicida en adolescentes / Methods and substances involved in teen suicide

Introducción: Actualmente, el suicidio es un problema de salud que constituye la tercera causa de muerte a nivel mundial en los adolescentes entre 11 y 18 años, y en Cuba es la cuarta causa de muerte en las edades de 10 a 19 años. Los métodos empleados para cometer el intento de suicidio y el suicidio están en dependencia de su disponibilidad, el acceso que la persona tenga a un método particular, el antecedente familiar que tenga del uso de uno u otros métodos, entre otros. Objetivo: Identificar el método utilizado para cometer el intento de suicidio y el suicidio en adolescentes. Métodos: Estudio descriptivo retrospectivo, que forma parte de varias tareas incluidas en el Proyecto de investigación Estrategia de prevención de la conducta suicida en adolescentes de provincias seleccionadas, que duró 10 años. Resultados: Los métodos empleados fueron consumo de psicofármacos y los tóxicos para los intento de suicidio y en los casos de suicidios, fueron, prioritariamente, ahorcamiento e incineración. Las sustancias mayormente empleadas fueron: herbicidas y lociones de uso externo para la piel. Conclusiones: Los métodos empleados que predominaron para los intentos de suicidio fueron los psicofármacos y tóxicos, y el ahorcamiento e incineración para el suicidio, lo que pudiera estar en correspondencia con la disponibilidad de los mismos(AU)

Introduction: Suicide is a current health problem constituting the third leading cause of death worldwide among 11-18-year-old teenagers. In Cuba it is the fourth leading cause of death in the 10-19 years age group. The methods used to commit a suicide attempt or suicide depend on their availability, the person's access to a given method, and family antecedents of the use of one method or another, among others. Objective: Identify the methods used by teenagers to commit attempted or actual suicide. Methods: A retrospective descriptive study was conducted as part of the various tasks included in the research project Strategy to prevent suicidal behavior among teenagers from selected provinces, which was developed for ten years. Results: The methods used in suicide attempts were the intake of psycholeptics and toxic substances, whereas the methods used for actual suicide were mainly hanging and burning. The most common substances were herbicides and topical skin lotions. Conclusions: The methods most frequently used were the intake of psycholeptics and toxic substances for suicide attempts and hanging and burning for suicide. This could be associated to the availability of resources required to commit the act(AU)

Assessment on health risk of drinking water in Hangzhou / 预防医学

Objective@#To assess the health risk associated with drinking water in Hangzhou from 2016 to 2017,and to provide evidence for the safety of drinking water .@*Methods@#The monitoring data of 5 genetic toxic substances（arsenic,hexavalent chromium,cadmium,chloroform,tetrachloromethane）and 13 body toxic substances（lead,mercury,selenium,cyanide,fluoride,nitrate,iron,ammonia nitrogen,manganese,copper,zinc,aluminum,volatile phenol）from 36 source water samples,36 finished water samples and 288 tap water samples in the main urban areas of Hangzhou were collected from 2016 to 2017. The health risk of drinking water containing the chemical pollutants mentioned above were assessed based on the evaluation models recommended by United States Environmental Protection Agency .@*Results@#The concentrations of 5 genetic toxic substances and 13 body toxic substances in source water,finished water and tap water were all within the reference limits issued by Standards for Drinking Water Quality（GB 5749—2006）. The carcinogenic risk,non-carcinogenic risk and total health risk caused by the chemical pollutants in the source water were 2.18×10-5/a,7.75×10-9/a and 2.18×10-5/a. The carcinogenic risk,non-carcinogenic risk and the total health risk caused by the chemical pollutants in the finished water were 1.08×10-5/a,3.70×10-9/a and 1.08×10-5/a. The carcinogenic risk,non-carcinogenic risk and total health risk caused by the chemical pollutants in the tap water were 1.96×10-5/a,3.61×10-9/a and 1.96×10-5/a. The carcinogenic risk and total health risk caused by chemical pollutants ranged from high to low in the source water,tap water and finished water. The non-carcinogenic risks ranged from high to low in the source water,finished water and tap water .@*Conclusion@#The health risks of 18 chemical pollutants in drinking water in Hangzhou were at a low level,with the greater carcinogenic risk than the non-carcinogenic risk. Hexavalent chromium had the highest carcinogenic risk,while fluoride and aluminum had the highest non-carcinogenic risk.

La vida posible de poblaciones expuestas a sustancias tóxicas: desafíos para una cultura de paz

La dignidad humana se reconoce como el principio ético básico que fundamenta la forma de gobierno democrática adoptada constitucionalmente en Paraguay. Este principio se entiende como autonomía o como posibilidad de diseñar un plan vital y de determinarse según características propias, requiere de ciertas condiciones materiales concretas de existencia y exige protección de la integridad física e integridad moral. Desde esta perspectiva, se reflexiona, a partir del análisis de estudios sobre poblaciones expuestas a sustancias tóxicas en diferentes contextos, acerca de la vida posible de dichas poblaciones, condicionada por la vulneración de derechos básicos, situación que plantea desafíos para promover una educación para la paz desde dichas realidades.

Human dignity is recognized as the basic ethical principle that underlies the form of democratic government constitutionally adopted in Paraguay. This principle is understood as autonomy or as the possibility to design a life plan and to determine one's own choices according to one's own characteristics. It requires certain basic material conditions of existence, which include the protection of an individual's physical and moral integrity. Based on this perspective, we reflect about the possible life of populations exposed to toxic substances, using analyses of overpopulation studies exposed to toxic substances in different contexts, conditioned by the violation of basic human rights, a reality that poses challenges in the promotion of education towards a peaceful existence.

Necesidades educativas sobre infecciones de transmisión sexual en adolescentes de La Habana Vieja, Cuba / Educational requirements of adolescents from Old Havana municipality in relation to sexually transmitted diseases, Cuba

Objetivos: Identificar necesidades educativas sobre infecciones de transmisión sexual en adolescentes del municipio La Habana Vieja. Métodos: Se conformaron grupos pareados. Se definió como grupo estudio todos los adolescentes diagnosticados con alguna ITS durante el 2013 (n= 110) y el grupo control se conformó con adolescentes no diagnosticados con ITS en el mismo período y que tuvieran las mismas características en cuanto a edad, sexo, grado escolar, consejo popular de residencia y área de salud donde reciben atención. Resultados: Los conocimientos sobre las infecciones de transmisión sexual y su prevención resultaron insuficientes. La frecuencia en que se presentaron las actitudes protectoras fue baja. Los sentimientos afectivos y los valores se tuvieron poco en cuenta en las prácticas de sexualidad. La edad promedio de inicio de las relaciones sexuales fue 12 años para ambos sexos. Se encontró una baja percepción de riesgo. Conclusiones: Se identificaron las necesidades educativas sobre infecciones de transmisión sexual y su prevención. Se comprobó que ambos grupos eran homogéneos respecto a las necesidades educativas identificadas(AU)

Objectives: To identify educational requirements of adolescents from Old Havana municipality in relation sexually transmitted diseases. Methods: Paired groups were formed. All adolescents diagnosed with some STI during 2013 (n= 110) were defined as the study group and the adolescents with no diagnosis of sexually-transmitted disease made up the control group in the same period and who had the same characteristics in terms of age, sex, educational level, area of residence and health area where they receive medical assistance. Results: Knowledge about sexually transmitted infections and their prevention was not broad. The frequency of protective attitudes was low. Emotional feelings and moral values were almost ignored in sexual practice. The average age of onset of sexual intercourse was 12 years for both sexes. A low perception of risk was found. Conclusions: The educational requirements about sexually transmitted infections and their prevention are considered. Both groups are homogeneous with respect to the identified educational requirements(AU)

Formas utilizadas para tentativa de suicídio e características sociodemográficas dos pacientes atendidos no serviço de emergência de um hospital de ensino / Methods used in suicide attempts and sociodemographic characteristics of patients treated at the emergency department of a teaching hospital

OBJETIVOS: Caracterizar as formas utilizadas para tentativa de suicídio e características sociodemográficas de pacientes atendidos no serviço de emergência de um hospital de ensino. MÉTODOS: Estudo transversal retrospectivo, com busca ativa em prontuários eletrônicos de pacientes atendidos entre janeiro e dezembro de 2015 no serviço de emergência de um hospital de ensino, que integra a rede pública de saúde do interior do estado do Rio Grande do Sul, Brasil. Foram incluídos todos os casos de tentativa de suicídio, independente de sua forma. Não foram investigados os casos que resultaram em óbito por suicídio. Foi utilizada estatística descritiva e foram avaliadas associações por análise univariada, sendo aplicado o teste do quiquadrado de Pearson. RESULTADOS: No período estudado foram encaminhados 233 pacientes atendidos na emergência para realização de avaliação psiquiátrica, sendo 122 casos caracterizados por tentativa de suicídio. Desses, a média de idade dos pacientes foi de 36,8±14,3 anos, com mínima de 14 e máxima de 88 anos e, 74 (60,6%) eram do sexo feminino. As formas mais utilizadas de tentativa de suicídio foram ingesta de medicamentos (72 casos, 59%) e ingesta de agrotóxicos (14 casos, 11,5%). Do total de pacientes, 119 (97,5%) residiam no município de Santa Cruz do Sul, com predominância nos moradores da zona urbana (103 pacientes, 84,4%). Dos 50 (41,0%) encaminhamentos, 32 (64,0%) foram para o Centro de Atendimento Psicossocial, 7 (14%) para Centro de Atendimento Psicossocial da Infância e Adolescência, 6 (12%) para internação em unidade de saúde mental e 5 (10%) para o Centro de Atendimento Psicossocial Álcool e Drogas. Em 66 (54,1%) pacientes não foi encontrado nenhum registro em prontuário eletrônico sobre o desfecho após a alta e 6 (4,9%) pacientes evadiram. CONCLUSÕES: A maioria dos pacientes atendidos por tentativa de suicídio foram adultos jovens do sexo feminino. Como principal forma utilizada para a tentativa de suicídio identificou-se a ingesta de medicamentos e em seguida a de agrotóxicos.

AIMS: To describe the methods used in suicide attempts and sociodemographic characteristics of suicidal patients treated at the emergency department of a teaching hospital. METHODS: Observational and descriptive study, with active search for electronic medical records of patients treated at the emergency department of a public teaching hospital in the countryside of Rio Grande do Sul, Brazil, from January to December 2015. All cases of suicide attempt were included, regardless of the suicide methods used. Successful suicide cases were not investigated. The statistical analyses included descriptive statistics, univariate analysis, and Pearson's chi-square test. RESULTS: A total of 233 patients treated at the emergency department were referred for psychiatric evaluation, and 122 of them had attempted suicide. The mean age of the suicidal patients was 36.8±14.3 years, (minimum of 14 years and maximum of 88 years) and 74 (60.6%) of them were female. The most common suicide attempt methods were ingestion of medications (72 cases, 59%) and of pesticide (14 cases, 11.5%). Of all patients, 119 (97.5%) lived in Santa Cruz do Sul, predominantly in the urban area (103 patients, 84.4%). Of the 50 (41.0%) referrals, 32 (64.0%) were sent to the Center for Psychosocial Care, 7 (14%) to the Center for Children's and Adolescents' Psychosocial Care, 6 (12%) were admitted to a mental health unit, and 5 (10%) were sent to Psychosocial Care Center for Alcohol and Drug Abuse. Sixty-six (54.1%) patients had no electronic medical records of their outcome after discharge and 6 (4.9%) were lost to follow-up. CONCLUSIONS: Most of the treated suicidal patients were young adult females. The most common method of suicide attempt was the ingestion of medications, followed by the ingestion of pesticides.

Internações por intoxicação de crianças de zero a 14 anos em hospital de ensino no Sul do Brasil, 2006-2011 / Poison-related hospitalizations of children aged 0-14 at a teaching hospital in Southern Brazil, 2006-2011 / Internaciones por intoxicación de niños de cero a 14 años en hospital de enseñanza en el sur de Brasil, 2006-2011

OBJETIVO: descrever o perfil das intoxicações que levaram à internação de crianças cadastradas no Centro de Controle de Intoxicações do Hospital Universitário Regional de Maringá no período de 2006 a 2011. MÉTODOS: estudo descritivo, com dados secundários das fichas de Ocorrência Toxicológica (OT) referentes a vítimas de intoxicação na idade de zero a 14 anos, internadas por um período mínimo de 12 horas. RESULTADOS: foram registradas 694 internações por intoxicação, sendo os medicamentos os principais responsáveis (42,4%); a maioria das internações ocorreu na faixa etária de um a quatro anos (66,7%); o sexo masculino apresentou maior número de internações, em todas as faixas etárias; e a maioria das intoxicações ocorreu no período da manhã (55,6%). CONCLUSÃO: os medicamentos foram o principal agente causador de intoxicações; entre as vítimas internadas, predominaram crianças de menor idade e do sexo masculino.

OBJECTIVE: to describe the profile of poisoning leading to children's hospitalizations, as registered at the Maringá Regional University Hospital Poisoning Control Center in the period 2006 to 2011. METHODS: this was a descriptive epidemiological study using secondary data from Intoxication Incident Report Forms, involving poisoned children aged between 0 and 14 years, hospitalized for at least 12 hours. RESULTS: 694 hospitalizations due to poisoning were registered, with medication poisoning accounting for 42.4% of cases; the 1-4 age group was the most affected (66.7%); males accounted for a higher number of hospital admissions in all age groups; most poisoning cases occurred in the morning (55.6%). CONCLUSION: medication was the main cause of poisoning; younger children and males were predominant among hospitalized victims.

OBJETIVO: describir el perfil de las intoxicaciones que llevaron a la internación de niños, registradas en el Centro de Control por Envenenamiento del Hospital Universitario Regional de Maringá en el periodo de 2006-2011. MÉTODOS: estudio descriptivo con datos secundarios obtenidas de las fichas de Ocurrencia Toxicología (OT), referentes a víctimas de intoxicación en niños entre cero y 14 años, hospitalizados por un mínimo de 12 horas. RESULTADOS: fueron 694 hospitalizaciones por intoxicación, siendo los fármacos los principales responsables (42,4%); el grupo de edad de uno a cuatro años fue el más afectado (66,7%); los hombres tuvieron un mayor número de hospitalizaciones en todos los grupos etarios; la mayoría de casos fue en la mañana (55,6%). CONCLUSIÓN: las drogas fueron la principal causa de intoxicación; entre las víctimas hospitalizadas predominaron niños más pequeños y de sexo masculino.

Towards a personalized risk assessment for exposure of humans to toxic substances / Em direção a uma avaliação de risco personalizado para exposição de seres humanos a substâncias tóxicas

Abstract Great response variability caused by genetic and/or environmental factors has been observed among organisms exposed to hazardous chemicals. This subject has been a topic of intense discussion in the USA since President Obama announced support for an “era of precision medicine”, which consists in the inclusion of genetic data of patients in the treatment design, imposing a new approach to risk assessment. Personalized evaluation must consider the phenotypic factors of an individual. Among the markers that have been developed to evaluate any alteration in the structure or function of organisms, biomarkers of susceptibility are of great importance because they indicate the natural characteristics of a given organism which make it more sensitive to a specific adverse effect or disease, or more responsive to exposure to a specific chemical/drug. The ‘-omics’ technologies provide an insight into the relationship between chemical effects and molecular mechanisms of action. These technologies are the pillars for a personalized toxicology and precision medicine. Predictive toxicology requires a more comprehensive knowledge on specific individual factors or susceptibilities predisposing to diseases, enabling personalized risk assessment and adequate medical treatment.

Resumo Há uma grande variabilidade nas respostas observadas entre os organismos expostos a uma substância química perigosa. Essa variabilidade é causada por causas genéticas e / ou ambientais. Esse assunto tem sido intensamente discutido, mesmo nos Estados Unidos, desde que o presidente Obama anunciou o apoio a uma “era da medicina de precisão”, a qual consiste na inclusão de dados genéticos do paciente no projeto do tratamento, impondo uma nova abordagem para avaliação de risco. A avaliação personalizada deve considerar fatores fenotípicos de um indivíduo. Entre os biomarcadores que foram desenvolvidos para avaliar qualquer alteração da estrutura ou função do organismo, os biomarcadores de susceptibilidade têm uma grande importância, uma vez que indicam as características naturais de um dado organismo, que o tornam mais sensíveis a um efeito ou doença adversa específica ou em resposta a uma determinada exposição. As tecnologias “ômicas” permitem a compreensão da relação entre os efeitos químicos e dos mecanismos moleculares de ação. Essas tecnologias “ômicas” são os pilares para a toxicologia personalizada e para a medicina de precisão. Toxicologia preditiva exige uma melhor compreensão dos fatores ou susceptibilidades individuais específicas predisponentes a doenças, permitindo uma avaliação de riscos personalizada e um tratamento médico adequado.

Consumo de sustancias tóxicas en adolescentes con infecciones de transmisión sexual / Toxic substances consumption by adolescent with sexually transmitted infections

Introducción: el panorama mundial muestra un incremento de inadecuados comportamientos no saludables del adolescente, como el inicio de las relaciones sexuales tempranas, la alta incidencia de infecciones de transmisión sexual y el consumo de sustancias tóxicas. Todo esto pudiera estar influenciado por la presencia de factores relacionados con el medio en que se desarrollan los jóvenes, entre ellos el ambiente familiar y la comunidad. Objetivos: identificar necesidades educativas sobre infecciones de transmisión sexual y consumo de sustancias tóxicas en adolescentes de 12 a 15 años de edad residentes en La Habana Vieja, Cuba. Métodos: investigación cualitativa realizada en curso académico 2014-2015. Se evaluó la opinión de adolescentes mediante la realización de un grupo nominal. La información fue analizada y clasificada por los autores en unidades de significación. Resultados: se definieron cinco categorías: incrementar conocimientos sobre los riesgos para las infecciones de transmisión sexual, incrementar conocimientos sobre las prácticas de prevención de las infecciones de transmisión sexual, recibir información sobre las consecuencias del consumo de sustancias tóxicas, actualizar e incrementar conocimientos sobre el uso adecuado del condón y cómo conversar sobre sexualidad y hábitos tóxicos en el hogar, la escuela y el barrio. Conclusiones: las categorías que obtuvieron la mayor puntuación y están en las primeras prioridades para el desarrollo de una estrategia de intervención educativa fueron: recibir información sobre las consecuencias del consumo de sustancias tóxicas, incrementar conocimientos sobre las prácticas de prevención de las infecciones de transmisión sexual y cómo conversar sobre sexualidad y hábitos tóxicos en el hogar, la escuela y el barrio(AU)

Introduction: The world panorama shows an increase in adolescents' unhealthy inadequate behaviors, such as starting sexual intercourse early, the high incidence of sexually transmitted infections and the consumption of toxic substances. All this might be influenced by the presence of factors related with the environment the adolescent are raised in, among them the family and community. Objective: To identify the educational needs about sexually transmitted infections and toxic substances consumption in adolescents at ages 12-15 years residents of the Old Havana Municipality (Cuba). Methods: Qualitative research carried out in the academic year 2014-2015. The adolescents' opinion was assessed by the realization of a nominal group. The information was analyzed and classified by the authors into signification units. Results: Fiver categories were defined: increasing knowledge about the risk for sexually transmitted infections, increasing knowledge about the practices for preventing sexually transmitted infections, receiving information about the consequences of toxic substances consumption, updating and increasing knowledge about the condom's adequate use, and how to talk about sexuality and toxic habits in the home, the school and the neighborhood. Conclusions: The categories that obtained the highest marking and among the first priorities for developing an educational intervention strategy were: receiving information about the consequences of toxic substances consumption, increasing knowledge about the practices for preventing sexually transmitted infections, and how to talk about sexuality and toxic habits in the home, the school and the neighborhood(AU)

Hematological Alterations Induced by Tityus discrepans Scorpion Venom in Mice / Alteraciones Hematológicas Inducidas por el Veneno del Escorpión Tityus discrepans en Ratones

In order to evidence the hematological changes induced by the venom of the scorpion Tityus discrepans, a sublethal dose of Tityus discrepans venom (Tdv, 1 µg/g) in a total volume of 0.1 mL was intraperitoneally injected in BALB/c female mice (20±2 g; n=20). Mice were anesthetized and blood samples were withdrawn by cardiocentesis at 0 h, 3 h, 6 h, and 12 h after Tdv administration. Hematologic analyses were performed by routine procedures. A significant (p<0.05) increase in hematocrit, hemoglobin concentration and total protein concentration was observed at 3 h and 6 h, possibly due to dehydration, splenic contraction and acute-phase protein induction. The red blood cell count in envenomed mice was significantly (p<0.05) higher in comparison with the control only at 12 h. Tityus discrepans venom caused neutrophilia and lymphopenia probably as a result of catecholamine release, without significant (p>0.05) changes in absolute leukocyte count. Neither platelets number nor hematimetric indexes significantly (p>0.05) changed. Altogether, these results suggest that Tdv administration induces alterations in the hematologic profile in mice.

Para evidenciar los cambios hematológicos inducidos por la inyección intraperitoneal de una dosis subletal (1 µg/g) de veneno del escorpión Tityus discrepans (VTd), se usaron ratones hembras de la raza BALB/c con un peso de 20±2g (n=20). Los ratones fueron anestesiados y se obtuvieron muestras de sangre por cardiocentesis a las 0 h, 3 h, 6 h y 12 h después de administrado el VTd. Los análisis hematológicos fueron realizados por procedimientos rutinarios. Se observó un aumento significativo (p<0,05) en el hematocrito, la concentración de hemoglobina y la concentración de proteínas plasmáticas a las 3 h y 6 h, posiblemente debido a deshidratación, contracción esplénica e inducción de proteínas de fase aguda. El conteo de glóbulos rojos en ratones envenenados fue significativamente (p<0,05) mayor en comparación con el control sólo a las 12 h. El VTd causó neutrofilia y linfopenia probablemente debido a la liberación de catecolaminas, sin observarse cambios significativos (p>0,05) en el conteo total de leucocitos. Ni el número de plaquetas ni los índices hematimétricos fueron afectados significativamente (p>0,05) por la administración de VTd. Considerando los hallazgos, la administración de VTd induce alteraciones en el perfil hematológico en ratones.

Origen e historia de la Toxicología / Origin and history of Toxicology

Se presentan en orden cronológico acontecimientos relacionados con la Toxicología ocurridos a nivel mundial y en Cuba. Se realizó una revisión bibliográfica sobre los orígenes e historia de la Toxicología, la cual surgió desde inicios de la humanidad. Se destaca el actuar de reconocidos médicos de la antigüedad, así como acciones realizadas por famosos envenenadores; todo esto recogido en los papiros, la literatura mitológica, religiosa, médica y universal. También se mencionan diversos tóxicos descubiertos o utilizados a lo largo de la historia y su clasificación de acuerdo con su origen animal, vegetal o mineral. Además se evidencia la vinculación que existe entre esta ciencia y la Medicina Legal. La Toxicología quedó constituida como ciencia independiente en la década del cincuenta del pasado siglo.

This paper chronologically described the events in toxicology that took place worldwide and in Cuba. A literature review was made about the origin and history of toxicology, which emerged since the very beginning of mankind. It reflected the actions taken by well known doctors from ancient times, as well as the work of renowned poisoners. Such information was retrieved from papyri and from mythological, religious, medical and universal literature. A number of toxics discovered or used throughout history were mentioned, including their classification according to their origin: animal, vegetable or mineral. Additionally, the linkage between this science and forensic medicine was stressed. Toxicology became an independent science in the 50's of the last century.

Intoxicación con rodenticidas: casos reportados al Centro de Información, Gestión e Investigación en Toxicología de la Universidad Nacional de Colombia / Rodenticide poisoning: cases reported to the Toxicology Research, Management and Information Center, National University of Colombia

Antecedentes. Los rodenticidas son sustancias químicas destinadas al control de roedores, provocándoles la muerte por diferentes mecanismos: inhibiendo sus sistemas de coagulación sanguínea, bloqueando la enzima acetil colinesterasa, alterando el ciclo de Krebs y por inhibición de sistemas enzimáticos con desplazamiento celular de iones. Objetivo. Identificar los rodenticidas involucrados de manera más frecuente en casos de intoxicaciones agudas en Colombia. Materiales y métodos. Investigación descriptiva retrospectiva, donde se revisaron casos de intoxicaciones por rodenticidas reportados al Centro de Información, Gestión e Investigación en Toxicología (CIGITOX) en 2012, ocurridos en Colombia y algunos países de Suramérica. Resultados. Se reportaron 177 casos de exposiciones a rodenticidas, más de un 80% de los casos en población joven, 53% de ellos en el sexo femenino y 69% por intentos de suicidio. Los departamentos de Valle del Cauca, Antioquia y Cundinamarca fueron los que más reportaron casos, mientras que un 45% de los eventos ocurrieron en el hogar de la víctima. El rodenticida más usado fue el carbamato aldicarb con 55% de los eventos, seguido por rodenticidas anticoagulantes con 29% y fluoroacetato de sodio con 12%; en la intoxicación con anticoagulantes predominaron los pacientes asintomáticos con 45% de los eventos, en la intoxicación con carbamatos fueron las crisis colinérgicas con 60% y en la intoxicación con fluoroacetato de sodio fueron más frecuentes los síntomas gastrointestinales y del sistema nervioso periférico con 45%. El 64% de los pacientes fue dado de alta después de observación y tratamiento básico, 26% de ellos fue remitido a nivel superior de atención y 5% no se pudo determinar su evolución. Conclusiones. Las intoxicaciones por rodenticidas traen consigo una alta morbilidad y sin intervenciones médicas precisas y oportunas pueden llegar a ser letales.

Background. Rodenticides are chemical compounds designed to kill rats and mice through different mechanisms: by impairing their clotting systems; by blocking the acetylcholinesterase enzyme, resulting in a severe cholinergic crisis, by halting the Krebs cycle and therefore cellular respiration or by inhibition of cellular enzyme systems with ion displacement. Objective. To identify the most frequently involved rodenticides in cases of acute poisoning in Colombia. Materials and methods. A retrospective, descriptive research has been developed, and is a review of cases that took place in Colombia and other South American countries. These cases were reported to the Toxicology Research, Management and Information Center CIGITOX, in 2012. Results. 177 cases of rodenticide exposures were reported from april to august 2012; more than 80% of the cases occurred to youngsters, 53% of them involved the female gender while 69% were due to suicidal attempts. The departments of Valle del Cauca, Antioquia and Cundinamarca reported most of the cases; and 45% of the events took place in the victim's home. The most used rodenticide was the carbamate aldicarb in 55% of the events, followed by anticoagulant rodenticides with 29% and sodium fluoroacetate with 12%; in the events with anticoagulant rodenticides, most patients were asymptomatic (45% of cases), 60% of the carbamate intoxications were featured with cholinergic crises, and in the sodium fluoroacetate poisoning, gastrointestinal upset and symptoms from the peripheral nervous system were dominant with 45% of the events. Sixty four percent of the patients were discharged after few hours of clinical observation and supportive care, while 26% of them were referred to tertiary care hospitals; 5% of the patients had their fate unclear. Conclusions. The rodenticide intoxication brings along high morbidity, this might be fatal if there is no proper and timely medical attention.

Intoxicación por fluoroacetato de sodio / Sodium fluoroacetate intoxication: case report

El fluoroacetato de sodio es conocido como compuesto 1080, fue descubierto por químicos alemanes durante la segunda guerra mundial. Es un compuesto inodoro e insaboro, soluble en agua, la dosis letal 50 en humanos es de 2 a 4 mg/kg. Debido a su letalidad, ha sido retirado del mercado en algunos países incluyendo Colombia. Este compuesto causa efectos bioquímicos y fisiológicos como acumulación de citrato, alteración de los trasportadores mitocondriales del citrato, acumulación de acido láctico, alteración de la regulación de la glucosa y alteraciones hidrioelectroliticas (principalmente en los niveles de calcio). Las manifestaciones clínicas de intoxicación por esta sustancia son inespecíficas, lo que dificulta su identificación y tratamiento oportuno, aumentando su letalidad. El etanol aumenta el nivel de acetato, ofreciendo así un sustrato alterno al ciclo de Krebs y puede ofrecer beneficios en el tratamiento agudo de estos pacientes. Sin embargo, el manejo de soporte es el pilar fundamental del manejo de estos casos. Se presenta un caso de ingestión intencional en un adolescente con diagnóstico tardío y con desenlace satisfactorio.

Sodium fluoroacetate is known as compound 1080; it was discovered by the German chemicals during World War II. It is a compound soluble in water, odorless and tasteless. The lethal dose 50 in humans is 2 to 4 mg/kg. Because of its lethality, it has been recalled in several countries including Colombia. This compound causes biochemical and physiological effects as citrate accumulation, altered mitochondrial Citrate transporter, the accumulation of lactic acid, impaired glucose regulation and hidroelectrolyte disorders (mainly calcium disturbances). The clinical manifestations of poisoning by this substance are non-specific, which males their identificacion and treatment difficult, making it to increase its lethality. Ethanol increases the level of acetat, thus providing an alternative substrate Krebs cycle and may offer benefits in the acute treatment of these patients; however, management support is the mainstay of management of these cases. Here it is reported a case of intentional ingestion in an adolescent, with delayed diagnosis a successful outcome.

Chemical control of Aedes aegypti: a historical perspective / Control químico de Aedes aegypti: una perspectiva histórica

Objective: To describe the use of chemical insecticides throughout history as the main tool to fight against Aedes aegypti, a vector of dengue virus. Methods: A text mining approach was conducted on databases, such as PUBMED and SCIENCE DIRECT, using the keywords “Aedes aegypti”, combined with the words “insecticides”, “resistance”, “organochlorines”, “organophosphates”, “carbamates” and “pyrethroids”. Results related to historical information dealing with the chemical control of Aedes aegypti, in particular those containing data on insecticide resistance for this species, were scrutinized and analyzed. Results: Different chemical groups have been utilized to control A. aegypti, including organochlorine, organophosphate, carbamate and pyrethroid insecticides. In general, the tendency has been to replace a particular pesticide, for which resistance had been detected, for a new one, mosquito-sensitive, and with little evidence of deleterious effects derived from its use. The spread of resistance has been registered in several countries of America, Asia and Africa. Two mechanisms have been highly cited to be responsible for the resistance; the increase activity of detoxifying enzymes, and structural changes in the insecticide target site, mostly within the central nervous system. Conclusion: Excessive use of chemical insecticides and the lack of dosing control have led to widespread resistance in A. aegypti, as no “safer” alternative chemical options are available for vector control in different countries, impacting human health.

Objetivo: Describir el uso de insecticidas químicos a través de la historia como la principal herramienta contra Aedes aegypti, un mosquito vector del virus del dengue. Métodos: Una búsqueda en minería de textos fue realizada en bases de datos como PubMedy Science Direct, utilizando las palabras clave “Aedes aegypti”, en combinación con “insecticidas”, “resistencia”, “organoclorados”, “organofosforados”,“carbamatos” y “piretroides”.Resultados afines con la información histórica relacionada con el control químico del mosquito Aedes aegypti, en particular las que contienen datos sobre la resistencia a insecticidas de esta especie, fueron examinados y analizados. Resultados: Diferentes grupos químicos han sido desarrollados para el control de A. aegypti, siendo los más utilizados organoclorados, organofosforados, carbamatos y piretroides. En general, la tendencia ha sido la de sustituir un pesticida particular, para el que ha sido detectado resistencia, por uno nuevo, mosquito-sensible, y con evidencia de efectos perjudiciales derivados de su uso. La propagación de la resistencia se ha registrado en varios países de América, Asia y África. Dos mecanismos han sido altamente referenciados de ser responsable de la resistencia, el aumento de actividad de las enzimas de desintoxicación, y los cambios estructurales en el sitio de destino de los insecticidas, en su mayoría dentro del sistema nervioso central. Conclusión: El uso excesivo de insecticidas químicos y la falta de control de dosificación han dado lugar a una resistencia generalizada en Aedes aegypti, y alternativas químicas “más seguras” no están disponibles para el control de vectores en diferentes países, afectando la salud humana.

Influencia da adubação com dejetos orgânicos e adubo mineral sobre o teor de metais pesados no solo e na cana-de-açúcar / Influence of the fertilization with organic dejections and mineral fertilizer on the tenor of heavy metals in soil and sugarcane

A adubação inadequada com resíduos orgânicos pode levar a adição de metais pesados no solo e na planta. Assim, esta pesquisa teve como objetivo avaliar os teores de metais pesados no solo e na cultura de cana-de-açúcar na região de Uberlândia- MG, quando fertilizado com adubo mineral e dejetos orgânicos, em diferentes profundidades e épocas de crescimento da planta. A área da pesquisa localizou-se na Fazenda da Cia Mineira de Açúcar e Álcool do Triângulo Mineiro Ltda, município de Uberlândia­MG. O delineamento experimental foi em blocos casualisados, em esquema fatorial de parcelas subdivididas no espaço, em 5x2x4, correspondendo a cinco tipos de adubo: cama de frango , cama de peru , adubo compostado , esterco bovino e a testemunha, todos combinados com a presença e/ou a ausência de gesso agrícola; analisado em quatro profundidades e em duas épocas. Foram avaliados os teores de metais pesados no solo, nas folhas e nos colmos da cana-de-açúcar. Os resultados obtidos foram submetidos à análise de variância e as médias dos fatores comparadas pelo teste de Tukey ao nível de 0,05 de significância. Os teores dos metais pesados no colmo não ultrapassaram o limite crítico e foram menores na época seca. Não foram detectados Cd e Cr no solo, e Ni e Pb estiveram abaixo do limite crítico de contaminação. O gesso não influenciou nos teores metais pesados no solo e na parte aérea da planta.

The fertilizing inadequate by means of organic residues can add heavy metals to soils and plants. Thus, this study evaluated the movement of heavy metals in the soil and in sugarcane in the region of Uberlândia- MG, after fertilization with chemical fertilizer and organic waste, at different depths and cane growth periods. The study area was the farm of Cia Mineira de Açúcar e Álcool do Triângulo Mineiro Ltda, located in the municipality of Uberlândia, State of Minas Gerais. The experimental design was randomized blocks, in a 5x2x4 factorial, with split plots in time, corresponding to five fertilizer types: chicken bedding (CF), turkey bedding (CP), composted manure (AC), cattle manure (EB) and the control, all combined with the presence or lack of agricultural gypsum; analyzed at four depths and at two times. The heavy metals was evaluated in the soil, sugarcane stalk and leaves. The results obtained were submitted to analysis of variance and the averages of the factors compared by the Tukey test at 0.05 significance. The heavy metals contents in the stalks were smaller in time 2. In contrast, heavy metals stalk contents did not exceed the critical limit. No Cd and Cr were detected in the soil, while Ni and Pb were below the critical contamination limit. Agricultural gypsum did not affect the levels of micronutrients or heavy metals in the soil or in the sugarcane.