Exposição ocupacional a agrotóxicos organofosforados e neoplasias hematológicas: uma revisão sistemática / Occupational exposure to organophosphate pesticides and hematologic neoplasms: a systematic review

RESUMO: Objetivo: Atualizar achados de estudos observacionais analíticos sobre a associação entre exposição ocupacional a organofosforados e neoplasias hematológicas. Métodos: Revisão sistemática de literatura, incluindo estudos de coorte e caso controle, sem limitação de tempo de publicação, nos idiomas português e inglês. O rastreamento de artigos foi feito no período de junho de 2017 a julho de 2019 nas bases de dados PubMed, MEDLINE, LILACS, Web of Science e Scopus. A avaliação qualitativa de risco de viés foi feita com a Escala Newcastle-Otawa e com o Checklist Downs e Black. Os resultados foram apresentados segundo as recomendações da Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Resultados: Foram elegíveis 17 estudos avaliados como de boa/alta qualidade metodológica. A exposição a diazinon (um coorte), fonofós (um coorte), diclorvós, crotoxifós e fanfur (um caso controle) associou-se à leucemia, enquanto a exposição a organofosforados associou-se aos linfomas (seis caso controle). O risco de linfoma não-Hodgkin foi maior para os indivíduos expostos a diazinon (um caso controle) e malation (três caso controle), em relação aos não expostos. O mieloma múltiplo ocorreu mais comumente em expostos a organofosforados do que entre os não expostos (um caso controle). Conclusão: A exposição ocupacional a organofosforados aumenta o risco de neoplasias hematológicas, sobretudo entre os indivíduos com maior período de exposição. Medidas de monitoramento de trabalhadores e de controle da exposição são recomendadas.

ABSTRACT: Objective: To update findings of observational analytical studies on the association between occupational exposure to organophosphates and hematologic malignancies. Methodology: Systematic literature review, including cohort and case-control studies, without limitation of publication time, in Portuguese and English. The articles were traced from June 2017 to July 2019 in PubMed, MEDLINE, LILACS, Web of Science, and Scopus databases. The qualitative bias risk assessment was performed using the Newcastle-Ottawa Scale and the Downs and Black Checklist. Results were presented according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Results: Seventeen studies evaluated as good/high methodological quality were eligible. Exposure to diazinon (1 cohort), phonophos (1 cohort), dichlorvos, crotoxiphos and famphur (1 case control) was associated with leukemia, while exposure to organophosphate was associated to lymphomas (6 case control); the risk of non-Hodgkin's lymphoma was higher in those exposed to diazinon (1 control case) and malathion (3 control case) than non-exposed ones. Multiple myeloma occurred more commonly in organophosphate exposed than in non-exposed individuals (1 case-control). Conclusion: Occupational exposure to organophosphates increases the risk of hematologic malignancies, especially among individuals with longer exposure periods. Worker monitoring and exposure control measures are recommended.

Afectación de las funciones cognitivas y motoras en niños residentes de zonas rurales de Jujuy y su relación con plaguicidas inhibidores de la colinesterasa: Un estudio piloto / Impairment of cognitive and motor functions in children from rural areas of Jujuy, and its relationship with cholinesterase inhibitor pesticides: A pilot study

El objetivo de este trabajo fue estudiar el efecto de la exposición a plaguicidas en las funciones cognitivas y motoras de 42 niños de una zona rural con mayor probabilidad de exposición a plaguicidas organofosforados y carbámicos (Yuto, Jujuy). Los resultados de las pruebas realizadas para estudiar el efecto fueron comparados con los resultados obtenidos con 29 niños con menor exposición a plaguicidas (León, Jujuy). A todos los participantes se les realizó historia clínica, evaluación médica, revisión de antecedentes, pruebas neuroconductuales, de motricidad gruesa y equilibrio, y medición de biomarcadores (colinesterasa plasmática y eritrocitaria). Se realizó una historia clínica neurológica estándar con las siguientes pruebas: Subtest de Dígitos y Símbolos, Subtest de Recuerdo de Dígitos, Subtest de Laberinto del WISC-III de Wechsler. En la prueba de Laberintos realizada en el presente estudio se observan diferencias entre las localidades y se comprobó una relación lineal inversa entre los años de residencia y la puntuación de la prueba. Se observó reducción en las actividades de acetilcolinesterasas en los niños pertenecientes a Yuto. No se observó una correlación signifca-tiva entre los niveles de actividad de las enzimas y el rendimiento en la prueba, para ninguna de las dos localidades. Los resultados señalaron la probabilidad de que la exposición crónica a bajas dosis de plaguicidas pudiera estar dañando algunas funciones cognitivas y que esto dependería de la duración de la exposición. Por falta de correlación entre las actividades de las enzimas y los resultados adversos en las pruebas neuroconductuales de motricidad y de equilibrio, no fue evidente una asociación entre ambos.

The aim of this research was to study the effects of these toxics on the cognitive and motor functions of a group of 42 children of a rural town with high percentage of exposure to organophosphate and carbamic pesticide (Yuto) and compare the results with a group of 29 children with low percentage of exposure to pesticides. In both cases a research of the patients history was done, a medical revision and a full checkup including neurobehavioral tests, motor and balance tests and biomarkers levels (plasma pseudocholinesterase and erythrocyte cholinesterase). The behavioral assessment was performed by a standard neurological clinic history, a digital and symbol subtest, a digital memory, a maze test, intelligence test WISC-III of Wechsler and gross motor and balance tests. In the group from Yuto, Pearson correlations were done between the years of residency and the neurobehavioral tests and the linear correlation between the years of residency and the acetylcholinesterase activities. In the maze test results there were differences between the two towns and it was proved an inverse lineal relation between the years of residency and the tests scores. It was also observed a reduction in the acetylcholinesterase activities both erythrocyte and plasma in the children from Yuto. Nevertheless there were not signifcant correlations between the levels of enzyme activities and the performance in the tests for neither of the towns. The results achieved did not point out that chronic exposure to low-dose pesticides can produce cognitive malfunctions, such as psychomotor problems. The lack of correlations between the activities of the acetylcholinesterase enzyme and the negative results of the neurobehavioral motor and balance tests couldn´t be associated.

Intoxicación por organofosforados: experiencia institucional / By organophosphate poisoning: institutional experience

Objetivo. Describir las características epidemiológicas así como los síntomas y signos de presentación y su relación con el curso evolutivo de los pacientes que ingresan a la Unidad de Urgencias (UU) del Hospital de Clínicas, La Paz, con intoxicación por organofosforados (OF) y carbamatos (CM), con el objetivo de determinar que factores podrian predecir una evolución hospitalaria complicada. Métodos. Se realizó un estudio de serie de casos con 300 pacientes, en base a criterios predefinidos, durante el periodo del 1 de enero al 31 de diciembre de 2003. Resultados. Todas las intoxicaciones fuerón por vía oral, la mayor parte intencionales (97 por ciento), y en pacientes jóvenes (edad media 23.9 rango 13-62). Las mujeres excedieron en número a los varones en proporción de casi 2:1.Los sintomas más comunes en la presentación fueron el dolor abdominal (83 por ciento), nauseas/vómitos (79 por ciento), miosis (72 por ciento), broncorrea (44 por ciento), diarrea (41 por ciento) y fasciculaciones (31 por ciento). Las complicaciones más frecuentes fueron la aspiración (18 por ciento), el paro cardiorrespiratorio (9 por ciento) y convulsiones (7 por ciento); la mortalidad fue del 6 por ciento. Los tratamientos incluyeron el lavado gástrico en 96 por ciento de pacientes, y atropina (dosis media 7.75 mg por paciente.=7.33mg). El predominio de signos colinérgicos se asocio con una proporción más alta de complicaciones. Aunque casi todas intoxicaciones eran tentativas de suicidio, menos de la mitad de los pacientes recibió apoyo psiquiátrico posterior. Conclusiones. La intoxicación por OF es una causa común de morbilidad y mortalidad autoinfligida entre las personas jóvenes en La Paz, Bolivia. La presencia predominante de signos colinérgicos predice una probabilidad más alta de complicaciones durante la hospitalización.

Objective The objective of this study was to describe the demographics, symptoms and hospital course of patients admitted to the Emergency Department (ED) of the Hospital de Clinicas, La Paz, Bolivia with organophosphate (OP) intoxication, with the aim of determining which factors might predict a complicated hospital course. METHODSThis was a retrospective chart review using predefined criteria of 300 patients, who were admitted between Jan. 1, 2003 and Dec. 31, 2003. RESULTSThe intoxications were all oral ingestion, mostly intentional (97%), and in young patients (mean age 23.9, range 13-62). Females outnumbered males almost 2:1. The most common symptoms on admission were abdominal pain (83%), nausea/vomiting (79%), miosis (72%), bronchorrhea (44%), diarrhea (41%) and fasciculations (31%). The most frequent complications were aspiration (18%), cardiopulmonary arrest (9%) and seizure (7%); mortality was 6%. Treatments included gastric lavage in 96% of patients, and atropine (mean dose 7.75mg per patient, σ = 7.33mg). A predominance of cholinergic symptoms at admission was associated with a higher rate of complications. Although almost all intoxications were suicide attempts, less than half of patients received psychiatric consultation. CONCLUSIONSOP intoxication is a common cause of self-inflicted morbidity and mortality among young people in La Paz, Bolivia. Presence of predominantly cholinergic...

Intermediate syndrome in organophosphorous poisoning.

One hundred and fifty three cases of Organophosphorous poisoning cases presented to Kasturba Hospital, Manipal, India during a 2 year period ( 2001- 2002), out of which 45 cases (29.4%) had features of Intermediate Syndrome. Largest number of victims were in the age group of 21-30 years (37.7%). Males predominated (71.1%). Methyl Parathion was the commonest compound (57.7%). Respiratory muscle weakness was the most common manifestation seen (84.4%). Mortality was 22.3%.