La ingestión de cáusticos en el niño: un problema de salud pública / The caustic ingestion in children: a public health problem

La ingestión de cáusticos en la edad pediátrica es un problema grave al producir una lesión progresiva y devastadora en el esófago y el estómago. Estudio retrospectivo y descriptivo de 421 pacientes en edades comprendidas de 2 meses a 14 años quienes ingirieron cáusticos entre 1.992 y 2.008, evaluados en el Hospital Universitario de Maracaibo. El 60,09% eran pre-escolares y el 62,23% eran del sexo masculino. La sustancia tipo álcali fue ingerida en el 90,73% de los casos y los cáusticos se encontraban almacenados en su envase original en 3,8% y trasegados en el 96,2% de los casos. La ingestión fue de origen accidental en el 99,53%. Todos los pacientes manifestaron alguna sintomatología como lesiones orofaríngeas, vómitos y sialorrea. La evaluación endoscópica se realizó en el 89,31% de los casos y se evidenció lesiones en el tracto gastrointestinal en 60,63%. Los pacientes con Esofagitis Grado III y estenosis esofágica fueron incluidos en el programa de dilatación, con una buena evolución en el 35,91% de ellos. La ingestión de cáusticos constituye un problema frecuente y serio, en su mayoría de origen accidental, afecta principalmente a menores de 6 años y el álcali es el principal agente involucrado. La Endoscopia Digestiva es el estudio por excelencia para evaluar estos pacientes. Las dilataciones esofágicas son moderadamente exitosas. El mejor tratamiento es la prevención.

The caustic ingestion in the pediatric population is a serious problem because produce a progressive and devastating injury to the esophagus and stomach. Retrospective and descriptive study of 421 patients with age from 2 months to 14 years who ingested caustic between 1.992 to 2.008 evaluated at the Hospital Universitario de Maracaibo. The 60.09% were pre-school and 62.23% were male. The substance type alkali was swallowed by 90.73% of cases and the caustics were stored in its original packaging by 3.8% and decanted in 96.2% of cases. Intake was accidental source in 99.53%. All patients showed some symptoms as oropharyngeal lesions, vomiting and drooling. Endoscopy evaluation was performed by 89.31% of cases and revealed gastrointestinal tract injuries in 60.63%. Patients with grade 3 Esophagitis and esophageal stricture were admitted in the dilatation program with a good success in 35.91% of them. The caustic ingestion is a common and serious problem, mostly from accidental origin, mainly affects children under 6 years and the alkali is the principal agent involved. The Esophagoscopy is the ideal mean for evaluate these patients. The esophageal dilatations are moderately successful. The best treatment is the prevention.

Chlorinated drinking water, cancers and adverse health outcomes in Gangtok, Sikkim, India.

Long-term impacts of drinking chlorinated water on the incidence of cancers and other adverse health outcomes were assessed in a population-based cross-sectional study. The study was conducted by comparing a group exposed to chlorinated drinking water for more than thirty years with control groups with less or no exposure to chlorine. A house-to-house survey was completed to gather information on residential history, age, education, income, source and extent of treatment of water and health characteristics. All residents below thirty years of age were excluded from the database used for analyses to ensure that the groups were comparable. Fourteen cancer cases were found in the long-term exposed groups of 1085 persons and 9 cancer cases in the two control populations of 725 persons. The odds ratio for cancers (OR) was 1.05 (95% CI = 0.43-2.65) and is not statistically significant. Odds ratios for gastrointestinal disorders, kidney problems and skin infections were statistically significant ranging from 2.06 (95% CI = 1.01-4.17) to 2.2 (95% CI = 1.45-3.33). These OR values indicate that there is no significant association between the incidence of cancer and exposure to chlorinated water while chlorinating drinking water significantly reduced the incidence of non-carcinogenic adverse health effects like gastrointestinal diseases, skin infections, and kidney diseases.

O uso do cloro na desinfecçäo de águas, a formaçäo de trihalometanos e os riscos potenciais à saúde pública / Chlorine use in water disinfection, trihalomethane formation, and potential risks to public health

Antes do desenvolvimento da teoria dos microorganismos como causadores de doenças (1880), acreditava-se que estas eram transmitidas através de odores. A desinfecçäo, tanto da água de abastecimento como dos esgotos, surgiu como tentativa da eliminaçäo desses odores. Existem muitos agentes desinfetantes, mas, em geral, o cloro é o principal produto utilizado na desinfecçäo de águas de abastecimento. A presença de compostos orgânicos em águas que sofrem o processo de cloraçäo resulta na formaçäo dos trihalometanos, compostos formados por um átomo de carbono, um de hidrogênio e três de halogênio (cloro, bromo, iôdo). Os trihalometanos säo considerados compostos carcinogênicos e sua presença na água deve ser evitada. Levantamentos epidemiológicos relacionando a concentraçäo dos trihalometanos com a morbidade e a mortalidade por câncer evidenciaram associaçoes positivas em alguns casos de carcinomas. Entretanto, a substituiçäo do cloro por outro desinfetante no tratamento de água pode trazer mais riscos do que benefícios, considerando-se que a diminuiçäo da incidência de doenças transmissíveis pela água somente foi alcançada com a difusäo do emprego da técnica de cloraçäo.

Avaliaçäo do comportamento do tecido conjuntivo de ratos a implantes de cones de prata submetidos à açäo de soluçöes irrigadoras / Evaluation of connective tissue reactions of rats from implants with silver cones submitted to the action of irrigators solutions

Neste estudo, foram avaliadas as reaçöes provocadas no tecido subcutâneo de ratos pela implantaçäo de cones de prata submetidos ou näo ao contato prévio com soluçöes irrigadoras de uso endodôntico. Segmentos de 1 cm de cones de prata foram implantados, sem prévio tratamento ou submetidos à açäo de soda clorada, "Endo-PTC" associado com liquído de Dakin e EDTA, em 24 animais, para análise histopatológica nos tempos de 7, 15, 30 e 60 dias. Os cones tratados com soda clorada provocaram as mais intensas reaçöes, com formaçäo de abscessos. Alteraçöes da estrutura dos cones de prata, pela açäo da soda clorada, favorecendo a sua corrosäo, bem como a provável interaçäo química entre a prata, o hipoclorito de sódio e os fluídos teciduais säo discutidos como possíveis causas da agressäo. Cuidados com a neutralizaçäo ou remoçäo de substâncias irrigadoras cloradas do interior do canal quando do uso de cones de prata como material obturador, säo recomendados

Pentalogia de cantrell con malformaciones múltiples y asociada a inhalación de cloro / Cantrell pentalogy with multiple malformations and asociated to inhalation of chloro

Primigesta de 26 años, inhalación accidental de cloro de uso doméstico, en semana 3 del embarazo. En la semana 22 se detectan por ultrasonido exencefalia, ectopia cordis cervical, banda amniótica de ápex a exencéfalo, brevedad del cordón, malrotación intestinal, malformaciones de los dedos, ventrículo único, comunicación interauricular amplia, posible defecto facial. En semana 33 se interrumpe el embarazo por cesárea por la brevedad del cordón. Se filma en VHS los primeros 30 minutos de vida del producto. Anatomía patológica demuestra displasia frontonasal y origen común de arterias carótidas. Todos los hallazgos antenatales fueron comprobados y se concluye en una Pentalogía de Cantrell con ectopía cordis cervical asociada a múltiples malformaciones.

Effect of chlorine gas leak on the pulmonary functions of school children.

Pulmonary function tests (PFT) were performed on 84 children studying in a Municipal School, near a plant manufacturing chemicals in Chembur, a suburb of Bombay, from where large amounts of chlorine gas leaked out on 30th August, 1985. It was found that only 23.8% had normal PFT's. 66.7% showed an obstructive pattern and 9.5% showed a restrictive pattern of PFT's. This is a preliminary report to establish the prevalence of lower PFT values in children staying in an area of air pollution in Bombay.