Perfil clínico e epidemiológico dos acidentes por Lepidópteros, do gênero Lonomia, atendidos no CIATox/PR, 2015-2019 / Clinical and epidemiological profile of accidents caused by Lepidoptera, of the Lonomia genus, assisted at CIATox/PR

Introdução: Os acidentes por lepidópteros são agravos de interesse à saúde pública e a avaliação de suas características pode contribuir para melhorar sua assistência e prevenção. Este estudo analisou o perfil epidemiológico dos acidentes por lagartas do gênero Lonomia no Paraná. Métodos: Trata-se de estudo retrospectivo de base secundária realizado no Centro de Informação e Assistência Toxicológica do Paraná (CIATox/PR), em Curitiba, no período de 2015 a 2019. A análise foi realizada por estatística descritiva e Teste do qui-quadrado (p<0,05). Resultados: A amostra foi composta de 84 acidentes por Lonomia sp. com predomínio em adultos (45,2%), do sexo masculino (59,5%), e de lesões em membros superiores (84,5%). O contato com as lagartas ocorreram na área peridomiciliar da residência habitual do paciente (72,6%), na zona rural (64,27%) da macrorregião oeste paranaense (38,1%). O verão concentrou 71,4% dos casos, seguido por primavera e outono com 14,3% dos casos, respectivamente, sem registros no inverno. As manifestações clínicas mais frequentes foram dor local (62,4%), equimose (34,1%), eritema (34,1%), edema e queimação (17,6% cada). A classificação leve mostrou uma redução entre a fase inicial e a final do processo, ao contrário da moderada e grave, que tiveram aumento significativo de casos (p=0,006). O RNI (Relação Normatizada Internacional) foi incoagulável em 16,7% dos pacientes. Dois casos apresentaram piora do quadro clínico, sendo uma evolução para acidente vascular cerebral hemorrágico e um óbito. Discussão: Maior número de casos registrados na zona rural, tanto na residência habitual ou ambiente laboral, se dá pelo maior contato com o habitat das lagartas como árvores frutíferas e grandes monoculturas, o que também explica o fato de a macrorregião oeste ter o maior número de casos registrados. O aumento do desmatamento, incentivos à construção de parques públicos e plantio de árvores frutíferas na zona urbana são hipóteses para o aumento de casos nessa área. Percebeu-se que manifestações clínicas discretas podem ter uma evolução desfavorável, quando comparado estadiamento inicial e final. A realização do RNI se mostrou de grande importância na mudança de estadiamento, conduta terapêutica e diagnóstico. Conclusão: O perfil encontrado foi de acidentes por Lonomia sp. com sazonalidade no verão, em homens adultos da zona rural com gravidade moderada. Esses achados revelam a importância do diagnóstico e tratamento precoce frente às diferentes possibilidades de evolução clínica desses acidentes. É fundamental estimular estratégias para identificação da lagarta, notificação dos casos e medidas preventivas permanentes para reduzir riscos e agravos (AU).

Introduction: Lonomic accidents are of public health interest and the evaluation of their characteristics can contribute to the improvement of their attention and prevention. This study analyzed the epidemiological profile of Lonomic accidents in Paraná. Methods: This study is a retrospective secondary-based study carried out at the Center of Toxicologic Information and Assistance of Paraná (CIATox/PR), in Curitiba, from 2015 to 2019. Descriptive statistical analyses were performed using the Chi-square test (p<0.05). Results: The sample consisted of 84 accidents with Lonomia sp., showing greater occurrences among adults (45.2%) of the male gender (59.5%) and injuries on the upper limbs (84.5%). Contact with the worm occurred mainly in the patient's usual residence (72.6%), in the rural area (64.27%), and in Paraná's West macro-region (38.1%). Most cases were registered in the summer (71.4%), followed by spring and autumn (14.3%), and no accidents were registered in winter. The most frequent clinical manifestations were local pain (62.3%), ecchymosis (34.1%), erythema (34.1%), swelling and burning (17.6% each). The mild classification showed a reduction between the initial and the final phase of the process, as opposed to moderate and severe classifications, which showed a significant increase in the percentage (p=0,006). The INR was incoagulable in 16.7% of patients. Two cases showed progressive worsening, one of them evolved into a hemorrhagic stroke and one death. Discussion: The greater number of incidents registered in the rural area, both in the patients' usual residence and work environment, can be due to the greater contact with the caterpillar's natural habits, such as fruit trees and large monocultures. This also explains the larger number of registered incidents in the western macro-region. The increased deforestation, the construction of public parks, and the planting of fruit trees in the urban area are hypotheses for the increase of reported cases in this area. When comparing initial and final staging, it was noticed that discrete clinical manifestations could have an unfavorable evolution. The INR request proved to be of great importance in the management, diagnosis and change of staging of the patient. Conclusion:The epidemiological profile was of Lonomia sp. accidents happening in summer in adult males in the rural area with moderate severity. These findings reveal the importance of early diagnosis and treatment in view of these accidents' different possibilities of clinical evolution. It is essential to encourage strategies for identifying the caterpillar, reporting cases, and implementing permanent preventive measures to reduce risks and complications (AU).

Guía de actuación y abordaje frente a intoxicación por dióxido de cloro/clorito de sodio, a partir de la experiencia de los CIAT de América Latina / Guidelines for action and approach to chlorine dioxide/sodium chlorite poisoning based on the experience of the CIATs in Latin America

Resumen El 11 de marzo de 2020, la Organización Mundial de la Salud, declaró la pandemia a nivel mundial por la COVID-19. Ante este escenario, los centros de información y asesoramiento toxicológico (CIAT) de América Latina comenzaron a recibir consultas por exposición/intoxicación a dióxido de cloro/clorito de sodio y sus compuestos relacionados, por desvío de uso, destinado a la prevención y/o tratamiento de la COVID-19 sin aval científico alguno ni contar con registro sanitario para ese fin. A través de la Red de Toxicología de América Latina y el Caribe (RETOXLAC), se comprobó que no eran hechos aislados, sino que se estaba produ ciendo el mismo fenómeno en toda la región y que existían antecedentes de intoxicaciones con dichos productos y alertas desde hace más de una década, con indicaciones no aprobadas, para el tratamiento de distintas patologías como SIDA, cáncer, esclerosis lateral amiotrófica ELA, malaria, autismo, entre otras, sin evidencia. Ante esta realidad, los CIAT presentan una revisión de los signos y síntomas observados según la vía de ingreso, basados en la comunicación de riesgo en salud; proponiéndose pruebas de apoyo al diagnóstico, algoritmo de tratamiento para las intoxicaciones y modelo de ficha clínica para la vigilancia epidemiológica de los casos atendidos. Recomendamos a las autoridades y organismos responsables, reforzar las acciones tendientes a la vigilancia, control y prevención de este tipo de intoxicaciones, producto del mal uso de un desinfectante no autorizado para fines terapéuticos/médicos.

Abstract On March 11th, 2020, the World Health Organization declared a global pandemic due to COVID-19. Faced with this sce- nario, the Poison Control Centers (CIATs for its initials in spanish) in Latin America began to receive consultations for exposure/poi- soning to chlorine dioxide/sodium chlorite and its related compounds for their use aimed to prevent or treat COVID-19 without any scientific endorsement or having a sanitary registry for that purpose. It was found through the Toxicology Network of Latin America and the Caribbean (RETOXLAC) that they were not isolated events but rather that the same phenomenon was occurring throughout the region and that there has been a history of poisoning and alerts with these products for more than a decade with unapproved indications for the treatment of different pathologies such as AIDS, cancer, amyotrophic lateral sclerosis (ALS), malaria, autism, among others, without evidence. In the light of this situation, the CIATs present a review of the signs and symptoms observed ac- cording to the route of exposure based on health risk communication; proposing tests to support the diagnosis, an algorithm for poisoning treatment, and a model of a clinical record for the epidemiological surveillance of the assisted cases. We recommend to the authorities and responsible organisms reinforce the actions aimed at surveillance, control, and prevention of this type of poisoning due to the misuse of an unauthorized disinfectant for therapeutic or medical purposes.

Epidemiological Characteristics of Sedative-Hypnotics and Opioid Painkillers at High-Frequency Exposure / 法医学杂志

Drug poisoning has a high incidence and serious consequences in medical institutions; its epidemiological characteristics also directly affect the changes in national laws and policies and the implementation of local management policies. Chinese statistics on drug-related abnormal death cases generally come from judicial appraisal centers and medical units. However, due to differences in work content and professional restrictions, there are differences in information management forms, which makes it difficult for appraisers to conduct a professional and systematic analysis of drug-related cases. This article focuses on the analysis of epidemiological characteristics of sedative-hypnotics and opioid painkillers and their exposure patterns in cases of poisoning death by analyzing the annual report of the American Association of Poison Control Center, combined with the characteristics of drug exposure in China.

Clinical and epidemiological analysis of suicide attempts in children assisted by a poison control center / Análise clínica e epidemiológica das tentativas de suicídio em crianças atendidas em um centro de informação e assistência toxicológica

ABSTRACT Objective: To assess suicide attempts in children seeking care at a Poison Control Center. Methods: Cross-sectional study with children (<12 years old) that attempted suicide and were cared at the Poison Control Center in Londrina, Paraná, Southern Brazil, from April 1985 to December 2018. Results: We identified 59 children, most of them females (74.6%), who used only one product (77.9%). Among the products involved, medications were the most important ones (88.1%). Neurological/psychiatric/muscular manifestations (61.0%) were the main symptoms presented. The main reason identified for the suicide attempt was conflicts with family and/or friends (27.1%). Suicide attempts were more frequent in 2001-2003 and 2016-2018. Conclusions: Suicide attempts occurred mainly in female children with a single agent (mainly medications), and the main reason was family conflicts..

RESUMO Objetivo: Analisar as tentativas de suicídio em crianças atendidas em um Centro de Informação e Assistência Toxicológica (CIATox-Londrina). Métodos: Estudo transversal com crianças (<12 anos) atendidas no CIATox-Londrina, Paraná, de abril/1985 a dezembro/2018, com tentativa de suicídio. Resultados: Identificaram-se 59 crianças, com predomínio do sexo feminino (74,6%) e com o uso de apenas um produto (77,9%). Entre os produtos envolvidos, destacaram-se os medicamentos (88,1%). As manifestações neurológicas/psíquicas/musculares (61,0%) foram os principais sintomas apresentados. O principal motivo identificado da tentativa de suicídio foram os conflitos com familiares e/ou amigos (27,1%). Houve maior frequência de tentativas de suicídio nos triênios 2001-2003 e 2016-2018. Conclusões: As tentativas de suicídio ocorreram predominantemente nas crianças do sexo feminino, com um único agente (em geral, medicamentos), em que o principal motivo foram os conflitos familiares, observando-se um aumento ao longo dos anos.

Severe acute toxic exposures in children and adolescents: case series / Exposições tóxicas agudas graves em crianças e adolescentes: série de casos

ABSTRACT Objective: To describe a case series of severe acute toxic exposures (SATE) in individuals <20 years old followed-up by a regional Poison Control Center (PCC). Methods: Descriptive cross-sectional study. All patients who were <20yo and classified as score 3 (severe) and 4 (fatal) following Poisoning Severity Score were included for analysis. According to the outcome, patients were classified as PSS 3 when they developed intense clinical manifestations with risk of death or important sequelae; and as PSS 4 when death had resulted from direct cause or complication of the initial exposure. The data of patients were obtained from the Brazilian electronic database system (DATATOX). Results: During the biennium 2014-2015, Campinas PCC followed up 5,095 patients <20yo, with 30 being classified as SATE (PSS=3, n=24; PSS=4, n=6). The exposures circumstances were unintentional (15); intentional (14; suicide attempt = 11; street drugs consumption = 3); and not explained (1). The exposures were significantly more frequent in adolescents >14yo (n=17; p<0.01). The involved agents were venomous animals (8; scorpions=5); medicines (8; miscellaneous=6); chemicals (6); illegal rodenticides containing acetylcholinesterase inhibitors (chumbinho, 4); drugs of abuse (3); button battery (1). Three patients evolved with sequels (esophageal stricture post-corrosive ingestion). The median length of hospital stay was 6 days (IQR: 5-12 days); 26 patients were treated in intensive care units, and 22 of them needed mechanical ventilation; 12, inotropic/vasopressors; and 3, renal replacement therapy. Conclusions: Scorpion stings and poisonings caused by medicines and chemicals were the main causes of SATE. The SATE were significantly more frequent in adolescents, due to deliberate self-poisoning.

RESUMO Objetivo: Descrever uma série de casos de exposições tóxicas agudas graves (ETAG) em pacientes <20 anos seguidos por um Centro de Informação e Assistência Toxicológica (CIATox) regional. Métodos: Estudo descritivo de corte transversal. Incluídos no estudo todos os casos classificados como escore 3 (graves) e 4 (fatais) de acordo com o escore de gravidade de intoxicações (poisoning severity score - PSS). Segundo o PSS, os casos são classificados em relação ao desfecho como escore 3 quando os pacientes desenvolveram manifestações clínicas intensas, com risco de morte ou que resultaram em sequelas importantes; e escore 4 quando a morte foi resultado de causa direta ou por complicação da exposição. Os dados analisados foram obtidos da base eletrônica brasileira do Sistema Nacional de Informações Tóxico-Farmacológicas DATATOX. Resultados: No biênio 2014-2015 o CIATox de Campinas atendeu 5.095 casos de pacientes <20 anos, dos quais 30 foram classificados como ETAG (PSS=3, n=24; PSS=4, n=6). Quanto à circunstância, 15 foram acidentais, 14 intencionais (11 por tentativas de suicídio e três por abuso de drogas) e um de causa não esclarecida, sendo significativamente mais frequentes nos adolescentes >14 anos (n=17; p<0,01). Os grupos de agentes envolvidos foram: animais peçonhentos (8; escorpiões=5); medicamentos (8; associações=6); produtos químicos de uso domiciliar/industrial (6); rodenticidas inibidores da colinesterase de uso ilegal (chumbinho=4); drogas de abuso (3); e bateria no formato de disco (1). Três pacientes evoluíram com sequelas (estenose esofágica pós-ingestão de corrosivos). O tempo mediano de internação foi de seis dias (mediana, quartis e intervalo interquartil=5-12 dias), sendo 26 pacientes admitidos em unidades de cuidados intensivos, dos quais 22 necessitaram de ventilação mecânica, 12 de inotrópicos/vasopressores e três de terapia de substituição renal. Conclusões: Escorpionismo e intoxicações por medicamentos e por produtos químicos de uso domiciliar/industrial foram as principais causas de ETAG, sendo elas significativamente mais frequentes em adolescentes, principalmente por tentativas de suicídio.

Caracterización epidemiológica de las exposiciones a dióxido de cloro/clorito de sodio en el contexto de la pandemia COVID-19: Reporte de los centros toxicológicos de América Latina / Epidemiological characterization of exposures to chlorine dioxide/ sodium chlorite in the context of the COVID-19 pandemic: Report of Poison Control Centers in Latin America

Resumen Los centros de información y asesoramiento toxicológico CIATs de América Latina, en el contexto de la pandemia de COVID-19, recibieron una serie de llamadas para consultas y asesoramientos relacionados con el uso de dióxido de cloro/clorito de sodio, que se estaban empleando en el tratamiento o prevención de dicha enfermedad. Dentro de la legislación vigente en los países de América Latina, no se contemplan productos farmacéuticos registrados para uso en humanos, ni se tiene evidencia de registros sanitarios en Europa, Canadá o Estados Unidos para tal fin, que contengan dióxido de cloro o clorito de sodio. Esta publicación, compila la información registrada como parte de la estadística del trabajo de ocho CIATs correspondientes a igual número de países de América Latina. Se identificó sexo, edad, sintomatología, circunstancia y grado de severidad de los 56 casos de pacientes intoxicados con dióxido de cloro/clorito de sodio registrados en el período del 15 de marzo al 30 de septiembre de 2020 en estos ocho países. Los resultados obtenidos confirman que la causa más común fue por mal uso, y el lugar de ocurrencia fue el hogar o sus alrededores, siendo el mayor porcentaje adultos jóvenes comprendidos entre 30 y 49 años. Los síntomas de intoxicación más frecuentemente encontrados fueron gastrointestinales, seguidos de cardiovasculares y respiratorios. La vía de ingreso al organismo en la mayoría de los casos fue por vía oral, reportándose algunos casos por vía inhalatoria, y en el 50% de los casos se constituyeron casos de severidad moderada, severa o fatal (3 fallecimientos). Este estudio contribuye a generar información relevante para las diferentes autoridades sanitarias, los ministerios de salud, las entidades encargadas de inspección, vigilancia y control de los países en los que se comercializan estos productos de manera ilegal por medio de redes sociales y promoviéndolos para uso en humanos para prevenir o curar COVID-19.

Abstract The Poison Control Centers in Latin America, in the context of COVID-19 pandemic, received a series of calls for consultations and recommendations related to the use of chlorine dioxide/sodium chlorite, in the treatment or prevention of CO-VID-19. Under current legislation in Latin America, no pharmaceutical products are registered for use in humans that contain chlorine dioxide or sodium chlorite, nor is there evidence of sanitary registries in Europe, Canada, or the United States for this purpose. This publication compiles the information registered by eight Poison Control Centers that correspond to the same number of Latin American countries. Sex, age, symptoms, circumstance, and degree of severity of the 56 cases of patients poisoned with chlorine dioxide/ sodium chlorite registered in the period from March 15th to September 30th, 2020 were identified. The results obtained confirm that the most common cause of poisoning was unintentional misuse, all of which occurred at home or its surroundings, with the highest percentage of registered cases being young adults between 30 and 49 years old. The most frequent symptoms of intoxication were gastrointestinal, followed by cardiovascular and respiratory. The route of exposure in most cases was oral, with some cases reported by inhalation; 48.2% of the cases were of moderate, severe, or fatal (3 deaths). This study contributes to the generation of relevant information for different health authorities, ministries of health, entities in charge of inspection, surveillance, and control in countries where these products are illegally marketed through social networks and promoted for use in humans to prevent or cure COVID-19.

Caracterización de las consultas realizadas a un Centro de Información Toxicológica por productos de aseo y productos cosméticos en niños / Characterization of the phone-calls made to a poison center related to household and cosmetics products exposition in pediatrics

INTRODUCCIÓN: Los productos de aseo y cosméticos son necesarios en el diario vivir y ampliamente utilizados por la población. Sin embargo, su uso puede no estar exento de riesgos, especialmente cuando no se utilizan o almacenan según lo recomendado. Es importante caracterizar las exposiciones, ya que eso es útil para implementar estrategias para reducir la morbilidad, mortalidad y costos asociados, especialmente en la población infantil. OBJETIVO: Caracterizar los reportes asociados a exposiciones a productos de aseo y productos cosméticos en pacientes menores de 12 años reportados al Centro de Información Toxicológica de la Universidad Católica de Chile (CITUC). PACIENTES Y MÉTODO: Estudio descriptivo transversal de llamados telefónicos reportados a CITUC durante el año 2016. Se analizaron las variables: edad, sexo, agente, interlocutor, localización del interlocutor e inciden te, circunstancia de exposición, vía(s) de exposición, sintomatología, y severidad, mediante fichas de registro manual y desde el software de registro electrónico denominado "INTOX Data Manage ment System" de la OMS. RESULTADOS: Cumplieron criterios de inclusión 3.415 casos. Los menores de 5 años representaron el 91% de las exposiciones y el 58,5% correspondió al sexo masculino. Un 99,4% correspondió a exposiciones accidentales y el 98,6% ocurrieron en el hogar. El 68,3% no presentó síntomas, tras la exposición. Las llamadas fueron realizadas por familiares (57%) y personal de salud (42%). Los 4 agentes con mayor incidencia fueron cloro doméstico (27,6%), limpiadores y lustres de pisos (13,1%), lavalozas (7,9%) y perfumes/colonias (5,8%). La principal vía de exposición fue digestiva (89,4%). CONCLUSIONES: Los productos de aseo y cosméticos son causas comunes de exposiciones especialmente en menores de 5 años. Si bien son productos de baja mortalidad y morbilidad, es importante educar a la población para prevenir posibles intoxicaciones en la población infantil.

INTRODUCTION: Household cleaning products and cosmetics are necessary for daily life and widely used by the population. However, their use may not be risk-free, especially when they are not used or stored as recommended. It is important to characterize exposures, as this is useful for developing stra tegies to reduce morbidity, mortality, and health costs associated, especially in the child population. OBJECTIVE: To describe reports associated with household cleaning products and cosmetics exposure in patients under the age of 12, reported to the Poison Information Center of the Catholic University of Chile (CITUC). PATIENTS AND METHOD: Descriptive cross-sectional study of phone calls to CITUC during 2016. The analyzed variables were age, sex, product, caller, caller and incident location, ex posure circumstances, exposure route(s), symptoms, and severity from manual records and from the WHO's electronic record software 'INTOX Data Management System'. RESULTS: 3,415 cases met the inclusion criteria. Children under the age of five represented 91% of the exposures, and 58.5% were male. 99.4% were accidental exposures, and 98.6% occurred at home. Family members (57%) and health personnel (42%) made the calls. 68.3% of the patients had no symptoms after exposure. The four products with the highest incidence were household bleach (27.6%), floor cleaners and polishers (13.1%), dish soap (7.9%), and perfume/cologne (5.8%). The main exposure route was by ingestion (89.4%). CONCLUSIONS: Household cleaning products and cosmetics are common causes of exposures especially in children under the age of five. Although these products have a low morbidity and mortality rate, it is important to educate the population to prevent possible poisonings in the child population.

Adolescentes internados por tentativa de suicídio com agentes químicos: um estudo transversal / Adolescents hospitalized for attempted suicide with chemical agents: a cross-sectional study

Este estudo objetivou descrever as internações por de tentativas de suicídio com agentes químicos em adolescentes internados em um hospital de ensino no período de janeiro de 2011 a dezembro de 2015. Pesquisa transversal e descritiva, com análise retrospectiva de fichas de ocorrência toxicológica, arquivadas em um centro de assistência toxicológica do noroeste do Paraná. Foram selecionadas 27 internações de adolescentes que tentaram suicídio com agentes químicos. As idades encontradas variaram de 12 a 19 anos, sendo a maioria dos internados do sexo feminino, com idade entre 16 e 19 anos (70,4%). A residência foi o local de maior ocorrência das intoxicações, e os principais agentes utilizados foram medicamentos (51,9%) e produtos de uso veterinário (14,8%). Conflitos familiares, tentativa de suicídio anterior e transtorno mental foram fatores observados entre a população estudada e que podem ter relação com a ocorrência do evento suicida. A média de internação foi de 6,2 dias. Dez pacientes internados foram classificados como moderados, 15 como graves e dois como fatais. Foram identificados fatores que permitem dimensionar um problema social emergente: tentativas de suicídio com utilização de agentes químicos entre os adolescentes. Corroborou fatores relacionados à tentativa de suicídio: sexo feminino, espaço domiciliar como cenário, utilização de medicamentos como agente tóxico, e conflitos familiares e afetivos como causa principal, embora pouco relatados nas fichas de atendimento. Fatores como tentativa de suicídio anterior e transtorno mental também foram observados entre a população em estudo (AU)

This study aimed to describe hospitalizations for attempted suicide with chemical agents in adolescents admitted to a teaching hospital from January 2011 to December 2015. Transversal and descriptive research, with retrospective analysis of toxicological records, filed in a toxicological assistance center in the northwest of Paraná. We selected 27 hospitalizations of adolescents who attempted suicide with chemical agents. The ages ranged from 12 to 19 years, with the majority of women hospitalized, aged between 16 and 19 (70.4%). Residency was the most frequent site of poisoning, and the main agents used were medicines (51.9%) and veterinary products (14.8%). Family conflicts, previous suicide attempt and mental disorder were observed among the study population and may be related to the occurrence of the suicidal event. The mean hospitalization was 6.2 days. Ten hospitalized patients were classified asmoderate, 15 as severe and two as fatal. Factors that identify an emerging social problem were identified: suicide attempts with the use of chemical agents among adolescents. Corroborated factors related to the suicide attempt: female sex, home space as scenario, use of medication as a toxic agent, and family and affective conflicts as the main cause, although little reported in the service records. Factors such as previous suicide attempt and mental disorder were also observed among the study population (AU)

Risco social de famílias de usuários de drogas internados por trauma físico social / Risk for the family of drug users hospitalized due to physical injury / Riesgo social para la familia de usuarios de drogas hospitalizado por un trauma fisico

Objetivo: Classificar o risco social de famílias de indivíduos internados por trauma físico e usuários de drogas, investigados como eventos sentinela. Métodos: Estudo exploratório-descritivo, realizado em um centro de assistência toxicológica do Paraná, com 30 eventos sentinela - indivíduos internados com diagnóstico de trauma físico associado à intoxicação por drogas de abuso, no período de abril a setembro de 2014. Instrumentos de coleta de dados foram um roteiro para entrevista semiestruturada e a Escala do Risco Familiar de Coelho e Savassi, respondidos por um familiar informante-chave. Os escores foram analisados descritivamente. Resultados: A pontuação dos escores da Escala de Risco Familiar indicou 19 famílias em risco social, sendo nove com Risco máximo, e famílias com percentuais sociodemográficos de camadas populares da população. Conclusão: Tempo de uso das drogas de abuso, desemprego e baixo vínculo social dos eventos sentinela, influenciaram os índices de risco familiar

Objetivo: Clasificar el riesgo social familiar delos consumidores de drogas a largo plazo y hospitalizado por un trauma físico. Método: Estudio exploratorio descriptivo, realizado en un centro de asistencia toxicológica de Paraná, con eventos centinela - 30 personas hospitalizadas con diagnóstico de trauma físico asociado a la intoxicación por drogas de abuso, de abril a septiembre de 2014. Instrumentos de recolección de datos fueron una hoja de ruta para la entrevista semiestructurada y Escala de Riesgo Familia de Coelho y Savassi, respondida por un informante clave familiar. Las puntuaciones se analizaron descriptivamente. Resultados: La puntuación de la Escala de Riesgo familia indicaron 19 familias en riesgo social, nueve con máximo riesgo, y las familias con el porcentaje sociodemográfico de las clases más bajas de la población. Conclusión: Uso del tiempo de las drogas de abuso, el desempleo y la baja vínculo social de los eventos centinela influyeron en los índices de riesgo de la familia

Objective: The study's purpose has been to classify the familiar social risk of long-term drug users and hospitalized due to physical trauma. Methods: It is a descriptive-exploratory study that was carried out in a toxicological assistance center from Parana State and through 30 sentinel events - hospitalized individuals diagnosed with physical trauma associated with poisoning by drugs abuse, over the period from April to September 2014. Data collection instruments were a semi-structured interview and the Coelho-Savassi's Family Risk Scale, where it was answered by a family key-informant. The scores were analyzed descriptively. Results: The Family Risk Scale score have indicated that 19 families were under social risk, where 9 of them were under maximum risk, and have also shown families with socio-demographic percentage matching the lower classes of the population. Conclusion: The following categories influenced the family risk rates: drugs of abuse use period; unemployment; and low social bond of sentinel events

Tendências de eventos toxicológicos relacionados a medicamentos atendidos por um Centro de Informações Toxicológicas / Trends of drug-related poisoning cases attended to at a poison control center

RESUMO: Introdução: Os eventos toxicológicos relacionados a medicamentos têm alto impacto na morbimortalidade, representando a primeira causa de intoxicação no Brasil. Objetivo: Descrever as tendências de casos de eventos toxicológicos relacionados a medicamentos atendidos por um Centro de Informações Toxicológicas. Método: Estudo com abordagem quantitativa (transversal e de tendência), com análise dos dados referentes aos casos de eventos toxicológicos relacionados a medicamentos atendidos pelo Centro de Informações Toxicológicas do Hospital Universitário da Universidade Estadual de Londrina. Os dados foram coletados das fichas de atendimento, referentes ao período de 1985 a 2014. Para a análise estatística, utilizou-se um modelo de regressão linear simples. Resultados: Dos 36.707 casos atendidos pelo serviço, 22,5% (n = 8.608) foram eventos toxicológicos relacionados a medicamentos. Houve um aumento da proporção de casos em ambos os sexos (R2 = 0,195; p = 0,014) e no sexo masculino (R2 = 0,403; p < 0,001). Detectou-se tendência de elevação da proporção de casos envolvendo a classe de analgésicos, anti-inflamatórios e imunossupressores (R2 = 0,521; p = 0,018), antidepressivos (R2 = 0,923; p < 001) e antipsicóticos (R2 = 0,869; p < 0,001). Os antimicrobianos apresentaram tendência de redução da proporção de casos (R2 = 0,773; p = 0,001). Conclusões: Observou-se tendência de aumento da proporção de casos de eventos toxicológicos relacionados a medicamentos no sexo masculino. Também houve aumento nas tendências envolvendo analgésicos/anti-inflamatórios/imunossupressores, antidepressivos e antipsicóticos.

ABSTRACT: Introduction: Drug-related poisonings have a high impact on morbidity and mortality, representing the first cause of intoxication in Brazil. Objective: To describe the trends of cases of drug-related poisonings attended to by a poison control center. Method: A quantitative approach (cross-sectional trend study) with data analysis of cases of drug-related poisonings attended to at the Poison Control Center of University Hospital of the State University of Londrina. Data were collected from service notification records for the period 1985 to 2014. For statistical analysis, a simple linear regression model was used. Results: Of the 36,707 cases attended to by the service, 22.5% (n = 8,608) were drug-related poisonings. There was an increase in the proportion of cases for both sexes (R2 = 0.195, p = 0.014) and males (R2 = 0.403, p < 0.001). There was a trend towards a higher proportion of cases involving the analgesic, anti-inflammatory and immunosuppressive drug classes (R2 = 0.521, p = 0.018), antidepressants (R2 = 0.923, p < 0.001) and antipsychotics (R2 = 0.869; p < 0.001). Antibiotics showed a trend toward a lower proportion of cases (R2 = 0.773, p = 0.001). Conclusions: There was a trend for a higher proportion of cases of drug-related poisonings in males. Also, there was an increased trend towards cases involving analgesics/anti-inflammatories/immunosuppressants, antidepressants and antipsychotics.

Geographical distribution of health indicators related to snake bites and envenomation in Morocco between 1999 and 2013 / 한국역학회지

OBJECTIVES: Envenomation from snake bites is a significant cause of morbidity and mortality worldwide. The aim of this study was to describe the epidemiological features of snake bites in Morocco and to evaluate time-space trends in snake bite incidence, the mortality rate, and the case-fatality rate. METHODS: This is a retrospective study of snake bite cases reported to the Moroccan Poison Control Center between 1999 and 2013. RESULTS: During the study period, 2,053 people were bitten by snakes in Morocco. Most victims were adults (55.4%). The average age of the patients was 26.48±17.25 years. More than half of the cases (58.1%) were males. Approximately 75% of snake bites happened in rural areas, and 85 deaths were recorded during this period. The incidence of snake bites remained generally steady over the 15-year period of this study, with a marked increase noted since 2012. The mortality rate has increased slightly, from 0.02 deaths per 100,000 inhabitants in 1999 to 0.05 in 2013. The geographical distribution of snake bite cases in the regions of Morocco showed that Tanger-Tétouan had the highest annual incidence of snake bites (1.41 bites per 100,000 inhabitants). However, the highest annual mortality rates were recorded in the Guelmim-Es Semara and Souss-Massa-Drâa regions (0.09 deaths per 100,000 inhabitants for both regions). CONCLUSION: The geographical distribution of the incidence, mortality, and case-fatality rates of snake bites in Morocco showed large disparities across regions during the three 5-year periods included in this study, meaning that certain areas can be considered high-risk for snake bites.

Aplicação da análise multivariada para o mapeamento dos casos de intoxicações agudas atendidos no Centro de Controle de Intoxicações da cidade de São Paulo / Application of multivariate analysis for the mapping of acute intoxication cases attended in Poison Control Center of the São Paulo city

A Toxicologia tem desempenhado um importante papel na identificação de efeitos nocivos à população, gerando subsídios para a tomada de decisões na prática clínica, auxiliando desta forma no bom prognóstico de pacientes intoxicados. De acordo com a Pan American Health Organization, o sucesso em qualquer intervenção em saúde somente pode ser obtido com a criação e manutenção de um banco de dados confiável, que seja capaz de predizer as diversas particularidades das intoxicações, como a população-alvo e suas suscetibilidades. Assim, recomenda-se que médicos, especialistas, legisladores e administradores em saúde adotem em sua rotina uma coleta de dados sistêmica e integrada para o mapeamento e caracterização das intoxicações. Neste cenário, técnicas de análises multivariadas poderiam ser empregadas para evidenciar possíveis intercorrelações; entretanto, seu uso ainda não é comum na toxicologia clínica. Neste trabalho foram identificados e quantificados agentes exógenos em amostras biológicas (sangue e urina) provenientes do Centro de Controle de Intoxicações da cidade de São Paulo, correlacionando os dados obtidos dessas análises com o perfil clínico e prognóstico dos pacientes. Fármacos benzodiazepínicos, antidepressivos, anticonvulsivantes, paracetamol, drogas de abuso e praguicidas foram selecionados de acordo com a incidência reportada por esse centro no período de 2013 a 2014. Do total de amostras analisadas (n = 320), 192 foram positivas para alguma substância, sendo 101 positivas para etanol e 131 positivas para as demais substâncias. Os dados obtidos foram submetidos à análise de correspondência múltipla e análise hierárquica de cluster. A partir da análise multivariada foi possível agrupar os indivíduos em 3 clusters, o que correspondeu a 66,5% do total de informações. No primeiro eixo houve a separação dos pacientes do gênero feminino, que se intoxicaram ou foram expostos a medicamentos e drogas de abuso, por tentativa de suicídio, dos pacientes do gênero masculino, de idade entre 30 a 39 anos, que se intoxicaram com drogas de abuso. No segundo eixo fatorial foram agrupados os pacientes que se intoxicaram com etanol isoladamente, juntamente com pacientes que se intoxicaram com diazepam. Este trabalho contribuiu para o mapeamento dos casos de intoxicação atendidos pelo CCI-SP e foi um estudo inicial para a criação de um banco de dados que poderá ser alimentado constantemente e assim, oferecer ao sistema de toxicovigilância uma base para políticas educativas

Toxicology has played an important role in the identification of harmful effects to the population, generating subsidies for decision making in clinical practice, helping in this way the good prognosis of acutely intoxicated patients. According to the Pan American Health Organization, success in any health intervention can only be achieved by creating and maintaining a reliable database that is capable of predicting the various characteristics of intoxications, such as the target population and their susceptibilities. Thus, it is recommended that doctors, specialists, legislators and health administrators adopt in their routine a systemic and integrated data collection for the mapping and characterization of intoxications. In this scenario, multivariate analysis techniques could be used to evidence possible intercorrelations; however, its use is not yet common in clinical toxicology. In this work, were identified and quantified exogenous agents in biological samples (blood and urine) from the Poison Control Center São Paulo city, correlating the data obtained from these analyzes with the clinical and prognostic profile of the patients. Benzodiazepines, antidepressants, anticonvulsants, acetaminophen, drugs of abuse and pesticides were selected according to the incidence reported by this center in the period from 2013 to 2014. Of the total number of samples analyzed (n = 320), 192 samples have shown to be positive for some of the analytes, from these 100 were positive for ethanol and 131 positive for other substances. The data were submitted to multiple correspondence analysis and hierarchical cluster analysis. From the multivariate analysis it was possible to group the individuals into 3 clusters, which corresponded to 66.5% of the total information. In the first axis, the patients were separated from the female gender, who were intoxicated or were exposed to drugs and suicide attempt of the male patients, aged between 30 and 39 years, who became intoxicated with drugs of abuse. In the second factorial axis were grouped the patients who were intoxicated with ethanol, together with patients who became intoxicated with diazepam. This work contributed to the mapping of intoxication cases attended by the CCI-SP and was a initial study for the creation of a database that could be fed constantly and thus provide the toxicovigilance system with a basis for educational policies

Geographical distribution of health indicators related to snake bites and envenomation in Morocco between 1999 and 2013 / 한국역학회지

OBJECTIVES: Envenomation from snake bites is a significant cause of morbidity and mortality worldwide. The aim of this study was to describe the epidemiological features of snake bites in Morocco and to evaluate time-space trends in snake bite incidence, the mortality rate, and the case-fatality rate.METHODS: This is a retrospective study of snake bite cases reported to the Moroccan Poison Control Center between 1999 and 2013.RESULTS: During the study period, 2,053 people were bitten by snakes in Morocco. Most victims were adults (55.4%). The average age of the patients was 26.48±17.25 years. More than half of the cases (58.1%) were males. Approximately 75% of snake bites happened in rural areas, and 85 deaths were recorded during this period. The incidence of snake bites remained generally steady over the 15-year period of this study, with a marked increase noted since 2012. The mortality rate has increased slightly, from 0.02 deaths per 100,000 inhabitants in 1999 to 0.05 in 2013. The geographical distribution of snake bite cases in the regions of Morocco showed that Tanger-Tétouan had the highest annual incidence of snake bites (1.41 bites per 100,000 inhabitants). However, the highest annual mortality rates were recorded in the Guelmim-Es Semara and Souss-Massa-Drâa regions (0.09 deaths per 100,000 inhabitants for both regions).CONCLUSION: The geographical distribution of the incidence, mortality, and case-fatality rates of snake bites in Morocco showed large disparities across regions during the three 5-year periods included in this study, meaning that certain areas can be considered high-risk for snake bites.

Reportes al Centro Nacional de Toxicología de mujeres en edad fértil expuestas a plaguicidas / Reports to the National Center for Toxicology of women of childbearing age exposed to pesticides

Introducción: el amplio uso de los plaguicidas químicos en la agricultura propicia la exposición semejante de mujeres y hombres a estos productos. Los riesgos por exposición a plaguicidas, tales como los de toxicidad aguda y crónica, efectos inmunológicos, hormonales, endocrinos y sobre la reproducción, no han recibido atención suficiente a nivel mundial. Objetivo: caracterizar los reportes al Centro Nacional de Toxicología de mujeres en edad fértil expuestas a plaguicidas entre 2009 y 2013. Métodos: se realizó un estudio observacional en una serie de 402 mujeres, se analizaron las variables edad, circunstancia, gravedad de la intoxicación y tipo de pesticida. Resultados: las mujeres en edad fértil atendidas representaron la mitad del total de expuestas, con edad promedio de 30,3 años, la mayor incidencia fue de los eventos leves con fines suicidas. Los plaguicidas más involucrados pertenecen al grupo otros/varios. Conclusiones: las mujeres más afectadas fueron las del grupo 12 a 24 años de edad, con intoxicaciones intencionales suicidas de leve intensidad, ocasionadas por plaguicidas del grupo otros/varios(AU)

Introduction: The widespread use of chemical pesticides in agriculture lead to similar exposure of women and men to these products. Risks from exposure to pesticides, such as acute and chronic toxicity, immunological, hormonal, endocrine and reproductive effects, have not received sufficient global attention. Objective: Characterize the reports to the National Center for Toxicology of women of childbearing age exposed to pesticides between years 2009 and 2013. Methods: An observational study was conducted in a sample of 402 women, in which the following variables were studied; age, circumstance, severity of intoxication and type of pesticide. Results: Women of childbearing age accounted for half of the total number of patients exposed, with a mean age of 30,3 years, with milder events being suicidal. The pesticides most involved belong to the group others/various. Conclusions: The most affected women were those in the 12 to 24 years of age, with intentional poisonings of mild intensity caused by pesticides of the group others/various(AU)

Analysis of Poisoning Patients Using 2016 ED Based Injury in-depth Surveillance Data

PURPOSE: Some advanced countries have reported annual statistics for poisoning based on data from poison control centers. This study was conducted to propose a baseline format and statistics of poisoning in Korea from a national representative database. METHODS: This study was a retrospective analysis of poisoning patients based on data from an emergency department (ED) based injury in-depth surveillance project by the Korea Centers for Disease Control and Prevention in 2016. Bite or sting injuries were not included. Variables related to poisoning were summarized using a similar format as the National Poison Data System in the United States. RESULTS: A total of 7,820 poisoning patients presented to 23 EDs. Adults ≥20 years accounted for 84% of the population, while the proportion of intentional poisoning was 59.4%. The most common poisoning substances were therapeutic drugs (45%), gas (21%), pesticides (15%), and artificial toxic substances (13%). Overall, 34.5% of patients were admitted for further treatment. The mortality was 3.2% (248 cases), and the most common causative substances were carbon monoxide, glyphosate, and paraquat, in order. CONCLUSION: This study showed the recent status of poisoning in Korea. However, a comprehensive poisoning registry based on poison control centers may be required to provide more accurate national statistics in the future.

A Case Report of Acute Nicotine Poisoning from Subcutaneous Injection of Nicotine Solution for Electronic Cigarette

Nicotine-poisoning related to the electronic cigarettes (e-cigarette) is increasing worldwide. Moreover, the American Association of Poison Control Centers has advised the public to use caution with e-cigarette devices and highly concentrated liquid nicotine after a surge in related poisonings. We report here the first case of nicotine poisoning from self-injected e-cigarette fluid in Korea. A 17-year-old male patient subcutaneously injected himself with 0.5 ml of nicotine solution for an electronic cigarette via the dorsum of his hand, after which he complained of nausea, vomiting, dizziness and dyspnea. His vital signs were within the normal range, but his mental status was drowsy. He was admitted for observation and the symptoms disappeared the following day. Sinus bradycardia with a rate of 45/min was observed on the third hospital day, but improved after 6 hours. He was discharged without complications.

Intoxicações exógenas agudas registradas em Centro de Assistência Toxicológica / Acute exogenous intoxications reported in a Toxicological Care Center

O objetivo deste trabalho foi descrever o perfil clínico e sociodemográfico dos casos de intoxicação aguda registrados pelo Centro de Assistência Toxicológica da Paraíba (Ceatox-PB) em 2012. O estudo foi transversal e retrospectivo, pautado na análise documental de dados secundários obtidos no Ceatox (PB). No ano de 2012, foram atendidos 208 casos de intoxicações exógenas no Ceatox-PB. A idade dos pacientes variou de 1 a 77 anos (17,3± 18), com faixa etária mais prevalente inferior a 18 anos (58,2%), e 52,8% do sexo feminino. O principal tipo de intoxicação foi acidente individual (47,6%), e no grupo entre 20-40 anos os casos relacionaram-se a tentativas de suicídio e acidentes individuais. As tentativas de suicídio foram mais frequentes no sexo feminino (60,8%). Os casos ocorreram no ambiente domiciliar (80%) e as causas mais frequentes foram medicamentos (24,6%) e via de intoxicação oral (83,2%). O padrão epidemiológico das intoxicações exógenas notificadas pelo Ceatox-PB, em 2012, foi similar ao relatado em outros estudos, em que jovens e mulheres foram os grupos de maior risco e medicamentos ingeridos de forma acidental, os principais causadores.

Clinical and socio-demographic profile of acute intoxication cases reported at the Toxicological Care Center of Paraíba (Ceatox-PB), Brazil, in 2012, is described by a transversal and retrospective study based on the documental analysis of secondary data retrieved from Ceatox-PB. In 2012, 208 cases of exogenous intoxications were treated at Ceatox-PB. Patients ranged between 1 and 77 years (17,3±18), with prevalent age bracket lower than 18 years (58,2%); 52,8% were female. Main intoxication was accidental (47,6%), and in groups aged 20 - 40 years related to suicide attempts and individual accidents. Attempts at suicide were more frequent in females (60,8%). Cases occurred at home (80%) and medicines taken orally (83,2%) were the most frequent cause (24,6%). Epidemiological pattern of exogenous intoxications at Ceatox-PB in 2012 was similar to that in other studies where young people and females constituted the highest risk group, with main agent as accidentally-taken medicines.

La vigilancia de las intoxicaciones en Argentina y en América Latina. Notificación, análisis y gestión de eventos / Surveillance of poisoning in Argentina and Latin America. Reporting, analysis and event management

La vigilancia de las intoxicaciones, o toxicovigilancia, es una herramienta fundamental de la evaluación de riesgos para la salud y de la valoración de los efectos de las medidas regulatorias que hacen a la seguridad de los productos químicos. Existen numerosas experiencias latinoamericanas desde los Sistemas Nacionales de Vigilancia Epidemiológica donde muchas intoxicaciones han sido incluidas en los listados de enfermedades de notificación obligatoria, tales como las intoxicaciones por plaguicidas, por metales y por hidrocarburos, el botulismo, los envenenamientos por animales ponzoñosos, las intoxicaciones medicamentosas o por drogas de abuso. En este campo se observan también diferencias en los listados nacionales y regionales, destacándose, por ejemplo, la notificación de las intoxicaciones por alcohol adulterado con metanol o por glifosato en Colombia, la intoxicación paralizante por mariscos en países del Cono Sur, las intoxicaciones por plaguicidas en Centroamérica y su relación con la enfermedad renal crónica. También hay peculiaridades en las definiciones de brote y las alertas epidemiológicas, así como en la urgencia o periodicidad requerida para la notificación. Los Centros de Información y Asesoramiento Toxicológicos y los Laboratorios de Análisis Clínicos Toxicológicos también cumplen una importante función al respecto, siendo los efectores más especializados en el diagnóstico y donde se puede obtener información de mayor calidad. Importante ha sido la implementación de la toxicovigilancia en convenios internacionales de Seguridad Química, tales como el de Rotterdam y el de Estocolmo, y los esfuerzos realizados por las Naciones Unidas para armonizar los registros y los informes nacionales.

Surveillance of poisoning, or toxicovigilance, is a fundamental tool for the assessment of health risks and the assessment of the effects of regulatory measures that make the safety of chemicals. There are many Latin American experiences from the National Epidemiological Surveillance where many poisonings have been included in the lists of notifiable diseases such as pesticide poisoning, metals and oil, botulism poisonings venomous animals, poisoning drug or drugs of abuse. In this field also differences are observed in national and regional listings, highlighting, for example, notification of poisoning by adulterated alcohol with methanol or glyphosate in Colombia, paralytic shellfish poisoning in Southern Cone countries, pesticide poisoning in Central America and its relationship to chronic kidney disease. There are also peculiarities in the definitions of outbreak and epidemiological alerts, as well as the urgency or frequency required for notification. Information Centers and Toxicological Consulting and Clinical Toxicology Laboratories Analysis also play an important role in this regard, the most specialized effectors in the diagnosis and where you can get better information. Important has been the implementation of international conventions toxicovigilance Chemical Safety such as Rotterdam and Stockholm, and efforts by the United Nations to harmonize national records and reports.

Rodenticide poisoning in a Toxicological Assistance Center / Intoxicação por raticida em um Centro de Assistência Toxicológica

Objective: to characterize rodenticide poisoning sold illegally under the name Chumbinho. Methods: this is a descriptive and cross-sectional study by retrospective analysis of epidemiological forms of Toxicological Occurrence of a Toxicological Assistance Center, from 2006 to 2013. Results: 115 forms were analyzed, with an annual average of 14.4 ± 4.8 cases and 35.6% of the records in the fourth biennial. Most poisonings occurred in males (57.3%), aged between 15 and 49 years (78.3%) and suicide attempted (90.4%). It was found clinical severity of cases because 92.1% intoxicated required hospitalization and occurred four deaths (3.5%). Conclusion: the cases of poisoning by Chumbinho increased gradually over the studied years, in males, in an economically active age, and by intentional poisoning. There is a need for greater sanitary inspection in the region, aiming to reduce supply and improvement of guidance to consumers.

Objetivo: caracterizar as intoxicações por raticida comercializado clandestinamente sob a denominação de chumbinho. Métodos: estudo descritivo e transversal, por análise retrospectiva de fichas epidemiológicas de Ocorrência Toxicológica de um Centro de Assistência Toxicológica, dos anos de 2006 a 2013. Resultados: foram analisadas 115 fichas, com média anual de 14,4 ± 4,8 casos e 35,6% dos registros no quarto biênio. A maioria das intoxicações ocorreu no sexo masculino (57,3%), na faixa etária entre 15 e 49 anos (78,3%) e pela circunstância tentativa de suicídio (90,4%). Constatou-se gravidade clínica dos casos, pois 92,1% intoxicados necessitaram de internação hospitalar e aconteceram quatro óbitos (3,5%). Conclusão: os casos de intoxicação por chumbinhoaumentaram gradualmente nos anos estudados, em indivíduos do sexo masculino, em idade economicamente ativa e por intoxicação intencional. Há necessidade de maior fiscalização sanitária na região, visando diminuição da oferta e aprimoramento das orientações aos consumidores.