Caracterização epidemiológica dos casos de intoxicação exógena no estado do Pará entre 2012 e 2021 / Epidemiological characterization of exogenous poisoning cases in the state of Pará between 2012 and 2021

Objetivo: Caracterizar o perfil epidemiológico dos casos de intoxicação exógena no estado do Pará, entre 2012 e 2021. Métodos: Estudo quantitativo, de caráter descritivo e delineamento transversal, realizado a partir da coleta de dados no Sistema de Informação de Agravos de Notificação. Resultados: Nesse período, foram registrados 5.803 casos de intoxicação exógena no Pará. Houve predominância no sexo feminino (56,92%), faixa etária de 20 a 39 anos (39,10%) e cor/raça parda (74,93%). Sobressaíram-se as circunstâncias de tentativa de suicídio (32,62%)e uso acidental (24,47%), os agentes tóxicos medicamentos (25,52%) e agrotóxicos agrícolas (13,42%), casos de exposição aguda-única (58,94%), diagnóstico clínico (47,11%) como critério de confirmação e evolução para cura sem sequelas (65,88%). Ao relacionar circunstâncias com faixa etária e sexo, identificou-se número elevado de tentativas de suicídio entre jovens e adultos (n=1.633), principalmente mulheres (n=1.198), enquanto que no uso acidental, os principais acometidos foram as crianças (n=840), em especial, do sexo masculino (n=740). Conclusão: As intoxicações exógenas surgem como uma problemática de saúde no estado do Pará, apresentando características específicas, sendo necessária a promoção de ações de educação em saúde para servir de auxílio no alerta às crianças, jovens, famílias e à comunidade como um todo. Descritores: Epidemiologia; Sistemas de Informação em Saúde; Intoxicação

Objective: To characterize the epidemiological profile of exogenous poisoning cases in the state of Pará between 2012 and 2021. Methods: Quantitative, descriptive and cross-sectional study, based on data collected from the Notifiable Diseases Information System. Results: During this period, 5,803 cases of exogenous poisoning were recorded in Pará. There was a predominance of females (56.92%), aged between 20 and 39 (39.10%) and brown (74.93%). The circumstances that stood out were suicide attempts (32.62%) and accidental use (24.47%), the toxic agents drugs (25.52%) and agricultural pesticides (13.42%), cases of acute-single exposure (58.94%), clinical diagnosis (47.11%) as a confirmation criterion and progression to cure without sequelae (65.88%). When relating circumstances to age group and gender, a high number of suicide attempts were identified among young people and adults (n=1,633), mainly women (n=1,198), while in accidental use, the main victims were children (n=840), especially males (n=740). Conclusion: Exogenous poisoning has become a health problem in the state of Pará, with specific characteristics, and it is necessary to promote health education to help alert children, young people, families and the community as a whole. Descriptors: Epidemiology; Health Information Systems; Poisoning

Reporte de caso: síndrome de absorción intravascular en histeroscopia, intoxicación por glicina / Case report: Intravascular absorption syndrome in hysteroscopy, glycine intoxication

El síndrome de absorción intravascular en histeroscopia se origina por la rápida absorción vascular de soluciones isotónicas e hipotónicas utilizadas en irrigación intrauterina, ocasionando hipervolemia y dilución de electrolitos, especialmente hiponatremia. Cuando este síndrome es debido a intoxicación por glicina al 1,5% causa acidosis severa y neurotoxicidad. La incidencia de este síndrome es baja pero puede aumentar por factores como: falta de control de altura de bolsas de irrigación, ausencia de equilibrio de fluidos de soluciones de irrigación, tejidos altamente vascularizados como miomas uterinos y uso de sistema de electrocirugía monopolar. Se reporta el caso de una paciente con miomas uterinos, programada para resección mediante histeroscopia que cursa con síndrome de absorción intravascular por glicina, el temprano diagnóstico y rápido tratamiento intraoperatorio y postoperatorio permitió una evolución favorable. El manejo se basó en el uso de diuréticos, restricción de fluidos y soluciones hipertónicas de sodio.

Intravascular absorption syndrome in hysteroscopy is caused by rapid vascular absorption of isotonic and hypotonic solutions used in intrauterine irrigation, causing hypervolemia and electrolyte dilution, especially hyponatremia. When this syndrome is due to 1.5% glycine toxicity, it causes severe acidosis and neurotoxicity. The incidence of this syndrome is low but may increase due to factors such as: lack of control of the height of irrigation bags, lack of fluid balance in irrigation solutions, highly vascularized tissues such as uterine myomas and use of a monopolar electrosurgery system. The case of a patient with uterine myomas, scheduled for resection by hysteroscopy, who presents with intravascular glycine absorption syndrome, is reported. Early diagnosis and rapid intraoperative and postoperative treatment allowed a favorable evolution. Management was based on the use of diuretics, fluid restriction, and hypertonic sodium solutions.

Análise do perfil de intoxicação exógena no estado da bahia entre 2012 a 2021 / Analysis of exogenous poisoning profile in the state of Bahia between 2012 to 2021 / Análisis del perfil de intoxicación exógeno em el estado de Bahia entre 2012 a 2021

Introdução:As intoxicações exógenas têm sido um importante problema de saúde pública, em decorrência da sua elevada frequência, morbidade e complexidade. Objetivo:Analisar o perfil de intoxicação exógena no estado da Bahia durante o período de 2012 a 2021, utilizando como base de informações as notificações disponíveis no Sistema de Informação de Agravo e Notificação. Metodologia:Estudo transversal, descritivo, retrospectivo, de série temporal, com abordagem quantitativa, utilizando dados secundários de natureza pública disponibilizados pelo Ministério da Saúde do Brasil. Foram analisadas informações sobre as intoxicações exógenas no estado da Bahia no período temporal de 2010 a 2021.O total de notificações, total de notificações por ano, sexo, raça, faixa etária e escolaridade foram avaliados. A circunstância da intoxicação, o agente tóxico, os critérios de confirmação dos casos, tipo de exposição e a evolução dos casos também foram investigados. Resultados:No período temporalanalisado,foram notificados um total de 46.187 casos de intoxicação exógena no estado da Bahia, com destaque para região leste do estado (43,26%). 55,21% dos indivíduos eram do sexo feminino, parda (46,52%), com faixa etária de 20 a 39 anos (41,71%), e com ensino médio completo (5,76%). A maioria dos casos aconteceram mediante a tentativas de suicídio (30,68%), tendo como principais agentes tóxicos o uso de medicamentos (36,39%). Grande partedos casos foram confirmados mediante ao estado clínico (53,01%). As intoxicações aguda-única apareceram em maior proporção (53,05%). 1,15% dos pacientes notificados foram a óbito. Conclusões:As intoxicações exógenas consistem em um importante problema desaúde pública para o estado da Bahia, reiterando dessa forma, a importância da adoção de medidas preventivas (AU).

Introduction:Exogenous intoxications have been an important public health problem, due to their high frequency, morbidity and complexity. Objective:To analyze the profile of exogenous intoxication in the state of Bahia during the period from 2012 to 2021, using the notifications available in the Grievance and Notification Information System as a basis for information. Methodology:Cross-sectional, descriptive, retrospective, time-series study, with a quantitative approach, using secondary data of a public nature made available by the Brazilian Ministry of Health. Information on exogenous intoxications in the state of Bahia in the time period from 2010 to 2021 was conducted. The total number of notifications, total number of notifications per year, sex, race, age group and education were evaluated. The circumstance of intoxication, the toxic agent, the criteria for confirming the cases, the type of exposure and the evolution of the cases were also investigated. Results:In the time period analyzed, a total of 46,187 cases of exogenous intoxication were reported in the state of Bahia, with emphasis on the eastern region of the state (43.26%). 55.21% of the individuals were female, brown (46.52%), aged between 20 and 39 years (41.71%), and with complete secondary education (5.76%). Most cases occurred through suicide attempts (30.68%), with the use of medication as the main toxic agents (36.39%). Most cases were confirmed based on the clinical status (53.01%). Acute-single intoxications appeared in a greater proportion (53.05%). 1.15% of the notified patients died. Conclusions:Exogenous intoxications are an important public health problem for the state of Bahia, thus reiterating the importance of adopting preventive measures (AU).

Introducción:Las intoxicaciones exógenas hansido un importante problema de salud pública, por su alta frecuencia, morbilidad y complejidad.Objetivo:Analizar el perfil de las intoxicaciones exógenas en el estado de Bahía durante el período de 2012 a 2021, utilizando como base de información las notificaciones disponibles en el Sistema de Información de Quejas y Notificaciones.Metodología:Estudio transversal, descriptivo, retrospectivo, de serie temporal, con abordaje cuantitativo, utilizando datos secundarios de carácter público puestos a disposición por el Ministerio de Salud de Brasil. Se realizó información sobre intoxicaciones exógenas en el estado de Bahía en el período de 2010 a 2021. Se evaluó el número total de notificaciones, el número total de notificaciones por año, el sexo, la raza, elgrupo de edad y la educación. También se investigó la circunstancia de intoxicación, el agente tóxico, los criterios de confirmación de los casos, el tipo de exposición y la evolución de los casos. Resultados:En el período de tiempo analizado, se notificaron un total de 46.187 casos de intoxicación exógena en el estado de Bahía, con énfasis en la región este del estado (43,26%). El 55,21% de los individuos eran del sexo femenino, morenos (46,52%), con edad entre 20 y 39 años (41,71%) y con enseñanza secundaria completa (5,76%). La mayoría de los casos ocurrieron por intento de suicidio (30,68%), siendo el uso de medicamentos el principal agente tóxico (36,39%). La mayoría de los casos se confirmaron en base al estado clínico (53,01%). Las intoxicaciones agudas-simples se presentaron en mayor proporción (53,05%). Falleció el 1,15% de los pacientes notificados.Conclusiones:Las intoxicaciones exógenas son un importante problema de salud pública para el estado de Bahía, lo que reitera la importancia de adoptar medidas preventivas (AU).

Muerte accidental por consumo combinado de cocaína y etanol Revisión bibliográfica / Accidental death from combined cocaine and ethanol use. Literature review

La autopsia médico legal en Costa Rica, en casos sospechosos de intoxicación por cocaetileno se debe realizar bajo las normas establecidas en la Guía de estándares de trabajo para la Sección de Patología Forense del Departamento de Medicina Legal. El análisis del mecanismo fisiopatológico de cómo estas sustancias provocan alteraciones en el organismo que pueden conllevar a un eventual fallecimiento corresponde a parte del análisis requerido en la investigación ante la sospecha de esta causa de muerte. Por lo anterior, el objetivo de este artículo es describir los mecanismos fisiopatológicos que ocurren durante el consumo combinado de cocaína y etanol, los mecanismos que conllevan a la muerte de personas consumidoras de estas sustancias y las consideraciones médico legales a tomar en cuenta para el diagnóstico de esta causa de muerte. Se realizó revisión de artículos científicos, sobre los efectos del uso combinado de la cocaína y el etanol. La literatura describe que el uso combinado de cocaína y etanol potencia los efectos farmacocinéticos y bioquímicos de cada una de estas sustancias, que su derivado, el cocaetileno, es capaz de generar por sí mismo los mecanismos causantes de la muerte. Que los principales mecanismos fisiopatológicos que conllevan la muerte ante el uso combinado de estas sustancias son de origen cardiovascular y hepático. Como consideraciones médico legales a tomar en cuenta para el diagnóstico de esta manera de muerte accidental, en la Sección de Toxicología del Departamento de Ciencias Forenses de Costa Rica, la cuantificación del cocaetileno y las sustancias relacionadas no se realiza, aunque se encuentra actualmente en el desarrollo de un proyecto para la determinación de la estabilidad de las drogas en sangre bajo las condiciones de almacenamiento, con el fin de ofrecer la posibilidad de cuantificar ciertas drogas (en donde se podría incluir el cocaetileno) en un futuro próximo.

Medical-legal autopsy in Costa Rica, in suspected cases of cocaethylene poisoning must be performed under the regulations established in the Work Standards Guide for the Forensic Pathology Section of the Department of Legal Medicine. The analysis of the pathophysiological mechanism of how these substances cause alterations in the organism that can lead to eventual death corresponds to part of the analysis required in the investigation when this cause of death is suspected. Therefore, the objective of this article is to describe the pathophysiological mechanisms that occur during the combined consumption of cocaine and ethanol, the mechanisms that lead to the death of people who consume these substances, and the medico-legal considerations to be considered for the diagnosis. of this cause of death. A review of scientific articles was carried out on the effects of the combined use of cocaine and ethanol. The literature describes that the combined use of cocaine and ethanol enhances the pharmacokinetic and biochemical effects of each one of these substances, that its derivative, cocaethylene, can generate the mechanisms that cause death by itself. That the main pathophysiological mechanisms that lead to death in the combined use of these substances are of cardiovascular and hepatic origin. As legal medical considerations to take into account for the diagnosis of this type of accidental death, in the Toxicology Section of the Department of Forensic Sciences of Costa Rica, the quantification of cocaethylene and related substances is not carried out, although it is currently in the development of a project for the determination of the stability of drugs in blood under storage conditions, in order to offer the possibility of quantifying certain drugs (which could include cocaethylene) in the near future.

Cocaína adulterada con opioides en la provincia de Buenos Aires: análisis epidemiológico para pensar una nueva política de drogas / Cocaine adulterated with opioids in the province of Buenos Aires: epidemiological analysis to think about a New Drug Policy

INTRODUCCIÓN: En febrero de 2022 se produjo en la provincia de Buenos Aires un brote de intoxicación por consumo de cocaína adulterada con opioides. El objetivo de este trabajo fue describir la población afectada, las acciones realizadas desde el Ministerio de Salud de la Provincia de Buenos Aires a partir de la detección de la problemática y analizar las modalidades de abordaje de los consumos respecto de los paradigmas de atención desde la perspectiva de la salud y las normativas vigentes en la temática en Argentina. MÉTODOS: Se realizó un estudio descriptivo transversal con enfoque cuantitativo. Se estudió a todas las personas que presentaban síntomas compatibles con cuadros de intoxicación por consumo de cocaína adulterada y que consultaron en establecimientos de salud de la provincia de Buenos Aires en febrero de 2022. RESULTADOS: Se notificaron 124 casos, el rango etario fue de 18 a 57 años, y el 84,5% fueron informados como sexo legal masculino. El 66% requirió internación hospitalaria, y 19 personas fallecieron. Los resultados de laboratorio confirmaron que la sustancia consumida era cocaína con carfentanilo. DISCUSIÓN: La identificación de opioides es un fenómeno novedoso en la región, que invita a problematizar los marcos normativos y los paradigmas de abordaje vigentes para superar visiones que reducen la problemática a los aspectos inherentes a los individuos y sus conductas respecto del consumo de sustancias psicoactivas.

Intoxicación intencional por paracetamol en adolescentes: un problema de salud creciente: a propósito de un caso / Intentional paracetamol poisoning in adolescents: a growing health problem: clinical case study / Intoxicação intencional por paracetamol em adolescentes: um problema de saúde crescente: relato de caso

La intoxicación por paracetamol de causa no intencional en niños pequeños, e intencional en adolescentes es un motivo de consulta cada vez más frecuente en los servicios de urgencia. La gravedad y el pronóstico de esta intoxicación están dados por el riesgo de falla hepática. Ante la sospecha de ingesta de paracetamol, se debe conocer el tiempo transcurrido, la cantidad de ingesta del fármaco, estimar la toxicidad de la dosis ingerida para predecir hepatotoxicidad, determinar las medidas de contaminación necesarias, dosificar paracetamol en sangre y evaluar la necesidad de administración de antídoto. Se describe el caso de una adolescente que con intención suicida presentó una intoxicación aguda por paracetamol con riesgo de daño hepático requiriendo decontaminación digestiva, administración de antídoto y abordaje interdisciplinario de sus problemas psicoemocionales.

Paracetamol intoxication due to an unintentional cause in young children, and intentional in adolescents, is an increasingly frequent cause for consultation in emergency services. The severity and prognosis of this poisoning is due to the risk of liver failure. Given the suspicion of paracetamol ingestion, the time passed since the ingestion, the amount of paracetamol ingested, the estimate of the dose ingested to predict hepatotoxicity, we must determine the necessary decontamination measures and the paracetamol dose in blood and evaluate the need to administer a paracetamol antidote. We describe the case of an adolescent who presented acute paracetamol poisoning with risk of liver damage resulting from a suicide attempt and who required digestive decontamination, antidote administration and an interdisciplinary approach to her psychological and emotional problems.

A intoxicação não intencional por paracetamol em crianças pequenas e a intoxicação intencional em adolescentes é um motivo cada vez mais comum de consulta em serviços de emergência. A gravidade e o prognóstico desse envenenamento são dados pelo risco de insuficiência hepática. Quando há suspeita de ingestão de paracetamol, o tempo decorrido desde que é ingerido, a quantidade de paracetamol ingerida, a estimação da dose ingerida para predizer hepatotoxicidade, utilizamse para determinar as medidas de contaminação necessárias, dosar paracetamol no sangue e avaliar a ne- cessidade de administração de antídoto. Descrevemos o caso de uma adolescente com intenção suicida que apresentou intoxicação aguda por paracetamol com risco de lesão hepática com necessidade de descontaminação digestiva, administração de antídoto e abordagem interdisciplinar de seus problemas psicoemocionais.

Uso de agrotóxicos e mortes por câncer no estado do Rio Grande do Sul / Pesticide use and cancer deaths in Rio Grande do Sul, Brazil

Resumo Este estudo teve como objetivo caracterizar as regiões de saúde do estado do Rio Grande do Sul (RS) quanto ao uso de agrotóxicos e à mortalidade por câncer de próstata, linfoma não Hodgkin (LNH) e leucemias. Para cada região de saúde foram estimados o volume total de agrotóxicos utilizado, o volume usado por área plantada, a proporção de lavouras com uso, a proporção de agricultura familiar e o grau de desigualdade na distribuição das terras. A mortalidade pelos três tipos de câncer foi descrita com base na mortalidade proporcional e na taxa de mortalidade ajustada por idade. A associação entre as variáveis foi estimada pelo coeficiente de correlação de Spearman. A mortalidade por câncer de próstata mostrou-se relacionada à produção agrícola intensa, utilização de elevado volume de agrotóxicos e menor proporção de agricultura familiar. Já a mortalidade por linfoma não Hodgkin e leucemias esteve associada positivamente à proporção de agricultura familiar. Mortalidade proporcional e taxa de mortalidade ajustada por idade mostraram-se positivamente correlacionadas para os três tipos de câncer. Este estudo demonstrou que, nas regiões de saúde do RS, a mortalidade pelos três tipos de câncer investigados está vinculada, em diferentes intensidades, ao uso de agrotóxicos e a características da agricultura praticada.

Abstract This study characterizes the health regions of the Rio Grande do Sul State regarding pesticide use and mortality by prostate cancer, Non-Hodgkin's Lymphoma and leukemias. Total volume of pesticide used, volume used per planted area, the proportion of crops using pesticides, the proportion of family farming and the degree of inequality in land distribution were estimated for each region. Mortality from the three types of cancer was described by proportional mortality and age-adjusted mortality rate. Association between variables was estimated using Spearman's correlation coefficient. Prostate cancer mortality was associated with intense agricultural production, high volume of pesticide use and a lower proportion of family farming. Mortality from Non-Hodgkin's Lymphoma and leukemias, in turn, was positively associated with the proportion of family farming. Proportional mortality and age-adjusted mortality rate were positively correlated for the three types of cancer. In conclusion, in the health regions of Rio Grande do Sul, mortality by the three types of cancer investigated is associated, albeit at different intensities, with pesticide use and the type of agriculture practiced.

Intoxicação cutânea grave por Paraquat / Serious skin poisoning by Paraquat

O Paraquat é um herbicida não seletivo altamente tóxico, sendo responsável por altas taxas de letalidade acidentais ou provocadas, devido, principalmente, à insuficiência respiratória. Apesar de a intoxicação por via oral ser a principal e mais grave, o contato prolongado com a substância em uma grande área corporal pode gerar uma toxicidade similar e levar ao óbito ­ fato pouco elucidado na literatura. Este é o relato de caso de um homem de 22 anos, que foi admitido em um hospital devido a queixas de mal-estar, náuseas, febre, cefaleia, dor abdominal, diarreia, queimaduras e dispneia. A suspeita diagnóstica inicial foi de hantavirose, leptospirose, dengue e tromboembolismo pulmonar e, posteriormente, foi comprovado intoxicação exógena com agrotóxico por via inalatória e cutânea. Exames de imagem revelaram fibrose pulmonar difusa e ele também apresentou alterações renais, hepáticas e coagulatórias. Como não há antídoto específico, foi empregado tratamento sintomático e suportivo, com uso de carvão ativado, antibióticos, corticoides, antioxidantes e hemodiálise. No entanto, o paciente teve uma piora progressiva do quadro, vindo a óbito devido à síndrome da angústia respiratória aguda e fibrose pulmonar. O Paraquat, embora proibido no Brasil em 2020, continua sendo utilizado de forma ilegal. Além disso, seu substituto, o Diquat, possui toxicidade semelhante. Assim, é fundamental que os profissionais da saúde reconheçam o diagnóstico da intoxicação por tais substâncias e suas diferentes vias de exposição. Também são necessárias novas medidas de fiscalização das substâncias e maior investimento em educação em saúde para evitar exposições acidentais, assim como relatado (AU).

Paraquat is a highly toxic non-selective herbicide and is responsible for high accidental or provoked lethality rates, mainly due to respiratory failure. Although oral poisoning is the primary and most severe, prolonged contact with the substance in a large body area can lead to similar toxicity and death ­ a fact that is little elucidated in the literature. This is the case report of a 22-year-old man admitted to a hospital due to complaints of malaise, nausea, fever, headache, abdominal pain, diarrhea, burns and dyspnea. The initial diagnostic suspicion was hantaviruses, leptospirosis, dengue and pulmonary thromboembolism, and there was subsequently proven exogenous intoxication with pesticides by inhalation and cutaneous route. Imaging tests revealed diffuse pulmonary fibrosis and he also had renal, hepatic and coagulation alterations. As there is no specific antidote, symptomatic and supportive treatment was performed using activated charcoal, antibiotics, corticosteroids, antioxidants and hemodialysis. However, the patient had a progressive worsening of the condition and died due to acute respiratory distress syndrome and pulmonary fibrosis. Paraquat, although banned in Brazil in 2020, continues to be used illegally. In addition, its substitute, the Diquat, has similar toxicity. Thus, it is essential that health professionals recognize the diagnosis of intoxication by such substances and their different exposure routes. New control measures for these substances and greater investment in health education are also needed to prevent accidental exposure, as reported (AU).

Intoxication par tortue de mer vue au Centre Hospitalier Universitaire Antanambao, Toliara, Madagascar / Poisoning by sea turtle at the Antanambao University Hospital, Toliara, Madagasca

Le chélonitoxisme est une intoxication collective par consommation de la chair, de la peau et des viscères de la tortue marine. Elle est peu fréquente. Notre objectif était de décrire l'aspect épidémio-clinique et thérapeutique de l'intoxication par tortue de mer. Méthodes : Il s'agit d'un rapport de cas effectué au Centre Hospitalier Universitaire (CHU) Antanambao Toliara, Madagascar après une intoxication collective dans la commune rurale de Soalara Sud, Toliara. Résultats : Nous avons colligé 70 patients qui ont ingéré une tortue adulte du genre Eretmochelys imbricata. Les signes cliniques étaient du type chélonitoxisme. Parmi les 70 cas, 8 patients ont été hospitalisés. L'âge des patients intoxiqués variait de 2 ans à 65 ans avec un âge moyen de 20 ± 14 ans. La tranche d'âge entre 10-20 ans était la plus touchée (44%). Les hommes représentaient 54% des patients avec un sex ratio de 1,18. Cinquante-huit pourcent ont eu leurs premiers signes 24 heures après l'intoxication et 81% des patients ont été vus au CHU entre 24 et 48 heures. Les signes cliniques du chélonitoxisme sont polymorphes : 86% ont présenté une asthénie, 91% des nausées, 25% des vomissements, 71% des céphalées et 21% des stomatites. A l'issue de l'hospitalisation, 99% des malades ont été guéris et un patient est décédé. Les traitements étaient symptomatiques. Conclusion : L'intoxication par tortue de mer est généralement bénigne. La prise en charge est symptomatique.

Intoxicación por plaguicidas en autopsias medicolegales. Tegucigalpa 2014-2020 / Poisoning by pesticides in medicolegal autopsies. Tegucigalpa 2014- 2020

Justificación: Los plaguicidas han provocado un significativo problema de salud pública ya que han generado una importante carga a la mortalidad y a la morbilidad. Los suicidios con plaguicidas representan alrededor de un tercio de todos los suicidios en el mundo. Objetivo: Caracterizar las muertes relacionadas a plaguicidas, sometidas a autopsia médico legal en la Dirección de Medicina Forense de Tegucigalpa durante los años 2014- 2020. Metodología: Se consultó la base de datos digital la Dirección de Medicina Forense, encontrando 255 casos relacionados a muerte por plaguicidas de los que se seleccionaron 215 casos con expediente completo y disponible. Los cálculos estadísticos se realizaron con el programa PSPP. Resultados: Se encontraron 215 casos, el 58% eran hombres y el 42% mujeres, 54% eran solteros y 29% en unión libre. Sin escolaridad 11%, primaria incompleta 20%, primaria completa 15%, secundaria incompleta 12%, secundaria completa 10%. Respecto a la ocupación de los fallecidos, los oficios domésticos fue la más frecuente entre las mujeres y la agricultura entre los hombres. El 65% eran personas jóvenes menores de 40 años con una media de edad de 35 años (rango 8- 89a). La manera de muerte más frecuente fue suicida con el 71%. El plaguicida más utilizado como instrumento de muerte fue el fosfuro de aluminio (66%).Conclusión: La mayoría de las muertes por intoxicación con plaguicidas fueron suicidas; hombres jóvenes, menores de 40 años, solteros, con escolaridad que no sobrepasaba la secundaria; utilizaron las pastillas de fosfuro de aluminio como instrumento de autolesión. Se requiere estudiar más detalladamente el uso de tóxicos en general y de los plaguicidas en particular como instrumentos de autolesión y se evidencia la necesidad imperiosa de habilitar medidas de regulación para la comercialización y campañas de educación en la población para el uso y manejo adecuado...(AU)

Intoxicación fatal con paraquat por vía dérmica. Reporte de caso / Fatal paraquat poisoning by dermal exposure. Case report

Introducción: Por su alta letalidad el paraquat® es utilizado con fines suicidas, siendo la principal vía de uso, la oral; los casos por vía cutánea son escasos y raras veces son fatales. Este reporte presenta un caso de compromiso sistémico severo y muerte después de exposición dérmica a paraquat® . Resumen del caso: Paciente femenina de 47 años, soltera, ama de casa, de procedencia rural, con secundaria incompleta; e historia de aplicación de paraquat® en ulcera. A las 24h de aplicación presento fiebre, vómito y malestar general; al ingreso hospitalario presento además ictericia generalizada, insuficiencia renal aguda, insuficiencia respiratoria, deterioro progresivo de su estado de salud y muerte, por lo que fue remitida a autopsia médico legal. Los hallazgos de autopsia descartaron la ingesta oral y mostraron páncreas hemorrágico, riñones congestivos, hígado de tamaño aumentado (2550g) y hemorrágico, corazón aumentado de tamaño. Los estudios histopatológicos mostraron daño alveolar difuso, (membranas hialinas, edema y hemorragia); neumonía en pulmón y congestión visceral generalizada...(AU)

Clinical characteristics and follow-up analysis of 12 patients of acute phosphine poisoning / 中华劳动卫生职业病杂志

Objective: To investigate the clinical characteristics of patients with acute phosphine poisoning, and to follow up and evaluate the prognosis of patients. Methods: In May 2022, 12 patients with phosphine poisoning by respiratory inhalation in Beijing Chao-Yang Hospital of Capital Medical University were analyzed. The patients were treated with symptomatic support therapy. Three months later, patients were re-evaluated the symptoms of poisoning, pulmonary function and magnetic resonance imaging (MRI) of the brain to understand the prognosis of the phosphine poisoning. Results: The main symptoms of 12 patients were respiratory and central nervous system symptoms with hypoxia. The symptoms of poisoning improved after treatment. Follow-up found that the patients had different degrees of residual symptoms. Pulmonary function showed increased airway resistance. Airway challenge test was positive in some patients. MRI of the head of some patients showed small ischemic focus in bilateral frontal lobes. Conclusion: Acute phosphine poisoning may cause persistent damage to the respiratory system and central system, and residual symptoms after 3 months.

One case of myocardial damage caused by carbamate pesticide poisoning / 中华劳动卫生职业病杂志

The data of a patient with carbamate pesticide poisoning were analyzed. Cardiac arrest, oliguria, acute renal injury and pulmonary infection occurred during treatment. After cardiopulmonary resuscitation, tracheal intubation, CRRT, anti-infection and other symptomatic support treatment, the patient recovered and discharged. The myocardial damage caused by carbamate pesticide poisoning is easy to be ignored, and it often causes cardiac manifestations such as arrhythmia and cardiac insufficiency, and the related markers of cardiac injury, electrocardiogram and echocardiogram are also changed. Therefore, the awareness of cardiac damage caused by carbamate pesticide poisoning should be improved.

Three cases of acute chlorfenapyr poisoning / 中华劳动卫生职业病杂志

This paper reported 3 cases of poisoning caused by chlorfenagyr. Chlorfenapyr poisoning has gradually increased in clinical practice. The early stage after poisoning is digestive tract symptoms, followed by sweating, high fever, changes in consciousness, changes in myocardial enzymology, etc. Its main mechanism of intoxication is uncoupling oxidative phosphorylation. Since there is no specific antidote after poisoning, the fatality rate of chlorfenapyr poisoning remains high. The therapeutic measures are early gastrointestinal decontamination, symptomatic and supportive treatments, and early blood purification may be an effective treatment.

Epidemiological characteristics of pesticide poisoning in Chengdu City from 2012 to 2021 / 中华劳动卫生职业病杂志

Objective: To explore the present situation and epidemiological characteristics of pesticide poisoning in Chengdu City from 2012 to 2021, and to provide scientific evidence for further prevention and control. Methods: In January 2022, the pesticide poisoning report cards of Chengdu City from 2012 to 2021 were collected from the China Disease Control and Prevention Information System. The data of the report card was reorganized and the distribution characteristics of pesticide poisoning such as time, region, gender, age and pesticide types were analyzed. Results: 14326 cases of pesticide poisoning were reported in Chengdu City from 2012 to 2021, 651 deaths, and the fatality rate was 4.54%. The cases of productive pesticide poisoning and unproductive pesticide poisoning were 504 and 13822, respectively. The fatality rates of productive and unproductive pesticide poisoning were 1.39% and 4.66%, which were significant different (χ(2)=11.99, P=0.001). The highest reported cases of pesticide poisoning was in 2013 (1779) and the lowest in 2021 (1047). The number of reported cases showed a downward trend year by year (t=-12.30, P<0.001), and the fatality rates also showed a downward trend year by year (χ(2)(trend)=25.48, P<0.001). The fluctuation range of unproductive pesticide poisoning cases in each month of the year was small, and the productive pesticide poisoning mainly occurred from May to August. The regions with the largest number of reported poisoning cases were Pengzhou (1620), Jianyang (1393), Jintang (1266) and Qionglai (1158). The high incidence of poisoning was among 25-54 years old (50.21%, 7193/14326). The fatality rate in the age group 75-96 years old was the highest (8.98%, 95/1058), and the fatality rates increased gradually with age (χ(2)(trend)=186.03, P<0.001). The pesticides causing poisoning were mainly insecticide (43.86%, 6284/14326) and herbicides (35.75%, 5121/14326). Herbicides paraquat had the highest fatality rate (9.54%, 286/2998) . Conclusion: Pesticide poisoning in Chengdu City is mainly unproductive poisoning. Health education should be carried out for key areas and people, and the control of highly toxic pesticides such as insecticide and herbicides should be strengthened.

A case of dimethylformamide poisoning caused by skin contact / 中华劳动卫生职业病杂志

In this paper, the clinical data of a case of accidental poisoning of dimethylformamide in a traffic accident was analyzed. The patient was trapped in the driving room, his limbs were soaked in dimethylformamide for a long time, and dimethylformamide was inhaled at the same time. After 4 days of treatment in a local hospital, he was transferred to the Department of Poisoning & Occupational Diseases, Emergency Medicine of Qilu Hospital of Shandong University for treatment. The main clinical manifestation of the patient was liver damage and intractable abdominal pain, which was cured by active treatment.

A case of delayed peripheral neuropathy caused by diquat poisoning / 中华劳动卫生职业病杂志

Diquat is a kind of conductive contact-killing herbicides. The damage of central nervous system is relatively common, but the peripheral neuropathy caused by diquat has not been reported yet. In September 2021, we treated a patient with diquat poisoning. During the hospitalization, the patient was diagnosed with peripheral neuropathy. Therapy for peripheral nerve injury was given on the basis of conventional treatment of poisoning. The patient was discharged after his condition was stable. The follow-up showed that the peripheral neuropathy of patient was better than before. According to the condition of this patient, it is suggested that we should not only protect the function of gastrointestinal tract, liver, kidney, and central nervous system early, but should also pay attention to the damage of peripheral nervous system in clinical work. We should intervene earlier to improve the prognosis of patients.

Clinical characteristics of acute occupational poisoning caused by carbon dioxide leakage from a cargo ship / 中华劳动卫生职业病杂志

Carbon dioxide is a simple asphyxial gas, with low concentrations having an excitatory effect on the respiratory center, while high concentrations have an inhibitory effect on the respiratory center. Simple carbon dioxide poisoning is rarely seen clinically. This article reviews and analyzes the treatment process of 9 cases of acute inhalation carbon dioxide poisoning in a cargo ship carbon dioxide leakage accident in May 2019, summarizes clinical treatment experience, and provides timely and effective treatment for acute pulmonary edema caused by acute inhalation carbon dioxide poisoning. In particular, the application of hormones has a good prognosis, improving clinicians' understanding of the disease.

A case of poisoning by oral lime sulfur / 中华劳动卫生职业病杂志

Lime sulfur is a common bactericide with strong alkalinity, and is highly corrosive to humans and animals. It is rare for lime sulfur poisoning clinically. This article discusses the clinical manifestations of a patient who was poisoned by oral lime sulfur. After the poisoning, the mucosa of the lips and pharynx broke, fever, and pulmonary inflammation quickly appeared. The pulmonary CT showed slight interstitial changes in both lungs. Through high flow oxygen inhalation, fluid infusion, drainage, maintenance of water and electrolyte balance, protection of important organ functions, and other symptomatic support and treatment, as well as control of blood pressure, blood sugar, maintenance of circulatory function and other targeted measures, the patient's condition gradually improved.