Perfil toxicológico dos suicídios no Rio Grande do Sul, Brasil, 2017 a 2019 / Perfil toxicológico de los casos de suicidio en Rio Grande do Sul (Brasil), 2017-2019 / Toxicology of suicide cases in the state of Rio Grande do Sul, Brazil, 2017 to 2019

RESUMO Objetivo. Descrever o perfil toxicológico de todas as vítimas de suicídio no Rio Grande do Sul, Brasil, de 2017 a 2019. Métodos. Neste estudo descritivo e transversal, foram consultados todos os laudos periciais e as ocorrências policiais relacionados aos óbitos por suicídio no estado. Foram realizadas análises de correspondência múltipla e construídos modelos independentes de regressão logística, tendo como variáveis dependentes o etanol, os ansiolíticos, os antidepressivos, as substâncias ilícitas e os agentes tóxicos não medicamentosos. Resultados. Foram realizados 2 978 exames de alcoolemia, com resultado positivo em 28,5%. A chance de resultados positivos para alcoolemia foi 0,5 (IC95%: 1,1 a 2,2) vez maior para suicídio durante a noite, 1,0 (IC95%: 1,4 a 2,9) vez maior para suicídio aos finais de semana e 0,9 (IC95%: 1,3 a 2,7) vez maior na presença de antecedentes criminais. A pesquisa de psicotrópicos (2 900 amostras) detectou algum medicamento em 30,4%. Os ansiolíticos foram a classe mais frequente, com chance 1,5 (IC95%: 1,6 a 4,1) vez maior em mulheres e 0,8 (IC95%: 1,2 a 2,7) vez maior para suicídios ocorridos no outono-inverno. As substâncias ilícitas (n = 338) tiveram chance 4,1 (IC95%: 1,9 a 14,4) vezes maior de detecção na macrorregião de Pelotas em relação à de Passo Fundo e 1,2 (IC95%: 1,3 a 3,6) vez maior em pessoas com resultados positivos para etanol. Não houve diferença significativa entre adolescentes e adultos. Conclusões. Embora sem evidência de causalidade, os resultados mostram um vínculo entre o suicídio e diversos psicoativos. Os médicos legistas devem ser orientados quanto à necessidade de realização de exames toxicológicos em todos os casos de suicídio.

ABSTRACT Objective. To describe the toxicology of suicide cases recorded in the state of Rio Grande do Sul, Brazil, from 2017 to 2019. Method. The present descriptive, cross-sectional study examined all the medico-legal reports and police records related to suicide deaths in the state. Multiple correspondence analyses were performed along with independent logistic regression models having ethanol, anxiolytic and antidepressant drugs, illicit drugs, and non-medical substances as dependent variables. Results. Ethanol was investigated in 2 978 samples, with positive results in 28.5%. The odds of a positive ethanol finding were 0.5 time higher (95%CI: 1.1; 2.2) for suicides occurring at night, 1.0 (95%CI: 1.4; 2.9) time higher for suicides occurring on weekends, and 0.9 (95%CI: 1.3; 2.7) time higher in individuals with a prior criminal record. Investigation of psychotropic drugs (2 900 samples) was positive in 30.4% samples. Anxiolytics were the most common medication detected, with 1.5 (95%CI: 1.6; 4.1) time higher odds of occurrence in women and 0.8 time higher odds (95%CI: 1.2; 2.7) for suicides occurring in the fall-winter. The odds of detecting illicit drugs (n = 338) were 4.1 times higher (95%CI: 1.9; 14.4) in the regions of Pelotas (south of the state) vs. Passo Fundo (north), and 1.2 (95%CI: 1.3; 3.6) time higher in cases with positive ethanol results, without significant difference between adolescents and adults. Conclusions. Despite the lack of evidence on causality, the present results support a link between suicide and several psychoactive drugs. Medico-legal experts should be guided regarding the need to perform toxicological tests in all suicide cases.

RESUMEN Objetivo. Describir el perfil toxicológico de todas las víctimas de suicidio en Rio Grande do Sul desde el 2017 hasta el 2019. Métodos. En este estudio descriptivo y transversal se consultaron todos los informes periciales y policiales sobre las muertes por suicidio en el estado. Se realizaron análisis de correspondencia múltiple y se crearon modelos independientes de regresión logística, con empleo de etanol, productos ansiolíticos y antidepresivos, sustancias ilícitas y agentes tóxicos no medicamentosos como variables dependientes. Resultados. Se realizaron 2 978 exámenes de alcoholemia, con resultado positivo en un 28,5%. La probabilidad de obtener resultados positivos para alcoholemia aumentó 0,5 (IC95%: 1,1-2,2) en casos de suicidio durante la noche, 1,0 (IC95%: 1,4-2,9) en casos de suicidio en los fines de semana y 0,9 (IC95%: 1,3-2,7) cuando había antecedentes penales. En la investigación de productos psicotrópicos (2 900 muestras) se detectó algún medicamento en un 30,4%. Los ansiolíticos fueron la clase detectada con más frecuencia, con un aumento de la probabilidad de 1,5 (IC95%: 1,6-4,1) en las mujeres y de 0,8 (IC95%: 1,2-2,7) en casos de suicidio durante el otoño y el invierno. El aumento de la probabilidad de detección de sustancias ilícitas (n = 338) fue de 4,1 (IC95%: 1,9-14,4) en la macrorregión de Pelotas en comparación con la de Passo Fundo y de 1,2 (IC95%: 1,3-3,6) en personas con resultados positivos en la prueba de detección de etanol, sin que hubiera ninguna diferencia significativa entre adolescentes y adultos. Conclusiones. Aun sin haberse comprobado la causalidad, los resultados muestran que existe un vínculo entre el suicidio y diversos productos psicoactivos. Es preciso orientar a los médicos legistas con respecto a la necesidad de realizar exámenes toxicológicos en todos los casos de suicidio.

Consumo de sustancias y suicidios en México: resultados del sistema de vigilancia epidemiológica de las adicciones, 1994-2006 / Substance use in suicides in Mexico: results of the epidemiological surveillance system of addictions, 1994-2006

OBJETIVO: Determinar la relación que existe entre el consumo y número de sustancias y la presentación del suicidio. MATERIAL Y MÉTODOS: Los datos se tomaronde la cédula forense del Sistema de Vigilancia Epidemiológica de las Adicciones entre 1994 y 2006 de 27 entidades federativas participantes en México. RESULTADOS: El suicidio se presentó en 8.7% de las defunciones por causa violenta en el periodo de estudio. En los hombres se observó que a medida que aumentaba el número de sustancias se elevaba la posibilidad para fallecer por suicidio, en comparación con los decesos por otras causas (una sustancia: RM= 1.8; dos o más: RM= 3.3). En las mujeres, dicha posibilidad se mantiene prácticamente igual en relación con el aumento del número de sustancias detectadas (una sustancia: RM= 3.2; dos o más: RM= 3.6). CONCLUSIÓN: El consumo de sustancias es un factor importante vinculado con el suicidio en los sujetos cuya causa de defunción fue dictaminada por el Servicio Médico Forense mexicano.

OBJECTIVE: To determine the association between substance use and the number of substances with the presentation of suicide. MATERIAL AND METHODS: Data were taken from the forensic certificate of the Epidemiological Surveillance System of Addictions in the period between 1994 and 2006 from 27 states in Mexico. RESULTS: Suicide was detected in 8.7% of the violent deaths during the study period. Among men, it was observed that the increased number of substances increased the possibility for death by suicide, compared to deaths from other causes (one substance: OR = 1.8; two or more: OR = 3.3). In women, that possibility remains virtually unchanged with the increase in the number of substances detected (one substance: OR = 3.2; two or more: OR = 3.6). DISCUSSION: The use of substances is a major factor associated with suicide in the population whose cause of death was issued by the Mexican Forensic Medical Services.

Consumo reciente de alcohol y drogas en accidentes del trabajo / Recent use of alcohol and drugs in victims of work related accidents

Background: Twenty to twenty two percent of work related accidents have a direct or indirect relationship with recent alcohol use. Aim: To detect recent alcohol or drug use in patients who required hospitalization for severe work related accidents. Patients and methods: Blood and urine samples were obtained from patients admitted to a hospital within 6 hours of an accident severe enough to require hospitalization. Blood alcohol and urinary metabolites of cocaine, marijuana, amphetamines and benzodiazepines were measured. Patient identity was kept confidential throughout the study. Once patients were stabilized, they were interviewed by a psychologist that was blind to laboratory results. Results: Two hundred thirty men and 18 women were studied and 29 percent (30 percent of men and 17 percent of women) had recent use of alcohol or drugs. The most common substances were alcohol in 15 percent and benzodiazepines in 13 percent. Use of alcohol or drugs was found in 21 percent of professionals, in 33 percent of other occupational levels, half of agricultural workers and 25 percent of commerce workers. Only two of 60 positive cases, admitted substance use during the interview. Most of negative cases admitted the use of alcohol or other drugs during the month prior to the accident. Conclusions: Recent use of alcohol and drugs is frequent among severe work related accident victims. Probably, a high proportion of these subjects are problem drinkers. The combination of alcohol and benzodiazepines is an additional risk factor

Some studies on heroin addicts

The present study in corporates information on the clinical and socio - economic profile of Forty heroin addicts. A special proforma was used for recording important clinical and laboratory findings, and collecting data on various issues related to the socio - economic aspect of the problem.The majority of the addicts were in the age group of 20 - 30 years. Most of them were uneducated and consumed upto one gram of herion per day. Values of Blood Pressure, heart rate and WBC were in normal range. The values of RBC, haemoglobin and plasma proteins were below normal in the majority of cases. The values of ESR, urea, blood sugar, cholesterol and bilirubin were in normal range, with the exception of three, six, two, one and six subjects respectively. Values for enzymes [SGOT, SGPT, alkaline phosphatase] were also in normal range with the exception of two, one and two patients respectively. Low haemoglobin level and RBC count indicate that all the addicts suffered from moderate to severe degree of anaemia. Hypoproteinemia was seen in the majority of the cases showing that the addicts suffered from severe malnutrition. More extensive studies are suggested to arrive at clear - cut conclusions about the effect of heroin addiction on blood urea, cholesterol and bilirubin, and enzymes like SGOT and Alkaline phosphatase