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1.
Rev. med. Risaralda ; 26(2): 166-171, jul.-dic. 2020. tab, graf
Article in English | LILACS, COLNAL | ID: biblio-1150026

ABSTRACT

Abstract Introduction: Sodium fluoroacetate, known as compound 1080, was discovered in Germany during the Second World War. It is usually used as a rodenticide, it is an odorless and tasteless substance, with a lethal dose in humans of 2 mg / kg that is why it was withdrawn from the market in some countries, including Colombia; however, it is obtained illegally. This substance has biochemical and physiological effects at the cellular level that alter the transport of citrate at the mitochondrial level, generating accumulation of lactic acid and alteration of the glucose use. The clinical manifestations are nonspecific since there is no any cardinal symptom. Therefore, its diagnosis is made due to high clinical suspicion associated with establishment of exposure to the compound in view of the difficulty to obtain paraclinical confirmation in a timely manner. Methods: We present a case report of intentional ingestion of sodium fluoroacetate in an adolescent that is associated with an infection added to the bloodstream by methicillin- sensitive Staphylococcus aureus (MSSA). The patient developed multiple complications that lead to support in the Intensive Care Unit (ICU) with a satisfactory outcome. In view of the lack of a specific antidote, she was treated with ethanol in order to increase the level of acetate; thus, offering an alternative substrate to the Krebs cycle. It is suggested that the ethanol offers benefits in the acute treatment of these patients. Results: The patient with sodium fluoroacetate poisoning and kidney failure received renal replacement therapy with a favorable evolution and survival at discharge from the intensive care unit of a third-level hospital in the city of Pereira, Risaralda, Colombia. Conclusions: Sodium fluoroacetate poisoning is relatively rare and can cause acute kidney injury and multi-organ failure with a high rate of complications and death. A case of self-inflicted poisoning that received a timely manner continuous renal replacement therapy with a favorable outcome in terms of ICU survival was presented.


Resumen Introducción: El fluoroacetato de sodio ⎯conocido como compuesto 1080⎯, fue descubierto en Alemania durante la segunda guerra mundial, suele ser utilizado como raticida y se caracteriza por ser una sustancia inodora e insabora. En humanos, una dosis de 2 a mg/kg es letal; debido a su toxicidad fue retirado del mercado en algunos países, incluyendo Colombia, no obstante, se consigue de forma ilegal. Esta sustancia tiene efectos bioquímicos y fisiológicos a nivel celular que altera el transporte del citrato a nivel mitocondrial, generando acumulación de ácido láctico y alteración en la utilización de la glucosa. Las manifestaciones clínicas son inespecíficas y no existe un síntoma cardinal. Por ende, su diagnóstico se realiza por alta sospecha clínica, asociado al establecimiento de la exposición al compuesto, ya que la confirmación paraclínica es difícil de realizar oportunamente. Métodos: Se presenta un reporte de caso de ingestión intencional en un adolescente, asociado con infección agregada al torrente sanguíneo por Estafilococos Aureos Meticilino Sensible (EAMS). El paciente desarrolló múltiples complicaciones y requirió asistencia en Unidad de Cuidados Intensivos (UCI) con desenlace satisfactorio. Ya que no se cuenta con antídoto específico , se le dio tratamiento con etanol para aumentar el nivel de acetato, ofreciendo así un sustrato alterno al ciclo de Krebm. Se estima que el etanol puede ofrecer beneficios en el tratamiento agudo de estos pacientes. Resultados: Paciente con intoxicación por fluoroacetato de sodio e insuficiencia renal, recibe terapia de reemplazo renal con un evolución favorable y supervivencia al alta de la Unidad de Cuidados Intensivos de un hospital de tercer nivel en la ciudad de Pereira, Risaralda, Colombia. Conclusiones: La intoxicación por fluoroacetato de sodio es relativamente poco frecuente y puede causar injuria renal aguda y falla multiorgánica con alta tasa de complicaciones y muerte. Se presentó un caso de intoxicación autoinfligida que recibió terapia de reemplazo renal continua temprana con un desenlace favorable en términos de supervivencia en la UCI.


Subject(s)
Humans , Male , Adolescent , Staphylococcus aureus , Toxicity , Fluoroacetates , Methicillin , Acetates , Rodenticides , Citric Acid Cycle , Citric Acid , Lactic Acid , Diagnosis , Ethanol , Eating , Acute Kidney Injury , Hoarding , Survivorship , Continuous Renal Replacement Therapy , Glucose , Hospitals , Intensive Care Units , Lead
2.
Med. leg. Costa Rica ; 36(2): 76-81, sep.-dic. 2019. graf
Article in Spanish | LILACS | ID: biblio-1040447

ABSTRACT

Resumen Los rodenticidas son sustancias de venta libre ampliamente utilizadas a nivel agrícola y a nivel doméstico para el control de roedores. Los rodenticidas anticoagulantes de larga duración tienen un mecanismo de acción similar al de la warfarina, pero con mayor potencia de acción. El espectro de manifestaciones clínicas de la intoxicación por rodenticidas anticoagulantes es muy amplio, que se puede presentar de manera asintomática hasta con sangrados que comprometan la vida del paciente. El tratamiento se basa en el control del sangrado y la reposición con su antídoto lógico que corresponde a la vitamina K para restablecer la hemostasis.


Abstract Rodenticides are agriculturally and domestically used substances used for the control of rats and other rodents, easily available on the market. Anticoagulant rodenticides have a similar mechanism of action than that of warfarin, but their potency is bigger. The spectrum of clinical manifestations of rodenticide intoxications is broad; and it varies from asymptomatic cases to hemorrhages that compromise the patient's life. Treatment is based on active bleeding control and reposition of its logical antidote Vitamin K in order to restore hemostasis.


Subject(s)
Humans , Poisoning , Rodenticides , Anticoagulants
3.
Acta toxicol. argent ; 27(2): 60-64, Sept. 2019.
Article in Spanish | LILACS | ID: biblio-1088538

ABSTRACT

Introducción. Los superwarfarinicos (SWF) son una de las herramientas utilizadas por el ser humano para el control de roedores y a la vez son tóxicos para el hombre y pueden conducir a la muerte sin los debidos cuidados en su uso.Casos clinicos. Tres pacientes masculinos, que consultaron por sangrados (gingivorragia, epistaxis, hematuria, hemartrosis y hematomas cutaneos) asociados a alteraciones del coagulograma (Tiempo de protrombina (TP) y tiempo de tromboplastina parcial (KPTT) prolongados). Todos tuvieron exposición a superwarfarinicos. Nuestro servicio no dispone del análisis de SWF en suero. Se administró vitamina K1 en los tres pacientes y plasma fresco congelado (PFC) en uno solo (sangrado mayor: hematuria). El seguimiento se realizó mediante controles seriados de coagulograma y su evolución fue favorable. Discusión. En todos los casos, el diagnóstico de intoxicación por SWF fue clínico, basado en caracteristicas clínicas de pacientes y alteraciones en sus parámetros de coagulación, y debido a imposibilidad de derivación de análisis a otro laboratorio. Se realizo tratamiento especifico (vitamina K1 y PFC) segun recomendación de expertos, ya que no hay hasta la fecha, estudios clinicos que evaluen las diferentes opciones terapéuticas. Conclusión. La intoxicación por SWF aunque no es frecuente, debe sospecharse en casos de paciente con coagulopatia sin otras causas que puedan justificarlo. El manejo del cuadro tóxico es la reposición de vitamina k y de plasma fresco congelado, en casos donde se necesite una rápida corrección de la alteración hemostática, como los sangrados mayores. Es imprescindible la oportuna consulta con médicos hematólogos y/o la consulta con un centro regional de control de intoxicaciones para todas las exposiciones sospechosas por SWF.


Introduction. Superwarfarinics (SWF) are one of the tools used by humans for rodent control. They are toxic to humans and can lead to death without due care in its use. Clinical cases. Three male patients, who consulted due to bleeding (gingivorragia, epistaxis, hematuria, hamartrosis and skin hematomas) associated with coagulogram alterations (prolonged protombine time (PT) and partial thromboplastin time (KPTT)). All them exposure to superwarfarinics. SWF serum analysis was not available in our hospital. Vitamin K1 was administered in all three patients and fresh frozen plasma (PFC) in only one (major bleeding: hematuria). The followup was performed by serial coagulogram controls and the evolution was. Discussion. In all cases, the diagnosis of SWF intoxication was clinical, based on clinical characteristics of patients and alterations in their coagulation parameters, due to the impossibility of deriving the analysis of SWF in serum to another laboratory. Specific treatment was carried out (vitamin k and PFC) according to experts' recommendation, since there are no clinical studies to evaluate the different therapeutic options to date. Conclusion. SWF poisoning, although not frequent, should be suspected in patients with coagulopathy without other causes that may justify it. The management of toxic symptoms is the administration of vitamin K1 and fresh frozen plasma, in cases where a rapid correction of the haemostatic alteration is required, such as major bleedings. It is essential to consult with hematologists and / or consult a regional poison control center for all suspicious exposures by superwarfarins.


Subject(s)
Humans , Male , Adult , Rodenticides/poisoning , Rodenticides/toxicity , Vitamin K/therapeutic use , Argentina , Vitamin K Deficiency Bleeding
4.
Epidemiology and Health ; : 2018022-2018.
Article in English | WPRIM | ID: wpr-786851

ABSTRACT

OBJECTIVES: Aluminum phosphide (ALP), also known in Iran as rice tablets, is one of the most effective rodenticides used to protect stored grain. However, ALP poisoning regularly causes mortality in humans. The aim of this study was to evaluate the characteristics and predictive factors of mortality from ALP poisoning.METHODS: This study evaluated all patients with ALP poisoning referred to Imam Khomeini Hospital in Kermanshah Province, Iran from 2014 to 2015. For each patient, the following information was recorded: age, sex, the number of tablets consumed, the number of suicide attempts, the time elapsed from consumption to treatment, blood pressure, blood pH, HCO3 levels, and PCO2. Differences between the survivors and non-survivors of ALP poisoning were analyzed using univariate logistic regression and multivariate analysis.RESULTS: In this study, 48 patients were male and 29 patients were female (total: 77 patients). The average age of the survivors and non-survivors was 28.7 and 31.3 years, respectively. All cases (100%) of ALP poisoning were intentional, with the goal of committing suicide. The main predictive variables of mortality from ALP poisoning were blood pressure, blood pH, and time elapsed from consumption to treatment.CONCLUSIONS: The likelihood of mortality in patients with ALP poisoning can be predicted using blood pressure, blood pH, and time elapsed from consumption to treatment. These findings may help healthcare providers take more effective measures to treat patients with ALP poisoning.


Subject(s)
Aluminum , Blood Pressure , Clergy , Female , Health Personnel , Humans , Hydrogen-Ion Concentration , Iran , Logistic Models , Male , Mortality , Multivariate Analysis , Poisoning , Rodenticides , Suicide , Survivors , Tablets
5.
Epidemiology and Health ; : e2018022-2018.
Article in English | WPRIM | ID: wpr-721091

ABSTRACT

OBJECTIVES: Aluminum phosphide (ALP), also known in Iran as rice tablets, is one of the most effective rodenticides used to protect stored grain. However, ALP poisoning regularly causes mortality in humans. The aim of this study was to evaluate the characteristics and predictive factors of mortality from ALP poisoning. METHODS: This study evaluated all patients with ALP poisoning referred to Imam Khomeini Hospital in Kermanshah Province, Iran from 2014 to 2015. For each patient, the following information was recorded: age, sex, the number of tablets consumed, the number of suicide attempts, the time elapsed from consumption to treatment, blood pressure, blood pH, HCO3 levels, and PCO2. Differences between the survivors and non-survivors of ALP poisoning were analyzed using univariate logistic regression and multivariate analysis. RESULTS: In this study, 48 patients were male and 29 patients were female (total: 77 patients). The average age of the survivors and non-survivors was 28.7 and 31.3 years, respectively. All cases (100%) of ALP poisoning were intentional, with the goal of committing suicide. The main predictive variables of mortality from ALP poisoning were blood pressure, blood pH, and time elapsed from consumption to treatment. CONCLUSIONS: The likelihood of mortality in patients with ALP poisoning can be predicted using blood pressure, blood pH, and time elapsed from consumption to treatment. These findings may help healthcare providers take more effective measures to treat patients with ALP poisoning.


Subject(s)
Aluminum , Blood Pressure , Clergy , Female , Health Personnel , Humans , Hydrogen-Ion Concentration , Iran , Logistic Models , Male , Mortality , Multivariate Analysis , Poisoning , Rodenticides , Suicide , Survivors , Tablets
6.
Rev. RENE ; 17(1): 3-9, jan.-fev. 2016.
Article in English | LILACS, BDENF | ID: lil-786861

ABSTRACT

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.


Subject(s)
Community Health Nursing , Health Surveillance , Poison Control Centers , Poisoning , Rodenticides
7.
Rev. gaúch. enferm ; 37(2): e54799, 2016. tab
Article in Portuguese | LILACS, BDENF | ID: lil-782965

ABSTRACT

RESUMO Objetivo Determinar os fatores associados aos óbitos em vítimas de envenenamento por carbamato (“chumbinho”). Método Estudo retrospectivo, epidemiológico tipo caso-controle, baseado nas fichas de notificação de intoxicação do centro de controle de intoxicações localizado na região metropolitana do Rio de Janeiro. Foram utilizadas 24 fichas de notificação de intoxicações de homens dos 20 aos 59 anos com história de envenenamento por carbamato entre 2005 e 2009. As fichas foram sorteadas aleatoriamente, respeitando-se a razão de 1:3 (um caso para três controles). A faixa etária variou de 23 a 58 anos; a média 43,83 anos. Resultados Os sintomas mais recorrentes foram: miose (OR = 1.0; IC 95%: 0,27 – 3,69. p= 1.0), sialorreia (OR = 0,83; IC 95%: 0,22 – 3,12. p= 0,78), dispneia (OR = 0,66; IC 95%: 0.14 – 3,03. p= 0,59). Conclusão Os óbitos apresentaram associação com sialorreia, miose e dispneia e uma forte associação com estertores pulmonares, broncoespasmos e os roncos pulmonares.


RESUMEN Objetivo Determinar los factores asociados a la muerte en las víctimas de envenenamiento por carbamato (“Chumbinho”). Método Estudio retrospectivo, epidemiológico de caso y control sobre el envenenamiento en los formularios de notificación un centro de control de envenenamiento localizado en la región metropolitana de Río de Janeiro. Utilizamos 24 formularios de notificación de envenenamiento en hombres de 20 a 59 años con intoxicación por el carbamato de 2005 a 2009. Los registros fueron seleccionados al azar, respetando la proporción de 1:3 (un caso y tres controles). El rango de edad fue de 23 a 58 años, promedio de 43,83 años. Resultados Los síntomas más frecuentes fueron miosis (OR = 1,0; IC del 95%: 0,27 a 3,69 p = 1.0.), Babeo (OR = 0,83, IC 95% 0,22-3,12 p. = 0,78), disnea (OR = 0,66; IC del 95%: 0:14 - 3.03 p = 0.59). Conclusión Las muertes se asociaron con babeo, miosis y disnea, y una fuerte asociación con estertores pulmonares, broncoespasmo y el ronquido pulmonar.


ABSTRACT Objective To determine the factors associated with death in poisoning victims by carbamate (“Chumbinho”). Method Retrospective study, epidemiological case-control based on poisoning reporting forms, a poison control center located in the metropolitan region of Rio de Janeiro. We used 24 notification forms of poisoning in men aged 20 to 59 years with poisoning by carbamate history from 2005 to 2009. The records were randomly selected, respecting the ratio 1:3 (a case to three controls). The age range was 23-58 years, average 43.83 years. Results The most frequent symptoms were myosis (OR=1.0; 95% CI: 0.27 to 3.69 p=1.0.), drooling (OR=0.83; 95% CI. 0.22 to 3.12 p=0.78), and dyspnea (OR=0.66; 95% CI: 0:14-3.03 p=0.59). Conclusion The deaths were associated with drooling, miosis and dyspnea and a strong association with pulmonary rales, bronchospasm and pulmonary snoring.


Subject(s)
Humans , Male , Adult , Young Adult , Rodenticides/toxicity , Carbamates/toxicity , Poisoning/diagnosis , Poisoning/epidemiology , Respiration Disorders/chemically induced , Sialorrhea/chemically induced , Suicide/statistics & numerical data , Suicide, Attempted/statistics & numerical data , Brazil/epidemiology , Case-Control Studies , Miosis/chemically induced , Retrospective Studies , Sampling Studies , Symptom Assessment , Time-to-Treatment , Middle Aged
8.
Acta toxicol. argent ; 23(1): 44-52, mayo 2015.
Article in Spanish | LILACS | ID: lil-757035

ABSTRACT

Introducción: en la actualidad existe utilización masiva de rodenticidas y su venta no está restringida al público. Las etiologías de intoxicación por estos agentes son variadas pudiendo ser de tipo intencional o accidental. Objetivo: analizar estudios realizados en torno a intoxicaciones con rodenticidas superwarfarínicos en humanos con el propósito de reunir información que oriente a un adecuado tratamiento. Metodología: se realizó una revisión integradora en las bases de datos electrónicas PubMed, TripDataBase, Cochrane, además de Google Scholar y SciELO, libros de divulgación científica, documentos de convenciones, páginas web de instituciones públicas, privadas y artículos vinculados a efectos, cuadro clínico y tratamiento de exposiciones a rodenticidas en seres humanos. Se analizaron los documentos y la información se organizó en tres temáticas: toxicidad de los rodenticidas superwarfarínicos, cuadro clínico y tratamiento médico, y rodenticidas no anticoagulantes disponibles en Chile. Resultados: la dosis tóxica mínima reportada en adultos es de 1 mg de principio activo; en pacientes pediátricos ingestas accidentales rara vez producen síntomas. Los síntomas se observan de forma tardía y su toxicidad es variable. El examen de elección es el International Normalized Ratio (INR) y se realiza en todo paciente con factores de riesgo presentes. El antídoto no se administra de forma profiláctica y la dosis se ajusta individualmente. Conclusión: en niños las ingestas accidentales no son riesgosas por lo que pueden ser observados en el hogar. Pacientes con ingestas masivas requieren controles de INR por meses por lo que es importante que posterior al alta médica exista una óptima coordinación con nivel primario de atención.


Introduction: Currently there is a widespread use of rodenticides, unrestricted to the public. The exposure to these agents may varied being intentional or accidental. Objective: To analyze studies about superwarfarin poisoning in humans, with the purpose of gathering information to guide proper treatment. Methodology: It was conducted an integrative review in the electronic databases PubMed, TripDataBase, Cochrane, Google Scholar and SciELO, science books (reference textbooks), convention documents, websites from public and private institutions and articles about the effects, clinical manifestations and treatment of human exposures to rodenticides. Documents were analyzed and the information organized into three themes: superwarfarin toxicity, clinical features and medical treatment, and non-anticoagulant rodenticides available in Chile. Results: In adults, the minimum dose reported to cause toxicity is 1 mg of active ingredient. In pediatric patients, accidental intakes rarely produce symptoms. The symptoms of poisoning are usually delayed and its toxicity is variable. The test of choice is International Normalized Ratio (INR) and it is performed in all patients with risk factors. The antidote must not be administered prophylactically and the dose is adjusted individually. Conclusions: Accidental intakes in children are not risky and they can be observed at home. Patients with massive intakes require INR monitoring for months so, it is important that an optimal coordination with primary care facilities still exists after medical discharge.


Subject(s)
Humans , Rodenticides/toxicity , Vitamin K 1/therapeutic use , Rodenticides/antagonists & inhibitors , Rodenticides/poisoning
9.
Article in Chinese | WPRIM | ID: wpr-326037

ABSTRACT

<p><b>OBJECTIVE</b>To investigate the characteristics of pesticide poisoning in Jiangsu Province, China, and to provide a scientific basis for developing effective intervention measures and prevention strategies.</p><p><b>METHODS</b>The data from report cards of pesticide poisoning in Jiangsu Province from 2006 to 2013 were arranged using EXCEL tables, and assessed. Statistical analysis was applied to the epidemiological data using SPSS.</p><p><b>RESULTS</b>From 2006 to 2013, a total of 32672 cases of pesticide poisoning were reported in Jiangsu Province. Most of the cases were caused by non-occupational poisoning (life poisoning) (72.78%). A majority of patients with pesticide poisoning were 35-54 years old (40.85%) or older than 65 years (15.69%). There were more female patients (58.22%) than male patients (41.78%). Among patients with occupational poisoning, male patients (50.90%) were more than female patients. Among patients with non-occupational poisoning, female patients were more than male patients (38.37%). Pesticide poisoning mainly occurred from July to September. The case-fatality rate of occupational poisoning (0.47%) was lower than that of non-occupational poisoning (7.10%). All 13 cities in Jiangsu Province reported cases of pesticide poisoning. There were more cases in the northern regions than in the southern regions. Pesticide poisoning was mainly caused by organophosphorus insecticides including methamidophos, dichlorvos, dimethoate, omethoate, and parathion, which accounted for 65.58%of all cases. Paraquat had the highest case-fatality rate (10.06%) among all pesticides, followed by tetramine (10.00%), dimethoate or omethoate (7.85%), methamidophos (7.79%), and dimehypo (7.68%).</p><p><b>CONCLUSION</b>Pesticide poisoning cannot be ignored. The management and control should be improved in production and usage of highly toxic pesticides including organophosphorus insecticides, rodenticides, and herbicides. More attention should be paid to the protection of vulnerable groups including women, children, and the elderly.</p>


Subject(s)
Adult , Age Distribution , Aged , China , Epidemiology , Cities , Dichlorvos , Dimethoate , Environmental Exposure , Female , Herbicides , Poisoning , Humans , Insecticides , Poisoning , Male , Middle Aged , Organothiophosphorus Compounds , Paraquat , Pesticides , Poisoning , Poisoning , Epidemiology , Rodenticides
11.
Article in English | WPRIM | ID: wpr-116727

ABSTRACT

BACKGROUND/AIMS: Recently, many cases of vitamin K-dependent coagulopathy of unknown origin have been reported. Such patients lack any relevant family history and have no systemic disease, raising suspicion of superwarfarin intoxication. We evaluated individual risk factors causing coagulopathy and hemorrhagic symptoms in patients with suspected superwarfarin intoxication. In addition, we determined how to effectively treat vitamin K-dependent coagulopathy caused by suspected superwarfarin intoxication. METHODS: Seven patients with suspected superwarfarin intoxication who lacked any definitive history of rodenticide ingestion were included. Thirty-one patients initially diagnosed with rodenticide poisoning were also included. We performed a retrospective chart review of all subjects and examined clinical data including patient demographics and medical histories. RESULTS: Patients initially diagnosed with rodenticide poisoning were divided into two groups, one of which had a laboratory abnormality (prothrombin time [PT] > 13 seconds) and another group with PTs in the normal range. There was no significant difference between the two groups in any of age, gender, the extent of chronic alcohol consumption, the causative rodenticide, psychiatric problems, ingestion of drugs interacting with warfarin, the extent of intoxication, or the type of ingestion attempt. The albumin level of the former group was significantly lower than that of the latter group (p = 0.014). Furthermore, a significant difference between the two groups was evident in terms of simultaneous ingestion of rodenticide and alcohol (p = 0.023). CONCLUSIONS: Most patients with superwarfarin poisoning did not exhibit any complication. When such complications were evident, they were associated with serum albumin level and coingestion of rodenticide and alcohol.


Subject(s)
4-Hydroxycoumarins/poisoning , Adolescent , Adult , Aged , Aged, 80 and over , Alcohol Drinking/adverse effects , Anticoagulants/poisoning , Blood Coagulation/drug effects , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Partial Thromboplastin Time , Prothrombin Time , Republic of Korea , Retrospective Studies , Risk Factors , Rodenticides/poisoning , Serum Albumin/metabolism , Vitamin K/blood , Vitamin K Deficiency Bleeding/blood , Young Adult
14.
Rev. Inst. Nac. Hig ; 43(2): 51-56, dic. 2012. graf, tab
Article in Spanish | LILACS, LIVECS | ID: lil-702801

ABSTRACT

El fluoroacetato de sodio, es un raticida prohibido en algunos países y permitido en otros, que causa severas intoxicaciones humanas y animales. Actúa por inhibición del ciclo de Krebs e interfiere con la producción de energía, lo cual conduce a disfunción celular irreversible, especialmente en sistema nervioso central y corazón. El alcohol etílico, debido a su oxidación a acido acético y a su amplia disponibilidad, es uno de los fármacos usados en esta intoxicación, lo que podría causar controversias éticas y legales. La biotransformación del hidrato de cloral a tricloroetanol y a ácido tricloroacético, el efecto anticonvulsivante y su amplio uso en Pediatría, fueron las razones para su evaluación en la intoxicación por fluoroacetato. Se realizó un estudio experimental, para comparar los efectos de hidrato de cloral y alcohol en ratas intoxicadas con fluoroacetato de sodio. El análisis estadístico aplicado fue la prueba de chi cuadrado. Los resultados mostraron que el hidrato de cloral a dosis bajas, permite la sobrevivencia en 100% de los animales expuestos. Se confirmó igualmente la efectividad del alcohol etílico a dosis altas. Este resultado sugiere que el hidrato de cloral puede ser una opción tan útil como el etanol y que podría ser el fármaco de elección en aquellos pacientes que no puedan recibir monoacetin o etanol o porque haya mayor accesibilidad al hidrato de cloral.


Sodium fluoroacetate is a banned rodenticide in some countries and allowed in others, which causes severe human and animal poisonings. It acts for inhibition of Krebs's cycle and interferes with energy production leading to irreversible cellular dysfunction, specially in nervous central system and heart. Ethyl alcohol, because oxidation to acetic acid and to its wide availability, is one of the drugs used in this poisoning, which should can cause ethical and legal controversies. Biotransformation of chloral hydrate to trichloroethanol and trichloroacetic acid, the anticonvulsant effect and its widespread use in Pediatrics, were the reasons for its evaluation in fluoroacetate poisoning. An experimental study was conducted, to compare effects of chloral hydrate and ethanol in poisoned rats with sodium fluoroacetate. The statistical analysis applied was the chi square test. The results showed that chloral hydrate in low doses allows survival in 100 % of the exposed animals. It also confirms the effectiveness of ethyl alcohol at high doses. This result suggests that chIoral hydrate may be an option as useful as ethanol and could be the choice drug in those patients who could not receive monoacetin or ethanol or because there is greater accessibility to chloral hydrate.


Subject(s)
Humans , Male , Female , Rats , Poisoning/complications , Rodenticides/adverse effects , Pharmaceutical Preparations/classification , Fluoroacetates/toxicity , Chloral Hydrate/chemical synthesis , Public Health , Ethanol/chemical synthesis
17.
Ain-Shams Journal of Forensic Medicine and Clinical Toxicology. 2011; 15 (Jan.): 57-67
in English | IMEMR | ID: emr-126434

ABSTRACT

Acute poisoning with pesticides is a global public health problem and accounts for as many as 300.000 deaths worldwide yearly. Zinc phosphide has been widely used as a rodenticide since 1942-43 and its easy availability pushed up the incidence of self poisoning. This retrospective study was designed to highlight and evaluate the problem of zinc phosphide intoxicated cases presented and admitted to poison control centre [PCCA] during the year 2007, and was compared with its incidence during the previous 5 years, 2002-2006. The comparative study of the previous five years included the number of all cases of intoxication presented to the PCCA from 2002-2006, the number of zinc phosphide intoxication cases during the same period and their classification according to hospital admission: Intensive care unit [ICU], inpatient and emergency room [ER]. Regarding the retrospective study of zinc phosphide cases during the year 2007, it was carried out on the medical records of all patients admitted to PCCA during the year 2007, with a discharge disgnosis of zinc phosphide. The following parameters were reviewed and analyzed: Sociodemographic data [age, sex, residence and social class], intoxication data [delay time, mode and route of intoxication], presenting symptoms, vital signs, laboratory investigations and ECG monitoring. Different treatment modalities were analyzed and the outcome was recorded. The percentage of zinc phosphide poisoning during the period 2002-2006 in relation to the total number of poisoning cases admitted to PCCA ranged from 2.09%-5.38% and during 2007 it was 3.03%. The inpatient group showed the highest number of cases followed by the ER and then the ICU group. Death rate ranged from 0.3%-0.7% during the years 2002-2006, while during 2007, it was only 0.15%. The total number of cases during the year 2007 were 650 cases. The inpatient group comprised most of the cases followed by ER and ICU groups. The majority of patients were in the age group of 10-

Subject(s)
Humans , Male , Female , Zinc Compounds/toxicity , Rodenticides , Poisoning/epidemiology , Poison Control Centers/statistics & numerical data , Hospitals, University , Intensive Care Units , Signs and Symptoms , Treatment Outcome , Retrospective Studies , Mortality
18.
Rio de Janeiro; s.n; 2011. 151 p. ilus, tab, graf.
Thesis in Portuguese | LILACS | ID: lil-620487

ABSTRACT

Atualmente o uso de substâncias químicas no ambiente domiciliar é muitodifundido e utilizado para diferentes finalidades como limpeza doméstica (desinfetantes, detergentes),e controle de vetores (inseticidas, raticidas, carrapaticidas) sendo que osconsumidores na maioria das vezes desconhecem as propriedades tóxicas dos componentes das formulações que utilizam. O comércio oferta uma variedade de produtos e marcas de inseticidas e raticidas com diferentes formas de apresentações (líquidos, em pó, em pasta, e elétricos), e com grande diversidade de princípios ativos.O objetivo desse estudo foi avaliar os sentidos atribuídos ao uso de agentes químicos potencialmente tóxicos utilizados no controle dos vetores no ambiente doméstico, relacionando-os com a influência de peças publicitárias desses produtos na mídia televisiva e das mensagens de rótulos desses produtos e sua conformidade com alegislação pertinente. A pesquisa é do tipo quali-quantitativa e foi realizada nomunicípio de Niterói, na Região Oceânica em 2010. Adotamos estratégias distintas e complementares: análise documental; observação participante; questionários; eentrevistas semi-estruturadas sobre peças publicitárias de inseticidas domésticos. A pesquisa incluiu questionários em 125 residências para avaliar as práticas e a percepçãodos riscos no uso de inseticidas e raticidas no ambiente domiciliar. Destes 50 foram realizados em condomínio de classe média alta e 75 em Comunidade de baixa renda ambos na Região Oceânica de Niterói. Nossos resultados demonstraram que 92 por cento dogrupo Condomínio usam inseticidas e 77,7 por cento do grupo Colônia de Pescadores também usam. Em relação aos cuidados com manuseio de inseticidas, 54 por cento dos entrevistados do Grupo Condomínio e 25,3 por cento dos entrevistados do Grupo Colônia de Pescadores,disseram que não tomavam nenhum cuidado ao usar estes produtos. Em relação à freqüência de uso dos inseticidas, no Grupo Condomínio, 22 por cento dos entrevistados faziamuso dos inseticidas diariamente, 42 por cento só aplicavam o inseticida quando havia inseto e 10 por cento semanalmente. Já no Grupo Colônia de Pescadores, 16 por cento aplicavam inseticidas diariamente, 26 por cento quando apareciam insetos, e 9,3 por cento semanalmente. Quanto à leiturados rótulos das embalagens dos inseticidas, 60 por cento dos entrevistados do Grupo Condomínio disseram que liam estes rótulos, e 29,3 por cento do Grupo Colônia de Pescadores fizeram a mesma afirmação. Quanto à forma de conhecimento dos inseticidas foi através das propagandas de televisão referidas pelos dois grupos pesquisados. Em uma segunda etapa verificamos a influência de peças publicitárias de inseticidas domésticosno sentido atribuído a tais produtos. Para isso foram: 1) selecionadas 03 peças publicitárias em circulação na mídia televisiva; 2) analisadas e criadas categorias; 3) submetidas aos entrevistados. Foram analisadas 3 peças publicitárias de inseticidas veiculadas na mídia televisiva no período de 2008, 2009, 2010, utilizando-se o métodode análise de conteúdo. As categorias geradas pela análise foram: Apelo ao status do usuário; Ocultação e minimização dos riscos; Símbolos de modernidade e cientificidade; Representações de um mundo asséptico; Representações de força, podere controle. Com base nelas realizamos entrevistas semi-estruturadas em uma subamostra composta por 20 residências. A análise das entrevistas revelou o grau de eficácia de taisestratégias de persuasão e mostrou o quanto as propagandas influenciam na compra dos produtos.


Evidenciamos ainda que risco à saúde e ao ambiente no uso destas substâncias é percebido no grupo de maior escolaridade e que a leitura e a compreensão dos rótulos dos inseticidas é dificultada pela linguagem técnica e excesso de informação. O fato de que o uso indiscriminado e contínuo destes produtos podem acarretar resistência aos inseticidas, não foi observado por nenhum entrevistado. Observamos neste estudo que a vulnerabilidade do consumidor é (independente da classe social, uma vez que todos se expõem aos inseticidas de alguma forma. O Grupo Colônia de Pescadores (baixa renda) se expõe mais para o risco de intoxicações agudas, pois são eles que aplicam os produtos usados no ambiente doméstico, já o Grupo Condomínio (alta renda) usam mais produtos e contaminam mais o ambiente coletivo, mas também se expõem de forma crônica, pois usam inseticidas de uso contínuo, e pulverizam seus condomínios com o fumacê. Concluímos que todas as propagandas analisadas utilizaram estratégias que ocultam o risco dos inseticidas no ambiente doméstico e não cumprem a legislação.


Subject(s)
Humans , Environment , Health Surveillance , Insecticides/adverse effects , Insecticides/toxicity , Propaganda , Rodenticides/adverse effects , Rodenticides/toxicity , Chemical Contamination , Chemical Compounds/policies , Health Care Coordination and Monitoring , Products Commerce , Household Products/toxicity , Vector Control
19.
Article in English | WPRIM | ID: wpr-306874

ABSTRACT

<p><b>OBJECTIVE</b>To evaluate the effects of epicutaneous application of anticoagulant warfarin, by examining the presence of tissue injury and immune/inflammatory activity in exposed skin.</p><p><b>METHODS</b>Rats were exposed to warfarin by applying 10 μg of warfarin-sodium to 10-12 cm(2) skin (range 0.8-1 μg per 1 cm(2)) for 3 consecutive days. Tissue injury was evaluated by lipid peroxidation, histomorphological changes and signs of reparative activity in skin. T cell infiltration and selected aspects of epidermal cell activity were examined as indicators of immune/inflammatory skin response to warfarin application.</p><p><b>RESULTS</b>Repeated warfarin application exerted no effect on skin metabolic viability, but resulted in tissue injury (increased malondialdehyde, MDA, production, evident histo-morphological changes in epidermis and dermis depicting cell injury and death). Increased numbers of proliferating cell nuclear antigen (PCNA(+)) cells indicated reparative processes in injured skin. Infiltration of CD3(+) cells (T lymphocytes) along with the increased production of tumor necrosis factor-a (TNF-a) by epidermal cells from warfarin-treated skin and their co-stimulatory effect in an in vitro T-cell activation assay demonstrated immunomodulatory effects of epicutaneous warfarin.</p><p><b>CONCLUSION</b>Presented data have documented tissue damage associated with immune/inflammatory activity in skin exposed to warfarin. Observed effects are relevant to immunotoxic potential of this anticoagulant in settings of external exposure.</p>


Subject(s)
Animals , CD3 Complex , Genetics , Metabolism , Dermatitis, Contact , Pathology , Epidermis , Cell Biology , Gene Expression Regulation , Physiology , Inflammation , Metabolism , Lipid Peroxidation , Male , Proliferating Cell Nuclear Antigen , Genetics , Metabolism , Rats , Rodenticides , Pharmacology , Skin , Cell Biology , Metabolism , T-Lymphocytes , Physiology , Warfarin , Pharmacology
20.
Rev. peru. med. exp. salud publica ; 27(4): 578-585, dic. 2010. ilus, tab
Article in Spanish | LIPECS, LILACS, LIPECS | ID: lil-573938

ABSTRACT

Se realizó una búsqueda sistemática para identificar publicaciones sobre la seguridad ante la exposición de raticidas que contienen Salmonella para humanos y animales. Se consideraron publicaciones a texto completo que incluían descripción de su metodología y la presentación adecuada de sus resultados. De 545 publicaciones recuperadas, 47 se revisaron a texto completo de las que se seleccionaron 12. En seis se reportan casos de salmonelosis en humanos, incluso casos fatales, asociados a la exposición a versiones anteriores de estos raticidas. El único ensayo clínico encontrado reporta una mayor frecuencia de diarrea y fiebre en el grupo que ingirió Salmonella contenida en Biorat® (presentación comercial actual); sin embargo, la diferencia no fue estadísticamente significativa, pero el ensayo presentó problemas metodológicos. Las cepas de Salmonella enteritidis contenidas en una versión anterior (Ratin®) y en la versión actual corresponden a la misma variedad (Danysz) y fagotipo (6a), y están cercanamente relacionadas según la técnica de electroforesis en gel de campo pulsado (PFGE). No se reporta efectos patógenos de esta Salmonella para las diferentes especies de animales ensayadas; sin embargo, se encontraron limitaciones en la metodología empleada. Se concluye que la Salmonella enteritidis contenida en versiones anteriores de raticidas produjo enfermedad en humanos por lo que fue prohibida su comercialización y que existiría un riesgo potencial de la versión actual por contener una bacteria muy similar y por no tener evidencia suficiente que garantice su seguridad. Son necesarios estudios bien diseñados por instituciones sin conflicto de interés, antes de su aplicación en salud pública o agricultura.


We conducted a systematic search of the literature to identify publications on the safety of exposure to Salmonella-based rodenticides by humans and animals. We included full-text publications that described the methods and presented their results satisfactorily. Of 545 publications retrieved, 47 were reviewed in full text and from those 12 were selected. Six reports featured cases of salmonellosis in humans, with fatal cases, associated with exposure to previous versions of this type of rodenticide. A clinical trial reported an increased frequency of diarrhea and fever in the group that ingested Biorat ® (the current commercial form) containing Salmonella, however the difference from the control group was not significant, but the trial had methodological problems. Strains of Salmonella enteritidis from an earlier version of the rat poison (Ratin®) and those in the current version correspond to the same variety (Danyzs) and phage type (6a), and were found to be closely related using the technique of pulsed field gel electrophoresis (PFGE). No pathogenic effects of this Salmonella were reported in different animal species tested; however, we found limitations in the methodology. We conclude that the Salmonella enteritidis contained in earlier rat poison formulations produced illness in humans so that its commercialization was prohibited, and that there would be a potential risk with the present formulation because it contains a very similar bacteria, and because there is not sufficient evidence to guarantee its safety. Well-designed studies still need to be done by institutions that do not have a conflict of interest before it can be applied in the areas of public health and agriculture.


Subject(s)
Humans , Pest Control, Biological , Rodenticides/adverse effects , Salmonella , Public Health
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