The Poisoning Information Database Covers a Large Proportion of Real Poisoning Cases in Korea

The poisoning information database (PIDB) provides clinical toxicological information on commonly encountered toxic substances in Korea. The aim of this study was to estimate the coverage rate of the PIDB by comparing the database with the distribution of toxic substances that real poisoning patients presented to 20 emergency departments. Development of the PIDB started in 2007, and the number of toxic substances increased annually from 50 to 470 substances in 2014. We retrospectively reviewed the medical records of patients with toxic exposure who visited 20 emergency departments in Korea from January to December 2013. Identified toxic substances were classified as prescription drug, agricultural chemical, household product, animal or plant, herbal drug, or other. We calculated the coverage rate of the PIDB for both the number of poisoning cases and the kinds of toxic substances. A total of 10,887 cases of intoxication among 8,145 patients was collected. The 470 substances registered in the PIDB covered 89.3% of 8,891 identified cases related to poisoning, while the same substances only covered 45.3% of the 671 kinds of identified toxic substances. According to category, 211 prescription drugs, 58 agricultural chemicals, 28 household products, and 32 animals or plants were not covered by the PIDB. This study suggested that the PIDB covered a large proportion of real poisoning cases in Korea. However, the database should be continuously extended to provide information for even rare toxic substances.

Intoxicaciones agudas por plantas tóxicas reportadas por Centro de Toxicología de Villa Clara en período 2008-2011 / Acute poisoning by toxic plants as reported by Villa Clara Toxicology Center, 2008-2011

INTRODUCCIÓN: a nivel mundial la exposición accidental o voluntaria a sustancias tóxicas es causa frecuente de intoxicación. En reportes estadísticos predominan las intoxicaciones por psicofármacos y plaguicidas, pero las plantas tóxicas también son frecuentemente consultadas en los servicios de urgencias. OBJETIVO: caracterizar el comportamiento de las intoxicaciones agudas por plantas tóxicas en cuanto a incidencia y morbilidad, reportadas por Centro de Toxicología de Villa Clara (CENTOX-VC), e identificar los tipos de plantas causales, lugar de procedencia del paciente intoxicado y tipo de intoxicación más frecuente. MÉTODOS: se realizó un estudio observacional, descriptivo, retrospectivo en el Centro de Toxicología Clínica de Villa Clara, Cuba, durante los cuatro primeros años de su creación (2008-2011), considerando variables como edad, municipio y/o provincia, planta tóxica responsable, causas de la intoxicación y vías de exposición. RESULTADOS: se atendieron 70 pacientes intoxicados en la consulta de urgencia por plantas tóxicas (8,22 %). Hubo mayor incidencia en el año 2009 con 47 pacientes (67,1 %). Predominó el rango de edad entre 5 y 14 años, el sexo masculino (57,1 %); las intoxicaciones más frecuentes fueron por nuez o nogal (Aleurites trilobus J.R. Forst. & G. Forst) (52,9 %), piñón de botija (Jatropha curcas L) (14,3 %), salvadera (Hura crepitans L) y yuquilla (Cycas circinalis L) (12,9 %) y (10 %) respectivamente. Predominaron las intoxicaciones no intencionales (94,3 %) y la vía de exposición digestiva (95,8 %). Cifuentes fue el municipio de mayor incidencia con 37 pacientes (52,8 %). CONCLUSIONES: la caracterización en nuestro estudio de la incidencia y morbilidad expuesta, así como ser el sexo masculino, grupos etarios (niños y adolescentes) los más afectados por las intoxicaciones agudas de forma no intencional por vía digestiva, brinda conocimientos e información para los profesionales de la salud en el manejo de estos pacientes, debiéndose continuar con su estudio, y realizar labores de divulgación para disminuir su morbilidad.

INTRODUCTION: accidental or intentional exposure to toxic substances is a frequent cause of poisoning worldwide. Statistical reports show a predominance of poisoning by psycholeptics and pesticides, but poisoning by toxic plants is also frequently treated at emergency services. OBJECTIVE: characterize the incidence and morbidity of acute poisoning by toxic plants as reported by Villa Clara Toxicology Center (CENTOX-VC) and identify the types of causal plants, place of residence of the poisoned patient and most frequent poisoning type. METHODS: an observational retrospective descriptive study was conducted at Villa Clara Clinical Toxicology Center in Cuba during the four years following the founding of the Center (2008-2011). The variables considered were age, municipality and/or province, causal toxic plant, causes of the poisoning episode and manner of exposure. RESULTS: seventy patients were cared for at the emergency service for poisoning by toxic plants (8.22 %). The highest incidence was found in the year 2009 with 47 patients (67.1 %). There was a predominance of the 5-14 age range and the male sex (57.1 %). The most frequent causal agents were walnut tree (Aleurites trilobus J. R. Forst. & G. Forst) (52.9 %), physic nut (Jatropha curcas L.) (14.3 %), sandbox tree (Hura crepitans L.) (12.9%) and queen sago (Cycas circinalis L.) (10 %). A predominance was observed of unintentional poisoning (94.3 %) and oral intake (95.8 %). The highest incidence was found in the municipality of Cifuentes with 37 patients (52.8 %). CONCLUSIONS: a characterization is provided of poisoning by toxic plants which includes reference to its incidence and morbidity, the groups most frequently affected (children and adolescents and the male sex), and manner of exposure (unintentional by oral intake). These contents will be useful to health professionals managing poisoning episodes. Further studies should be conducted and dissemination activities performed with a view to reducing the morbidity of these events.

Pyrrolizidine alkaloids: a word of caution

Most plant bearing pyrrolizidine alkaloids (PAs) are toxic to men and animals. These natural products are recognized to be hepatotoxic, pneumotoxic, carcinogenic and mutagenic. Thus, the presence of toxic pyrrolizidine alkaloids in certain medicinal plants entails a serious health risk. Moreover, people are exposed to undetermined toxicity hazards of pyrrolizidine alkaloid-containing plants due to the consumption of milk and meat from chronically PA-poisoned animals and honey from wild bees. Symphytum officinale (comfrey) has been used freely as tea, topical cream, salad and beverage. This is a clear and actual example of how lack of knowledge about chemistry and toxicology of a plant made easy its spreading in the consumer society as beneficial and safe.

The official use of medicinal plants in public health

Medicinal plants are widely employed in both rural and urban Brazil, many in accordance with traditional practices that were developed by the native population or were brought to the country by immigrant peoples from Europe, Africa and Asia. Their use in official public health care requires however more than traditional knowledge. Recently published laws which will come into force by the end of the century, require that scientific evidence be brought to support the popular use, that possible toxicity, especially when chronic use is contemplated, be known to the medical profession and that the raw plant material and final formulation have a chemical composition that lies within limits that can be specific and checked by analysis. Clinical evidence of efficacy should be provided and wherever possible some indication of the mechanism of action and what components of the original plant contribute to this action, are desirable. At the same time, once a plant of given chemical compositon is approved for use, then its widespread production must be organized in such a way that suppy of a product of established quality meets the demand.

Toxicological and toxicogenetic effects of plants used in popular medicine and in cattle food

Toxicological and toxicogenetic effects of aqueous (tea) and hexanica fruit extract of Indigofera suffruticosa Mill, and hydroalcoholic root extract od Solanum agrarium Stendt. Were evaluated in Balb C male mice intraperitoneally exposed. A hepatotoxic effect was observed just for animals treated with aqueous fruit extract of I. suffruticosa. In relation to the toxicogenetic effect, just the group trreated with 12.5% of toxic dose of aqueous fruit extract of I. suffruticosa showed a statistically significant increase in the frequency of cells with chromosome aberrations (cytogenetic effect), although a slight increase was also observed for the highest dose (25% of LF50_ of hydroalcoholic root extract of S. agrarium. The results obtanied show that before S. agrarium is used as medicine and before the wide use of I. suffruticosa in cattle food, careful evaluation must be done.