Leucoencefalopatía tóxica fatal: tres casos asociados al consumo de pasta base de cocaína / Fatal toxic leukoencephalopathy associated with consumption of pasta base of cocaine: Report of three cases

The prevalence of drug-associated toxic encephalopathy is unknown, but it is an uncommon condition. Toxic leukoencephalopathy was described associated with heroin consumption, it has been less commonly described with the use of cocaine and there are no reports of its association with consumption pasta base of cocaine (PBC). We report two females aged 31 years and a male aged 19 years, consumers of PBC who developed a fatal toxic leukoencephalopathy. They initiated their disease with severe and persistent headache, sequential focal neurologic deficits and a progressive impairment of consciousness that culminated with their death. Laboratory parameters such as blood count, cerebrospinal fluid analyses or infectious biological indices were normal. MRI showed multifocal lesions in brain white matter of both hemispheres confirming the leukoencephalopathy. There was no response to the use of methylprednisolone.

A Case of Life-Threatening Acute Kidney Injury with Toxic Encephalopathy Caused by Dioscorea quinqueloba

Some herbal medications induce acute kidney injury. The acute kidney injuries caused by herbal medications are mild and commonly treated by palliative care. A 51-years-old man who drank the juice squeezed from the raw tubers of Dioscorea quinqueloba (D. quinqueloba) was admitted with nausea, vomiting and chilling. He developed a seizure with decreased level of consciousness. He was diagnosed with acute kidney injury, which was cured by continuous venovenous hemodialfiltration. Non-detoxified D. quinqueloba can cause severe acute kidney injury with toxic encephalopathy. It is critical to inform possible adverse effects of the medicinal herbs and to implement more strict regulation of these products.

Neurotoxicidad de los plaguicidas como agentes disruptores endocrinos: una revisión / Neurotoxicity of pesticides as endocrine disruptors agents: a review

Los plaguicidas se encuentran en el medio ambiente como contaminantes formando mezclas complejas, los estudios recientes se han centrados en la evaluación de los efectos y riesgos que pueden causar estas mezclas de plaguicidas en el ser humano y los ecosistemas.Esta revisión hace hincapié a tres plaguicidas específicos, representativos de los grupos químicos organofosforados, carbamato de tipo ditiocarbamato y triazinas, como son: Paratión® etílico, Mancozeb® y Atrazina®, respectivamente. Ha sido demostrado en animales de experimentación la neurotoxicidad de estos plaguicidas por alteración de la transmisión sináptica y de los mecanismos de la homeostasis del sistema neuroendocrino, lo cual explica la acción de estos plaguicidas como disruptores endocrinos. Varios trabajos demuestran que estos plaguicidas son potencialmente tóxicos a la salud humana, y aún en bajas concentraciones, pueden afectar al organismo causando alteraciones en el sistema neuroendocrino, especialmente en los ejes hipotálamo-hipófisis-gónada e hipotálamo-hipófisis-tiroides. Los investigadores destacan que los momentos de particular sensibilidad de la exposición a plaguicidas disruptores endocrinos son las etapas tempranas de la vida como: durante el desarrollo embrionario y la primera infancia, períodos en los cuales los procesos de crecimiento son controlados por las hormonas afectando el desarrollo del cerebro, el sistema inmune y otros órganos como el sistema reproductor y tiroideo. Los cambios neuroquímicos provocados por la exposición a estos plaguicidas durante el desarrollo cerebral constituyen un alto riesgo porque son capaces de interferir en los procesos de neurogénesis y sinaptogénesis, afectando de manera adversa las funciones cognitivas y motoras, cuyos efectos se observan durante las etapas posteriores de la vida.

Pesticides are found in the environment as complex mixtures forming pollutants, recent studies have focused on evaluating the effects and risks that may cause these mixtures of pesticides on humans and ecosystems. This review highlights three specific, representative of organophosphorus pesticide chemical groups carbamate, dithiocarbamate and triazine type, such as: ethyl Paratión®, Mancozeb® and Atrazina®, respectively.It has been demonstrated in experimental animal’s neurotoxicity of these pesticides by altering synaptic transmission and mechanisms of homeostasis of the neuroendocrine system, which explains the action of these pesticides as endocrine disruptors. Several studies show that these pesticides are potentially toxic to human health, and even in low concentrations, can affect the body causing alterations in the neuroendocrine system, especially in the hypothalamic-pituitary-gonadal and hypothalamic-pituitary-thyroid axis. The researchers point out that the moments of particular sensitivity of exposure Endocrine disruptor pesticide are the early stages of life as during embryonic development and early childhood periods in which growth processes are controlled by hormones affecting the development brain, immune system and other organs such as the thyroid and reproductive system. The neurochemical changes induced by exposure to these pesticides during brain development are at high risk because they are able to interfere with the processes of neurogenesis and synaptogenesis, adversely affecting cognitive and motor functions, whose effects are observed during the later stages of life.

Complicaciones neurológicas relacionada con la mordedura de serpiente venenosa: reporte de un caso clínico / Neurological complications related to a venomous snake bites: A Case Report

La mordedura de serpiente venenosa es una condición de emergencia pediátrica, que predomina en países tropicales y subdesarrollados, afecta a millones de personas a nivel mundial, produciendo alta morbilidad y mortalidad. Las complicaciones neurológicas pueden ser producidas por efecto de neurotoxinas o por alteraciones en la cascada de coagulación. Se presenta caso de un adolescente mordido por una serpiente barba amarilla que no recibió tratamiento oportuno y manifestó desde las primeras 48 horas, alteraciones hematológicas y a partir del cuarto día de evolución presentó signos de encefalopatía. Posteriormente se analiza el mecanismo mediante el cual se produjeron estos eventos...(AU)

O abuso de êxtase no Brasil: uma droga de final de semana ou algo mais? / The abuse of ecstasy in Brasil: a weekend drug or something else?

O 3,4-metilenodioximetanfetamina (MDMA) popularmente conhecido por ’êxtase’ é uma droga sintéticaque chegou ao Brasil nos anos 90, portanto poucos estudos científicos estão disponíveis sobre a epidemiologia e os padrões de consumo desta droga. O perfil dos usuários de êxtase é na maioria das vezes composto por indivíduos jovens de até 25 anos, poliusuários de drogas, homens, heterossexuais, solteiros, de nível superior completo ou incompleto e pertencente às classes sócio-econômicasmais elevadas. Farmacologicamente o êxtase atua sobre o sistema serotonérgico, promovendo aumentoda liberação e inibição da recaptação de 5-HT pelos terminais nervosos, aumentando efetivamente a concentração de 5-HT na fenda sináptica. Além disso, o êxtase também promove ativação de vias noradrenérgicas e dopaminérgicas centrais. Todas estas alterações neuroquímicas podem desencadear uma série de manifestações clínicas, tais como euforia, bem-estar, desinibição,sudorese e alucinações. O uso do êxtase também pode provocar complicações como hipertemia fulminante, complicações cardiovasculares e psiquiátricas, que podem inclusive levar a morte o indivíduo. Adicionalmente,o abuso de êxtase pode causar dependência e tolerância em humanos. Em conclusão, torna útil enfatizar a importância de programas educacionais na prevenção ao consumo de drogas, dando particular ênfase ao êxtase.Outro fator que merece atenção é a capacitação dos profissionais da saúde para atuarem em intervenções deemergência em casos de intoxicações decorrentes do uso abusivo de êxtase.

3,4-methylenedioxymethamphetamine (MDMA) popularly named ecstasy is a synthetic drug that arrived in Brazil in the 90’s. Due to this fact, few studies are still available about the pattern of ecstasy’s users in Brazil. However, many epidemiological studies indicate that the profile of ecstasy’s users is generally young people (up to 25 years old), drug polyusers, men, heterosexual, single, graduate or undergraduate students, and belonging to a privileged economic class. Pharmacologically, ecstasy acts on the serotonergic system, by increasing the release and inhibiting the re-uptake of serotonin in thenervous system. Together, these actions produce a robust increase of serotonin concentrations in the synaptic cleft. Despite serotonergic effects, ecstasy also acts on noradrenergic and dopaminergic pathways, thus promotinga very complex myriad of clinic symptoms, such as euphoria, disinhibition, sweat, hallucinations. Use of ecstasy also can promote hyperthermia, cardiovascular andpsychiatric alterations, which could lead the user to death, besides dependence and tolerance when chronically used. In conclusion, educational programs back toward the prevention of ecstasy consumption and training of heath professional workers is absolutely required for reducing the abuse of this drug and for improving the treatment of users.

Neurotoxicidad por solventes orgánicos, aspectos neurológicos y neurofisiológicos / Neurotoxicity syndromes for organic solvents: Neurological aspects and presentation of cases

Se presenta una actualización de las principales manifestaciones neurológicas por exposición laboral a solventes orgánicos; de la forma como debe investigarse una posible fuente laboral de toxicidad y la utilización de los estudios neuropsicológicos y electrofisiológicos en su confirmación. Para terminar se propone un protocolo de investigación de toxicidad por solventes orgánicos de fácil aplicación en nuestro medio

Acantosis Nigricans de etiología benigna / Acanthosis nigricans of benign etiology

Esta comunicación tiene por objeto presentar un caso de Acantosis nigricans de etiología poco frecuente. La misma se caracteriza por la presencia de placas hiperpigmentadas y de tacto verrugoso aterciopelado, distribuidas simétricamente en áreas de flexión. Estas lesiones pueden ser manifestación de patologías benignas o acompañar a distintas neoplasias, constituyendo en este último caso un síndrome paraneoplásico. El caso que se presenta corresponde a un cuadro de Acantosis nigricans de etiología benigna poco frecuente.