Problemas associados ao uso de plantas medicinais comercializadas no Mercadão de Madureira, município do Rio de Janeiro, Brasil / Problems associated with the use of medicinal plants commercialized in "Mercadão de Madureira", Rio de Janeiro City, Brazil

O uso de plantas medicinais pela população brasileira é prática tradicional, sendo muitas vezes o único recurso utilizado na atenção básica de saúde. O uso terapêutico dessas plantas envolve várias etapas da cadeia produtiva, sendo a procedência, coleta, secagem, armazenamento, comércio, modo de preparo pelo usuário e uso. O objetivo desse trabalho documental, de caráter exploratório, foi levantar a produção científica existente sobre os problemas associados a cada uma dessas etapas e discutir as questões relacionadas à carência de estudos para comprovar a eficácia farmacológica e a ausência de riscos toxicológicos, bem como a prática de autodiagnóstico. As vinte plantas mais comercializadas em grande mercado do município do Rio de Janeiro em agosto de 2007 serviram de base para o levantamento documental do presente estudo. Dessas, seis apresentaram propriedades tóxicas comprovadas dependendo do preparo e uso, a arnica (Solidago chilensis Meyen), aroeira (Shinus terebinthifolius Raddi.), arruda (Ruta graveolens L.), babosa (Aloe vera L.), confrei (Symphytum officinale L.) e poejo (Mentha pulegium Lam. & DC.). A Agência Nacional de Vigilância Sanitária aponta contra indicações para boldo-do-Chile (Peumus boldus Molina), chapéu-de-couro (Echinodorus macrophyllus Micheli), erva-cidreira (Lippia alba N.E.Br.), erva-de-bicho (Polygonum spp.), espinheira-santa (Maytenus spp.), picão (Bidens pilosa L.), poejo (Mentha pulegium Lam.) e tanchagem (Plantago major L.). O abajerú, arnica, boldo-do-Chile, confrei, erva-de-bicho e espinheira-santa tiveram relato de problemas de identificação na coleta e comercialização frente a outras morfologicamente semelhantes. Plantas cultivadas e silvestres apresentam variabilidade de princípios ativos influenciados por fatores ambientais e genéticos, como chapéu-de-couro (Echinodorus macrophyllus Micheli), erva-cidreira (Lippia alba N.E.Br.) e erva-de-bicho (Polygonum spp.). A contaminação e o comprometimento da preservação dos princípios ativos pela secagem e armazenamento inadequados foram relatados para o guaco (Mikania glomerata Sprengel), camomila (Chamomilla recutita L.), erva-cidreira, chapéu-de-couro e boldo-do-Chile (Peumus boldus Molina). Pode-se constatar que todas as etapas da cadeia produtiva das plantas medicinais apresentam desafios para que se possa garantir identificação da espécie, disponibilidade, qualidade, segurança e eficácia de uso.

The use of medicinal plants by the Brazilian population is a traditional practice and is often the main resource used in primary healthcare. The therapeutic use of these plants involves several steps in the supply chain: origin, harvest, drying, storage, form of preparation by the user and use. The aim of this documental study of exploratory nature was to survey the scientific literature about the problems associated with each of those steps and discuss the issues related to the lack of studies to prove the pharmacological efficacy and the absence of toxicological risks, as well as the autodiagnosis practice. The 20 plants most commercialized in a large market of Rio de Janeiro City in August 2007 were the basis for the documental survey of the present study. Of these, six had proven toxic properties depending on their preparation and use: arnica (Solidago chilensis Meyen), aroeira (Shinus terebinthifolius Raddi.), rue (Ruta graveolens L.), "babosa" (Aloe vera L.), comfrey (Symphytum officinale L.) and pennyroyal (Mentha pulegium Lam. & DC.). The National Agency for Sanitary Surveillance shows contraindications for: "boldo-do-Chile" (Peumus boldus Molina), "chapéu-de-couro" (Echinodorus macrophyllus Micheli), lemon balm (Lippia alba N.E.Br.), "erva-de-bicho" (Polygonum spp.), "espinheira-santa" (Maytenus spp.), "picão" (Bidens pilosa L.), pennyroyal (Mentha pulegium Lam.) and plantain (Plantago major L.). "Abajerú", arnica, "boldo-do-Chile", comfrey, "erva-de-bicho" and "espinheira-santa" were reported to show identification problems in the harvest and in the commercialization compared to morphologically similar plants. Cultivated and wild plants showed variability in active principles influenced by environmental and genetic factors: "chapéu-de-couro" (Echinodorus macrophyllus Micheli), lemon balm (Lippia alba N.E.Br.) and "erva-de-bicho" (Polygonum spp.). Contamination and compromising of the preservation of active principles due to inadequate drying and storage was reported for guaco (Mikania glomerata Sprengel), camomile (Chamomilla recutita L.), lemon balm, "chapéu-de-couro" and "boldo-do-Chile" (Peumus boldus Molina). All stages of the supply chain of medicinal plants constitute challenges to ensure the proper species identification, availability, quality, safety, and efficacy of their use.

Epidemiological profile of snakebites in Rio de Janeiro, Brazil, 2001-2006

All snakebites registered in Rio de Janeiro state, Brazil, between 2001 and 2006 were analyzed. Of these, the snake species involved was identified in 2,431 cases, most of which were caused by Bothrops (2,347). Most victims were male (78.4%) and the age group most frequently attacked was between 20 and 39 years (38.4%). As for severity, 1,118 (45.9%) were classified as minor, 748 (30.7%) as moderate, and 209 (8.6%) as severe. Progression towards complete cure occurred in 1,567 patients; 39 had sequelae; three died; and clinical outcomes were not monitored in 822 cases. The time between bite and first medical attention was less than three hours in 74.6% of cases. Most occurred in municipalities with vast areas of preserved Atlantic Forest: Angra dos Reis (208), Rio de Janeiro (197), Parati (186), Teresópolis (134), and Petrópolis (110). Accident frequency was highest between November and April, in which the daily average is practically twice that observed in other months. Although results show that Rio de Janeiro state has a good level of medical care, it could be improved by creating multidisciplinary teams that include doctors, biologists, and nurses. The Vital Network for Brazil helps to promote a stimulating environment for this type of training, with both traditional courses and distance learning. Training hours must be increased to improve the skills of professionals responsible for victim care.(AU)