Measurement of pesticides in hair samples from pemphigus foliaceus and pemphigus vulgaris patients in Southeastern Brazil

Abstract Background Pesticides, mainly organophosphates (OP), have been related to increased risk of pemphigus vulgaris (PV) and pemphigus foliaceus (PF), nevertheless, their measurement has not been determined in pemphigus patients. Objective To evaluate pesticide exposure and pesticide measurement, comparing PV, PF and control groups in Southeastern Brazil. Methods Information about urban or rural residency and exposure to pesticides at the onset of pemphigus was assessed by questionnaire interview; hair samples from the scalp of PV, PF, and controls were tested for OP and organochlorines (OC) by gas-phase chromatography coupled to mass spectrometry. Results The minority of PV (2 [7.1%] of 28) and PF (7 [18%] of 39), but none of the 48 controls, informed living in rural areas at the onset of pemphigus (p = 0.2853). PV (33.3%), PF (38.5%), and controls (20%) informed exposure to pesticides (p = 0.186). Twenty-one (14.8%) of 142 individuals tested positive for OP and/or OC: PV (2 [6.3%] of 32) and PF (11 [25.6%] of 43) had similar pesticides contamination as controls (8 [11.9%] of 67) (p = 0.4928; p = 0.0753, respectively), but PF presented higher contamination than PV (p = 0.034). PV did not present any positivity for OP. Three (7%) PF tested positive for both OP and OC. Some PF tested positive for three or four OP, mainly diazinon and dichlorvos. Study limitation Lack of data for some controls. Conclusion Although the frequency of PV and PF patients exposed to pesticides was similar, pesticides were more frequently detected in hair samples from PF compared to PV. The cause-effect relationship still needs to be determined.

Alcohol and brief intervention for trauma victims / Consumo de álcool e intervenção breve em vítimas de trauma

Objective:to describe the causes and severities of trauma in patients who met the criteria for alcohol abuse or dependence according to Mini International Neuropsychiatric Interview, and to display the pattern of alcohol consumption and subsequent changes one year after trauma.Methods:a transversal and longitudinal quantitative study carried out between November 2012 and September 2013 in the ED. Medical and nursing students collected blood samples, applied the J section of the Mini International Neuropsychiatric Interview (MINI) and submitted alcohol abusers and dependents to BI. One year after admission, patients were contacted and asked about their patterns of alcohol use and their reasons for any changes.Results:from a sample of 507 patients admitted to the ED for trauma, 348 responded to MINI, 90 (25.9%) being abusers and 36 (10.3%) dependent on alcohol. Among the abusers, the most frequent cause of injury was motorcycle accident (35.6%) and among the dependents it was predominantly interpersonal violence (22.2%). Positive blood samples for alcohol were identified in 31.7% of the abusers and 53.1% of the dependents. One year after trauma, 66 abusers and 31 dependents were contacted, and it was ascertained that 36.4% of the abusers and 19.4% of the dependents had decreased alcohol consumption. The main reported reason for the reduction was the experienced trauma.Conclusion:the motorcycle accident was the most common cause of injury. The detection of problematic alcohol use and implementation of BI are important strategies in the ED, however for alcohol abusers and dependents, BI was not the most reported reason for any changes in patterns of alcohol use.

Objetivo:avaliar os mecanismos e a gravidade do trauma em pacientes que preenchessem critérios para abuso ou dependência de álcool de acordo com o Mini International Neuropsychiatric Interview e apresentar o padrão de consumo de álcool e as mudanças um ano após o trauma.Métodos:estudo quantitativo transversal e longitudinal realizado de novembro de 2012 a setembro de 2013 em Unidade de Emergência. O paciente era submetido a uma entrevista semiestruturada que avalia abuso e dependência de álcool. Os pacientes abusadores e dependentes de álcool foram submetidos à intervenção breve. Um ano após a admissão os pacientes foram contatados e questionados acerca do padrão de uso e as razões de eventuais mudanças.Resultados:de uma amostra de 507 pacientes admitidos na UE por trauma, 348 responderam ao MINI, sendo 25,9% abusadores e 10,3% dependentes de álcool. Entre os abusadores o mecanismo de trauma mais frequente foi o acidente de motocicleta (35,6%) e nos dependentes houve predomínio de espancamento (22,2%). Amostras de sangue positivas para álcool foram identificadas em 31,7% dos abusadores e 53,1% dos dependentes. Um ano após o trauma, 66 abusadores e 31 dependentes foram contatados, constatando-se que 36,4% dos abusadores e 19,4% dos dependentes diminuíram o padrão de consumo de álcool. A principal razão relatada de redução foi o trauma.Conclusão:o acidente de motocicleta foi o mecanismo de trauma mais frequente e entre os abusadores e dependentes de álcool houve redução do consumo de álcool após o trauma, porém a IB não foi a razão mais relatada para a mudança do hábito.

Suicide attempt using pure methanol with hospitalization of the patient soon after ingestion: case report / Tentativa de suicídio com metanol puro em paciente admitido precocemente após a ingestão: relato de caso

CONTEXT: Most patients with methanol poisoning typically show up one to several days after ingestion, presenting severe acidosis, visual disorders, or both. Reports of hospitalization less than 6 h after exposure are unusual. We describe a case of attempted suicide using methanol admitted 3 h after ingestion. CASE REPORT: A 52-year-old male was hospitalized 3 h after intentional ingestion of 150 ml of 99.9 percent methanol with no co-ingestion of ethanol. He was alert and cooperative, presenting nausea and vertigo, and reporting six episodes of vomiting. Physical examination showed no remarkable features. A blood sample for methanol and ethanol determination was obtained 4 h after ingestion. The result (available 10 h after ingestion) showed 70 mg/dl of methanol, without detectable ethanol. He was treated with a loading dose of 10 percent ethanol solution (7 ml/kg, intravenously), followed by a maintenance dose of 0.9-1.0 ml/kg/h intravenously (10 to 51 h); hemodialysis (19 to 27 h, together with 2.1 ml/kg/h of 10 percent ethanol intravenously); and folinic acid intravenously (50 mg every 6 h, from 4 to 51 h). He developed mild/moderate metabolic acidosis without acidemia and was discharged on day four after ophthalmological evaluation and cerebral computed tomography scan, without abnormalities. Follow-up revealed no sequelae. CONCLUSION: This could be classified as a potentially severe case of methanol poisoning, according to the amount and concentration of methanol ingested, and blood methanol concentration at 4 h. The good outcome was attributable to early hospitalization and early antidotal therapy with hemodialysis, starting at 10 and 19 h, respectively.

CONTEXTO: A maioria dos pacientes intoxicados por metanol se apresenta um a vários dias após a ingestão, com acidose grave e/ou alterações visuais, sendo rara a admissão com menos de seis horas da exposição. Descrevemos uma tentativa de suicídio com metanol puro admitido três horas após a ingestão. RELATO DE CASO: Homem de 52 anos, admitido três horas após ingestão intencional de 150 ml de metanol 99,9 por cento sem co-ingestão de etanol. Ele estava alerta e cooperativo, apresentando náuseas, vertigem e relatando seis episódios de vômitos. Sem achados relevantes no exame físico. Foi coletada amostra sanguínea para determinação dos níveis séricos de metanol e etanol em quatro horas, com resultado liberado em 10 horas, mostrando metanol = 70 mg/dl e etanol não detectável. O paciente foi tratado com uma dose de ataque intravenosa (IV) de etanol 10 por cento de 7 ml/kg, seguida por uma dose de manutenção de 0,9-1,0 ml/kg/h IV de 10 a 51 horas; hemodiálise (19 a 27 horas), recebendo, nesse período, 2,1 ml/kg/h de etanol 10 por cento IV e oito doses de ácido folínico IV (50 mg cada 6 horas, de 4 a 51 horas). Desenvolveu acidose metabólica leve/moderada, sem acidemia, sendo liberado no quarto dia de internação após avaliação oftalmológica e realização de tomografia computadorizada cerebral, sem alterações. Acompanhamento não revelou sequelas. CONCLUSÃO: O presente caso pode ser classificado como uma intoxicação potencialmente grave por metanol, considerando a quantidade e a concentração ingerida e o nível sérico de metanol obtido em quatro horas. A boa evolução pode ser atribuída ao intervalo entre a exposição e a admissão hospitalar, e o tratamento específico com o antídoto e a hemodiálise, respectivamente iniciados em 10 e 19 horas.

Aldicarb: uma possibilidade de análise com finalidade forense / Aldicarb: an analysis with forensic aim

The carbamate insecticide Aldicarb is a chemical prevalent in suicide, homicide and accidental intoxication. The LD50 in rats is 1 mgkg-1 bory wegth. The laboratorial diagnosis is carried out by toxicological analysis. It can show the presence of this toxic agent. the objective of this work is to show that the detection and differentiation of carbamate in forensic samples is possible by thin layer...