Caracterización de las exposiciones a plaguicidas entre los años 2006 y 2013 reportadas al Centro de Información Toxicológica de la Pontificia Universidad Católica de Chile / Characterization of pesticide exposures reported between 2006 and 2013 to a poison information center in Chile

Background: Pesticides are widely used to increase crop yields and vector control. However, both acute and chronic exposure have health consequences. There is paucity of information about the global occurrence of pesticide poisonings. Aim: To characterize the reports of pesticide exposures received by a University Poison Information Center. Material and Methods: All pesticide exposures reported in Chile between 2006 and 2013 were analyzed. A data-collection sheet provided by the International Programme on Chemical Safety of the World Health Organization, was used to collect information. Results: In the study period, 13,181 reports were analyzed. The main age groups exposed were preschoolers and adults. Sixty one percent of exposures occurred accidentally and 24.8% were suicide attempts. Exposures to acetylcholinesterase inhibitors was reported in 29.3% of cases, to superwarfarin rodenticides in 28.5% and to pyrethroids in 24.0%. An increased risk of suicide attempts with pesticides was observed among women, when compared with men (odds ratio: 1.5; 95% confidence intervals: 1.4-1.6; p < 0.001). The risk was higher among teenage girls. Conclusions: The amount of cases under acetyl cholinesterase inhibitor exposure, the most toxic pesticides currently in use should be highlighted. Workers should be educated and all cases should be reported to take actions aiming at reducing these events.

Exposición a agentes de riesgo biológico en trabajadores chilenos: Reporte del Centro de Información Toxicológica de la Pontificia Universidad Católica de Chile (CITUC) / Exposure to occupational biological risks: Experience of a toxicology information center

Background: Exposure to Biological Agents during work is an emergent type of occupational risk. Aim: To characterize occupational biological risk exposure among Chilean workers which have been registered by the Toxicology Information Center, between January 2006 and December 2009. Material and Methods: All incoming calls reporting exposure to biological agents during the studied period were analyzed. The information obtained from the caller was registered using the Communication Record Instrument of the WHO International Programme on Chemical Safety (IPCS INTOX). Results: In the studied period, 77 calls were received. The mean age of exposed patients was 35 ± 15 years and 57% of them were females. The most common involved agents were vaccines for veterinary use (42%) followed by Loxosceles laeta bites in 16%. The main routes of exposure were injections, cuts and needle stick injuries in 39% and stings and bites in 38%. The highest exposure rates were observed in Southern Chile due to self-inoculation of veterinary vaccines used in the salmon industry (22.7/100.000 actual workers). Fifty-eight percent of calls were from health care workers, and 51% of them were from health care facilities. Sixty percent of exposures occurred during summer and spring. There was a fourfold higher risk of calls involving women exposed to bites or stings (odds ratio (OR) 4.5 (CI95 1.5-13.9, p < 0.01). Men had a fourfold higher risk of being exposed to vaccines or medications for veterinary use (OR 4.2, CI95 1.4-12.6 p < 0.01). Conclusions: Most calls involving an exposure to a biological agent were caused by self-inoculation of veterinary medications.

Caracterización de la ingestión por sobredosis de paracetamol: Reporte de un centro de información toxicológica chileno / Characterization of paracetamol overdose: Report of a poison information center in Chile

Background: Paracetamol (acetaminophen) is an analgesic and antipyretic drug widely used across the world. Its ingestion is one of the most common causes of drug overdose. In the United States is the first cause of acute hepatitis in adults. Aim: To describe the epidemiological profile of paracetamol overdose in Chile. Material and Methods: Cross sectional retrospective study that included all the phone call inquiries received at the Poison Control Center of the Pontificia Universidad Catolica de Chile (CITUC) during 2009. Results: Nine hundred fifty nine inquiries involving acute paracetamol exposures were received. Women represented a 63.1% of the cases. Half of the cases were suicide attempts, of which 74.8% were women. Accidental exposures occurred mainly in children. In 29.3% of the patients, the exposure was considered to involve a hepatotoxic dose. Women had 2.7 times the risk of men to ingest a toxic dose of paracetamol with suicidal purpose (Odds ratio (OR) = 2.7; 95% confidence interval (Cl): 2.1-3.6; p < 0.001). Adolescents had 3.4 times the risk of the general consultants (OR: 3.4; 95% Cl: 2.4-4.7; p < 0.001). Conclusions: Paracetamol overdose is common in Chile. Authorities should carry out preventive measures. Antidotes and the capacity to measure plasma levels of paracetamol should be available in healthcare centers.

Pediatria ambiental: um tema emergente / Environmental pediatrics: an emerging issue

OBJETIVO: Revisar os artigos mais relevantes sobre a pediatria ambiental, seus efeitos potenciais para a saúde e, especialmente, seus avanços na prevenção. FONTES DOS DADOS: Foi realizada uma pesquisa utilizando as bases de dados MEDLINE/PubMed e SciELO. Foram revisados artigos de 1990 a 2010, além de capítulos de livros relacionados à pediatria ambiental. SÍNTESE DOS DADOS: Há uma variedade significativa de fatores que tornam as crianças altamente vulneráveis à exposição a riscos ambientais, associados principalmente ao consumo comparativamente maior de água, comida e ar por parte da criança, em relação ao seu peso corporal. De acordo com a Organização Mundial de Saúde, mais de 3 milhões de crianças menores de 5 anos morrem devido a doenças relacionadas ao meio ambiente. Aproximadamente 30-40 por cento das doenças pediátricas estão relacionadas a fatores ambientais. As crianças estão constantemente expostas a vários riscos ambientais para a saúde, dentre os quais se destacam: água contaminada, falta de condições adequadas de saneamento, poluição do ar, vetores de doenças, perigos químicos, injúrias e acidentes. CONCLUSÕES: Atualmente, os pediatras são desafiados a tratar das necessidades de saúde ligadas à pediatria ambiental. A história pediátrica deve ser mais abrangente, acrescentando-se questões pontuais que ajudem a identificar potenciais riscos ambientais. A conscientização e o entendimento sobre os efeitos nocivos das várias condições ambientais e o conhecimento sobre as medidas de prevenção relacionadas resultarão em intervenções oportunas e adequadas que melhorarão a saúde e o desenvolvimento das nossas crianças.

OBJECTIVE: To review the most relevant articles regarding environmental pediatrics, its potential effects on health, and especially its advances in prevention. SOURCES: A literature search was conducted using MEDLINE/PubMed and SciELO databases. Articles from 1990 to 2010 were reviewed, in addition to book chapters related to environmental pediatrics. SUMMARY OF THE FINDINGS: There is a significant variety of factors that make children highly vulnerable to environmental hazard exposure, which are mainly associated with children’s comparatively greater consumption of water, food, and air in relation to body weight. According to the World Health Organization, every year more than 3 million children under the age of 5 die because of environment-related conditions. Approximately 30 to 40 percent of pediatric diseases are related to environmental factors. Children are constantly exposed to various environmental health hazards, among which the following stand out: contaminated water, lack of adequate sanitation facilities, air pollution, disease vectors, chemical hazards, injuries, and accidents. CONCLUSIONS: Nowadays, pediatricians are challenged to address environmental pediatrics health care needs. The pediatric health history needs to be more comprehensive by adding pointed questions to help identify potential environmental risks. Awareness and understanding of the noxious effects of various environmental conditions and knowledge of the related prevention measures will result in timely and adequate interventions that will improve our children’s health and development.

Análise de um sistema de avaliação de aprendizagem para internato em pediatria baseado em exame clínico objetivo estruturado, observação de prática clínica e exame escrito / Analysis of a learning assessment system for pediatric internship based upon objective structured clinical examination, clinical practice observation and written examination

OBJETIVO: Descrever e analisar três ferramentas usadas no sistema de avaliação aplicado ao internato em pediatria por um período de 7 anos na Faculdade de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile. MÉTODOS: Pesquisa observacional retrospectiva projetada para as modalidades de avaliação usadas de 2001 a 2007 que foram implementadas no internato em pediatria. As ferramentas foram as seguintes: exame clínico objetivo estruturado (objective structured clinical examination, OSCE), exame escrito e diretrizes de observação de prática clínica diária (DOPCD). Os métodos de avaliação foram aplicados ao internato em pediatria do sexto ano, com um total de 697 alunos. A análise estatística incluiu uma avaliação descritiva, com correlação e regressões linear simples e múltipla (ANOVA), teste de Bonferroni e coeficiente alfa de Cronbach. O nível de significância foi de 5 por cento. RESULTADOS: Escores de sucesso com a OSCE foram atingidos em 75,7±8 por cento, com melhor média entre o sexo feminino (p < 0,001). Os escores de OSCE melhoraram após o terceiro ano de implementação. O coeficiente alfa de Cronbach foi de 0,11-0,78. O exame escrito teve escore médio de 79,8±10 por cento, e não houve diferenças quanto a gênero. O escore médio de DOPCD 97,1±3 por cento, com melhores resultados entre as mulheres (p < 0,005). A correlação entre os três métodos de avaliação mostrou uma relação positiva moderada, exceto no ano de 2007, quando a correlação foi maior (p < 0,001). CONCLUSÕES: Análise do sistema de avaliação da aprendizagem foi realizada usando OSCE, exame escrito e DOPCD, que são complementares entre si, gerando bons resultados.

OBJECTIVE: To describe and analyze three tools used in the assessment system applied to the pediatric internship over a 7-year period at the School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile. METHODS: Retrospective observational research design for the assessment modalities implemented in the pediatric internship from 2001 through 2007. The tools were as follows: objective structured clinical examination (OSCE), written examination and daily clinical practice observation guidelines (DCPOG). The assessment methods were applied to the sixth-year pediatric internship with a total of 697 students. Statistical analysis included a descriptive assessment, with correlation and simple linear and multiple regressions (ANOVA), Bonferroni test and Cronbach's alpha coefficient. Significance level was set at p < 0.05. RESULTS: OSCE success scores were reached in 75.7±8 percent, with a better mean among females (p < 0.001). OSCE scores improved after the third year of implementation. Cronbach's alpha coefficient was 0.11-0.78. Written examination had a mean score of 79.8±10 percent and there were no sex differences. Mean DCPOG score was 97.1±3 percent and the results were better among females (p < 0.005). Correlation between the three assessment methods showed a moderate positive relationship except in the year of 2007, where the correlation was higher (p < 0.001). CONCLUSIONS: Analysis of the learning assessment system was performed using OSCE, written examination and DCPOG, which are complementary to each other, and yielded good results.

Epidemiología de las intoxicaciones: análisis de las llamadas efectuadas durante el año 2007 al Centro de Información Toxicológica (CITUC) de la Pontificia Universidad Católica de Chile / Epidemiology of intoxications: analysis of calls made during 2007 to the Toxicology Information Center (CITUC) of the Catholic University of Chile

Objetivo: Describir y caracterizar la epidemiología de las consultas por intoxicaciones al Centro de Información Toxicológica de la Universidad Católica (CITUC) y conocer las variaciones epidemiológicas producidas entre los años 2004 y 2007. Método: Se realizó un estudio retrospectivo, observacional y descriptivo de las llamadas registradas por el Centro durante el periodo del año 2007. Se analizaron las siguientes variables: número total de llamadas, lugar de las llamadas, circunstancias de la exposición, tipo y números de agentes involucrados, vías de exposición, tiempo desde la exposición, características demográficas y las indicaciones y tratamientos recomendados. Resultados: Se registraron 30.171 llamadas. El 45 por ciento de las consultas provenían del hogar y el 52,5 por ciento de las instalaciones de salud. El 67,2 por ciento de las consultas fueron exposiciones accidentales y el 29,2 por ciento fueron intencionales. Los Medicamentos se presentaron en un 57,1 por ciento de las llamadas, seguidos por los Productos de uso doméstico (16,5 por ciento), Productos de uso industrial (4,7 por ciento), y Pesticidas (5,8 por ciento). La ingestión fue la vía de exposición que se predominó en un 76,6 por ciento del total de casos. El 23,3 por ciento del total de las llamadas, se realizaron dentro de la primera hora post-exposición. Las intoxicaciones en niños menores de 14 años correspondieron al 50 por ciento de las llamadas. Respecto al año 2004 aumentó la proporción de llamadas procedentes del hogar y el porcentaje de intoxicaciones intencionales. Conclusiones: Los medicamentos constituyen el principal agente de intoxicación. La principal vía de exposición es la ingesta y el principal grupo de población afectado son los niños menores de 14 años. Estos son indicadores evidentes y claros de la necesidad imperante de desarrollar campañas publicitarias preventivas e informativas, avaladas por el Ministerio de Salud, respecto al correcto almacenamiento...

Objective: To describe the epidemiological features of the intoxication cases reported to CITUC and the variations produced between 2004 and 2007. Method: A retrospective and descriptive study of the calls registered at the Center during 2007. The following data were analyzed: number and place of the calls; circunstances of exposure; type and number of agents involved; routes of exposure; time since exposure; sex and age of the subjects, and treatment and advice offered. Findings: 30.171 calls were received, 45 percent from the home and 52,5 percent from Health Care Service; 67,2 percent were accidents and 29,2 percent were intentional exposures. The agents were: medicines (57,1 percent); cleaning products (16,5 percent) pesticides (5,8 percent); other chemical and industrial products (4,7 percent). The exposure route was oral in 76,6 percent of cases; 48 percent of calls occurred within one hour of exposure. Children under six were the main group involved. Conclusion: The evidence substantiates a need for prevention campaigns, sponsored by the Health Ministry, about the correct storage of medicines and the appropiate management of poisoning at home. Child-resistant containers and education are two essential elements for prevention of pediatric intoxications.

Tóxicos al alcance de los niños / Household hazardous

Existen productos frecuentes de uso doméstico y plantas ornamentales en nuestros jardines con gran poder toxigénico que son importantes de conocer.

Intoxicación por rodenticidas anticoagulantes / Poisoning by anticoagulant rodenticides

El Centro de Información Toxicológica de la Universidad Católica (CITUC) recibe llamados telefónicos de todo Chile en relación a intoxicaciones. Este artículo realiza una revisión de los llamados recibidos durante 2007 y específicamente los relacionados a intoxicación con rodenticidas, sustancia importante por la gravedad de sus consecuencias.

Caracterización clínico-epidemiológica telefónica de la mordedura por araña de rincón, en un centro de información toxicológica de Chile, durante el año 2005 / Prevalence and epidemiology of Loxosceles laeta bite. Analysis of consultations to a poison control center

Background: Loxoscelism is caused by the bite of spider Loxosceles laeta. It can cause a cutaneous or systemic syndrome. Aim: To determine the epidemiol¢gica! and clinical features of patients bitten by the Chilean recluse spider (Loxosceles laeta). Material and Methods: All communications received at a telephonic orientation center for intoxications during 2005 were analyzed, selecting those who involved patients with symptoms that suggested loxoscelism (i.e., pain, burning sensation, blue area, hematuria, fever or myalgia). These were derived to the emergency room for confirmation of the diagnosis. Forty-eight hours after the initial communication, patients were contacted by phone to find out about the definitive diagnosis. The variables analyzed were: gender, age, geographical location, time since exposure, part of the body involved, clinical signs and definitive diagnosis. Results: Of 2,831 telephonic consultations with suspected loxoscelism, the diagnosis was confirmed in 287. All of these patients had cutaneous loxoscelism and only 7.3 percent of them developed visceral loxoscelism. Fifty six percent of patients with loxoscelism presented two or more clinical signs. The most common were a blue area, pain and a burning sensation, in 69 percent, 58 percent and 38 percent of patients, respectively. Fifty-one percent of patients developed signs within the first 12 hours. All patients with visceral syndrome presented with hemoglobinuria. No cases of loxoscelism were registered in areas located southern than the Xth region of Chile. There were no fatalities attributed to loxoscelism. Conclusions: Most cases of loxoscelism of this series were cutaneous. The population must be educated about the clinical signs of spider bite to seek early and adequate medical treatment.

Intoxicación por antidepresivos tricíclicos en pediatría / Tricyclic antidepressant poisoning in children

Los medicamentos antidepresivos son recetados con frecuencia en adultos y lamentablemente están al alcance de los niños en muchos domicilios, lo que tiene como consecuencia el riesgo de intoxicación accidental o con fines suicidas. Se decriben en este artículo los graves efectos de la intoxicación por antidepresivos tricíclicos.

Epidemiología de las intoxicaciones que generaron llamadas durante el año 2004 al Centro de Información Toxicológica (CITUC) de la Pontificia Universidad Católica de Chile: Región Metropolitana / Epidemiology of intoxication cases that originated calls to the Toxicology Information Centre (CITUC) of the Catholic University of Chile: Metropolitan Region, 2004

Objetivo: Describir y caracterizar la epidemiología de las consultas por intoxicaciones, reportados al Centro de Información Toxicológica de la Universidad Católica (CITUC). Método: Se realizó un estudio retrospectivo y descriptivo de las llamadas registradas por el centro durante el período del año 2004. Se analizarán los siguientes datos: número total de llamadas, lugar de la llamada, circunstancias de la exposición, tipo y nº de agentes involucrados, vías de exposición, tiempo desde la exposición, sexo y edad de los pacientes, y las indicaciones y tratamientos recomendados. Resultados: Se registraron 22.168 llamadas. El 52,5 por ciento de las consultas provenían del hogar y el 40,2 por ciento de los Servicios de Urgencia. El 71,6 por ciento de las consultas eran exposiciones accidentales y el 19,8 por ciento fueron intencionales. Los medicamentos se presentaron en un 53,6 por ciento de las llamadas, seguidos por los Productos de Aseo (13,7 por ciento), Productos industriales y Químicos (10,2 por ciento), y Pesticidas (7,1 por ciento). El 92,5 por ciento de las exposiciones eran con un agente tóxico. La ingestión fue la vía de exposición que se registró en un 82 por ciento. El 44,6 por ciento del total de las llamadas, se realizaron dentro de la primera hora post-exposición. Las intoxicaciones en niños menores de 6 años correspondieron al 47,9 por ciento de las llamadas. Conclusiones: Los medicamentos constituyen el principal agente de intoxicación. La principal vía de exposición es la ingesta y que el principal grupo de población afectado son los niños menores de 6 años. Estos son indicadores evidentes y claros de la necesidad imperante de desarrollar campañas publicitarias preventivas e informativas, avaladas por el Ministerio de Salud, respecto al correcto almacenaje de los medicamentos y el manejo de las intoxicaciones en el hogar. La introducción del envase resistente a niños y la educación constituyen dos piezas fundamentales en la prevención de las intoxicaciones pediátricas.

Intoxicación por clobutinol y oxolamina / Poisoning for clobutinol and oxolamine

El objetivo de este artículo es revisar los efectos y rasgos tóxicos descritos en la literatura y establecer un manejo clínico adecuado y específico para la intoxicación con estos medicamentos.

Contaminantes orgánicos persistentes (COPs) / Persistent organic pollutans

En la actualidad se están desarrollando estudios respecto a la influencia del medio ambiente en la naturaleza y en la salud humana y especialmente en el niño por ser un individuo en crecimiento que, en general, tiene más contacto con el medio ambiente tanto por vía inhalatoria, digestiva como dérmica. La civilización, el desarrollo industrial y agrícola han incorporado sustancias principalmente derivadas del petróleo, que tienen efectos tóxicos para el ser humano, situación que el pediatra debe conocer y participar en las discuciones para proteger al niño.