Perfil toxicológico dos suicídios no Rio Grande do Sul, Brasil, 2017 a 2019 / Perfil toxicológico de los casos de suicidio en Rio Grande do Sul (Brasil), 2017-2019 / Toxicology of suicide cases in the state of Rio Grande do Sul, Brazil, 2017 to 2019

RESUMO Objetivo. Descrever o perfil toxicológico de todas as vítimas de suicídio no Rio Grande do Sul, Brasil, de 2017 a 2019. Métodos. Neste estudo descritivo e transversal, foram consultados todos os laudos periciais e as ocorrências policiais relacionados aos óbitos por suicídio no estado. Foram realizadas análises de correspondência múltipla e construídos modelos independentes de regressão logística, tendo como variáveis dependentes o etanol, os ansiolíticos, os antidepressivos, as substâncias ilícitas e os agentes tóxicos não medicamentosos. Resultados. Foram realizados 2 978 exames de alcoolemia, com resultado positivo em 28,5%. A chance de resultados positivos para alcoolemia foi 0,5 (IC95%: 1,1 a 2,2) vez maior para suicídio durante a noite, 1,0 (IC95%: 1,4 a 2,9) vez maior para suicídio aos finais de semana e 0,9 (IC95%: 1,3 a 2,7) vez maior na presença de antecedentes criminais. A pesquisa de psicotrópicos (2 900 amostras) detectou algum medicamento em 30,4%. Os ansiolíticos foram a classe mais frequente, com chance 1,5 (IC95%: 1,6 a 4,1) vez maior em mulheres e 0,8 (IC95%: 1,2 a 2,7) vez maior para suicídios ocorridos no outono-inverno. As substâncias ilícitas (n = 338) tiveram chance 4,1 (IC95%: 1,9 a 14,4) vezes maior de detecção na macrorregião de Pelotas em relação à de Passo Fundo e 1,2 (IC95%: 1,3 a 3,6) vez maior em pessoas com resultados positivos para etanol. Não houve diferença significativa entre adolescentes e adultos. Conclusões. Embora sem evidência de causalidade, os resultados mostram um vínculo entre o suicídio e diversos psicoativos. Os médicos legistas devem ser orientados quanto à necessidade de realização de exames toxicológicos em todos os casos de suicídio.

ABSTRACT Objective. To describe the toxicology of suicide cases recorded in the state of Rio Grande do Sul, Brazil, from 2017 to 2019. Method. The present descriptive, cross-sectional study examined all the medico-legal reports and police records related to suicide deaths in the state. Multiple correspondence analyses were performed along with independent logistic regression models having ethanol, anxiolytic and antidepressant drugs, illicit drugs, and non-medical substances as dependent variables. Results. Ethanol was investigated in 2 978 samples, with positive results in 28.5%. The odds of a positive ethanol finding were 0.5 time higher (95%CI: 1.1; 2.2) for suicides occurring at night, 1.0 (95%CI: 1.4; 2.9) time higher for suicides occurring on weekends, and 0.9 (95%CI: 1.3; 2.7) time higher in individuals with a prior criminal record. Investigation of psychotropic drugs (2 900 samples) was positive in 30.4% samples. Anxiolytics were the most common medication detected, with 1.5 (95%CI: 1.6; 4.1) time higher odds of occurrence in women and 0.8 time higher odds (95%CI: 1.2; 2.7) for suicides occurring in the fall-winter. The odds of detecting illicit drugs (n = 338) were 4.1 times higher (95%CI: 1.9; 14.4) in the regions of Pelotas (south of the state) vs. Passo Fundo (north), and 1.2 (95%CI: 1.3; 3.6) time higher in cases with positive ethanol results, without significant difference between adolescents and adults. Conclusions. Despite the lack of evidence on causality, the present results support a link between suicide and several psychoactive drugs. Medico-legal experts should be guided regarding the need to perform toxicological tests in all suicide cases.

RESUMEN Objetivo. Describir el perfil toxicológico de todas las víctimas de suicidio en Rio Grande do Sul desde el 2017 hasta el 2019. Métodos. En este estudio descriptivo y transversal se consultaron todos los informes periciales y policiales sobre las muertes por suicidio en el estado. Se realizaron análisis de correspondencia múltiple y se crearon modelos independientes de regresión logística, con empleo de etanol, productos ansiolíticos y antidepresivos, sustancias ilícitas y agentes tóxicos no medicamentosos como variables dependientes. Resultados. Se realizaron 2 978 exámenes de alcoholemia, con resultado positivo en un 28,5%. La probabilidad de obtener resultados positivos para alcoholemia aumentó 0,5 (IC95%: 1,1-2,2) en casos de suicidio durante la noche, 1,0 (IC95%: 1,4-2,9) en casos de suicidio en los fines de semana y 0,9 (IC95%: 1,3-2,7) cuando había antecedentes penales. En la investigación de productos psicotrópicos (2 900 muestras) se detectó algún medicamento en un 30,4%. Los ansiolíticos fueron la clase detectada con más frecuencia, con un aumento de la probabilidad de 1,5 (IC95%: 1,6-4,1) en las mujeres y de 0,8 (IC95%: 1,2-2,7) en casos de suicidio durante el otoño y el invierno. El aumento de la probabilidad de detección de sustancias ilícitas (n = 338) fue de 4,1 (IC95%: 1,9-14,4) en la macrorregión de Pelotas en comparación con la de Passo Fundo y de 1,2 (IC95%: 1,3-3,6) en personas con resultados positivos en la prueba de detección de etanol, sin que hubiera ninguna diferencia significativa entre adolescentes y adultos. Conclusiones. Aun sin haberse comprobado la causalidad, los resultados muestran que existe un vínculo entre el suicidio y diversos productos psicoactivos. Es preciso orientar a los médicos legistas con respecto a la necesidad de realizar exámenes toxicológicos en todos los casos de suicidio.

Establishment of Automation System for Detection of Alcohol in Blood / 法医学杂志

OBJECTIVES@#To establish an automation system for detection of alcohol content in blood.@*METHODS@#The determination was performed by automated workstation of extraction-headspace gas chromatography （HS-GC）. The blood collection with negative pressure, sealing time of headspace bottle and sample needle were checked and optimized in the abstraction of automation system. The automatic sampling was compared with the manual sampling.@*RESULTS@#The quantitative data obtained by the automated workstation of extraction-HS-GC for alcohol was stable. The relative differences of two parallel samples were less than 5%. The automated extraction was superior to the manual extraction. A good linear relationship was obtained at the alcohol concentration range of 0.1-3.0 mg/mL （r≥0.999） with good repeatability.@*CONCLUSIONS@#The method is simple and quick, with more standard experiment process and accurate experimental data. It eliminates the error from the experimenter and has good repeatability, which can be applied to the qualitative and quantitative detections of alcohol in blood.

Estresse Isolado ou Associado ao Etanol Libera Prostanóides em Aorta de Ratos via ?2-Adrenoceptores / Stress Alone or associated with Ethanol Induces Prostanoid Release in Rat Aorta via ?2-Adrenoceptor

Fundamento: Estresse e etanol são ambos, independentemente, importantes fatores de risco cardiovascular. Objetivo: avaliar o risco cardiovascular do consumo de etanol e exposição ao estresse, isolados e em associação, em ratos machos adultos. Métodos: Os ratos foram separados em quatro grupos: controle, etanol (20% na água de beber durante seis semanas), estresse (imobilização 1h dia/5 dias por semana/ 6 semanas) e estresse/etanol. As curvas de concentração-resposta à noradrenalina - na ausência e na presença de ioimbina, L-NAME ou indometacina - ou fenilefrina foram determinadas em aortas torácicas com e sem endotélio. EC50 e resposta máxima (n = 8-12) foram comparadas através de ANOVA de dois fatores (two-way) / método de Bonferroni. Resultados: Estresse ou estresse em associação com o consumo de etanol aumentaram as respostas máximas de noradrenalina em aortas intactas. Essa hiper-reatividade foi eliminada pela remoção do endotélio, ou pela presença da indometacina ou ioimbina, mas não foi alterada pela presença de L-NAME. Enquanto isso, o consumo de etanol não alterou a reatividade à noradrenalina. As respostas da fenilefrina em aortas com e sem endotélio também permaneceram inalteradas independentemente do protocolo. Conclusão: O estresse crônico aumentou as respostas aórticas dos ratos à noradrenalina. Esse efeito é dependente do endotélio vascular e envolve a liberação de prostanóides vasoconstritores através da estimulação de α-2 adrenoceptores endoteliais. Além disso, o consumo crônico de etanol pareceu não influenciar as respostas de noradrenalina em aorta de rato, nem modificar o aumento de tais respostas observadas em consequência da exposição ao estresse. .

Background: Stress and ethanol are both, independently, important cardiovascular risk factors. Objective: To evaluate the cardiovascular risk of ethanol consumption and stress exposure, isolated and in association, in male adult rats. Methods: Rats were separated into 4 groups: Control, ethanol (20% in drinking water for 6 weeks), stress (immobilization 1h day/5 days a week for 6 weeks) and stress/ethanol. Concentration-responses curves to noradrenaline - in the absence and presence of yohimbine, L-NAME or indomethacin - or to phenylephrine were determined in thoracic aortas with and without endothelium. EC50 and maximum response (n=8-12) were compared using two-way ANOVA/Bonferroni method. Results: Either stress or stress in association with ethanol consumption increased the noradrenaline maximum responses in intact aortas. This hyper-reactivity was eliminated by endothelium removal or by the presence of either indomethacin or yohimbine, but was not altered by the presence of L-NAME. Meanwhile, ethanol consumption did not alter the reactivity to noradrenaline. The phenylephrine responses in aortas both with and without endothelium also remained unaffected regardless of protocol. Conclusion: Chronic stress increased rat aortic responses to noradrenaline. This effect is dependent upon the vascular endothelium and involves the release of vasoconstrictor prostanoids via stimulation of endothelial alpha-2 adrenoceptors. Moreover, chronic ethanol consumption appeared to neither influence noradrenaline responses in rat thoracic aorta, nor did it modify the increase of such responses observed as a consequence of stress exposure. .

Effects of additives in blood collection tubes on testing the alcohol concentration in blood samples / 法医学杂志

OBJECTIVE@#To discuss blood collection tubes with different additives and their effects on the testing results of alcohol concentration in blood samples.@*METHODS@#Blood samples from 10 volunteers were collected 2 hours after drinking with seven different types of disposable vacuum blood collection tubes, including ordinary tube without anticoagulant, coagulant tube, separating gel-coagulant tube, sodium citrate (1:4) tube, sodium citrate (1:9) tube, sodium citrate (9:1) tube and EDTA-K2 tube. The alcohol concentrations in these blood samples were analyzed by headspace gas chromatography.@*RESULTS@#The concentration testing results of the same blood samples in different types of tubes were different from one to another. The sequence was as follows: separating gel-coagulant tube > coagulant tube > ordi- nary tube without anticoagulant > EDTA-K2 tube> sodium citrate (1:9) tube> sodium citrate (1:4) tube, whereas the results of the same blood sample in sodium citrate (1:9) tube and sodium citrate (9:1) tube showed no obvious difference.@*CONCLUSION@#It is better to collect a suspicious drunk driver's blood sam- ple using a disposable vacuum blood collection tube, with the EDTA-K2 tube being preferred.

Dietary grapes (Vitis vinifera) feeding attenuates ethanol-induced oxidative stress in blood and modulates immune functions in mice.

Ethanol metabolism is known to induce overwhelming production of reactive oxygen species (ROS) and also to cause associated immune dysfunction. Several interventional agents of plant origin, in particular fruits and vegetables have been used to counteract these alterations induced by ethanol. In this study, we investigated the efficacy of dietary feeding of skin and flesh of grapes (Vitis vinifera L.) on the alterations in immune and vascular functions in mice with liver abnormalities induced by chronic ethanol consumption. Results revealed that feeding of both grape skin and flesh (2.5 g/kg body wt/day) effectively attenuated the oxidative stress and alterations in immune function and angiogenesis induced by chronic ethanol consumption (1.6 g/kg body wt/day for 12 weeks) in mice. The antioxidant actions of the grape skin and flesh as observed in this study might be attributed to the polyphenols present in the grapes.

Ley chilena de tolerancia cero al alcohol: fortalezas, falencias y carencias que no deben ser obviadas / Alcohol zero tolerance law in Chile: strengths, flaws and shortcomings that should not be overlooked

Background: Chile has recently entered into force Act No. 20.580, which modifies the legal limits of blood alcohol concentration in drivers and increases the penalties for driving under the influence of alcohol, narcotics or psychotropic substances. The aim of this review was to give an account of the strengths of this new law but, at the same time, to alert the scientific and legal community about its flaws. We also present some shortcomings of Chilean regulatory framework that remain uncorrected, those that should be considered in the design of public policies for improving road safety and the criteria that judges should ponder during judgment, to determine either conviction or acquittal.

Relación entre mortalidad hospitalaria y edad en pacientes con trauma encéfalo craneano moderado y grave / Relationship between hospital mortality and age in patients with moderate and severe traumatic brain injury

INTRODUCCIÓN: Internacionalmente se ha determinado el valor de indicadores pronósticos en manejo de traumatismo craneoencefálico como Escala de Coma de Glasgow al ingreso, edad paciente, diámetro pupilar, reflejo fotomotor, hipotensión, tipo de lesiones en tomografía axial computada e hipoxia; sin embargo, la edad funciona como factor pronóstico independiente. Para determinar el rol de edad adulta (≥ 60 años) en mortalidad intrahospitalaria, y debido a la ausencia de estudios que demuestren su rol definitorio, este estudio propone que pacientes mayores de 60 años tienen una mortalidad intrahospitalaria mayor estadísticamente significativa en comparación con menores de 60 años. MATERIAL Y MÉTODO: Estudio transversal. Se recolectaron fichas clínicas de pacientes ingresados por traumatismo encéfalo craneano grave o moderado, entre enero 2008 y junio2010 (n=96) del Hospital Van Buren, Valparaíso. Se excluyó aquellos con datos incompletos o ficha clínica extraviada, se separó en un grupo a los menores de 60 años (n=47) y en otro a ≥ 60 años (n=29). Se analizaron las variables de mortalidad intrahospitalaria, Escala de Coma de Glasgow, ingreso, sexo, presencia de hipotensión, saturación oxígeno normal, alteración pupilar y presencia de alcohol en sangre, a través de prueba exacta de Fisher y Odds Ratio. RESULTADOS: El grupo no evidenció una diferencia estadísticamente significativa al utilizar 60 años como punto de corte, sin embargo, existió una tendencia no estadísticamente significativa hacia la mayor mortalidad en el grupo mayor. DISCUSIÓN: Una proyección del estudio buscando mayor casuística, enfocándose en grupo de mayor riesgo y traumatismo encéfalo craneano grave, podría definir un punto de quiebre para la mortalidad.

INTRODUCTION: International literature has determined the value of prognostic factors, such as Glasgow Coma Scale at admission, patient’s age, pupillary diameter, pupillary light reflex, hypotension, types of injuries on computed tomography and hypoxia; however, age works as an independent prognosis factor. The objective was to determine the role of adulthood (patients aged over 59 years old) in hospital mortality. Due to the absence of evidence, this study proposes to demonstrate that patients over 59 years old have a statistically significant increased hospital mortality compared to those under 60. MATERIAL AND METHOD: Transversal study. Clinical files of all patients admitted at Hospital Carlos Van Buren for moderate to severe traumatic injury between January 2008 and June 2010 (n=96) were collected and divided in two groups: over 59 years old (n=29) and below 60 years old (n= 47). Those with incomplete or misplaced clinical files were excluded. Variables of hospital mortality, Glasgow Coma Scale at admission, sex, hypotension, normal oxygen saturation, pupillary abnormalities and blood alcohol presence, were analyzed with the Fisher test and the Odds Ratio. RESULTS: The analyzed group did not show any statistically significant difference when establishing 60 years old as an age cutoff point did show a tendency to a higher mortality. DISCUSSION: Future studies considering more cases and focusing on the higher-risk group (with severe traumatic brain injury) could define a cutoff point for mortality on the studied population.

Alcoolemia e etanol no ar exalado: validação de uma metodologia rápida e sua aplicação em um grupo populacionalexposto a doses controladas / Alcohol and ethanol in exhaled air: validation of a rapid methodology and its application in a population group exposed to controlled doses

O consumo de bebidas alcoólicas é praticado pela sociedade desde, pelo menos, o início dos registros históricos em rituais religiosos, comemorações e confraternizações. Na saúde, o etanol é utilizado como antiséptico e desinfetante. Também é empregado como veículo para alguns tipos de apresentações farmacêuticas. Contudo, seu principal impacto é devido ao uso não-médico, tanto pela alta frequência de uso como pelos inúmerosproblemas de Saúde e Segurança Pública a ele associados. Com a entrada em vigor da chamada “Lei Seca” faz-se necessário um maior conhecimento dos efeitos do etanol sobre o organismo humano especificamente sobre apopulação brasileira. Assim, este trabalho tem por objetivo realizar os procedimentos de validação de uma metodologia cromatográfica para identificação e quantificação de etanol e do acetaldeído e de sua aplicação emum grupo populacional exposto. Nesta validação foram estudados os critérios e estabelecidas as condições cromatográficas que atendam ao objetivo supracitado. Foram analisados pela metodologia padronizado e pelo etilômetro, 6 indivíduos nesse primeiro momento, estando o valor do etilômetro subestimado em 40 por cento em 4 desses casos, diferença que no entanto desaparece quando esses dados são estudados de forma conjunta, sendoentão estatisticamente semelhantes. Assim deve-se utilizar individualmente esses resultados, para que as características metabólicas singulares de cada um, sejam evidenciadas. Existe também a necessidade de análises de um grupo maior, para que haja maior robustez nos resultados.

Validação do método titulométrico para determinação de etanol em sangue utilizando ácido nítrico 54 e ácido sulfúrico concentrado / Validation of chemical titration for blood-alcohol determination using nitric acid 54 and concentrated sulfuric acid

A causa da maioria dos acidentes automobilisticos tern sido há muito associada ao consumo de álcool e, visando diminuir esses acidentes, os países tem estabelecido limites de alcoolemia para os condutores. A determinação da alcoolemia tem se tornado importante para fins de aprendizagem, clínico-legais, administrativos, e particularmente no cumprimento da lei, com aplicação específica nas violações automobilísticas, podendo subsequentemente assumir relevância forense como evidência de intoxicação. A quantificação sanguínea de etanol por titulometria é bastante utilizada, fornecendo boa correlação linear, sensibilidade, precisão, exatidão, baixo custo e relativa facilidade de execução. Devido à proibição da venda de ácido nítrico concentrado pela Polícia Federal, Polfcia Civil e Exército Brasileiro, o objetivo desse trabalho foi avaliar as características de desempenho do método utilizando outros reagentes em substituição ao ácido nítrico concentrado, com isso garantindo a eficiência na quantificação do etanol em sangue. Os melhores resultados foram obtidos com ácido nítrico 54%, necessitando apenas de ajustes em relação aos volumes utilizados na técnica original. A solução sulfocrômica mostrou-se de difícil manipulação em função de sua viscosidade. Os resultados demonstraram que o método modificado apresentou linearidade, precisão e exatidão, de acordo com a resolução especificada pela ANVISA, Agência Brasileira Regulatória.

All over the world, the main cause of traffic accidents has been associated to alcohol use. In many countries, laws have been introduced to control drink-driving, reducing accidents. Accurate blood-alcohol determination has become increasingly important for learning, clinical, forensic and administrative purposes. It is required in law enforcement, with specific application to automobile traffic violations. Blood ethanol determinations carried out for diagnostic purposes can subsequently assume forensic relevance as evidence of intoxication. Blood-alcohol determinations by chemical titration has been used for many years, it supplies good linear correlation, sensitivity, precision, accuracy, low cost and relative easiness of execution. Due to sale prohibition of concentrated nitric acid by Federal Policy, Civil Policy and Brazilian Army is the aim of this work to carry through assays with other reagents in substitution to that one, to evaluate its performance characteristics and to guarantee its efficiency. The best ones resulted had been gotten with nitric acid 54%, needing only volumes adjustments beside original technique. Chromic acid solution prepared with concentrated sulfuric acid had viscosity of difficult manipulation. Based on the results, the method presented good linear correlation, was accurate and precise according to specific resolution from ANVISA, the Brazilian Regulatory Agency.

Prevalência de alcoolemia em óbitos por acidente de transporte e por outras causas externas / Prevalence of alcoholemy in deaths from traffic accidents and other external causes

Introdução: Trauma é a principal causa de óbitos em indivíduos entre 18 e 44 anos de vida no Brasil. Por mais de um século, o álcool tem sido reconhecido como um dos principais fatores de risco para acidentes fatais, desempenhando um importante papel na etiologia do trauma. O objetivo deste estudo foi comparar o diagnóstico de alcoolemia entre mortos por acidentes de trânsito e outras causas externas (afogamento, homicídio e suicídio). Métodos: Foi realizado um estudo transversal onde se utilizaram dados secundários do Departamento de Medicina Legal de Porto Alegre no período de janeiro a dezembro de 2001. As variáveis estudadas foram o nível de alcoolemia e óbitos por causas externas. Resultados: Foram analisados 1.588 óbitos. Os homicídios ocorreram na faixa etária entre 19 e 45 anos, representando 80% dos casos. As causas externas ocorrem com mais frequência em homens e a maior causa de óbitos entre mulheres foi por acidente de trânsito, com menor alcoolemia. Os pacientes que apresentam alcoolemia positiva tiveram uma razão de prevalência de 1,18 (IC 95%:1,05 a 1,32) em relação ao óbito por acidente de trânsito em comparação ao suicídio. Conclusão: Este estudo demonstra que o álcool é fator contribuinte de morte por causas externas, especialmente aquelas causadas por acidentes de trânsito e homicídio

Introduction: Trauma is the leading cause of death in individuals between 18 and 44 years of age living in Brazil. For over a century, alcohol has been recognized as a major risk factor for fatal accidents, playing an important role in the etiology of trauma. The aim of this study was to compare the diagnosis of alcoholemy in individuals who died in traffic accidents and from other external causes (drowning, homicide and suicide). Methods: We conducted a cross-sectional study based on secondary data from the Department of Forensic Medicine of Porto Alegre from January to December 2001. The variables were blood alcohol content (BAC) and deaths from external causes. Results: We analyzed 1,588 deaths. The murders occurred between the ages of 19-45 years, accounting for 80% of the cases. External causes occur more frequently in men, and traffic accidents are the leading cause of death among women, with lower blood alcohol levels. Patients with positive blood alcohol content had a prevalence ratio of 1.18 (95% CI: 1.05 to 1.32) in relation to death by traffic accidents as compared to suicide. Conclusion: This study demonstrates that alcohol is a contributing factor of death from external causes, especially those caused by traffic accidents and homicide

Uso de álcool em vítimas de acidentes de trânsito: estudo do nível de alcoolemia / Uso de alcohol en accidentes de tránsito: estudio del nivel de alcoholemia / Alcohol use and traffic accidents: a study of alcohol levels

Trata-se de estudo exploratório descritivo. O objetivo foi correlacionar os níveis de alcoolemia, detectados nas vítimas fatais por acidentes de trânsito, na cidade do Rio de Janeiro, a partir dos registros do Instituto Medico Legal -IML, com o perfil da vítima e as características dos acidentes. Os dados foram levantados no arquivo do IML, por meio dos prontuários de vítimas fatais por acidentes de trânsito, compilados e tabulados Poe meio do programa estatístico SPSS, no período compreendido entre janeiro e maio de 2005. Avaliaram-se 348 prontuários de vítimas fatais por acidentes de trânsito. Desses, apenas 94 realizaram o exame de alcoolemia, sendo que 83 apresentaram alcoolemia positiva e 60,2 por cento níveis acima de 0,6g/l. Evidenciou-se o envolvimento do álcool com vítimas fatais nos acidentes de trânsito em níveis acima e abaixo de 0,6g/l de álcool por litro de sangue.

Se trata de estudio epidemiológico exploratorio y descriptivo. El objetivo fue correlacionar los niveles de alcoholemia detectados en las víctimas fatales por accidentes de tránsito, en la ciudad de Río de Janeiro (datos de los registros del Instituto Médico Legal/IML) con el perfil de la víctima y las características de los accidentes. Los datos fueron recolectados del archivo del IML, a través de los registros que constaban en las fichas de víctimas fatales por accidentes de tránsito; fueron compilados y se elaboraron tablas con el Programa estadístico SPSS, en el período comprendido entre enero y mayo de 2005. Fueron levantados datos sobre 348 víctimas fatales por accidentes de tránsito, de estos, apenas 94 realizaron el examen de alcoholemia, siendo que en 83 fueron detectados niveles de alcoholemia; el 60,2 por ciento presentó niveles por encima de 0,6g de alcohol por litro de sangre. Se mostró evidente el envolvimiento del alcohol en accidentes de tránsito con víctimas fatales, en niveles por encima y por debajo de 0,6g de alcohol por litro de sangre.

This was an exploratory, descriptive study that aimed to correlate alcohol levels detected in fatal victims of traffic accidents, in Rio de Janeiro city, with the victim’s profile and the characteristics of the accident. The data were retrieved from the registers of the Legal Medicine Institute/IML, through the registers of the medical records of the fatal victims of traffic accidents. Compiled and tabulated using the Statistics Program SPSS, for the period between January and May 2005, 348 fatal victims of traffic accidents were reported. Of these victims, 94 had been tested for alcohol, of these, 83 had levels of alcohol detected, 60.2 percent presented levels above 0.6g/l blood. The use of alcohol was evident, at levels above and below 0.6g per liter of blood, in the cases of fatal victims of traffic accidents.

Failure of carnitine in improving hepatic nitrogen content in alcoholic and non-alcoholic malnourished rats

AIMS: To investigate the effect of carnitine supplementation on alcoholic malnourished rats' hepatic nitrogen content. METHODS: Malnourished rats, on 50 percent protein-calorie restriction with free access to water (malnutrition group) and malnourished rats under the same conditions with free access to a 20 percent alcohol/water solution (alcohol group) were studied. After the undernourishment period (4 weeks with or without alcohol), both groups were randomly divided into two subgroups, one of them nutritionally recovered for 28 days with free access to a normal diet and water (recovery groups) and the other re-fed with free access to diet and water plus carnitine (0.1 g/g body weight/day by gavage) (carnitine groups). No alcohol intake was allowed during the recovery period. RESULTS: The results showed: i) no difference between the alcohol/no alcohol groups, with or without carnitine, regarding body weight gain, diet consumption, urinary nitrogen excretion, plasma free fatty acids, lysine, methionine, and glycine. ii) Liver nitrogen content was highest in the carnitine recovery non-alcoholic group (from 1.7 to 3.3 g/100 g, P<0.05) and lowest in alcoholic animals (about 1.5 g/100g). iii) Hepatic fat content (~10 g/100 g, P>.05) was highest in the alcoholic animals. CONCLUSION: Carnitine supplementation did not induce better nutritional recovery.

Consumo de sustancias y suicidios en México: resultados del sistema de vigilancia epidemiológica de las adicciones, 1994-2006 / Substance use in suicides in Mexico: results of the epidemiological surveillance system of addictions, 1994-2006

OBJETIVO: Determinar la relación que existe entre el consumo y número de sustancias y la presentación del suicidio. MATERIAL Y MÉTODOS: Los datos se tomaronde la cédula forense del Sistema de Vigilancia Epidemiológica de las Adicciones entre 1994 y 2006 de 27 entidades federativas participantes en México. RESULTADOS: El suicidio se presentó en 8.7% de las defunciones por causa violenta en el periodo de estudio. En los hombres se observó que a medida que aumentaba el número de sustancias se elevaba la posibilidad para fallecer por suicidio, en comparación con los decesos por otras causas (una sustancia: RM= 1.8; dos o más: RM= 3.3). En las mujeres, dicha posibilidad se mantiene prácticamente igual en relación con el aumento del número de sustancias detectadas (una sustancia: RM= 3.2; dos o más: RM= 3.6). CONCLUSIÓN: El consumo de sustancias es un factor importante vinculado con el suicidio en los sujetos cuya causa de defunción fue dictaminada por el Servicio Médico Forense mexicano.

OBJECTIVE: To determine the association between substance use and the number of substances with the presentation of suicide. MATERIAL AND METHODS: Data were taken from the forensic certificate of the Epidemiological Surveillance System of Addictions in the period between 1994 and 2006 from 27 states in Mexico. RESULTS: Suicide was detected in 8.7% of the violent deaths during the study period. Among men, it was observed that the increased number of substances increased the possibility for death by suicide, compared to deaths from other causes (one substance: OR = 1.8; two or more: OR = 3.3). In women, that possibility remains virtually unchanged with the increase in the number of substances detected (one substance: OR = 3.2; two or more: OR = 3.6). DISCUSSION: The use of substances is a major factor associated with suicide in the population whose cause of death was issued by the Mexican Forensic Medical Services.

Ethanol in low chronic dose level attenuates major organic effects in malnourished rats

The aim of the present study was to evaluate the chronic toxicity of ethanol low blood levels in malnourished rats. Female Wistar rats (220 g) were subjected to either an ad libitum diet (W, well-nourished, n=10) or food restriction (M, malnourished, n=10). Water (WW and MW) or ethanol solution (W5 percent and M5 percent) was offered to half of each nutritional group (n=5) as the only fluid source. The treatment was continued for two months. After sacrifice, blood biochemical parameters and macroscopic, histologic and morphometric evaluation of the liver were performed. Results indicated that: Ethanol consumption was higher in malnourished rats and minimized body weight loss in malnourished rats, while it decreased the body weight gain in well-nourished ones. Behavioral ethanol intoxication was more severe in malnourished rats. Malnutrition decreased hematocrit and hemoglobin but, on the other hand, ethanol was a protective factor of that effect (hemoglobin: MW 10.6 mg/dl / ME 13.02 mg/dl, p< 0.05). Ethanol increased the relative liver weight of both well-nourished and malnourished rats. Ethanol intake minimized iron pigment, collagen area and binuclear hepatocyte/ field increased by malnutrition. These data are in accordance with previous reports which showed ethanol as an important source of calories and, even chronically, ethanol still attenuates the effects of malnutrition.

Young people's blood alcohol concentration and the alcohol consumption city law, Brazil / Alcoolemia de jovens e lei contra o consumo de álcool / Alcoholemia de jóvenes y la ley contra consumo de alcohol, Brasil

The paper assesses blood alcohol concentration and risk behaviors for traffic accidents before and after the implementation of a law which prohibits the use of alcoholic beverages on city gas stations. In Porto Alegre, Southern Brazil, young people go out at night and drive to gas station convenience stores to buy alcoholic beverages which are consumed on the premises of parking lots in gas stations. Data were obtained from self-administered questionnaires and breath analyzers in two cross-sectional collections with purposive samples of youngsters in May and July 2006 (n=62, and n=50, respectively). There were no significant differences between the groups before and after the city law was passed. Blood alcohol concentration greater than 0.06 percent was found in 35.5 percent of pre-law group and 40 percent of post-law group (p=0.62). Results point out heavy alcohol use in both groups, which did not change after the law was passed.

No artigo foram analisados a alcoolemia e comportamentos de risco para acidentes de trânsito em jovens antes e depois da implementação de lei proibindo o consumo de bebidas alcoólicas em postos de gasolina. Em Porto Alegre (RS), os jovens costumam sair à noite e dirigir até lojas de conveniência de postos de gasolina para comprar e consumir bebidas alcoólicas nos estacionamentos dentro dos postos. Os dados foram obtidos de questionários autoaplicáveis e bafômetro em duas coletas transversais realizadas com jovens, abordados em maio e julho de 2006 com amostragem intencional (n=62 e n=50, respectivamente). Não houve diferença significativa entre os grupos entrevistados. Alcoolemia >0,06 por cento foi encontrada em 35,5 por cento e 40 por cento dos indivíduos antes e depois da lei, respectivamente (p=0,62). Os resultados apontam o uso pesado de álcool em ambos os grupos, inalterado pela implementação da lei.

En el artículo se analizaron la alcoholemia y los comportamientos de riesgo de accidentes de transito en jóvenes antes y después de la implementación de la ley que prohíbe el consumo de bebidas alcohólicas en puestos de gasolina. En Puerto Alegre (Sur de Brasil), los jóvenes acostumbran salir de noche y conducir hasta las tiendas de conveniencia de puestos de gasolina para comprar y consumir bebidas alcohólicas en los estacionamientos dentro de los puestos. Los datos fueron obtenidos de encuestas auto-aplicables y alcoholímetro en dos colectas transversales realizadas con jóvenes, abordados en mayo y julio de 2006 con muestreo intencional (n=62 y n=50, respectivamente). No hubo diferencia significativa entre los grupos entrevistados. Alcoholemia > 0,06 por ciento fue encontrada en 35,5 por ciento y 40 por ciento de los individuos antes y después de la ley, respectivamente (p=0,62). Los resultados señalan el uso pesado de alcohol en ambos grupos, inalterado por la implementación de la ley.

Repercussões fetais do consumo materno de álcool / Fetal effects of maternal alcohol consumption

O álcool é o mais comum agente teratogênico humano e seus efeitos lesivos para o feto são reconhecidos desde a Antigüidade. A mais relatada conseqüência decorrente do consumo dessa substância durante a gravidez é o aparecimento de um espectro de anormalidades estruturais e alterações neurocognitivas e comportamentais, conhecido como distúrbio do espectro alcoólico fetal. A manifestação mais extrema desse conjunto é denominada síndrome alcoólica fetal (SAF) e caracteriza-se por alterações crânio-faciais, neurais, cardíacas, renogenitais, cutâneas, musculares e de crescimento. São descritas, também, associações entre o consumo de etanol pela gestante e o aparecimento de abortos espontâneos no primeiro trimestre, leucemia aguda na criança, maior incidência de infecções neonatais, síndrome de abstinência alcoólica fetal e maior incidência de dermatite atópica na infância. Neste estudo é feita uma revisão dos potenciais efeitos lesivos para o feto, provenientes do consumo de álcool pela futura mãe, num contexto atual sobre a patogênese e as manifestações desses danos, passo primordial para incentivar o surgimento de ações em saúde pública visando à prevenção do problema.

Alcohol is the most common teratogenic substance for humans, and its harmful effects to the fetus have been long known. The most mentioned consequence, which is due to the use of this substance during pregnancy, is a spectrum of structural anomalies and neurocognitive and behavioral disabilities known as fetal alcohol spectrum disorder. The most severe manifestation of this set is called fetal alcohol syndrome, characterized by craniofacial, neural, cardiac, renogenital, skin, muscle and growth changes. Another discussed association is the relation between maternal use of ethanol and spontaneous abortion during the pregnancy first trimester, acute leukemia in childhood, higher incidence of newborn infections, fetal withdrawal syndrome, and higher incidence of atopic dermatitis during childhood. In this article we will review potential harmful effects of alcohol usage by a pregnant mother and argue up-to-date data about the pathogenesis and the manifestation of such damages, in order to stimulate public health actions to prevent this problem.

Pharmacodynamics & toxicological profile of PartySmart, a herbal preparation for alcohol hangover in Wistar rats.

BACKGROUND & OBJECTIVE: PartySmart is a herbal preparation intended for the management of alcohol hangover and other related toxic effects in clinical situation. The present study was designed to investigate the pharmacodynamics and oral toxicity of PartySmart, a herbal formulation in rats. METHODS: Effect of PartySmart on blood acetaldehyde and alcohol levels was evaluated at doses of 125, 250 and 500 mg/kg b.wt. in rats. Acute toxicity study was conducted with PartySmart at a limit test dose of 2000 mg/kg b.wt., p.o. In repeated dose 90 day study, PartySmart was administered at doses of 500 and 1000 mg/kg b.wt. once-a-day, orally throughout the study period. RESULTS: PartySmart dose-dependently decreased blood ethanol and acetaldehyde levels as compared to control. PartySmart at a dose of 500 mg/kg b.wt. significantly reduced the area under curve (AUC) of ethanol and acetaldehyde levels. It increased the hepatic alcohol dehydrogenase (ADH) at 500 mg/kg b.wt. and aldehyde dehydrogenase (ALDH) activities at doses of 250 and 500 mg/kg b.w. significantly. Acute toxicity study showed no clinical signs and pre-terminal deaths. The LD(50) of PartySmart was found to be greater than 2000 mg/kg b.wt. No significant differences in PartySmart-treated groups were observed on body weight, food intake, haematological and clinical chemistry, and organ weight ratios as compared to control group in the repeated dose study. Histopathological examination of all target organs showed no evidence of lesions attributing to drug toxicity. INTERPRETATION & CONCLUSION: PartySmart enhanced acetaldehyde metabolism by increasing ADH and ALDH activity without any side effects. These findings indicate that PartySmart may exert beneficial role in the management of alcohol hangover without any toxicity.

Occurrence of severe and moderate traumatic brain injury in patients attended in a Brazilian Teaching Hospital: epidemiology and dosage of alcoholemy

This study aimed at observing aspects of epidemiology in order to investigate the use of alcohol in patients older than 18 with severe and moderate traumatic brain injury, which were attended in the Clinics Hospital of the University of Uberlândia. Positive alcoholemy was found in 39.3 percent of the patients. Of the 33 positive exams alcoholemy was found higher than 60 mg/dL in 28 (84.6 percent). There was not significant relation between alcoholemy levels and trauma severity. The major prevalence occurred on Saturdays nights. The most frequent types of external causes were transportation accidents (64.74) followed by accidental falls (17.27 percent) and physical aggression (16.55 percent). 93.9 percent of the patients with positive alcoholemy were men aged 20-29. 24.2 percent of the ones with positive alcoholemy died yet no significant difference was found in the study of the ones with negative alcoholemy (n=51) (p=0.93); RR= 0.9; IC95 percent=0.40-2.08.

Os objetivos deste estudo são investigar aspectos da epidemiologia e identificar o uso de álcool em pacientes com traumatismo craniencefálico grave e moderado em maiores de 18 anos atendidos no Hospital de Clínicas da Universidade Federal de Uberlândia. Encontrou-se alcoolemia positiva em 39,3 por cento dos pacientes. Nos 33 exames positivos, foram observadas alcoolemias superiores a 60 mg/dL em 28 (84,6 por cento). Não houve relação significativa entre os níveis de alcoolemia e a gravidade do trauma. Maior prevalência ocorreu aos sábados, no período noturno. Os tipos de causa externa mais frequentes foram os acidentes de transporte (64,74 por cento), seguidos de quedas acidentais (17,27 por cento) e de agressões (16,55 por cento). Dos pacientes com alcoolemia positiva, 93,9 por cento eram do sexo masculino, com maior prevalência dos 20 aos 29 anos. Dentre aqueles com alcoolemia positiva, 24,2 por cento vieram a falecer, não havendo diferença significante com os pacientes com alcoolemia negativa (n=51) (p=0,93); RR= 0,9; IC95 por cento=0,40-2,08.