Complicaciones pulmonares de la neumonía química: A propósito de un caso / Pulmonary complications of chemical pneumonía; a case report

La aspiración de hidrocarburos puede causar un daño significativo a los pulmones al inducir una respuesta inflamatoria, alveolitis exudativa hemorrágica y pérdida de la función del tensioactivo pulmonar. El efecto secundario más grave de la aspiración de hidrocarburos es la neumonía por aspiración. Anteriormente se han notificado casos de neumotórax, neumatocele, síndrome de dificultad respiratoria aguda (SDRA), absceso pulmonar, fístula broncopleural, derrame pleural bilateral hemorrágico y pioneumotórax. En este artículo presentamos el caso de un paciente hospitalizado debido a neumonía por aspiración que desarrolló pleuritis y neumotórax después de ingerir disolvente para pintura. Se presenta este caso ya que raramente se ha informado en niños como causa de complicaciones pulmonares diferentes. Es necesario evaluar integralmente a los pacientes con complicaciones asociadas a la intoxicación por hidrocarburos. Debe evitarse el alta hospitalaria temprana de los pacientes, quienes deben ser controlados durante, al menos, 48 horas, aunque no tengan síntomas respiratorios. Debe considerarse que los pacientes con neumonía química pueden tener complicaciones pulmonares graves.

Hydrocarbon aspiration (HA) can cause significant lung disease by inducing an inflammatory response, hemorrhagic exudative alveolitis, and loss of surfactant function. The most serious side effect of HA is aspiration pneumonia. Pneumothorax, pneumatocele, acute respiratory distress syndrome (ARDS), pulmonary abscess, bronchopleural fistula, bilateral hemorrhagic pleural effusion and pyopneumothorax were previously reported. Hereby we report a patient hospitalized due to aspiration pneumonia who developed pleurisy and pneumothorax after drinking paint thinner. It is presented as it was seldom reported in children to cause distinct pulmonary complications. Patients with complaints associated withhydrocarbon poisoning must be fully evaluated. They must not be discharged from the hospital early and must be followed for at least 48 hours even if they don't have respiratory symptoms. It should be kept in mind that severe pulmonary complications can develop in patients with chemical pneumonia.

Predictors of outcome in children with hydrocarbon poisoning receiving intensive care.

The retrospective study included 48 children between 8.5 months--10 years, admitted to the PICU of an urban, tertiary care, teaching hospital in northern India from January 1995 to December 2001. Eighteen (38%) patients were hypoxemic on arrival, of which 8 (45%) required mechanical ventilation. Compared to the non-hypoxemic children, the hypoxemic patients were more likely to have received gastric lavage before arrival to our center (Odds Ratio 23.2, 95% CI 2.4 - 560.7) and had higher frequency of severe respiratory distress and leucocytosis (Odds Ratio 8.0, 95% CI 1.79 -38.6). On multiple regression analysis, we could not identify any particular variable that could predict hypoxemia. Secondary pneumonia developed in 16 (33.3%), with the duration of PICU stay being longer in these patients as against those who did not (144 hours vs 72 hours, p <0.05). Two (4.2%) children died and one suffered hypoxic sequelae. Prior lavage, hypoxemia at admission, need for ventilation, secondary sepsis and ventilator related complications were associated with poor outcome.

Psiquiatria ocupacional II: síndromes psiquiátricas orgânicas relacionadas ao trabalho / Occupational psychiatry II: organic psychiatric syndromes due to work

Este artigo é o segundo de uma série sobre psiquiatria ocupacional e apresenta uma breve revisão bibliográfica das síndromes psiquiátricas orgânicas relacionadas ao trabalho nos seus aspectos conceituais, clínicos, diagnósticos, ambientais, fatores relacionados aos riscos ocupacionais e suas repercussões psicossociais e organizacionais, a partir de uma abordagem feita pelo Laboratório de Saúde Mental e Trabalho do Departamento de Psicologia Médica e Psiquiatria da Faculdade de Ciências Médicas da Universidade Estadual de Campinas (LSMT/DPMP/FCM/UNICAMP).

The spectrum of accidental childhood poisoning in the Caribbean

Objective. To assess accidental poisoning in children in the Caribbean country of Antigua and Barbuda, including the incidence, the types of substances ingested, the age of the children involved, and the clinical outcomes. The results from Antigua and Barbuda were compared with the results of other reports from the English-speaking Caribbean and from the United States of America. Design and Methods. We performed a retrospective review of the charts of all patients less than 13 years old admitted to the Children's Ward at Holberton Hospital in Antigua for accidental poisoning between March 1989 and March 1999. Those data were compared with data from earlier reports from Barbados, Guyana, Jamaica, and the United States of America. Results. In Antigua and Barbuda there were 255 hospital admissions for accidental poisoning among children below 13 years old over that 10-year period. Of the 255 ingestions, 115 of them (45 percent) were in 1-year-old children, 69 (27 percent) were in 2-year-old children, and 26 (10 percent) were in 3-year-old children. These proportions in Antigua and Barbuda are similar to the age patterns seen in the other countries with which we made comparisons. In Antigua and Barbuda there was an annual average of 26 hospital admissions for poisoning for the roughly 20 000 children below 13 years of age, for a rate of 1.3 per 1 000. In comparing the patterns of childhood poisoning in all the countries we studied, we found that, as economic levels rose, there was a shift in the substances ingested, with hydrocarbon and plant ingestions decreasing and chemical and medication ingestions increasing. Conclusions. There is an increasing variety and complexity of poisonous substances ingested as economic conditions improve. This trend would make the establishment of a poison control center for the English-speaking Caribbean a logical step

Intoxicaciones agudas por agentes de uso doméstico / Agude intoxications by agents of domestic use

Con la finalidad de determinar el tipo y frecuencia de intoxicaciones por agentes de uso doméstico, se estudiaron los pacientes menores de 13 años, que acudieron a la emergencia pediatrica del Hospital Central Universitario "Dr. Antonio María Pineda" de Barquisimeto, en el lapso Abril 1993 a Marzo 1994. La información se obtuvo del interrogatorio a familiares del paciente y se registró en la ficha de recolección de datos y en la encuesta socioeconómica familiar. Se estudiaron un total de 170 pacientes. La primera causa de intoxicación la constituyeron los hidrocarburos (67,65 por ciento), siendo el Kerosene el producto responsable del mayor número de casos. El grupo más afectado fue el de los lactantes mayores (52,94 por ciento). Predominaron los pacientes del sexo masculino (51,76 por ciento) y los procedentes del medio urbano (84 por ciento). La circunstancia predominante fue la accidental (97,66 por ciento) y la vía de intoxicación fue la oral (98,26 por ciento). En la cocina ocurrieron el mayor número de casos de intoxicaciones (49,46 por ciento) y los agentes involucrados se utilizaban mayormente en la limpieza del hogar. El 73,52 por ciento de los productos se encontraban fuera de su envase original, siendo contenidos el mayor número en envases de alimentos. La clínica respiratoria fue la más frecuentemente presentada. El 65,25 por ciento de los pacientes no representaron complicaciones en su cuadro clínico y en los que las presentaron, las respiratorias fueron la más frecuente.

Intoxicación por hidrocarburos / Intoxication by hydrocarbons

Entre las intoxicaciones destaca la producida por hidrocarburos, debido al amplio uso de estos productos en la población general, los cuales en su mayoría son envasados inadecuadamente y quedan al alcanze de los niños, que son sus principales víctimas