ABSTRACT
Twenty-six epidemics of asthma occurred in Barcelona between 1981 and 1987 in relation to inhalation of soy dust from grain silo unloading in the harbor. No further epidemics occurred after filters were installed, until a 1994 outbreak of asthma due to soy was detected in L'Hospitalet de Llobregat, a city on the outskirts of Barcelona. We describe 9 patients who presented with acute asthma attacks of sudden onset within a time span of 135 minutes. Counts of total IgE and IgE specific to soy extract were analyzed in all patients. Skin prick tests confirmed exposure to soy in all cases. Atmospheric levels of alcoholic fractions of soy particles (beta-sitosterol and stigmasterol) registered in L'Hospitalet de Llobregat were higher than those detected in Barcelona. We confirmed that soy had been unloaded in the harbor the same day, and that climatic conditions favored the movement of air from the port toward the city of L'Hospitalet. We postulate the need to periodically review preventive measures given the potential severity of the such epidemics.
Subject(s)
Asthma/etiology , Disease Outbreaks , Glycine max/adverse effects , Occupational Diseases/etiology , Suburban Population , Acute Disease , Adult , Aged , Aged, 80 and over , Asthma/diagnosis , Asthma/epidemiology , Disease Outbreaks/statistics & numerical data , Dust/adverse effects , Female , Food Handling , Humans , Male , Middle Aged , Occupational Diseases/diagnosis , Occupational Diseases/epidemiology , Spain/epidemiology , Suburban Population/statistics & numerical dataABSTRACT
About 5% of the patients admitted to emergency departments with poisonings are seriously ill and need admission to intensive care units (ICUs). This paper presents the result of three multicentric studies carried out in Spain during the last ten years. A study was made of 6 ICUs in 1980, 41 in 1987 and 15 in 1990 with a total of 596 patients. The average age (36) remained stable throughout, but the number of female cases decreased each time. The most frequent cause (79%) was attempted suicide. The products used most frequently were therapeutic drugs (82, 71 and 58%) followed by drugs of abuse, and then agricultural, household and industrial products. We observed a progressive decrease in barbiturates (54, 15 and 2%) and an increase in benzodiazepines and cyclic antidepressants. Therapeutic methods used were mostly gastric lavage (64%), activated charcoal (35%), forced diuresis (43%), extracorporeal therapy (11%) and antidotes. The mortality rate fluctuated between 6.4 and 9.1%, being significantly higher with poisoning by non-therapeutic drugs. In conclusion, the most common poisoning admitted to our ICUs was by psychoactive drugs in suicide attempts. We observed the under-use of activated charcoal and an excessive usage of kidney and extracorporeal methods. The prognosis was worse for poisonings with non-therapeutic drugs.
