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1.
Histol Histopathol ; 38(9): 989-997, 2023 Sep.
Article in English | MEDLINE | ID: mdl-36896890

ABSTRACT

AIMS: Pancreatic adenocarcinoma represents a therapeutic challenge due to the high toxicity of antineoplastic treatments and secondary effects of pancreatectomy. T-514, a toxin isolated from Karwinskia humboldtiana (Kh) has shown antineoplastic activity on cell lines. In acute intoxication with Kh, we reported apoptosis on the exocrine portion of pancreas. One of the mechanisms of antineoplastic agents is the induction of apoptosis, therefore our main objective was to evidence structural and functional integrity of the islets of Langerhans after the administration of Kh fruit in Wistar rats. METHODS: TUNEL assay and immunolabelling against activated caspase-3 were used to detect apoptosis. Also, immunohistochemical tests were performed to search for glucagon and insulin. Serum amylase enzyme activity was also quantified as a molecular marker of pancreatic damage. RESULTS: Evidence of toxicity on the exocrine portion, by positivity in the TUNEL assay and activated caspase-3, was found. On the contrary, the endocrine portion remained structurally and functionally intact, without apoptosis, and presenting positivity in the identification of glucagon and insulin. CONCLUSIONS: These results demonstrated that Kh fruit induces selective toxicity on the exocrine portion and establish a precedent to evaluate T-514 as a potential treatment against pancreatic adenocarcinoma without affecting the islets of Langerhans.


Subject(s)
Adenocarcinoma , Islets of Langerhans , Karwinskia , Pancreatic Neoplasms , Rats , Animals , Rats, Wistar , Karwinskia/toxicity , Caspase 3/metabolism , Glucagon/metabolism , Adenocarcinoma/drug therapy , Adenocarcinoma/metabolism , Fruit/toxicity , Pancreatic Neoplasms/drug therapy , Pancreatic Neoplasms/metabolism , Islets of Langerhans/metabolism , Insulin , Pancreatic Neoplasms
2.
Toxicon ; 203: 1-11, 2021 Nov.
Article in English | MEDLINE | ID: mdl-34600913

ABSTRACT

In accidental intoxicated animals and humans, Karwinskia humboldtiana (Kh) causes lesions in the central and peripheral nervous system and organs like the kidney, liver, and lung. The objective was to evaluate the histology of myocardium and skeletal muscle after experimental chronic intoxication with mature fruit of Kh in Wistar rat. Twenty-five rats were used and divided into five groups (n = 5): four intoxicated and one control. Kh fruit was ground, dried, sieved, and administered by an orogastric tube. Intoxicated rats received 3.5 g/kg body weight fractionated in 5 doses. Control rats received only water. Animals were euthanized at 24, 48, 58, and 112 days, respectively. Samples of the myocardium and skeletal muscle were obtained and processed for light microscopy evaluation. Morphological analyses were performed, including a microdensitometric analysis. Results showed areas of necrosis in the muscle fibers, fibers with vacuolated cytoplasm, and disorganization of myofilaments, as well as staining variations in both myocardium and skeletal muscle time-depending. Zones with loss of continuity of the external lamina were identified with PAS with the diastase histochemical method. Immunolabeling with specific antibodies demonstrated diminution of actin and desmin myofilaments. The microdensitometric analysis showed a statistically significant difference between the intoxicated vs control group. These findings demonstrate that chronic intoxication of Kh fruit also causes damage in myocardial and skeletal muscle, these alterations will be useful to understand that the toxic effects of Kh fruit in accidently intoxicated humans are systemic, and not only over the nervous system.


Subject(s)
Heart/drug effects , Karwinskia , Muscle, Skeletal/drug effects , Animals , Fruit/toxicity , Karwinskia/toxicity , Muscle, Skeletal/pathology , Myocardium/pathology , Rats , Rats, Wistar
3.
Histol Histopathol ; 31(9): 1001-10, 2016 Sep.
Article in English | MEDLINE | ID: mdl-26877198

ABSTRACT

Karwinskia humboldtiana (Kh) is a poisonous plant that grows in some regions of the American continent. Consuming large amounts of Kh fruit results in acute intoxication leading to respiratory failure, culminating in death within days. There is evidence of histological damage to the lungs, liver, and kidneys following accidental and experimental Kh intoxication. To date, the microscopic effect of Kh consumption on the pancreas has not been described. We examined the early effects of Kh fruit on pancreatic tissue at different stages of acute intoxication in the Wistar rat. We found progressive damage confined to the exocrine pancreas, starting with a reduction in the number of zymogen granules, loss of acinar architecture, the presence of autophagy-like vesicles, apoptosis and inflammatory infiltrate. The pancreatic pathology culminated in damaged acini characterized by necrosis and edema, with a complete loss of lobular architecture. Interestingly, the morphology of the islets of Langerhans was conserved throughout our evaluations. Taken together, our results indicate the damage induced by a high dose of Kh fruit in the Wistar rat is consistent with an early acute necrotizing pancreatitis that exclusively affects the exocrine pancreas. Therefore, this system might be useful as an animal model to study the treatment of pancreatic diseases. More importantly, as the islets of Langerhans were preserved, the active compounds of Kh fruit could be utilized for the treatment of acinar pancreatic cancer. Further studies might provide insight into the severity of acute Kh intoxication in humans and influence the design of treatments for pancreatic diseases and acinar pancreatic cancer.


Subject(s)
Acinar Cells/pathology , Islets of Langerhans/pathology , Karwinskia/toxicity , Pancreatitis, Acute Necrotizing/pathology , Animals , Disease Models, Animal , Immunohistochemistry , Rats , Rats, Wistar
4.
Histol Histopathol ; 31(4): 393-402, 2016 Apr.
Article in English | MEDLINE | ID: mdl-26544757

ABSTRACT

The accidental ingestion of Karwinskia humboldtiana (Kh) fruit in humans and animals causes chronic or acute intoxication. Acute poisoning induces respiratory failure that progresses rapidly to death. Studies in animals intoxicated with Kh describe lesions in cerebral cortex, cerebellum, spinal cord, hippocampus and caudate nucleus. Kh intoxication in Wistar rats models the sub-lethal clinical phase observed in humans. Considering these reports, the present study analyzed the histopathological alterations within the striatum following experimental Kh intoxication. Twenty Wistar rats were divided into three groups (n =5) and were intoxicated with Kh fruit. A control group (n =5) was included. Animals were euthanized at several time points (48, 58 and 170 days post-intoxication). The brain was collected, divided and processed for conventional histology or electron microscopy. Sections were stained with hematoxylin and eosin, cresyl violet, Klüver-Barrera, and toluidine blue. Immunolabeling was performed for glial cells in the striatum, and the samples were analyzed with light microscopy. Morphometric and statistical analyses were performed. In control group, neurons, axon bundles and neuropil had a normal appearance. At 48 days, hyperchromic neurons with apparent decreased size were observed interspersed among the normal neurons. At 58 days, we observed an increased number of hyperchromic neurons and disorganization of the myelin sheath and neuropil. At 170 days, these alterations persisted in the paralysis group. In treated groups, we observed signs of gliosis and increased axonal diameters. This study is the first report that describes the histopathological alterations within the striatum caused by chronic intoxication with Kh fruit in the Wistar rat.


Subject(s)
Corpus Striatum/pathology , Karwinskia/toxicity , Animals , Disease Models, Animal , Female , Fruit/toxicity , Peripheral Nervous System Diseases/etiology , Rats , Rats, Wistar
5.
Biol Res ; 48: 17, 2015 Mar 19.
Article in English | MEDLINE | ID: mdl-25889629

ABSTRACT

BACKGROUND: Karwinskia humboldtiana (Kh) is a poisonous plant of the rhamnacea family. To elucidate some of the subcellular effects of Kh toxicity, membrane fluidity and ATPase activities as hydrolytic and as proton-pumping activity were assessed in rat liver submitochondrial particles. Rats were randomly assigned into control non-treated group and groups that received 1, 1.5 and 2 g/Kg body weight of dry powder of Kh fruit, respectively. Rats were euthanized at day 1 and 7 after treatment. RESULTS: Rats under Kh treatment at all dose levels tested, does not developed any neurologic symptoms. However, we detected alterations in membrane fluidity and ATPase activity. Lower dose of Kh on day 1 after treatment induced higher mitochondrial membrane fluidity than control group. This change was strongly correlated with increased ATPase activity and pH gradient driven by ATP hydrolysis. On the other hand, membrane fluidity was hardly affected on day 7 after treatment with Kh. Surprisingly, the pH gradient driven by ATPase activity was significantly higher than controls despite an diminution of the hydrolytic activity of ATPase. CONCLUSIONS: The changes in ATPase activity and pH gradient driven by ATPase activity suggest an adaptive condition whereby the fluidity of the membrane is altered.


Subject(s)
Adenosine Triphosphatases/metabolism , Karwinskia/toxicity , Membrane Fluidity/drug effects , Mitochondria, Liver/drug effects , Animals , Fruit/toxicity , Male , Mitochondria, Liver/enzymology , Proton-Motive Force/drug effects , Random Allocation , Rats, Sprague-Dawley , Subcellular Fractions/drug effects , Submitochondrial Particles/drug effects
6.
Biol. Res ; 48: 1-6, 2015. graf
Article in English | LILACS | ID: biblio-950781

ABSTRACT

BACKGROUND: Karwinskia humboldtiana (Kh) is a poisonous plant of the rhamnacea family. To elucidate some of the subcellular effects of Kh toxicity, membrane fluidity and ATPase activities as hydrolytic and as proton-pumping activity were assessed in rat liver submitochondrial particles. Rats were randomly assigned into control non-treated group and groups that received 1,1.5 and 2 g/Kg body weight of dry powder of Kh fruit, respectively. Rats were euthanized at day 1 and 7 after treatment. RESULTS: Rats under Kh treatment at all dose levels tested, does not developed any neurologic symptoms. However, we detected alterations in membrane fluidity and ATPase activity. Lower dose of Kh on day 1 after treatment induced higher mitochondrial membrane fluidity than control group. This change was strongly correlated with increased ATPase activity and pH gradient driven by ATP hydrolysis. On the other hand, membrane fluidity was hardly affected on day 7 after treatment with Kh. Surprisingly, the pH gradient driven by ATPase activity was significantly higher than controls despite an diminution of the hydrolytic activity of ATPase. CONCLUSIONS: The changes in ATPase activity and pH gradient driven by ATPase activity suggest an adaptive condition whereby the fluidity of the membrane is altered.


Subject(s)
Animals , Male , Rats , Mitochondria, Liver/drug effects , Adenosine Triphosphatases/metabolism , Karwinskia/toxicity , Membrane Fluidity/drug effects , Subcellular Fractions/drug effects , Submitochondrial Particles/drug effects , Mitochondria, Liver/enzymology , Random Allocation , Rats, Sprague-Dawley , Proton-Motive Force/drug effects , Fruit/toxicity
7.
Int. j. morphol ; 31(4): 1216-1222, Dec. 2013. ilus
Article in Spanish | LILACS | ID: lil-702296

ABSTRACT

Karwinskia humboldtiana (Kh) es un arbusto venenoso responsable de numerosos casos de intoxicación accidental en humanos. En estudios previos en nuestro laboratorio reportamos un incremento de células cebadas en nervio periférico (NP) durante la intoxicación con Kh, este hallazgo no ha sido reportado previamente en otros órganos durante esta intoxicación por lo que en el presente estudio buscamos la presencia de estas células en otros órganos, además de distinguir subpoblaciones de células cebadas mediante reacciones histoquímicas para la identificación de los gránulos de secreción. El objetivo de este estudio fue evaluar la presencia de células cebadas en órganos distintos al NP y diferenciar histoquímicamente la composición de sus gránulos. Se utilizaron 32 ratas Wistar, se dividieron en cuatro grupos (n= 8) en donde 5 ratas de cada grupo fueron intoxicadas y 3 fueron control no intoxicadas. A las ratas intoxicadas se les administraron por vía oral 3,5 g/kg del fruto seco y molido de Kh fraccionados en 5 dosis de 1,5; 0,5, 0,5; 0,5 y 0,5 g/kg los días 0, 3, 7, 10 y 14 respectivamente. Las ratas control solo recibieron agua. Cada grupo fue sacrificado a diferentes tiempos según la evolución de la parálisis. Se obtuvieron muestras de Hígado, Riñón, Pulmón y SNP, se procesaron hasta obtener bloques de parafina, se obtuvieron cortes y se tiñeron con azul de toluidina, PAS, Azul alciano/PAS y Azul alciano/Safranina. Se identificó la presencia de células cebadas en NP y pulmón con la tinción de azul de toluidina y se realizo un estudio morfométrico observando un incremento progresivo del número de células cebadas por grupo así como variaciones histoquímicas en sus gránulos en cada etapa y órgano analizado, lo que sugiere la participación de las células cebadas y sus secreciones en cada una de las etapas de la intoxicación crónica con el fruto maduro de Kh.


Karwinskia humboldtiana (Kh) is a poisonous shrub causing a number of accidental intoxications in humans. In previous studies in our laboratory, we reported an increased number of mast cells present in peripheral nerve of Kh intoxicated rats. This finding has not been reported in other organs of intoxicated animals. For this reason, in the present study we searched for mast cells in several organs, identifying mast cell subpopulations on the basis of different histochemical reactivity of their secretory granules. Thus the objective of the present study was to evaluate the presence of mast cells in organs other than peripheral nerve and, to distinguish mast cells by their granule content, applying histochemical reactions. 32 Wistar rats were divided into 4 groups (n=8). For each group, 5 rats were intoxicated with Kh and 3 received water only as a control.Intoxicated rats received 3.5 g/ Kg body weight of dry powder of Kh fruits, fractionated in 5 doses as follows 1.5, 0.5, 0.5, 0.5, 05 on days 0, 3,7,10,14 respectively. Control rats received water only. Each group was killed at different times during paralysis evolution. Samples of liver, kidney, lung and brain, were obtained and processed by routine technique until paraffin embedding. Sections were obtained and stained with toluidine blue, PAS, alcian blue/PAS and alcian blue/safranin. Mast cells infiltrates were observed in peripheral nerve and lung. Mast cells were counted. An increasing number of mast cells were recorded as well as variations in the histochemical pattern of their granules for each organ. These findings suggest a role for mast cells and their secretions in the intoxication with mature fruit of Kh.


Subject(s)
Animals , Rats , Karwinskia/toxicity , Mast Cells/pathology , Peripheral Nerves/pathology , Lung/pathology , Karwinskia/toxicity , Rats, Wistar
8.
Int. j. morphol ; 31(4): 1449-1454, Dec. 2013. ilus
Article in Spanish | LILACS | ID: lil-702332

ABSTRACT

Karwinskia humboldtiana (Kh) es un arbusto venenoso responsable de numerosos casos de intoxicación accidental en humanos. En la literatura se ha descrito a la intoxicación crónica con Kh como uno polineuropatía sin describir si existen o no alteraciones en órganos distintos al SNC y SNP como lo es el riñón. El objetivo de este estudio fue evaluar la morfología renal en un modelo de intoxicación crónica con Kh. Se utilizaron 32 ratas Wistar, se dividieron en cuatro grupos (n=8) en donde 5 ratas de cada grupo fueron intoxicadas y 3 fueron control no intoxicadas. A las ratas intoxicadas se les administraron por vía oral 3,5 g/kg del fruto seco y molido de Kh fraccionados en 5 dosis de 1,5; 0,5; 0,5; 0,5 y 0,5 g/kg los días 0, 3, 7, 10 y 14 respectivamente. Las ratas control solo recibieron agua. Cada grupo fue sacrificado a diferentes tiempos según la evolución de la parálisis. Se obtuvieron muestras de riñón, se procesaron hasta obtener bloques de parafina y resinas epóxicas, se obtuvieron cortes y se tiñeron y contrastaron para su observación al microscopio de luz y electrónico de transmisión (MET) respectivamente. A microscopia de luz identificamos congestión vascular, necrosis de los túbulos contorneados y fibrosis de la cápsula de renal, en la etapa de parálisis se realizo un conteo de los glomérulos afectados en las muestras tratadas con Kh, a MET además de los hallazgos previamente descritos se identificó la presencia de abundantes depósitos de matriz extracelular en la membrana basal de la cápsula renal y en la barrera de filtración de todos los grupos intoxicados, siendo más evidentes en el grupo de recuperación, lo que demuestra que la intoxicación crónica con Kh es una intoxicación sistémica y no exclusiva del SNC y SNP.


Karwinskia humboldtiana (Kh) is a poisonous shrub causing a number a accidental intoxications in humans. In previous studies, damage has been reported to Peripheral and Central Nervous System. Main intoxication sign is the presence of paralysis. However, no studies have been documented about damage to other organs like the kidney. The objective of this research is to evaluate kidney histology during chronic intoxication. Thirty two (32) Wistar rats were divided into 4 groups (n=8). For each group, 5 rats were intoxicated with Kh and 3 received water only as a control. Intoxicated rats received 3.5 g/Kg body weight of dry powder of Kh fruit, fractionated in 5 doses as follows 1.5, 0.5, 0.5, 0.5, 05 on days 0, 3, 7, 10 and 14 respectively. Control rats received water only. Each group was euthanized at different times during paralysis evolution. Samples of kidney were obtained and processed by routine technique until paraffin embedding for light microscopy studies, and in epoxy resins for transmission electron microscopy. Sections were obtained and stained with H&E, Masson's trichrome, and treated for PAS with diastase reaction to demonstrate basal membranes. At the light microscopic level we observed blood vessel congestion, tubular necrosis and fibrosis of renal capsule. Both at Light microscopy and electron microscopy, it was identified a thickening of the filtration barrier and of renal capsule, in all intoxicated animals, especially in the recovery group. These findings demonstrate that Kh causes a systemic intoxication and not only of the nervous system, as has been considered up to now.


Subject(s)
Animals , Rats , Karwinskia/toxicity , Kidney , Kidney/pathology , Karwinskia , Microscopy, Electron, Transmission , Plants, Toxic , Rats, Wistar
9.
Int. j. morphol ; 30(2): 572-578, jun. 2012. ilus
Article in Spanish | LILACS | ID: lil-651832

ABSTRACT

La ingesta accidental de fruto de Karwinskia humboldtiana ocasiona una parálisis flácida, simétrica, progresiva y ascendente, similar al síndrome de Guillain-Barré. Evoluciona en el transcurso de 3 a 12 meses hasta su recuperación total, pero los casos graves terminan en la muerte por insuficiencia respiratoria. No existe un tratamiento específico. La lesión histopatológica descrita en nervio periférico de pacientes, y animales de experimentación corresponde a una desmielinización segmentaria acompañada de degeneración Walleriana. Una de las toxinas extraídas a partir de la semilla, la T-514, ocasiona un incremento de radicales libres in vitro. Los radicales libres se han relacionado con la desmielinización que se presenta en otros tipos de neuropatías como en la diabética. Ya que la lesión ultraestructural que se presenta en los modelos animales de diabetes es similar a la que se observa en la intoxicación experimental con fruto de K. humboldtiana, se decidió administrar un potente agente antioxidante, el ácido a-lipoico en un modelo de intoxicación crónica por fruto de K. humboldtiana. Sin embargo, no se observó mejoría sobre las manifestaciones clínicas evaluadas en los animales o sobre las lesiones histopatológicas presentes en el nervio periférico. Estos resultados sugieren que los radicales libres no son el mecanismo principal de lesión sobre el nervio periférico en la polineuropatía causada por K. humboldtiana.


The accidental ingestion of Karwinskia humboldtiana causes a flaccid, symmetrical, progressive and ascending paralysis, similar to Guillain-Barre syndrome. It evolves over the course of 3 to 12 months until full recovery, but severe cases end in death due to respiratory failure. There is no specific treatment. The histopathological lesions described in peripheral nerve of patients and in experimental animals, corresponds to segmental demyelination accompanied by Wallerian degeneration. One of the toxins extracted from the seed, T-514, causes an increase of free radicals in vitro. Free radicals have been associated to demyelination that occurs in other types of neuropathy such as diabetic neuropathy. Since the ultrastructural damage that occurs in animal models of diabetes is similar to that observed in experimental poisoning with the fruit of K. humboldtiana, we decided to administer a powerful antioxidant, a-lipoic acid, in a model of chronic poisoning due of K. humboldtiana. However, no improvement was observed on the clinical manifestations evaluated in animals or in the histopathological lesions in the peripheral nerve. These results suggest that free radicals are not the primary mechanism of injury on the peripheral nerve caused by K. humboldtiana.


Subject(s)
Animals , Rats , Thioctic Acid/administration & dosage , Karwinskia/toxicity , Peripheral Nerves/pathology , Polyneuropathies/drug therapy , Antioxidants/administration & dosage , Demyelinating Diseases/chemically induced , Karwinskia/toxicity , Plant Poisoning , Plants, Toxic , Paralysis/chemically induced , Polyneuropathies/chemically induced , Rats, Wistar
10.
J Peripher Nerv Syst ; 11(3): 253-61, 2006 Sep.
Article in English | MEDLINE | ID: mdl-16930288

ABSTRACT

Intoxication by Karwinskia humboldtiana (buckthorn) fruit presents a neurological picture similar to that of Guillain-Barré syndrome. In this report, we describe an experimental animal model of peripheral neuropathy induced by buckthorn fruit. Four groups of Wistar rats received one oral dose of 1.5 g/kg followed by oral doses of 0.5 g/kg at days 3, 7, 10, and 14 of dried and ground buckthorn fruit in aqueous suspension. Rats were sacrificed at 24, 48, 58, and 112 days after initial dose. Treated animals developed progressive paralysis through 58 days, then completely recovered by 112 days. Sciatic nerves showed segmental demyelination and cellular infiltrates until 58 days after exposure and then remyelinating changes at 112 days. This experimental model for peripheral neuropathy is reproducible and easy to handle. Its manipulation is relatively innocuous and allows us to study reversible peripheral nerve damage. This model can be developed in other animal species and may be useful to test new therapies for peripheral neuropathy.


Subject(s)
Disease Models, Animal , Fruit/toxicity , Karwinskia/toxicity , Peripheral Nervous System Diseases/chemically induced , Animals , Body Weight/drug effects , Female , Male , Microscopy, Electron, Transmission/methods , Peripheral Nervous System Diseases/pathology , Rats , Rats, Wistar , Sciatic Nerve/drug effects , Sciatic Nerve/pathology , Sciatic Nerve/ultrastructure , Time Factors
11.
Toxicon ; 46(1): 99-103, 2005 Jul.
Article in English | MEDLINE | ID: mdl-15922384

ABSTRACT

Our previous acute toxicity studies with Karwinskia humboldtiana (Kh) in rats showed renal hemodynamic changes with a marked increase in the fractional excretion of sodium and morphological damage. To analyse the effects of Kh or 'tullidora' on energetic metabolism, a single dose of an oral preparation from the seed fruits was given to Wistar rats (1.25 g/kg). In tullidora-treated rats there was 8% mortality. ATP concentrations in renal tissue decreased significantly (control: 53.85+/-3.34, tullidora 38.28+/-5.31 micromol/g fresh tissue, P<0.05). Total blood (54.8+/-0.96, tullidora: 40.2+/-1.55 micromol/dL, P<0.01) and haemoglobin-ATP concentrations (3.69+/-0.12, tullidora: 2.56+/-0.11 micromol/g, P<0.01) were also significantly diminished. Moreover, the total protein in renal cortex from tullidora-treated rats decreased as compared to control group (control: 71.43+/-2.88, tullidora: 55.20+/-4.06 mg/g fresh tissue, P<0.05). In contrast, Na+-K+-ATPase activity in tullidora-treated animals was not different from control rats. These findings might partially explain the acute effects and mortality observed in the Kh treated rats.


Subject(s)
Adenosine Triphosphate/blood , Adenosine Triphosphate/metabolism , Karwinskia/toxicity , Kidney/drug effects , Kidney/metabolism , Animals , Lethal Dose 50 , Male , Plants, Toxic , Rats , Rats, Wistar
12.
Gac. méd. Méx ; 131(1): 100-6, ene.-feb. 1995. ilus
Article in Spanish | LILACS | ID: lil-174025

ABSTRACT

La ingestión del fruto maduro de la Karwinskia humboldtiana, arbusto comúnmente conocido como tullidora o coyotillo, provoca una intoxicación descrita en la bibliografía como una parálisis fláccida, simétrica de los miembros inferiores, progresiva y ascendente, que en casos graves puede causar parálisis bulbar y muerte. Se presenta el caso de una familia en la que diez de sus trece miembros ingirieron accidentalmente el fruto de la tullidora; tres fallecieron: el padre y dos hijas. Además, se describe por primera vez, la determinación de las toxinas en sangre por medio de cromatografía en capa fina. Este método resulta útil para el diagnóstico diferencial con otras polirradiculoneuritis, v.gr. poliomielitis y Síndrome de Guillain-Barre


Subject(s)
Child, Preschool , Child , Adult , Middle Aged , Humans , Male , Female , Karwinskia/toxicity , Mortality , Paralysis/etiology , Plant Poisoning/blood , Plants, Toxic/chemistry
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