[Clinical and epidemiological characteristics of severe poisoning in an adult population admitted to an intensive care unit]. / Características clínicas y epidemiológicas de intoxicaciones graves en una población adulta que ingresa a una unidad de cuidados intensivos.

OBJECTIVE: To describe the clinical and epidemiological features of severe acute poisonings in an adult population. DESIGN: Retrospective analysis of clinical cases. PATIENTS AND METHODS: Analysis of the clinical charts, risk factors and main outcomes of 55 acute poisoned patients admitted to an intensive care unit (ICU). RESULTS: Of the 55 clinical charts reviewed, female prevailed over male gender with a relation of 1.5:1, the average age was 32 years (16-83 years), the major etiologic factor for the acute poisonings were drugs in 35 cases (64%), and home or work chemicals in 20 cases (36%). The mechanisms of intoxication/poisoning were: attempted or successful suicide in 51 cases (93%), accidental poisoning in three cases (5%), and iatrogenic in one case (2%). Precipitating factors were major depressive disorder in 29 cases (53%), dysthymic disorder in 12 cases (22%) and adjustment disorder with depressive mood or impulsive act in nine cases (16%). Associated feature comorbid conditions were: homosexuality, schizophrenia, drug addiction, AIDS, other chronic diseases, and previous suicide attempts. Outcomes were 33 (60%) patients discharged from the ICU without sequela, seven (13%) with permanent severe sequela and 15 (27%) deaths. CONCLUSIONS: There was a high rate of suicides related with depressive disorders in a predominantly female population. Drug products were used more frequently than home or work chemicals. Although advanced life support and antidotal treatments were available, mortality was high. Areas where injury prevention efforts might have an influence on adult poisoning morbidity and mortality include management of depression as well suitable control of drugs and chemicals.

Determinacion de plomo en liquido cefalorraquideo. / Determination of lead in cerebrospinal fluid

En el estudio de 54 muestras de liquido cefalorraquideo (LCR) normales, se encontraron concentraciones promedio de plomo de 0.213 +/- 0.289 micromol/l (4.42 +/- 6.0 micrograma/dl. El analisis simultaneo de 22 muestras de sangre mostro valores de plomo de 0.491 +/- 0.358 micromol/l (10.19 +/- 7.42 micrograma/dl) y, para sus correspondientes pares de LCR, los valores fueron de 0.240 +/- 0.375 micromol/l (4.98 +/- 7.78 micrograma/ dl). La relacion entre estos dos ultimos valores fue estadisticamente significativa (p < 0.05), y corrobora el paso normal del plomo desde la sangre hacia el LCR a traves de la barrera hematoencefalica. El conocimiento de las concentraciones normales de plomo en el LCR se considera de utilidad en el estudio de ninos con encefalopatia plumbica y para el diagnostico diferencial de este padecimiento con otros procesos inflamatorios del cerebro

[Acute-onset extrapyramidal syndromes caused by drugs]. / Síndromes extrapiramidales de evolución aguda causados por drogas.

In childhood, several drugs are the cause of acute extrapyramidal syndromes which are true medical emergencies. In the course of one year out of 321 children with acute poisoning, 49 (14.9%) showed these side effects. The responsible drugs were mainly the phenothiazines and haloperidol; only in two cases the metoclopramide. The extrapyramidal syndromes were characterized by akathisia, dyskinesia with dystonic reactions, parkinsonism and akinesia. Diphenhydramine has shown to be useful in treating acute extrapyramidal disturbances when used intravenously followed by oral administration.

Sindromes extrapiramidales de evolucion aguda causados por drogas. / Acute extrapyramidal syndromes caused by drugs

En la edad pediatrica, diversas drogas pueden causar sintomas extrapiramidales que por su evolucion aguda constituyen verdaderas urgencias medicas. En el transcurso de un ano, del total de 321 ninos internados con el diagnostico de intoxicacion aguda, 48 (14.9%) habian recibido ese tipo de drogas. De estas, las que con mayor frecuencia causaron los sintomas fueron las fenotiacinas y el haloperidol; la manera como los ninos se expusieron a ellas fue en la mayor parte de los casos por yatrogenia y despues por ingestion accidental. Las manifestaciones clinicas que predominaron fueron acatisia, discinesias paroxisticas del tipo de las crisis oculogiras, las distonias de torsion de cuello y tronco y las crisis bucolinguales, parkinsonismo caracterizado por temblores finos, sialorrea e hipertonia y finalmente, acinesia. Se propone un esquema de tratamiento empleando unicamente difenhidramina por via parenteral y bucal con lo que se obtienen buenos resultados terapeuticos

Rotavirus. II. Virus relacionados con la gastroenteritis aguda en el nino. / Rotavirus. II. Viruses associated with acute gastroenteritis in children

Se estudio la presencia de rotavirus en la materia fecal de 232 ninos menores de cinco anos con gastroenteritis infecciosa aguda por medio de la tecnica de electroforesis del RNA viral. Se encontraron 15.1 por ciento de casos positivos, no observandose predominio en relacion con la edad o la epoca del ano.Aproximadamente 50 por ciento correspondieron a cada uno de los dos tipos de rotavirus, pero el tipo 2 (2 L) predomino en los seis primeros meses del ano y el tipo 1 (2 S) en los otros seis. Los resultados concuerdan con los obtenidos por otros autores, ya que se considera que aproximadamente 20 por ciento de las diarreas agudas de la infancia son causadas por estos agentes virales

[Poisoning by nalidixic acid in children]. / Intoxicación por ácido nalidíxico en niños.

A review was made of the clinical histories of 18 children who were admitted to the Emergency Department of the Hospital de Pediatría del C.M.N. (IMSS) with the diagnosis of nalidixic acid intoxication. The study covered a period of 3 years, from 1976 through 1978. There were no differences as to sex; infants under one year were most frequently attached; iatrogenesis was the most frequent mechanism. The clinical manifestations were characterized by neurological disorders of the state of alertness, hypertensive cranial syndrome and neuronal damage; there was metabolic acidosis in other cases. Treatment included gastric lavage, general measures, correction of acid-base unbalance, control of convulsive crises. Indications for the use of nalidixic acid are reviewed stressing that it must be used in urinary infections and as second choice drug.

[Assessment of five laboratory tests for differential diagnosis in bacterial and viral meningoencephalitides]. / Evaluación de cinco pruebas de laboratorio para el diagnóstico diferencial entre meningoencefalitis purulenta y viral.

The usefulness of five different laboratory tests for differential diagnosis in bacterial and viral meningoencephalitides was assessed. The clinical manifestations and cytochemical alterations of cerebrospinal fluid (CSF) were used as criteria for diagnostic selection. The causal agent was identified by means of CSF cultures in 47.8 per cent of bacterial meningoencephalitis cases; Gram stain was postive in CSF smear in 34.8 per cent and protein electrophoresis in CSF did not show significant differences when compared to cases of bacterial or viral etiology and the control group. PH and CSF lactate determinations allowed diagnosis of all cases of bacterial meningoencephalitis and was not modified in those cases where this disease was of a viral origin. We suggest to add these determinations to the initial cytochemical study of CSF in all cases where meningoencephalitis is suspected.

[Evaluation of racemic epinephrine with intermittent positive pressure in the treatment of acute infections laryngotracheitis]. / Evaluación de la epinefrina racémica con presión positiva intermitente en el tratamiento de la laringotraqueítis infecciosa aguda.

Fourteen children admitted to the Hospital de Pediatría of the C.M.N. of the I.M.S.S. with the diagnosis of acute infectious laryngotracheobronchitis were divided into two groups with similar conditions for their study. The benefit derived from the application of recemic epinephrine with intermittent positive pressure was confirmed 15 and 30 minutes later by means of a double blind study; the improvement was swift and spectacular, but temporary; therefore, such treatment must be given only in hospitals, since relapses may show up two to four hours later, making in dangerous to send the patients home or to apply to ambulatory cases. The use of racemic epinephrine is proposed for hospitals having equipment and personnel trained in its management and the convenience of further studies is set forth to determine the period of effectiveness of racemic epinephrine and the advantage of giving repeated doses.

[Supraventricular paroxysmal tachycardia as a pediatric cardiologic emergency]. / La taquicardia paroxística supraventricular como urgencia cardiológica pediátrica.

Seven cases with the diagnosis of supraventricular paroxysmal tachycardia, confirmed by the electrocardiogram were included in the study. Their ages fluctuated from 19 days to 14 years, with predominance of small infants. The etiology was varied. They were managed with digitalis and conversion to sinusal rhythm in a short term. The drug was maintained to prevent relapses and/or heart failure. No mortality issued. We recommend the use of digitalis as selective drug because it may be readily obtained and its appication and response are sure. The clinical findings and results agree with the literature reviewed.