RESUMO
We reported the case of an adolescent, without neurological background, who attempted suicide by organochlorine pesticide ingestion. The acute intoxication was expressed as a convulsive status epilepticus followed by an acute neurogenic pulmonary edema with rapid recovery within 48 hours. The diagnosis of neurogenic pulmonary edema in pediatrics, and particulary after a seizure, is unusual and often an exclusion one. Its evolution tends to be favorable, but can be fatal if it is not recognized and treated early. An acute nervous system injury associated with signs and symptoms of respiratory failure suggests the diagnosis. Other causes of pulmonary edema must be ruled out in order to avoid evaluation and treatment mistakes.
Assuntos
Hidrocarbonetos Clorados/intoxicação , Praguicidas/intoxicação , Edema Pulmonar/induzido quimicamente , Tentativa de Suicídio , Adolescente , Feminino , Humanos , Doenças do Sistema Nervoso/induzido quimicamenteRESUMO
Intoxication with organophosphate (OP) and carbamate (CM) compounds is a common reason for presentation to the Emergency Department (ED) in La Paz, Bolivia. The objective of this study was to describe the demographics, presenting symptoms, and hospital course of patients presenting with OP or CM intoxication to the ED of the Hospital de Clinicas, La Paz, Bolivia, with the aim of determining which factors might predict a complicated hospital course. This was a retrospective chart review, using predefined criteria, of 300 patients who presented from January 1, 2003 to December 31, 2003. The intoxications were all oral, mostly intentional (97%), and in young patients (mean age 23.9 years, range 13-62 years). Females outnumbered males almost 2:1. The most common symptoms on presentation were abdominal pain (83%), nausea/vomiting (79%), miosis (72%), bronchorrhea (44%), diarrhea (41%), and fasciculations (31%). The most frequent complications were aspiration (18%), cardiopulmonary arrest (9%), and seizure (7%); mortality was 6%. Treatments included gastric lavage in 96% of patients, and atropine (median 5 mg per patient, range 0-48 mg). Miosis, bronchorrhea, diarrhea, and fasciculations at presentation were associated with a higher rate of complications. Although almost all intoxications were suicide attempts, less than half of patients received a psychiatric consultation. OP intoxication is a common cause of self-inflicted morbidity and mortality among young people in La Paz, Bolivia. Presence of miosis, bronchorrhea, diarrhea, and fasciculations at presentation suggest a higher likelihood of complications.
Assuntos
Carbamatos/intoxicação , Hidrocarbonetos Clorados/intoxicação , Intoxicação/epidemiologia , Comportamento Autodestrutivo/epidemiologia , Dor Abdominal/etiologia , Adolescente , Adulto , Bolívia/epidemiologia , Área Programática de Saúde , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Adulto JovemRESUMO
Organochlorine compounds (OCCs), such as pesticides and polychlorinated biphenyls (PCBs), are persistent lipophilic chemicals identified as endocrine disruptors, mainly with estrogen-like effects. Northeastern Argentina, near the Paraná River, is characterized by intensive farming and agricultural activities and industrial development, and is therefore prone to high incidences of environmental and dietary exposure to OCCs. Hence, we conducted a study to (1) estimate the organochlorine residues present in mammary fat tissue in a population of women from this littoral region and (2) identify potential sources of exposure to OCCs. Our subjects were 76 women (residing in and around Santa Fe city and not occupationally exposed to organochlorines) who underwent excision biopsy of a breast lesion or had plastic surgery. Both frequency of occurrence and levels of organochlorine residues were high in breast adipose tissue of all the participants. The organochlorine residues most frequently found were p,p'-dichlorodiphenyldichloroethylene (p,p'-DDE) in all the subjects analyzed, hexachlorobenzene (HCB) in 86.8%, and beta-hexachlorocyclohexane (beta-HCH) in 75.0%. The incidence of PCB congeners was very low. p,p'-DDE and beta-HCH residues reached the highest levels, 4794 and 1780 ppb, respectively. The diet was a relevant source of exposure, consumption of animal fat and freshwater fish playing a significant role. Bioaccumulation was evidenced by the significant positive association between organochlorine levels and body mass index (p = 0.0003) and the age of the patient (p = 0.0002). The frequency and levels of OCCs found in our study population raise concerns regarding Argentinean exposure to these endocrine disruptors.
Assuntos
Tecido Adiposo/metabolismo , Poluentes Atmosféricos/farmacocinética , Disruptores Endócrinos/farmacocinética , Exposição Ambiental/efeitos adversos , Hidrocarbonetos Clorados/farmacocinética , Poluentes Atmosféricos/intoxicação , Argentina , Mama/metabolismo , Disruptores Endócrinos/intoxicação , Feminino , Humanos , Hidrocarbonetos Clorados/intoxicação , Pessoa de Meia-Idade , Estatísticas não Paramétricas , População UrbanaRESUMO
In order to assess the trend in the body load of chlorinated hydrocarbon residues in Trinidad, during 1972 and 1973, samples of fat were taken during routine forensic post mortems in non-poisoning cases of all ages at the General Hospital, Port-of-Spain. The levels of two main pesticides DDT and Dieldrin were found to be far lower than the toxic levels. No marked differences were observed in levels throughout Trinidad. Trinidad and Tobago compares favourably with other countries in which similar surveys have been done. A brief account of the statistics of the forencic post mortems with reference to deaths due to acute poisoning is given as encountered at the General Hospital, Port-of-Spain, which receives cases from all over the country