Regulamentação e criminalização das drogas no Brasil / Drug regulation and criminalization in Brazil

O presente estudo visa avaliar, através de uma revisão narrativa da literatura, como o controle do Estado exerceu ao longo da história do Brasil a regulamentação do uso de drogas. Método Foram consultados livros, artigos de periódicos acadêmicos indexados, trabalhos completos apresentados em congressos e documentos históricos disponíveis na internet relativos ao tema. Resultados A primeira legislação penal em relação ao uso de drogas surge apenas no Brasil império. Nesse período começam a surgir também os primeiros problemas devido ao uso de drogas. A criação de cursos superiores nas áreas de saúde e de ciências naturais veio a formar profissionais capacitados na manipulação e fiscalização de produtos químicos e farmacêuticos. Com o tempo, observando-se os efeitos, algumas substâncias passam a ser proscritas. Conclusão Por toda história do país, o uso e a regulação das drogas, permearam todas as épocas influenciando na cultura, educação e no modo de vida da população. Atualmente há um grande debate acerca das políticas sobre drogas no Brasil, principalmente sobre a maconha e seus usos terapêuticos, mostrando novamente a influência do Estado sobre a saúde e a segurança da população.

The present study aims to evaluate, through a narrative review of the literature, how State's control has exercised regulation of drug use throughout the history of Brazil. Method Books, articles from indexed academic journals, complete works presented at conferences and historical documents available on the internet relating to the topic were consulted. Results The first criminal legislation related to drug use only appeared in Imperial Brazil. During this period, the first problems due to drug use also begin to appear. The creation of higher education courses in the areas of health and natural sciences resulted in the training of professionals capable of handling and supervising chemical and pharmaceutical products. Over time, observing the effects, some substances become proscribed. Conclusion Throughout the country's history, the use and regulation of drugs has permeated all eras, influencing culture, education and the population's way of life. There is currently a great debate about drug policies in Brazil, mainly regarding marijuana and its therapeutic uses, once again showing the influence of the State on the health and safety of the population.

Pesquisa e desenvolvimento de nanomedicamentos: olhar bioético / Nanodrug research and development: a bioethical approach / Investigación y desarrollo de nanomedicinas: desde la mirada bioética

Resumo Nanotecnologia é a utilização de materiais na escala nanométrica, em que estes adquirem características próprias. A área de pesquisa e desenvolvimento de novos nanomedicamentos é uma das mais promissoras atualmente, todavia essas partículas necessitam de avaliação particular e ainda não há consenso referente às testagens específicas a serem seguidas, o que dificulta a formação de uma legislação que garanta a segurança e eficácia destes medicamentos, além de um processo de registro mais eficaz. Assim, é necessária uma abordagem bioética da nanotecnologia e sua utilização em medicamentos, visando garantir que o progresso científico não acarrete impactos irreversíveis. Diante dessa problemática, busca-se promover uma discussão nanoética referente ao processo de pesquisa e desenvolvimento de nanomedicamentos, por meio de estudo qualitativo, exploratório-descritivo e de caráter analítico, utilizando revisão bibliográfica, análise documental e dados quantitativos disponíveis como técnicas de pesquisa.

Abstract Nanotechnology consist of using materials at the nanoscale, in which they acquire specific characteristics. Nanodrug research and development is one of the most promising fields today; however, these particles require particular evaluation. Moreover, studies lack consensus on which specific tests to follow, thus hindering the elaboration of legislation that ensure their safety and efficacy, as well as a more effective registration process. Thus, a bioethical approach to nanotechnology and its use in drug development is necessary to ensure scientific progress without irreversible impacts. Given this scenario, this article proposes a nanoethics discussion regarding nanodrug research and development by means of a qualitative, exploratory and descriptive analysis, based on literature review, documental analysis and quantitative data available.

Resumen La nanotecnología utiliza materiales nanométricos, en que estos adquieren características propias. El área de investigación y desarrollo de nuevas nanomedicinas es una de las más prometedoras en la actualidad, sin embargo, estas partículas requieren de una evaluación particular y aún no existe consenso en cuanto a las pruebas específicas que seguir, lo que dificulta establecer una legislación que garantice la seguridad y eficacia de estos medicamentos, además de un proceso de registro más efectivo. Por lo tanto, se necesita un enfoque bioético de la nanotecnología y su uso en medicamentos para garantizar que el avance científico no tenga impactos irreversibles. Ante esta problemática, se pretende promover el debate sobre la nanoética en el proceso de investigación y desarrollo de nanomedicinas a partir de un estudio cualitativo, exploratorio-descriptivo y analítico, que utiliza como técnicas de investigación la revisión bibliográfica, el análisis de documentos y los datos cuantitativos disponibles.

Toxinology in the proteomics era: a review on arachnid venom proteomics

The word venomics was coined to acknowledge the studies that use omics to investigate venom proteins and peptides. Venomics has evolved considerably over the last 20 years. The first works on scorpion or spider venomics were published in the early 2000's. Such studies relied on peptide mass fingerprinting (PMF) to characterize venom complexity. After the introduction of new mass spectrometers with higher resolution, sensitivity and mass accuracy, and the next-generation nucleotide sequencing, the complexity of data reported in research on scorpion and spider venomics increased exponentially, which allowed more comprehensive studies. In the present review article, we covered key publications on scorpion venomics and spider venomics, presenting historical grounds and implemented technologies over the last years. The literature presented in this review was selected after searching the PubMed database using the terms "(scorpion venom) AND (proteome)" for scorpion venomics, and "(spider venom) AND (proteome)" for publications on spider venomics. We presented the key aspects related to proteomics in the covered papers including, but not restricted to, the employed proteomic strategy (i.e., PMF, two-dimensional gel electrophoresis, shotgun/bottom-up and/or top-down/peptidome), and the type of mass spectrometer used. Some conclusions can be drawn from the present study. For example, the scorpion genus Tityus is the most studied concerning venomics, followed by Centruroides; whereas for spiders the studied genera were found more equally distributed. Another interesting conclusion is the lack of high throughput studies on post-translational modifications (PTMs) of scorpion and spider proteins. In our opinion, PTMs should be more studied as they can modulate the activity of scorpion and spider toxins.(AU)

Óbitos e internações de vítimas de eventos toxicológicos não medicamentosos no Brasil, 2009 a 2018 / Muertes y hospitalizaciones de víctimas de eventos toxicológicos no medicamentosos en Brasil, 2009 a 2018 / Deaths and hospitalizations of victims of non-drug toxicological events in Brazil, 2009 to 2018

Objetivo: determinar a taxa de internações por eventos agudos de intoxicação não medicamentosa (NMx) e analisar a mortalidade decorrente desses agravos no Brasil, de 2009 a 2018. Métodos: estudo de série temporal, no qual se analisaram registros de internações por "tratamento de intoxicação ou envenenamento por exposição a substâncias de uso não medicamentoso" no Sistema de Informações Hospitalares (SIH), por regressão de Prais-Winsten. Resultados: ocorreram 125.570 internações em virtude de intoxicação NMx. A taxa média de internações foi de 6,3/100 mil habitantes, sendo maior no sexo masculino (8,0/100 mil hab.) comparado ao feminino (4,6/100 mil hab.). A taxa de internações e a mortalidade geral de internações por intoxicação NMx diminuíram de 9,4 para 4,5/100 mil hab. e de 2,5 para 1,6/1 milhão de hab., respectivamente. Conclusões: houve redução da taxa de internações e da mortalidade por intoxicações NMx durante a década analisada.

Objetivo: determinar la tasa de hospitalizaciones por eventos agudos de intoxicación no medicamentosa (NMx) y analizar la mortalidad resultante en Brasil de 2009 a 2018. Métodos: estudio de serie temporal en el que se analizaron los registros de hospitalizaciones por "tratamiento de intoxicación o envenenamiento por exposición a sustancias de uso no farmacológico" del Sistema de Información Hospitalaria (SIH) por la regresión de Prais-Winsten. Resultados: hubo 125.570 hospitalizaciones por intoxicación NMx. La mortalidad promedio de hospitalizaciones fue de 6,3/100 mil hab., siendo más alta en el sexo masculino (8,0/100 mil hab.) en comparación con el femenino (4,6/100 mil hab.). La tasa de hospitalizaciones y la mortalidad global de las hospitalizaciones por NMx disminuyeron de 9,4 a 4,5 por 100 mil hab. y de 2,5 a 1,6 por 1 millón de hab., respectivamente. Conclusiones: hubo reducción en la tasa de hospitalizaciones y en la mortalidad por intoxicaciones NMx durante la década analizada.

Objective: to determine the rate of hospitalizations due to acute non-drug poisoning (NDP) events and to analyze mortality arising from these health conditions in Brazil from 2009 to 2018. Methods: this was a time-series study using Prais-Winsten regression to analyze records of hospitalizations for "treatment of intoxication or poisoning due to exposure to non-drug substances" held on the Hospital Information System. Results: there were 125,570 hospitalizations due to NDP. The average hospitalization rate was 6.3/100,000 inhabitants, although it was higher in males (8.0/100,000 inhab.) compared to females (4.6/100,000 inhab.). The hospitalization rate and the overall mortality rate due NDP to fell from 9.4 to 4.5/100,000 inhab. and from 2.5 to 1.6/1 million inhab., respectively. Conclusions: there was a reduction in the NDP hospitalization rate and in mortality due to NDP during the decade analyzed.

Manual de Organización y Funciones del Centro de Información y Asesoramiento Toxicológico / Organization and Functions Manual of the Toxicological Information and Advice Center

El presente manual tiene como Objetivo establecer las directrices que permitan la toma de decisiones oportunas para la respuesta a brotes de intoxicaciones y/o desastres químicos, además de comunicar la información para lograr una acción de prevención y control más efectiva en los diferentes niveles del Sistema Nacional Integrado de Salud

The objective of this manual is to establish the guidelines that allow timely decision-making to respond to outbreaks of poisoning and / or chemical disasters, in addition to communicating the information to achieve a more effective prevention and control action at the different levels of the System. National Integrated Health

Intoxicación por adelfa, un caso poco frecuente / Oleander poisoning, a rare case

Introducción: Las intoxicaciones por plantas son infrecuentes, de complicada orientación diagnóstica, que en general, se dificulta la identificación de la planta, su potencial tóxico y el tratamiento específico. Entre ellas la adelfa, capaz de producir cuadros de intoxicación grave, como un caso consultado a la guardia del Centro Nacional de Toxicología. Objetivos: Presentar un caso clínico de intoxicación grave por adelfa. Caso clínico: Paciente adulto, con intranquilidad, vómitos, dolores abdominales, tensión arterial 150/90 mmHg, frecuencia cardiaca y respiratoria normales, refirió que había consumido vía oral y rectal una poción elaborada con una planta, como tratamiento antiparasitario. El médico de guardia decidió comunicarse con el Centro Nacional de Toxicología. Se identificó la planta como adelfa. A pesar de la aplicación de reposición de volumen, lavado gástrico y la administración de carbón activado; presentó bloqueo auriculoventricular, extrasístoles aisladas y bradicardia. Se suministró atropina endovenosa, luego se trasladó hacia la unidad de cuidados intensivos y posteriormente egresó. Conclusiones: El caso presentó una intoxicación aguda grave por adelfa, con un correcto diagnóstico y tratamiento, que requirió de la labor conjunta de los médicos del cuerpo de guardia del hospital, la terapia intensiva y del Centro Nacional de Toxicología(AU)

Introduction: Poisoning by plants is infrequent, with a complicated diagnostic orientation, which in general makes it difficult to identify the plant, its toxic potential and specific treatment. Among them the oleander, capable of producing serious intoxication, as a case consulted to the National Toxicology Center. Objectives: To present a clinical case of severe oleander poisoning. Clinical case: Adult patient with restlessness, vomiting, abdominal pain, blood pressure 150/90 mmHg, normal heart and respiratory rates, and reported that he had consumed orally and rectally a potion made with a plant, as an antiparasitic treatment. The doctor who assisted him decided to communicate with the National Toxicology Center. The plant was identified as oleander. Despite the application of volume replacement, gastric lavage and the administration of activated charcoal; the patient presented atrioventricular block, isolated extrasystoles and bradycardia, intravenous atropine was administered, and subsequent transfer to the intensive care unit, and later he was discharged. Conclusions: The case presented a severe acute oleander poisoning, there was correct diagnosis and treatment, which required the joint work of the doctors from hospital emergency, the intensive care unit and the National Toxicology Center(AU)

Escorpiones de la provincia de Misiones, Argentina: Un elenco de interés medico / Scorpions from the province of Misiones, Argentina: An assemblage of medical interest

INTRODUCCIÓN: Los envenenamientos producidos por escorpiones son un problema de salud pública en constante aumento en Argentina y el mundo. Por diversas causas, los ensambles de animales venenosos de una región varían en el tiempo. El objetivo de este trabajo fue presentar la información reciente y actualizar el elenco de escorpiones de la provincia de Misiones. MÉTODOS: Se realizó un estudio descriptivo observacional a partir de la revisión de los ejemplares depositados en la Colección de Herpetología y Arácnidos del Instituto Nacional de Medicina Tropical. RESULTADOS: Se obtuvieron los primeros registros para la provincia de Tityus confluens, mientras que nuevos registros de accidentes con Tityus trivittatus ampliaron la zona de presencia de la especie en la provincia. El ensamble de escorpiones de Misiones reúne a las cuatro especies de interés médico del país. DISCUSIÓN: La detección del elenco de escorpiones de interés médico más importante del país fue consecuencia del trabajo conjunto entre los especialistas de los distintos grupos de animales ponzoñosos y los profesionales de la salud. Es importante generar y profundizar los espacios de interacción de saberes, con el objetivo de mejorar la Vigilancia de la Salud

Amazonian scorpions and scorpionism: integrating toxinological, clinical, and phylogenetic data to combat a human health crisis in the world's most diverse rainfores

Venom from Amazonian scorpions of the genus Tityus contains components capable of eliciting a distinct clinical, mostly neurological, syndrome. This contrasts with the mainly autonomic manifestations produced after envenomation by congeneric southern and northern South American species. Herein, we summarize Pan-Amazonian scorpionism by synthesizing available toxinological, clinical, and molecular data gathered from all affected areas in Amazonia, including Brazil, Ecuador, Colombia, Peru, Venezuela, and French Guiana. We searched multiple databases, as well as our own records, for reports of scorpion envenomations in Amazonia by confirmed Tityus spp., and compared the clinical manifestations. To help uncover clinical and venom relationships among problematic species, we explored phylogenetic relationships with a rate-calibrated analysis of mitochondrial COI data from available species. The possible existence of diversity gradients for venom toxic and immunogenic components despite the predicted strong phylogenetic association among species is underscored by discussed clinical and toxinological findings. A multicentric effort, involving all nations affected by this neglected disease, is urgently needed to offer alternatives for treating and understanding this pathology, including the preparation of neutralizing antibodies with a broad range of efficacy.(AU)

Pioneer women in the development of toxicology in Brazil

Women have always played an important role in the development of toxicology all over the world. Specifically in Brazil, toxicology has had greater female representation than other countries, but women's participation at high hierarchical levels is low. Although more than 62% of the members of the Brazilian Society of Toxicology are women, only 7 out of the 22 presidents have been women throughout its 48 years of existence. This article aims to celebrate women in the field of toxicology in Brazil, based on interviews with five of these scientists who have changed the field of toxicology in Brazil as we know it today, each in their specific sub-areas. These women are: Dr. Ester de Camargo Fonseca Moraes, Dr. Silvia Berlanga de Moraes Barros, Dr. Alice Aparecida da Matta Chasin, Dr. Gisela de Aragão Umbuzeiro, and Dr. Tania Marcourakis. They are not only pioneers but they are also examples of admirable persistence in fighting the adversities presented to them. They broke the glass ceiling and opened doors for future generations of women in science. We hope that this article helps inspire women in their careers in toxicology.

Cáncer avanzado de orofaringe. Nuevo paradigma de tratamiento / ADVANCED OROPHARYNGEAL CANCER TREATED WITH SEQUENTIAL CHEMORADIATION PRESERVING THE ORGAN

Antecedentes: Hasta la década del 80 los pacientes con esta patología eran intervenidos quirúrgicamente. A partir de 1997 la Cleveland Clinic publica un estudio basado en la quimioradioterapia en el cáncer avanzado de orofaringe con resultados similares a los de la época anterior, pero con preservación del órgano. En nuestro medio no existe bibliografía que analice estadísticamente los resultados y los factores que lo condicionaron. Objetivo: Evaluar los resultados con quimioradioterapia secuencial en el cáncer avanzado de la región orofaríngea. Lugar de aplicación: Hospital de atención terciaria Diseño: Prospectivo no randomizado Material y metodo: Desde Enero del 2002 al 30 de diciembre del 2004 se estudiaron 60 pacientes, 55 pertenecían al sexo masculino, con edad media de 60 años, el 76.7% eran T III y los restantes T IV con tumores malignos de la región orofaríngea mediante quimioradioterapia secuencial. Resultados: La supervivencia a 152 meses fue del 30.1%. El análisis univariado, demostró que el estadío, con p<0,001, la reducción con p=0,010 y la cirugía de rescate con p=0,028 fueron las únicas variables estadísticamente significativas, mientras la edad, el sexo y la localización no tuvieron los mismos resultados. En el análisis multivariado, el estadío con una p< 0.001, el sexo con una p=0.016 y la reducción con una p=0.024 resultaron ser estadisticamente significativos. Conclusiones: El tratamiento de los tumores de la región orofaríngea, en estadíos III y IV, mediante quimioradioterapia secuencial alcanzaron resultados similares a los tratados con cirugía seguida de radioterapia, pero con preservación del órgano

Background: Until the 80th decade, patients with advanced oropharyngeal cancer were surgically treated. In 1997 the Cleveland Clinic published similar results with chemoradiotherapy but preserving the organ. In our country there are not papers analyzing those results and conditional factors. Objective: Evaluation of sequential chemoradiation results in advanced oropharyngeal cancer Setting: Public tertiary care Hospital of tumours Design: Prospective not randomized. Population and methods: From January 2002 to December 2008, 60 patients were analysed, 55 of them were male with a mean age of 60, 76.7% TIII/IV oropharyngeal carcinomas treated with sequential chemoradiation. Results: The overall 152 months of survival was 30.1%. Univariate analize showed stage p<001, reduce of lesion p:0.010 and rescue surgery p:0.028 were statiscally significative. Age, gender and subsite had not similar results. In multivariate analize only stage p:0.001, gender p: 0.016 and reduce of lesion p:0.024 resulted statiscally significative. Conclusions: Sequential chemoradiation of III and IV stage tumours of oropharyngeal area have similar long terms results than those treated with surgery plus radiation but with organ preservation

Las 100 revistas de mayor impacto sobre farmacología, toxicología y farmacia / The 100 highest impact pharmacology, toxicology and pharmacy journals

Introducción: Los indicadores bibliométricos ayudan a evaluar la repercusión de la evidencia disponible. Objetivo: Comparar el Factor de Impacto, el Eigenfactor Score, SCImago Journal & Country Rank y el Source Normalized Impact per Paper, en revistas de farmacología, toxicología y farmacia de mayor impacto a nivel mundial en sus ediciones 2018. Métodos: Estudio descriptivo, retrospectivo, obtenido del análisis bibliométrico. Se realizó una búsqueda electrónica en el Instituto para la Información Científica en revistas incluidas en el Journal Citation Report (https://scijournal.org/), para la obtención del Factor de Impacto y Puntuación del factor propio, en el portal web oficial de Scimago Journal para acceder al SCImago Journal & Country Rank (https://www.scimagojr.com/) y para la obtención del Source Normalized Impact per Paper en el portal Journal Indicators (https://www.journalindicators.com/indicators), edición 2018. Los datos se cuantificaron mediante el paquete estadístico STATA v.14.0. Se analizó las características de las revistas para cada indicador, la correlación entre las variables se estimó mediante la prueba de Spearman. Resultados: Se analizaron 100 revistas, todas indizadas en las bases de datos seleccionadas. Los coeficientes de correlación de Spearman obtenidos entre los indicadores estudiados fueron: Factor de Impacto y Puntuación del factor propio = 0,246; Factor de Impacto y Scimago Journal & Country Rank = 0,758; Factor de impacto y Source Normalized Impact per Paper = 0,680; Puntuación del factor propio y Scimago Journal & Country Rank = 0,367, Puntuación del factor propio y Source Normalized Impact per Paper = 0,264 y SCImago Journal & Country Rank y Source Normalized Impact per Paper = 0,541; además fueron estadísticamente significativas (p < 0,05). Conclusiones: Se encontró una correlación moderada a alta y significativa entre el factor de impacto, Puntuación del factor propio, SCImago Journal & Country Rank y el Source Normalized Impact per Paper(AU)

Introduction: Bibliometric indicators are useful to evaluate the impact of the evidence available. Objective: Compare the Impact Factor, the Eigenfactor Score, the SCImago Journal & Country Rank and the Source Normalized Impact per Paper of the highest worldwide impact pharmacology, toxicology and pharmacy journals in their 2018 editions. Methods: A retrospective descriptive study was performed of data obtained from bibliometric analysis. An electronic search was conducted at the Scientific Information Institute of journals included in the Journal Citation Report (https://scijournal.org/) to obtain the Impact Factor and the Eigenfactor Score, in the SCImago Journal official web portal to access the SCImago Journal & Country Rank (https://www.scimagojr.com/) and in Journal Indicators (https://www.journalindicators.com/indicators) 2018 edition to obtain the Source Normalized Impact per Paper. Data were quantified with the statistical package STATA v.14.0. An analysis was done of the characteristics of the journals for each indicator, whereas correlation between the variables was estimated with Spearman's test. Results: A total 100 journals were examined, all of them indexed in the databases selected. Examination of the indicators studied revealed the following Spearman's correlation coefficients: Impact Factor and Eigenfactor Score = 0,246; Impact Factor and SCImago Journal & Country Rank = 0,758; Impact Factor and Source Normalized Impact per Paper = 0,680; Eigenfactor Score and SCImago Journal & Country Rank = 0,367, Eigenfactor Score and Source Normalized Impact per Paper = 0,264, and SCImago Journal & Country Rank and Source Normalized Impact per Paper = 0,541. They were all statistically significant (p < 0,05). Conclusions: A moderate to high and significant correlation was found between Impact Factor, Eigenfactor Score, SCImago Journal & Country Rank and Source Normalized Impact per Paper(AU)

Bisfenol-A: cuantificacion en orina de mujeres embarazadas por cromatografia gaseosa-espectrometria de masa / Bisfenol-A: quantification in urine of pregnant women by gas chromatography-mass spectrometry / Bisfenol-A: quantificacao em urina de gestantes por cromatografia gasosa-espectrometria de massa

El uso de bisfenol-A (BPA) a nivel de la industria global se ha venido incrementando en los ultimos anos, y fueron los mercados emergentes los impulsores de esta demanda creciente. Las aplicaciones de BPA en la industria de los alimentos y bebidas representan solo del 3 al 4% del consumo global de policarbonato, pero su uso esta siendo reexaminado debido a que se conocieron varios trabajos cientificos que indican la existencia de una relacion directa entre el BPA y los efectos adversos para la salud. La contaminacion de los alimentos y bebidas se produce por migracion del BPA desde los envases que los contienen (alimentos enlatados, vinos, etc.), y es la principal fuente de exposicion en el humano. Para evaluar dicha exposicion se desarrollo y valido un metodo analitico por cromatografia gaseosa acoplada a espectrometria de masa para la cuantificacion de BPA total en orina de mujeres embarazadas atendidas en el Hospital Italiano de Buenos Aires en el ano 2013, con un limite de cuantificacion de 2,0 ng/mL y un limite de deteccion de 0,8 ng/mL. De las 149 muestras de orina analizadas, el 66,4% fueron cuantificables, con la mediana de BPA total de 4,8 ng/mL (4,3 ng/mg de creatinina) y la media geometrica de 4,8 ng/mL (4,7 ng/mg de creatinina).

The use of bisphenol-A (BPA) at the level of the global industry has been increasing in recent years, with emerging markets being the drivers of this growing demand. BPA applications in the food and beverage industry represent only 3 to 4% of the global consumption of polycarbonate, but its use is being reexamined because several scientific works were reported indicating the existence of a direct relationship between BPA and adverse effects on health. The contamination of food and beverages is produced by the migration of BPA from the containers that hold them (canned foods, wines, etc.) and it is the main source of exposure in humans. To evaluate this exposure, an analytical method was developed by gas chromatography coupled to mass spectrometry for the quantification of total BPA in urine of pregnant women treated at the Hospital Italiano de Buenos Aires in 2013, with a limit of quantification of 2.0 ng/mL and of detection of 0.8 ng/mL. Of the 149 urine samples analyzed, 66.4% were quantifiable, with a median total BPA of 4.8 ng/mL (4.3 ng/mg creatinine) and a geometric mean of 4.8 ng/mL (4.7 ng/mg creatinine).

O uso de bisfenol-A (BPA) ao nivel da industria global foi aumentando nos ultimos anos, e foram os mercados emergentes que deram impulso a essa demanda crescente. As aplicacoes de BPA na industria de alimentos e bebidas representam apenas 3 a 4% do consumo global de policarbonato, mas seu uso esta sendo reexaminado visto que varios trabalhos cientificos indicando a existencia de uma relacao direta entre o BPA e os efeitos adversos na saude foram conhecidos. A contaminacao dos alimentos e bebidas e produzida pela migracao de BPA das embalagens que os contem (alimentos enlatados, vinhos, etc.) e e a principal fonte de exposicao em humanos. Para avaliar esta exposicao, foi desenvolvido e avaliado um metodo analitico por cromatografia gasosa acoplada a espectrometria de massas para a quantificacao do BPA total na urina de gestantes atendidas no Hospital Italiano de Buenos Aires em 2013, com um limite de quantificacao de 2,0 ng/mL e um limite de deteccao de 0,8 ng/mL. Das 149 amostras de urina analisadas, 66,4% foram quantificaveis, com uma mediana de BPA total de 4,8 ng/mL (4,3 ng/mg de creatinina) e a media geometrica de 4,8 ng/mL (4,7 ng/mg de creatinina).

Accidental poisoning in children and adolescents admitted to a referral toxicology department of a brazilian emergency hospital / Intoxicações exógenas acidentais em crianças e adolescentes atendidos em um serviço de toxicologia de referência de um hospital de emergência brasileiro

ABSTRACT Objective: To describe the profile of children and adolescents admitted for exogenous unintentional poisoning in the emergency room and analyze factors associated with subsequent in-hospital admissions. Methods: This is a cross-sectional study based on hospital records of all subjects up to 19 years-old admitted in 2013 at a specialized toxicology service on a major public emergency hospital due to unintentional intoxication (as reported). Accidents with poisonous animals and insects were excluded. Percentages and frequencies were calculated for the qualitative variables, and measures of central tendency and dispersion for the continuous quantitative variables. Multivariate analysis was performed using binary logistic regression to identify variables associated with subsequent in-hospital admissions. Results: In 2013, 353 cases were reported. Poisonings were more frequent in children 0-4 years-old (72.5%) and in boys (55%). The vast majority was of dwellers of the Metropolitan Region of Belo Horizonte (83%), and 90% of the accidental poisonings occurred at home. 82.7% of the poisonings occurred by oral ingestion, especially of medicinal (36.5%) and cleaning products (29.4% of all poisonings). Only 12.2% of the cases resulted in hospitalization, and only one resulted in death. Residing outside Belo Horizonte (OR=5.20 [95%CI 2.37-11.44]) and poisoning by two or more products (OR=4.29 [95%CI 1.33-13.82]) were considered risk factors for hospitalization. Conclusions: Accidental poisonings occurred most frequently by ingestion of household medications and cleaning products, especially among children under 4 years-old. Preventive strategies should be primarily directed for this prevalent profile.

RESUMO Objetivo: Descrever o perfil dos atendimentos de crianças e adolescentes vítimas de intoxicações exógenas acidentais e os fatores associados às internações hospitalares. Métodos: Foi realizado um estudo transversal com base na revisão dos registros de todas as intoxicações acidentais de indivíduos com até 19 anos de idade, atendidos no setor de toxicologia de um hospital público de referência em 2013, excluídos os acidentes com animais peçonhentos e insetos. A intencionalidade da intoxicação foi baseada nos relatos. Foram calculadas percentagens e frequências para as variáveis qualitativas, e medidas de tendência central e de dispersão das variáveis quantitativas contínuas. Foi realizada análise múltipla, utilizando regressão logística binária para identificar as variáveis associadas à internação hospitalar das vítimas atendidas. Resultados: Em 2013, foram identificados 353 atendimentos em crianças e adolescentes. A faixa etária mais prevalente foi a de zero a quatro anos (72,5%), e predominaram indivíduos do sexo masculino (55%). A maioria dos atendimentos foi de pacientes residentes na região metropolitana (83%). Noventa por cento das intoxicações ocorreram nos domicílios; 82,7% se deram pela via oral, especialmente por medicamentos (36,5%) e produtos de limpeza (29,4% de todas as intoxicações). Resultaram em internações 12,2% dos casos, ocorrendo um único óbito. As variáveis associadas à internação foram: residir fora do município sede (razão de chances [OR]=5,20; intervalo de confiança de 95% [IC95%] 2,37-11,44) e o envolvimento de mais do que uma substância na intoxicação (OR=4,29; IC95% 1,33-13,82). Conclusões: O ambiente doméstico é o principal local em que ocorrem as intoxicações em crianças e adolescentes, especialmente por ingestão de medicamentos e produtos de limpeza e abaixo de quatro anos de idade. Esses achados justificam a priorização de ações preventivas direcionadas para esse perfil de acidentes.

Scorpion stings in pregnancy: an analysis of outcomes in 66 envenomed pregnant patients in Iran

Scorpionism is one of the most important health problems in tropical regions, which unfortunately results in thousands of deaths annually. Pregnant women are potential victims in areas with high scorpion-sting prevalence. Limited medical data are available on the effects of scorpion envenomation in pregnant women. This study aimed to examine the effect of scorpion envenomation on pregnancy outcomes in 66 cases. Methods: The present descriptive/analytical cross-sectional study was performed on 66 scorpion-envenomed pregnant women referred to the clinical toxicology unit of Ahvaz Razi Hospital in Iran during 2015-2017. The variables assessed in all cases, via questionnaire and hospital medical records, were: age, patient residency, gestational week, status of the fetus, laboratory anomalies, clinical severity of envenomation, sting site and scorpion species. Pregnancy outcome (miscarriage, stillbirth, preterm birth, normal delivery) and status of the newborns were also evaluated. Data were analyzed using SPSS ® software (version 24.0). Results: The following pregnancy outcomes were recorded from envenomed pregnant women: miscarriage = 1.5% (n = 1), stillbirth = 4.5% (n = 3), preterm birth = 10.6% (n = 7), normal birth = 83% (n = 55). Among participants whose pregnancy led to birth, 11(17.7%) cases had prenatal-neonatal complications. Neonatal complications, including Apgar score less than 8 points at 5 min, were found in 7 (11.3%) preterm birth cases and in 4 (6.4%) normal birth cases, along with birth weight below 2500 g in normal births. A significant relationship was found between adverse pregnancy outcomes and bite location, as well as scorpion species, but no relationship was found with other variables. Conclusion: Envenomation significantly contributes to preterm birth. Moreover, the location of bites and the type of scorpion species have a decisive role in the pregnancy outcome of scorpion-envenomed pregnant women.(AU)

Toxinology in Colombia: contributions of ophidism/scorpionism program and other research groups / Toxinología en Colombia: contribuciones del programa de ofidismo/escorpionismo y de otros grupos de investigación

Background: Toxinology is a sub-field of toxicology dedicated to studying toxins produced by animals, plants and, microorganisms. In Colombia, during the last thirty years, this area has been mainly investigated by Ophidism/Scorpionism Program of Universidad de Antioquia. However, some other research groups have also contributed to our knowledge of venoms and toxins, as well as their related effects and treatments. Objective: to highlight the most significant findings in toxinology made by the Ophidism/Scorpionism Program and other research groups in Colombia. Methods: 119 papers dealing with the history of ophidiology and toxinology in Colombia were collected and analyzed. Results: some useful terms are described to understand toxinology and its scope. Also, a brief history of ophidiology is presented, spanning from the discovery of America until present-day findings. Finally, an overall description of several results related to toxin isolation, characterization, antivenoms, clinical trials, description of new species, proteomic and transcriptomic, among others. The nineteens were characterized by the study of snakebites, their clinic manifestations, and the use of antivenoms. In addition, the ethnopharmacological studies of medicinal plants used in snakebite treatments began to be explored. The 2000s included the newly ethnopharmacology, toxin isolation, clinical trials, inhibitor studies, scorpion venom characterization, and scorpion stings features. Finally, from 2010 until today, proteomic and transcriptomic gave the most important findings. Conclusions: Toxinology works in Colombia have contributed to our knowledge about endemic species, clinical manifestations of snakebite and scorpion stings, and the development of new therapeutic agents. However, we invite Colciencias and other funding agencies to assign more resources to support a higher number of researchers in this field, since snakebite is considered a neglected tropical disease by the World Health Organization, which needs more attention from governments and scholars. Finally, the venoms of some species and their possible mode of action are still unknown to us. Besides, given the complexity of venoms, we are not yet aware of the potential use of toxins in current biomedicine. Thus, studies in toxinology must continue.

Antecedentes: La Toxinología es el campo de la Toxicología que estudia las toxinas producidas por animales, plantas y microorganismos. En Colombia, durante los últimos treinta años, los estudios realizados en esta área han sido desarrollados principalmente por el Programa de Ofidismo/Escorpionismo de la Universidad de Antioquia. Sin embargo, otros grupos de investigación también han contribuido en el conocimiento de venenos, toxinas, efectos y tratamientos. Objetivo: Destacar los hallazgos más relevantes en toxinología realizados por el Programa de Ofidismo Escorpionismo y otros grupos de investigación en Colombia. Métodos: Se recopilaron 119 artículos referentes a la historia de la ofidiología y la toxinología en Colombia. Resultados: Se describieron algunos términos útiles para el entendimiento de la toxinología y sus alcances. Se construyó una breve historia de la ofidiología que inicia con el descubrimiento de América y finaliza con hallazgos recientes. Se realizó una amplia descripción de varios resultados relacionados con el aislamiento y caracterización de toxinas, antivenenos, ensayos clínicos, descripciones de nuevas especies, proteómica y transcriptómica, entre otras. Así, la década de los noventa se caracterizó por el estudio de las mordeduras de serpientes, sus manifestaciones clínicas, el uso de antivenenos y la exploración de la etnofarmacología asociada a las mordeduras de serpiente. La década del 2000 incluyó nuevamente etnofarmacología, el aislamiento de toxinas, ensayos clínicos, estudios sobre inhibidores de toxinas, caracterización de venenos y picaduras de escorpión. Finalmente, desde 2010 hasta hoy, la proteómica y transcriptómica aportaron los hallazgos más importantes. Conclusiones: Los estudios de Toxinología en Colombia han contribuido al conocimiento de especies endémicas, manifestaciones clínicas de mordeduras de serpientes y picaduras escorpiones, y el desarrollo de nuevos agentes terapéuticos. No obstante, se invita a Colciencias y a otras agencias de financiamiento a apoyar la investigación en este campo, ya que es considerada una enfermedad tropical desatendida por la Organización Mundial de la Salud y necesita mayor atención por parte del gobierno e instituciones académicas. Además, dada la complejidad de los venenos, se desconoce el uso potencial de las toxinas en la biomedicina actual. Así, se deben continuar realizando estudios en toxinología.

Estudio exploratorio: relación entre nivel de pobreza y exposiciones agudas a sustancias potencialmente tóxicas en Chile / Exploratory study: Association between the poverty level and acute exposures to potentially toxic substances in Chile

Objetivo: explorar la siguiente pregunta de investigación: ¿De qué manera el nivel socioeconómico de una persona, específicamente el nivel de pobreza se asocia a las características de las exposiciones agudas a sustancias con potencial tóxico en Chile? Métodos: estudio epidemiológico, de diseño transversal y semi-ecológico. Se recopiló información proveniente de una muestra de casos atendidos por el Centro de información toxicológica y de medicamentos de la Pontificia Universidad Católica de Chile (CITUC). La variable independiente corresponde al índice de pobreza comunal de la Encuesta de Caracterización Socioeconómica Nacional (CASEN). Las variables dependientes fueron las características de las exposiciones registradas por el centro toxicológico de acuerdo con el nivel de pobreza de los casos observados. Se analizó el fenómeno a través de tablas cruzadas, cálculo de Odds Ratio con análisis estratificado. Resultados: se observan diferencias significativas en las circunstancias de las exposiciones: las personas que viven en comunas con mayor porcentaje de pobreza muestran más exposiciones intencionales versus aquellas con menor porcentaje de pobreza. Otro hallazgo significativo es el uso del sistema de salud en casos de exposiciones dependiente de la situación socioeconómica. Para las otras variables no se encuentran diferencias significativas entre los grupos comparados. Conclusio-nes: se observa una relación entre el nivel de pobreza y las exposiciones a sustancias potencialmente tóxicas. Los resultados abren una línea investigativa y nuevas interrogantes que podrían generar medidas de control de las intoxicaciones en Chile.Palabras clave:toxicología; exposición a compuestos químicos; envenenamiento; determinantes sociales de la saludAbstractObjective: explore the following research question: How is a person's socio-economic level, the poverty, associated with the characteristics of acute exposures to substances with toxic potential in Chile?. Methods: epidemiological, cross-sectional and semi-ecological study. Information collected from a sample of cases attended by the Centre for Toxicological and Drug Information of the Pontifical Catholic University of Chile (CITUC). The independent variable corresponds to the communal poverty index of the National Socioeconomic Characterization Survey. Dependent variables were the characteristics of the exposures recorded by the toxicological center according to the poverty level of the cases observed. The phenomenon is analyzed through cross-tables, calculating Odds Ratios with stratified analysis. Results: significant differences observed in the circumstances of exposures: people living in communes with higher poverty rates show more intentional exposures versus those with lower poverty rates. Another significant finding is the use of the health system in cases of exposures, depending on the socio-economic situation. For the other variables, there are no significant differences between the compared groups. Conclusions: there is a link between the poverty level and acute exposures to potentially toxic substances. The results open a research line and new questions that could generate measures to control poisonings in Chile.Keywords:poisoning; social determinants of health; poverty(1) Centro de Información Toxicológica y de Medicamentos, Pontificia Universidad Católica de Chile.(2) Unidad docente de Farmacología y Toxicología, Facultad de Medicina, Pontificia Universidad Católica de Chile.(3) Departamento de Salud del Adulto y Senescente, Escuela de Enfermería, Pontificia Universidad Católica de Chile.(4) Departamento de Laboratorios Clínicos, Facultad de Medicina, Pontificia Universidad Católica de Chile.(5) Departamento de Salud Pública, Facultad de Medicina, Pontificia Universidad Católica de Chile.Autor de correspondencia: Juan Carlos Ríos jriosb@uc.clFecha de envío: 19 de agosto de 2019 - Fecha de aceptación: 26 de diciembre de 2019

Intoxicaciones agudas por medicamentos consumidos con fines de abuso / Acute poisoning due to medications used for abuse purposes

Introducción: El consumo de sustancias con fines de abuso y entre ellas los medicamentos, se ha incrementado a nivel mundial. Objetivo: Caracterizar a los pacientes atendidos por intoxicaciones agudas debido a medicamentos consumidos con fines de abuso. Métodos: El universo estuvo constituido por consultas de 961 pacientes, realizadas al servicio de información toxicológica de urgencia del Centro Nacional de Toxicología, durante el período 2010 al 2014. Fueron todas las intoxicaciones agudas por consumo de sustancias con fines de abuso. La serie incluyó 578 pacientes con intoxicaciones agudas con fines de abuso, donde el agente causal fueron los medicamentos. Se recopilaron los datos sociales y biológicos, formas de consumo, grupos farmacológicos, manifestaciones clínicas, aspectos de la toxicocinética y la toxicodinamia. Resultados: Los consumidores de medicamentos con fines de abuso, representaron el 60,14 por ciento de las consultas por consumo de sustancias con fines de abuso. El grupo etario de hasta 20 años fue el de mayor consumo (360 consultas; 62,28 por ciento) y el sexo masculino el más frecuente (447 pacientes; 77,3 por ciento). La combinación de medicamentos más alcohol fue la forma de consumo más empleada (292 consultas; 50,5 por ciento). La carbamazepina fue el medicamento más consumido (305 consultas; 52,7 por ciento). Conclusiones: Predominó la intoxicación aguda en el grupo etario de 10-20 años y del sexo masculino. La ingestión de medicamentos más alcohol, fue la forma de consumo más empleada. El grupo farmacológico más utilizado con fines no médicos, fue el de los anticonvulsivantes (carbamazepina), seguido de las benzodiacepinas y los opiáceos. Las manifestaciones clínicas que predominaron fueron del sistema neurológico, seguido del cardiovascular y el digestivo(AU)

ABSTRACT Introduction: The consumption of substances for the purpose of abuse, including drugs, has increased worldwide. Objective: To characterize patients treated for acute intoxications due to drugs consumed for abuse purposes. Methods: The universe was constituted by consultations of 961 patients, made to the emergency toxicology information service of the National Center of Toxicology, during the period from 2010 to 2014. They were all acute intoxications due to the consumption of substances for the purpose of abuse. The series included 578 patients with acute intoxications for abuse, where the causative agent was medication. We collected social and biological data, forms of consumption, pharmacological groups, clinical manifestations, aspects of toxicokinetics and toxicodynamics. Results: Consumers of medications for the purpose of abuse accounted for 60.14 percent of consultations for the consumption of substances for the purpose of abuse. The age group of up to 20 years consumed the most (360 consultations, 62.28 percent) and the most frequent was the male sex (447 patients, 77.3 percent). The combination of drugs plus alcohol was the most used form of consumption (292 consultations, 50.5 percent). Carbamazepine was the most commonly used medication (305 consultations, 52.7 percent). Conclusions: Acute intoxication predominated in the age group of 10-20 years and of the male sex. The ingestion of drugs plus alcohol was the most used form of consumption. The most used pharmacological group for non-medical purposes was the anticonvulsant group (carbamazepine), followed by benzodiazepines and opiates. The clinical manifestations that predominated were of the neurological system, followed by cardiovascular and digestive(AU)

Herramientas farmacométricas para antichagásicos, aplicadas a estudios fármaco y toxicocinéticos en contexto pediátrico / Pharmacometric tools for antihagasics, applied to drug and toxicokinetic studies in a pediatric context

La enfermedad de Chagas afecta aproximadamente a 10 millones de personas en Sudamérica y 1,5 millones en la Argentina. La transmisión congénita es la más importante en áreas urbanas. Existen dos drogas aprobadas para el tratamiento: nifurtimox (Laboratorios Bayer) y benznidazol (BNZ) (Laboratorios Roche, LAFEPE y Elea) que fueron desarrolladas hace más de 40 años y cuya farmacología y metabolismo en humanos han sido poco estudiados. La información disponible es virtualmente inexistente en niños y mujeres embarazadas. Se busca aportar estudios sistemáticos hacia una farmacoterapéutica racional en niños ya que empíricamente ha demostrado gran efectividad. Se desarrollaron métodos bioanalíticos aplicables a matrices biológicas como plasma, orina y leche materna para las drogas madres y la identificación de metabolitos en muestras de pacientes bajo terapéutica. La farmacocinética poblacional pediátrica descripta aquí para BNZ es concluyente respecto de sus diferencias con la farmacocinética en adultos. Se identificaron tres compuestos presentados como metabolitos del BNZ. La transferencia de dicho fármaco a la leche materna no supone riesgo para el lactante. Estos resultados brindan información para mejorar los protocolos de tratamiento existentes buscando una farmacoterapéutica adaptada a la edad y un uso más seguro de los fármacos en niños y eventualmente en adultos.

Chagas disease affects approximately 10 million people in South America and 1.5 million in Argentina. Congenital transmission is most important in urban areas. There are two drugs approved for treatment: nifurtimox (Bayer) and benznidazole (BNZ) (Roche, LAFEPE, Elea),developed more than 40 years ago. Their pharmacology and metabolism in humans have been seldom studied. The information available on children and pregnant women is virtually non-existent. The aim of this study is to provide systematic studies towards a rational pharmacotherapeutic sin children, which has been empirically proven to be highly effective. Bioanalytical methods were developed for plasma, urine and breast milk for parent drugs and for the identification of their metabolites in samples of patients under treatment. The pediatric population pharmacokinetics described here for BNZ is conclusive about their differences from adult pharmacokinetics. Three compounds presented as BNZ metabolites were identified. The transfer of this drug to the breast milk does not present a risk to the infant. These evidences offer information to improve the existing treatment protocols, seeking a pharmacotherapy adapted to the age and a safer use of the drugs in children and eventually in adults.

A doença de Chagas afeta aproximadamente 10 milhões de pessoas na América do Sul e 1,5 milhão na Argentina. A transmissão congênita é a mais importante em áreas urbanas. Existem dois medicamentos aprovados para o tratamento: nifurtimox (Laboratórios Bayer) e benznidazol (BNZ) (Laboratórios Roche, LAFEPE e Elea), desenvolvidas há mais de 40 anos, e sua farmacologia e seu metabolismo em humanos têm sido pouco estudados. A informação disponível é praticamente inexistente em crianças e mulheres grávidas. O objetivo é fornecer estudos sistemáticos para uma farmacoterapêutica racional em crianças visto que foram comprovadas empiricamente como sendo altamente eficazes. Métodos bioanalíticos aplicáveis a matrizes biológicas como plasma, urina e leite materno para fármacos-mãe e para a identificação de metabólitos em amostras de pacientes em tratamento terapêutico foram desenvolvidos. A farmacocinética da população pediátrica aqui descrita para BNZ é conclusiva em relação às suas diferenças com a farmacocinética de adultos. Três compostos apresentados como metabólitos do BNZ foram identificados. A transferência do referido medicamento para o leite materno não representa risco para o lactente. Essas evidências oferecem informações para melhorar os protocolos de tratamento existentes, buscando uma farmacoterapia adaptada à idade e um uso mais seguro dos medicamentos em crianças e eventualmente em adultos.

Micetismos: Parte 3: Síndromes tempranos gastrointestinales / Mycetisms Part 3: Early Gastrointestinal Syndromes

En esta Parte 3 de la serie de cuatro artículos sobre micetismos se analizan los síndromes tempranos con síntomas gastrointestinales que se caracterizan por presentar un período de latencia muy corto, de menos de 6 horas después de la ingestión de los macromicetos. Los restantes síndromes tempranos con sintomatología compleja serán tratados en la Parte 4 de la serie. Actualmente se conocen más de 200 especies responsables de síndromes gastrointestinales, pero en este trabajo se abordarán solamente diez ejemplos que involucran los géneros Boletus [Boletus satanas (o Rubroboletus satanas) y Boletus venenatus (o Neoboletus venenata)], Hypholoma, Agaricus (Agaricus xanthodermus), Omphalotus, Lactarius, Russula, Entoloma, Chlorophyllum (Chlorophyllum molybdetes) y Leucoprinus (Leucoprinus birnbaumii). Las toxinas involucradas en estos casos presentan gran variedad estructural, desde proteínas hasta terpenoides, en particular sesquiterpenoides y triterpenoides, vinilglicina, fenol y azocompuestos, pero todas generan la misma sintomatología. Estas sustancias y otros componentes químicos de los hongos suelen ser indigestos, con una susceptibilidad variable entre los consumidores. El tratamiento es de apoyo y es estrictamente para esos casos con cuadros más graves de deshidratación. Normalmente, los casos evolucionan favorablemente después de 12 a 48 horas. Se analizan los síntomas, las toxinas involucradas, los mecanismos de acción, cuando se conocen y las especies causantes de los micetismos.

This part 3 of the series of four articles on mushroom poisoning refers to early-onset gastrointestinal syndromes, which are characterized by a very short latency period of less than 6 hours after mushroom ingestion. The remaining early-onset syndromes with complex symptoms will be treated in Part 4 of the series. Currently, more than 200 species responsible for gastrointestinal syndromes are known, but in this paper only ten examples will be addressed involving the genera Boletus [e.g., Boletus satanas (or Rubroboletus satanas), and Boletus venenatus (or Neoboletus venenata)], Hypholoma, Agaricus (e.g., Agaricus xanthodermus), Omphalotus, Lactarius, Russula, Entoloma, Chlorophyllum (e.g., Chlorophyllum molybdetes), and Leucoprinus (e.g., Leucoprinus birnbaumii). The toxins involved in these cases have a great structural variety, from proteins to terpenoids, in particular sesquiterpenoids and triterpenoids, vinylglycine, phenol, and azocompounds, but all show the same symptoms. These substances and other mushroom chemical constituents are usually indigestible, with varying consumer susceptibility. The treatment is supportive and is strictly for those cases with more severe dehydration. Usually, the cases progress favourably after 12 to 48 hours.The symptoms, toxins involved, mechanisms of action when known, and the species of mushrooms responsible for the mycetisms are analysed.

Nesta parte 3 da série de quatro artigos sobre intoxicação por cogumelos são analisadas as síndromes precoces com sintomas gastrointestinais que se caracterizam por apresentar um período de latência muito curto, de menos de 6 horas, após a ingestão de cogumelos. As síndromes precoces restantes com sintomatologia complexa serão tratadas na Parte 4 da série. Atualmente, são conhecidas mais de 200 espécies responsáveis por síndromes gastrointestinais, mas neste trabalho serão abordados apenas dez exemplos que envolvem os gêneros Boletus [Boletus satanas (ou Rubroboletus satanas) e Boletus venenatus (ou Neoboletus venenata)], Hypholoma, Agaricus (Agaricus xanthodermus), Omphalotus, Lactarius, Russula, Entoloma, Chlorophyllum (Chlorophyllum molybdetes) e Leucoprinus (Leucoprinus birnbaumii). As toxinas envolvidas nestes casos têm uma grande variedade estrutural, desde proteínas até terpenóides, em particular sesquiterpenóides e triterpenóides, vinilglicina, fenol e azo compostos, mas todas apresentam a mesma sintomatologia. Essas substâncias e outros constituintes químicos dos cogumelos costumam ser indigestos, com uma suscetibilidade variável entre aqueles que os consomem. O tratamento é de suporte e é rigorosamente para esses casos com quadros mais graves de desidratação. Normalmente, os casos evoluem favoravelmente após 12 a 48 horas. São analisados os sintomas, as toxinas envolvidas, os mecanismos de ação, quando conhecidos, e as espécies de cogumelos responsáveis pelas intoxicações.