Acute Pesticide Poisoning in Tobacco Farming, According to Different Criteria.

BACKGROUND: Brazil is one of the world's largest pesticide consumers, but information on pesticide poisoning among workers is scarce. OBJECTIVE: To evaluate acute pesticide poisoning among tobacco growers, according to different criteria. METHODS: This was a two-step cross-sectional study with 492 pesticide applicators. It used a 25 question pesticide-related symptoms (PRS) questionnaire and medical diagnosis for comparison with toxicological assessment. Associations were evaluated using Poisson regression. RESULTS: 10.6% reported two or more PRS, while 8.1% reported three or more. Furthermore, 12.2% received a medical diagnosis of poisoning. According to toxicologists, possible cases accounted for 14.2% and probable cases for 4.3%. PRS increased during the period of greater exposure. Those exposed to dithiocarbamates, sulfentrazone, pyrethroids, fipronil and iprodione exhibited more PRS. The number of exposure types, multi-chemical exposure, clothes wet with pesticides and spillage on the body/clothes were associated with acute poisonings. All criteria showed sensitivity greater than 79% for probable cases but only greater than 70% for medical diagnosis when compared to possible cases, presenting substantial Kappa agreement. CONCLUSION: The prevalence of acute pesticide poisoning is much higher than officially recorded. Trained physicians can screen for pesticide poisoning. It is necessary to improve workers' education to reduce pesticide use and exposure to them.

Household pollution and COVID-19: irrelevant association?

Evidence supports the link between air pollution and coronavirus disease 2019 (COVID-19). Therefore, exposure to indoor pollution (IDP) is likely to be associated with the disease. The poor, refugees, and migrant workers who live in feeble conditions are the most vulnerable. The pandemic has caused many people to remain indoors, especially at-risk individuals (e.g., the elderly, diabetics, obese, cardiac, and chronic lung disease patients). Home isolation may be an underlying factor to other health problems among these populations if the place where they are socially isolating is not adequately ventilated. Therefore, understanding the consequences of the relationship between IDP and the COVID-19 pandemic is essential.

Acute generalized exanthematous pustulosis associated with spider bite.

Acute generalized exanthematous pustulosis (AGEP) is an acute febrile rash, usually induced by drugs, which recently has been linked to spider bite. We report a case of a male patient, 48 years old, with an erythematous rash accompanied by fever and small non-follicular pustules. He reported previous pain in the buttock with the onset of a necrotic plaque. The lesion was compatible with spider bite of the genus Loxosceles. According to the EuroSCAR group instrument, the patient scored +10 indicating definite diagnosis of AGEP. As the patient had a compatible lesion and had no other triggers of AGEP, in an Loxosceles endemic area, the AGEP would be associated with spider bite, as described in other publications.

Acute generalized exanthematous pustulosis associated with spider bite

Abstract: Acute generalized exanthematous pustulosis (AGEP) is an acute febrile rash, usually induced by drugs, which recently has been linked to spider bite. We report a case of a male patient, 48 years old, with an erythematous rash accompanied by fever and small non-follicular pustules. He reported previous pain in the buttock with the onset of a necrotic plaque. The lesion was compatible with spider bite of the genus Loxosceles. According to the EuroSCAR group instrument, the patient scored +10 indicating definite diagnosis of AGEP. As the patient had a compatible lesion and had no other triggers of AGEP, in an Loxosceles endemic area, the AGEP would be associated with spider bite, as described in other publications.

The EXTRIP (EXtracorporeal TReatments In Poisoning) workgroup: guideline methodology.

Extracorporeal treatments (ECTRs), such as hemodialysis and hemoperfusion, are used in poisoning despite a lack of controlled human trials demonstrating efficacy. To provide uniform recommendations, the EXTRIP group was formed as an international collaboration among recognized experts from nephrology, clinical toxicology, critical care, or pharmacology and supported by over 30 professional societies. For every poison, the clinical benefit of ECTR is weighed against associated complications, alternative therapies, and costs. Rigorous methodology, using the AGREE instrument, was developed and ratified. Methods rely on evidence appraisal and, in the absence of robust studies, on a thorough and transparent process of consensus statements. Twenty-four poisons were chosen according to their frequency, available evidence, and relevance. A systematic literature search was performed in order to retrieve all original publications regardless of language. Data were extracted on a standardized instrument. Quality of the evidence was assessed by GRADE as: High = A, Moderate = B, Low = C, Very Low = D. For every poison, dialyzability was assessed and clinical effect of ECTR summarized. All pertinent documents were submitted to the workgroup with a list of statements for vote (general statement, indications, timing, ECTR choice). A modified Delphi method with two voting rounds was used, between which deliberation was required. Each statement was voted on a Likert scale (1-9) to establish the strength of recommendation. This approach will permit the production of the first important practice guidelines on this topic.

[Environmental chemical hazards and child health]. / Riscos químicos ambientais à saúde da criança.

OBJECTIVES: To review the recent medical literature on environmental chemical hazards to child health. SOURCES OF DATA: Articles published on this subject between 1999 and 2005 were searched in the MEDLINE database. Books, manuals and statements on child environmental health, issued by institutions such as the American Academy of Pediatrics and the World Health Organization, were also reviewed. SUMMARY OF THE FINDINGS: There has been a growing concern in the last few years with the exposure of children to environmental chemicals. Around 85,000 synthetic chemicals are produced today, and 2,800 of them are mass-produced. There is little knowledge regarding their effects on developing organisms. Children have a greater exposure to environmental pollutants than adults, because their metabolic needs and behaviors (e.g.: crawling, bringing objects to the mouth, playing closer to the ground) put them at special risk of contact with chemicals when they breathe, eat, drink or play. Heavy metals, pesticides, persistent organic pollutants and, at home, environmental tobacco smoke have been associated with the increasing number of diseases such as asthma, neurodevelopmental disorders and childhood cancer. CONCLUSION: Screening of risk situations using tools such as Environmental History has been stimulated alongside a greater commitment of pediatricians towards measures that can reduce the exposure of children and adolescents to environmental chemicals.

Riscos químicos ambientais à saúde da criança / Environmental chemical hazards and child health

OBJETIVO: Rever, na literatura médica recente, as informações disponíveis sobre os riscos da exposição de crianças a agentes químicos no meio ambiente. FONTES DOS DADOS: Foi realizada uma busca de artigos publicados sobre o tema na base de dados bibliográficos MEDLINE entre os anos de 1999 e 2005 e também em livros, manuais e recomendações publicados nos últimos anos por instituições como a Academia Americana de Pediatria e a Organização Mundial da Saúde, abordando saúde ambiental com foco na criança. SíNTESE DE DADOS: Nos últimos anos, observa-se uma preocupação crescente em todo o mundo com os riscos relacionados à exposição de crianças a agentes químicos presentes no meio ambiente. Em torno de 85.000 produtos químicos sintéticos são produzidos nos dias de hoje, dos quais 2.800 são considerados de alto volume de produção. Sabe-se ainda muito pouco a respeito de seus efeitos sobre organismos em desenvolvimento. Crianças, por conta de suas características fisiológicas (maior demanda de água e alimentos) e hábitos (como engatinhar, levar objetos a boca, brincar próximo ao solo) estão particularmente expostas à contaminação por agentes químicos presentes em água, ar e solo. Agentes como metais pesados, pesticidas, poluentes orgânicos persistentes e contaminantes do ambiente doméstico, como a fumaça do tabaco, têm sido cada vez mais relacionados ao aumento da ocorrência de doenças como asma, distúrbios neurológicos e comportamentais e câncer infantil. CONCLUSÃO: Estimula-se a identificação de situações de risco utilizando instrumentos como a anamnese ou história ambiental, bem como o envolvimento dos pediatras na busca da redução da exposição de crianças e adolescentes a agentes químicos.