Short-Term Risk of Unintentional Poisoning After New Initiation of Central Nervous System Medications in Swedish Older Adults: A Register-Based Case-Crossover Study.

INTRODUCTION: Medications acting on the central nervous system (CNS) are common causes of medication-related unintentional poisoning. Little is known about the short-term effects of CNS medications on unintentional poisoning. OBJECTIVE: This study aims to determine the short-term association between newly prescribed CNS drugs and unintentional poisoning. METHODS: We conducted a register-based case-crossover study of 9354 patients (age ≥ 50 years) with first-time hospitalization for unintentional poisoning in Sweden between 1 July, 2006 and 30 September, 2018. Newly initiated CNS medication was identified based on dispensations from the Swedish Prescribed Drug Register during 28 days prior to the unintentional poisoning event and compared with dispensations during an equally long control period. Conditional logistic regression was used to estimate the odds ratio and 95% confidence intervals. RESULTS: After a newly initiated CNS treatment, we found an increased risk of unintentional poisoning during the following 2 weeks with an odds ratio (95%) being 2.52 (1.98-3.21) and 1.47 (1.08-2.00) for the first and second week, respectively. The risk was elevated in all sub-groups but to a different degree with odds ratio ranges of 1.73-2.47 by age, 1.91-2.21 by sex, 1.40-2.30 by Charlson Comorbidity Index, 2.00-2.07 by neuropsychiatric comorbidity, and 1.63-2.82 by number of other medications. CONCLUSIONS: The risk of unintentional poisoning doubles in 2 weeks following a new initiation of CNS drugs and the risk is increased across a range of population groups. Clinicians should carefully monitor signs of poisoning after such initiation among not only multimorbid older adults but also those with less comorbidity and polypharmacy.

Genetic profile for the detection of susceptibility to poisoning by exposure to pesticides.

INTRODUCTION: In humans, there are sets of genes that encode enzymes that decrease or increase the risks derived from exposure to pesticides. These include DNA repair genes (XRCC1, OGG1 and XRCC4); pesticide metabolizers (GSTP1 and PON1), and genes that act against oxidative stress (SOD2 and NQO1). OBJECTIVE: The aim of this literature review is to provide information about the genes involved in the defence systems against exposure to pesticides, as well as their polymorphisms, functions, and general characteristics of the encoded enzymes. MATERIAL AND METHODS: Information was obtained from scientific articles published between 2015-2020 in the PubMed database (https://pubmed.ncbi.nlm.nih.gov). RESULTS: Genes related to the defence processes against pesticides present single-nucleotide polymorphisms (SNPs) with allelic variants that affect the expressions or structures of the encoded enzymes, negatively altering their activities. If we knew the genetic profile that includes polymorphisms of DNA-repairing genes, metabolizing genes, and genes against oxidative stress in subjects exposed to pesticides, we would also know about their susceptibility to poisoning caused by these chemicals. CONCLUSIONS: The genes could be used to propose a genetic profile in farmers exposed to various pesticides, including 10 gene polymorphisms involved in susceptibility to various pathologies related to DNA repair, xenobiotic metabolism, and oxidative stress. It could also be useful as a preventive measure to identify susceptibility to pesticide poisoning.

Poisoning in domestic cats in Brazil: toxicants, clinical signs, and therapeutic approaches / [Intoxicação em gatos domésticos no Brasil: toxicantes, sinais clínicos e abordagens terapêuticas]

This study evaluated the most common toxic agents affecting domestic cats, the clinical signs of toxicity, and the therapeutic approaches for recovery. A survey on poisoning in cats was conducted among small animal veterinary practitioners from 2017 to 2018. Of the 748 completed questionnaires, 543 (72.6%) were evaluated. Pesticides and household cleaning supplies were the most common causes of poisoning in cats. The toxicant groups included pesticides and household cleaning supplies (organophosphates), human drugs (acetaminophen), plants/plant derivatives (lily), and veterinary drugs (tramadol). The major clinical signs for these four groups of toxicants were (1) acetaminophen poisoning, which caused oxidative erythrocyte damage; (2) muscarinic and nicotinic cholinergic syndrome, which resulted from organophosphate poisoning; (3) acute kidney injury, which resulted from intoxication of lily; and (4) serotonin syndrome, which resulted from tramadol toxicosis. Interventions for treating poisoning in cats were based on the clinical presentation of animals. In the present study, the significant toxins identified to be dangerous for cats were characterized using the obtained data in Brazil as well as the main associated clinical signs and therapy recommended by veterinarians.(AU)

Objetiva-se com este trabalho caracterizar os principais toxicantes para gatos domésticos, bem como os prevalentes sinais clínicos e a terapêutica associada. Uma pesquisa sobre envenenamento em gatos foi realizada entre médicos veterinários no período de 2017 a 2018. Dos 748 questionários preenchidos, 543 (72,6%) foram avaliados. Pesticidas e domissanitários foram os principais causadores de intoxicação em gatos. Entre os grupos tóxicos, destacaram-se, na categoria pesticidas e domissanitários (organofosforados), medicamentos humanos (acetaminofeno), plantas e derivados de planta (lírio) e medicamentos veterinários (tramadol). Os principais sinais clínicos para os quatro grupos de substâncias tóxicas foram: (1) intoxicação por acetaminofeno, que causou dano eritrocitário oxidativo; (2) síndrome colinérgica muscarínica e nicotínica, resultante do envenenamento por organofosforado; (3) lesão renal aguda, causada pela intoxicação por lírio; e (4) síndrome serotoninérgica, resultante da exposição ao tramadol. As intervenções realizadas para o tratamento dos envenenamentos foram justificáveis mediante a apresentação clínica dos animais. Por meio dos dados obtidos, puderam-se caracterizar os principais tóxicos para gatos no Brasil, bem como os principais sinais clínicos associados e a terapêutica preconizada pelos médicos veterinários.(AU)

Electronic cigarette explosion/burn and poisoning related emergency department visits, 2018-2019.

BACKGROUND: Electronic cigarette (ECIG) use has increased dramatically in recent years. Negative ECIG-related acute health effects have included explosion/burn injuries from battery failure and child ingestion/poisoning of liquid nicotine. However, there is an urgent need for continued surveillance of ECIG health effects to determine whether these outcomes change as ECIG devices and liquids rapidly evolve. This study updates national estimates of ECIG-related emergency department (ED) visits and describes the context of these injuries. METHODS: A keyword search of case narrative text was used to identify ECIG-related ED visits in the National Electronic Injury Surveillance System (NEISS) data. These cross-sectional data are designed to be weighted to provide national estimates of consumer product-related injuries treated in EDs. ECIG-related injuries were described and categorized, and sampling weights applied to model national estimates. RESULTS: From 2015 to 2019 there were an estimated 3369 ED visits from ECIG explosion/burn injuries (95% CI = 2020, 4718), and an estimated 676 visits from 2019 alone (95% CI = 315, 1036). In 2018-2019, there were an estimated 1550 cases of children <5 years old ingesting ECIG liquids (95% CI = 778, 2322). CONCLUSIONS: Despite a notable shift in the US market towards ECIG devices that use lower electrical power and disposable "pods" (e.g., JUUL), liquid chemical ingestion among young children and ECIG explosion/burn injuries persist. Improved product regulations are urgently needed to prevent negative health effects caused by ECIGs, as well as prevent their ingestion and use by children.

Poisoning exposure cases involving e-cigarettes and e-liquid in the United States, 2010-2018.

Introduction: Poisoning exposure cases involving e-cigarettes have increased since 2010, coinciding with increasing rates of e-cigarette use in the United States (US). Given the increasing prevalence of e-cigarette use and ever-changing product designs, particularly the development of new products with high nicotine levels, it is important to conduct ongoing surveillance of poisoning exposure cases involving e-cigarettes. The objective of this study is to describe trends and characteristics of poisoning exposure cases involving e-cigarettes and e-liquids reported to poison control centers in the US.Methods: We analyzed e-cigarette exposure cases from the National Poison Data System (NPDS) during 2010-2018 by year and other characteristics.Results: The annual number of e-cigarette exposure cases increased greatly between 2010 and 2014, reaching a peak of 3742 in 2014, and then decreasing each year between 2015 and 2017. Between 2017 and 2018, the overall number of e-cigarette exposure cases increased by 25.0% (from 2320 to 2901). Approximately two-thirds (64.8%) of all cases were in children under age five, and 14.7% were in children aged 5-17 years or young adults aged 18-24 years. A small proportion of cases developed life-threatening symptoms (0.1%); and cases with more serious medical outcomes tended to be exposed to a higher e-liquid or nicotine quantity.Conclusions: Annual declines in e-cigarette exposure cases between 2015 and 2017 did not continue in 2018. The rapid changes in the occurrence of poisoning exposure cases involving e-cigarettes coupled with the development of new tobacco products and ever-evolving tobacco use landscape underscore the importance of continued surveillance of these poisoning exposure cases. Continuous monitoring of these poisoning exposure cases may inform efforts aimed at preventing e-cigarette poisoning exposures.

Increased overall and cause-specific mortality associated with disability among workers' compensation claimants with low back injuries.

BACKGROUND: Mortality tends to be higher among people who do not work than among workers, but the impact of work-related disability on mortality has not been well studied. METHODS: The vital status through 2015 was ascertained for 14 219 workers with an accepted workers' compensation claim in West Virginia for a low back injury in 1998 or 1999. Mortality among the cohort compared with the West Virginia general population was assessed using standard life table techniques. Associations of mortality and disability-related factors within the cohort were evaluated using Cox proportional hazards regression. RESULTS: Compared to the general population, mortality from accidental poisoning was significantly elevated among the overall cohort and lost-time claimants. Most deaths from accidental poisoning in the cohort were due to drug overdoses involving opioids. Mortality from intentional self-harm was also significantly elevated among lost-time claimants. In internal analyses, overall mortality and mortality from cancer, heart disease, intentional self-harm, and drug overdoses involving opioids was significantly associated with lost time. Overall mortality and mortality from drug overdoses involving opioids were also significantly associated with amount of lost time, permanent partial disability, and percent permanent disability. Heart disease mortality was also significantly associated with the amount of lost time. CONCLUSIONS: The results suggest that disability itself may impact mortality risks. If confirmed, these results reinforce the importance of return to work and other efforts to reduce disability.

Demografia, óbitos e indicadores de agravamento nas internações por intoxicações medicamentosas entre menores de 5 anos no Brasil / Demographics, deaths and severity indicators in hospitalizations due to drug poisoning among children under age five in Brazil

RESUMO: Introdução: No Brasil, os medicamentos são os principais agentes causadores de intoxicação, e o maior número de casos desse problema envolve menores de 5 anos. Assim, o objetivo deste estudo foi descrever as internações por intoxicação medicamentosa nessa população quanto a sua demografia, óbitos e indicadores de agravamento. Métodos: Verificou-se a frequência das internações por intoxicação medicamentosa entre 2003 e 2012, utilizando os dados do Sistema de Informação Hospitalar. As variáveis utilizadas foram ano, sexo, idade, município de residência e de internação, evolução do paciente, diagnóstico principal, diagnóstico secundário, natureza do estabelecimento de saúde e valor referente aos gastos de unidade de terapia intensiva. Resultados: Ocorreram 17.725 internações por intoxicação medicamentosa em menores de 5 anos de idade, com o predomínio do sexo masculino e de crianças de 2 anos. As internações fora do município de residência deram-se em 25% dos casos, com predomínio da Região Nordeste. A proporção de óbitos nas internações foi de 0,4%, com maior número de óbitos na Região Sudeste. Conclusão: Apesar da diminuição do número de internações no período, permaneceram disparidades regionais que podem ser atenuadas com a oferta de atenção especializada às intoxicações medicamentosas nos municípios, ampliando o acesso a cuidados de maior complexidade.

ABSTRACT: Introduction: In Brazil, drugs are the main causative agents of poisonings, and children under age five are the group with the highest number of cases. The objective of the present study was to describe hospitalizations due to drug poisoning in this population regarding demographics, deaths and worsening indicators in hospitalizations. Methods: The frequency of hospitalizations for drug poisoning between 2003 and 2012 was verified using data from the Hospital Information System. The study variables were year, gender, age, place of residence and hospitalization, patient follow-up, main diagnosis, secondary diagnosis, nature of the health establishment and amount related to Intensive Care Unit expenses. Results: There were 17,725 hospitalizations due to drug poisoning in children under five, predominantly two-year-old male children. The hospitalizations outside the city of residence occurred in 25% of the cases, with predominance in the Northeastern region. The proportion of deaths in hospitalizations was 0.4%, with a higher number of deaths in the Southeastern region. Conclusion: Despite the decrease in the number of hospitalizations in the period, regional disparities remained, which could be attenuated with the provision of specialized attention to drug poisonings in municipalities, expanding the access to a more complex care.

Actualización en el manejo de intoxicación sistémica por anestésicos locales / Local anesthetics systemic toxicity: update in management

Systemic toxicity by local anesthetics an adverse reaction that occurs when local anesthetics (AL) reach significant systemic levels, primarily affects the central and cardiovascular nervous system, and while it is an infrequent event, it can be potentially fatal. The main determinant of the toxicity is the plasma concentration of LA, especially the free fraction. The most serious symptoms are seizures and cardiac arrest, which can occur with the administration of any LA. Bupivacaine is the most cardiotoxic of the commonly used LAs, followed in decreasing order by levobupivacaine, ropivacaine and lidocaine.

La intoxicación sistémica por anestésicos locales (ISAL), una reacción adversa que ocurre cuando los anestésicos locales (AL) alcanzan niveles sistémicos significativos, afecta principalmente al sistema nervioso central y cardiovascular, y si bien, es un evento infrecuente, puede ser potencialmente fatal. El principal determinante de la ISAL es la concentración plasmática de AL, en especial la fracción libre. Los síntomas más graves son las convulsiones y paro cardíaco, los cuales pueden ocurrir con la administración de cualquier AL. La bupivacaína es el más cardiotóxico de los AL comúnmente utilizados, seguido en orden decreciente por levobupivacaína, ropivacaína y lidocaína.

Brote de intoxicación alimentaria en un jardín de infantes de la provincia de Buenos Aires / Food poisoning outbreak in a kindergarten in the Province of Buenos Aires, Argentina

Resumen El 27 de noviembre de 2008 ocurrió un brote de intoxicación alimentaria asociado al consumo de salpicón de ave en un jardín de infantes de Hurlingham, provincia de Buenos Aires. Treinta y siete niños y 10 adultos presentaron síntomas gastrointestinales. Cinco niños fueron internados con signos de deshidratación, y uno de ellos requirió cuidados intensivos. Se aisló Staphylococcus aureus subsp. aureus del alimento involucrado, de 4/5 muestras de materia fecal de pacientes y de 3/5 manipuladores (nariz del manipulador 1, manos de manipuladores 2 y 3). Las cepas aisladas portaban los genes que codifican las enterotoxinas SEA y SED. Por electroforesis de campo pulsado con la enzima SmaI, los patrones de macrorrestricción presentaron 100% de similitud. La investigación oportuna del brote permitió identificar al agente causal de la intoxicación, determinar las fallas en la elaboración del alimento e implementar las medidas correctivas correspondientes.

Abstract On November 27, 2008, a foodborne disease outbreak associated with the consumption of chicken salad occurred in a kindergarten in the District of Hurlingham, Province of Buenos Aires. Thirty-seven children and 10 adults with gastrointestinal symptoms were affected. Five children were hospitalized with signs of dehydration, one of them requiring intensive care. Staphylococcus aureus subsp. aureus was isolated from the mentioned food in 4 out of 5 stool specimens from the patients, and in 3 out of 5 food handlers (nose of food handler #1, hands of food handlers #2 and 3). The isolates carried the genes coding for enterotoxins SEA and SED. The macrorestriction patterns showed 100% similarity by pulsed-field gel electrophoresis using the SmaI enzyme. A timely outbreak investigation allowed us to identify the causative agent of the food poisoning as well as the failures in food processing and to implement corrective measures.

A study of the predictive factors of mortality in acute poisoning with aluminum phosphide with special reference to echocardiography and SOFA score.

Aluminum phosphide (AlP) is considered now one of the most common causes of poisoning among agricultural pesticides. Poisoning with AlP is extremely toxic to humans with high mortality rate. The aim of this work was to evaluate the prognostic factors and outcome of acute aluminum phosphide poisoning in Alexandria Main University Hospital during a period of 6 months from 1 November 2017 until the end of April 2018, highlighting the role of SOFA score and echocardiography in predicting the mortality. The prospective study was conducted on all patients admitted with acute AlP poisoning to Alexandria Main University Hospital for those 6 months. Patients' data were collected in a special sheet and included biosocial data, medical history, poisoning history, complete medical examination, investigations, duration of hospital stay, and the outcome. All patients were assessed according to SOFA score on admission. Thirty patients were admitted during the period of the current study. Females outnumbered males in all age groups with a sex ratio of 2.75:1. The mean age of patients was 22.77 ± 12.79 years. 96.6% of patients came from rural areas. 93.3% of the cases were exposed to poisoning at home, where suicidal poisoning accounted for (86.7%) of cases. 43.3% of patients died (n = 13), and the median value of SOFA score among non-survivors was 10, versus 1 among survivors. The median value of ejection fraction among non-survivors (25%) was half its value in survivors (50%). Although there were many predictors of severity of AlP poisoning, SOFA score was the most predictive factor of mortality detected by multivariate analysis.

Occupational exposure and poisoning by chemical products in the Federal District.

OBJECTIVE: to describe case of occupational exposure to chemical products. METHOD: descriptive retrospective study using record data of 382 workers assisted in the Outpatient Care for Occupational Toxicology of the Reference Center of Workers' Health of the Federal District, between 2009 and 2013. RESULTS: From the total, 66.7% were men, 55.2% had up to 9 years of activity and 81% did not use personal protective equipment (PPE). Nearly 60% were farmers and environmental surveillance agents, exposed to pesticides (63%), of which 40% were organophosphorus insecticides. The majority (68%) presented butyrylcholinesterase activity decreased, mostly farmers (85.9%); 57.3% of workers were considered poisoned - 61.6% by pesticides and 37.9% by industrial chemicals -, and away from work for at least 10 days. CONCLUSION: The profile was male workers, from 30 to 39 years, which not used PPE, indicating the need for prevention together with them to prevent poisonings.

Occupational exposure and poisoning by chemical products in the Federal District / Exposición e intoxicación ocupacional a productos químicos en el Distrito Federal / Exposição e intoxicação ocupacional a produtos químicos no Distrito Federal

ABSTRACT Objective: to describe case of occupational exposure to chemical products. Method: descriptive retrospective study using record data of 382 workers assisted in the Outpatient Care for Occupational Toxicology of the Reference Center of Workers' Health of the Federal District, between 2009 and 2013. Results: From the total, 66.7% were men, 55.2% had up to 9 years of activity and 81% did not use personal protective equipment (PPE). Nearly 60% were farmers and environmental surveillance agents, exposed to pesticides (63%), of which 40% were organophosphorus insecticides. The majority (68%) presented butyrylcholinesterase activity decreased, mostly farmers (85.9%); 57.3% of workers were considered poisoned - 61.6% by pesticides and 37.9% by industrial chemicals -, and away from work for at least 10 days. Conclusion: The profile was male workers, from 30 to 39 years, which not used PPE, indicating the need for prevention together with them to prevent poisonings.

RESUMEN Objetivo: describir casos de exposición ocupacional a productos químicos. Método: estudio retrospectivo descriptivo utilizando datos del prontuario de 382 trabajadores atendidos en el Ambulatorio de Toxicología Ocupacional del Centro de Referencia en Salud del Trabajador del Distrito Federal entre 2009 y 2013. Resultados: El 66,7% eran hombres, el 55,2% tenía hasta 9 años de actividad y el 81% no usaba el equipo de protección individual (EPI). Casi el 60% eran agricultores y agentes de vigilancia ambiental, expuestos a agrotóxicos (63%), de los cuales 40% insecticidas organofosforados. La mayoría (68%) presentó actividad de butirilcolinesterasa disminuida, principalmente agricultores (85,9%); el 57,3% de los trabajadores fueron considerados intoxicados, 61,6% por agrotóxicos y 37,9% por productos químicos industriales, y alejados del trabajo por lo menos 10 días. Conclusión: El perfil de los trabajadores atendidos fue de hombres, predominantemente de 30 a 39 años, que no utilizaban el EPI, indicando la necesidad de acciones de prevención junto a esa población para evitar la ocurrencia de intoxicaciones.

RESUMO Objetivo: descrever casos de exposição ocupacional a produtos químicos. Método: estudo retrospectivo descritivo utilizando dados do prontuário de 382 trabalhadores atendidos no Ambulatório de Toxicologia Ocupacional do Centro de Referência em Saúde do Trabalhador do Distrito Federal, entre 2009 e 2013. Resultados: 66,7% eram homens, 55,2% tinham até 9 anos de atividade e 81% não usavam equipamento de proteção individual (EPI). Quase 60% eram agricultores e agentes de vigilância ambiental, expostos a agrotóxicos (63%), dos quais 40% inseticidas organofosforados. A maioria (68%) apresentou atividade de butirilcolinesterase diminuída, principalmente agricultores (85,9%); 57,3% dos trabalhadores foram considerados intoxicados, 61,6% por agrotóxicos e 37,9% por produtos químicos industriais, e afastados do trabalho por pelo menos 10 dias. Conclusão: O perfil dos trabalhadores atendidos foi de homens, predominantemente de 30 a 39 anos, que não utilizavam EPI, indicando a necessidade de ações de prevenção junto a essa população para evitar a ocorrência de intoxicações.

Development and validation of a gas chromatography-mass spectrometry method for opiates and cocaine in human bone.

A method based on gas chromatography-mass spectrometry (GC-MS) is described for the determination of opioids (6-monoacetylmorphine, morphine, methadone and tramadol) and cocaine and its major metabolite in human bone. After the addition of nalorphine as internal standard, pulverized samples were incubated in acetonitrile for 1 h under ultrasounds. After adjusting the pH of the samples to 6, they were subjected to solid phase extraction and the analytes were eluted using 2 ml of dichloromethane/isopropanol/ammonia (78:20:2). Chromatography was performed on a fused silica capillary column and analytes were determined in the selected-ion-monitoring (SIM) mode. The assay was validated in the range 0.3-1 ng/mg (depending on the drug) to 150 ng/mg, the mean absolute recoveries ranging from 66% to 110%, the matrix effect from 62% to 121% and process efficiency from 61% to 89% depending on the analyte. The intra- and inter-assay accuracy values were always better than 20%. The validated method was then successfully applied to real bone samples from forensic cases in which toxicological analysis for these drugs in blood was positive. Drugs were detected in bone in 12 of the 15 blood positive results. The approximate concentration range was 3-5 ng/g for 6-monoacetylmorphine, 3-7 ng/g for morphine, 14-28 ng/g for methadone and 6 ng/g and 11 ng/g for tramadol and benzoylecgonine.

The effects of ω-3 fish oil emulsion-based parenteral nutrition plus combination treatment for acute paraquat poisoning.

OBJECTIVE: To investigate the effects of parenteral nutrition (PN) including ω-3 fish-oil emulsion on nutritional state, inflammatory response, and prognosis in patients with acute paraquat poisoning. METHODS: Patients randomized to receive medium chain triglycerides (MCT)/long chain triglycerides (LCT)-based PN (control group) or MCT/LCT-based PN containing ω-3 fish-oil emulsion (intervention group) were compared for 90-day survival and short-term treatment efficacy. RESULTS: Tumour necrosis factor-α levels were significantly lower in the intervention group ( n = 101) versus controls ( n = 73) on treatment days 4 and 7. Intervention group C-reactive protein (CRP) levels were significantly increased on day 4, decreased to baseline (day 1) levels on day 7, and were significantly lower than baseline on day 10. Control group CRP levels were significantly increased on days 4 and 7 versus baseline, and returned to baseline levels on day 10. On day 7, retinol binding protein had recovered to baseline levels in the intervention group only. Intervention group mortality rate (36.6%) was significantly lower than controls (57.5%). ω-3 fish-oil PN was associated with reduced risk of death (hazard ratio 0.52; 95% confidence interval 0.33, 0.82). CONCLUSION: In patients with acute paraquat poisoning, MCT/LCT with ω-3 fish-oil emulsion PN plus combination treatment advantageously attenuated the inflammatory response, modified the nutritional state, and was associated with significantly improved 90-day survival versus treatment without ω-3 fish oil.

Tendências de eventos toxicológicos relacionados a medicamentos atendidos por um Centro de Informações Toxicológicas / Trends of drug-related poisoning cases attended to at a poison control center

RESUMO: Introdução: Os eventos toxicológicos relacionados a medicamentos têm alto impacto na morbimortalidade, representando a primeira causa de intoxicação no Brasil. Objetivo: Descrever as tendências de casos de eventos toxicológicos relacionados a medicamentos atendidos por um Centro de Informações Toxicológicas. Método: Estudo com abordagem quantitativa (transversal e de tendência), com análise dos dados referentes aos casos de eventos toxicológicos relacionados a medicamentos atendidos pelo Centro de Informações Toxicológicas do Hospital Universitário da Universidade Estadual de Londrina. Os dados foram coletados das fichas de atendimento, referentes ao período de 1985 a 2014. Para a análise estatística, utilizou-se um modelo de regressão linear simples. Resultados: Dos 36.707 casos atendidos pelo serviço, 22,5% (n = 8.608) foram eventos toxicológicos relacionados a medicamentos. Houve um aumento da proporção de casos em ambos os sexos (R2 = 0,195; p = 0,014) e no sexo masculino (R2 = 0,403; p < 0,001). Detectou-se tendência de elevação da proporção de casos envolvendo a classe de analgésicos, anti-inflamatórios e imunossupressores (R2 = 0,521; p = 0,018), antidepressivos (R2 = 0,923; p < 001) e antipsicóticos (R2 = 0,869; p < 0,001). Os antimicrobianos apresentaram tendência de redução da proporção de casos (R2 = 0,773; p = 0,001). Conclusões: Observou-se tendência de aumento da proporção de casos de eventos toxicológicos relacionados a medicamentos no sexo masculino. Também houve aumento nas tendências envolvendo analgésicos/anti-inflamatórios/imunossupressores, antidepressivos e antipsicóticos.

ABSTRACT: Introduction: Drug-related poisonings have a high impact on morbidity and mortality, representing the first cause of intoxication in Brazil. Objective: To describe the trends of cases of drug-related poisonings attended to by a poison control center. Method: A quantitative approach (cross-sectional trend study) with data analysis of cases of drug-related poisonings attended to at the Poison Control Center of University Hospital of the State University of Londrina. Data were collected from service notification records for the period 1985 to 2014. For statistical analysis, a simple linear regression model was used. Results: Of the 36,707 cases attended to by the service, 22.5% (n = 8,608) were drug-related poisonings. There was an increase in the proportion of cases for both sexes (R2 = 0.195, p = 0.014) and males (R2 = 0.403, p < 0.001). There was a trend towards a higher proportion of cases involving the analgesic, anti-inflammatory and immunosuppressive drug classes (R2 = 0.521, p = 0.018), antidepressants (R2 = 0.923, p < 0.001) and antipsychotics (R2 = 0.869; p < 0.001). Antibiotics showed a trend toward a lower proportion of cases (R2 = 0.773, p = 0.001). Conclusions: There was a trend for a higher proportion of cases of drug-related poisonings in males. Also, there was an increased trend towards cases involving analgesics/anti-inflammatories/immunosuppressants, antidepressants and antipsychotics.

A case of synthetic cannabinoid poisoning in Croatia.

The number of new psychoactive substances (NPS), synthetic cannabinoids (SCs) in particular, is growing constantly. Because of the insufficiently explored effects on consumer health, they have become a major problem in the emergency departments. They are difficult to identify, and there are no antidotes that could reverse their detrimental effects. We report a case of poisoning of a young man who used SCs. The patient was admitted to the emergency department of the Clinical Hospital Merkur, Zagreb (Croatia) after sniffing and smoking a herbal product bought on the street. He presented with severe cognitive difficulties and visible eye redness. Other symptoms included somnolence, disorientation, loss of coordination, unsteady gait, hyporeflexia, stiffness, cramps and cold limbs, blurred vision, teeth grinding, dry mouth, tinnitus, fear, suicidal thoughts, impaired focus, memory, and speech, sedation, fatigue, depression, thought blocking, and autistic behaviour. His skin was dry, and his mucosa dry and irritated. Herbal products "Rainbow Special" and "Luminated Aroma" used by the patient were qualitatively analysed with gas chromatography / mass spectrometry (GC/MS) after direct extraction with an organic solvent. Solid-phase extraction method was used to analyse serum and urine samples. Despite the negative findings of biological samples, mostly due to the limitations of GC/MS, the clinical picture infallibly pointed to the poisoning with SCs. This was confirmed by the findings of 5-fluoro AMB (methyl 2-(1-(5-fluoropentyl)-1H-indazole-3-carboxamido)-3-methylbutanoate) in the herbal products.

Increased risk for hypothyroidism after anticholinesterase pesticide poisoning: a nationwide population-based study.

PURPOSE: Previous animal studies have reported that acute anticholinesterase pesticide (organophosphate and carbamate) poisoning may affect thyroid hormones. However, there is no human study investigating the association between hypothyroidism and anticholinesterase pesticide poisoning, and therefore, we conducted a retrospective nationwide population-based cohort study to delineate this issue. METHODS: We identified 10,372 anticholinesterase pesticide poisoning subjects and matched 31,116 non-anticholinesterase pesticide poisoning subjects between 2003 and 2012 from the Nationwide Poisoning Database and the Longitudinal Health Insurance Database 2000, respectively, in a 1:3 ratio by index date, age, and sex for this study. We compared the cumulative incidence of hypothyroidism between the two cohorts by following up until 2013. Independent predictors for hypothyroidism were also investigated. RESULTS: In total, 75 (0.72%) anticholinesterase pesticide poisoning subjects and 184 (0.59%) non-anticholinesterase pesticide poisoning subjects were diagnosed with hypothyroidism during the follow-up. Cox proportional hazard regression analysis showed that anticholinesterase pesticide poisoning subjects had higher risk for hypothyroidism than did non-anticholinesterase pesticide poisoning subjects (adjusted hazard ratio: 1.47, 95% confidence interval: 1.11-1.95) after adjusting for age, sex, hypertension, malignancy, liver disease, renal disease, atrial fibrillation or flutter, thyroiditis, goiter, other endocrine disorders, and mental disorder. Stratified analysis showed that anticholinesterase pesticide poisoning subjects had higher risk for hypothyroidism than did non-anticholinesterase pesticide poisoning subjects in terms of the age subgroup of 40-64 years, female sex, past history of goiter, follow-up of <1 month, and anticholinesterase pesticide poisoning subjects without atropine treatment (incidence rate ratio [IRR]: 1.66, 95% confidence interval: 1.20-2.30). Female sex, malignancy, renal disease, thyroiditis, goiter, mental disorder, and anticholinesterase pesticide poisoning without atropine treatment were independent predictors for hypothyroidism. CONCLUSIONS: Anticholinesterase pesticide poisoning is associated with increased risk for hypothyroidism. Early evaluation of thyroid function in anticholinesterase pesticide poisoning subjects is suggested, especially in subjects without atropine treatment, aged 40-64 years, female sex, and past history of goiter.