Guía de actuación y abordaje frente a intoxicación por dióxido de cloro/clorito de sodio, a partir de la experiencia de los CIAT de América Latina / Guidelines for action and approach to chlorine dioxide/sodium chlorite poisoning based on the experience of the CIATs in Latin America

Resumen El 11 de marzo de 2020, la Organización Mundial de la Salud, declaró la pandemia a nivel mundial por la COVID-19. Ante este escenario, los centros de información y asesoramiento toxicológico (CIAT) de América Latina comenzaron a recibir consultas por exposición/intoxicación a dióxido de cloro/clorito de sodio y sus compuestos relacionados, por desvío de uso, destinado a la prevención y/o tratamiento de la COVID-19 sin aval científico alguno ni contar con registro sanitario para ese fin. A través de la Red de Toxicología de América Latina y el Caribe (RETOXLAC), se comprobó que no eran hechos aislados, sino que se estaba produ ciendo el mismo fenómeno en toda la región y que existían antecedentes de intoxicaciones con dichos productos y alertas desde hace más de una década, con indicaciones no aprobadas, para el tratamiento de distintas patologías como SIDA, cáncer, esclerosis lateral amiotrófica ELA, malaria, autismo, entre otras, sin evidencia. Ante esta realidad, los CIAT presentan una revisión de los signos y síntomas observados según la vía de ingreso, basados en la comunicación de riesgo en salud; proponiéndose pruebas de apoyo al diagnóstico, algoritmo de tratamiento para las intoxicaciones y modelo de ficha clínica para la vigilancia epidemiológica de los casos atendidos. Recomendamos a las autoridades y organismos responsables, reforzar las acciones tendientes a la vigilancia, control y prevención de este tipo de intoxicaciones, producto del mal uso de un desinfectante no autorizado para fines terapéuticos/médicos.

Abstract On March 11th, 2020, the World Health Organization declared a global pandemic due to COVID-19. Faced with this sce- nario, the Poison Control Centers (CIATs for its initials in spanish) in Latin America began to receive consultations for exposure/poi- soning to chlorine dioxide/sodium chlorite and its related compounds for their use aimed to prevent or treat COVID-19 without any scientific endorsement or having a sanitary registry for that purpose. It was found through the Toxicology Network of Latin America and the Caribbean (RETOXLAC) that they were not isolated events but rather that the same phenomenon was occurring throughout the region and that there has been a history of poisoning and alerts with these products for more than a decade with unapproved indications for the treatment of different pathologies such as AIDS, cancer, amyotrophic lateral sclerosis (ALS), malaria, autism, among others, without evidence. In the light of this situation, the CIATs present a review of the signs and symptoms observed ac- cording to the route of exposure based on health risk communication; proposing tests to support the diagnosis, an algorithm for poisoning treatment, and a model of a clinical record for the epidemiological surveillance of the assisted cases. We recommend to the authorities and responsible organisms reinforce the actions aimed at surveillance, control, and prevention of this type of poisoning due to the misuse of an unauthorized disinfectant for therapeutic or medical purposes.

Severe acute toxic exposures in children and adolescents: case series / Exposições tóxicas agudas graves em crianças e adolescentes: série de casos

ABSTRACT Objective: To describe a case series of severe acute toxic exposures (SATE) in individuals <20 years old followed-up by a regional Poison Control Center (PCC). Methods: Descriptive cross-sectional study. All patients who were <20yo and classified as score 3 (severe) and 4 (fatal) following Poisoning Severity Score were included for analysis. According to the outcome, patients were classified as PSS 3 when they developed intense clinical manifestations with risk of death or important sequelae; and as PSS 4 when death had resulted from direct cause or complication of the initial exposure. The data of patients were obtained from the Brazilian electronic database system (DATATOX). Results: During the biennium 2014-2015, Campinas PCC followed up 5,095 patients <20yo, with 30 being classified as SATE (PSS=3, n=24; PSS=4, n=6). The exposures circumstances were unintentional (15); intentional (14; suicide attempt = 11; street drugs consumption = 3); and not explained (1). The exposures were significantly more frequent in adolescents >14yo (n=17; p<0.01). The involved agents were venomous animals (8; scorpions=5); medicines (8; miscellaneous=6); chemicals (6); illegal rodenticides containing acetylcholinesterase inhibitors (chumbinho, 4); drugs of abuse (3); button battery (1). Three patients evolved with sequels (esophageal stricture post-corrosive ingestion). The median length of hospital stay was 6 days (IQR: 5-12 days); 26 patients were treated in intensive care units, and 22 of them needed mechanical ventilation; 12, inotropic/vasopressors; and 3, renal replacement therapy. Conclusions: Scorpion stings and poisonings caused by medicines and chemicals were the main causes of SATE. The SATE were significantly more frequent in adolescents, due to deliberate self-poisoning.

RESUMO Objetivo: Descrever uma série de casos de exposições tóxicas agudas graves (ETAG) em pacientes <20 anos seguidos por um Centro de Informação e Assistência Toxicológica (CIATox) regional. Métodos: Estudo descritivo de corte transversal. Incluídos no estudo todos os casos classificados como escore 3 (graves) e 4 (fatais) de acordo com o escore de gravidade de intoxicações (poisoning severity score - PSS). Segundo o PSS, os casos são classificados em relação ao desfecho como escore 3 quando os pacientes desenvolveram manifestações clínicas intensas, com risco de morte ou que resultaram em sequelas importantes; e escore 4 quando a morte foi resultado de causa direta ou por complicação da exposição. Os dados analisados foram obtidos da base eletrônica brasileira do Sistema Nacional de Informações Tóxico-Farmacológicas DATATOX. Resultados: No biênio 2014-2015 o CIATox de Campinas atendeu 5.095 casos de pacientes <20 anos, dos quais 30 foram classificados como ETAG (PSS=3, n=24; PSS=4, n=6). Quanto à circunstância, 15 foram acidentais, 14 intencionais (11 por tentativas de suicídio e três por abuso de drogas) e um de causa não esclarecida, sendo significativamente mais frequentes nos adolescentes >14 anos (n=17; p<0,01). Os grupos de agentes envolvidos foram: animais peçonhentos (8; escorpiões=5); medicamentos (8; associações=6); produtos químicos de uso domiciliar/industrial (6); rodenticidas inibidores da colinesterase de uso ilegal (chumbinho=4); drogas de abuso (3); e bateria no formato de disco (1). Três pacientes evoluíram com sequelas (estenose esofágica pós-ingestão de corrosivos). O tempo mediano de internação foi de seis dias (mediana, quartis e intervalo interquartil=5-12 dias), sendo 26 pacientes admitidos em unidades de cuidados intensivos, dos quais 22 necessitaram de ventilação mecânica, 12 de inotrópicos/vasopressores e três de terapia de substituição renal. Conclusões: Escorpionismo e intoxicações por medicamentos e por produtos químicos de uso domiciliar/industrial foram as principais causas de ETAG, sendo elas significativamente mais frequentes em adolescentes, principalmente por tentativas de suicídio.

Clinical and epidemiological analysis of suicide attempts in children assisted by a poison control center / Análise clínica e epidemiológica das tentativas de suicídio em crianças atendidas em um centro de informação e assistência toxicológica

ABSTRACT Objective: To assess suicide attempts in children seeking care at a Poison Control Center. Methods: Cross-sectional study with children (<12 years old) that attempted suicide and were cared at the Poison Control Center in Londrina, Paraná, Southern Brazil, from April 1985 to December 2018. Results: We identified 59 children, most of them females (74.6%), who used only one product (77.9%). Among the products involved, medications were the most important ones (88.1%). Neurological/psychiatric/muscular manifestations (61.0%) were the main symptoms presented. The main reason identified for the suicide attempt was conflicts with family and/or friends (27.1%). Suicide attempts were more frequent in 2001-2003 and 2016-2018. Conclusions: Suicide attempts occurred mainly in female children with a single agent (mainly medications), and the main reason was family conflicts..

RESUMO Objetivo: Analisar as tentativas de suicídio em crianças atendidas em um Centro de Informação e Assistência Toxicológica (CIATox-Londrina). Métodos: Estudo transversal com crianças (<12 anos) atendidas no CIATox-Londrina, Paraná, de abril/1985 a dezembro/2018, com tentativa de suicídio. Resultados: Identificaram-se 59 crianças, com predomínio do sexo feminino (74,6%) e com o uso de apenas um produto (77,9%). Entre os produtos envolvidos, destacaram-se os medicamentos (88,1%). As manifestações neurológicas/psíquicas/musculares (61,0%) foram os principais sintomas apresentados. O principal motivo identificado da tentativa de suicídio foram os conflitos com familiares e/ou amigos (27,1%). Houve maior frequência de tentativas de suicídio nos triênios 2001-2003 e 2016-2018. Conclusões: As tentativas de suicídio ocorreram predominantemente nas crianças do sexo feminino, com um único agente (em geral, medicamentos), em que o principal motivo foram os conflitos familiares, observando-se um aumento ao longo dos anos.

Caracterización epidemiológica de las exposiciones a dióxido de cloro/clorito de sodio en el contexto de la pandemia COVID-19: Reporte de los centros toxicológicos de América Latina / Epidemiological characterization of exposures to chlorine dioxide/ sodium chlorite in the context of the COVID-19 pandemic: Report of Poison Control Centers in Latin America

Resumen Los centros de información y asesoramiento toxicológico CIATs de América Latina, en el contexto de la pandemia de COVID-19, recibieron una serie de llamadas para consultas y asesoramientos relacionados con el uso de dióxido de cloro/clorito de sodio, que se estaban empleando en el tratamiento o prevención de dicha enfermedad. Dentro de la legislación vigente en los países de América Latina, no se contemplan productos farmacéuticos registrados para uso en humanos, ni se tiene evidencia de registros sanitarios en Europa, Canadá o Estados Unidos para tal fin, que contengan dióxido de cloro o clorito de sodio. Esta publicación, compila la información registrada como parte de la estadística del trabajo de ocho CIATs correspondientes a igual número de países de América Latina. Se identificó sexo, edad, sintomatología, circunstancia y grado de severidad de los 56 casos de pacientes intoxicados con dióxido de cloro/clorito de sodio registrados en el período del 15 de marzo al 30 de septiembre de 2020 en estos ocho países. Los resultados obtenidos confirman que la causa más común fue por mal uso, y el lugar de ocurrencia fue el hogar o sus alrededores, siendo el mayor porcentaje adultos jóvenes comprendidos entre 30 y 49 años. Los síntomas de intoxicación más frecuentemente encontrados fueron gastrointestinales, seguidos de cardiovasculares y respiratorios. La vía de ingreso al organismo en la mayoría de los casos fue por vía oral, reportándose algunos casos por vía inhalatoria, y en el 50% de los casos se constituyeron casos de severidad moderada, severa o fatal (3 fallecimientos). Este estudio contribuye a generar información relevante para las diferentes autoridades sanitarias, los ministerios de salud, las entidades encargadas de inspección, vigilancia y control de los países en los que se comercializan estos productos de manera ilegal por medio de redes sociales y promoviéndolos para uso en humanos para prevenir o curar COVID-19.

Abstract The Poison Control Centers in Latin America, in the context of COVID-19 pandemic, received a series of calls for consultations and recommendations related to the use of chlorine dioxide/sodium chlorite, in the treatment or prevention of CO-VID-19. Under current legislation in Latin America, no pharmaceutical products are registered for use in humans that contain chlorine dioxide or sodium chlorite, nor is there evidence of sanitary registries in Europe, Canada, or the United States for this purpose. This publication compiles the information registered by eight Poison Control Centers that correspond to the same number of Latin American countries. Sex, age, symptoms, circumstance, and degree of severity of the 56 cases of patients poisoned with chlorine dioxide/ sodium chlorite registered in the period from March 15th to September 30th, 2020 were identified. The results obtained confirm that the most common cause of poisoning was unintentional misuse, all of which occurred at home or its surroundings, with the highest percentage of registered cases being young adults between 30 and 49 years old. The most frequent symptoms of intoxication were gastrointestinal, followed by cardiovascular and respiratory. The route of exposure in most cases was oral, with some cases reported by inhalation; 48.2% of the cases were of moderate, severe, or fatal (3 deaths). This study contributes to the generation of relevant information for different health authorities, ministries of health, entities in charge of inspection, surveillance, and control in countries where these products are illegally marketed through social networks and promoted for use in humans to prevent or cure COVID-19.

Caracterización de las consultas realizadas a un Centro de Información Toxicológica por productos de aseo y productos cosméticos en niños / Characterization of the phone-calls made to a poison center related to household and cosmetics products exposition in pediatrics

INTRODUCCIÓN: Los productos de aseo y cosméticos son necesarios en el diario vivir y ampliamente utilizados por la población. Sin embargo, su uso puede no estar exento de riesgos, especialmente cuando no se utilizan o almacenan según lo recomendado. Es importante caracterizar las exposiciones, ya que eso es útil para implementar estrategias para reducir la morbilidad, mortalidad y costos asociados, especialmente en la población infantil. OBJETIVO: Caracterizar los reportes asociados a exposiciones a productos de aseo y productos cosméticos en pacientes menores de 12 años reportados al Centro de Información Toxicológica de la Universidad Católica de Chile (CITUC). PACIENTES Y MÉTODO: Estudio descriptivo transversal de llamados telefónicos reportados a CITUC durante el año 2016. Se analizaron las variables: edad, sexo, agente, interlocutor, localización del interlocutor e inciden te, circunstancia de exposición, vía(s) de exposición, sintomatología, y severidad, mediante fichas de registro manual y desde el software de registro electrónico denominado "INTOX Data Manage ment System" de la OMS. RESULTADOS: Cumplieron criterios de inclusión 3.415 casos. Los menores de 5 años representaron el 91% de las exposiciones y el 58,5% correspondió al sexo masculino. Un 99,4% correspondió a exposiciones accidentales y el 98,6% ocurrieron en el hogar. El 68,3% no presentó síntomas, tras la exposición. Las llamadas fueron realizadas por familiares (57%) y personal de salud (42%). Los 4 agentes con mayor incidencia fueron cloro doméstico (27,6%), limpiadores y lustres de pisos (13,1%), lavalozas (7,9%) y perfumes/colonias (5,8%). La principal vía de exposición fue digestiva (89,4%). CONCLUSIONES: Los productos de aseo y cosméticos son causas comunes de exposiciones especialmente en menores de 5 años. Si bien son productos de baja mortalidad y morbilidad, es importante educar a la población para prevenir posibles intoxicaciones en la población infantil.

INTRODUCTION: Household cleaning products and cosmetics are necessary for daily life and widely used by the population. However, their use may not be risk-free, especially when they are not used or stored as recommended. It is important to characterize exposures, as this is useful for developing stra tegies to reduce morbidity, mortality, and health costs associated, especially in the child population. OBJECTIVE: To describe reports associated with household cleaning products and cosmetics exposure in patients under the age of 12, reported to the Poison Information Center of the Catholic University of Chile (CITUC). PATIENTS AND METHOD: Descriptive cross-sectional study of phone calls to CITUC during 2016. The analyzed variables were age, sex, product, caller, caller and incident location, ex posure circumstances, exposure route(s), symptoms, and severity from manual records and from the WHO's electronic record software 'INTOX Data Management System'. RESULTS: 3,415 cases met the inclusion criteria. Children under the age of five represented 91% of the exposures, and 58.5% were male. 99.4% were accidental exposures, and 98.6% occurred at home. Family members (57%) and health personnel (42%) made the calls. 68.3% of the patients had no symptoms after exposure. The four products with the highest incidence were household bleach (27.6%), floor cleaners and polishers (13.1%), dish soap (7.9%), and perfume/cologne (5.8%). The main exposure route was by ingestion (89.4%). CONCLUSIONS: Household cleaning products and cosmetics are common causes of exposures especially in children under the age of five. Although these products have a low morbidity and mortality rate, it is important to educate the population to prevent possible poisonings in the child population.

Risco social de famílias de usuários de drogas internados por trauma físico social / Risk for the family of drug users hospitalized due to physical injury / Riesgo social para la familia de usuarios de drogas hospitalizado por un trauma fisico

Objetivo: Classificar o risco social de famílias de indivíduos internados por trauma físico e usuários de drogas, investigados como eventos sentinela. Métodos: Estudo exploratório-descritivo, realizado em um centro de assistência toxicológica do Paraná, com 30 eventos sentinela - indivíduos internados com diagnóstico de trauma físico associado à intoxicação por drogas de abuso, no período de abril a setembro de 2014. Instrumentos de coleta de dados foram um roteiro para entrevista semiestruturada e a Escala do Risco Familiar de Coelho e Savassi, respondidos por um familiar informante-chave. Os escores foram analisados descritivamente. Resultados: A pontuação dos escores da Escala de Risco Familiar indicou 19 famílias em risco social, sendo nove com Risco máximo, e famílias com percentuais sociodemográficos de camadas populares da população. Conclusão: Tempo de uso das drogas de abuso, desemprego e baixo vínculo social dos eventos sentinela, influenciaram os índices de risco familiar

Objetivo: Clasificar el riesgo social familiar delos consumidores de drogas a largo plazo y hospitalizado por un trauma físico. Método: Estudio exploratorio descriptivo, realizado en un centro de asistencia toxicológica de Paraná, con eventos centinela - 30 personas hospitalizadas con diagnóstico de trauma físico asociado a la intoxicación por drogas de abuso, de abril a septiembre de 2014. Instrumentos de recolección de datos fueron una hoja de ruta para la entrevista semiestructurada y Escala de Riesgo Familia de Coelho y Savassi, respondida por un informante clave familiar. Las puntuaciones se analizaron descriptivamente. Resultados: La puntuación de la Escala de Riesgo familia indicaron 19 familias en riesgo social, nueve con máximo riesgo, y las familias con el porcentaje sociodemográfico de las clases más bajas de la población. Conclusión: Uso del tiempo de las drogas de abuso, el desempleo y la baja vínculo social de los eventos centinela influyeron en los índices de riesgo de la familia

Objective: The study's purpose has been to classify the familiar social risk of long-term drug users and hospitalized due to physical trauma. Methods: It is a descriptive-exploratory study that was carried out in a toxicological assistance center from Parana State and through 30 sentinel events - hospitalized individuals diagnosed with physical trauma associated with poisoning by drugs abuse, over the period from April to September 2014. Data collection instruments were a semi-structured interview and the Coelho-Savassi's Family Risk Scale, where it was answered by a family key-informant. The scores were analyzed descriptively. Results: The Family Risk Scale score have indicated that 19 families were under social risk, where 9 of them were under maximum risk, and have also shown families with socio-demographic percentage matching the lower classes of the population. Conclusion: The following categories influenced the family risk rates: drugs of abuse use period; unemployment; and low social bond of sentinel events

Caracterización de las exposiciones a plaguicidas entre los años 2006 y 2013 reportadas al Centro de Información Toxicológica de la Pontificia Universidad Católica de Chile / Characterization of pesticide exposures reported between 2006 and 2013 to a poison information center in Chile

Background: Pesticides are widely used to increase crop yields and vector control. However, both acute and chronic exposure have health consequences. There is paucity of information about the global occurrence of pesticide poisonings. Aim: To characterize the reports of pesticide exposures received by a University Poison Information Center. Material and Methods: All pesticide exposures reported in Chile between 2006 and 2013 were analyzed. A data-collection sheet provided by the International Programme on Chemical Safety of the World Health Organization, was used to collect information. Results: In the study period, 13,181 reports were analyzed. The main age groups exposed were preschoolers and adults. Sixty one percent of exposures occurred accidentally and 24.8% were suicide attempts. Exposures to acetylcholinesterase inhibitors was reported in 29.3% of cases, to superwarfarin rodenticides in 28.5% and to pyrethroids in 24.0%. An increased risk of suicide attempts with pesticides was observed among women, when compared with men (odds ratio: 1.5; 95% confidence intervals: 1.4-1.6; p < 0.001). The risk was higher among teenage girls. Conclusions: The amount of cases under acetyl cholinesterase inhibitor exposure, the most toxic pesticides currently in use should be highlighted. Workers should be educated and all cases should be reported to take actions aiming at reducing these events.

Caracterización de la ingestión por sobredosis de paracetamol: Reporte de un centro de información toxicológica chileno / Characterization of paracetamol overdose: Report of a poison information center in Chile

Background: Paracetamol (acetaminophen) is an analgesic and antipyretic drug widely used across the world. Its ingestion is one of the most common causes of drug overdose. In the United States is the first cause of acute hepatitis in adults. Aim: To describe the epidemiological profile of paracetamol overdose in Chile. Material and Methods: Cross sectional retrospective study that included all the phone call inquiries received at the Poison Control Center of the Pontificia Universidad Catolica de Chile (CITUC) during 2009. Results: Nine hundred fifty nine inquiries involving acute paracetamol exposures were received. Women represented a 63.1% of the cases. Half of the cases were suicide attempts, of which 74.8% were women. Accidental exposures occurred mainly in children. In 29.3% of the patients, the exposure was considered to involve a hepatotoxic dose. Women had 2.7 times the risk of men to ingest a toxic dose of paracetamol with suicidal purpose (Odds ratio (OR) = 2.7; 95% confidence interval (Cl): 2.1-3.6; p < 0.001). Adolescents had 3.4 times the risk of the general consultants (OR: 3.4; 95% Cl: 2.4-4.7; p < 0.001). Conclusions: Paracetamol overdose is common in Chile. Authorities should carry out preventive measures. Antidotes and the capacity to measure plasma levels of paracetamol should be available in healthcare centers.

Sistema nacional de informações tóxico-farmacológicas: o desafio da padronização dos dados / National poison information system: the challenge of the data standardization

A incidência de intoxicações e envenenamentos constitui um grave problema de saúde pública. Para esse segmento, a importância de se dispor, a tempo e a hora, de informações fidedignas é condição primordial para se traçarem estratégias eficazes e efetivas de vigilância epidemiológica e sanitária. Para investigar uma faceta da qualidade dos dados registrados no país, sobre este tipo de agravo, este estudo volta-se para os Centros de Informação e Assistência Toxicológica (CIAT), uma das principais fontes para notificação e registro de tais casos, que fornecem dados que são consolidados pelo Sistema Nacional de Informações Tóxico-Farmacológicas (SINITOX). Partindo do pressuposto que a padronização é uma das principais variáveis que impactam a qualidade dos dados coletados, o estudo visou analisar a maneira como os CIAT interpretam e registram cada um dos eventos a eles notificados. Buscou-se reproduzir as práticas em curso no registro dos casos, com sua lógica e entendimento habitual. Os resultados apontam para o baixo grau de padronização dos dados que chegam ao SINITOX, o que impacta, qualitativamente, as informações geradas por este sistema. Um desenho de estratégias que atuem para aprimorar a padronização dos dados, por certo, conduzirá a um sistema de informação mais robusto e confiável.

Human poisoning is a serious public health issue around the world. Readily available and reliable information in this field are essential to the full implementation of epidemiological and sanitary surveillance and to establish efficient and effective strategies of control. The continuous improvement of data quality and consistency percent no doubt, a permanent challenge percent has a key role in the definition of public policies. To assess the accuracy of Brazilian data on human poisonings, this study explores data from a network of Toxicological Information and Assistance Centers, one of the main sources of such data in Brazil. Data are consolidated by the National Poison Information System (SINITOX). Assuming that standardization is one of the main procedures that influence the data quality collected and analyzed by SINITOX, the study assesses the operations of the Centers affiliated to the SINITOX in charge to interpret and register the events reported to them and highlights the procedures used to standardize case reports. The results show an evident insufficient degree of standardization of the data received at SINITOX. We emphasize the need to design strategies to improve standardization, aiming to develop a reliable system and to minimize the harms associated to human poisoning in Brazil.

Study of zinc phosphide intoxicated cases admitted to poison control centre - Ain shams university hospitals - Egypt [A retrospective study]

Acute poisoning with pesticides is a global public health problem and accounts for as many as 300.000 deaths worldwide yearly. Zinc phosphide has been widely used as a rodenticide since 1942-43 and its easy availability pushed up the incidence of self poisoning. This retrospective study was designed to highlight and evaluate the problem of zinc phosphide intoxicated cases presented and admitted to poison control centre [PCCA] during the year 2007, and was compared with its incidence during the previous 5 years, 2002-2006. The comparative study of the previous five years included the number of all cases of intoxication presented to the PCCA from 2002-2006, the number of zinc phosphide intoxication cases during the same period and their classification according to hospital admission: Intensive care unit [ICU], inpatient and emergency room [ER]. Regarding the retrospective study of zinc phosphide cases during the year 2007, it was carried out on the medical records of all patients admitted to PCCA during the year 2007, with a discharge disgnosis of zinc phosphide. The following parameters were reviewed and analyzed: Sociodemographic data [age, sex, residence and social class], intoxication data [delay time, mode and route of intoxication], presenting symptoms, vital signs, laboratory investigations and ECG monitoring. Different treatment modalities were analyzed and the outcome was recorded. The percentage of zinc phosphide poisoning during the period 2002-2006 in relation to the total number of poisoning cases admitted to PCCA ranged from 2.09%-5.38% and during 2007 it was 3.03%. The inpatient group showed the highest number of cases followed by the ER and then the ICU group. Death rate ranged from 0.3%-0.7% during the years 2002-2006, while during 2007, it was only 0.15%. The total number of cases during the year 2007 were 650 cases. The inpatient group comprised most of the cases followed by ER and ICU groups. The majority of patients were in the age group of 10-

Pacientes atendidos en un Centro Toxicológico de Venezuela / Patients attended at a Venezuelan Toxicology Centre

Objetivo Caracterizar los pacientes atendidos en un Centro Toxicológico de la Región Centro Occidental de Venezuela. Métodos Se realizó un estudio descriptivo y transversal. La población estuvo constituida por 1 938 pacientes registrados durante los años 2006 y 2007 en las planillas de recolección de datos del Centro. Resultados Del total de pacientes registrados en las planillas del Centro Toxicológico en el bienio 06-07, 57,4 por ciento consultaron en el 2006. La edad media de los pacientes atendidos fue de 19 años en el 2006 y 20 años en el 2007, con atención tanto de niños como de adultos, siendo el sexo masculino el que mayormente consultó (55,4 por ciento). La causa de consulta más frecuente en el lapso estudiado para ambos sexos fue emponzoñamientos, de los cuales más del 40 por ciento fue por serpientes del género Bothrops, en hombres la segunda causa fue intoxicación por plaguicidas (20,6 por ciento) y en mujeres intoxicación medicamentosa con un 26,6 por ciento. El municipio del Estado Lara con mayor afluencia de pacientes fue Iribarren con 47,8 por ciento, y durante los dos años se atendieron 95 pacientes (4,9 por ciento) que provenían de Estados vecinos (Portuguesa y Yaracuy principalmente). Conclusiones Se espera que con el presente estudio se implementen programas especiales de educación y atención para las patologías diagnosticadas con mayor frecuencia, así como los correctivos considerando los riesgos individuales y colectivos en las diferentes zonas geográficas del Estado Lara.

Objective Characterising patients attended at a toxicological centre in the central western area of Venezuela (the state of Lara). Methods This was a descriptive/cross-sectional study. The population consisted of 1,938 patients who registered during 2006 and 2007; data was collected from the Centre's data collection forms. Results 57.4 percent of the patients recorded on the toxicological centre's forms during 2006 and 2007 consulted during 2006. The patients' average age was 19 during 2006 (including adults and teenagers) and 20 during 2007. Males most often attended the centre (55.4 percent). The most common cause for consultation was poisoning from snake bite, more than 40 percent of the cases being caused by Bothrops. Pesticide intoxication was the second cause for male consultation (20.6 percent); female medication poisoning accounted for 26.6 percent. Iribarren County had the highest consultation rate in the State of Lara (47.8 percent of cases). 95 patients (4.9 percent) came from neighbouring States (Portuguesa and Yaracuy) during the two years this study lasted. Conclusions It is hoped that this study will lead to special education and attention programmes for the most commonly diagnosed pathologies being implemented with greater frequency, as well as corrective action being taken regarding individual and collective risk in the state of Lara's different geographical areas.

Eventos toxicológicos relacionados a medicamentos registrados no CEATOX de São José do Rio Preto, no ano de 2008 / Drug-related toxic events in the CEATOX of São José do Rio Preto, in 2008

A presença comum de uma extensa variedade de medicamentos no Brasil favorece o surgimento de problemasrelacionados a estes produtos, que representam um desafio à saúde pública tanto em países em desenvolvimento como em países desenvolvidos. Os medicamentos ocupam a primeira posição, também em nosso país, no quadro dos agentes tóxicos que mais causam intoxicações em seres humanos, e as maiores vítimas, crianças menores de cinco anos. O objetivo deste trabalho foi caracterizar as intoxicaçõesmedicamentosas agudas notificadas pelo CEATOX de São José do Rio Preto, no ano de 2008. Foram analisadas 502 fichas, que compreendem a totalidade das intoxicações medicamentosas agudas registradas no período de 1º de janeiro a 31 de dezembro de 2008. A grande maioria dos casos foi proveniente de indivíduos moradores da área urbana, menores de 4 anos de idade. No sexo feminino, a maior freqüência apareceu na faixa etária de 30–39, sendo a maior parte por tentativa de suicídio. Uma associação significativa foi observada entre tentativa de suicídio e sexo feminino, assim como acidente individual e sexo masculino, sendo a via oral a via de maior exposição, e os benzodiazepínicos as drogas mais comumente utilizadas.

The common presence of a wide variety of drugs in Brazil gives rise to problems related to these products, which represent a public health challenge both in developing countries as in developed countries. The drugs occupy the first position, also in our country, under the more toxic agents that cause intoxication in humans, and the main victims, children under five years. The objective of this study was to characterize acute drug intoxication reported by CEATOX Sao Jose do Rio Preto, in the year 2008. We analyzed 502 chips, which comprise the totality of acute drug intoxication recorded in the period from January 1 to December 31, 2008. The great majority of cases was from individuals living in urban area, under 4 years of age. In females, mostoften appeared between the ages of 30-39, with most of attempted suicide. A significant association was observed between attempted suicide and female sex, as well as individual accident and male sex, and the oral route of greater exposure, and the benzodiazepine drugs most commonly used.

Five year survey of toxicological testing of clinical body fluid samples at the poison control centre in the Indian State of Kerala.

The Poison Control Centre (PCC) at Amrita Institute of Medical Sciences, Kerala, was established in June 2003, but became fully operational from January 2005. There are only four PCCs in India recognized by the World Health Organization, of which this is one. A five-year (2005 to 2009) review of biological samples analyzed for chemicals, drugs and toxins by the analytical laboratory attached to the PCC is presented to give an indication of the commonest types of poisoning encountered in this region of India, aside from venomous bites and stings. Such data are not adequately available so far, which is also true for other parts of the country. Results of the survey show that there has been a steady rise in the receipt of samples over the entire period from 432 in 2005 to 601 in 2009. Among the samples analyzed, the commonest toxicants are pesticides, pharmaceuticals, heavy metals and alcohols. Of the pesticides, organophosphates accounted for the maximum number, while most of the remaining comprised zinc phosphide, carbamates, pyrethroids, paraquat, phosphorus, and bromadiolone. Aluminium phosphide, which is a common pesticide in some other regions, was virtually non-existent, while zinc phosphide, a rodenticide, is the second highest in incidence. Of the pharmaceuticals, the largest number comprised sedativehypnotics, while antipyretic drugs, especially paracetamol, accounted for a most of the remaining. Of the metals, the commonest was lead, followed by arsenic, mercury, iron, etc. Requests for copper testing were common, but mostly pertained to Wilson‟s disease, and not toxicity. Among the alcohols, ethanol was the commonest. Even though Kerala is rich in flora, plant toxins were low in incidence, because of the difficulty in testing for such toxins, as compared to chemicals. Bites and stings were not included in this study. Therapeutic monitoring of drugs, which accounts for a large number of samples received by the laboratory was also not part of the survey.

Acute intentional and accidental poisoning with medications in a southern Brazilian city / Intoxicações medicamentosas agudas intencionais e não intencionais notificadas em município do Sul do Brasil

The expansion of the pharmaceutical market in the 20th century led to important changes in the consumption of medications worldwide. The objective of the current study was to analyze acute intentional and accidental poisoning with medications according to factors related to the individual, the poisoning, and the drug involved. This was a cross-sectional study that collected secondary data on all cases of acute poisoning with medications reported from 2003 to 2004 by the Poison Control Center at the Regional University Hospital in Maringá, Paraná State, Brazil. We studied a total of 546 cases of acute poisoning with medications. Females predominated among intentional cases (79.8 percent), and the 0-9-year age bracket was the most common among accidental cases (51.9 percent). The most frequently involved drugs were those acting on the central nervous system (57.2 percent), predominantly those requiring controlled prescriptions, especially among the intentional cases (66.2 percent). The results demonstrate the characteristics of acute poisoning from medications in Maringá, confirming the need for preventive measures that contribute to the rational use of medications.

A proliferação do mercado farmacêutico no século XX propiciou mudanças importantes no consumo de medicamentos em todo o mundo. O objetivo do presente estudo foi analisar as intoxicações medicamentosas agudas intencionais e não intencionais segundo fatores relacionados ao intoxicado, à intoxicação e ao medicamento envolvido. Trata-se de um estudo transversal, com coleta de dados secundários referentes a todos os casos de intoxicações medicamentosas agudas notificadas em 2003 e 2004 pelo Centro de Controle de Intoxicações do Hospital Universitário Regional de Maringá, Paraná, Brasil. Foram estudados 546 casos de intoxicações medicamentosas agudas. O sexo feminino foi o mais acometido nos casos intencionais (79,8 por cento), e a faixa etária de 0-9 anos foi predominante entre as intoxicações não intencionais (51,9 por cento). Os medicamentos mais freqüentemente envolvidos foram os de ação no sistema nervoso central (57,2 por cento), com predomínio de fármacos que requerem retenção de receita na dispensação, principalmente entre os casos intencionais (66,2 por cento). Os resultados evidenciaram as características das intoxicações medicamentosas agudas em Maringá, confirmando a necessidade da implantação de medidas preventivas que contribuam para a utilização racional de medicamentos.

Análise dos dados dos Centros de Controle de Intoxicação do Rio de Janeiro, Brasil, como subsídio às ações de saúde pública / Analysis of data from Poison Control Centers in Rio de Janeiro, Brazil, for use in public health activities

Os sistemas de informação em saúde devem ser fonte de informações confiáveis e válidas, para que possam ser utilizadas pelos sistemas de vigilância para reduzir morbidade e mortalidade na população. Intoxicação não intencional é de interesse para a saúde pública, uma vez que é a principal causa de atendimento de emergência pediátrica. As informações sobre estes eventos estão registradas nos Centros de Controle de Intoxicações (CCIs). Este estudo analisou os registros de intoxicações não intencionais com produtos saneantes domissanitários existentes nos dois CCIs do Estado do Rio de Janeiro, Brasil, no período de 2000-2002. As variáveis analisadas foram sexo, idade, causa do acidente, via de exposição, agente tóxico e evolução do caso. Nos 2.810 registros estudados foi identificada a população vulnerável de meninos até quatro anos e a via de exposição (oral). Entretanto, a análise dos dados relativos ao agente tóxico, causa e evolução demonstrou que os dados registrados atualmente nos CCIs são inconsistentes. Há necessidade de revisar as definições adotadas pelos CCIs para que as informações geradas possam ser efetivas em subsidiar ações e políticas de vigilância sanitária.

Health information systems should be sources of reliable and valid data that can be used for surveillance to reduce morbidity and mortality. Unintentional poisoning is highly relevant to public health, since it is the most frequent cause of emergency pediatric care. Information on such events is recorded in Poison Control Centers (PCCs). The current study analyzed the records on unintentional poisoning with household cleaning products in two PCCs in the State of Rio de Janeiro, Brazil, in 2000-2002. The variables analyzed were gender, age, cause of the accident, exposure route, toxic agent, and outcome. In the 2,810 records studied, boys four years and younger were the most vulnerable group and oral ingestion was the most common exposure route. However, analysis of the data on the toxic agent, cause, and outcome showed that the data currently recorded in the PCCs are inconsistent. It is necessary to review the definitions used by the PCCs in order for the resulting data to effectively support public health measures and health surveillance policies.

Epidemiología de las intoxicaciones: análisis de las llamadas efectuadas durante el año 2007 al Centro de Información Toxicológica (CITUC) de la Pontificia Universidad Católica de Chile / Epidemiology of intoxications: analysis of calls made during 2007 to the Toxicology Information Center (CITUC) of the Catholic University of Chile

Objetivo: Describir y caracterizar la epidemiología de las consultas por intoxicaciones al Centro de Información Toxicológica de la Universidad Católica (CITUC) y conocer las variaciones epidemiológicas producidas entre los años 2004 y 2007. Método: Se realizó un estudio retrospectivo, observacional y descriptivo de las llamadas registradas por el Centro durante el periodo del año 2007. Se analizaron las siguientes variables: número total de llamadas, lugar de las llamadas, circunstancias de la exposición, tipo y números de agentes involucrados, vías de exposición, tiempo desde la exposición, características demográficas y las indicaciones y tratamientos recomendados. Resultados: Se registraron 30.171 llamadas. El 45 por ciento de las consultas provenían del hogar y el 52,5 por ciento de las instalaciones de salud. El 67,2 por ciento de las consultas fueron exposiciones accidentales y el 29,2 por ciento fueron intencionales. Los Medicamentos se presentaron en un 57,1 por ciento de las llamadas, seguidos por los Productos de uso doméstico (16,5 por ciento), Productos de uso industrial (4,7 por ciento), y Pesticidas (5,8 por ciento). La ingestión fue la vía de exposición que se predominó en un 76,6 por ciento del total de casos. El 23,3 por ciento del total de las llamadas, se realizaron dentro de la primera hora post-exposición. Las intoxicaciones en niños menores de 14 años correspondieron al 50 por ciento de las llamadas. Respecto al año 2004 aumentó la proporción de llamadas procedentes del hogar y el porcentaje de intoxicaciones intencionales. Conclusiones: Los medicamentos constituyen el principal agente de intoxicación. La principal vía de exposición es la ingesta y el principal grupo de población afectado son los niños menores de 14 años. Estos son indicadores evidentes y claros de la necesidad imperante de desarrollar campañas publicitarias preventivas e informativas, avaladas por el Ministerio de Salud, respecto al correcto almacenamiento...

Objective: To describe the epidemiological features of the intoxication cases reported to CITUC and the variations produced between 2004 and 2007. Method: A retrospective and descriptive study of the calls registered at the Center during 2007. The following data were analyzed: number and place of the calls; circunstances of exposure; type and number of agents involved; routes of exposure; time since exposure; sex and age of the subjects, and treatment and advice offered. Findings: 30.171 calls were received, 45 percent from the home and 52,5 percent from Health Care Service; 67,2 percent were accidents and 29,2 percent were intentional exposures. The agents were: medicines (57,1 percent); cleaning products (16,5 percent) pesticides (5,8 percent); other chemical and industrial products (4,7 percent). The exposure route was oral in 76,6 percent of cases; 48 percent of calls occurred within one hour of exposure. Children under six were the main group involved. Conclusion: The evidence substantiates a need for prevention campaigns, sponsored by the Health Ministry, about the correct storage of medicines and the appropiate management of poisoning at home. Child-resistant containers and education are two essential elements for prevention of pediatric intoxications.

Intoxicación por rodenticidas anticoagulantes / Poisoning by anticoagulant rodenticides

El Centro de Información Toxicológica de la Universidad Católica (CITUC) recibe llamados telefónicos de todo Chile en relación a intoxicaciones. Este artículo realiza una revisión de los llamados recibidos durante 2007 y específicamente los relacionados a intoxicación con rodenticidas, sustancia importante por la gravedad de sus consecuencias.

Epidemiología de las intoxicaciones que generaron llamadas durante el año 2004 al Centro de Información Toxicológica (CITUC) de la Pontificia Universidad Católica de Chile: Región Metropolitana / Epidemiology of intoxication cases that originated calls to the Toxicology Information Centre (CITUC) of the Catholic University of Chile: Metropolitan Region, 2004

Objetivo: Describir y caracterizar la epidemiología de las consultas por intoxicaciones, reportados al Centro de Información Toxicológica de la Universidad Católica (CITUC). Método: Se realizó un estudio retrospectivo y descriptivo de las llamadas registradas por el centro durante el período del año 2004. Se analizarán los siguientes datos: número total de llamadas, lugar de la llamada, circunstancias de la exposición, tipo y nº de agentes involucrados, vías de exposición, tiempo desde la exposición, sexo y edad de los pacientes, y las indicaciones y tratamientos recomendados. Resultados: Se registraron 22.168 llamadas. El 52,5 por ciento de las consultas provenían del hogar y el 40,2 por ciento de los Servicios de Urgencia. El 71,6 por ciento de las consultas eran exposiciones accidentales y el 19,8 por ciento fueron intencionales. Los medicamentos se presentaron en un 53,6 por ciento de las llamadas, seguidos por los Productos de Aseo (13,7 por ciento), Productos industriales y Químicos (10,2 por ciento), y Pesticidas (7,1 por ciento). El 92,5 por ciento de las exposiciones eran con un agente tóxico. La ingestión fue la vía de exposición que se registró en un 82 por ciento. El 44,6 por ciento del total de las llamadas, se realizaron dentro de la primera hora post-exposición. Las intoxicaciones en niños menores de 6 años correspondieron al 47,9 por ciento de las llamadas. Conclusiones: Los medicamentos constituyen el principal agente de intoxicación. La principal vía de exposición es la ingesta y que el principal grupo de población afectado son los niños menores de 6 años. Estos son indicadores evidentes y claros de la necesidad imperante de desarrollar campañas publicitarias preventivas e informativas, avaladas por el Ministerio de Salud, respecto al correcto almacenaje de los medicamentos y el manejo de las intoxicaciones en el hogar. La introducción del envase resistente a niños y la educación constituyen dos piezas fundamentales en la prevención de las intoxicaciones pediátricas.