[Neck pain among tobacco farm workers in Southern Brazil]. / Dolor cervical entre agricultores que producen tabaco en el sur de Brasil.

This study aims to assess neck pain prevalence and associated factors among tobacco farm workers. This is a cross-sectional study of 2,469 tobacco farm workers in southern Brazil. An adapted version of the Nordic Questionnaire of Musculoskeletal Symptoms was used to characterize neck pain. Multivariate analysis was performed using Poisson regression, following a hierarchical theoretical model. Neck pain prevalence in the last year among the population studied was 7.4%. Worker age, tobacco smoking, tobacco bundling, use of heavy chainsaws, working at an intense or accelerated pace and green tobacco sickness were variables associated with neck pain in females. Among males, age, use of heavy chainsaws, working in a sitting position on the ground, pesticide poisoning, and green tobacco sickness were associated with the outcome. The study reinforces the importance of ergonomic and physiological workloads in the determination of neck pain. Future studies are needed to understand the role of pesticides and nicotine exposures on musculoskeletal problems. The mechanization of tobacco harvesting could reduce ergonomic and chemical exposure, thereby improving farmers' health.

Este estudio tiene como objetivo evaluar la prevalencia del dolor cervical y los factores asociados entre agricultores que producen tabaco. Se realizó un estudio transversal en el que participaron 2.469 agricultores que producen tabaco en el sur de Brasil. Para la caracterización del dolor cervical se utilizó una adaptación del cuestionario nórdico para síntomas musculoesqueléticos. El análisis multivariante se realizó mediante la regresión de Poisson, siguiendo un modelo teórico jerárquico. La prevalencia del dolor cervical en el año previo entre la población estudiada fue del 7,4%. Las variables que se asociaron con el dolor cervical entre las mujeres trabajadoras fueron la edad, el consumo de tabaco, el enfardado del tabaco, el uso de motosierras pesadas, trabajar en un ritmo intenso o acelerado y la enfermedad del tabaco verde, mientras que, entre los varones, fueron la edad, el uso de motosierras pesadas, el trabajo sentado en el suelo, la intoxicación por plaguicidas y la enfermedad del tabaco verde. El estudio refuerza la importancia de las cargas de trabajo ergonómicas y fisiológicas en la determinación del dolor cervical. Se necesitan estudios futuros para comprender el papel de la exposición a los plaguicidas y a la nicotina en los problemas musculoesqueléticos. La mecanización de la cosecha del tabaco podría reducir la exposición ergonómica y química, mejorando así la salud de los agricultores.

Association of Copeptin, a Surrogate Marker of Arginine Vasopressin, with Decreased Kidney Function in Sugarcane Workers in Guatemala.

BACKGROUND: Vasopressin is elevated in response to heat and dehydration and has been postulated to have a role in the chronic kidney disease of unknown origin being observed in Central America. The aims of this study were to examine whether the vasopressin pathway, as measured by copeptin, is associated with the presence of kidney dysfunction, and to examine whether higher fluid intake is associated with lower circulating copeptin and thereby preserves kidney health among sugarcane workers exposed to hot conditions. METHODS: Utilizing a longitudinal study of 105 workers in Guatemala, we examined relationships between hydration indices, plasma copeptin concentrations, and kidney function markers at 3 times during the 6-month harvest. We also examined whether baseline copeptin concentrations increased the odds of developing an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2. RESULTS: Copeptin concentrations were positively associated with serum creatinine (ß 1.41, 95% CI 0.88-2.03) and negatively associated with eGFR (ß -1.07, 95% CI -1.43 to -0.70). In addition, as workers improved their hydration (measured by increases in fluid balance), copeptin concentrations were reduced, and this reduction was associated with an improvement in kidney function. CONCLUSIONS: Results suggest that copeptin should be studied as a potential prognostic biomarker.

Dolor cervical entre agricultores que producen tabaco en el sur de Brasil / Neck pain among tobacco farm workers in Southern Brazil

RESUMEN Este estudio tiene como objetivo evaluar la prevalencia del dolor cervical y los factores asociados entre agricultores que producen tabaco. Se realizó un estudio transversal en el que participaron 2.469 agricultores que producen tabaco en el sur de Brasil. Para la caracterización del dolor cervical se utilizó una adaptación del cuestionario nórdico para síntomas musculoesqueléticos. El análisis multivariante se realizó mediante la regresión de Poisson, siguiendo un modelo teórico jerárquico. La prevalencia del dolor cervical en el año previo entre la población estudiada fue del 7,4%. Las variables que se asociaron con el dolor cervical entre las mujeres trabajadoras fueron la edad, el consumo de tabaco, el enfardado del tabaco, el uso de motosierras pesadas, trabajar en un ritmo intenso o acelerado y la enfermedad del tabaco verde, mientras que, entre los varones, fueron la edad, el uso de motosierras pesadas, el trabajo sentado en el suelo, la intoxicación por plaguicidas y la enfermedad del tabaco verde. El estudio refuerza la importancia de las cargas de trabajo ergonómicas y fisiológicas en la determinación del dolor cervical. Se necesitan estudios futuros para comprender el papel de la exposición a los plaguicidas y a la nicotina en los problemas musculoesqueléticos. La mecanización de la cosecha del tabaco podría reducir la exposición ergonómica y química, mejorando así la salud de los agricultores.

ABSTRACT This study aims to assess neck pain prevalence and associated factors among tobacco farm workers. This is a cross-sectional study of 2,469 tobacco farm workers in southern Brazil. An adapted version of the Nordic Questionnaire of Musculoskeletal Symptoms was used to characterize neck pain. Multivariate analysis was performed using Poisson regression, following a hierarchical theoretical model. Neck pain prevalence in the last year among the population studied was 7.4%. Worker age, tobacco smoking, tobacco bundling, use of heavy chainsaws, working at an intense or accelerated pace and green tobacco sickness were variables associated with neck pain in females. Among males, age, use of heavy chainsaws, working in a sitting position on the ground, pesticide poisoning, and green tobacco sickness were associated with the outcome. The study reinforces the importance of ergonomic and physiological workloads in the determination of neck pain. Future studies are needed to understand the role of pesticides and nicotine exposures on musculoskeletal problems. The mechanization of tobacco harvesting could reduce ergonomic and chemical exposure, thereby improving farmers' health.

The Importance of Otoneurological Evaluation in Brazilian Workers Exposed to Pesticides: A Preliminary Study

Introduction: Agrochemicals, also known as pesticides, are widely used in agriculture and in public health. They are organic and inorganic chemical substances with a high level of toxicity not only for the environment, but also for human health. Objective: To verify findings on labyrinthine assessment in endemic disease control agents, and to recommend the inclusion of the vestibular exam in the set of tests for pesticide-exposed populations. Methods: Descriptive, prospective, cross-sectional study with a sample comprising 15 endemic disease control agents, males, mean age of 51.6 years old (standard deviation [SD] = 5.9). All of the participants were submitted to anamnesis, otorhinolaryngological screening, and vestibular assessment. Results: Regarding the most reported complaints, dizziness (73.4%), headache (60%), and tingling in the extremities (53.4%) were observed. The findings of the vestibular exams were normal in 53.3%, while 46.7% showed peripheral vestibular disorder, of which 26.7% were of deficitary type, and 20% of the irritative type. Conclusions: Alteration in the vestibular system was verified in 50% of the workers, with a greater prevalence in the caloric testing. Several disorders related to pesticides intoxication are scientifically known. Actions promoting knowledge and qualification of this population for the proper handling of chemicals are suggested, in addition to the elaboration and inclusion of protocols of vestibular assessment in hearing health programs for the prevention, diagnosis and treatment of vestibular disorders (AU)

Use of cotinine biomarker in workers to detect green tobacco sickness. / Uso de biomarcador cotinina em trabalhadores para detecção da doença da folha verde do tabaco.

OBJECTIVE: using the urinary cotinine biomarker to verify the occurrence of green tobacco sickness in workers who cultivate Burley tobacco. METHOD: paired case-control study, based on smoking status and on the 1:4 ratio, with participation of 20 case workers and 91 controls. Data collection included household surveys and urine collection for cotinine examination. Student's T-Test, the Mann-Whitney test, Pearson's chi-square or Fisher's exact tests were used. RESULTS: of the 23 suspected cases, 20 showed elevated levels of cotinine, signs and symptoms of headache, skin irritation, nausea, sickness and general malaise, especially in the morning. Most had worked with tobacco that was wet from the morning dew and when the weather was warm. CONCLUSION: there are signs suggestive of green tobacco sickness in Burley tobacco workers. The action of health professionals is necessary for the development of health promotion and preventive actions addressing work-related illness.

Neuropsychiatric Disorders in Farmers Associated with Organophosphorus Pesticide Exposure in a Rural Village of Northwest México.

This study aims to determine the degree of acetylcholinesterase inhibition and neurological symptoms for each of the psychiatric disorders diagnosed in the farm workers of a rural population in the state of Baja California, Mexico. We conducted a cross-sectional study on 140 agricultural workers (exposed participants). The study was run using the Mini International Neuropsychiatric Interview Diagnostic Test (MINI), a pre-established questionnaire to diagnose the mental state of each agricultural worker. Analysis of enzymatic activity was carried out using the modified Ellman method. The results showed that, among agricultural workers with slightly inhibited enzymatic activity, 25% met the criteria for the diagnosis of major depression with suicidal attitudes, 23.9% with inhibited enzymatic activity showed generalized anxiety, 23.5% showed combined depression⁻anxiety, and 22% met the criteria for major depression and no psychiatric diagnosis disorder. These results suggest the need for the development of effective public-health strategies to inform farm workers about integrated pesticide management in order to prevent serious health complications.

[Pesticides and hypothyroidism in farmers of plantain and coffee growing areas in Quindio, Colombia]. / Plaguicidas e hipotiroidismo en agricultores en zonas de cultivo de plátano y café, en Quindío, Colombia.

OBJECTIVES: To establish the correlation between hypothyroidism and blood pesticide levels. MATERIALS AND METHODS: Cross-sectional study in agricultural workers and their permanent partners in plantain and coffee producing municipalities as reference population. A representative sample was estimated and thyroid function tests were performed using ELISA Stat Fax 303/Plus reader, at a wavelength of 450 nm. Organochlorine pesticide residuality was determined, a dispersive liquid-liquid microextraction (DLLME) assisted by sonication was implemented, and a gas chromatography-micro-electron capture detector (GC-pECD) was used for the analysis. RESULTS: 819 participants, 58.7% men and 41.3% women were included; their average age was 48.1 years. Prevalence of symptomatic hypothyroidism (1.2%) and subclinical hypothyroidism (6.7%) was observed, with a higher prevalence in people older than 60 years (2.6% and 8.9%, respectively). Non-causal association was found between subclinical hypothyroidism and the organochlorine pesticides 4,4'-DDE (sig.0,006), Heptachlor (sig.0,04), and Endosulfan I (sig.0,02). Antiperoxidase (Anti TPO) antibodies ≥60 lU/ml were associated with subclinical hypothyroidism (OR 2.6). CONCLUSIONS: The prevalence of hypothyroidism in the studied population is similar to that reported in the literature, and lower than in urban areas. In turn, the prevalence of subclinical hypothyroidism is higher and positive anti-TPO values are related to risk of progression to frank hypothyroidism, which is why follow-up is required in these patients. Three organochlorine pesticides were associated with subclinical hypothyroidism. TSH screening is recommended in people aged 40 and over, especially if they are exposed to the aforementioned agrochemicals.

OBJETIVOS: Determinar relación entre hipotiroidismo y plaguicidas en sangre. METODOLOGÍA: Estudio de corte transversal, en agricultores y sus compañeros(as) permanentes en municipios productores de plátano y café. Se calculó muestra representativa. Se realizaron pruebas de función tiroidea, se utilizó un lector de ELISA Stat Fax 303/Plus, en una longitud de onda 450 nm. Se determinó la residualidad de plaguicidas organoclorados, se implementó un método de microextracción dispersiva en fase líquida (DLLME) asistida por sonicación, y se empleó cromatografía de gases con detector de micro captura de electrones (GC-µECD) para el análisis. RESULTADOS: Se incluyeron 819 participantes, 58,7% hombres y 41,3% mujeres; promedio de edad 48,1 años. Prevalencia de hipotiroidismo manifiesto 1,2% y de hipotiroidismo subclínico 6,7%, mayor prevalencia en personas mayores de 60 años (2,6% y 8,9% respectivamente). Se encontró asociación no causal de hipotiroidismo subclínico con plaguicidas organoclorados 4,4'-DDE (sig.0,006), Heptacloro (sig.0,04), y Endosulfán I (sig.0,02). Los anticuerpos antiperoxidasa (Anti TPO) ≥ 60 lU/ml se asociaron con h. subclínico, OR 2,6. CONCLUSIONES: La prevalencia de hipotiroidismo hallada es similar a lo referido en la literatura, es menor que en áreas urbanas; la prevalencia de hipotiroidismo subclínico es mayor y con riesgo de progresión a hipotiroidismo franco cuando se relaciona con Anti-TPO positivos, razón por la cual se requiere seguimiento en estos pacientes. Se asociaron a h. subclínico 3 plaguicidas organoclorados. Se recomienda tamizaje de TSH en personas de 40 y más años sobre todo si están expuestas a los agroquímicos mencionados.

Unadjusted point of care creatinine results overestimate acute kidney injury incidence during field testing in Guatemala.

OBJECTIVE: Acute kidney injury (AKI) occurs at high rates among agricultural workers (12-33%) in tropical environments. Because of the remote locations affected, traditional laboratory services are often unavailable. In this study we compare point of care (POC) creatinine values to standardized laboratory values, and examine the effect of POC testing on the interpretation of AKI rates under tropical field conditions. METHODS: Blood samples were collected from 104 sugarcane workers from two time points in January 2018 as a derivation cohort, and from 105 workers from February to April 2017 as a validation cohort. Finger stick and venipuncture samples were drawn at the end of a worker's shift to measure creatinine. Laboratory samples were tested in Guatemala City, Guatemala, in duplicate using the Jaffe Generation 2 method. An adjustment factor to improve agreement with serum creatinine was statistically derived and validated, and then used to determine impact on observed rates of acute kidney injury based on across shift changes in creatinine. RESULTS: POC creatinine and serum creatinine measures showed that POC consistently overestimated the creatinine by an average of 22% (95% CI: 19.8%, 24.7%) and the disagreement appeared greater at higher values of serum creatinine. An adjustment factor of 0.7775 was applied, which led to significantly greater agreement between the two measures. Rates of AKI in the two combined groups fell from 72% before adjustment to 57% afterwards. CONCLUSIONS: POC testing under tropical field conditions routinely overestimates creatinine compared to laboratory testing, which leads to overestimation of rates of acute kidney injury. The application of an adjustment factor significantly improved the accuracy of the POC value.

Respiratory Condition of Family Farmers Exposed to Pesticides in the State of Rio de Janeiro, Brazil.

Pesticide exposure is a growing public health concern. Although Brazil is the world’s largest consumer of pesticides, only a few studies have addressed the health effects among farmers. This study aimed to evaluate whether pesticide exposure is associated with respiratory outcomes among rural workers and relatives in Brazil during the crop and off-seasons. Family farmers (82) were interviewed about occupational history and respiratory symptoms, and cholinesterase tests were conducted in the crop-season. Spirometry was performed during the crop and off-season. Respiratory outcomes were compared between seasons and multiple regressions analysis were conducted to search for associations with exposure indicators. Participants were occupationally and environmentally exposed to multiple pesticides from an early age. During the crop and off-season, respectively, they presented a prevalence of 40% and 30.7% for cough, 30.7% and 24% for nasal allergies, and 24% and 17.3% for chest tightness. Significant associations between spirometry impairments and exposure indicators were found both during the crop and off-season. These findings provide complementary evidence about the association of pesticide exposure with adverse respiratory effects among family farmers in Brazil. This situation requires special attention as it may increase the risk of pulmonary dysfunctions, and the morbidity and mortality burden associated with these diseases.

[Exposure to organophosphate pesticides and peripheral polyneuropathy in workers from Maule Region, Chile]. / Exposición a plaguicidas organofosforados y polineuropatía periférica en trabajadores de la región del Maule, Chile.

OBJECTIVE: Organophosphate pesticides (OP) are used massively for their low cost, low environmental persistence and high effectiveness in insect pest control, however, agricultural workers, when exposed to OP, have negative consequences on their health mainly neurological. For the first time, a research is reported in a Latin American population that studied the association between labor exposure to OP and the presence of peripheral polyneuropathy in agricultural workers. The aim of the study was to estimate the relationship between occupational exposure to organophosphate pesticides (OP) and presence of peripheral polyneuropathy in workers in the Maule Region, Chile. METHODS: We conducted a cross-sectional study with 55 agricultural workers exposed to OP and 58 non-agricultural workers not exposed. It was applied a test for the detection of peripheral polyneuropathy through pallesthetic threshold assessment by on-off method. To estimate the relationship between exposure to OP pesticides and peripheral polyneuropathy, we used a multiple logistic regression model (95% confidence interval). RESULTS: 26% of the total sample had polyneuropathy, with 38% positive cases for the exposed group and 14% for the non-exposed group. The risk of developing peripheral polyneuropathy was 3.6 times higher in workers exposed to OP than in non-exposed workers. CONCLUSIONS: There is a positive association between the presence of peripheral polyneuropathy and chronic occupational exposure to OP, adjusting for age and sex.

OBJETIVO: Los plaguicidas organofosforados (OP) se usan de manera masiva, por su bajo costo y por su baja persistencia, en el medio ambiente y su alta efectividad en el control de plagas de insectos, sin embargo, los trabajadores agrícolas, cuando se exponen a OP, presentan consecuencias negativas en su salud, principalmente de caracter neurológico. Por primera vez se reporta una investigación en población latinoamericana que estudió la asociación entre exposición laboral a OP y presencia de polineuropatía periférica en trabajadores agrícolas. El objetivo del estudio fue estimar la relación entre exposición laboral a plaguicidas organofosforados (OP) y presencia de polineuropatía periférica en trabajadores de la Región del Maule, Chile. METODOS: Se realizó un estudio transversal analítico con 55 trabajadores agrícolas expuestos a OP y 58 trabajadores no agrícolas no expuestos. Se aplicó una prueba para la detección de polineuropatía periférica a través de la evaluación del umbral palestésico por método on-off. Para estimar la relación entre exposición a plaguicidas OP y polineuropatía periférica se realizó un modelo de regresión logística múltiple (intervalo de confianza del 95%). RESULTADOS: Un 26% del total de la muestra padecía de polineuropatía, con un 38% de casos positivos para el grupo expuesto y un 14% para el grupo no expuesto. El riesgo de desarrollar polineuropatía periférica fue 3,6 veces mayor en los trabajadores expuestos a OP que en los trabajadores no expuestos. CONCLUSIONES: Un 26% del total de la muestra padecía de polineuropatía, con un 38% de casos positivos para el grupo expuesto y un 14% para el grupo no expuesto. El riesgo de desarrollar polineuropatía periférica fue 3,6 veces mayor en los trabajadores expuestos a OP que en los trabajadores no expuestos.

Early detection of acute tubulointerstitial nephritis in the genesis of Mesoamerican nephropathy.

Mesoamerican nephropathy is a devastating disease of unknown etiology that affects mostly young agricultural workers in Central America. An understanding of the mechanism of injury and the early disease process is urgently needed and will aid in identification of the underlying cause and direct treatment and prevention efforts. We sought to describe the renal pathology in Mesoamerican nephropathy at its earliest clinical appearance in prospectively identified acute case patients in Nicaragua. We considered those with elevated (or increased at least 0.3 mg/dL or 1.5-fold from baseline) serum creatinine, leukocyturia, and either leukocytosis or neutrophilia for inclusion in this biopsy study. Renal tissue was obtained by ultrasound-guided biopsy for examination by light, immunofluorescence, and electron microscopy. All 11 individuals who underwent renal biopsy showed tubulointerstitial nephritis, with varying degrees of inflammation and chronicity. Interstitial cellular infiltrates (predominantly T lymphocytes and monocytes), mostly in the corticomedullary junction; neutrophilic accumulation in the tubular lumens; largely preserved glomeruli; few mild ischemic changes; and no immune deposits were noted. The acute components of tubulointerstitial nephritis were acute tubular cell injury, interstitial edema, and early fibrosis. Chronic tubulointerstitial nephritis included severe tubular atrophy, thickened tubular basement membrane, and interstitial fibrosis. Thus, renal histopathology in Mesoamerican nephropathy reveals primary interstitial disease with intact glomeruli.

Parkinsonism Signs and Symptoms in Agricultural Pesticide Handlers in Washington State.

OBJECTIVES: Examine associations between pesticide exposure and signs or symptoms of parkinsonism. METHODS: Prior to the 2014 pesticide spray season, the authors examined 38 active pesticide handlers aged 35 to 65 (median: 43.5) who participated in the State of Washington's cholinesterase monitoring program in the Yakima Valley, where cholinesterase-inhibiting insecticides are applied in fruit orchards. A movement disorder specialist assessed the workers using the Unified Parkinson's Disease Rating Scale (UPDRS) motor subscore 3 (UPDRS3). Participants also self-reported work and medical histories, including the UPDRS activities of daily living subscore 2 (UPDRS2). The authors explored the relation between these scores and lifetime occupational pesticide exposure while accounting for age. RESULTS: All participants were Hispanic men born in Mexico who had worked in agriculture for 4 to 43 years (median: 21 years, including 11 years applying pesticides, mostly in the United States). Ten participants (26%) reported difficulty with one or more UPDRS2 activities of daily living (maximum = 2), and nine (24%) had a UPDRS3 >0 (maximum = 10). The most common symptom and sign, respectively, were excess saliva (n = 6) and action tremor (n = 5). UPDRS2 and UPDRS3 scores were unrelated to the number of years applying pesticides, but UPDRS3, especially action tremor, was positively associated with living on or by a farm. CONCLUSIONS: Symptoms and signs of parkinsonism were absent to mild in this small sample of active workers who apply cholinesterase-inhibiting insecticides in Washington State, USA. Future studies should be larger and examine older, retired workers with greater cumulative exposure to agricultural pesticides at work and home, including other types of agricultural pesticides.

Adverse effects of pesticides on central auditory functions in tobacco growers.

OBJECTIVE: To investigate the effects of exposure to pesticides on the central auditory functions (CAF) of Brazilian tobacco growers. DESIGN: This was a cross-sectional study carried out between 2010 and 2012. Participants were evaluated with two behavioural procedures to investigate CAF, the random gap detection test (RGDT) and the dichotic digit test in Portuguese (DDT). STUDY SAMPLE: A total of 22 growers exposed to pesticides (study group) and 21 subjects who were not exposed to pesticides (control group) were selected. RESULTS: No significant differences between groups were observed for pure-tone thresholds. A significant association between pesticide exposure and the results for RGDT and DDT was found. Significant differences between pesticide-exposed and nonexposed subjects were found for RGDT frequency average and DDT binaural average, when including age and hearing level as covariates. Age was significantly associated with RGDT frequency average, DDT left ear score, DDT binaural average and DDT right ear advantage. Hearing levels were not significantly associated with any of the test scores. The relative risk of failing the DDT and RGDT for the study group was 1.88 (95% CI: 1.10-3.20) and 1.74 (95% CI: 1.06-2.86), respectively, as compared with the control group. CONCLUSIONS: The results showed that tobacco growers exposed to pesticides exhibited signs of central auditory dysfunction characterised by decrements in temporal processing and binaural integration processes/abilities.

Assessment of hematological parameters in workers exposed to organophosphorus pesticides, carbamates and pyrethroids in Cundinamarca 2016-2017.

OBJECTIVE: To establish hematotoxic alterations through clinical and paraclinical exploration in workers who are exposed to organophosphorus pesticides, carbamates and pyrethroids (OPCP) due to their work in production, packaging, distribution and fumigation processes in Cundinamarca-Colombia between 2016 and 2017. MATERIALS AND METHODS: A cross-sectional descriptive epidemiological study was carried out on a sample of 92 workers from six companies, mostly aged between 18 and 30 years, of which 61 % were males and 39 % females, and 71 % were workers in the operational area and 29 % in the administrative area. Univariate, bivariate and multivariate analyses were performed. RESULTS: Clinical exploration reported findings in 17 % of the sample group, of which only 2 % presented with erythrocyte cholinesterase outside the reference range. The values of hematological parameters such as peripheral blood smear (PBS) and complete blood count (CBC) were outside the range in 15 % and 47 % of the sample, respectively. DISCUSSION: The results suggest that there are hematological alterations in this group that could possibly be associated with chronic exposure to OPCP.

Caracterización de intoxicaciones agudas por plaguicidas en el departamento de Intibucá / Characterization of acute pesticide poisoning in the Department of Intibucá

Antecedentes: El uso de plaguicidas se ha incrementado a partir de los años 40's con la introducción de las sustancias sintetizadas químicamente. El uso de estos va de la mano con el crecimiento constante de la economía agraria. Los primeros plaguici - das utilizados fueron los Organoclorados, en los años 50's fueron sustituidos por Organofosforados y Carbamatos, actualmente existe una amplia variedad de agroquímicos con diferentes grados de toxicidad. Objetivo. Caracterizar los casos notiicados de intoxicación por plaguicidas en Hospital de Área Enrique Aguilar Cerrato en el Departamento de Intibucá. Material y métodos. Se revisaron 232 expedientes de pacientes con intoxicación aguda por plaguicidas, tratados en la emergencia de enero del 2010 a diciembre del 2014. Se recopilaron variables demográicas, clínicas y laboratoriales mediante icha de recolección de datos y se aplicó estadística descriptiva. Resultados. Predominó el sexo masculino 187 casos (81%) y la edad media fue de 26 años, siendo la población agri - cultora la más afectada (68%). El modo de intoxicación más frecuente fue la intencional (74%). Involucrados los bipiridilos (33%) y organofosforados (30%) predominantemente. Discusión. Las intoxicaciones agudas por plaguicidas en Intibucá son más frecuentes en los agricultores masculinos alfabetas y el intento suicida por vía oral la causa principal de las mismas. Los plaguicidas más impli - cados son los bipiridilos y los organofosforados, ocupando el primer y segundo lugar respectivamente. No hubo muertes reportadas en nuestro estudio...(AU)

Mesoamerican Nephropathy or Global Warming Nephropathy?

BACKGROUND: An epidemic of chronic kidney disease (CKD) of unknown cause has emerged along the Pacific Coast of Central America. The disease primarily affects men working manually outdoors, and the major group affected is sugarcane workers. The disease presents with an asymptomatic rise in serum creatinine that progresses to end-stage renal disease over several years. Renal biopsies show chronic tubulointerstitial disease. While the cause remains unknown, recent studies suggest that it is driven by recurrent dehydration in the hot climate. Potential mechanisms include the development of hyperosmolarity with the activation of the aldose reductase-fructokinase pathway in the proximal tubule leading to local injury and inflammation, and the possibility that renal injury may be the consequence of repeated uricosuria and urate crystal formation as a consequence of both increased generation and urinary concentration, similar to a chronic tumor lysis syndrome. The epidemic is postulated to be increasing due to the effects of global warming. SUMMARY: An epidemic of CKD has led to the death of more than 20,000 lives in Central America. The cause is unknown, but appears to be due to recurrent dehydration. Potential mechanisms for injury are renal damage as a consequence of recurrent hyperosmolarity and/or injury to the tubules from repeated episodes of uricosuria. KEY MESSAGES: The epidemic of CKD in Mesoamerica may be due to chronic recurrent dehydration as a consequence of global warming and working conditions. This entity may be one of the first major diseases attributed to climate change and the greenhouse effect.

[Tuberculosis caused by Mycobacterium bovis in workers of bovine tuberculosis sanitation farms in Antioquia, Boyacá and Cundinamarca]. / Tuberculosis por Mycobacterium bovis en trabajadores de fincas en saneamiento para tuberculosis bovina, de Antioquia, Boyacá y Cundinamarca.

OBJECTIVE: To perform classic and molecular epidemiological surveillance of human tuberculosis caused by Mycobacterium bovis in bovine supply chains at farms with PPD positive bovines in the departments of Antioquia, Boyacá and Cundinamarca during a one-year period. METHODS: Livestock farms with PPD positive bovines or buffalos were visited in the study departments according to information obtained in the "Programa Nacional de Tuberculosis bovina" (National program on bovine Tuberculosis) released by ICA (Colombian Agriculture and Livestock Institute). Data on socio-demographic information and tuberculosis risk factors associated to the occupation were collected through a survey applied to all workers at the visited farms. Sputum samples were obtained after informed consent. The sputa underwent microbiological and molecular testing to identify members of the M. tuberculosis complex. RESULTS: Thirty-three livestock farms were visited and information of 164 workers from the bovine supply chain was collected. Staying in a PPD positive farm for more than a year, ignorance about the disease and the presence of possible vectors, like dogs and cats, were identified as possible risk factors for developing tuberculosis. No cases of tuberculosis caused by M. bovis or M. tuberculosis in workers of the visited farms were found. CONCLUSION: No cases of the disease caused by this zoonotic agent were documented in the departments of Antioquia, Boyacá and Cundinamarca.