Acute pesticide poisoning: Comparison of epidemiological characteristics between the rural and urban population

Objective: To analyze the behavior of pesticide poisoning associated with lethality in rural and urban populations in Colombia from 2007 to 2017. Methodology: Retrospective observational study that included a descriptive cross-sectional study and an ecological design that analyzed aggregate measures of morbidity, mortality, and risk attributable to the population in rural and urban areas. In the cross-sectional study, the relative risk was estimated to measure the factors associated with lethality among intoxications using Poisson regression with logarithmic function. For the time series, the trends were established with simple linear regression, and the seasonal decomposition was performed using the multiplicative model. Autocorrelations were tested using the Box-Ljung statistic. Results: Between 2007-2017; 89 490 cases were reported. The Morbidity due to poisoning showed a higher proportion in the rural population 36.03 cases per 100 000; this indicator was three times higher than in urban areas (12.33 cases per 100 000). The mortality rates in rural and urban areas were 1.00 and 0.13 cases per 100 000, respectively. The relative risk of fatality in case of intoxication was associated with the intention of suicide in the rural population Relative Risk (RR): 5.9 (95% CI: 5.0-6.9). Conclusion: A higher proportion of lethality associated with these events occurred in populations living in rural areas and reporting cases of suicidal intent. In addition, morbidity and mortality due to pesticide poisoning had the highest proportion in rural areas and a growing trend over time.

Objetivo: Analizar el comportamiento de las intoxicaciones por plaguicidas en poblaciones rurales y urbanas asociadas a la letalidad en Colombia durante 2007-2017. Metodología: Estudio observacional retrospectivo que incluyó: un estudio descriptivo transversal y un diseño ecológico que analizó medidas agregadas de morbilidad, mortalidad y riesgo atribuibles a la población en áreas rurales y urbanas. En el estudio transversal se estimó el riesgo relativo para medir los factores asociados a la letalidad entre las intoxicaciones mediante regresión de Poisson con función logarítmica. Para la serie de tiempo, las tendencias se establecieron con regresión lineal simple y la descomposición estacional se realizó mediante el modelo multiplicativo. Las autocorrelaciones se probaron mediante el estadístico Box-Ljung. Resultados: Entre 2007-2017; Se notificaron 89 490 casos. La Morbilidad por intoxicación presentó mayor proporción en la población rural 36,03 casos por 100 000; este indicador fue tres veces mayor que en las áreas urbanas (12,33 casos por 100 000). Las tasas de mortalidad en el área rural y urbana fueron de 1,00 y 0,13 casos por 100 000, respectivamente. El riesgo relativo de fatalidad en caso de intoxicación se asoció con la intención de suicidio en la población rural RR: 5,9 (IC 95%: 5,0-6,9). Conclusión: Una mayor proporción de letalidad asociada a estos eventos ocurrió en poblaciones que viven en áreas rurales y reportan casos de intención suicida. Además, la morbilidad y mortalidad por intoxicación por plaguicidas tuvo la mayor proporción en las zonas rurales y una tendencia creciente en el tiempo.

Objetivo: Analisar o comportamento das intoxicações por agrotóxicos em populações rurais e urbanas associadas à letalidade na Colômbia durante 2007-2017. Metodologia: Estudo observacional retrospectivo que incluiu: estudo transversal descritivo e delineamento ecológico que analisou medidas agregadas de morbidade, mortalidade e risco atribuíveis à população em áreas rurais e urbanas. No estudo transversal, o risco relativo foi estimado para medir os fatores associados à letalidade entre as intoxicações por meio da regressão de Poisson com função logarítmica. Para as séries temporais, as tendências foram estabelecidas com regressão linear simples e a decomposição sazonal foi realizada usando o modelo multiplicativo. As autocorrelações foram testadas usando a estatística Box-Ljung. Resultados: Entre 2007-2017; 89.490 casos foram notificados. A Morbidade por intoxicação apresentou maior proporção na população rural 36,03 casos por 100.000; este indicador foi três vezes superior ao das zonas urbanas (12,33 casos por 100 000). As taxas de mortalidade nas áreas rural e urbana foram de 1,00 e 0,13 casos por 100.000 habitantes, respectivamente. O risco relativo de fatalidade em caso de intoxicação associou-se à intenção de suicídio na população rural RR: 5,9 (IC 95%: 5,0-6,9). Conclusão: Maior proporção de letalidade associada a esses eventos ocorreu em populações residentes em áreas rurais e com relato de casos de intenção suicida. Além disso, a morbimortalidade por intoxicação por agrotóxicos teve maior proporção na zona rural e tendência crescente ao longo do tempo.

Assessment of Factors Influencing Personal Exposure to Air Pollution on Main Roads in Bogota: A Mixed-Method Study.

Background and Objectives: Particulate Matter (PM), particles of variable but small diameter can penetrate the respiratory system via inhalation, causing respiratory and/or cardiovascular diseases. This study aims to evaluate the association of environmental particulate matter (PM2.5) and black carbon (BC) with respiratory health in users of different transport modes in four roads in Bogotá. Materials and Methods: this was a mixed-method study (including a cross sectional study and a qualitative description of the air quality perception), in 300 healthy participants, based on an exploratory sequential design. The respiratory effect was measured comparing the changes between pre- and post-spirometry. The PM2.5 and black carbon (BC) concentrations were measured using portable devices. Inhaled doses were also calculated for each participant according to the mode and route. Perception was approached through semi-structured interviews. The analysis included multivariate models and concurrent triangulation. Results: The concentration of matter and black carbon were greater in bus users (median 50.67 µg m-3; interquartile range (-IR): 306.7). We found greater inhaled dosages of air pollutants among bike users (16.41 µg m-3). We did not find changes in the spirometry parameter associated with air pollutants or transport modes. The participants reported a major sensory influence at the visual and olfactory level as perception of bad air quality. Conclusions: We observed greater inhaled doses among active transport users. Nevertheless, no pathological changes were identified in the spirometry parameters. People's perceptions are a preponderant element in the assessment of air quality.

Intento de suicidio en Colombia: un estudio de los factores asociados a la intoxicación intencionada. 2007-2017

Objetivo: Identificar los factores asociados a la intoxicación intencionada por plaguicidas en Colombia durante 2007-2017. Metodología: Se llevó a cabo un estudio analítico transversal en la población de intoxicados con intención suicida por plaguicidas de Colombia entre 2007 a 2017. Se calcularon prevalencias ajustadas por edad, expresadas por 100 000 personas contadas por sexo. Se realizó un modelo de regresión bivariado, en el cual la condición final se constituyó en la variable de interés (variable y; 0=vivo 1=muerto) y las variables explicativas fueron (variables x): sociodemográficas (sexo, edad, escolaridad y procedencia) y específicas del evento (vía de exposición). Resultados: el comportamiento de los Odds Ratio evidencia que, los hombres tienen un riesgo de fallecer de 1.39 (95 % IC: 1.238-1.567) más veces que las mujeres. Con respecto al régimen de afiliación en salud, las personas no aseguradas tienen un riesgo de fallecer por suicidio de 1.33 más veces con respecto a los que sobreviven (95 % IC: 1.131-1.555). Para la mortalidad por suicidio se identifican los siguientes factores asociados a la supervivencia (intentos de suicidio no consumados): en primer lugar, el área de residencia urbana y, en segundo lugar, los grupos de edad, adolescente y la adultez temprana. Conclusiones: Al analizar la mortalidad por suicidio asociada a la intoxicación por plaguicidas los hombres son identificados y caracterizados como el grupo de mayor riesgo, siguiendo tendencias generales (todos los métodos) similares a estudios realizados a nivel mundial.

Objective: To identify the social factors associated with intentional poisoning by pesticides in Colombia, during the 2007-2017 period. Methodology: A cross-sectional analytical study was carried out in the population of those intoxicated by pesticides with suicidal intent in Colombia between 2007 and 2017. Age-adjusted prevalences were calculated, expressed per 100,000 people, counted by sex. A bi-variate regression model was carried out, in which the final condition was constituted in the variable of interest (variable y; 0 = alive 1 = dead), and the explanatory variables were (variables x): sociodemographic (sex, age, education and origin) and specific to the event (route of exposure). Results: the behavior of the Odds Ratio shows that men have a risk of dying 1,393 (95% CI: 1,238-1,567) more times than women. Regarding the health affiliation scheme, uninsured people have a risk of dying by suicide 1.33 times more than those who survive (95% CI: 1.131-1.555). For mortality due to suicide, the following factors associated with survival (unsuccessful suicide attempts) are identified: firstly, the urban residence area and secondly, age groups: adolescents and early adulthood. Conclusions: When analyzing suicide mortality associated with pesticide poisoning, men are identified and characterized as the highest risk group, following general trends (all methods) similar to studies carried out worldwide.

Seroprevalence of the SARS-CoV-2 antibody in healthcare workers: a multicentre cross-sectional study in 10 Colombian cities.

BACKGROUND: Healthcare workers are at increased risk of infection due to occupational exposure to SARS-CoV-2-infected patients. The objective of this study was to determine the seroprevalence of SARS-CoV-2 in healthcare workers in Colombia. METHODS: This study is a cross-sectional study focused on estimating the seroprevalence of SARS-CoV-2 antibodies in healthcare workers from 65 hospitals in 10 cities in Colombia during the second semester of 2020. The seroprevalence was determined using an automated immunoassay (Abbott SARS-CoV-2 CLIA IgG). The study included a survey to establish the sociodemographic variables and the risk of infection. A multivariate model was used to evaluate the association between the results of seroprevalence and risk factors. RESULTS: The global seroprevalence of antibodies against SARS-CoV-2 was 35% (95% Bayesian CI 33% to 37%). All the personnel reported the use of protective equipment. General services personnel and nurses presented the highest ratios of seroprevalence among the healthcare workers. Low socioeconomic strata have shown a strong association with seropositivity. CONCLUSION: This study estimates the prevalence of SARS-CoV-2 infection among healthcare workers. Even though all the personnel reported the use of protective equipment, the seroprevalence in the general services personnel and nurses was high. Also, a significant difference by cities was observed.

From environment to clinic: the role of pesticides in antimicrobial resistance.

Antimicrobial resistance (AMR) in pathogens has been associated mainly with excessive use of antibiotics. Most studies of resistance have focused on clinical pathogens; however, microorganisms are exposed to numerous anthropogenic substances. Few studies have sought to determine the effects of chemical substances on microorganisms. Exposure to these substances may contribute to increased rates of AMR. Understanding microorganism communities in natural environments and AMR mechanisms under the effects of anthropogenic substances, such as pesticides, is important to addressing the current crisis of antimicrobial resistance. This report draws attention to molecules, rather than antibiotics, that are commonly used in agrochemicals and may be involved in developing AMR in non-clinical environments, such as soil. This report examines pesticides as mediators for the appearance of AMR, and as a route for antibiotic resistance genes and antimicrobial resistant bacteria to the anthropic environment. Available evidence suggests that the natural environment may be a key dissemination route for antibiotic-resistant genes. Understanding the interrelationship of soil, water, and pesticides is fundamental to raising awareness of the need for environmental monitoring programs and overcoming the current crisis of AMR.

La resistencia a los antimicrobianos (RAM) en los agentes patógenos ha sido relacionada principalmente con el uso excesivo de los antibióticos. La mayoría de los estudios sobre la resistencia se han centrado en los agentes patógenos de importancia clínica; sin embargo, los microorganismos están expuestos a numerosas sustancias antropogénicas. Son muy pocos los estudios dedicados a determinar los efectos que producen las sustancias químicas en los microorganismos. La exposición a estas sustancias puede contribuir a los niveles mayores de la RAM. Comprender las comunidades de microorganismos en el medioambiente natural y los mecanismos de la RAM por los efectos de las sustancias antropogénicas, como los plaguicidas, resulta importante para abordar la actual crisis de la resistencia a los antimicrobianos. En este informe se hace énfasis en las moléculas, en lugar de los antibióticos, que se usan generalmente en los productos agroquímicos y que podrían contribuir a que se desarrolle la RAM en entornos no clínicos, como el suelo. Asimismo, se analiza el papel de los plaguicidas como mediadores en la aparición de la RAM, así como la manera en la que los genes y los microorganismos resistentes a los antibióticos se trasladan hacia el entorno antrópico. La evidencia indica que el entorno natural podría ser una vía clave de propagación para los genes resistentes a los antibióticos. Comprender la interrelación entre el suelo, el agua y los plaguicidas es fundamental para crear consciencia en cuanto a la necesidad de establecer programas de seguimiento ambiental y así poder superar la crisis actual de la RAM.

A resistência antimicrobiana dos patógenos está principalmente associada ao uso excessivo de antibióticos. Os estudos sobre resistência se concentram, na sua maioria, nos patógenos de importância clínica. Porém, os microrganismos são expostos a inúmeras substâncias antropogênicas e existem poucos estudos sobre os efeitos que os compostos químicos causam nos microrganismos. A exposição a estes compostos pode contribuir para o aumento da resistência antimicrobiana. Entender as comunidades de microrganismos em ambiente natural e os mecanismos de resistência antimicrobiana por ação das substâncias antropogênicas, como os pesticidas, é essencial no combate à atual crise de resistência antimicrobiana. Este informe destaca os compostos ativos (exceto antibióticos) normalmente usados nos produtos agroquímicos que podem contribuir para o surgimento de resistência antimicrobiana em ambientes não clínicos, como o solo. Examina-se o papel dos pesticidas como mediadores da resistência antimicrobiana e as vias pelas quais os genes que conferem resistência e as bactérias resistentes aos antimicrobianos alcançam o ambiente antrópico. As evidências indicam que o ambiente natural pode ser uma das principais vias de disseminação dos genes que conferem resistência aos antibióticos. Entender a inter-relação entre solo, água e pesticidas é fundamental para conscientizar sobre a necessidade de programas de monitoramento ambiental e combater a atual crise de resistência antimicrobiana.

From environment to clinic: the role of pesticides in antimicrobial resistance

[ABSTRACT]. Antimicrobial resistance (AMR) in pathogens has been associated mainly with excessive use of antibiotics. Most studies of resistance have focused on clinical pathogens; however, microorganisms are exposed to numerous anthropogenic substances. Few studies have sought to determine the effects of chemical substances on microorganisms. Exposure to these substances may contribute to increased rates of AMR. Understanding microorganism communities in natural environments and AMR mechanisms under the effects of anthropogenic substances, such as pesticides, is important to addressing the current crisis of antimicrobial resistance. This report draws attention to molecules, rather than antibiotics, that are commonly used in agrochemicals and may be involved in developing AMR in non-clinical environments, such as soil. This report examines pesticides as mediators for the appearance of AMR, and as a route for antibiotic resistance genes and antimicrobial resistant bacteria to the anthropic environment. Available evidence suggests that the natural environment may be a key dissemination route for antibiotic-resistant genes. Understanding the interrelationship of soil, water, and pesticides is fundamental to raising awareness of the need for environmental monitoring programs and overcoming the current crisis of AMR.

[RESUMEN]. La resistencia a los antimicrobianos (RAM) en los agentes patógenos ha sido relacionada principalmente con el uso excesivo de los antibióticos. La mayoría de los estudios sobre la resistencia se han centrado en los agentes patógenos de importancia clínica; sin embargo, los microorganismos están expuestos a numerosas sustancias antropogénicas. Son muy pocos los estudios dedicados a determinar los efectos que producen las sustancias químicas en los microorganismos. La exposición a estas sustancias puede contribuir a los niveles mayores de la RAM. Comprender las comunidades de microorganismos en el medioambiente natural y los mecanismos de la RAM por los efectos de las sustancias antropogénicas, como los plaguicidas, resulta importante para abordar la actual crisis de la resistencia a los antimicrobianos. En este informe se hace énfasis en las moléculas, en lugar de los antibióticos, que se usan generalmente en los productos agroquímicos y que podrían contribuir a que se desarrolle la RAM en entornos no clínicos, como el suelo. Asimismo, se analiza el papel de los plaguicidas como mediadores en la aparición de la RAM, así como la manera en la que los genes y los microorganismos resistentes a los antibióticos se trasladan hacia el entorno antrópico. La evidencia indica que el entorno natural podría ser una vía clave de propagación para los genes resistentes a los antibióticos. Comprender la interrelación entre el suelo, el agua y los plaguicidas es fundamental para crear consciencia en cuanto a la necesidad de establecer programas de seguimiento ambiental y así poder superar la crisis actual de la RAM.

[RESUMO]. A resistência antimicrobiana dos patógenos está principalmente associada ao uso excessivo de antibióticos. Os estudos sobre resistência se concentram, na sua maioria, nos patógenos de importância clínica. Porém, os microrganismos são expostos a inúmeras substâncias antropogênicas e existem poucos estudos sobre os efeitos que os compostos químicos causam nos microrganismos. A exposição a estes compostos pode contribuir para o aumento da resistência antimicrobiana. Entender as comunidades de microrganismos em ambiente natural e os mecanismos de resistência antimicrobiana por ação das substâncias antropogênicas, como os pesticidas, é essencial no combate à atual crise de resistência antimicrobiana. Este informe destaca os compostos ativos (exceto antibióticos) normalmente usados nos produtos agroquímicos que podem contribuir para o surgimento de resistência antimicrobiana em ambientes não clínicos, como o solo. Examina-se o papel dos pesticidas como mediadores da resistência antimicrobiana e as vias pelas quais os genes que conferem resistência e as bactérias resistentes aos antimicrobianos alcançam o ambiente antrópico. As evidências indicam que o ambiente natural pode ser uma das principais vias de disseminação dos genes que conferem resistência aos antibióticos. Entender a inter-relação entre solo, água e pesticidas é fundamental para conscientizar sobre a necessidade de programas de monitoramento ambiental e combater a atual crise de resistência antimicrobiana.

Evaluation of concordance among surgeons and pathologists regarding the diagnosis and classification of acute appendicitis in children.

Acute appendicitis is the most frequent urgent abdominal surgical pathology in children. Therapeutic decisions in patients who have undergone an appendectomy are made based on the macroscopic findings at the moment of surgery. There is high variability between surgical and histopathological findings. METHOD: Concordance among surgeons and pathologists regarding the diagnosis and classification of acute appendicitis was assessed in children who have undergone an appendectomy. Surgical site infection (SSI) incidence was measured for both the surgical and pathological classification. RESULTS: The statistical analysis included 1092 children. The pathologists confirmed the presence of appendicitis in 90.4% of the patients. Concordance in the diagnosis of appendicitis among surgeons and pathologists was weak (kappa 0.57), while concordance in the classification of perforated or non-perforated appendicitis was moderate (kappa 0.7). There were no significant differences in these findings determined by the surgeons' experience or the open or laparoscopic approach. In the discordant group of 70 patients in which the surgeon classified the appendicitis as non-perforated but the pathologist classified as perforated, just one patient developed an intra-abdominal abscess. CONCLUSIONS: The classification of appendicitis as perforated or non-perforated shows moderate concordance between the surgical and histopathological diagnosis. This concordance is not determined by the surgeons' experience or the surgical approach. TYPE OF STUDY: Diagnostic Test LEVEL OF EVIDENCE: Level II.

Bufo marinus oocytes as a model for ion channel protein expression and functional characterization for electrophysiological studies.

Oocytes from Xenopus laevis are commonly used as an expression system for ion channel proteins. The aim of this study was to determine whether oocytes from the Colombian native toad, Bufo marinus, could be used as an alternative expression system for ion channel protein expression and functional characterization using the two-microelectrode voltage clamp method. B. marinus oocytes and X. laevis were isolated and cultured in similar conditions. The mean resting membrane potential of B. marinus oocytes was similar to that of X. laevis oocytes as well as the whole-cell basal currents. The potassium ion channel Kv1.1 was successfully expressed in B. marinus oocytes and showed a typical outward rectifying current. Potassium channel blockers reduced these currents. The similarities on electrical properties and expression of ion channel proteins show that B. marinus oocytes can be used effectively to express these proteins, making these cells a viable heterologous system for the expression of ion channel proteins and their electrophysiological characterization.