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.

Predicting Posttraumatic Stress Symptom Prevalence and Local Distribution after an Earthquake with Scarce Data.

BACKGROUND: After a major earthquake, the assignment of scarce mental health emergency personnel to different geographic areas is crucial to the effective management of the crisis. The scarce information that is available in the aftermath of a disaster may be valuable in helping predict where are the populations that are in most need. OBJECTIVE: The objectives of this study were to derive algorithms to predict posttraumatic stress (PTS) symptom prevalence and local distribution after an earthquake and to test whether there are algorithms that require few input data and are still reasonably predictive. METHODS: A rich database of PTS symptoms, informed after Chile's 2010 earthquake and tsunami, was used. Several model specifications for the mean and centiles of the distribution of PTS symptoms, together with posttraumatic stress disorder (PTSD) prevalence, were estimated via linear and quantile regressions. The models varied in the set of covariates included. RESULTS: Adjusted R2 for the most liberal specifications (in terms of numbers of covariates included) ranged from 0.62 to 0.74, depending on the outcome. When only including peak ground acceleration (PGA), poverty rate, and household damage in linear and quadratic form, predictive capacity was still good (adjusted R2 from 0.59 to 0.67 were obtained). CONCLUSIONS: Information about local poverty, household damage, and PGA can be used as an aid to predict PTS symptom prevalence and local distribution after an earthquake. This can be of help to improve the assignment of mental health personnel to the affected localities. Dussaillant F , Apablaza M . Predicting posttraumatic stress symptom prevalence and local distribution after an earthquake with scarce data. Prehosp Disaster Med. 2017;32(4):357-367.

Adapting the mini mental status to the context of the West-Indies.

The mini mental state examination (MMSE) has become a benchmark for the screening and follow-up of cognitive impairment. The numerous translations of the MMS into other languages attest to its popularity. Clinical practice suggests that the consensual French version from the Greco (Groupe de réflexion sur les évaluations cognitives - Research working group for cognitive assessment) is not adapted to the West-Indies population because of the low socio-economic level and the widespread use of the Creole language among the elderly population. Modification of certain items by a multidisciplinary committee made it possible to adapt the instrument to the Creole culture. This procedure increases comprehension of the instrument, and should lead to improved detection of cognitive impairment in the West-Indies.

Antimutagenic activity of cashew apple (Anacardium occidentale Sapindales, Anacardiaceae) fresh juice and processed juice (cajuína) against methyl methanesulfonate, 4-nitroquinoline N-oxide and benzo[a]pyrene

Cashew apple juice (CAJ), produced from the native Brazilian cashew tree (Anacardium occidentale), and has been reported to have antibacterial, antifungal, antitumor, antioxidant and antimutagenic properties. Both the fresh unprocessed juice and the processed juice (cajuína in Portuguese) has been shown to consist of a complex mixture containing high concentrations of anacardic and ascorbic acids plus several carotenoids, phenolic compounds and metals. We assessed both types of juice for their antimutagenic properties against the direct mutagens methyl methanesulfonate (MMS) and 4-nitroquinoline-N-oxide (4-NQO) and the indirect mutagen benzo[a]pyrene (BaP) using pre-treatment, co-treatment and post-treatment assays with Salmonella typhimurium strains TA100, TA102, and TA97a. In pre-treatment experiments with strains TA100 and TA102 the fresh juice showed high antimutagenic activity against MMS but, conversely, co-treatment with both juices enhanced MMS mutagenicity and there was an indication of toxicity in the post-treatment regime. In pre-, co-, and post-treatments with TA97a as test strain, antimutagenic effects were also observed against 4-NQO and BaP. These results suggest that both fresh and processed CAJ can protect the cells against mutagenesis induced by direct and indirect mutagens.