Zinc Phosphide Poisoning: From A to Z.

Zinc phosphide is a rodenticide that is used in agricultural, urban and industrial environments in México. After ingestion, it reacts with hydrochloric acid, hydrolyzing into phosphine. It causes cellular hypoxia via mitochondrial toxicity, resulting in multiple organ dysfunction and death. There is no antidote or specific treatment for zinc phosphide toxicity. We present the case of a 45-year-old female who ingested zinc phosphide with suicidal intent. On arrival at the emergency department, she had multisystemic disorders. Supportive care, decontamination and antidotal therapy were initiated. Subsequently, she evolved to clinical improvement with a resolution of the biochemical abnormalities of tissue hypoperfusion. She was discharged on day 7 without complications. In this review, we provide updated therapeutic options and discuss their specific pathophysiological basis.

Hematologic parameters and the effect of hemoparasites of wild anurans in Northern Sinaloa, Mexico.

BACKGROUND: Few hematologic profiles for free-ranging amphibians are available. Hematologic evaluation is a useful tool for determining the health of amphibian populations and providing further knowledge for conservation actions. OBJECTIVES: Hematologic variables and the presence and effect of hemoparasites in anuran species were evaluated in Northern Sinaloa, Mexico. METHODS: Blood samples were collected from wild anurans of eight species to perform blood cell counts, leukocyte differential counts, and serum protein concentrations using manual methods and refractometry. In addition, morphologic identification and quantification of the hemoparasites were performed on blood smears. RESULTS: Differences were observed by sex, age, and season for the hematologic values of Incilius alvarius (n = 23), Incilius mazatlanensis (n = 46), Rhinella horribilis (n = 64), Leptodactylus melanonotus (n = 46), Lithobates forreri (n = 135), Lithobates catesbeianus (n = 20), Smilisca fodiens (n = 42), and Scaphiopus couchii (n = 7). Intra- and extra-erythrocytic hemoparasites were found in 56.2% of amphibian hosts; the hemoparasite infection of R. horribilis and L. melanonotus was higher in the dry season, showing increases in erythroplastids and monocytes. For L. forreri, males were more infected than females, and increases in leukocytes were associated with infections of different types of hemoparasites species. CONCLUSIONS: Hematologic values, hemoparasite prevalence, and the response to hemoparasite infection vary among amphibian species, sex, and age, as well as on season and hemoparasite type. This highlights the importance of hematologic evaluations in wild amphibian populations to determine the subclinical effects of hemoparasite infections.

Suministro y demanda de sangre durante la pandemia de COVID-19. Una revisión / Blood supply and demand during the COVID-19 pandemic. A review

Resumen La propagación tan rápida del nuevo coronavirus 2 del síndrome respiratorio agudo grave (SARS-CoV-2), que se informó por primera vez en Wuhan (China) a finales de diciembre de 2019, y produce la enfermedad caracterizada por neumonía llamada enfermedad por coronavirus 2019 (COVID-19), ha causado un impacto significativo en los sistemas de salud en todo el mundo y la interrupción de la vida cotidiana. A finales de junio el número de casos confirmados es de 9,188,362 millones, con más de 474,339 muertes, y aproximadamente 4,937,282 personas recuperadas. Las estrictas medidas para restricción de la movilidad y medidas de distanciamiento social impuestas por los gobiernos, más el miedo y pánico resultado de manera abrumadora entre el público general, ha comprometido de manera importante la sostenibilidad del suministro de sangre segura, el cual se vuelve particularmente desafiante. La demanda de sangre y productos sanguíneos puede disminuir durante una pandemia debido al aplazamiento de cirugías electivas. Medidas como el distanciamiento físico y el bloqueo total de las ciudades, las provincias o países que intentan frenar la propagación de la infección pueden provocar una disminución importante en el suministro y una escasez general de productos sanguíneos. Los hospitales deben contar con un plan de manejo de sangre para emergencias en la planificación de preparación sobre la sostenibilidad y seguridad del suministro de sangre. Esta revisión considera el impacto de la pandemia de COVID-19 en el suministro de sangre y especifica aspectos importantes del manejo de los donantes, y la utilización apropiada de los componentes sanguíneos.

Abstract The rapid spread of the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which was first reported in Wuhan (China) in late December 2019, and produces the disease characterized by pneumonia called coronavirus disease 2019 (COVID-19), has caused a significant impact on health systems worldwide and disruption of daily life; at the end of June the number of confirmed cases is 9,188,362 million with more than 474,339 deaths, and approximately 4,937,282 people recovered. Strict measures to restrict mobility, social distancing measures imposed by governments, plus overwhelming fear and panic among the general public, have significantly compromised the sustainability of the safe blood supply, it becomes particularly challenging. The demand for blood and blood products may decrease during a pandemic due to the postponement of elective surgeries, measures such as physical distancing and the total blockade of cities, provinces or countries that try to stop the spread of the infection can cause a significant decrease in the supply and a general shortage of blood products. Hospitals must have a blood management plan for emergencies in preparedness planning on the sustainability and safety of the blood supply. This review considers the impact of the COVID-19 pandemic on blood supply and specifies important aspects of donor management, and the proper use of blood components.

Cryotherapy as a coadjuvant in crotaline snakebite management with F(ab')2 antivenom: A randomized pilot study.

INTRODUCTION: Local cryotherapy induces vasoconstriction, which leads to a reduction in the inflammatory process. However, the effectiveness of local cryotherapy as a coadjuvant in the treatment of snakebite with F(ab')2 antivenom is unknown. OBJECTIVE: To describe the clinical effectiveness of local cryotherapy as a coadjuvant in patients with snakebite treated with F(ab')2 antivenom therapy at the Hospital Juárez de Mexico. MATERIAL AND METHODS: Patients with grade II snakebite envenomation according to the Christopher-Rodning classification system were enrolled from the Clinical Toxicology Service of the Hospital Juárez de México. One group of patients received F(ab')2 antivenom therapy (Antivipmyn®) plus local cryotherapy, and the other group received only F(ab')2 antivenom therapy. RESULTS: Thirty-eight patients were included, of whom 86.8 % were male (n = 33). Approximately 81.5 % of the subjects were injured in an upper extremity, while 18.5 % were injured in a lower extremities; 47.3 % of the subjects reported treatment of the snakebite prior to hospitalization (suction, the application of a tourniquet, incision of the bite site, or the application of traditional medicine). No differences were found concerning edema, swelling, and pain between the groups. The group that received local cryotherapy as a coadjuvant to F(ab')2 antivenom therapy had a shorter hospital stay (Cohen's d = 1.33; 95 % confidence interval [95 % CI] = 0.74-1.62; p < 0.01) and received fewer doses of F(ab')2 antivenom therapy (Cohen's d = 0.69; 95 % CI = 0.19-3.80; p = 0.03). CONCLUSIONS: The use of adequate local cryotherapy as a coadjuvant to F(ab')2 antivenom therapy reduces the length of hospital stay and the number of doses of F(ab')2 antivenom therapy used.

Integrating remotely sensed fires for predicting deforestation for REDD.

Fire is an important tool in tropical forest management, as it alters forest composition, structure, and the carbon budget. The United Nations program on Reducing Emissions from Deforestation and Forest Degradation (REDD+) aims to sustainably manage forests, as well as to conserve and enhance their carbon stocks. Despite the crucial role of fire management, decision-making on REDD+ interventions fails to systematically include fires. Here, we address this critical knowledge gap in two ways. First, we review REDD+ projects and programs to assess the inclusion of fires in monitoring, reporting, and verification (MRV) systems. Second, we model the relationship between fire and forest for a pilot site in Colombia using near-real-time (NRT) fire monitoring data derived from the Moderate Resolution Imaging Spectroradiometer (MODIS). The literature review revealed fire remains to be incorporated as a key component of MRV systems. Spatially explicit modeling of land use change showed the probability of deforestation declined sharply with increasing distance to the nearest fire the preceding year (multi-year model area under the curve [AUC] 0.82). Deforestation predictions based on the model performed better than the official REDD early-warning system. The model AUC for 2013 and 2014 was 0.81, compared to 0.52 for the early-warning system in 2013 and 0.68 in 2014. This demonstrates NRT fire monitoring is a powerful tool to predict sites of forest deforestation. Applying new, publicly available, and open-access NRT fire data should be an essential element of early-warning systems to detect and prevent deforestation. Our results provide tools for improving both the current MRV systems, and the deforestation early-warning system in Colombia.

Cumplimiento e incumplimiento del tratamiento antihipertensivo desde la perspectiva del paciente / Compliance and non-compliance of antihypertensive treatment from a patient perspective

Los prestadores de servicios de salud, los pacientes, los familiares y la población en general elaboran hipótesis acerca de las causas que influyen en el cumplimiento o no de las prescripciones médicas. La literatura plantea un amplio grupo de factores influyentes en la conducta de cumplimiento o incumplimiento del tratamiento médico, involucrando componentes de naturaleza psicosocial, médica (características de la enfermedad y el tratamiento propiamente dicho) y de la relación médico-paciente. La OMS destacó la influencia de factores socioeconómicos y los relacionados con el sistema o el equipo que presta los servicios de salud. El presente trabajo tiene como finalidad indagar a través de una técnica de investigación de corte cualitativo cuáles son las causas que afectan o que contribuyen al cumplimiento del tratamiento antihipertensivo desde la perspectiva de las personas que padecen la enfermedad. Los resultados apuntan hacia cuestiones que tienen que ver con la organización de los servicios de salud, las configuraciones personológicas individuales del paciente, algunas características del tratamiento, los recursos económicos para realizar el tratamiento dietético y las redes de apoyo familiar necesarias para asumir el rol de enfermo. Para contribuir al control de la hipertensión arterial y lograr una atención médica de calidad, los aspectos relacionados con la organización de los servicios de salud deben ser atendidos de manera prioritaria.

Health service providers, patients, relatives and the general population work out their hypotheses about the causes influencing the compliance and non-compliance of medical prescriptions. The scientific literature presents a wide group of influencing factors in compliance or non-compliance of the medical treatment involving components of psychosocial, medical character and of the physician-patient relationship. The World Health Organization stressed the effect of socioeconomic factors and of those related to the system or equipment rendering health services. The present paper was aimed at ascertaining through a qualitative research technique the causes that affect or contribute to the compliance with the antihypertensive treatment from the perspective of the persons suffering this disease. The results pointed to questions that have to do with the organization of health services, the individual personality configurations of the patient, some characteristics of the treatment, the economic resources to carry out the dietary treatment and the networks of family backup necessary to assume the role of the patient. For contributing to blood hypertension control and to quality medical care, the aspects related to the health service organization should be addressed in a priority way.