RESUMO
Systemic insecticides are recognized as one of the drivers of the worldwide bee decline as they are exposed to them through multiple pathways. Specifically, neonicotinoids, some of which are banned for outdoor use in the European Union (EU), have been pointed out as a major cause of bee collapse. Thus, farmers have had to look for alternatives for pest control and use known insecticides or new substances reportedly less harmful to bees. We evaluated the oral acute toxicity of six insecticides (three of them systemic: imidacloprid, thiacloprid and sulfoxaflor) with four different modes of action on buff-tailed bumblebee workers (Bombus terrestris): two banned neonicotinoids (imidacloprid, thiacloprid), two pyrethroids (deltamethrin, esfenvalerate), one sulfoximine (sulfoxaflor) and a microbial insecticide based on Bacillus thuringiensis toxins, present in genetically modified (Bt) maize. The microbial insecticide only caused mortality to bumblebee workers at extremely high concentrations, so it is expected that Bt maize does not pose a risk to them. The toxicity of the other five insecticides on bumblebees was, from highest to lowest: imidacloprid, sulfoxaflor, deltamethrin, esfenvalerate and thiacloprid. This outcome suggests that certain insecticides in use are more toxic to B. terrestris than some banned neonicotinoids. Further chronic toxicity studies, under realistic conditions, are necessary for a proper risk assessment.
RESUMO
El paciente que consulta por mareos o vértigo es sin duda un desafío para el médico que trabaja en un servicio de urgencia. Esto se da en parte por la dificultad de los pacientes de definir el síntoma, a la amplia gama de diagnósticos diferenciales y su potencial riesgo de desenlace negativo, como en el caso del accidente cerebrovascular de fosa posterior. En esta revisión narrativa, el objetivo: es explicar el enfrentamiento inicial del paciente con mareos y vértigo, describir las pruebas y métodos diagnósticos complementarios, distinguir los diagnósticos diferenciales más frecuentes y explicar el manejo inicial. Método:se realizó una revisión bibliográfica de literatura científica sobre esta patología, basado en la propuesta de Edlow (2016), donde se enfatiza en un enfoque basado en temporalidad, factores desencadenantes y contexto del síntoma.(AU)
The patient who consults for dizziness or vertigo is undoubtedly a challenge for the emergency physician. This is partly due to the difficulty of the patients to define the symptom, the wide range of differential diagnoses and their potential risk of negative outcome, as in the case of posterior circulation stroke. In this narrative review, the objective is to explain the initial approach of the patient with dizziness and vertigo, describe the tests and complementary diagnostic methods, distinguish the most frequent differential diagnoses and explain the initial management. A bibliographic review of the scientific literature on this pathology was carried out, based on the proposal of Edlow (2016), which emphasizes an approach based on temporality, trigger factors and context of the symptom. (AU)
