Does chlorhexidine reduce the incidence of ventilator-associated pneumonia in ICU patients? A systematic review and meta-analysis / El cuidado bucal de rutina con clorhexidina reduce la incidencia de neumonía asociada al ventilador en pacientes de la UCI? Una revisión sistemática y metanálisis

Objective This study aimed to investigate chlorhexidine’s efficacy in preventing ventilator-associated pneumonia (VAP). Design A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Settings The data were obtained from Pubmed, Cochrane Library, and EMBASE. Patients or participants Only mechanically ventilated patients for at least 48h were included. Interventions Randomized clinical trials applying any dosage form of chlorhexidine were eligible. Main variables of interest The relative risk (RR) of the VAP incidence and all-cause mortality was assessed using the random-effects model. The mean difference in days of mechanical ventilation duration and intensive care unit (ICU) length of stay were also appraised. Results Ten studies involving 1233 patients were included in the meta-analysis. The oral application of CHX reduced the incidence of VAP (RR, 0.73 [95% CI, 0.55, 0.97]) and did not show an increase in all-cause mortality (RR, 1.13 [95% CI, 0.96, 1.32]). Conclusions CHX proved effective to prevent VAP. However, a conclusion on mortality rates could not be drawn because the quality of the evidence was very low for this outcome (AU)

Objetivo Este estudio tuvo como objetivo investigar la eficacia de la clorhexidina en la prevención de la neumonía asociada al ventilador (NAV). Diseño se realizó una revisión sistemática y un metanálisis siguiendo los elementos de informe (PRISMA) Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Ámbito Los datos se obtuvieron de Pubmed, Cochrane Library y EMBASE. Pacientes o participantes solo se incluyeron pacientes con ventilación mecánica durante al menos 48 horas. Intervenciones Fueron elegibles los ensayos clínicos aleatorios que aplicaban cualquier forma de dosificación de clorhexidina. Variables de interés principales Se evaluó el riesgo relativo (RR) de incidencia de NAVM y mortalidad por todas las causas mediante el modelo de efectos aleatorios. También se evaluó la diferencia media en los días de duración de la ventilación mecánica y la duración de la estancia en la unidad de cuidados intensivos (UCI). Resultados Diez estudios con 1233 pacientes se incluyeron en el metanálisis. La aplicación oral de CHX redujo la incidencia de VAP (RR, 0,73 [IC 95%, 0,55, 0,97]) y no mostró un aumento en la mortalidad por todas las causas (RR, 1,13 [IC 95%, 0,96, 1,32]. Conclusiones CHX demostró ser eficaz para prevenir la VAP. Sin embargo, no se pudo establecer una conclusión sobre las tasas de mortalidad porque la calidad de la evidencia fue muy baja para este resultado (AU)

Juvenile xanthogranuloma as a differential diagnosis for sellar and suprasellar lesions in child: Case report and review of literature.

Juvenile xanthogranuloma (JXG) is a rare type of non-Langerhans cell histiocytosis. Its systemic form affects 4% of patients. Lesions in the Central Nervous System (CNS) occur in 2% of systemic cases. Sellar JXG should be one of the differential diagnoses for sellar lesions in young. This is a 15-year-old patient with non-specific headache, progressive visual loss and magnetic resonance imaging showing sellar lesion with suprasellar extension. The patient underwent microsurgery by pterional craniotomy with partial resection of the tumor. Pathology evidenced JXG. It progressively evolved with impairment of neuroendocrine functions, new lesions in different CNS locations and death two years after diagnosis. Sellar JXG without cutaneous manifestations is rare. There are no specific findings of the disease. Diagnosis requires additional tests, being defined by pathological analysis. Total resection presents a greater potential control comparing to partial resection. Even so, some patients may have progressive disease with poor clinical outcome.

Does chlorhexidine reduce the incidence of ventilator-associated pneumonia in ICU patients? A systematic review and meta-analysis.

OBJECTIVE: This study aimed to investigate chlorhexidine's efficacy in preventing ventilator-associated pneumonia (VAP). DESIGN: A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. SETTINGS: The data were obtained from Pubmed, Cochrane Library, and EMBASE. PATIENTS OR PARTICIPANTS: Only mechanically ventilated patients for at least 48h were included. INTERVENTIONS: Randomized clinical trials applying any dosage form of chlorhexidine were eligible. MAIN VARIABLES OF INTEREST: The relative risk (RR) of the VAP incidence and all-cause mortality was assessed using the random-effects model. The mean difference in days of mechanical ventilation duration and intensive care unit (ICU) length of stay were also appraised. RESULTS: Ten studies involving 1233 patients were included in the meta-analysis. The oral application of CHX reduced the incidence of VAP (RR, 0.73 [95% CI, 0.55, 0.97]) and did not show an increase in all-cause mortality (RR, 1.13 [95% CI, 0.96, 1.32]). CONCLUSIONS: CHX proved effective to prevent VAP. However, a conclusion on mortality rates could not be drawn because the quality of the evidence was very low for this outcome.

The influence of acetylsalicylic acid on bone regeneration: systematic review and meta-analysis.

Acetylsalicylic acid (ASA) is commonly used as a non-steroidal anti-inflammatory drug that interferes with multiple biological pathways. ASA acts by stimulating osteogenesis and inhibiting osteoclastogenesis. Thus, the objective of this study was to perform a systematic review and meta-analysis to evaluate the effectiveness of the use of ASA in the bone regeneration in animal models. This review was structured based on the PRISMA Statement and registered on PROSPERO database according to protocol number #CDR42018111403. The quality of evidence was assessed by using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE). With the development of search strategies, we identified studies on the use of ASA from the following databases: 1- Medline (via PubMed); 2 - Web of Science; 3 - Scopus; and 4 - EMBASE. A total of 296 articles were identified and after screening the title, abstract, and full text, only 18 studies were selected for qualitative analysis and 12 were selected for performance of the quantitative analysis (meta-analysis). A meta-analysis of the amount of bone tissue formed showed a significant advantage when ASA was locally used, revealing a mean difference (MD) of 22.75% (95% CI: 15.39-30.12) p < 0.00001. Within the limitations of the available data, the results were promising and showed that ASA can be effective in bone formation in animal models.

Survival of dental implants placed in HIV-positive patients: a systematic review.

No consensus has been reached on the use of dental implants in human immunodeficiency virus (HIV)-positive patients. This systematic review evaluated dental implants in HIV-positive patients in terms of implant survival and success rates, marginal bone loss, and complications. The review was conducted according to the PRISMA checklist. Two independent reviewers performed a comprehensive search of the PubMed/MEDLINE, Scopus, and Cochrane Library databases for studies published until October 2017. Six studies were selected for review. In total, 821 implants were placed: 493 in 169 HIV-positive patients, and 328 in 135 HIV-negative patients. The mean duration of follow-up was 47.9 months. Weighted mean survival rate, success rate, and marginal bone loss values were calculated for the HIV-positive patients. Mean survival and success rates at the patient level (according to the number of patients) were 94.76% and 93.81%, respectively; when calculated at the implant level (according to the number of implants), these rates were 94.53% and 90.37%, respectively. Mean marginal bone loss was 0.83mm at the patient level and 0.99mm at the implant level. Thus, dental implants are suitable for the rehabilitation of HIV-positive patients with controlled risk factors and normal CD4+ cell counts.

Bilateral balanced occlusion compared to other occlusal schemes in complete dentures: A systematic review.

No consensus has been reached regarding the best occlusal scheme for making complete dentures. Thus, the purpose of this systematic review was to compare bilateral balanced occlusion (BBO) with other occlusal schemes (canine guidance, lingualised occlusion and zero degree) in complete dentures. The schemes were compared in terms of quality of life/satisfaction and masticatory performance. Two independent reviewers performed a comprehensive search of studies published in or before October 2017 using the PubMed/MEDLINE, Scopus and Cochrane Library databases. The search was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The focused question was: "In conventional complete denture, is BBO better than lingualised occlusion, canine guidance and zero degree in terms of quality of life, patient satisfaction and masticatory performance/muscle activity?" Seventeen studies were selected for analysis. In total, there were 492 patients with a mean age of 64.78 years and a mean follow-up duration of 2.96 months (range: 1-6 months). All studies compared BBO with the other occlusal schemes. Eleven studies evaluated the influence of the occlusal scheme designs on quality of life and satisfaction, and 8 studies evaluated masticatory performance and muscle activity between BBO and the other occlusion schemes. The present systematic review indicated that BBO does not confer better quality of life/satisfaction or masticatory performance and muscle activity. Thus, lingualised occlusion can be considered a predictable occlusal scheme for complete dentures in terms of quality of life/satisfaction and masticatory performance, while canine guidance can be used to reduce muscular activity.

Dental implants in patients with osteoporosis: a systematic review with meta-analysis.

There is currently no consensus regarding the survival rate of osseointegrated implants in patients with osteoporosis. A systematic review with meta-analysis was performed to evaluate the survival rate of implants in such patients. The PubMed/MEDLINE, Web of Science, Cochrane Library, and SciELO databases were used to identify articles published up to September 2016. The systematic review was performed in accordance with PRISMA/PICO requirements and the risk of bias was assessed (Australian National Health and Medical Research Council scale). The relative risk (RR) of implant failure and mean marginal bone loss were analyzed within a 95% confidence interval (CI). Fifteen studies involving 8859 patients and 29,798 implants were included. The main outcome of the meta-analysis indicated that there was no difference in implant survival rate between patients with and without osteoporosis, either at the implant level (RR 1.39, 95% CI 0.93-2.08; P=0.11) or at the patient level (RR 0.98, 95% CI 0.50-1.89; P=0.94). However, the meta-analysis for the secondary outcome revealed a significant difference in marginal bone loss around implants between patients with and without osteoporosis (0.18mm, 95% CI 0.05-0.30, P=0.005). Data heterogeneity was low. An increase in peri-implant bone loss was observed in the osteoporosis group. Randomized and controlled clinical studies should be conducted to analyze possible biases.

Treatments for intrusive luxation in permanent teeth: a systematic review and meta-analysis.

Intrusive luxation is a severe form of dental trauma and there is no consensus regarding its management for permanent teeth. A systematic review and meta-analysis was performed to identify the appropriate treatment for teeth with intrusive luxation. The PubMed/MEDLINE, Embase, US Clinical Trials, and ISRCTN Registry electronic databases were used to search for articles in English and unpublished studies without a date limit. Eligible studies evaluated periodontal results (root resorption as the primary outcome; marginal bone defects and/or pulpal changes as secondary outcomes) after spontaneous re-eruption (SRE), orthodontic repositioning (ORP), or surgical repositioning (SRP) for patients with one or more traumatically intruded permanent teeth. Risk ratios with 95% confidence intervals were used to compare treatments. The meta-analysis revealed no significant difference (P>0.05) between SRP and SRE for root resorption. For secondary outcomes, SRE was significantly better than SRP and ORP (P<0.05). Subgroup analyses showed no significant differences among treatments in teeth with completely formed roots (P>0.05) and a better prognosis when SRE was performed in teeth with incompletely formed roots (P<0.05). The available evidence does not allow us to conclude on the best treatment for traumatically intruded teeth. More reliable evidence is needed.

Genetic diversity of the Neotropical tree Hancornia speciosa Gomes in natural populations in Northeastern Brazil.

Mangabeira (Hancornia speciosa Gomes) is a fruit tree of the Apocynaceae family, which is native to Brazil and is a very important food resource for human populations in its areas of occurrence. Mangabeira fruit is collected as an extractive activity, and no domesticated varieties or breeding programs exist. Due to a reduction in the area of ecosystems where it occurs, mangabeira is threatened by genetic erosion in Brazil. The objective of this study was to characterize and evaluate the genetic diversity of 38 mangabeira individuals collected from natural populations in Pernambuco State using inter-simple sequence repeat (ISSR) molecular markers. The ISSR methodology generated a total of 93 loci; 10 were monomorphic and 83 were polymorphic. The average number of loci per primer was 15.5, ranging from 9 (#UBC 866) to 21 (#UBC 834). The results showed a high level of genetic diversity (0.30), and found that only around 30% of genetic variability is distributed among populations (GST = 0.29, ФST = 0.30), with the remainder (ФCT = 70%) found within each population, as expected for forest outcrossing species. Estimates for historic gene flow (1.18) indicate that there is some isolation of these populations, and some degree of genetic differentiation.

Effect of exercise training on Ca2+ release units of left ventricular myocytes of spontaneously hypertensive rats

In cardiomyocytes, calcium (Ca2+) release units comprise clusters of intracellular Ca2+ release channels located on the sarcoplasmic reticulum, and hypertension is well established as a cause of defects in calcium release unit function. Our objective was to determine whether endurance exercise training could attenuate the deleterious effects of hypertension on calcium release unit components and Ca2+ sparks in left ventricular myocytes of spontaneously hypertensive rats. Male Wistar and spontaneously hypertensive rats (4 months of age) were divided into 4 groups: normotensive (NC) and hypertensive control (HC), and normotensive (NT) and hypertensive trained (HT) animals (7 rats per group). NC and HC rats were submitted to a low-intensity treadmill running protocol (5 days/week, 1 h/day, 0% grade, and 50-60% of maximal running speed) for 8 weeks. Gene expression of the ryanodine receptor type 2 (RyR2) and FK506 binding protein (FKBP12.6) increased (270%) and decreased (88%), respectively, in HC compared to NC rats. Endurance exercise training reversed these changes by reducing RyR2 (230%) and normalizing FKBP12.6 gene expression (112%). Hypertension also increased the frequency of Ca2+ sparks (HC=7.61±0.26 vs NC=4.79±0.19 per 100 µm/s) and decreased its amplitude (HC=0.260±0.08 vs NC=0.324±0.10 ΔF/F0), full width at half-maximum amplitude (HC=1.05±0.08 vs NC=1.26±0.01 µm), total duration (HC=11.51±0.12 vs NC=14.97±0.24 ms), time to peak (HC=4.84±0.06 vs NC=6.31±0.14 ms), and time constant of decay (HC=8.68±0.12 vs NC=10.21±0.22 ms). These changes were partially reversed in HT rats (frequency of Ca2+ sparks=6.26±0.19 µm/s, amplitude=0.282±0.10 ΔF/F0, full width at half-maximum amplitude=1.14±0.01 µm, total duration=13.34±0.17 ms, time to peak=5.43±0.08 ms, and time constant of decay=9.43±0.15 ms). Endurance exercise training attenuated the deleterious effects of hypertension on calcium release units of left ventricular myocytes.

Effect of exercise training on Ca²âº release units of left ventricular myocytes of spontaneously hypertensive rats.

In cardiomyocytes, calcium (Ca²âº) release units comprise clusters of intracellular Ca²âº release channels located on the sarcoplasmic reticulum, and hypertension is well established as a cause of defects in calcium release unit function. Our objective was to determine whether endurance exercise training could attenuate the deleterious effects of hypertension on calcium release unit components and Ca²âº sparks in left ventricular myocytes of spontaneously hypertensive rats. Male Wistar and spontaneously hypertensive rats (4 months of age) were divided into 4 groups: normotensive (NC) and hypertensive control (HC), and normotensive (NT) and hypertensive trained (HT) animals (7 rats per group). NC and HC rats were submitted to a low-intensity treadmill running protocol (5 days/week, 1 h/day, 0% grade, and 50-60% of maximal running speed) for 8 weeks. Gene expression of the ryanodine receptor type 2 (RyR2) and FK506 binding protein (FKBP12.6) increased (270%) and decreased (88%), respectively, in HC compared to NC rats. Endurance exercise training reversed these changes by reducing RyR2 (230%) and normalizing FKBP12.6 gene expression (112%). Hypertension also increased the frequency of Ca²âº sparks (HC=7.61 ± 0.26 vs NC=4.79 ± 0.19 per 100 µm/s) and decreased its amplitude (HC=0.260 ± 0.08 vs NC=0.324 ± 0.10 ΔF/F0), full width at half-maximum amplitude (HC=1.05 ± 0.08 vs NC=1.26 ± 0.01 µm), total duration (HC=11.51 ± 0.12 vs NC=14.97 ± 0.24 ms), time to peak (HC=4.84 ± 0.06 vs NC=6.31 ± 0.14 ms), and time constant of decay (HC=8.68 ± 0.12 vs NC=10.21 ± 0.22 ms). These changes were partially reversed in HT rats (frequency of Ca²âº sparks=6.26 ± 0.19 µm/s, amplitude=0.282 ± 0.10 ΔF/F0, full width at half-maximum amplitude=1.14 ± 0.01 µm, total duration=13.34 ± 0.17 ms, time to peak=5.43 ± 0.08 ms, and time constant of decay=9.43 ± 0.15 ms). Endurance exercise training attenuated the deleterious effects of hypertension on calcium release units of left ventricular myocytes.

Application of glass particles doped by Zn(+2) as an antimicrobial and atoxic compound in LLDPE and HDPE.

This study demonstrates the potential application of glass particles doped with Zn(+2) (GZn) as an atoxic, antimicrobial additive when used in conjunction with high density polyethylene (HDPE) and linear low density polyethylene (LLDPE) polymers. Toxicity tests demonstrated that these modified glass particles were nontoxic to human cells, and atomic absorption analyses demonstrated the migration of ionic species in quantities less than 2.0ppm for both the HDPE/GZn and LLDPE/GZn compounds. Microbiological tests demonstrated the antimicrobial effect of the pure GZn compound as well as the polymeric HDPE/GZn and LLDPE/GZn compounds. In addition, at percentages of GZn higher than 2.00wt.% and at a time of 4h, the bactericidal performance is excellent and equal for both polymeric compounds.

Dielectric study of the adhesion of mesenchymal stem cells from human umbilical cord on a sugarcane biopolymer.

It is of current interest the identification of appropriate matrices for growing mesenchymal stem cells (MSC). These cells are able not only to regenerate themselves but also to differentiate into other type of functional cells, and so they have been extensively used in tissue engineering. In this work, we have evaluated the use of electric impedance spectroscopy (EIS) to follow the adhesion of MSC from Wharton's jelly of the human umbilical cord (hWJMSC) on sugarcane biopolymers (SCB). Impedance spectra of the systems were obtained in the frequency range of 10(2)-10(5) Hz. An EIS investigation showed that when deposited on a metallic electrode SCB films prevent the passage of electrons between the solution and the metallic interface. The impedance spectra of hWJMSCs adhered on SCB revealed that there is a significant increase in the magnitude of the impedance when compared to that of pure SCB. The corresponding resistance (real part of the impedance) was even higher for the SCB-hWJMSC system than for SCB without cells on their surface, in an indication of an increased blockage to the electron transfers. The resistance charge transfer is extracted by curve-fitting the impedance spectra to an equivalent circuit model. Also, a shift of the phase angle to higher frequencies was obtained for SCB-hWJMSC system as a result from hWJMSC adhesion. Our study demonstrates that EIS is an appropriate method to evaluate the adhesion of MSC. SCB can be considered as a promising biomaterial for tissue engineering.

Protein restriction does not impair adaptations induced in cardiomyocytes by exercise in rats.

The effect of a treadmill running program on physical performance and morphofunctional adaptations was investigated in control and malnourished rats. Male 4-week old Wistar rats were randomized in groups of 12 animals: control trained (CT), control sedentary (CS), malnourished trained (MT) and malnourished sedentary (MS). Control and malnourished animals received chow with 12% protein or 6% protein, respectively. Trained groups were subjected to a treadmill running program for 8 weeks. Physical performance, biochemical parameters, cardiomyocytes morphology and biomechanics were determined. Malnourished animals presented reduction in body mass, serum levels of total protein, albumin and hemoglobin compared to the control groups. At 1 and 3 Hz cardiomyocytes from CT and MT showed higher cell shortening, speed of contraction and relaxation compared to the other groups. At 3 Hz cardiomyocytes from MS showed reduction in cell shortening and speed of contraction compared to CS. Protein restriction does not prevent the improvement in physical performance or cardiomyocytes biomechanical efficiency and growth in response to exercise. These findings could represent a modulatory effect of exercise to maintain cardiomyocyte growth at the expense of reducing the rate of body growth in order to ensure proper cellular function in conditions of cardiovascular overload imposed by exercise.

Diabetes mellitus and inflammatory pulpal and periapical disease: a review.

Diabetes mellitus (DM) is one of the most common metabolic disorders. DM is characterized by hyperglycaemia, resulting in wound healing difficulties and systemic and oral manifestations, which have a direct effect on dental pulp integrity. Experimental and clinical studies have demonstrated a higher prevalence of periapical lesions in patients with uncontrolled diabetes. The influence of DM on periapical bone resorption and its impact on dental intervention of such patients are reviewed, and its aetiology and pathogenesis are analysed at molecular level. Pulps from patients with diabetes have the tendency to present limited dental collateral circulation, impaired immune response, increased risk of acquiring pulp infection (especially anaerobic ones) or necrosis, besides toothache and occasional tendency towards pulp necrosis caused by ischaemia. In regard to molecular pathology, hyperglycaemia is a stimulus for bone resorption, inhibiting osteoblastic differentiation and reducing bone recovery. The relationship between poorly controlled diabetes and bone metabolism is not clearly understood. Molecular knowledge about pulp alterations in patients with diabetes could offer new therapeutic directions. Knowledge about how diabetes affects systemic and oral health has an enduring importance, because it may imply not only systemic complications but also a higher risk of oral diseases with a significant effect on pulp and periapical tissue.

Alongamento da musculatura inspiratoria por intermedio da reeducacao postural global (RPG) / Inspiratory Muscle Stretching through postural global reeduction

O objetivo deste estudo foi analisar o efeito do alongamento dos musculos da cadeia muscular inspiratoria, proposto pelo metodo de reeducacao postural global(RPG), sobre a forca muscular respiratoria e a expansibilidade toracica. Participaram deste estudo 20 voluntarios sadios, do sexo feminino, com idade entre 18 e 23 anos(media=21,2, DP=1,61), que foram divididos de forma randonizada em dois grupos: 10 voluntarios submetidos a postura `ra no chao com bracos fechados` por 20 minutos (grupo RPG) e 10 voluntarios que nao receberam o alongamento, permanecendo em repouso por 20 minutos(grupo controle). Utilizaram-se para a valiacao a medida das pressoes respiratorias maximas e a toracometria em ambos os grupos, antes e apos o periodo estabelecido. Observou-se que o metodo de alongamento utilizado proporcionou aumento da expansibilidade toracica e das pressoes respiratorias maximas, havendo significancia estatistica pelo metodo de Wilcoxon no que se refere a forca dos musculos inspiratorios no grupo que recebeu o alongamento. Tambem houve diferenca significativa na expansibilidade toracica da regiao axilar no grupo RPG quando comparado com o grupo controle. Os resultados sugerem investigar o efeito desse metodo de alongamento em pneumonopatias cronicos, os quais poderiam ser beneficiados, visando a sua utilizacao como recurso fisioterapeutico

Diversity and biomass of chironomidae (Diptera) larvae in an impacted coastal lagoon in Rio De Janeiro, Brazil.

Diversity and biomass of Chironomidae larvae were studied between January-November 1993 and March-November 1994 in an impacted lagoon in Rio de Janeiro, Southeastern Brazil, in an attempt to establish the ecological consequences of anthropogenic eutrophication processes. Nine hundred and seventy-five organisms belonging to the Tanypodinae, Orthocladiinae, and Chironominae were collected. Polypedilum (62%) and Chironomus (58%) were the most common genera found in the limnetic and littoral zones.

Diversity and biomass of Chironomidae (Diptera) larvae in an impacted coastal lagoon in Rio de Janeiro, Brazil

Diversity and biomass of Chironomidae larvae were studied between January-November 1993 and March-November 1994 in an impacted lagoon in Rio de Janeiro, Southeastern Brazil, in an attempt to establish the ecological consequences of anthropogenic eutrophication processes. Nine hundred and seventy-five organisms belonging to the Tanypodinae, Orthocladiinae, and Chironominae were collected. Polypedilum (62 percent) and Chironomus (58 percent) were the most common genera found in the limnetic and littoral zones

Toxicity of drugs used for treatment of rhinitis: a reminder to the otorhinolaryngologist.

We retrospectively studied files on toxicity of drugs used for treatment of rhinitis (nasal antihistamines, oral antihistamines, nasal vasoconstrictors, oral decongestants, nasal corticosteroids, nasal anticholinergic agent, nasal mast cell stabilizer, and respiratory antigen preparations for oral use) that occurred in São Paulo, Brazil, from 1 July 1996 to 30 June 1998. There were 823 cases of toxicity by these agents, with a predominance of oral decongestants (in combination with antihistamines) (53.4%). There was a significant incidence of toxicity within children aged 1 to 4 years (P < 0.05) and a preponderance among males aged 5-9 years and females aged 10-39 years. Accidental intake of medicines accounted for the majority of toxicity cases (57.2%).