Metabolomics profile of plasma in acute diquat-poisoned patients using gas chromatography-mass spectrometry.

Diquat (DQ) has been confirmed to be toxic to humans and responsible for severe health impairment. While to date, very little is known about the toxicological mechanisms of DQ. Thus, investigations to discover the toxic targets and potential biomarkers of DQ poisoning are urgently needed. In this study, a metabolic profiling analysis was conducted to reveal the changes of metabolites of plasma and find out the potential biomarkers of DQ intoxication by GC-MS. First, multivariate statistical analysis demonstrated that acute DQ poisoning can lead to metabolomic changes in human plasma. Then, metabolomics studies showed that 31 of the identified metabolites were significantly altered by DQ. Pathway analysis indicated that three primarily metabolic pathways including phenylalanine, tyrosine and tryptophan biosynthesis, taurine and hypotaurine metabolism, and phenylalanine metabolism were affected by DQ, resulting in the perturbations of phenylalanine, tyrosine, taurine, and cysteine. Finally, the results of receiver operating characteristic analysis showed the above four metabolites could be used as reliable tools for the diagnosis and severity assessments of DQ intoxication. These data provided the theoretical basis for basic research to understand the potential mechanisms of DQ poisoning, and also identified the desirable biomarkers with great potential for clinical applications.

Effects of pesticides on rural workers: haematological parameters and symptomalogical reports / Efeitos dos pesticidas sobre trabalhadores rurais: parâmetros hematológicos e relatos sintomatológicos

Abstract Exposure to pesticides by the rural population is increasing worldwide. Pesticides can induce the development of different diseases such as cancer and diseases of the central nervous system. This study analysed the clinical symptoms and haematological changes of a rural population in Conceição do Castelo, Espirito Santo, Brazil. For evaluation of symptomatology exposure to pesticides, 142 rural workers were interviewed. Of these, 22 workers were selected for haematological tests randomly as to evaluate haematological changes during the period of exposure to pesticides. Haematological analyses showed that erythrocytes, haemoglobin, haematocrit, mean corpuscular (VCM) volume, mean corpuscular haemoglobin (MCH), mean corpuscular haemoglobin concentration (MCHC) are in accordance with the reference intervals in haematology. Variations in the concentrations of rods and neutrophils indicates that exposure to pesticides increases the amount of those cells. Haematological disorders in rural workers exposed to pesticides can be correlated with reported symptoms. The results described in this study are relevant to the health public and reinforce the concern about the indiscriminate use of pesticides.

Resumo A exposição a pesticidas pela população rural está crescendo em todo o mundo. Os pesticidas podem induzir o desenvolvimento de diferentes doenças, como o cancer e as do sistema nervoso central. Este estudo analisou os sintomas clínicos e alterações hematológicas de uma população rural em Conceição do Castelo, Espírito Santo, Brasil. Para a avaliação da exposição a pesticidas e sintomatologias, 142 trabalhadores rurais foram entrevistados. Destes, 22 trabalhadores foram selecionados de randomicamente para testes hematológicos e avaliação de alterações hematológicas durante o período de exposição a pesticidas. Análises hematológicas mostraram que eritrócitos, hemoglobina, hematócrito, volume corpuscular médio (VCM), hemoglobina corpuscular média (HCM), concentração de hemoglobina corpuscular média (CHCM) estão em conformidade com os intervalos de referência. As variações nas concentrações de bastonetes e neutrófilos indicam que a exposição a pesticidas aumenta a quantidade dessas células. Alterações hematológicas em trabalhadores rurais expostos a pesticidas podem ser correlacionados com alguns sintomas relatados. Os resultados descritos neste estudo são relevantes para a saúde pública e para reforçar a preocupação com o uso indiscriminado de pesticidas.

Human and experimental toxicology of diquat poisoning: Toxicokinetics, mechanisms of toxicity, clinical features, and treatment.

Diquat (1,1'-ethylene-2,2'-bipyridinium ion; DQ) is a nonselective quick-acting herbicide, which is used as contact and preharvest desiccant to control terrestrial and aquatic vegetation. Several cases of human poisoning were reported worldwide mainly due to intentional ingestion of the liquid formulations. Its toxic potential results from its ability to produce reactive oxygen and nitrogen species through redox cycling processes that can lead to oxidative stress and potentially cell death. Kidney is the main target organ due to DQ toxicokinetics and redox cycling. There is no antidote against DQ intoxications, and the efficacy of treatments currently applied is still unsatisfactory. The aim of this work was to review the most relevant human and experimental findings related to DQ, characterizing its chemistry, activity as herbicide, mechanisms of toxicity, consequences of poisoning, and potential therapeutic approaches taking into account previous experience in developing antidotes for paraquat, a more toxic bipyridinium herbicide.

Clinical and epidemiological aspects of scorpion stings in the northeast region of Brazil / Aspectos clínicos e epidemiológicos dos acidentes escorpiônicos na região do nordeste do Brasil

Scorpion stings are a serious public health issue in tropical and subtropical countries. This is a descriptive and retrospective study of the clinical-epidemiological characteristics of scorpion sting cases registered in the Health System in the city of Campina Grande, Paraíba state, from 2007 to 2012. Data was collected from the Injury Notification Information System data banks of the Ministry of Health. A total of 2,283 records, provided by the Third Health Sector of Campina Grande, were analyzed. Data revealed that the majority of the victims are female aged between 20 and 29 years, and the highest incidence of stings was in the urban area. Victims were mostly stung on the feet and hand. Serotherapy was not administered in most cases. The majority of the victims received medical assistance within 1 to 3 hours after the sting. The most prevalent clinical manifestations were pain, edema and paresthesias. Most cases were classified as mild, though seven deaths were reported. The high incidence rate suggests that this town may be an endemic area of scorpion stings, supporting the need to develop strategies to control and prevent scorpion stings.

Os acidentes escorpiônicos constituem um grave problema de saúde pública em países tropicais e subtropicais. Este estudo retrospectivo analisou as notificações dos acidentes escorpiônicos registrados no Sistema de Saúde do município de Campina Grande, no estado da Paraíba, de 2007 a 2012. As informações foram coletadas do banco de dados do Sistema de Informação de Agravos de Notificação do Ministério da Saúde. Foram analisadas 2283 fichas de notificação. Os dados revelaram que a maioria dos acidentados é do sexo feminino, com idade entre 20 e 29 anos. Os acidentes foram mais frequentes em área urbana, sendo os pés e as mãos os locais anatômicos do corpo mais atingidos pelas picadas. A soroterapia não foi administrada na maioria dos acidentados e as vítimas prevalentemente recorreram aos sistemas de saúde dentro do período de 1 a 3 horas após o acidente. As manifestações clínicas mais frequentes foram dor, edema e parestesias. A maioria dos acidentes foi classificada como leve, porém foram registrados 7 casos de óbito. A elevada taxa de incidência de acidentes escorpiônicos sugere que esse município pode ser uma área endêmica de escorpiões, justificando a necessidade da elaboração de estratégias de controle e prevenção de acidentes por estes animais.

Reactivation of plasma butyrylcholinesterase by pralidoxime chloride in patients poisoned by WHO class II toxicity organophosphorus insecticides.

Some clinicians assess the efficacy of pralidoxime in organophosphorus (OP) poisoned patients by measuring reactivation of butyrylcholinesterase (BuChE). However, the degree of BuChE inhibition varies by OP insecticide, and it is unclear how well oximes reactivate BuChE in vivo. We aimed to assess the usefulness of BuChE activity to monitor pralidoxime treatment by studying its reactivation after pralidoxime administration to patients with laboratory-proven World Health Organization (WHO) class II OP insecticide poisoning. Patient data were derived from 2 studies, a cohort study (using a bolus treatment of 1g pralidoxime chloride) and a randomized controlled trial (RCT) (comparing 2g pralidoxime over 20 min, followed by an infusion of 0.5 g/h, with placebo). Two grams of pralidoxime variably reactivated BuChE in patients poisoned by 2 diethyl OP insecticides, chlorpyrifos and quinalphos; however, unlike acetylcholinesterase reactivation, this reactivation was not sustained. It did not reactivate BuChE inhibited by the dimethyl OPs dimethoate or fenthion. The 1-g dose produced no reactivation. Pralidoxime produced variable reactivation of BuChE in WHO class II OP-poisoned patients according to the pralidoxime dose administered, OP ingested, and individual patient. The use of BuChE assays for monitoring the effect of pralidoxime treatment is unlikely to be clinically useful.

Epidemiology of snakebite accidents in the municipalities of the state of Paraíba, Brazil / Epidemiologia dos acidentes ofídicos ocorridos nos municípios do Estado da Paraíba, Brasil

Acidentes por animais peçonhentos representam um importante, embora negligenciado, problema de saúde pública mundial. Neste sentido, foi realizado um estudo descritivo dos acidentes ofídicos atendidos e registrados, entre 2007 e 2010, nas unidades de saúde dos municípios do Cariri, Estado da Paraíba, Nordeste do Brasil. As informações foram coletadas do banco de dados do Sistema de Informação de Agravos de Notificação do Ministério da Saúde. Um total de 351 registros de vítimas de ataques por serpentes peçonhentas foram analisados. As vítimas foram predominantemente trabalhadores rurais do sexo masculino com mais de 50 anos. As maiores incidências de acidentes ofídicos ocorreram em áreas rurais, entre abril e junho de 2007 e 2010. As serpentes do gênero Bothrops foram responsáveis pela maioria dos casos, e as vítimas foram, em sua maioria, picado nos pés. A maioria das vítimas recebeu assistência médica no prazo de 1h a 3h após a picada. As manifestações clínicas mais comuns foram dor, edema e equimoses, classificadas como leve ou moderada. Duas mortes foram relatadas. Os resultados deste estudo podem contribuir para identificar as condições que aumentam o risco dos acidentes ofídicos na Região Nordeste.

Accidents involving venomous animals represent an important, albeit neglected, public health issue worldwide. A descriptive study was made of snakebite cases attended and recorded between 2007 and 2010 in the health units of the municipalities of Cariri, State of Paraíba, northeastern Brazil. Data was collected from the Injury Notification Information System data banks of the Health Ministry and a total of 351 records of snakebite victims were reviewed. Victims were predominantly male farm workers over 50. The highest incidence of snakebites occurred in rural areas, between April and June of 2007 and 2010. Snakes of the genus Bothrops were responsible for most cases, and victims were mostly bitten on the feet. The majority of the victims received medical assistance within 1 to 3 hours after being bitten. The most common clinical manifestations were pain, edema and ecchymosis, which were mainly classified as mild or moderate. Two deaths were reported. It was concluded that there is a significant impact of seasonality in snakebites, the prevalence of attacks caused by Bothrops, affecting the lower limbs of adult male farmers in rural areas. The findings of this study may contribute to identify the conditions that increase the risk of snake attacks in the northeastern region.

Sistema nacional de informações tóxico-farmacológicas: o desafio da padronização dos dados / National poison information system: the challenge of the data standardization

A incidência de intoxicações e envenenamentos constitui um grave problema de saúde pública. Para esse segmento, a importância de se dispor, a tempo e a hora, de informações fidedignas é condição primordial para se traçarem estratégias eficazes e efetivas de vigilância epidemiológica e sanitária. Para investigar uma faceta da qualidade dos dados registrados no país, sobre este tipo de agravo, este estudo volta-se para os Centros de Informação e Assistência Toxicológica (CIAT), uma das principais fontes para notificação e registro de tais casos, que fornecem dados que são consolidados pelo Sistema Nacional de Informações Tóxico-Farmacológicas (SINITOX). Partindo do pressuposto que a padronização é uma das principais variáveis que impactam a qualidade dos dados coletados, o estudo visou analisar a maneira como os CIAT interpretam e registram cada um dos eventos a eles notificados. Buscou-se reproduzir as práticas em curso no registro dos casos, com sua lógica e entendimento habitual. Os resultados apontam para o baixo grau de padronização dos dados que chegam ao SINITOX, o que impacta, qualitativamente, as informações geradas por este sistema. Um desenho de estratégias que atuem para aprimorar a padronização dos dados, por certo, conduzirá a um sistema de informação mais robusto e confiável.

Human poisoning is a serious public health issue around the world. Readily available and reliable information in this field are essential to the full implementation of epidemiological and sanitary surveillance and to establish efficient and effective strategies of control. The continuous improvement of data quality and consistency percent no doubt, a permanent challenge percent has a key role in the definition of public policies. To assess the accuracy of Brazilian data on human poisonings, this study explores data from a network of Toxicological Information and Assistance Centers, one of the main sources of such data in Brazil. Data are consolidated by the National Poison Information System (SINITOX). Assuming that standardization is one of the main procedures that influence the data quality collected and analyzed by SINITOX, the study assesses the operations of the Centers affiliated to the SINITOX in charge to interpret and register the events reported to them and highlights the procedures used to standardize case reports. The results show an evident insufficient degree of standardization of the data received at SINITOX. We emphasize the need to design strategies to improve standardization, aiming to develop a reliable system and to minimize the harms associated to human poisoning in Brazil.

Clinical and epidemiological study of 27 poisonings caused by ingesting puffer fish (Tetrodontidae) in the states of Santa Catarina and Bahia, Brazil / Estudo clinico-epidemiológico de 27 envenenamentos causados pela ingestão de baiacus (Tetrodontidae) nos estados de Santa Catarina e Bahia, Brasil

Puffer fish can be poisonous due to the presence of the potent neurotoxins such as Tetrodotoxin (TTX) and Saxitoxin (STX) found in its tissues. The authors report 27 human poisonings from ingestion of puffer fish in patients treated at Toxicology Centers in the states of Santa Catarina and Bahia, Brazil, between 1984 and January 2009. Poisonings were classified as moderate (52 percent) and severe (33 percent), two deaths were observed. Early diagnosis is very important to ensure respiratory support.

Os baiacus ou peixes-bola podem ser venenosos devido à presença em seus tecidos corporais de Tetrodotoxina e/ou Saxitoxina, ambas potentes neurotoxinas. Os autores relatam 27 envenenamentos por ingestão da carne de baiacus. Os pacientes foram atendidos nos Centros de Toxicologia de Santa Catarina e da Bahia de 1984 a 2009. Os acidentes foram classificados em moderados (52 por cento) e graves (33 por cento), havendo dois óbitos. O diagnóstico precoce é fundamental no sentido de garantir suporte ventilatório aos pacientes.