Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 21.546
Filtrar
1.
Esc. Anna Nery Rev. Enferm ; 26: e20210015, 2022. tab, graf
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1350741

RESUMO

Resumo Objetivo construir e validar um fluxograma de atendimento multiprofissional para casos de intoxicações agudas por agrotóxicos na Atenção Primária à Saúde. Método estudo metodológico, realizado em duas etapas: produção-construção e validação do conteúdo. A construção do fluxograma foi realizada com base na literatura, abordando a temática agrotóxicos, e entrevista coletiva envolvendo 19 profissionais da Atenção Primária à Saúde de um município catarinense, em dezembro de 2018. O processo de validação foi realizado por meio de questionário do Google Forms, por sete juízes. Utilizou-se o Percentual de Concordância e o Índice de Validade de Conteúdo. Resultados o fluxograma apresentou validade de conteúdo global igual a 0,97, tendo os oito primeiros itens apresentado valor máximo e aprovação pelo Conselho Municipal de Saúde. Conclusão o fluxograma passou a ser utilizado como instrumento tecnológico que orienta e qualifica os atendimentos dos casos de intoxicações agudas por agrotóxicos. Implicações para a prática a utilização do fluxograma na assistência ao paciente, suspeito ou intoxicado por agrotóxico, constitui-se como ferramenta de gestão do cuidado, permitindo que a equipe de saúde atue de forma harmônica, além de que as ações da assistência sejam sistematizadas e, consequentemente, se obtenha qualidade do serviço prestado.


Resumen Objetivo construir y validar un diagrama de flujo de atención multiprofesional para casos de intoxicación aguda por plaguicidas en Atención Primaria de Salud. Método estudio metodológico, realizado en dos etapas: producción-construcción y validación de contenido. La construcción del diagrama de flujo se llevó a cabo a partir de la literatura que aborda el tema plaguicidas, y una entrevista colectiva a 19 profesionales de Atención Primaria de Salud de un municipio de Santa Catarina, en diciembre de 2018. El proceso de validación se realizó a través de un cuestionario de Google Forms, por siete jueces. Se utilizaron el porcentaje de acuerdo y el índice de validez de contenido. Resultados el diagrama de flujo tuvo una validez de contenido global de 0.97, mostrando los primeros ocho ítems el valor máximo y la aprobación del Consejo Municipal de Salud. Conclusión el diagrama de flujo pasó a ser utilizado como un instrumento tecnológico que orienta y califica la atención en casos de intoxicación aguda por plaguicidas. Implicaciones para la Practica el uso del diagrama de flujo en el cuidado de pacientes sospechosos o intoxicados por pesticidas es una herramienta de gestión de la atención, permitir que el equipo de salud actúe en armonía, que se sistematicen las acciones asistenciales y consecuentemente se obtiene calidad de servicio.


Abstract Objective To construct and validate a multiprofessional care flowchart for acute pesticide intoxication cases in Primary Health Care. Method This is a methodological study, carried out in two stages: production-construction and content validation. The flowchart construction was carried out based on scientific literature, addressing the topic of pesticides, and a press conference involving 19 Primary Health Care professionals in a municipality in Santa Catarina, in December 2018. The validation process was carried out through a Google Forms questionnaire, by seven judges. The Percentage of Agreement and the Content Validity Index were used. Results The flowchart had a global content validity of 0.97, with the first eight items having a maximum value and approval by the Municipal Health Council. Conclusion The flowchart started to be used as a technological tool that guides and qualifies the care of acute pesticide intoxications cases. Implications for practice The flowchart use in care for patients suspected or intoxicated by pesticides is a care management tool, allowing the health team to act harmoniously, in addition to assistance actions systematized and, consequently, obtain the quality of the service provided.


Assuntos
Humanos , Masculino , Feminino , Envenenamento/enfermagem , Atenção Primária à Saúde , Agroquímicos/envenenamento , Fluxo de Trabalho , Assistência ao Paciente , Equipe de Assistência ao Paciente , Prática Profissional , Métodos
3.
Cien Saude Colet ; 26(12): 6037-6047, 2021 Dec.
Artigo em Português, Inglês | MEDLINE | ID: mdl-34909996

RESUMO

The intensive use of pesticides in agriculture is associated with several negative externalities, which affect both the environment and public health. It is known that the number of records is lower than that of pesticide poisonings, and that underreporting occurs. Aiming to understand this underreporting, we analyzed the data from two information systems for notifications and health injuries and a case study was carried out with professionals from the 5th Regional Health Center and the health network of a municipality in the state of Paraná. It was concluded that underreporting occurs in the information systems, confirming the inconsistency of data and the lack of communication between them, making it difficult to understand the reality of poisonings. In the case study, the occurrence of prior underreporting was identified: when many workers do not seek health systems; the training of professionals is insufficient and neutralized by high turnover, especially among physicians; the diagnosis, conduct and treatment of pesticide poisoning are not part of the curriculum of many courses in the health area; the capacity of health services in many municipalities falls short of the demand, causing work overload to the professionals and the consequent underreporting.


Assuntos
Praguicidas , Envenenamento , Agricultura , Brasil/epidemiologia , Cidades , Atenção à Saúde , Humanos
4.
Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi ; 39(10): 789-790, 2021 Oct 20.
Artigo em Chinês | MEDLINE | ID: mdl-34727665

RESUMO

The case of oral hydrochloric acid poisoning is rare in clinic, and it is easy to be misdiagnosed when the poison is not clear. The clinical data of 1 case of oral hydrochloric acid poisoning successfully treated was retrospectively analyzed to provide reference for diagnosis and treatment of similar clinical cases.


Assuntos
Envenenamento , Venenos , Administração Oral , Humanos , Ácido Clorídrico , Estudos Retrospectivos
5.
Medicine (Baltimore) ; 100(40): e27485, 2021 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-34622880

RESUMO

ABSTRACT: Pharmaceutical poisoning in children is almost unintentional and there are various types of drug out of curiosity. Understanding the attractive features and formulation of drugs related to poisoning in younger children may be helpful in treatment and prevention of poisoning. To investigate the impact of drug formulation on outcomes of pharmaceutical poisoning in young children.We retrospectively reviewed the data of pharmaceutical exposures among children who were registered in a Korean 23-center, emergency department (ED) based registry from 2011 to 2016. Our study was conducted on preschool children aged 0 to 7 years. According to the formulation and category of the ingested drugs, the exposures were divided into the "tablet and capsule (TAC)" and "syrup" groups. In the TAC group, we additionally recorded data on the shape, color, and size of the drugs. The ED outcomes, such as hospitalization and length of stay, were compared between the 2 groups.Among the 970 enrolled exposures, 674 (69.5%) were classified into the TAC group. In this group, hormones/hormone antagonists (18.5%) were the most commonly ingested, followed by central nervous system drugs (17.1%). In the syrup group, antihistamines (28.4%) were the most commonly ingested, followed by respiratory drugs (24.3%). The TAC group showed a higher hospitalization and transfer rate to tertiary centers than the counterpart (TAC, 18.0% vs syrup, 11.5%, P = .03) without a significant difference in the length of stay (TAC, 173.5 minutes [interquartile range, 95.0-304.0] vs syrup, 152.5 [77.5-272.0]; P = .08). No in-hospital mortality occurred in the exposures. Round-shaped and chromatic TACs, accounting for 91.7% (618) and 56.1% (378), respectively, were more commonly ingested. The median size of the TACs was less than 1.0 cm.Young children who visited the ED ingested TACs more frequently than syrups, particularly small, round-shaped, or chromatic drugs, leading to a higher hospitalization rate. Our findings can contribute to prevention strategies and safety education on childhood drug poisoning.


Assuntos
Formas de Dosagem , Composição de Medicamentos/estatística & dados numéricos , Envenenamento/epidemiologia , Medicamentos sob Prescrição/envenenamento , Cápsulas , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , República da Coreia , Estudos Retrospectivos , Comprimidos
6.
Artigo em Inglês | MEDLINE | ID: mdl-34639533

RESUMO

A relatively high proportion of attempted suicides employ self-poisoning with medication. Data from emergency department presentations can help to identify possible risk drug classes and provide a basis for preventive measures. This retrospective analysis included cases presenting at the emergency department of the University Hospital of Bern, Switzerland, from May 2012 to August 2016, after attempted suicide with drugs. We excluded attempted suicides with only alcohol or other non-medical substances. During the study period, there were 488 cases (466 patients) of attempted suicide with medical substances. The median patient age was 33 years (range 16-93) and 354 (73%) cases were female. The most commonly involved substances/drug classes were benzo-diazepines (n = 167, 34%), neuroleptics (n = 114, 23%) and paracetamol (n = 111, 23%). A total of 231 (47%) cases employed only a single substance. Common symptoms included somnolence (n = 245, 50%), tachycardia (n = 119, 24%) and nausea/vomiting (n = 76, 16%). In most cases, the poisoning was of minor severity (n = 231, 47%) and the patients were admitted to a psychiatric hospital (n = 264, 54%). Important preventive measures may include careful monitoring for suicidal behaviour when prescribing psychotropic drugs, in addition to restrictions in pack size. Efforts should also be made to enhance the awareness of health professionals qualified to prescribe or supply paracetamol.


Assuntos
Preparações Farmacêuticas , Envenenamento , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicotrópicos/efeitos adversos , Estudos Retrospectivos , Tentativa de Suicídio , Adulto Jovem
7.
Arq. Ciênc. Vet. Zool. UNIPAR (Online) ; 24(2, cont.): e2406, jul-dez. 2021. tab, ilus
Artigo em Inglês | ID: biblio-1352311

RESUMO

The Elapidae family comprises 35 snake species in Brazil, with Micrurus ibiboboca being widely distributed in the northeast of the country. Despite the high number of Micrurus species in Brazil, there are few cases of human envenomation in literature. This study describes a clinical report of envenomation due to the bite of M. ibiboboca in the State of Pernambuco, Northeast Brazil, that took place in 2017. The patient presented symptoms of muscle paralysis and sweating. He was admitted to the intensive care unit. A total of 10 ampoules of anti-elapidic serum were administered. The patient complained of local pain that extended through the arm, paresthesia in the lower limbs, headache, and chest pain. Changes in the visual, respiratory, and neurological systems were not observed. This clinical case report on coral snake poisoning is useful for increasing the knowledge on the toxicological action of snake poison and its effect on injured individuals, thereby helping in the clinical evaluation and treatment.(AU)


A família Elapidae compreende 35 espécies de serpentes no Brasil, com Micrurus ibiboboca amplamente distribuída no Nordeste. Apesar do elevado número de espécies de Micrurus no Brasil, são poucos os casos de envenenamento humano na literatura. Descrevemos aqui um relato clínico de envenenamento por picada de M. ibiboboca no Estado de Pernambuco, Nordeste do Brasil, ocorrido em 2017. O paciente apresentava sintomas de paralisia muscular e sudorese. Ele foi internado na Unidade de Terapia Intensiva. Um total de 10 ampolas de soro anti-elapídico foi administrado. O paciente queixava-se de dor local que se estendia pelo braço, parestesia em membros inferiores, cefaleia e dor torácica. Não foram observados alterações nos sistemas de visão, respiratório e neurológico. Este relato de caso clínico de intoxicação por cobra coral é útil para aumentar o conhecimento sobre a ação toxicológica da peçonha da serpente e seu efeito sobre os acidentados, auxiliando na avaliação clínica e no tratamento.(AU)


La familia Elapidae comprende 35 especies de serpientes en Brasil como la Micrurus ibiboboca ampliamente distribuidas en el Noreste. A pesar de lo alto número de especies de Micrurus en Brasil, hay pocos casos de envenenamiento humano en la literatura. Describimos aquí un informe clínico de envenenamiento por mordedura de M. ibiboboca en el estado de Pernambuco, Noreste de Brasil, ocurrido en 2017. El paciente presentaba síntomas de parálisis muscular y sudoración. Fue ingresado en la unidad de cuidados intensivos. Se administraron un total de 10 ampollas de suero antielapídico. El paciente se quejaba de dolor local que se extendía por el brazo, parestesias en las extremidades inferiores, cefalea y dolor torácico. No se observaron cambios en los sistemas visual, respiratorio y neurológico. Este informe de caso clínico sobre la intoxicación por serpiente coral es útil para aumentar el conocimiento sobre la acción toxicológica del veneno de serpientes y su efecto en los individuos lesionados, ayudando así en la evaluación clínica y el tratamiento.(AU)


Assuntos
Animais , Envenenamento , Mordeduras de Serpentes , Cobras Corais
8.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 33(8): 999-1002, 2021 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-34590571

RESUMO

OBJECTIVE: To investigate the clinical values of the differences between hematocrit and serum albumin (HCT-ALB) for evaluating the severity of patients with acute paraquat (PQ) poisoning. METHODS: Patients with acute PQ poisoning admitted to the Second People's Hospital of Yunnan Province from January 2018 to December 2019 were enrolled, and healthy voluteers during the same period were selected as the control. The general information, poisoning dose and poisoning time of patients, as well as the HCT and serum ALB levels before blood product infusion, intravenous infusion, or hemopurification at admission were collected, and the HCT-ALB was calculated. According to the results of rapid semiquantitative test of PQ in urine at admission, the patients were divided into PQ low concentration group (0-10 mg/L) and PQ high concentration group (30-100 mg/L). The relationship between poisoning time, poisoning dose, HCT-ALB and the degree of acute PQ poisoning were analyzed, and Spearman method was used to analyze the grade correlation. RESULTS: A total of 295 patients with acute PQ poisoning were enrolled, including 118 cases in PQ low concentration group and 177 cases in PQ high concentration group, and another 200 healthy persons matched with PQ patients in gender and age (healthy control group). The poisoning time of PQ low concentration group was significantly longer than that of PQ high concentration group [hours: 11.0 (6.0, 60.0) vs. 8.0 (5.0, 20.5), P < 0.01], but the poisoning dose was significantly lower than that of PQ high concentration group [mL: 10.0 (5.8, 15.0) vs. 40.0 (20.0, 80.0), P < 0.01]. The HCT and HCT-ALB in PQ low and high concentration groups were significantly higher than those of the healthy control group [HCT: (43.14±4.41)%, (43.54±5.40)% vs. (42.14±2.15)%, HCT-ALB: 3.59±6.26, 5.94±7.80 vs. -7.26±3.55, all P < 0.01], but ALB was significantly lower than that of the healthy control group (g/L: 39.54±5.74, 37.60±7.15 vs. 49.40±3.41, both P < 0.01). With the increase of urine PQ concentration, the HCT and HCT-ALB further increased, and ALB further decreased. There were significant differences between PQ high concentration group and PQ low concentration group [HCT: (43.54±5.40)% vs. (43.14±4.41)%, HCT-ALB: 5.94±7.80 vs. 3.59±6.26, ALB (g/L): 37.60±7.15 vs. 39.54±5.74, all P < 0.05]. The poisoning severity of patients with acute PQ poisoning were negatively correlated with poisoning time and ALB (r values were -0.195 and -0.695, respectively, both P < 0.01), there were positively correlated with poisoning dose, HCT, and HCT-ALB (r values were 0.650, 0.256, 0.737, respectively, all P < 0.01), and the correlation between HCT-ALB and poisoning severity was the strongest. CONCLUSIONS: The HCT-ALB can reflect the poisoning severity of patients with acute PQ poisoning and indirectly reveal the pathological changes of microvessels in patients with acute PQ poisoning.


Assuntos
Paraquat , Envenenamento , China , Hematócrito , Humanos , Prognóstico , Albumina Sérica
9.
West J Emerg Med ; 22(5): 1139-1145, 2021 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-34546890

RESUMO

INTRODUCTION: Toxicologic exposures (TE) are a major preventable public health issue, with most cases due to unintentional causes. Although these cases are well documented and reported via the National Poison Data System, there is little information regarding toxicologic exposure cases in the emergency department (ED). The aim of this study was to identify demographic groups at risk for potential poisoning. METHODS: This was a cross-sectional study. We used data from the California State Emergency Department Database (SEDD) 2011 for statistical analysis. RESULTS: The study included 10,124,598 ED visits in California in 2011. The prevalence of TE was 383.4 (379.6-387.3) per 100,000 visits. Toxicologic exposures were most common among patients aged <10 years (555.4, 95% confidence interval [CI]: 544.5-566.5 per 100,000 visits). Overall, TE was more common among males. White patients showed the highest prevalence of TE compared to other racial groups (P <0.001). Subpopulation analysis showed Native American female patients ages 10-19 had a noticeably higher prevalence of TE (1,464.4, 95% CI: 802.9-2444.9 per 100,000). The prevalence of TE was higher in households of higher median income (P <0.001). Prevalence of TE among those with a history of substance use was also elevated. CONCLUSION: Toxicologic exposure cases in the ED are elevated in particular age and race/ethnicity groups, as well as among those with a diagnosis of substance use disorder. The strength of association between these factors and TE in the general population may be different because we examined ED visits only. Further preventive and education strategies are necessary and should target the demographic groups identified in this epidemiological study.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Envenenamento/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , California/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Distribuição por Sexo , Adulto Jovem
10.
Indian Pediatr ; 58(9): 893-894, 2021 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-34508335
11.
BMJ Open ; 11(9): e048000, 2021 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-34479934

RESUMO

OBJECTIVE: To examine sex differences in age-standardised rates (ASR) of overall and drug-specific drug poisoning deaths in Ireland between 2004 and 2017. DESIGN: Repeated cross-sectional study. SETTING: Drug poisoning deaths in Ireland. PARTICIPANTS: National Drug-Related Deaths Index and pharmacy claims database (Primary Care Reimbursement Service-General Medical Services) data from 2004 to 2017. OUTCOME MEASURES: The primary outcome was trends in drug poisoning death rates by sex. The secondary outcomes were trends in drug poisoning death rates involving (1) any CNS (Central Nervous System) depressants, (2) ≥2 CNS depressants and (3) specific drugs/drug classes (eg, prescription opioids, benzodiazepines, antidepressants, alcohol, cocaine and heroin) by sex. Joinpoint regression was used to examine trends, stratified by sex, in the ASR of drug poisoning deaths (2004-2017), change points over time and average annual percentage changes (AAPCs) with 95% CI. RESULTS: Increased ASR for all drug poisoning deaths from 6.86 (95% CI 6.01 to 7.72) per 100 000 in 2004 to 8.08 (95% CI 7.25 to 8.91) per 100 000 in 2017 was mainly driven by increasing deaths among men (AAPC 2.6%, 95% CI 0.2 to 5.1), with no significant change observed among women. Deaths involving ≥2 CNS depressants increased for both men (AAPC 5.6%, 95% CI 2.4 to 8.8) and women (AAPC 4.0%, 95% CI 1.1 to 6.9). Drugs with the highest significant AAPC increases for men were cocaine (7.7%, 95% CI 2.2 to 13.6), benzodiazepines (7.2%, 95% CI 2.9 to 11.6), antidepressants (6.1%, 95% CI 2.4 to 10.0) and prescription opioids (3.5%, 95% CI 1.6 to 5.5). For women, the highest AAPC was for antidepressants (4.2%, 95% CI 0.2 to 8.3), benzodiazepines (3.3%, 95% CI 0.1 to 6.5) and prescription opioids (3.0%, 95% CI 0.7 to 5.3). CONCLUSION: Drugs implicated in drug poisoning deaths vary by sex. Policy response should include prescription monitoring programmes and practical harm reduction information on polydrug use, especially CNS depressant drugs.


Assuntos
Overdose de Drogas , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Preparações Farmacêuticas , Envenenamento , Analgésicos Opioides , Estudos Transversais , Feminino , Humanos , Irlanda/epidemiologia , Masculino
12.
N Z Med J ; 134(1541): 45-56, 2021 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-34531596

RESUMO

AIM: To quantify and describe presentations to a New Zealand tertiary hospital emergency department (ED) associated with paediatric exploratory ingestions (PEIs) during 2019 in comparison to 1999. METHODS: A retrospective descriptive study was conducted of PEI presentations by children under 7 years of age to Christchurch Hospital ED between 1 January and 31 December 2019. Data were studied for demographic and management details and compared to data from 1999. RESULTS: There were 111 PEI presentations in children under 7 years during 2019, out of 9,445 presentations for this age group (1.2%). The estimated incidence of PEIs was 223.8 per 100,000. PEI presentations relative to total paediatric presentations had reduced compared to 1999 (X2=94.7, p<0.001). Two year olds were most likely to have PEIs (odds ratio (OR)=15.01, 95% confidence interval (CI)=6.78, 33.22). Children of Asian (OR=0.50, 95% CI=0.26, 0.95) and Pacific (OR=0.34, 95% CI=0.12, 0.93) ethnicity were less likely to present with PEIs. Paracetamol was the most commonly ingested substance (15.3%), followed by opioids (11.7%). CONCLUSION: Paediatric presentations due to exploratory ingestions reduced between 1999 and 2019. However, there was a concerning increase in ingestions of medications like opioids that have a significant risk of toxicity at low doses.


Assuntos
Ingestão de Alimentos , Corpos Estranhos/epidemiologia , Utensílios Domésticos , Produtos Domésticos , Preparações Farmacêuticas , Envenenamento/epidemiologia , Acidentes Domésticos/estatística & dados numéricos , Acetaminofen , Analgésicos não Narcóticos , Analgésicos Opioides , Anti-Inflamatórios não Esteroides , Criança , Pré-Escolar , Detergentes , Serviço Hospitalar de Emergência , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Tempo de Internação/estatística & dados numéricos , Masculino , Nova Zelândia/epidemiologia , Óleos Voláteis , Plantas , Envenenamento/etiologia , Psicotrópicos , Estudos Retrospectivos
13.
J Med Toxicol ; 17(4): 333-362, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34535889

RESUMO

The Toxicology Investigators Consortium (ToxIC) Registry was established by the American College of Medical Toxicology in 2010. The registry collects data from participating sites with the agreement that all bedside and telehealth medical toxicology consultation will be entered. This eleventh annual report summarizes the Registry's 2020 data and activity with its additional 6668 cases. Cases were identified for inclusion in this report by a query of the ToxIC database for any case entered from January 1 to December 31, 2020. Detailed data was collected from these cases and aggregated to provide information which included demographics, reason for medical toxicology evaluation, agent and agent class, clinical signs and symptoms, treatments and antidotes administered, mortality, and whether life support was withdrawn. Gender distribution included 50.6% cases in females, 48.4% in males, and 1.0% identifying as transgender. Non-opioid analgesics were the most commonly reported agent class, followed by opioid and antidepressant classes. Acetaminophen was once again the most common agent reported. There were 80 fatalities, comprising 1.2% of all registry cases. Major trends in demographics and exposure characteristics remained similar to past years' reports. Sub-analyses were conducted to describe race and ethnicity demographics and exposures in the registry, telemedicine encounters, and cases related to the COVID-19 pandemic.


Assuntos
Congressos como Assunto , Substâncias Perigosas/toxicidade , Envenenamento/diagnóstico , Envenenamento/terapia , Sistema de Registros/estatística & dados numéricos , Relatório de Pesquisa , Toxicologia/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19 , Canadá , Feminino , Humanos , Israel , Masculino , Pessoa de Meia-Idade , Pandemias/estatística & dados numéricos , SARS-CoV-2 , Tailândia , Estados Unidos
14.
Kidney Int ; 100(4): 720-736, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34358487

RESUMO

Baclofen toxicity results from intentional self-poisoning (acute baclofen poisoning) or accumulation of therapeutic dose in the setting of impaired kidney function. Standard care includes baclofen discontinuation, respiratory support and seizure treatment. Use of extracorporeal treatments (ECTRs) is controversial. To clarify this, a comprehensive review of the literature on the effect of ECTRs in baclofen toxicity was performed and recommendations following EXTRIP methods were formulated based on 43 studies (1 comparative cohort, 1 aggregate results cohort, 1 pharmacokinetic modeling, and 40 patient reports or series). Toxicokinetic data were available for 20 patients. Baclofen's dialyzability is limited by a high endogenous clearance and a short half-life in patients with normal kidney function. The workgroup assessed baclofen as "Moderately dialyzable" by intermittent hemodialysis for patients with normal kidney function (quality of evidence C) and "Dialyzable" for patients with impaired kidney function (quality of evidence C). Clinical data were available for 25 patients with acute baclofen poisoning and 46 patients with toxicity from therapeutic baclofen in kidney impairment. No deaths or sequelae were reported. Mortality in historical controls was rare. No benefit of ECTR was identified in patients with acute baclofen poisoning. Indirect evidence suggests a benefit of ECTR in reducing the duration of toxic encephalopathy from therapeutic baclofen in kidney impairment. These potential benefits were balanced against added costs and harms related to the insertion of a catheter, the procedure itself, and the potential of baclofen withdrawal. Thus, the EXTRIP workgroup suggests against performing ECTR in addition to standard care for acute baclofen poisoning and suggests performing ECTR in toxicity from therapeutic baclofen in kidney impairment, especially in the presence of coma requiring mechanical ventilation.


Assuntos
Overdose de Drogas , Envenenamento , Baclofeno , Estudos de Coortes , Overdose de Drogas/terapia , Humanos , Envenenamento/terapia , Diálise Renal , Convulsões
15.
Arch Dis Child ; 106(11): 1050-1055, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34462264

RESUMO

BACKGROUND: Globally, injuries cause >5 million deaths annually and children and young people are particularly vulnerable. Injuries are the leading cause of death in people aged 5-24 years and a leading cause of disability. In most low-income and middle-income countries where the majority of global child injury burden occurs, systems for routinely collecting injury data are limited. METHODS: A new model of injury surveillance for use in emergency departments in Nepal was designed and piloted. Data from patients presenting with injuries were collected prospectively over 12 months and used to describe the epidemiology of paediatric injury presentations. RESULTS: The total number of children <18 years of age presenting with injury was 2696, representing 27% of all patients presenting with injuries enrolled. Most injuries in children presenting to the emergency departments in this study were unintentional and over half of children were <10 years of age. Falls, animal bites/stings and road traffic injuries accounted for nearly 75% of all injuries with poisonings, burns and drownings presenting proportionately less often. Over half of injuries were cuts, bites and open wounds. In-hospital child mortality from injury was 1%. CONCLUSION: Injuries affecting children in Nepal represent a significant burden. The data on injuries observed from falls, road traffic injuries and injuries related to animals suggest potential areas for injury prevention. This is the biggest prospective injury surveillance study in Nepal in recent years and supports the case for using injury surveillance to monitor child morbidity and mortality through improved data.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Carga Global da Doença/economia , Vigilância em Saúde Pública/métodos , Ferimentos e Lesões/epidemiologia , Acidentes por Quedas/estatística & dados numéricos , Acidentes de Trânsito/estatística & dados numéricos , Adolescente , Animais , Mordeduras e Picadas/epidemiologia , Queimaduras/epidemiologia , Criança , Pré-Escolar , Afogamento/epidemiologia , Serviço Hospitalar de Emergência/tendências , Feminino , Humanos , Masculino , Nepal/epidemiologia , Envenenamento/epidemiologia , Estudos Prospectivos , Índices de Gravidade do Trauma , Ferimentos e Lesões/mortalidade , Ferimentos e Lesões/prevenção & controle
16.
Clin Toxicol (Phila) ; 59(10): 877-887, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34396873

RESUMO

CONTEXT: Poisoning may lead to respiratory failure, shock, cardiac arrest, or death. Extracorporeal membrane oxygenation (ECMO) may be used to provide circulatory support, termed venoarterial (VA) ECMO; or respiratory support termed venovenous (VV) ECMO. The clinical utility of ECMO in poisoned patients remains unclear and guidelines on its use in this setting are lacking. OBJECTIVES: To perform a literature search and narrative review on the use of ECMO in poisonings. Additionally, to provide recommendations on the use of ECMO in poisonings from physicians with expertise in ECMO, medical toxicology, critical care, and emergency medicine. METHODS: A literature search in Ovid MEDLINE from 1946 to October 14, 2020, was performed to identify relevant articles with a strategy utilizing both MeSH terms and adjacency searching that encompassed both extracorporeal life support/ECMO/Membrane Oxygenation concepts and chemically-induced disorders/toxicity/poisoning concepts, which identified 318 unique records. Twelve additional manuscripts were identified by the authors for a total of 330 articles for screening, of which 156 were included for this report. NARRATIVE LITERATURE REVIEW: The use of ECMO in poisoned patients is significantly increasing over time. Available retrospective data suggest that patients receiving VA ECMO for refractory shock or cardiac arrest due to poisoning have lower mortality as compared to those who receive VA ECMO for non-poisoning-related indications. Poisoned patients treated with ECMO have reduced mortality as compared to those treated without ECMO with similar severity of illness and after adjusted analyses, regardless of the type of ingestion. This is especially evident for poisoned patients with refractory cardiac arrest placed on VA ECMO (termed extracorporeal cardiopulmonary resuscitation [ECPR]). INDICATIONS: We suggest VA ECMO be considered for poisoned patients with refractory cardiogenic shock (continued shock with myocardial dysfunction despite fluid resuscitation, vasoactive support, and indicated toxicologic therapies such as glucagon, intravenous lipid emulsion, hyperinsulinemia euglycemia therapy, or others), and strongly considered for patients with cardiac arrest in institutions which are structured to deliver effective ECPR. VV ECMO should be considered in poisoned patients with ARDS or severe respiratory failure according to traditional indications for ECMO in this setting. CONTRAINDICATIONS: Patients with pre-existing comorbidities with low expected survival or recovery. Relative contraindications vary based on each center's experience but often include: severe brain injury; advanced age; unrepaired aortic dissection or severe aortic regurgitation in VA ECMO; irreversible organ injury; contraindication to systemic anticoagulation, such as severe hemorrhage. CONCLUSIONS: ECMO may provide hemodynamic or respiratory support to poisoned patients while they recover from the toxic exposure and metabolize or eliminate the toxic agent. Available literature suggests a potential benefit for ECMO use in selected poisoned patients with refractory shock, cardiac arrest, or respiratory failure. Future studies may help to further our understanding of the use and complications of ECMO in poisoned patients.


Assuntos
Sistema Cardiovascular/efeitos dos fármacos , Oxigenação por Membrana Extracorpórea , Pulmão/efeitos dos fármacos , Envenenamento/terapia , Sistema Cardiovascular/fisiopatologia , Oxigenação por Membrana Extracorpórea/efeitos adversos , Oxigenação por Membrana Extracorpórea/mortalidade , Hemodinâmica/efeitos dos fármacos , Humanos , Pulmão/fisiopatologia , Envenenamento/diagnóstico , Envenenamento/mortalidade , Envenenamento/fisiopatologia , Recuperação de Função Fisiológica , Respiração/efeitos dos fármacos , Medição de Risco , Fatores de Risco , Resultado do Tratamento
17.
Artigo em Inglês | MEDLINE | ID: mdl-34444056

RESUMO

OBJECTIVE: To investigate if case fatality and other indicators of the severity of human pesticide poisonings can be used to prioritize pesticides of public health concern. To study the heterogeneity of data across countries, cause of poisonings, and treatment facilities. METHODS: We searched literature databases as well as the internet for studies on case-fatality and severity scores of pesticide poisoning. Studies published between 1990 and 2014 providing information on active ingredients in pesticides or chemical groups of active ingredients were included. The variability of case-fatality-ratios was analyzed by computing the coefficient of variation as the ratio of the standard deviation to the mean. FINDINGS: A total of 149 papers were identified of which 67 could be included after assessment. Case-fatality-ratio (CFR) on 66 active ingredients and additionally on 13 groups of active ingredients were reported from 20 countries. The overall median CFR for group of pesticides was 9%, for single pesticides 8%. Of those 12 active ingredients with a CFR above 20% more than half are WHO-classified as "moderately hazardous" or "unlikely to present acute hazard". Two of seven pesticides considered "unlikely to present hazard in normal use" showed a CFR above 20%. The cross-study variability of reported case fatality was rather low. Studies most often utilized the Glasgow Coma Score for grading the severity of poisoning. CONCLUSION: Although human pesticide poisoning is a serious public health problem, an unexpectedly small number of publications report on the clinical outcomes within our study period. However, CFRs of acute human pesticide poisoning are available for several groups of pesticides as well as for active ingredients showing moderate cross-study variability. Our results underline that CFR is an indicator of the human toxicity of pesticides and can be utilized to prioritize highly hazardous pesticides especially since there is limited correspondence between the animal-test-based hazard classification and the human CFR of the respective pesticide. The reporting of available poisoning data should be improved, human case-fatality data are a reasonable tool to be included systematically in the periodic statutory review of pesticides and their regulation.


Assuntos
Praguicidas , Envenenamento , Animais , Coleta de Dados , Bases de Dados Factuais , Instalações de Saúde , Humanos , Praguicidas/toxicidade , Saúde Pública
18.
J Forensic Leg Med ; 83: 102247, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34454338

RESUMO

BACKGROUND: Poisoning has been and still is a major problem faced throughout the globe. But its patterns are different and changing in different parts of the world due to local influences. This calls for a study to explore the issue in this unique South Indian state. METHODS: A cross-sectional exploratory study was conducted to analyse the patterns of poisoning and the socio-demographic characteristics of the patients. Subgroups were compared using Fisher-Freeman-Halton exact test and further analysed by multivariate logistic regression. RESULTS: 48% of cases were of pharmaceutical drug poisoning. 27.5% of these cases involved polymedication and Paracetamol (Acetaminophen) turned out to be the single most drug used. Suicide was the most common circumstance. 10% of patients had co-diagnoses of psychiatric disorders. Univariate analysis separately showed that females (p < 0.001), higher educated (p = 0.149), higher socioeconomic strata (p = 0.136) and non-addicts (p = 0.002) were more exposed to drugs whereas males, lower educated, lower socioeconomic strata and addicts are skewed to pesticides for poisoning. Most repeat suicide attempts were with the same poisonous agent. 70% of patients with a diagnosed psychiatric disorder have attempted suicide before using some drugs (p < 0.001). CONCLUSION: Our study highlights the importance of a region-wise, targeted approach in policymaking to curb poisoning.


Assuntos
Envenenamento/epidemiologia , Acidentes/estatística & dados numéricos , Adolescente , Adulto , Idoso , Comorbidade , Overdose de Drogas/epidemiologia , Feminino , Humanos , Índia/epidemiologia , Masculino , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Classe Social , Suicídio/estatística & dados numéricos , Adulto Jovem
19.
Lancet Psychiatry ; 8(10): 892-900, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34332697

RESUMO

BACKGROUND: There is widespread concern over the impact of public health measures, such as lockdowns, associated with COVID-19 on mental health, including suicide. High-quality evidence from low-income and middle-income countries, where the burden of suicide and self-harm is greatest, is scarce. We aimed to determine the effect of the pandemic on hospital presentations for self-poisoning. METHODS: In this interrupted time-series analysis, we established a new self-poisoning register at the tertiary care Teaching Hospital Peradeniya in Sri Lanka, a lower-middle-income country. Using a standard extraction sheet, data were gathered for all patients admitted to the Toxicology Unit with self-poisoning between Jan 1, 2019, and Aug 31, 2020. Only patients classified by the treating clinician as having intentionally self-poisoned were included. Data on date of admission, age or date of birth, sex, and poisoning method were collected. No data on ethnicity were available. We used interrupted time-series analysis to calculate weekly hospital admissions for self-poisoning before (Jan 1, 2019-March 19, 2020) and during (March 20-Aug 31, 2020) the pandemic, overall and by age (age <25 years vs ≥25 years) and sex. Individuals with missing date of admission were excluded from the main analysis. FINDINGS: Between Jan 1, 2019, and Aug 31, 2020, 1401 individuals (584 [41·7%] males, 761 [54·3%] females, and 56 [4·0%] of unknown sex) presented to the hospital with self-poisoning and had date of admission data. A 32% (95% CI 12-48) reduction in hospital presentations for self-poisoning in the pandemic period compared with pre-pandemic trends was observed (rate ratio 0·68, 95% CI 0·52-0·88; p=0·0032). We found no evidence that the impact of the pandemic differed by sex (rate ratio 0·64, 95% CI 0·44-0·94, for females vs 0·85, 0·57-1·26, for males; pinteraction=0·43) or age (0·64, 0·44-0·93, for patients aged <25 years vs 0·81, 0·57-1·16, for patients aged ≥25 years; pinteraction=0·077). INTERPRETATION: This is the first study from a lower-middle-income country to estimate the impact of the pandemic on self-harm (non-fatal) accounting for underlying trends. If the fall in hospital presentations during the pandemic reflects a reduction in the medical treatment of people who have self-poisoned, rather than a true fall in incidence, then public health messages should emphasise the importance of seeking help early. FUNDING: Elizabeth Blackwell Institute University of Bristol, Wellcome Trust, and Centre for Pesticide Suicide Prevention. TRANSLATIONS: For the Sinhalese and Tamil translations of the abstract see Supplementary Materials section.


Assuntos
COVID-19/psicologia , Hospitalização/estatística & dados numéricos , Envenenamento/psicologia , Comportamento Autodestrutivo/psicologia , Adulto , COVID-19/complicações , COVID-19/diagnóstico , COVID-19/epidemiologia , Efeitos Psicossociais da Doença , Países em Desenvolvimento/estatística & dados numéricos , Feminino , Hospitalização/tendências , Humanos , Incidência , Análise de Séries Temporais Interrompida/métodos , Masculino , Envenenamento/epidemiologia , SARS-CoV-2/genética , Comportamento Autodestrutivo/epidemiologia , Sri Lanka/epidemiologia , Suicídio/prevenção & controle , Suicídio/psicologia
20.
Rev. Saúde Pública Paraná (Online) ; 4(2): 13-24, Ago 18, 2021.
Artigo em Português | Coleciona SUS, CONASS, SESA-PR | ID: biblio-1284424

RESUMO

Apesar de ser uma doença multifatorial, estudos indicam que a depressão pode estar associada a exposição a agrotóxicos. Objetivou-se descrever o perfil, aspectos de vida, trabalho e adoecimento de mulheres depressivas expostas a agrotóxicos em um município localizado no oeste do Paraná. Trata-se de pesquisa descritiva, qualitativa com 10 mulheres selecionadas a partir de inquérito populacional, por meio de entrevista com uma questão norteadora, no período de março a abril de 2017. As informações foram submetidas à análise temática. As mulheres tinham entre 18 e 65 anos de idade, baixa escolaridade e estavam inseridas no mercado de trabalho. A partir da análise das informações identificaram-se as seguintes temáticas: Início da vida laboral na infância, exposição a agrotóxicos durante longo período da vida sem proteção, aspectos da vida e do trabalho, história de exposição e intoxicação por agrotóxicos e; adoecimento por depressão. Sugerem-se estudos epidemiológicos e clínicos complementares sobre a relação desse fenômeno com o desenvolvimento de transtornos de humor. (AU)


Despite being a multifactorial disease, studies indicate that depression may be associated with exposure to pesticides. The objective was to describe the profile, aspects of life, work and illness of depressed women exposed to pesticides in a municipality located in the west of Paraná. This is a descriptive, qualitative research with 10 women selected from a population survey, through an interview with a guiding question, from March to April 2017. The information was submitted to thematic analysis. The women were between 18 and 65 years of age, with low education and were included in the labor market. From the information analysis, the following themes were identified: Beginning of working life in childhood, exposure to pesticides for a long life period without protection, life and work aspects, history of exposure and poisoning by pesticides and; illness due to depression. Complementary epidemiological and clinical studies are suggested on the relationship of this phenomenon with the development of mood disorders. (AU)


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Envenenamento , Mulheres , Estudos Epidemiológicos , Saúde Mental , Agroquímicos , Transtornos do Humor , Depressão
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...