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1.
PLoS Negl Trop Dis ; 14(3): e0008060, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32163415

RESUMO

The northeast (NE) region of Brazil commonly goes through drought periods, which favor cyanobacterial blooms, capable of producing neurotoxins with implications for human and animal health. The most severe dry spell in the history of Brazil occurred between 2012 and 2016. Coincidently, the highest incidence of microcephaly associated with the Zika virus (ZIKV) outbreak took place in the NE region of Brazil during the same years. In this work, we tested the hypothesis that saxitoxin (STX), a neurotoxin produced in South America by the freshwater cyanobacteria Raphidiopsis raciborskii, could have contributed to the most severe Congenital Zika Syndrome (CZS) profile described worldwide. Quality surveillance showed higher cyanobacteria amounts and STX occurrence in human drinking water supplies of NE compared to other regions of Brazil. Experimentally, we described that STX doubled the quantity of ZIKV-induced neural cell death in progenitor areas of human brain organoids, while the chronic ingestion of water contaminated with STX before and during gestation caused brain abnormalities in offspring of ZIKV-infected immunocompetent C57BL/6J mice. Our data indicate that saxitoxin-producing cyanobacteria is overspread in water reservoirs of the NE and might have acted as a co-insult to ZIKV infection in Brazil. These results raise a public health concern regarding the consequences of arbovirus outbreaks happening in areas with droughts and/or frequent freshwater cyanobacterial blooms.


Assuntos
Morte Celular/efeitos dos fármacos , Microcefalia/patologia , Envenenamento/complicações , Envenenamento/patologia , Saxitoxina/toxicidade , Infecção por Zika virus/complicações , Infecção por Zika virus/patologia , Animais , Toxinas Bacterianas/análise , Toxinas Bacterianas/toxicidade , Encéfalo/patologia , Brasil/epidemiologia , Células Cultivadas , Modelos Animais de Doenças , Surtos de Doenças , Feminino , Humanos , Incidência , Toxinas Marinhas/análise , Toxinas Marinhas/toxicidade , Camundongos Endogâmicos C57BL , Microcistinas/análise , Microcistinas/toxicidade , Modelos Teóricos , Neurotoxinas/análise , Neurotoxinas/toxicidade , Saxitoxina/análise , Água/química
2.
J Vet Emerg Crit Care (San Antonio) ; 30(1): 60-65, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31714003

RESUMO

OBJECTIVE: To describe the prevalence of acute kidney injury (AKI), clinical course, decontamination procedures, and outcome in dogs following grape or raisin ingestion. DESIGN: Retrospective case series from 2005 to 2014. SETTING: Three university veterinary teaching hospitals. ANIMALS: One hundred thirty-nine client-owned dogs with known grape or raisin ingestion. MEASUREMENTS AND MAIN RESULTS: Among dogs with biochemical data, the prevalence of AKI was 6.7% (8/120). The prevalence of AKI in the early presentation (3/67) and late (5/53) presentation groups were 4.5% and 9%, respectively. The prevalence of AKI was not significantly different between groups (P = 0.27). Four dogs (3.3%) were azotemic at presentation and 4 dogs (3.3%) had increases in creatinine of ≥26.5 µmol/L (0.3 mg/dL) at recheck (3 from the early and 1 from the late group). Vomiting was the most common clinical sign (18/139). One hundred twenty-two dogs (88%) underwent gastrointestinal decontamination and significantly more dogs in the early group were decontaminated (P < 0.0001). Two dogs received continuous renal replacement therapy. One hundred thirty-eight dogs survived and 1 died. CONCLUSIONS: The prevalence of AKI and mortality was low in dogs with confirmed grape or raisin ingestion. Due to the retrospective nature of the study, conclusions about the utility of gastrointestinal decontamination and other therapies cannot be made.


Assuntos
Lesão Renal Aguda/veterinária , Doenças do Cão/epidemiologia , Vitis/envenenamento , Lesão Renal Aguda/complicações , Lesão Renal Aguda/epidemiologia , Animais , Doenças do Cão/sangue , Cães , Feminino , Masculino , Envenenamento/complicações , Envenenamento/veterinária , Prevalência , Estudos Retrospectivos , Estados Unidos/epidemiologia
4.
Rev Med Interne ; 40(11): 742-749, 2019 Nov.
Artigo em Francês | MEDLINE | ID: mdl-31421899

RESUMO

A huge variety of medical diseases may potentially present with isolated psychotic symptoms, and disease-specific treatment or management is available for a significant part of them. The initial medical work-up of a first-episode psychosis (FEP) is of crucial importance. This literature review aimed to identify medical conditions potentially revealed by FEP, to list the warning signs of secondary psychosis, and to discuss a screening strategy. Underlying organic conditions may be drugs and medications, neurologic diseases, infections, inflammatory and/or autoimmune pathologies, and metabolic disorders whether of hereditary origin. Each patient presenting with a first-episode psychosis should be evaluated with a precise anamnesis, a careful clinical examination, and routine laboratory tests. Brain imaging and tests (depending on the context) should be performed in the presence of atypical clinical features or "red flags", leading to suspect an organic disease.


Assuntos
Transtornos Psicóticos/etiologia , Encéfalo/diagnóstico por imagem , Doenças do Sistema Nervoso Central/complicações , Doenças do Sistema Nervoso Central/diagnóstico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/complicações , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico , Humanos , Infecções/complicações , Infecções/diagnóstico , Anamnese , Doenças Neurodegenerativas/complicações , Doenças Neurodegenerativas/diagnóstico , Exame Neurológico , Testes Neuropsicológicos , Envenenamento/complicações , Envenenamento/diagnóstico
6.
Artigo em Chinês | MEDLINE | ID: mdl-30929357

RESUMO

Objective: To analyze the clinical characteristics, treatment and prognosis of rhabdomyolysis (RM) caused by acute poisoning.Summarize the clinical characteristics and treatment experience, pay attention to the complications and improve the quality of rescue. Methods: We collecte and summarize the clinical data, treatment and prognosis of 22 cases of RM caused by acute poisoning. Results: We found that 21 patients (95.5%) had muscle damage, 13(59.1%) with coma, 8(36.4%) with brown, tea or even soy sauce urine, 6(27.3%) had acute renal injury (AKI), and 4(18.2%) had multiple organ dysfunction syndrome (MODS). After the treatment, 21 cases (95.5%) got better, and one case were discharged. All the patients with AKI were survived, three of them were treated by hemodialysis, and the other recovered gradually after massive fluid replacement. Conclusion: Acute poisoning combined with RM is not uncommon in clinic. We should pay attention to examination of serum enzymes and other indicators, observe the clinical symptoms and make early diagnosis. The key to diagnosis and treatment is early fluid resuscitation, comprehensive treatment, blood purification and maintain the stability of water and electrolyte.


Assuntos
Envenenamento/complicações , Rabdomiólise/diagnóstico , Rabdomiólise/terapia , Lesão Renal Aguda , Humanos , Insuficiência de Múltiplos Órgãos , Prognóstico , Diálise Renal
7.
Rev Bras Enferm ; 72(suppl 1): 32-40, 2019 Feb.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30942342

RESUMO

OBJECTIVE: to describe case of occupational exposure to chemical products. METHOD: descriptive retrospective study using record data of 382 workers assisted in the Outpatient Care for Occupational Toxicology of the Reference Center of Workers' Health of the Federal District, between 2009 and 2013. RESULTS: From the total, 66.7% were men, 55.2% had up to 9 years of activity and 81% did not use personal protective equipment (PPE). Nearly 60% were farmers and environmental surveillance agents, exposed to pesticides (63%), of which 40% were organophosphorus insecticides. The majority (68%) presented butyrylcholinesterase activity decreased, mostly farmers (85.9%); 57.3% of workers were considered poisoned - 61.6% by pesticides and 37.9% by industrial chemicals -, and away from work for at least 10 days. CONCLUSION: The profile was male workers, from 30 to 39 years, which not used PPE, indicating the need for prevention together with them to prevent poisonings.


Assuntos
Exposição Ocupacional/efeitos adversos , Envenenamento/etiologia , Adulto , Vazamento de Resíduos Químicos/estatística & dados numéricos , Fazendeiros/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Exposição Ocupacional/estatística & dados numéricos , Equipamento de Proteção Individual , Praguicidas/efeitos adversos , Envenenamento/complicações , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Inquéritos e Questionários
8.
Vet J ; 244: 1-6, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30825884

RESUMO

Epileptic seizures are a common indication for neurological evaluation. This retrospective study reviewed 789 cats referred for epileptic seizure evaluation to the Department of Small Animal Medicine and Surgery of the University of Veterinary Medicine in Hannover, between 1998 and 2017. The aim of this study was to determine common causes for reactive seizures (RS) in cats. Reactive seizures were diagnosed in 62 (7.9%) of 789 feline patients. The most common cause of RS was presumptive or confirmed intoxication (n=34/62; 54.8%). Toxins included permethrin (n=5/62; 8.1%), fipronil (n=1/62; 1.6%), and pesticide (n=1/62; 1.6%). Other common causes were hepatic and renal encephalopathy (n=6/62; 9.7% each), hypertension (n=5/62; 8.1%), hyperthyroidism (n=3/62; 4.8%), hypoglycaemia (n=3/62; 4.8%), and hyperglycaemia (n=1/62; 1.6%). Most commonly, cats with RS presented with generalised tonic-clonic seizures (n=25/62; 40.3%). A single status epilepticus was observed in 9.7% (n=6/62) and 4.8% (n=3/62) presented only with cluster seizures. Focal seizures were the only presenting sign in 3.2% (n=2/62) of cases, however in 4.8% (n=3/62) they were accompanied by tonic-clonic seizures. The mean age of all cats presented for RS was 10.8 years. In the intoxication group, the mean age was 2.9 years. Intoxication (confirmed or presumptive) was the most common cause of RS identified. Clinicians should suspect intoxication when other causes of RS are excluded; when there are appropriate historical findings; when the cat is frequently unobserved by the owner; when symptomatic treatment leads to cessation of epileptic seizures; and when seizures do not recur after treatment has been discontinued.


Assuntos
Doenças do Gato/epidemiologia , Convulsões/veterinária , Animais , Doenças do Gato/etiologia , Gatos , Feminino , Alemanha/epidemiologia , Masculino , Exame Neurológico/veterinária , Praguicidas/toxicidade , Envenenamento/complicações , Envenenamento/veterinária , Recidiva , Estudos Retrospectivos , Convulsões/epidemiologia , Convulsões/etiologia
9.
PLoS One ; 14(2): e0199486, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30753193

RESUMO

INTRODUCTION: Repetition of deliberate self-harm is an important predictor of subsequent suicide. Repetition rates in Asian countries appear to be significantly lower than in western high-income countries. Methodological differences in studies, and the impact of access to means of self-harm with comparatively higher lethality have been suggested as reasons for these reported differences. This prospective study determines the rates and demographic patterns of deliberate self-poisoning (DSP), suicide and repeated deliberate self-harm resulting non-fatal and fatal outcomes in rural Sri Lanka. METHODS: Details of DSP admission in all hospitals (n = 46) and suicides reported to all police stations (n = 28) in a rural district were collected for the years 2011, 2012 and 2013. Demographic details of the cohort of patients admitted to all hospitals in 2011 due to deliberate self-poisoning (N = 4022), were screened to link with patient records and police reports of the successive two years with high sensitivity using a computer program. Then high specificity manual matching of all screened links was performed to identify repetition within 2 years of initial presentation. Life time repetition was assessed in a randomly selected subset of DSP patients (n = 433). RESULTS: There were 15,639 DSP admissions, aged more than 9 years, and 1078 suicides during the study period. The incidence of deliberate self-poisoning and suicide in the population within the study area were 248.3/100,000 and 20.7/100,000 respectively, in 2012. Repetition rates at four weeks, one-year and two-years were 1.9% (95% CI 1.5-2.3%), 5.7% (95% CI 5.0-6.4) and 7.9% (95% CI 7.1-8.8) respectively. The median interval between two attempts were 92 (IQR 10-238) and 191 (IQR 29-419.5) days for the one and two-year repetition groups. The majority of patients used the same poison in the repeat attempt. The age and duration of hospital stay of individuals with repetitive events were not significantly different from those who had no repetitive events. The rate of suicide at two years following DSP was 0.7% (95% CI 0.4-0.9%). The reported life time history of deliberate self-harm attempts was 9.5% (95% CI 6.7-12.2%). CONCLUSIONS: The comparatively low rates of repetition in rural Sri Lanka was not explained by higher rates of suicide, access to more lethal means or differences in study methodology.


Assuntos
Comportamento Autodestrutivo/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Estudos de Coortes , Feminino , Hospitalização , Humanos , Incidência , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Envenenamento/complicações , Envenenamento/epidemiologia , Envenenamento/psicologia , Estudos Prospectivos , Fatores de Risco , População Rural , Sri Lanka/epidemiologia , Suicídio/prevenção & controle , Suicídio/tendências , Tentativa de Suicídio
10.
Clin Toxicol (Phila) ; 57(3): 181-188, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30318932

RESUMO

PURPOSE: To determine the demographic and social characteristics of acutely intoxicated patients in the emergency department (ED), intention of drug/chemical intake, main toxic agents, outcomes and time trends for all variables. METHODS: This prospective, observational study included acutely intoxicated patients treated in the ED of the University Hospital Centre Sisters of Charity, Zagreb, Croatia, during the years 2001, 2010 and 2015. The diagnosis was derived from patient's self-report, clinical observations and laboratory test results (quantitative test for serum ethanol levels and qualitative tests for drugs in urine). RESULTS: A total of 1593 patients were enrolled in the study (331 in 2001, 618 in 2010, 644 in 2015), with a predominance of men (55.9%, 65.2%, 70.7%, respectively). The median age was 28 [18-89], 39 [18-92] and 40 years [18-95], respectively. There was a decline in the number of suicide attempts during the study (46.2%, 22.2%, 17.1% of patients, respectively) with a predominance of women (64.1-68.2%), and an escalation in the number of unintentional overdoses by substances of abuse (50.2%, 72.3%, 81.7% of patients, respectively) with a predominance of men (74.1-79.1%). Ethanol was the main toxic agent (40.2%, 69.4%, 75.8% of patients, respectively), used primarily as a substance of unintentional overdose. Anxiolytics were the most frequently implicated pharmaceuticals among all patients (46.5%, 32.0%, 18.5% of patients, respectively) and the main substance used in suicide attempts. The number of patients hospitalized in the Intensive Care Unit (ICU) decreased during the study from 20.2% of all patients in 2001 to 7.9% in 2010 and 6.8% in 2015. They accounted for 7.2%, 5.8% and 5.6% of all ICU-treated patients, respectively. In-hospital mortality (ED and ICU) caused by acute intoxications was low (0.9%, 0.8%, 0.8%, respectively). CONCLUSIONS: The escalation of overdoses by ethanol was a major medical and public concern in Zagreb. Anxiolytics were the main substance used in suicide attempts, with a low death rate due to their good safety profile.


Assuntos
Envenenamento/complicações , Envenenamento/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Depressores do Sistema Nervoso Central/envenenamento , Comorbidade , Cuidados Críticos , Croácia/epidemiologia , Overdose de Drogas/epidemiologia , Etanol/envenenamento , Feminino , Seguimentos , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Envenenamento/terapia , Estudos Prospectivos , Fatores Socioeconômicos , Tentativa de Suicídio/estatística & dados numéricos , Resultado do Tratamento , Adulto Jovem
11.
J Small Anim Pract ; 59(11): 659-669, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30102417

RESUMO

Hypoglycaemia is a common, life-threatening complication that occurs as a component of a wide variety of disease processes. Despite its frequent occurrence, information concerning the aetiology, characteristics and outcomes of hypoglycaemic crises in veterinary medicine is limited. This review summarises the current understanding of the pathophysiology of hypoglycaemia, the body's counter-regulatory response, underlying aetiologies, diagnosis and treatment. Disease mechanisms are discussed and published evidence in veterinary literature regarding prognostic indicators, prevalence, diagnosis and treatment is examined for hypoglycaemia-related disease processes including insulinoma, glucose-lowering toxins and medications.


Assuntos
Hipoglicemia/veterinária , Animais , Encéfalo/metabolismo , Sistema Cardiovascular/fisiopatologia , Glucose/metabolismo , Hipoglicemia/etiologia , Hipoglicemia/fisiopatologia , Hipoglicemia/terapia , Insulina/efeitos adversos , Neoplasias/complicações , Neoplasias/veterinária , Envenenamento/complicações , Envenenamento/veterinária
12.
BMC Pediatr ; 18(1): 274, 2018 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-30121087

RESUMO

BACKGROUND: The burden of poisoning among children is largely underexplored in rural Sri Lanka. This study describes the patterns of demographic characteristics, poison related factors, clinical management and outcome following acute poisoning among children (9 months- 12 years) in rural Sri Lanka. METHOD: This hospital based multi-center study included Anuradhapura Teaching hospital, Polonnaruwa District General hospital, and 34 regional hospitals within Regional Director of Health Services in North Central province of Sri Lanka. The study assessed clinical profiles, poison related factors, clinical management, complications, harmful first aid practices, reasons for delayed management, complications and outcomes following acute poisoning over 7 years. RESULTS: Among 1621 children with acute poisoning, the majority were in preschool age group. Household chemicals were accountable for 489 acute poisonings (30.2%). The most common poison was kerosene oil, followed by paracetamol. Most events occurred within their own domestic premises. Potentially harmful first aid measures were practiced by approximately one third of care givers. Reasons for delayed presentation at emergency center included lack of concern by family members regarding the urgency of the situation and lack of knowledge regarding possible complications. Complications were observed in 12.5% and the most common complication was chemical pneumonitis. CONCLUSIONS: Children with acute poisoing in rural Sri Lanka were predominantly preschoolers. They are poisonined mostly within their own housing premises. Kerosene oil, in addition to being the most common poison, had additional risks of aspiration pneumonia following potentially hazadrous first aid measures practised by the care givers. Complications though rare were potentially preventable by community education and awareness on timely attention to seek medical care, and avoidance of harmful first aid practices.


Assuntos
Agroquímicos/envenenamento , Produtos Domésticos/envenenamento , Envenenamento/epidemiologia , Doença Aguda , Distribuição por Idade , Cuidadores , Criança , Pré-Escolar , Feminino , Hospitalização , Humanos , Entrevistas como Assunto , Masculino , Envenenamento/complicações , Envenenamento/terapia , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , População Rural , Sri Lanka/epidemiologia , Resultado do Tratamento
13.
BMJ Open ; 8(7): e020036, 2018 07 07.
Artigo em Inglês | MEDLINE | ID: mdl-29982199

RESUMO

OBJECTIVES: Poisoning is a frequent cause of admission to the emergency department (ED) and may involve drugs known to prolong the QT interval. This study aims to describe the prevalence of QTc prolongation among ED patients with suspected poisoning and to calculate the absolute and relative risk of mortality or cardiac arrest associated with a prolonged QTc interval. METHODS: We performed a register-based cohort study, including all adult first-time contacts with suspected poisoning to the ED of two Swedish hospitals (January 2010-December 2014) and two Danish hospitals (March 2013-April 2014). We used propensity score matching to calculate HRs for all-cause mortality or cardiac arrest (combined endpoint) within 30 days after contact comparing patients with a prolonged QTc interval (≥450 ms men, ≥460 ms women) with patients with a QTc interval of <440 ms. RESULTS: Among all first-time contacts with suspected poisoning that had an ECG recorded within 4 hours after arrival (n=3869), QTc prolongation occurred in 6.5%. The overall mortality after a 30-day follow-up period was 0.8% (95% CI 0.6 to 1.2), with an absolute risk of mortality or cardiac arrest in patients with QTc prolongation of 3.2% (95% CI 1.4 to 6.1). A prolonged QTc interval on arrival was associated with a HR of 3.6 (95% CI 1.0 to 12.2). CONCLUSION: In the ED, a prolonged QTc interval in patients arriving with suspected poisoning seems to be associated with a threefold increased risk of 30-day all-cause mortality or cardiac arrest.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Síndrome do QT Longo/mortalidade , Envenenamento/epidemiologia , Adolescente , Adulto , Idoso , Comorbidade , Estudos Transversais , Eletrocardiografia , Feminino , Humanos , Síndrome do QT Longo/etiologia , Masculino , Pessoa de Meia-Idade , Envenenamento/complicações , Prevalência , Pontuação de Propensão , Fatores de Risco , Análise de Sobrevida , Suécia/epidemiologia , Fatores de Tempo , Adulto Jovem
14.
Rev. esp. enferm. dig ; 110(6): 404-406, jun. 2018. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-177696

RESUMO

En el artículo se describe el caso clínico de una paciente con fallo multiorgánico y colitis isquémica secundario a intoxicación por magnesio, debido a la ingesta crónica de un producto de parafarmacia, utilizado para el tratamiento del estreñimiento crónico. Se describe el caso clínico y se realiza una revisión de la literatura


The article describes the clinical case of a patient with multi-organ failure and ischemic colitis secondary to magnesium poisoning, due to the chronic intake of a parapharmacy product, used for the treatment of chronic constipation. The clinical case is described and a review of the literature is made


Assuntos
Humanos , Feminino , Idoso , Magnésio/envenenamento , Envenenamento/complicações , Insuficiência de Múltiplos Órgãos/etiologia , Colite Isquêmica/induzido quimicamente , Linfoma de Célula do Manto/complicações , Constipação Intestinal/tratamento farmacológico
15.
Medisan ; 22(4)abr. 2018. tab
Artigo em Espanhol | LILACS | ID: biblio-894710

RESUMO

Se realizó una investigación descriptiva, observacional y prospectiva de 172 pacientes de hasta 18 años con diagnóstico de intoxicación exógena, ingresados en el Hospital Infantil Docente Sur Dr Antonio María Béguez César de Santiago de Cuba, de enero del 2015 a igual mes del 2016, a fin de caracterizarles de acuerdo con algunas variables clínicas y epidemiológicas. Como medida de resumen para las variables cualitativas se utilizó el porcentaje y los resultados se compararon mediante la prueba de la X², con 95 por ciento de confianza. Existió un predominio de los adolescentes en las edades de 14-18 años, del sexo femenino y del tipo de intoxicación voluntaria. En general, los medicamentos constituyeron el agente causal más frecuente, la mayoría de los pacientes evolucionó satisfactoriamente y el porcentaje de complicaciones fue bajo. Se recomendó continuar perfeccionando las estrategias de intervención comunitaria en los niveles primario y secundario de atención sanitaria, para lograr disminuir el número de afectados por este problema de salud.


A descriptive, observational and prospective investigation of 172 patients of up to 18 years with diagnosis of exogenous intoxication, admitted to Dr. Antonio María Béguez César Southern Teaching Children Hospital in Santiago de Cuba was carried out from January, 2015 to same month in 2016, in order to characterize them according to some clinical and epidemiological variables. The percentage was used as summary measure for the qualitative variables and the results were compared by means of the chi-square test, with 95 percent of confidence. There was a prevalence of adolescents aged 14-18, female sex and voluntary intoxication type. In general, medications constituted the most frequent causal agent, most of the patients had a favorable clinical course and the percentage of complications was low. It was recommended to continue improving the strategies of community intervention in the primary and secondary levels of health care, to be able to diminish the number of affected patients due to this health problem


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Envenenamento/complicações , Envenenamento/diagnóstico , Medicina de Emergência Pediátrica , Envenenamento/epidemiologia , Tentativa de Suicídio , Preparações Farmacêuticas , Estudos Prospectivos , Hospitais Pediátricos
16.
Lab Med ; 49(3): 272-275, 2018 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-29365146

RESUMO

Rat poisoning should be considered in the differential diagnosis of a patient presenting with signs and symptoms of vitamin K deficiency without a more likely explanation. However, confirming this diagnosis may be difficult due to the varying sensitivities of available assays. A 40-year-old Caucasian woman presented to our hospital with chronic abdominal pain, hematuria, and a history of diarrhea of unknown etiology, despite an extensive work-up. Her laboratory evaluation results were consistent with vitamin K deficiency. Because she reported that she had not ingested warfarin, rat poisoning was suspected; however, the results of the first assay were negative. A second specimen was sent to another reference laboratory with a more sensitive assay, and the diagnosis of brodifacoum poisoning was confirmed. The patient was treated with oral vitamin K. If a patient presents with unexplained signs and symptoms of vitamin K deficiency, toxicological evaluation should be performed and repeat testing may be warranted, depending on the sensitivity of the original testing method.


Assuntos
4-Hidroxicumarinas/envenenamento , Envenenamento , Rodenticidas/envenenamento , Deficiência de Vitamina K/etiologia , Adulto , Feminino , Humanos , Coeficiente Internacional Normatizado , Envenenamento/sangue , Envenenamento/complicações , Envenenamento/diagnóstico , Envenenamento/psicologia
17.
J Am Vet Med Assoc ; 252(3): 336-342, 2018 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-29346050

RESUMO

CASE DESCRIPTION A 14-year-old 4.1-kg (9.02-lb) male harpy eagle (Harpia harpyja) was evaluated because of vomiting, anorexia, lethargy, and weight loss (decrease of 0.35 kg [0.77 lb]) of 4 weeks' duration. The bird had previously been treated orally with fenbendazole after the initial onset of clinical signs. CLINICAL FINDINGS An initial CBC revealed marked heteropenia and anemia, but whole-body contrast-enhanced CT images and other diagnostic test findings were unremarkable. Clinical signs persisted, and additional diagnostic testing failed to reveal the cause. During celiotomy, a biopsy specimen of the duodenum was obtained for histologic examination, which revealed lymphoplasmacytic inflammation, consistent with inflammatory bowel disease (IBD). TREATMENT AND OUTCOME Prior to histopathologic diagnosis of IBD, barium sulfate administered via gavage resulted in a temporary improvement of clinical signs. Following diagnosis of IBD, corticosteroid administration was initiated in conjunction with antifungal prophylaxis. Cessation of vomiting and a return to normal appetite occurred within 3 days. Fifteen months after cessation of corticosteroid treatment, the eagle continued to do well. CLINICAL RELEVANCE To our knowledge, this was the first report of diagnosis and management of IBD in an avian species. For the eagle of the present report, results of several diagnostic tests increased clinical suspicion of IBD, but histologic examination of an intestinal biopsy specimen was required for definitive diagnosis. Although successful in this case, steroid administration in avian species must be carefully considered. Conclusive evidence of fenbendazole toxicosis was not obtained, although it was highly suspected in this bird.


Assuntos
Antinematódeos/efeitos adversos , Doenças das Aves/diagnóstico , Águias , Fenbendazol/efeitos adversos , Doenças Inflamatórias Intestinais/veterinária , Corticosteroides/uso terapêutico , Animais , Doenças das Aves/induzido quimicamente , Doenças das Aves/diagnóstico por imagem , Doenças das Aves/tratamento farmacológico , Diagnóstico Diferencial , Humanos , Doenças Inflamatórias Intestinais/induzido quimicamente , Doenças Inflamatórias Intestinais/complicações , Doenças Inflamatórias Intestinais/diagnóstico , Masculino , Envenenamento/complicações , Envenenamento/diagnóstico , Envenenamento/veterinária , Tomografia Computadorizada por Raios X/veterinária , Vômito/etiologia , Vômito/veterinária
18.
Rev. méd. Minas Gerais ; 28: [1-5], jan.-dez. 2018.
Artigo em Português | LILACS | ID: biblio-970207

RESUMO

Intoxicações por medicações de uso habitual ou drogas ilícitas tornaram-se um grave problema de saúde pública, com um impacto não apenas na mortalidade, mas com sequelas psicossociais relevantes. As manifestações clínicas dependem das propriedades farmacológicas da droga. Uso de solução lipídica no tratamento de intoxicações graves tem se tornado uma realidade cada vez mais consistente. O objetivo deste trabalho é relatar o caso de uma paciente atendida no HPS João XXIII a partir de coleta de dados em prontuário. C.R.F ,39 anos sexo feminino, encaminhada da Unidade de pronto-atendimento de Ribeirão das Neves devido a ingestão proposital de três cartelas de atenolol, fluoxetina e losartana, onde foi realizado lavagem gástrica, administração de carvão ativado, e reposição volêmica, sem resposta. À admissão, evoluiu com parada cardiorrespiratória durante 10 minutos, sendo iniciadas medidas de ressuscitação, seguida de administração de solução lipídica. Foi encaminhada para unidade de terapia intensiva onde permaneceu por seis dias, seguido de alta para enfermaria e após dez dias de internação alta hospitalar sem qualquer sequela. Os beta-bloqueadores são substâncias bem absorvidas pelo trato gastrointestinal. Os primeiros efeitos tóxicos aparecem 20 a 30 minutos após a ingestão e o efeito máximo ocorre após 4 a 6 horas, podendo chegar a 10 horas em alguns compostos. De 2014 a 2016 foram realizados 92 atendimentos devido a intoxicação por beta-bloqueador (19 presenciais e 73 por telefone) no Serviço de Toxicologia do Hospital João XXIII, sendo metade destes por tentativa de auto-extermínio. Nenhum óbito foi registrado nesse período. (AU)


Intoxications from commonly used medications or illicit drugs have become a serious public health problem, with an impact not only on mortality, but also on psychosocial and morbidity sequelae. The clinical manifestations depend on the pharmacological properties of the drug. Use of lipid solution in the treatment of severe poisoning has become an increasingly consistent reality. The purpose of this paper is to report the case of a patient attended in the HPS John XXIII from data collection in medical records. C.R.F, a 39-year-old female, referred from the Ribeirão das Neves emergency room due to the intentional ingestion of three tablets of atenolol, fluoxetine and losartan, where gastric lavage, activated carbon administration and volumetric replacement were performed without response. Upon admission, he evolved with cardiorespiratory arrest for 10 minutes, and resuscitation measures were initiated, followed by administration of lipid solution. She was referred to an intensive care unit where she remained for six days, followed by discharge to the ward and ten days after hospital discharge without any sequelae. Beta-blockers are well-absorbed substances in the gastrointestinal tract. The first toxic effects appear 20 to 30 minutes after ingestion and the maximum effect occurs after 4 to 6 hours, and can reach 10 hours in some compounds. From 2014 to 2016, 92 consultations were performed due to beta-blocker poisoning (19 presential and 73 by telephone) at the Toxicology Service of the Hospital João XXIII, half of which were for self-extermination. No deaths were recorded during this period. (AU)


Assuntos
Humanos , Feminino , Adulto , Cardiotoxicidade , Envenenamento , Soluções Farmacêuticas , Envenenamento/complicações , Tentativa de Suicídio , Emergências , Parada Cardíaca
19.
Artigo em Inglês | LILACS | ID: biblio-894170

RESUMO

In Brazil, the scorpion species responsible for most severe incidents belong to the Tityus genus and, among this group, T. serrulatus, T. bahiensis, T. stigmurus and T. obscurus are the most dangerous ones. Other species such as T. metuendus, T. silvestres, T. brazilae, T. confluens, T. costatus, T. fasciolatus and T. neglectus are also found in the country, but the incidence and severity of accidents caused by them are lower. The main effects caused by scorpion venoms - such as myocardial damage, cardiac arrhythmias, pulmonary edema and shock - are mainly due to the release of mediators from the autonomic nervous system. On the other hand, some evidence show the participation of the central nervous system and inflammatory response in the process. The participation of the central nervous system in envenoming has always been questioned. Some authors claim that the central effects would be a consequence of peripheral stimulation and would be the result, not the cause, of the envenoming process. Because, they say, at least in adult individuals, the venom would be unable to cross the blood-brain barrier. In contrast, there is some evidence showing the direct participation of the central nervous system in the envenoming process. This review summarizes the major findings on the effects of Brazilian scorpion venoms on the central nervous system, both clinically and experimentally. Most of the studies have been performed with T. serrulatus and T. bahiensis. Little information is available regarding the other Brazilian Tityus species.(AU)


Assuntos
Animais , Envenenamento/complicações , Venenos de Escorpião/toxicidade , Escorpiões , Sistema Nervoso Central/patologia , Venenos de Escorpião/farmacocinética , Brasil
20.
J Pak Med Assoc ; 67(11): 1751-1752, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29171574

RESUMO

Methanol toxicity can result in serious morbidity and mortality without timely diagnosis and treatment. Many cases of methanol poisoning outbreaks have been noted in our population but no study has been performed to estimate methanol exposure and its outcomes and complications. A retrospective study was conducted to review all the cases of methanol poisoning admitted from January 1988 to December 2015 at the Aga Khan University Hospital. A total of 35 methanol poisoning cases were reported. All the patients were male, and the mean age was 36.2±8.6 years. The mean Glasgow Coma Scale score on presentation in the emergency was 10.4 ± 4.4. Blurring of vision was present in 17 (48%) patients while 10 (28%) had complete blindness. Mean arterial pH was 6.8±0.5 on arrival. Ethanol was given to 30(88%) patients and 12(32%) patients received bicarbonate for immediate treatment. A total of 15 (42.8%) patients underwent dialysis, out of which only 5 (33.3%) patients survived. Overall, 19 (54.3%) patients expired secondary to methanol ingestion.


Assuntos
Metanol/envenenamento , Envenenamento , Adulto , Cegueira/epidemiologia , Cegueira/etiologia , Humanos , Masculino , Paquistão , Envenenamento/complicações , Envenenamento/epidemiologia , Envenenamento/mortalidade , Estudos Retrospectivos , Centros de Atenção Terciária
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