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1.
Forensic Sci Int ; 319: 110662, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33401231

RESUMO

Complex suicides are highly uncommon suicides in which multiple detrimental methods are used simultaneously or in chronological succession. We retrospectively analyzed through our database the 25512 autopsy reports registered at the Bureau of Legal Medicine of Milan in the last 27 years from 1993 until 2019, where 4498 suicides were documented. We assessed 53 cases of complex suicides and only one case of complicated suicide: for all of them we analyzed both data collected during the on-site investigation and the autopsy. In our case series, we identified a total number of 113 methods chosen and variably combined by the victims, which were classified into 17 categories. On the whole the most frequent association of suicide methods resulted in the combination of the plastic bag suffocation with inert gas inhalation (13 out of 53 complex suicides; 24.5%). We also analyzed our cases of simple suicides (1993-2019), to compare them with the complex suicides. In this study, we present a complete analysis regarding our cases of complex suicides, discussing the challenges and the interpretative issues which a forensic pathologist might deal with. A thorough on-site judicial inspection and a careful autopsy examination are crucial in such cases. Moreover, the clinical history of the victims and laboratory findings are supplemental elements to be necessarily considered to establish the actual manner of death and avoid any misinterpretations.


Assuntos
Suicídio Consumado/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Asfixia/mortalidade , Butanos/envenenamento , Afogamento/mortalidade , Feminino , Fogo , Medicina Legal , Hélio/envenenamento , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Nitrogênio/envenenamento , Envenenamento/mortalidade , Propano/envenenamento , Estudos Retrospectivos , Distribuição por Sexo , Ferimentos por Arma de Fogo/mortalidade , Ferimentos Perfurantes/mortalidade , Traumatismos do Punho/mortalidade , Adulto Jovem
2.
Rev Paul Pediatr ; 39: e2019262, 2021.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32638947

RESUMO

OBJECTIVE: To describe a case series of severe acute toxic exposures (SATE) in individuals <20 years old followed-up by a regional Poison Control Center (PCC). METHODS: Descriptive cross-sectional study. All patients who were <20yo and classified as score 3 (severe) and 4 (fatal) following Poisoning Severity Score were included for analysis. According to the outcome, patients were classified as PSS 3 when they developed intense clinical manifestations with risk of death or important sequelae; and as PSS 4 when death had resulted from direct cause or complication of the initial exposure. The data of patients were obtained from the Brazilian electronic database system (DATATOX). RESULTS: During the biennium 2014-2015, Campinas PCC followed up 5,095 patients <20yo, with 30 being classified as SATE (PSS=3, n=24; PSS=4, n=6). The exposures circumstances were unintentional (15); intentional (14; suicide attempt = 11; street drugs consumption = 3); and not explained (1). The exposures were significantly more frequent in adolescents >14yo (n=17; p<0.01). The involved agents were venomous animals (8; scorpions=5); medicines (8; miscellaneous=6); chemicals (6); illegal rodenticides containing acetylcholinesterase inhibitors (chumbinho, 4); drugs of abuse (3); button battery (1). Three patients evolved with sequels (esophageal stricture post-corrosive ingestion). The median length of hospital stay was 6 days (IQR: 5-12 days); 26 patients were treated in intensive care units, and 22 of them needed mechanical ventilation; 12, inotropic/vasopressors; and 3, renal replacement therapy. CONCLUSIONS: Scorpion stings and poisonings caused by medicines and chemicals were the main causes of SATE. The SATE were significantly more frequent in adolescents, due to deliberate self-poisoning.


Assuntos
Centros de Controle de Intoxicações/estatística & dados numéricos , Envenenamento/mortalidade , Adolescente , Adulto , Animais , Brasil/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Evolução Fatal , Feminino , Humanos , Lactente , Masculino , Índice de Gravidade de Doença , Adulto Jovem
3.
Pediatrics ; 147(1)2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33318224

RESUMO

BACKGROUND: Child maltreatment (CM) is a global public health issue, with reported impacts on health and social outcomes. Evidence on mortality is lacking. In this study, we aimed to estimate the impact of CM on death rates in persons 16 to 33 years. METHODS: A retrospective cohort study of all persons born in South Australia 1986 to 2003 using linked administrative data. CM exposure was based on child protection service (CPS) contact: unexposed, no CPS contact before 16 years, and 7 exposed groups. Deaths were observed until May 31, 2019 and plotted from 16 years. Adjusted hazard ratios (aHRs) by CPS category were estimated using Cox proportional hazards models, adjusting for child and maternal characteristics. Incident rate ratios (IRRs) were derived for major causes of death, with and without CPS contact. RESULTS: The cohort included 331 254 persons, 20% with CPS contact. Persons with a child protection matter notification and nonsubstantiated or substantiated investigation had more than twice the death rate compared with persons with no CPS contact: aHR = 2.09 (95% confidence interval [CI] = 1.62-2.70) to aHR = 2.61 (95% CI = 1.99-3.43). Relative to no CPS contact, persons ever placed in out-of-home care had the highest mortality if first placed in care aged ≥3 years (aHR = 4.67 [95% CI = 3.52-6.20]); aHR was 1.75(95% CI = 0.98-3.14) if first placed in care aged <3 years. The largest differential cause-specific mortality (any contact versus no CPS contact) was death from poisonings, alcohol, and/or other substances (IRR = 4.82 [95% CI = 3.31-7.01]) and from suicide (IRR = 2.82 [95% CI = 2.15-3.68]). CONCLUSIONS: CM is a major underlying cause of potentially avoidable deaths in early adulthood. Clinical and family-based support for children and families in which CM is occurring must be a priority to protect children from imminent risk of harm and early death as young adults.


Assuntos
Causas de Morte , Maus-Tratos Infantis/estatística & dados numéricos , Envenenamento/mortalidade , Transtornos Relacionados ao Uso de Substâncias/mortalidade , Suicídio Consumado/estatística & dados numéricos , Adulto , Austrália/epidemiologia , Criança , Serviços de Proteção Infantil/estatística & dados numéricos , Estudos de Coortes , Feminino , Humanos , Masculino , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores Socioeconômicos , Adulto Jovem
4.
MMWR Morb Mortal Wkly Rep ; 69(32): 1070-1073, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32790662

RESUMO

Alcohol-based hand sanitizer is a liquid, gel, or foam that contains ethanol or isopropanol used to disinfect hands. Hand hygiene is an important component of the U.S. response to the emergence of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19). If soap and water are not readily available, CDC recommends the use of alcohol-based hand sanitizer products that contain at least 60% ethyl alcohol (ethanol) or 70% isopropyl alcohol (isopropanol) in community settings (1); in health care settings, CDC recommendations specify that alcohol-based hand sanitizer products should contain 60%-95% alcohol (≥60% ethanol or ≥70% isopropanol) (2). According to the Food and Drug Administration (FDA), which regulates alcohol-based hand sanitizers as an over-the-counter drug, methanol (methyl alcohol) is not an acceptable ingredient. Cases of ethanol toxicity following ingestion of alcohol-based hand sanitizer products have been reported in persons with alcohol use disorder (3,4). On June 30, 2020, CDC received notification from public health partners in Arizona and New Mexico of cases of methanol poisoning associated with ingestion of alcohol-based hand sanitizers. The case reports followed an FDA consumer alert issued on June 19, 2020, warning about specific hand sanitizers that contain methanol. Whereas early clinical effects of methanol and ethanol poisoning are similar (e.g., headache, blurred vision, nausea, vomiting, abdominal pain, loss of coordination, and decreased level of consciousness), persons with methanol poisoning might develop severe anion-gap metabolic acidosis, seizures, and blindness. If left untreated methanol poisoning can be fatal (5). Survivors of methanol poisoning might have permanent visual impairment, including complete vision loss; data suggest that vision loss results from the direct toxic effect of formate, a toxic anion metabolite of methanol, on the optic nerve (6). CDC and state partners established a case definition of alcohol-based hand sanitizer-associated methanol poisoning and reviewed 62 poison center call records from May 1 through June 30, 2020, to characterize reported cases. Medical records were reviewed to abstract details missing from poison center call records. During this period, 15 adult patients met the case definition, including persons who were American Indian/Alaska Native (AI/AN). All had ingested an alcohol-based hand sanitizer and were subsequently admitted to a hospital. Four patients died and three were discharged with vision impairment. Persons should never ingest alcohol-based hand sanitizer, avoid use of specific imported products found to contain methanol, and continue to monitor FDA guidance (7). Clinicians should maintain a high index of suspicion for methanol poisoning when evaluating adult or pediatric patients with reported swallowing of an alcohol-based hand sanitizer product or with symptoms, signs, and laboratory findings (e.g., elevated anion-gap metabolic acidosis) compatible with methanol poisoning. Treatment of methanol poisoning includes supportive care, correction of acidosis, administration of an alcohol dehydrogenase inhibitor (e.g., fomepizole), and frequently, hemodialysis.


Assuntos
Higienizadores de Mão/envenenamento , Metanol/envenenamento , Adulto , Idoso , Arizona/epidemiologia , Ingestão de Alimentos , Feminino , Higienizadores de Mão/química , Humanos , Masculino , Metanol/análise , Pessoa de Meia-Idade , New Mexico/epidemiologia , Envenenamento/epidemiologia , Envenenamento/mortalidade , Adulto Jovem
5.
Medicine (Baltimore) ; 99(31): e21351, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756123

RESUMO

Paraquat (PQ) poisoning is associated with high mortality rate. Therefore, an accurate method for predicting the survival of patients with PQ poisoning is required. This study evaluated the value of serum anion gap (AG) at admission in predicting the survival of such patients.Cases of patients with PQ poisoning admitted to Cangzhou Central Hospital between May 2012 and March 2019 were retrospectively analyzed. The patients were classified into survival and nonsurvival groups on the basis of their 90-day prognosis. Correlation analysis, Cox regression analysis, and receiver operating characteristic and Kaplan-Meier curve analyses were performed to assess the value of AG in predicting the 90-day survival of patients with PQ poisoning.Only 44 of the 108 patients with PQ poisoning survived; thus, the 90-day survival was 40.74%. AG levels at admission were significantly higher in nonsurvivors (26.53 ±â€Š4.93 mmol/L) than in survivors (20.88 ±â€Š2.74 mmol/L) (P < .001) and negatively correlated with 90-day survival (r = -0.557; P < .001). Cox regression analysis revealed that AG at admission is an independent prognostic marker of the 90-day survival of patients with PQ poisoning. AG level at admission had an area under the receiver operating characteristic curve of 0.836 (95% confidence interval: 0.763-0.909) and an optimal cut-off value of 25.5 mmol/L (59.4% sensitivity and 95.5% specificity).AG level at admission may serve as a candidate marker for predicting the survival of patients with PQ poisoning.


Assuntos
Desequilíbrio Ácido-Base/sangue , Herbicidas/envenenamento , Paraquat/envenenamento , Envenenamento/mortalidade , Adulto , Biomarcadores/sangue , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Envenenamento/diagnóstico , Valor Preditivo dos Testes , Modelos de Riscos Proporcionais , Estudos Retrospectivos
6.
Alcohol ; 88: 29-32, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32693023

RESUMO

The coronavirus disease 2019 (COVID-19) spread rapidly worldwide and led to the deaths of thousands of people. To date, there is not any vaccine or specific antiviral medicine that can prevent or treat this virus. This caused panic among people who try their best to prevent being infected. In Iran, methanol poisoning was reported and led to the death of hundreds of people in several provinces. The incident occurred after a rumor circulated in the country that drinking alcohol (ethanol) can cure or prevent being infected by COVID-19.


Assuntos
Comunicação , Infecções por Coronavirus/prevenção & controle , Etanol/uso terapêutico , Metanol/envenenamento , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Envenenamento/mortalidade , Solventes/envenenamento , Adolescente , Adulto , Idoso , Consumo de Bebidas Alcoólicas , Bebidas Alcoólicas , Betacoronavirus , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Surtos de Doenças , Contaminação de Medicamentos , Feminino , Contaminação de Alimentos , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/epidemiologia , Envenenamento/epidemiologia , Envenenamento/etiologia , Solventes/uso terapêutico , Adulto Jovem
7.
J Zoo Wildl Med ; 51(2): 407-415, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32549572

RESUMO

Over a period of 5 mo, seven out of eight American white pelicans (Pelecanus erythrorhynchos) housed on a spring-fed pond at a zoo died or were euthanized. Clinical signs included inability to stand, anorexia, and weight loss. Clinicopathologic findings included heterophilic leukocytosis and elevated creatine kinase and aspartate aminotransferase. Histopathologic findings on all pelicans demonstrated severe, chronic, diffuse rhabdomyofiber degeneration and necrosis, making vitamin E deficiency a differential diagnosis despite routine supplementation. Based on tissue and pond water assays for the cyanobacterial toxin, microcystin, toxicosis is suspected as the inciting cause of death in these cases. We hypothesize that vitamin E exhaustion and resultant rhabdomyodegeneration and cardiomyopathy were sequelae to this toxicosis.


Assuntos
Doenças das Aves/diagnóstico , Aves , Microcistinas/envenenamento , Necrose/veterinária , Envenenamento/mortalidade , Envenenamento/veterinária , Alabama/epidemiologia , Animais , Doenças das Aves/microbiologia , Doenças das Aves/mortalidade , Diagnóstico Diferencial , Feminino , Masculino , Necrose/diagnóstico , Necrose/microbiologia , Necrose/mortalidade , Envenenamento/complicações , Envenenamento/diagnóstico
8.
Rev Bras Epidemiol ; 23: e200024, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32401920

RESUMO

BACKGROUND: Pesticide poisoning causes high morbidity and mortality. Surveillance is required for post-marketing monitoring of these products. AIM: To assess poisonings and associated factors with lethality by pesticides. METHOD: This is a case-control study based on the cases of pesticide poisoning assisted in 2017 by Brazilian Poison Control Centers. Patients who died were the cases and the survivors, the control. The odds ratio (OR) of death and 95% confidence interval (CI) were calculated. From the regression model, a predictive model of death was developed, stratified by age, gender and occupational context to investigate the risk of agricultural workers poisoned by extremely hazardous agents. RESULTS: 3,826 patients poisoned by pesticides were identified, of which 146 died. Older people (OR = 4.94; 95%CI 2.49 - 9.80), males (OR = 1.68; 95%CI 1.15 - 2.46), agricultural workers (OR = 2.20; 95%CI 1.15 - 4.24), suicide attempts (OR = 13.27; 95%CI 6.48 - 27.19) and exposure to extremely hazardous products (OR = 2.77; 95%CI 1.84 - 4.16) odds of death from pesticide poisoning. CONCLUSION: Out of 100 pesticides poisoning, four died. Elderly, males, working in the agricultural sector, suicide attempts and extremely hazardous products had a higher risk of death.


Assuntos
Praguicidas/envenenamento , Envenenamento/mortalidade , Adolescente , Adulto , Distribuição por Idade , Fatores Etários , Doenças dos Trabalhadores Agrícolas/mortalidade , Brasil/epidemiologia , Estudos de Casos e Controles , Criança , Pré-Escolar , Fazendeiros/estatística & dados numéricos , Feminino , Humanos , Lactente , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Exposição Ocupacional/efeitos adversos , Exposição Ocupacional/estatística & dados numéricos , Fatores de Risco , Distribuição por Sexo , Fatores Sexuais , Tentativa de Suicídio/estatística & dados numéricos , Adulto Jovem
9.
Rev Bras Epidemiol ; 23: e200016, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32159627

RESUMO

INTRODUCTION: In Brazil, drugs are the main causative agents of poisonings, and children under age five are the group with the highest number of cases. The objective of the present study was to describe hospitalizations due to drug poisoning in this population regarding demographics, deaths and worsening indicators in hospitalizations. METHODS: The frequency of hospitalizations for drug poisoning between 2003 and 2012 was verified using data from the Hospital Information System. The study variables were year, gender, age, place of residence and hospitalization, patient follow-up, main diagnosis, secondary diagnosis, nature of the health establishment and amount related to Intensive Care Unit expenses. RESULTS: There were 17,725 hospitalizations due to drug poisoning in children under five, predominantly two-year-old male children. The hospitalizations outside the city of residence occurred in 25% of the cases, with predominance in the Northeastern region. The proportion of deaths in hospitalizations was 0.4%, with a higher number of deaths in the Southeastern region. CONCLUSION: Despite the decrease in the number of hospitalizations in the period, regional disparities remained, which could be attenuated with the provision of specialized attention to drug poisonings in municipalities, expanding the access to a more complex care.


Assuntos
Tratamento Farmacológico/mortalidade , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/mortalidade , Hospitalização/estatística & dados numéricos , Preparações Farmacêuticas/administração & dosagem , Envenenamento/mortalidade , Distribuição por Idade , Brasil/epidemiologia , Pré-Escolar , Feminino , Sistemas de Informação Hospitalar/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Masculino , Envenenamento/etiologia , Distribuição por Sexo
10.
J Toxicol Sci ; 45(3): 163-175, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32147639

RESUMO

The benefits and adverse effects of immunosuppressive drugs (ISDs) in patients with paraquat (PQ) poisoning have not been thoroughly assessed. This meta-analysis study aims to evaluate the effect of ISDs in patients with moderate to severe PQ poisoning. We searched PubMed, Embase, Cochrane Library, Ovid Medline, CNKI and Wanfang Data from inception to January 2019. The Mantel-Haenszel method with a random-effects model was used to calculate the pooled relative risks (RRs) and 95% Confidence Intervals (CIs) as described by DerSimonian and Laird. An L'Abbé plot was drawn to explore the relationship between the degree of poisoning and mortality. Four randomized controlled trials, two prospective and seven retrospective studies were identified. ISDs were significantly associated with reduced mortality (RR 0.76; 95% CI, 0.58-0.99) and the incidence rate of multiple-organ dysfunction syndrome (MODS) (RR 0.63; 95% CI, 0.48-0.83) in patients with moderate to severe PQ poisoning. They were not associated with an increased incidence rate of hepatitis and reduced incidence rate of acute renal failure and hypoxia. The L'Abbé plot results showed a slight increase in mortality rate in the ISD group with increased mortality in the placebo group. This indicates a possible advantage of ISDs in most of the patients with severe PQ poisoning. These findings suggest that ISDs may reduce the mortality and incidence rate of MODS in moderate to severe PQ poisoning patients, and severe PQ poisoning patients might benefit more from ISDs.


Assuntos
Imunossupressores/administração & dosagem , Paraquat/envenenamento , Envenenamento/tratamento farmacológico , Envenenamento/mortalidade , Humanos , Mortalidade , Insuficiência de Múltiplos Órgãos/induzido quimicamente , Insuficiência de Múltiplos Órgãos/prevenção & controle , Índice de Gravidade de Doença
11.
Cien Saude Colet ; 25(2): 761-772, 2020 Feb.
Artigo em Português | MEDLINE | ID: mdl-32022215

RESUMO

Many studies analyze the epidemiological profile of deaths caused by a single toxic agent. However, broader mortality analyses can be obtained by evaluating multiple agents over the same period of time. For this purpose, a retrospective descriptive study was carried out of the deaths by intoxication registered in the Mortality Information System that occurred in Brazil from 2010 to 2015. Deaths were selected according to ICD-10 codes related to intoxication. There were 18,247 deaths and an increase of 3% of rates of mortality by intoxication during the period. The agents that caused the most deaths were pesticides (24%) followed by medication (23%) and street drugs (22%). With the exception of medication, where the female participation was 52%, there was a higher concentration of males for all agents and in most of the age groups. Only in the case of medication and pesticides was suicide the main circumstance of deaths. The results presented made it possible to define a mortality profile for each of the major toxic agents studied.


Assuntos
Sistemas de Informação/estatística & dados numéricos , Mortalidade/tendências , Envenenamento/epidemiologia , Suicídio/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Causas de Morte/tendências , Criança , Pré-Escolar , Feminino , Humanos , Drogas Ilícitas/envenenamento , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Praguicidas/envenenamento , Envenenamento/mortalidade , Estudos Retrospectivos , Distribuição por Sexo , Adulto Jovem
12.
Medicine (Baltimore) ; 99(6): e19063, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32028427

RESUMO

BACKGROUND: Severity index and plasma paraquat (PQ) concentration can predict the prognosis of patients with PQ poisoning. However, the better parameter is yet to be systematically investigated and determined. Thus, we conduct this systematic review and meta-analysis to investigate the prognostic value of severity index and plasma PQ concentration in patients with PQ poisoning. METHODS: We searched PubMed, Embase, Web of Science, ScienceDirect, and Cochrane Library to identify all relevant papers that were published up to March 2019. All diagnostic studies that compared severity index and plasma PQ concentration to predict mortality in patients with PQ poisoning were enrolled in this meta-analysis. Odds ratios (ORs) with 95% confidence intervals (CIs) for individual trials were pooled using a random-effect model. We also aggregated heterogeneity testing, sensitivity analysis, and publication bias analysis. RESULTS: Ultimately, seven studies involving 821 patients were included. The pooled OR with a 95% CI of severity index was 24.12 (95% CI: 9.34-62.34, P < .001), with an area under the curve of 0.88 (95% CI: 0.85-0.90), sensitivity of 0.84 (95% CI: 0.74-0.91), and specificity of 0.81 (95% CI: 0.75-0.87). Meanwhile, the pooled OR with 95% CI of plasma PQ concentration was 34.39 (95% CI: 14.69-80.56, P < .001), with an area under the curve of 0.94 (95% CI: 0.91-0.96), sensitivity of 0.86 (95% CI: 0.75-0.93), and specificity of 0.89 (95% CI: 0.76-0.95). Sensitivity analysis demonstrated the stability of the results of our meta-analysis. No significant publication bias was observed in this meta-analysis. CONCLUSION: Overall, this study indicated that severity index and plasma PQ concentration have relatively high-prognostic value in patients with PQ poisoning, and that the sensitivity and specificity of plasma PQ concentration are superior to those of severity index.


Assuntos
Paraquat/envenenamento , Envenenamento/mortalidade , Humanos , Paraquat/sangue , Envenenamento/sangue , Valor Preditivo dos Testes , Índice de Gravidade de Doença
13.
Ciênc. Saúde Colet ; 25(2): 761-772, Feb. 2020. tab, graf
Artigo em Português | LILACS | ID: biblio-1055834

RESUMO

Resumo Muitos estudos analisam o perfil epidemiológico dos óbitos causados por um único agente tóxico. No entanto, análises mais amplas da mortalidade podem ser obtidas avaliando múltiplos agentes em um mesmo período de tempo. Com esse objetivo, foi realizado um estudo descritivo retrospectivo dos óbitos decorrentes de intoxicações ocorridos de 2010 a 2015 no Brasil, registrados pelo SIM. Os óbitos foram selecionados de acordo com os códigos da CID-10 relacionados a intoxicações. Foram registrados pelo SIM, no período do estudo, 18.247 óbitos decorrentes de intoxicação, resultando em crescimento de 3% no coeficiente de mortalidade. Os agentes que mais causaram óbitos foram os agrotóxicos (24%) seguidos dos medicamentos (23%) e das drogas de abuso (22%). Com exceção dos medicamentos, em que a participação do sexo feminino foi de 52%, verificou-se maior concentração do sexo masculino para todos os agentes e na maioria das faixas etárias. Somente para os medicamentos e agrotóxicos, o suicídio foi a principal circunstância dos óbitos. Os resultados apresentados foram capazes de delinear um perfil de mortalidade para cada um dos principais agentes tóxicos estudados.


Abstract Many studies analyze the epidemiological profile of deaths caused by a single toxic agent. However, broader mortality analyses can be obtained by evaluating multiple agents over the same period of time. For this purpose, a retrospective descriptive study was carried out of the deaths by intoxication registered in the Mortality Information System that occurred in Brazil from 2010 to 2015. Deaths were selected according to ICD-10 codes related to intoxication. There were 18,247 deaths and an increase of 3% of rates of mortality by intoxication during the period. The agents that caused the most deaths were pesticides (24%) followed by medication (23%) and street drugs (22%). With the exception of medication, where the female participation was 52%, there was a higher concentration of males for all agents and in most of the age groups. Only in the case of medication and pesticides was suicide the main circumstance of deaths. The results presented made it possible to define a mortality profile for each of the major toxic agents studied.


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Envenenamento/epidemiologia , Suicídio/estatística & dados numéricos , Sistemas de Informação/estatística & dados numéricos , Mortalidade/tendências , Praguicidas/envenenamento , Envenenamento/mortalidade , Brasil/epidemiologia , Drogas Ilícitas/envenenamento , Estudos Retrospectivos , Causas de Morte/tendências , Distribuição por Sexo , Pessoa de Meia-Idade
14.
Am J Forensic Med Pathol ; 41(1): 18-26, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32000223

RESUMO

The suicide rate in the United States has been increasing steadily over the previous 10 years. In DC, these results are not mirrored. The suicide rate has a tendency to be lower than the rest of the country. During this retrospective review of suicides in DC, factors such as medical history and toxicology results were examined.In this study performed over 8 years (2009-2016), 394 suicides occurred. It was found that decedents committed suicide mostly by hanging (31.2%), firearms (20.3%), or drug intoxication (15.7%). The average age was 44.5 years. Similar to national statistics, male individuals committed suicide at a higher rate (77.9%) than did female individuals (22.1%). The toxicology data showed that ethanol (26.4%), antidepressants (20.1%), opioids (14.9%), and benzodiazepines (12.9%) were the drugs most frequently involved, although the finding of no drugs was most common (33.7%). Ethanol was present in 5 methods of suicide that include death by hanging, drowning, firearm, suffocation, and poisoning.This research provides information that may be useful for public health officials when confronting the issue of suicide. It is hoped that it will encourage other medical examiner offices to perform toxicological analysis and autopsy of all suicide cases.


Assuntos
Suicídio Consumado/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Asfixia/mortalidade , Depressores do Sistema Nervoso Central/análise , Criança , Grupos de Populações Continentais/estatística & dados numéricos , District of Columbia/epidemiologia , Afogamento/mortalidade , Etanol/análise , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Lesões do Pescoço/mortalidade , Preparações Farmacêuticas/análise , Envenenamento/mortalidade , Estudos Retrospectivos , Distribuição por Sexo , Ferimentos por Arma de Fogo/mortalidade , Adulto Jovem
15.
Int J Occup Med Environ Health ; 33(1): 77-90, 2020 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-31942869

RESUMO

OBJECTIVES: The aim of the research was to analyze the nature of changes and tendencies observed in the frequency, circumstances and causes of acute intentional poisonings within the agglomeration of Lódz, Poland. The study related to adults. MATERIAL AND METHODS: As the research material, medical records of patients hospitalized due to an acute poisoning in the Department of Toxicology in Lódz were used. Information on the hospitalized patients was gathered in the database created in accordance with the assumed criteria and an approved system of the collection of variables describing the issues of intentional acute poisonings. RESULTS: In the analyzed period, within the group of 18 918 adult patients hospitalized due to an acute poisoning, male patients prevailed, accounting for 57.17% of the whole group. Intentional poisonings constituted 40.19% of all poisonings, with women dominating within that group of patients - accounting for approximately 58.63%. The largest group was formed by young people, 18-35 years old, accounting for 43.22%. The average age of the intentionally poisoned patients showed an upward tendency; this tendency concerned women to a larger extent. Medications played the most powerful role in acute intentional poisonings. Within the whole population, they were responsible for 97.27% of intoxications. The analysis of the dynamics of changes in the percentage of patients referred for further mental treatment revealed that the number of patients continuing hospital treatment in psychiatric wards tended to grow. CONCLUSIONS: Observations indicating that women are more likely to attempt intentional poisoning, and that the number of patients with psychiatric disturbances tended to grow in the analyzed period, demonstrate an urgent need for preventive measures to be taken in the local communities. Int J Occup Med Environ Health. 2020;33(1):77-90.


Assuntos
Envenenamento/epidemiologia , Suicídio/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Adulto , Fatores Etários , Idoso , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Preparações Farmacêuticas , Envenenamento/mortalidade , Envenenamento/psicologia , Polônia/epidemiologia , Estudos Retrospectivos , Fatores Sexuais , Tentativa de Suicídio/psicologia , Tentativa de Suicídio/estatística & dados numéricos
17.
Drug Alcohol Depend ; 206: 107722, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31734034

RESUMO

BACKGROUND: Alcohol may cause death directly by acute poisoning, as well as induce illnesses or accidents that lead to death. Our research question was whether the current decreasing trend in acute fatal alcohol poisonings in Finland is a real phenomenon or an artefact caused by possible changes in the process of determining the cause of death. METHODS: All cases in the national post-mortem toxicology database in which the underlying cause of death was acute alcohol poisoning in 1987-2018 were investigated in terms of blood alcohol concentration (BAC), age and gender. The number of acute alcohol poisonings was compared to the number of deaths from alcohol induced illness in the post-mortem toxicology database. RESULTS: A total of 12 126 acute alcohol poisoning cases were retrieved. Between 2004 and 2017 the number of acute alcohol poisonings decreased 60.1 %. At the same time the number of alcohol induced illnesses in the study material remained stable or decreased marginally. The median BAC in all acute alcohol poisonings was 3.2 g/kg. The annual median BAC values showed a small but significant decrease over the study period. The proportion of women in acute alcohol poisonings increased significantly over the study period, from 17.1%-22.3%. Women were on average 2.5 years older than men. CONCLUSIONS: On grounds of the BAC statistics and supporting evidence, we conclude that the significant decrease in the number of fatal alcohol poisonings is true and likely reflects changes in the overall consumption of alcohol.


Assuntos
Intoxicação Alcoólica/mortalidade , Concentração Alcoólica no Sangue , Etanol/envenenamento , Envenenamento/mortalidade , Adulto , Intoxicação Alcoólica/sangue , Autopsia , Bases de Dados Factuais , Etanol/sangue , Feminino , Finlândia/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Envenenamento/sangue , Adulto Jovem
18.
Clin Toxicol (Phila) ; 58(4): 241-253, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31298045

RESUMO

Context: The influence of co-morbid conditions on the outcome of acute methanol poisoning in mass poisoning outbreaks is not known.Objective: The objective of this is to study the impact of burden of co-morbidities, complications, and methanol-induced brain lesions on hospital, follow-up, and total mortality.Methods: All patients hospitalized with methanol poisoning during a mass poisoning outbreak were followed in a prospective cohort study until death or final follow-up after 6 years. The age-adjusted Charlson co-morbidity index (ACCI) score was calculated for each patient. A multivariate Cox regression model was used to calculate the adjusted hazards ratio (HR) for death. The survival was modeled using the Kaplan-Meier method.Results: Of 108 patients (mean age with SD 50.9 ± 2.6 years), 24 (54.4 ± 5.9 years) died during hospitalization (mean survival with SD 8 ± 4 days) and 84 (49.9 ± 3.0 years; p = .159) were discharged, including 27 with methanol-induced brain lesions. Of the discharged patients, 15 (56.3 ± 6.8 years) died during the follow-up (mean survival 37 ± 11 months) and 69 (48.5 ± 3.3 years; p = .044) survived. The hospital mortality was 22%, the follow-up mortality was 18%; the total mortality was 36%. Cardiac/respiratory arrest, acute respiratory failure, multiorgan failure syndrome, and arterial hypotension increased the HR for hospital and total (but not follow-up) mortality after adjustment for age, sex, and arterial pH (all p < .05). All patients who died in the hospital had at least one complication. A higher ACCI score was associated with greater total mortality (HR 1.22; 1.00-1.48 95% CI; p = .046). Of those who died, 35 (90%) had a moderate-to-high ACCI. The Kaplan-Meier curve demonstrated that patients with a high ACCI had greater follow-up mortality compared to ones with low (p = .027) or moderate (p = .020) scores. For the patients who died during follow-up, cancers of different localizations were responsible for 7/15 (47%) of the deaths.Conclusions: The character and number of complications affected hospital but not follow-up mortality, while the burden of co-morbidities affected follow-up mortality. Methanol-induced brain lesions did not affect follow-up mortality. Relatively high cancer mortality rate may be associated with acute exposure to metabolic formaldehyde produced by methanol oxidation.


Assuntos
Formaldeído/envenenamento , Mortalidade Hospitalar , Hospitalização/estatística & dados numéricos , Metanol/envenenamento , Envenenamento/mortalidade , Adolescente , Adulto , Estudos de Coortes , Surtos de Doenças/estatística & dados numéricos , Feminino , Seguimentos , Formaldeído/metabolismo , Humanos , Estudos Longitudinais , Masculino , Metanol/farmacocinética , Pessoa de Meia-Idade , Envenenamento/epidemiologia , Estudos Prospectivos , Fatores de Risco , Taxa de Sobrevida , Adulto Jovem
19.
Biomed Res Int ; 2020: 8894180, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33490262

RESUMO

Background: Paraquat is a widely used nonselective and fast-acting contact herbicide worldwide. This study identified the early predictor of mortality in patients with acute paraquat poisoning. Methods: Twenty-nine patients with acute paraquat poisoning admitted at Nanjing Drum Tower Hospital from January 2018 to August 2020 were included in this study. The early predictor of mortality in patients with acute paraquat poisoning based on the blood tests was identified by correlation, logistic regression, and receiver operating characteristic (ROC) analyses. Result: 15 of the 29 patients died after poisoning. Compared to the survivors, the neutrophilic granulocyte ratio, leukocyte count, ALB, and Crea of the nonsurvivors were significantly higher with p value < 0.05, while the lymphocyte ratio and eGFR(MDRD) of the nonsurvivors were remarkably lower with p value < 0.01. Moreover, the neutrophil-to-lymphocyte ratio (NLR) was remarkably upregulated in the nonsurvivors. The area under the ROC curve (AUC) of the neutrophilic granulocyte ratio, lymphocyte ratio, leukocyte count, ALB, Crea, eGFR(MDRD), and NLR to predict the mortality in patients with acute paraquat poisoning was 0.8905 (95% CI: 0.7589-1.022), 0.8643 (95% CI: 0.7244-1.004), 0.8500 (95% CI: 0.7133-0.9867), 0.7286 (95% CI: 0.5338-0.9233), 0.8167 (95% CI: 0.6620-0.9713), 0.8714 (95% CI: 0.7330-1.010), and 0.8667 (95% CI: 0.7277-1.006), respectively. More interestingly, we also evaluated the diagnostic values of the different combinations of six blood test biomarkers by logistic regression analysis. According to the results of the logistic regression analysis, the AUCs for the combination of the neutrophilic granulocyte ratio, leukocyte count, and eGFR(MDRD) were the largest with 0.986 (95% CI: 0.952-1), and the sensitivity and specificity were 100% and 100%. Conclusion: This study demonstrated that the combination of the neutrophilic granulocyte ratio, leukocyte count, and eGFR(MDRD) could serve as an ideal early predictor of mortality in patients with acute paraquat poisoning. However, further research is needed to draw a clear conclusion.


Assuntos
Paraquat/envenenamento , Envenenamento/mortalidade , Adulto , Idoso , Área Sob a Curva , Biomarcadores , China , Feminino , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Paraquat/sangue , Envenenamento/diagnóstico , Envenenamento/epidemiologia , Prognóstico
20.
Rev. bras. epidemiol ; 23: e200024, 2020. tab, graf
Artigo em Português | LILACS | ID: biblio-1101598

RESUMO

Resumo: Introdução: As intoxicações por agrotóxicos causam elevada morbimortalidade. A vigilância é necessária da produção até o uso desses produtos. Objetivo: Analisar as intoxicações e os fatores associados à letalidade por agrotóxicos. Método: Trata-se de estudo caso controle baseado nos atendimentos de intoxicação por agrotóxicos realizados em 2017 por centros de informação e assistência toxicológica do Brasil. Pacientes que evoluíram a óbito compuseram o grupo caso, e os sobreviventes, o grupo controle. Calculou-se odds ratio (OR) dos fatores de risco para óbito, com intervalo de confiança (IC) de 95%. Com base no modelo de regressão, desenvolveu-se um modelo preditivo de morte, estratificado por faixa etária, sexo e contexto ocupacional, para investigação do risco dos trabalhadores agropecuários intoxicados por agentes extremamente tóxicos. Resultados: Identificaram-se 3.826 pacientes intoxicados por agrotóxicos, dos quais 146 evoluíram para óbito. Idosos (OR = 4,94; IC95% 2,49 - 9,80), homens (OR = 1,68; IC95% 1,15 - 2,46), trabalhadores do setor agropecuário (OR = 2,20; IC95% 1,15 - 4,24), tentativas de suicídio (OR = 13,27; IC95% 6,48 - 27,19) e exposição a produtos extremamente tóxicos (OR = 2,77; IC95% 1,84 - 4,16) apresentaram mais chances de óbito nas intoxicações por agrotóxicos. Conclusão: Em cada 100 intoxicações por agrotóxicos, quatro evoluíram para óbito. Idosos, homens, trabalho no setor agropecuário, tentativas de suicídio e produtos extremamente tóxicos apresentaram mais chances de óbito.


ABSTRACT: Background: Pesticide poisoning causes high morbidity and mortality. Surveillance is required for post-marketing monitoring of these products. Aim: To assess poisonings and associated factors with lethality by pesticides. Method: This is a case-control study based on the cases of pesticide poisoning assisted in 2017 by Brazilian Poison Control Centers. Patients who died were the cases and the survivors, the control. The odds ratio (OR) of death and 95% confidence interval (CI) were calculated. From the regression model, a predictive model of death was developed, stratified by age, gender and occupational context to investigate the risk of agricultural workers poisoned by extremely hazardous agents. Results: 3,826 patients poisoned by pesticides were identified, of which 146 died. Older people (OR = 4.94; 95%CI 2.49 - 9.80), males (OR = 1.68; 95%CI 1.15 - 2.46), agricultural workers (OR = 2.20; 95%CI 1.15 - 4.24), suicide attempts (OR = 13.27; 95%CI 6.48 - 27.19) and exposure to extremely hazardous products (OR = 2.77; 95%CI 1.84 - 4.16) odds of death from pesticide poisoning. Conclusion: Out of 100 pesticides poisoning, four died. Elderly, males, working in the agricultural sector, suicide attempts and extremely hazardous products had a higher risk of death.


Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Adulto Jovem , Praguicidas/envenenamento , Envenenamento/mortalidade , Tentativa de Suicídio/estatística & dados numéricos , Brasil/epidemiologia , Estudos de Casos e Controles , Modelos Logísticos , Fatores Sexuais , Fatores de Risco , Exposição Ocupacional/efeitos adversos , Exposição Ocupacional/estatística & dados numéricos , Fatores Etários , Distribuição por Sexo , Distribuição por Idade , Doenças dos Trabalhadores Agrícolas/mortalidade , Fazendeiros/estatística & dados numéricos , Pessoa de Meia-Idade
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