Abordagem inicial no atendimento ambulatorial em distúrbios neurotoxicológicos. Parte I - metais / Initial approach to outpatient treatment of neurotoxicological disorders. Part I – metals

Introdução: A toxicologia é uma ciência que envolve inúmeros sistemas necessitando de uma equipe multiprofissional e interdisciplinar. A indistinção clínica entre as doenças ocupacionais e não ocupacionais dificulta o seu diagnóstico. Nesse contexto, a neurotoxicologia ocupacional e ambiental estuda os distúrbios do sistema nervoso central (SNC) e periférico (SNP) decorrente da intoxicação dos mais variados agentes. Método: Trata-se de revisão atualizada da literatura a partir de pesquisa na base de dados MEDLINE e LILACS. Também utilizou-se livros e documentos publicados em formato eletrônico. Resultados e Discussão: Distúrbios neuromusculares, distúrbios do movimento, doença do neurônio motor, alterações cognitivocomportamentais e neurofisiológicas têm sido relacionados a inúmeros agentes tóxicos nos últimos anos. A proposta deste artigo é revisar os principais distúrbios neurológicos associados à exposição crônica por metais. A fim de facilitar a abordagem inicial no atendimento ambulatorial aos distúrbios neurotoxicológicos foram confeccionadas tabelas descrevendo os principais agentes tóxicos, as fontes de exposição envolvidas e suasprincipais manifestações neurológicas. Conclusão: Arsênio, chumbo, mercúrio, manganês, cádmio e estanho são alguns metais envolvidos nos distúrbios neurotoxicológicos. Contudo, fica evidente nesta revisão que são necessários novos estudos a fim de determinar a real associação destes e outros metais nos distúrbios crônicos do sistema nervoso central e periférico.

Introduction: Toxicology is a science that involves innumerable systems and requires a multiprofessional and interdisciplinary team. The clinical indistinctiveness of occupational and non-occupational disorders makes their diagnosis difficult. In this context, occupational and environmental toxicology studies the disorders of the central nervous system (CNS) and the peripheral nervous system (PNS) resulting from intoxication by a wide variety of agents. Method: The method consists of an updated review of the literature based on research in the MEDLINE and LILACS databases, as well as books and documents published online. Results and Discussion: Neuromuscular disorders, movement disorders, motor neuron disease, cognitive-behavioral and neurophysiological alterations have been attributed to innumerable toxic agents in recent years. This article proposes to review the main neurological disorders associated with chronic exposure to metals. To facilitate the initial approach to outpatient treatment of neurotoxicological disorders, tables were devised to describe the main toxic agents, the sources of exposure involved and their main neurological manifestations. Conclusions: Arsenic, lead, mercury, manganese, cadmium and tin are some of the metals involved in neurotoxicological disorders. However, this review reveals the need for new studies to determine the real association of these and other metals in chronic disorders of the central and peripheral nervous systems.

A survey of chronic renal failure in Jamaica

The prevalence of chronic renal failure (CRF)/end stage renal disease and the accessibility of long term renal replacement therapy in Jamaica were evaluated. The study was conducted at six Jamaican healthcare facilities between July 1998 and December 1999 and included 605 patients with CRF. Men with CRF (57 of patients, mean age of 56.7 years) were significantly older than women (mean age 53.2 years). Hypertension was the most commonly associated medical condition (60.8 of patients) followed by diabetes mellitus (31.4 of patients). The estimated crude point prevalence of CRF in persons 20 years and over at the end of 1999 was 327 per million population. More than one-third of patients with CRF (39) were receiving renal replacement therapy, the most common modality being haemodialysis, and only 1.8 of patients had received kidney transplantation. The prevalence of chronic renal failure was not increased in areas known to have high soil cadmium levels. Chronic renal failure is a significant public health problem in Jamaica and is placing an increasing financial burden on the healthcare sector