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INTRODUCTION: The increase in the production of substances to enhance the quality of life, the biodiversity of the different ecosystems in Mexico, and the unique characteristics of pediatric patients, contribute to intoxications within this population. METHOD: Analytical retrospective study of admissions to pediatric emergency care due to poisoning in < 16-year-old (2016 to 2020). Included variables were age, gender, type of toxic substance, exposure characteristics, and the season of the year. Frequencies, percentages, range, average and standard deviation were obteined. In the bivariate análisis, the Chi square test was used. A p-value < 0.05 was considered statistically significant. RESULTS: Over 5 years, there were 459 cases, with a prevalence of 3.16%. No gender predominance was observed. The most common was caused by venomous animals (28.5%), followed by medication ingestion (27.6%). Only 5% of cases were suicide attempts, the rest were accidental (95%). Children up to 5 years old were more commonly by medication ingestion, hydrocarbons, or household products (p = 0.03, p = 0.0001), while the causes in older children were contact with venomous animals and ingestion of stimulants drugs (alcohol, amphetamines, cannabis, cocaine) (p = 0.0001, p = 0.006). Intoxication with quaternary ammonium herbicides was lethal in all cases. CONCLUSIONS: Children under the age of 5 are more susceptible to intoxication from common household products. Older kids tend to be more frequently a combination of stimulants drugs.

INTRODUCCIÓN: El aumento en la producción de sustancias para mejorar la calidad de vida, la biodiversidad de los diferentes ecosistemas en México, así como las características propias de los pacientes pediátricos, contribuyen a la intoxicación dentro de esta población. MÉTODO: Estudio retrospectivo analítico de los ingresos por envenenamiento en niños menores de 16 años en urgencias pediátricas (2016 a 2020). Se analizaron la edad, el sexo, el tipo de xenobiótico, las características de exposición y la estación del año. Se obtuvieron frecuencias, porcentajes, rango, promedio y desviación estándar. En el análisis bivariado se utilizó la prueba chi al cuadrado, considerando estadísticamente significativo un valor p < 0.05. RESULTADOS: En el periodo de 5 años se atendieron 459 casos, con una prevalencia del 3.16%. No se observó predominio de sexo. La intoxicación más frecuente fue por animales venenosos (28.5%), seguida de la ingesta de medicamentos (27.6%). El 95% de los casos fueron accidentales y el 5% por intento de suicidio. En los menores de 5 años, lo más frecuente fue la ingesta de medicamentos, hidrocarburos o productos de uso doméstico (p = 0.03, p = 0.0001), mientras que en los mayores de 6 años fue por contacto con animales venenosos e ingesta de drogas estimulantes (alcohol, anfetaminas, cannabis, cocaína) (p = 0.0001, p = 0.006). El 100% de los intoxicados por herbicida cuaternario de amonio fallecieron. CONCLUSIONES: Los menores de 5 años son más propensos a la intoxicación con productos que se utilizan en sus propios domicilios. En los mayores de 6 años es más frecuente la combinación de drogas estimulantes.

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INTRODUCTION: Ethion is an organophosphate used as an acaricide and insecticide, that is restricted worldwide. In Colombia, pesticide poisoning is the third most common cause of chemical intoxication. On 9 October 2022, an outbreak of ethion poisoning occurred in Pereira. The aim of this study was to describe the clinical and epidemiological characteristics of the outbreak. METHODS: This is a descriptive study of an outbreak of organophosphate poisoning. The onset of symptoms occurred on 9 October 2022, following the consumption of empanadas. Information was collected on sociodemographic characteristics and clinical manifestations, as well as from paraclinical examinations. Data were obtained from clinical histories, field epidemiological investigations, and inspection visits. Food samples were collected for analysis by gas chromatography-mass spectrometry. Attack rates, proportions, and measures of central tendency, dispersion, and position were calculated. RESULTS: The case definition was met by 37 individuals with a median age of 30 years; all presented with muscarinic symptoms, 29 patients presented with nicotinic symptoms, and 20 patients presented with neurological symptoms. Males were the most affected (57%), and the most common time of symptom onset was 10:00 am. Twenty-three patients (62%) required intensive care unit admission, of whom 14 (38%) required mechanical ventilation. No deaths were reported. Erythrocyte acetylcholinesterase activity was reduced in all patients. Ethion was detected in mass-prepared maize and empanadas at concentrations greater than 0.1 mg/kg. The consumption of empanadas was identified as the common source. DISCUSSION: In Colombia, pesticide poisonings are the third most common type of poisoning caused by chemical substances reported to the National Health Institute through the National Public Health Surveillance System. In the present outbreak, ethion was in empanadas, likely due to contamination of cooking oil. CONCLUSIONS: We describe a large ethion-contaminated food poisoning outbreak reported in Colombia. The main symptoms were muscarinic, and the main treatment measures employed were atropine and respiratory support. Increased awareness of pesticide poisoning and training for food handlers are needed.

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Many cooked foods are prepared with spices and dried herbs; these can be contaminated by several types of microorganisms, including aerobic spore-forming bacteria. The Bacillus cereus group is very widespread in nature and is known among the common food contaminants. They are involved in food poisoning, causing two types of syndromes, diarrheal and emetic. The aims of the present work were to determine the prevalence of toxigenic Bacillus cereus spores in spices and herbs marketed in the Laghouat area and to identify their toxigenic genes via PCR. Among the 191 samples, 14.13% were determined to be B. cereus, with concentrations ranging from 2.52 to 5.82 log cfu/g, where the highest level of contamination was observed in allspice and ginger. Moreover, entFM (100%), nhe (88.23%) and cytK (70.58%) were the most frequently identified toxin genes, whereas hbl (23.52%) was less common, and no emetic toxin-encoding gene (cesB) was found in any of the samples. Considering the results of the present study, the B. cereus microbial load and toxin gene profiles of spices show that spices have potential for public health in Algeria. In this context, it is crucial to guarantee the microbiological safety of spices by respecting good hygiene practices, eliminating bacterial spores and toxin production via sterilization and using appropriate packaging for these products.

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Selenium is an essential micronutrient for ruminants, which participates in the optimal functioning of proteins and enzymes that can combat oxidative stress in the body; however, its toxicity is documented in different species. The objective of this work was to describe macroscopic and microscopic lesions in lambs intoxicated with selenium administered through intraruminal boluses. The main lesions at necropsy were pulmonary oedema; the myocardial surface presented multifocal pale areas; the thyroid and thymus glands were decreased in size, and areas of necrosis, haemorrhage and hyperkeratosis were observed in the reticulum and rumen. At the microscopic level, congestion, haemorrhage, oedema and hyaline membranes were observed in the lung; hepatic congestion, haemorrhage, degeneration and necrosis; degeneration and necrosis of the reticulum mucosa, as well as areas of hyperplasia and hyperkeratosis; myocardial degeneration, necrosis and fibrosis; congestion, haemorrhage, degeneration and renal tubular necrosis; thyroid follicular atrophy and thymic cortical atrophy. This study evidenced the main lesions related to selenium poisoning in lambs supplemented with the mineral through intraruminal boluses.

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Staphylococcus aureus stands out as one of the most virulent pathogens in the genus Staphylococcus. This characteristic is due to its ability to produce a wide variety of staphylococcal enterotoxins (SEs) and exotoxins, which in turn can cause staphylococcal food poisoning (SFP), clinical syndromes such as skin infections, inflammation, pneumonia, and sepsis, in addition to being associated with the development of inflammation in the mammary glands of dairy cattle, which results in chronic mastitis and cell necrosis. SEs are small globular proteins that combine superantigenic and emetic activities; they are resistant to heat, low temperatures, and proteolytic enzymes and are tolerant to a wide pH range. More than 24 SE genes have been well described (SEA-SEE, SEG, SEH, SEI, SEJ, SElK, SElL, SElM, SElN, SElO, SElP, SElQ, SElR, SElS, SElT, SElU, SElV, SElW, SElX, SElY, and SElZ), being a part of different SFP outbreaks, clinical cases, and isolated animal strains. In recent years, new genes (sel26, sel27, sel28, sel31, sel32, and sel33) from SEs have been described, as well as two variants (seh-2p and ses-3p) resulting in a total of thirty-three genes from Ses, including the nine variants that are still in the process of genetic and molecular structure evaluation. SEs are encoded by genes that are located in mobile genetic elements, such as plasmids, prophages, pathogenicity islands, and the enterotoxin gene cluster (egc), and housed in the genomic island of S. aureus. Both classical SEs and SE-like toxins (SEls) share phylogenetic relationships, structure, function, and sequence homology, which are characteristics for the production of new SEs through recombination processes. Due to the epidemiological importance of SEs, their rapid assessment and detection have been crucial for food security and public health; for this reason, different methods of identification of SEs have been developed, such as liquid chromatography coupled with high-resolution mass spectrometry (LC-HRMS), molecular methods, and whole-genome sequencing; providing the diagnosis of SEs and a better understanding of the occurrence, spread, and eradication of SEs. This review provides scientific information on the enterotoxins produced by S. aureus, such as structural characteristics, genetic organization, regulatory mechanisms, superantigen activity, mechanisms of action used by SEs at the time of interaction with the immune system, methods of detection of SEs, and recent biocontrol techniques used in food.

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In Brazil, ethnic-racial inequalities exist in all fields, obstructing access to goods, services, and opportunities, including healthcare services. However, there are no apparent studies that assess, at a national level, ethnic-racial disparities in poisoning cases, emphasizing skin color as a determining factor. The study aimed to examine the relationship between race/ethnicity and general poisoning cases, by medications, pesticides, and drug of abuse in Brazilian states. Poisoning cases data were extracted for the years 2017, 2018, and 2019. Notification data for general poisoning cases and toxic agents were collected: medications, pesticides, and drugs of abuse. Data were categorized between whites and non-whites (blacks, browns, and indigenous) and without information on skin color/ethnicity. Rates of poisonings amongst ethnic-racial groups and cases of not declared skin color as well as relative risk (RR) of poisoning among non-whites were calculated. All states in the North, Northeast (states with the worst Human Development Index), Midwest, and 2 states in the Southeast exhibited higher rates of poisoning cases per 100,000 inhabitants among non-whites. The RR values for nonwhite individuals were higher in the North and Northeast regions for all types of poisonings. The type of poisoning cases that presented the highest RR for non-whites over the 3 years was drugs of abuse (2-2.44), when compared to other types of poisonings from pesticides (2-2.33) and medications (1.5-1.91). The spatial distribution of poisoning cases rates and RR of nonwhite population support public policies to reduce socioeconomic and environmental inequalities.

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This study focuses on describing the diversity of pesticides, the knowledge and behaviors of their use, and the acute poisoning symptoms (APS) derived from their exposure from two agricultural production systems (papaya-Carica papaya L.- and chili-Capsicum annuum L.-) in Oaxaca, Mexico. Through surveys, sociodemographic information, characteristics of the production system, knowledge and behaviors in the handling of pesticides, and APS perceived by users were captured. Papaya producers are younger, have fewer years of activity, and have larger agricultural areas than chili producers. Insect attacks and diseases are an essential factor for the application of pesticides. Thirty-one active ingredients (Ais) were identified in papaya and thirty-seven in chili, predominantly insecticides and fungicides of toxicological category IV. Approximately 50% of users apply mixtures of different Ais, have little knowledge and inappropriate behavior in their handling, and report up to five acute pesticide poisoning symptoms, mainly burning and irritation of the skin, burning eyes, itchy skin, runny nose, headache, and watery eyes. The production of papaya and chili are relevant activities for generating economic income, but they risk the producer's and their family's health. Both systems are a potential scenario for the manifestation of diseases due to exposure to pesticides in the medium and long term.

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In recent years, suicide rates in Brazil have increased, but little is known about the temporal behavior and characteristics of suicides due to intentional self-poisoning by medicines. The aim of the present study was to provide an overview of sociodemographic characteristics and place of death related to suicide due to intentional self-poisoning by medicines, to evaluate the trend of mortality rates in Brazil between 2003 and 2022, and its relationship with regional and global crises. Ecological time series study with data from the Mortality Information System of the Brazilian Ministry of Health, related to individuals aged 10 years and over, who committed suicides due to intentional drug overdose, in the period from 2003 to 2022. The analyses were performed in the R environment in RStudio. Between 2003 and 2022, there was a predominance of deaths in women (55.5%), individuals aged 30-49 years (47.2%), of White race/color (53.2%), occurring in health facilities (67.0%), using drugs or unspecified substances (40.4%); a higher concentration in the southern region (22.8%) and a positive trend in mortality rates due to intentional drug overdose, especially from 2016 onwards. A rise of 264% was observed in the comparison of 2022 and 2003. A peculiar sociodemographic profile was observed in the victims of intentional self-poisoning by medicines and a positive temporal trend in mortality rates, especially in a period marked by regional and global crises.

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Resumen La utilización de agroquímicos en la agricultura y el aumento de intoxicaciones derivadas de su manejo han llevado a discusiones acerca de su peligrosidad para la salud humana y el ambiente. Objetivo: conocer las causas de intoxicaciones por el uso de agroquímicos y describir propuestas para enfrentar el problema desde la perspectiva de los agricultores rurales, agentes de salud y extensionistas rurales de Cerro Azul (Misiones, Argentina). Metodología: cualitativa de tipo exploratorio-descriptiva, se realizaron 14 entrevistas a los diferentes actores las cuales fueron transcriptas y analizadas con el apoyo del software Atlas ti. Resultados: se encontró que las causas de intoxicación identificadas por los actores fueron: no utilizar vestimenta protectora, no seguir medidas de bioseguridad apropiadas, no poseer los medios de protección, falta de conciencia de la peligrosidad de los agroquímicos, y falta del cumplimiento de la ley relativa al uso de agroquímicos tanto por parte de agricultores como de vendedores de insumos, como propuestas para enfrentar el problema se plantearon: tomar conciencia de la peligrosidad y usar correctamente los medios de protección, dar capacitaciones, hacer visitas a los predios productivos, hacer cumplir la ley y establecer controles de residuos sobre los productos agrícolas. Conclusiones: se identificó que el uso de agroquímicos tiene efectos en la salud humana y en el ambiente, esta afirmación debería ser suficiente para generar y promover cada vez más dispositivos, programas y modelos de producción que disminuyan o eliminen su utilización.

Abstract The use of agrochemicals in agriculture and the increase in poisoning resulting from their handling has led to discussions about their danger to human health and the environment. Objetive: the objective of this research was to know the causes of poisoning due to the use of agrochemicals and describe proposals to face the problem from the perspective of rural producers, health agents and rural extension workers of Cerro Azul (Misiones, Argentina). Methodology: the methodology used was qualitative, exploratory-descriptive, 14 interviews were carried out with the different actors, which were transcribed and analyzed with the support of the Atlas ti software. Results: as a result, it was found that the causes of poisoning identified by the actors were: not using protective clothing, not following appropriate biosafety measures, not having the means of protection, lack of awareness of the danger of agrochemicals, and lack of compliance with the law regarding the use of agrochemicals by both producers and input sellers. Proposals to address the problem were proposed: becoming aware of the danger and correctly using protective means, providing training, visiting productive properties, enforcing the law and establishing residue controls on agricultural products. Conclusion: As a discussion and conclusions, it was identified that the use of agrochemicals has effects on human health and the environment; this statement should be sufficient to generate and promote more and more devices, programs and production models that reduce or eliminate their use.

Resumo O uso de agroquímicos na agricultura e o aumento das intoxicações decorrentes do seu manuseio têm gerado discussões sobre seus perigos para a saúde humana e o meio ambiente. Objetivo: o objetivo desta pesquisa foi conhecer as causas das intoxicações pelo uso de agrotóxicos e descrever propostas para o enfrentamento do problema na perspectiva de produtores rurais, agentes de saúde e extensionistas rurais de Cerro Azul (Misiones, Argentina). Metodologia: a metodologia utilizada foi qualitativa, exploratório-descritiva, foram realizadas 14 entrevistas com os diferentes atores, as quais foram transcritas e analisadas com o apoio do software Atlas ti. Resultados: como resultado, constatou-se que as causas de intoxicação identificadas pelos atores foram: não utilizar roupas de proteção, não seguir medidas adequadas de biossegurança, não possuir meios de proteção, falta de conscientização sobre o perigo dos agroquímicos e falta de cumprimento das normas. a lei relativa ao uso de agroquímicos tanto pelos produtores quanto pelos vendedores de insumos. Foram propostas propostas para enfrentar o problema: conscientizar-se do perigo e utilizar corretamente os meios de proteção, ministrar treinamentos, visitar propriedades produtivas, fazer cumprir a lei e estabelecer controles de resíduos nos produtos agrícolas. Conclusões: como discussão e conclusões, identificou-se que o uso de agrotóxicos traz efeitos à saúde humana e ao meio ambiente; esta afirmação deveria ser suficiente para gerar e promover cada vez mais dispositivos, programas e modelos de produção que reduzam ou eliminem seu uso.

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Las diferentes especies de medusas, marinas o de agua dulce, pueden inyectar toxinas a los humanos si estos entran en contacto con ellas, ocasionando eritema, prurito, dolor neurogénico agudo y enrojecimiento localizado, derivados de la acción de las toxinas en el sistema nervioso periférico. En casos más severos, pueden manifestarse reacciones alérgicas sistémicas como anafilaxia, dificultades respiratorias y taquicardia, e incluso la muerte. El tratamiento involucra la inmediata remoción de los tentáculos adheridos, preferiblemente con agua salada, seguida de la aplicación local de frio moderado para inactivar las toxinas. El uso de analgésicos, antihistamínicos y, en casos graves, la administración de epinefrina, son medidas terapéuticas comunes. Es necesario y urgente derivar casos complicados o de reacciones alérgicas graves a unidades de atención médica para evaluación y manejo adecuado. Presentamos el caso de un adulto que sufrió envenenamiento por medusa de zona marítima.

Different species of jellyfish, marine or freshwater, can inject toxins into humans if they come into contact with them, causing erythema, pruritus, acute neurogenic pain and localized redness, derived from the action of the toxins in the peripheral nervous system. In more severe cases, systemic allergic reactions such as anaphylaxis, breathing difficulties and tachycardia, and even death may occur. Treatment involves immediate removal of attached tentacles, preferably with salt water, followed by local application of moderate cold to inactivate toxins. The use of analgesics, antihistamines and, in severe cases, the administration of epinephrine, are common therapeutic measures. It is necessary and urgent to refer complicated cases or severe allergic reactions to medical care units for evaluation and appropriate management. We present the case of an adult who suffered poisoning by jellyfish from the maritime area.

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INTRODUCTION: Lead poisoning in childhood remains an important public health concern. We highlight the radiological findings in a patient with a high blood lead concentration. CASE SUMMARY: A 7-year-old girl presented to hospital with abdominal pain, nausea, and asthenia. Laboratory tests showed severe hypochromic microcytic anemia, punctate basophilic stippling of erythrocytes, and a blood lead concentration of 880 µg/L (4.3 µmol/L). IMAGES: Radiographs of the femur, tibia, and fibula demonstrated dense metaphyseal bands ("lead lines"). On cranial computed tomography, we observed multiple speck-like and curvilinear hyperdensities involving subcortical regions, putamen, and left cerebellar hemisphere. CONCLUSION: In patients with lead poisoning, imaging of the brain and bones may show characteristic features. These imaging findings may point to the diagnosis of lead toxicity when these radiographic findings are discovered during the evaluation of vague complaints such as abdominal pain or mental status changes or when a blood lead concentration is not readily available.

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Atrazine is a triazine organochloride herbicide, frequently used in different agricultural activities. Rare acute intoxication with atrazine is reported in production animals, and its metabolism in mammals is unknown. We report a spontaneous case of atrazine acute intoxication in 16.1% animals of a 168-beef heifer herd exposed to the herbicide at a farm located in Buenos Aires province, Argentina. Affected heifers showed different neurological signs and died suddenly, similar to the previous natural atrazine intoxication report. During autopsy, no gross lesions were observed. Different body fluids and tissues samples were collected during postmortem examination. No relevant histopathological findings were observed. High levels of atrazine and its metabolites were detected in different fluids and tissues by ultra-liquid chromatography high performance coupled to triple quadrupole mass spectrometry. These findings suggest ruminal or hepatic metabolization of atrazine in the exposed cattle. This is the first report of quantification and distribution of atrazine and its metabolites in intoxicated mammals providing relevant information for diagnostic purposes.

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Introducción: la intoxicación por monóxido de carbono (CO) es un problema grave de salud. La aparición de secuelas neurológicas tardías incluye trastornos cognitivos, mentales, síntomas piramidales o extrapiramidales. Caso clínico: paciente de 12 años, sexo femenino, luego de 15 días de una intoxicación aguda grave por CO, presenta movimientos coreoatetoideos de miembros superiores, distonías de cuello, discinesias de cara, bradipsiquia y dificultades en la memoria. Resonancia magnética: lesiones isquémicas en globo pálido bilateral, sustancia blanca de hipocampo y cerebelo. Discusión: es fundamental el seguimiento posterior al alta para reconocer las secuelas neurológicas tardías, incluyendo la realización de pruebas neuropsicológicas estandarizadas.

Introduction: Carbon monoxide poisoning is a severe health problem. The appearance of delayed neurological sequelae includes cognitive and mental disorders and pyramidal or extrapyramidal symptoms. Case presentation: A 12-year-old female patient, after 15 days of severe acute CO poisoning, presents choreoathetoid movements of the upper limbs, neck dystonias, face dyskinesias, bradypsychia, and memory difficulties. Magnetic resonance imaging: ischemic lesions in bilateral globus pallidus, the white matter of hippocampus and cerebellum. Discussion: A follow-up visit after discharge is essential to recognize delayed neurological sequelae, including performing standardized neuropsychological tests.

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We aimed to describe a case of acute kidney injury (AKI) with an uncommon case. We described a previously health 24 years old male that presented acute kidney injury associated with neurological and respiratory symptoms. He was initially admitted at the hospital with nausea, vomiting, blurred vision, and reduced urine output. The patient's condition got worse approximately in one week. Laboratory tests revealed high levels of nitrogenous waste, hyponatremia, metabolic acidosis with an increased anion gap, and the presence of proteinuria and hematuria. The patient experienced paresthesia, seizures, respiratory alterations, and altered consciousness. The initial diagnostic hypothesis of rapidly progressive glomerulonephritis was not confirmed. A deeper investigation of the case exposed that it could have occurred an intentional exogenous poisoning with diethylene glycol (DEG). Renal biopsy unveil findings suggestive of poison-induced nephrotoxicity, which corroborated the suspicion. Despite therapeutic efforts, the patient died due to pulmonary complications. This case report shows the need to consider DEG poisoning as a etiology of AKI, especially in patients with neurological symptoms. Laboratory and histopathological analysis were crucial for the diagnosis.

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La intoxicación por naftaleno es poco frecuente en los niños. Es causada por la ingesta, la inhalación o el contacto con la piel de sustancias que contienen naftaleno. Los pacientes suelen tener orina de color marrón oscuro, diarrea acuosa y vómito bilioso. Los signos incluyen fiebre, taquicardia, hipotensión y valores bajos en la oximetría de pulso, incluso con oxigenoterapia. Los análisis de sangre detectan anemia hemolítica, metahemoglobinemia, insuficiencia renal e hiperbilirrubinemia. Además del tratamiento sintomático, se hacen transfusiones de eritrocitos y se les administran ácido ascórbico, azul de metileno y N-acetilcisteína. En este artículo, presentamos el caso de un paciente masculino de 23 meses de edad con metahemoglobinemia y hemólisis intravascular aguda que recibió atención en la unidad de cuidados intensivos durante cinco días por intoxicación por naftaleno. Si bien la intoxicación por naftaleno es muy poco frecuente, tiene consecuencias mortales y se debe ejercer precaución con su uso y venta.

Poisoning by naphthalene is uncommon in children. It is a type of poisoning brought on by ingesting, inhaling, or coming into touch with naphthalene-containing substances on the skin. Patients typically present with an initial onset of dark brown urine, watery diarrhea, and bile vomit. The signs include fever, tachycardia, hypotension, and low pulse oximetry readings even with oxygen support. Hemolytic anemia, methemoglobinemia, renal failure, and hyperbilirubinemia are all detected in blood tests. Erythrocyte transfusion, ascorbic acid, methylene blue, and N-acetylcysteine (NAC) therapies are provided to inpatients in addition to symptomatic treatment. We present a 23-month-old male patient who developed methemoglobinemia and acute intravascular hemolysis, who was followed up in the intensive care unit for five days due to naphthalene intoxication. Although naphthalene poisoning is very rare, it should be known that it has fatal consequences, and more care should be taken in its use and sale.

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Introducción: En los contextos del conflicto armado convergen actividades que potencialmente pueden producir toxicidad por metales pesados; inclusive, muchas víctimas de artefactos explosivos improvisados portan esquirlas residuales interiorizadas, de composición y potencial toxicidad desconocidas. Ello ha sido poco estudiado. Objetivo: Describir los niveles biológicos de plomo y mercurio en civiles supervivientes de la masacre de Bojayá, su eventual exposición actual, así como signos y síntomas compatibles con toxicidad crónica. Metodología: Estudio observacional descriptivo, tipo serie con 13 casos. Resultados: El 38.46 % de los casos tuvo niveles de plomo en sangre superiores o cercanos al valor límite superior, sin fuentes específicas identificadas. Un 46.15 % tuvo niveles mercuriales superiores o cercanos al límite de referencia, y se los considera exposición ambiental por minería aurífera regional. La valoración clínica toxicológica mostró síntomas y signos clínicos potencialmente asociados con toxicidad crónica por metales. Conclusión: Hubo presencia de residuos de artefactos explosivos en personas con hallazgos sugestivos de toxicidad por plomo o mercurio, sin que pueda afirmarse una relación directa y específica entre los dos aspectos; algunos casos sugieren exposición ambiental para mercurio, y exposición a proyectiles para el plomo, relacionadas con dinámicas del conflicto armado. Son necesarios estudios adicionales para afirmar la existencia de asociaciones causales.

Introduction: In the contexts of armed conflict, activities converge that can potentially produce heavy metal toxicity; including many victims of improvised explosive devices carry internalised residual shrapnel, of unknown composition and potential toxicity. This has been little studied. Objective: To describe the biological levels of lead and mercury in civilian survivors of the Bojayá massacre, their possible current exposure, as well as signs and symptoms compatible with chronic toxicity. Methodology: Descriptive observational study, serial type with 13 cases. Results: 38.46 % of the cases had blood lead levels above or close to the upper limit value, with no specific sources identified. 46.15 % had mercury levels above or close to the reference limit, and were considered environmental exposure from regional gold mining. Clinical toxicological assessment showed clinical signs and symptoms potentially associated with chronic metal toxicity. Conclusion: There was a presence of explosive ordnance residues in individuals with findings suggestive of lead or mercury toxicity, without a direct and specific relationship between the two; some cases suggest environmental exposure for mercury, and projectile exposure for lead, related to the dynamics of the armed conflict. Further studies are needed to affirm the existence of causal associations.

Introdução: Nos contextos de conflito armado, convergem atividades que podem potencialmente produzir toxicidade por metais pesados; Na verdade, muitas vítimas de dispositivos explosivos improvisados carregam lascas residuais internalizadas de composição desconhecida e potencial toxicidade. Isto tem sido pouco estudado. Objetivo: Descrever os níveis biológicos de chumbo e mercúrio em civis sobreviventes do massacre de Bojayá, sua eventual exposição atual, bem como sinais e sintomas compatíveis com toxicidade crônica. Metodologia: Estudo observacional descritivo, tipo série com 13 casos. Resultados: 38.46 % dos casos apresentaram níveis de chumbo no sangue superiores ou próximos ao valor limite superior, sem fontes específicas identificadas. 46.15 % apresentaram níveis de mercúrio superiores ou próximos ao limite de referência e são considerados exposição ambiental devido à mineração regional de ouro. A avaliação clínica toxicológica mostrou sintomas e sinais clínicos potencialmente associados à toxicidade crônica por metais. Conclusão: Houve presença de resíduos de artefatos explosivos em pessoas com achados sugestivos de toxicidade por chumbo ou mercúrio, sem que se pudesse afirmar uma relação direta e específica entre os dois aspectos; Alguns casos sugerem exposição ambiental ao mercúrio e exposição a projéteis de chumbo, relacionadas com a dinâmica do conflito armado. Estudos adicionais são necessários para confirmar a existência de associações causais.

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Two outbreaks of pine needle abortions in cattle are here reported for the first time in Argentina. The cases occurred in Chubut and Neuquén provinces in the Patagonia region, causing 29.6% and 9% of abortions in each herd respectively. In both outbreaks, the dams were in the last third of gestation, and, due to a period of cold, snow and lack of available forage, they gained access to Pinus ponderosa and Pinus contorta forests. No pathological lesions, serological, molecular, or microbiological evidence of infectious causes were observed in any of the six fetuses analyzed. Microhistological analysis of feces confirmed higher presence of fragments of Pinus spp. needles in the diet of affected dams than in that of non-affected ones (12.2 vs 3.0%). Moreover, toxicological analysis showed higher tetrahydroagathic acid in the sera of affected dams than in that of non-affected ones (10.05 vs 2.81 ppm). In addition, this acid was detected in different fetal fluids (3.6-8.1 ppm) of the six fetuses analyzed. Interestingly, isocupressic acid was detected only in needles of P. ponderosa, and its content was lower than that found in other areas of the world (0.31 and 0.5% in Chubut and Neuquén respectively). These results confirm that the consumption of P. ponderosa by dams could have been the cause of these abortion outbreaks, a fact that should be considered as differential diagnosis in abortions of cattle, especially in silvopastoral systems of Argentina.

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Paraquat®, or N,N'-dimethyl-4,4'-bipyridinium dichloride, is a bipyridyl compound used as a non-selective herbicide and desiccant that can cause acute poisoning through all routes of exposure. There is no known antidote, and the available treatments are based on avoiding its absorption and timely removing it, in adults and children. We describe a case series of 14 pediatric patients from the department of Cauca, Colombia, with acute intoxication after oral intake of paraquat. Patients were referred to a medium-high complexity hospital in southwestern Colombia and treated according to an institutional protocol for acute paraquat poisoning. Acute paraquat poisoning after oral ingestion is associated with a high mortality rate, even with timely medical attention, as the compound has no known antidote and quickly reaches systemic concentrations for fulminant poisoning. Based on the available literature, our center has proposed a clinical protocol including early standard management, immunosuppressive and antioxidant treatments, and systemic removal techniques. This protocol suggests an adequate approach to acute paraquat poisoning in the pediatric population.

El dicloruro de 1,1'-dimetil-4,4'-bipiridilo (Paraquat®) es un compuesto químico de la familia de las piridinas, utilizado como herbicida no selectivo y desecante. Este compuesto puede causar intoxicación aguda por todas las vías de exposición. En el momento, no hay un antídoto conocido y los tratamientos disponibles, incluidos los pediátricos, se basan en contrarrestar su absorción y propiciar su remoción oportuna. Se describe una serie de casos de 14 pacientes pediátricos, procedentes en su mayoría del departamento del Cauca, con intoxicación aguda por ingestión de paraquat. Los pacientes fueron remitidos y atendidos en un hospital de mediana a alta complejidad en el suroccidente colombiano, con un protocolo institucional para el manejo de la intoxicación aguda por el herbicida. La intoxicación aguda con paraquat por vía oral se asocia con una alta tasa de mortalidad, aún con atención médica oportuna, pues fácilmente se alcanzan concentraciones sistémicas para ser fulminante. Basado en la literatura disponible, el Hospital Universitario San José ha propuesto un protocolo clínico ­adecuado para la intoxicación aguda por paraquat en población pediátrica­ que incluye manejo estándar temprano, tratamiento inmunosupresor y antioxidante, y técnicas para su remoción sistémica.

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Mercury (Hg) pollution is a global public health concern because of its adverse effects on the environment and health. Single-nucleotide polymorphisms (SNPs) have been associated with Hg levels and outcomes. The aim of this review was to describe the research and discuss the evidence on the genetic susceptibility of Hg-exposed individuals to the development of neurocognitive disorders. A systematic review was performed to identify the genes/SNPs associated with Hg toxicokinetics and that, therefore, affect neurological function in exposed populations. Observational and experimental studies were identified by screening three databases. Thirteen articles were included (quality score 82-100%) and 8124 individuals were evaluated. Hg exposure was mainly fish consumption (77%) and, in 31% of the studies, the Hg levels exceeded the reference limits. Genetic susceptibility to higher Hg levels and neurotoxicity risk in Hg poisoning were associated with eight (ALAD rs1800435, CYP3A4 rs2740574, CYP3A5 rs776746, CYP3A7 rs2257401, GSTP1 rs1695, MT1A rs8052394, MT1M rs2270836, and MT4 rs11643815) and three (MT1A rs8052394, MT1M rs2270837, and MT2A rs10636) SNPs, respectively, and rs8052394 was associated with both outcomes. The MT1A rs8052394 SNP may be used as a susceptibility biomarker to identify individuals at greater risk for higher Hg levels and the development of neurocognitive disorders in metal-exposed populations.

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Introduction: Aluminum Phosphide (AlP) poisoning constituted the most common cause of poisoning death in some low- and middle-income countries (LMICs). This study aimed to evaluate the safety and efficacy of oil-based gastric lavage (GL) compared with standard therapy for the treatment of AlP poisoning. Materials and methods. This systematic review complied with "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" (PRISMA) Protocols. A comprehensive search was carried out, identifying randomized controlled trials (RCTs), including anyone presenting within 6 h of exposure to AlP, and the administration of GL with oils, including liquid paraffin or coconut oil. Results: We identified 7 RCTs. The evidence from 4 RCTs indicates that GL with paraffin oil is an effective treatment for acute AlP poisoning, decreasing the mortality rate (RR = 0.62; 95% CI = 0.48 to 0.81; participants = 226; I 2 = 10%; low-quality evidence). We estimate the Number Needed to Treat of 4. Likewise, this intervention reduces the need for intubation and mechanical ventilation (RR = 0.62; 95% CI = 0.40 to 0.79; I2 = 0%; low-quality evidence). Regarding GL with coconut oil, the evidence from 4 RCTs, indicates a slight reduction in mortality (RR = 0.82; 95% CI = 0.69 to 0.98; participants = 112; I2 = 0%; very low-quality evidence). Conclusions: Limited evidence suggests that GL with paraffin oil is effective in reducing the mortality rate. Likewise, limited evidence showed in favor of paraffin oil concerning the need for intubation and mechanical ventilation. Very limited evidence suggests that GL with coconut oil could reduce mortality. Both interventions would have a benign safety profile.