RESUMO
OBJECTIVE: In September 2006, a Panamanian physician reported an unusual number of patients with unexplained acute renal failure frequently accompanied by severe neurological dysfunction. Twelve (57%) of 21 patients had died of the illness. This paper describes the investigation into the cause of the illness and the source of the outbreak. METHODS: Case-control and laboratory investigations were implemented. Case patients (with acute renal failure of unknown etiology and serum creatinine > 2 mg/dl) were individually matched to hospitalized controls for age (+/- 5 years), sex and admission date (< 2 days before the case patient). Questionnaire and biological data were collected. The main outcome measure was the odds of ingesting prescription cough syrup in cases and controls. FINDINGS: Forty-two case patients and 140 control patients participated. The median age of cases was 68 years (range: 25-91 years); 64% were male. After controlling for pre-existing hypertension and renal disease and the use of angiotensin-converting enzyme inhibitors, a significant association was found between ingestion of prescription cough syrup and illness onset (adjusted odds ratio: 31.0, 95% confidence interval: 6.93-138). Laboratory analyses confirmed the presence of diethylene glycol (DEG) in biological samples from case patients, 8% DEG contamination in cough syrup samples and 22% contamination in the glycerin used to prepare the cough syrup. CONCLUSION: The source of the outbreak was DEG-contaminated cough syrup. This investigation led to the recall of approximately 60 000 bottles of contaminated cough syrup, widespread screening of potentially exposed consumers and treatment of over 100 affected patients.
Assuntos
Injúria Renal Aguda/epidemiologia , Surtos de Doenças , Etilenoglicóis/intoxicação , Injúria Renal Aguda/induzido quimicamente , Adolescente , Adulto , Idoso , Antitussígenos/análise , Estudos de Casos e Controles , Contaminação de Medicamentos , Etilenoglicóis/análise , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Panamá/epidemiologia , Adulto JovemRESUMO
Se estudia el primer caso de Fertilización In vitro y transferencia de embriones que se realizó en la República de Panamá y en Centro América, en una señora que tenía 10 años de esterilidad primaria y en quien se logró el nacimiento de una niña sana, que actualmente tiene un año de edad