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Las sustancias cáusticas son productos químicos capaces de provocar lesiones de diferente gravedad, según sea la concentración del producto, el tiempo de contacto y la vía de ingreso. La exposición es habitual por tratarse de productos utilizados en el hogar como destapacañerías y/o limpiahornos. Los cáusticos alcalinos producen necrosis por licuefacción de los tejidos. La ingesta causa edema, ulceraciones, sangrado, placas blanquecinas e intensa actividad fibroblástica con cicatrización en tres semanas. El esófago se afecta más que el estómago, en especial cuando se trata de productos sólidos o en escamas. La secuela observada es la estenosis esofágica, la cual puede requerir desde procedimientos de dilatación hasta cirugía de reemplazo, con alta morbilidad. El objetivo del trabajo es presentar tres casos clínicos y sus complicaciones a largo plazo; recordar el manejo inicial del paciente que ingiere cáusticos alcalinos, su seguimiento multidisciplinario y resaltar las medidas de prevención para evitar este tipo de accidentes graves.

Caustic are chemical substances capable of causing different degree of lesions, according to the product concentration, the time and the route of contact. The usual exposure is because of their use as household products such as drain openers and oven cleaners. Caustic alkalis produce tissue liquefaction necrosis. Ingestion causes edema, ulceration, bleeding, whitish plaques and intense fibroblastic activity with healing in three weeks. The esophagus is more affected than the stomach, especially when solids are involved. The observed sequel is esophageal stricture, requiring treatments as dilation or replacement surgery, with high morbilidad. The aim of the paper is to report three clinical cases and their long-term complications; review the initial management of patients who ingested caustic alkali, highlighting its multidisciplinary monitoring and prevention measures to avoid such serious accidents.

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OBJECTIVE: To describe a case of genital burn which raised the suspicion of maltreatment (sexual abuse and neglect by lack of supervision). CASE DESCRIPTION: An infant was taken to the Emergency Room of a pediatric hospital with an extensive burn in the vulva and perineum. The mother claimed the burn had been caused by a sodium-hydroxide-based product. However, the injury severity led to the suspicion of sexual abuse, which was then ruled out by a multidisciplinary team, based on the consistent report by the mother. Besides, the lesion type matched those caused by the chemical agent involved in the accident and the family context was evaluated and considered adequate. The patient had a favorable outcome and was discharged after four days of hospitalization. Outpatient follow-up during six months after the accident enabled the team to rule out neglect by lack of supervision. COMMENTS: Accidents and violence are frequent causes of physical injuries in children, and the differential diagnosis between them can be a challenge for healthcare workers, especially in rare clinical conditions involving patients who cannot speak for themselves. The involvement of a multidisciplinary trained team helps to have an adequate approach, ensuring child protection and developing a bond with the family; the latter is essential for a continued patient follow-up.

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OBJECTIVES: to evaluate the handling and risk factors for poisoning and/or digestive tract injuries associated with the use of sanitizing products at home. METHODS: interviews were conducted in 419 households from different regions, collecting epidemiological data from residents and risk habits related to the use and storage of cleaning products. RESULTS: sanitizing products considered to be a health risk were found in 98% of the households where the research was conducted, and in 54% of cases, they were stored in places easily accessible to children. Lye was found in 19%, followed by illicit products in 39% of homes. In 13% of households, people produced soap, and in 12% they stored products in non-original containers. The use of illicit products and the manufacture of handmade soap were associated with lower educational level of the household owners and with the regions and socioeconomic classes with lower purchasing power. CONCLUSIONS: risk practices such as inadequate storage, manufacturing, and use of sanitizing products by the population evidence the need for public health policies, including educational measures, as a means of preventing accidents. .

OBJETIVOS: avaliar a forma de utilização e os fatores de risco para intoxicações e/ou lesões do trato digestório associados ao uso dos produtos saneantes no domicílio. MÉTODOS: foram realizadas entrevistas em 419 domicílios de diferentes regiões, estabelecendo-se dados epidemiológicos dos moradores e hábitos de risco relacionados à utilização e armazenamento dos produtos de limpeza. RESULTADOS: dos domicílios onde foi realizada a pesquisa, havia produtos saneantes considerados de risco em 98%, sendo que em 54% dos casos, eles estavam armazenados em locais de fácil acesso para crianças. A soda cáustica estava disponível em 19% e os produtos "clandestinos" em 39% das moradias. Em 13% dos domicílios havia o hábito de fazer sabão e em 12% de armazenar os produtos fora da embalagem original. O uso de produtos clandestinos e a fabricação artesanal de sabão estavam associados à baixa escolaridade das donas das casas e às regiões e às classes econômicas de poder aquisitivo mais baixo. CONCLUSÕES: práticas de risco como armazenamento, fabricação e utilização inadequados de produtos saneantes pela população estudada apontam para a necessidade de políticas de saúde pública, incluindo medidas educacionais, como forma de prevenção de acidentes. .

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OBJECTIVE: To evaluate the effects of agents on corneal re-epithelization and metalloproteinase-2 and metalloproteinase-9 (MMP-2 and MMP-9) activities in corneas of rats submitted to ulceration. ANIMALS STUDIED: Ninety eight healthy rats. PROCEDURES: Corneal ulcers were created using 1N NaOH in their left eye. Eyes were treated every 6 h with 1% ethylenediaminetetraacetic acid (EDTA), 3% chondroitin sulfate (CS), 10% N-acetylcysteine NAc and saline (S) at 6-h intervals. Corneas were stained with fluorescein and photographed at the same time points. Following 20 h and 40-42 h of corneal injury, corneas were processed for scanning electron microscopy (SEM) to quantify microvilli density, and MMPs activities were analyzed using zymography. RESULTS: The percentage of wound area and the time in hours for corneal re-epithelization did not differ significantly among treatment groups (P > 0.05). In first and the second moments, latent MMP-2 was significantly elevated in the eyes treated with NAC and CS (P < 0.001). Active MMP-2 did not change significantly among treatment groups in the first moment (P > 0.05); significantly higher activity was observed in the second moment in the eyes treated with CS (P <0.001). In the second moment, latent MMP-9 decreased significantly in eyes treated with EDTA and S (P < 0.01). Microvilli corneal density did not change significantly between healthy subjects and treatment groups (P > 0.05). CONCLUSION: Any of the studied substances did not accelerate corneal re-epithelization and did not add protection to the corneal microvilli. Significant higher levels of active form of MMP-2 in 3% chondroitin sulfate-treated group may indicate that the agent acts as substrate for such enzyme. At the end of the experiment, 1% EDTA was the most efficient agent to inhibit significantly the latent form of MMP-9. However, any of the substances add benefit over saline on reducing the proteolytic activity in the cornea of rats after alkali injury.

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OBJECTIVES: to evaluate the handling and risk factors for poisoning and/or digestive tract injuries associated with the use of sanitizing products at home. METHODS: interviews were conducted in 419 households from different regions, collecting epidemiological data from residents and risk habits related to the use and storage of cleaning products. RESULTS: sanitizing products considered to be a health risk were found in 98% of the households where the research was conducted, and in 54% of cases, they were stored in places easily accessible to children. Lye was found in 19%, followed by illicit products in 39% of homes. In 13% of households, people produced soap, and in 12% they stored products in non-original containers. The use of illicit products and the manufacture of handmade soap were associated with lower educational level of the household owners and with the regions and socioeconomic classes with lower purchasing power. CONCLUSIONS: risk practices such as inadequate storage, manufacturing, and use of sanitizing products by the population evidence the need for public health policies, including educational measures, as a means of preventing accidents.

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An image analysis biomonitoring system was used to evaluate sublethal effects of pH on the mean swimming velocity of zebrafish. Responses to stress were tested comparing individual and group responses. Group analysis indicated no effect for all acid pH and for pH 9.0-9.5. Individual analysis indicated behavioral differences for most acid pH and higher than 9.5. Sensitivity to sublethal pH was best assessed when using individual analysis. Zebrafish decreased hyperactivity and increased hypoactivity with more acid or alkaline pH. Individual approach allowed to determine hyperactivity or hypoactivity and the species' thresholds of exposure, which is critical for the management of impairments.

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UNLABELLED: The ingestion of caustic substances is an important emergency situation, because of its serious consequences. PURPOSE: To study morphological and functional alterations of the esophagus in rabbits submitted to esophageal infusion of caustic soda (NaOH). METHODS: The 88 rabbits studied were divided into 4 groups: G1 (n=22) were submitted to esophageal infusion with distilled water. G2, G3, and G4 were submitted to esophageal infusion of 2%, 4% and 6% NaOH respectively. Morphological alterations were studied in 12 animals from each group and manometric alterations in the remaining 10. An analysis was made of lower esophageal sphincter (LES) pressure, number and amplitude of contractions in the distal third of the esophagus. These studies were performed before (moment M1) and at 30 minutes, 6 hours, and 24 hours after (moments M2, M3, and M4, respectively) esophageal infusion. RESULTS: Morphological evaluation: G1 - no alterations; G2 - edema, hyperemia, and ecdysis; G3 - enlarged calibre of esophagus, ulcers, ecdysis of mucosa; G4 - lesions similar to G3, but more intense, areas of extensive hemorrhage at M3 and M4. Functional evaluation: LES was higher at M2; the number of distal third lower esophageal contractions in G3, and G4 was lower; and the contraction amplitude was lower in G4. CONCLUSIONS: 1) Esophageal infusion with caustic soda in rabbits is a good experimental model for studying caustic esophagites. 2) Esophageal infusion with NaOH caused lesions in the esophageal wall, with gravity proportional to solution concentration; 3) Infusion caused LES spasm at M2, and reduced both contraction number and amplitude in the distal third of the esophagus.

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The ingestion of caustic substances is an important emergency situation, because of its serious consequences. PURPOSE: To study morphological and functional alterations of the esophagus in rabbits submitted to esophageal infusion of caustic soda (NaOH). METHODS: The 88 rabbits studied were divided into 4 groups: G1 (n=22) were submitted to esophageal infusion with distilled water. G2, G3, and G4 were submitted to esophageal infusion of 2 percent, 4 percent and 6 percent NaOH respectively. Morphological alterations were studied in 12 animals from each group and manometric alterations in the remaining 10. An analysis was made of lower esophageal sphincter (LES) pressure, number and amplitude of contractions in the distal third of the esophagus. These studies were performed before (moment M1) and at 30 minutes, 6 hours, and 24 hours after (moments M2, M3, and M4, respectively) esophageal infusion. RESULTS: Morphological evaluation: G1 - no alterations; G2 - edema, hyperemia, and ecdysis; G3 - enlarged calibre of esophagus, ulcers, ecdysis of mucosa; G4 - lesions similar to G3, but more intense, areas of extensive hemorrhage at M3 and M4. Functional evaluation: LES was higher at M2; the number of distal third lower esophageal contractions in G3, and G4 was lower; and the contraction amplitude was lower in G4. CONCLUSIONS: 1) Esophageal infusion with caustic soda in rabbits is a good experimental model for studying caustic esophagites. 2) Esophageal infusion with NaOH caused lesions in the esophageal wall, with gravity proportional to solution concentration; 3) Infusion caused LES spasm at M2, and reduced both contraction number and amplitude in the distal third of the esophagus.

A ingestão de substâncias cáusticas constitui importante situação de emergência, tendo em vista a gravidade de suas seqüelas. OBJETIVO: Estudar as alterações morfológicas e funcionais do esôfago de coelhos submetidos à infusão esofágica com soda cáustica (NaOH). MÉTODOS: 88 coelhos foram divididos em 4 grupos: G1 (n=22) foi submetido à infusão esofágica com água destilada; G2, G3 e G4 foram submetidos a infusão esofágica com NaOH a 2 por cento, 4 por cento e 6 por cento, respectivamente. Alterações morfológicas foram estudadas em 12 animais de cada grupo e as alterações manométricas, nos 10 animais restantes. Foram feitas análises do esfíncter inferior do esôfago (EIE), número e amplitude das contrações no terço distal do esôfago. Estes estudos foram realizados antes (momento 1 - M1) e aos 30 minutos, 6 horas e 24 horas após a infusão esofágica (momentos M2, M3 e M4, respectivamente). RESULTADOS: Avaliação macroscópica: G1 - sem alterações; G2 - edema, hiperemia e descamação; G3 - aumento do calibre do esôfago, úlceras, descamação da mucosa; G4 - lesões semelhantes as do G3, porém mais intensas, áreas de extensa hemorragia. Avaliação funcional: a pressão no EIE foi mais elevada em M2 no grupo 2; o número das contrações no terço distal do esôfago foi menor em G3 e G4, e a amplitude das contrações foi menor em G4. CONCLUSÕES: 1) a infusão esofágica com NaOH constitui excelente modelo experimental de esofagite cáustica no coelho; 2) a infusão esofágica com NaOH causa lesões na parede do esôfago, com gravidade proporcional a concentração da solução; 3) a infusão causou espasmo do EIE em M2 e redução do número e amplitude das contrações no terço distal do esôfago.

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The objective of the present study was to assess esophageal motor function in 21 children (7.5 +/- 2.9 years) with caustic strictures. Esophageal manometry was performed using a water-infusion system interfaced with a polygraph and displayed on a computer screen. The data were compared with those obtained from 9 healthy children. Radionuclide transit was determined by studying deglutition of a single bolus of 99mTc pertechnetate in 10 ml of water. Non-peristaltic low-amplitude and long-duration waves were the most common findings detected in patients with strictures longer than 20% of esophageal length (N = 11). Compared with the control group, these patients presented lower mean amplitude and longer mean duration of waves (24.4 +/- 11.2 vs 97.9 +/- 23.7 mmHg, P < 0.05, and 6.7 +/- 2.4 vs 1.6 +/- 0.1 s, P < 0.05, respectively). Six patients presented low-amplitude waves just below the constricted site. Ten children presented delayed esophageal transit. There was an association between dysphagia and abnormalities on manometry (P = 0.02) and between symptoms and scintigraphy data (P = 0.01). Dysphagia in caustic strictures is due to esophageal motility abnormalities, which are closely related to the scarred segment.

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The objective of the present study was to assess esophageal motor function in 21 children (7.5 ± 2.9 years) with caustic strictures. Esophageal manometry was performed using a water-infusion system interfaced with a polygraph and displayed on a computer screen. The data were compared with those obtained from 9 healthy children. Radionuclide transit was determined by studying deglutition of a single bolus of 99mTc pertechnetate in 10 ml of water. Non-peristaltic low-amplitude and long-duration waves were the most common findings detected in patients with strictures longer than 20 percent of esophageal length (N = 11). Compared with the control group, these patients presented lower mean amplitude and longer mean duration of waves (24.4 ± 11.2 vs 97.9 ± 23.7 mmHg, P < 0.05, and 6.7 ± 2.4 vs 1.6 ± 0.1 s, P < 0.05, respectively). Six patients presented low-amplitude waves just below the constricted site. Ten children presented delayed esophageal transit. There was an association between dysphagia and abnormalities on manometry (P = 0.02) and between symptoms and scintigraphy data (P = 0.01). Dysphagia in caustic strictures is due to esophageal motility abnormalities, which are closely related to the scarred segment.

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A segurança em laboratório se fundamenta no conhecimento das caracteristícas físico-químicas, na toxicocinética e/ou principais açöes e efeitos tóxicos das substâncias mais comumente utilizadas, como diversos solventes orgânicos, o ácido sulfúrico, a amônia e o hidróxido de sódio. É importante também, conhecer-se quais säo os riscos e os cuidados que se deve tomar no armazenamento e manuseio destes materiais e as medidas de primeiros socorros nos casos de exposiçäo excessiva.

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