Conceição Aparecida Turini

Profile of suicide attempts using intentional overdose with medicines, treated by a poison control center in Paraná State, Brazil

This study presents the profile of suicide attempts using intentional overdose with medicines, treated at the Poison Control Center in Londrina, Paraná State, Brazil. A retrospective study of cases treated from 1997 to 2007 was performed. Suicide attempts were significant among unemployed men, housewives, and retired women, and there was an association with other substances in 51.5% of the cases, with a higher frequency among men. 51.1% of the men combined the medicine with an alcoholic beverage, while in women, 84.8% of the associations involved other medicines. The most frequent pharmacological groups were tranquilizers (25.5%), antidepressants (17%), anticonvulsants (15%), and NSAIDs (11.9%). Prescribers must evaluate patients correctly before prescribing psychoactive drugs, since this is the pharmacological group most frequently associated with suicide attempts. Awareness-raising campaigns for rational use of medicines and social programs for suicidal patients should also help decrease the frequency of such cases.Este trabalho apresenta o perfil das tentativas de suicidio atendidas pelo Centro de Controle de Intoxicacoes da cidade de Londrina, Parana, Brasil. Foi realizado um estudo retrospectivo dos casos atendidos entre 1997-2007. As tentativas de suicidio foram significativas entre homens desempregados e mulheres donas-de-casa/aposentadas, e houve associacao com outras substâncias em 51,5% dos casos, sendo a frequencia maior entre os homens. 51,1% dos homens associaram o medicamento com bebida alcoolica, e entre as mulheres, 84,8% das associacoes se referiram a medicamentos. Os grupos farmacologicos de maior frequencia foram os tranquilizantes (25,5%), antidepressivos (17%), anticonvulsivos (15%) e AINES (11,9%), respectivamente. Os prescritores devem avaliar corretamente o paciente antes de receitar psicofarmacos, uma vez que esse e o grupo farmacologico mais frequente nas tentativas de suicidio. Campanhas de conscientizacao para o uso racional de medicamentos, juntamente com programas sociais de atendimento ao paciente suicida, tambem poderiam contribuir na diminuicao da frequencia desses casos.

Lead levels in milk and blood from donors to the Breast Milk Bank in Southern Brazil.

Brazilian scientific literature on the adverse effects of lead on the general population is still very limited. Lead, a potentially toxic substance, has become a public health problem due to its effects, mainly those affecting the central nervous system and on the synthesis of heme. The aim of this study is to evaluate the level of lead exposure of donors to the Breast Milk Bank in the city of Londrina, Parana, by estimating the levels of that metal in milk and blood samples. This is a cross-sectional study conducted during the period between January and July 2007. All mothers enrolled as donors in the Breast Milk Bank were included in this study. A total of 92 volunteers presenting the following inclusion criteria were evaluated in the project: volunteers who were healthy, without any chronic disease, full-term pregnancy, breastfeeding between the 15th and 210 th day after giving birth, and living in the city of the study. Lead in milk and blood was quantified using the inductive coupled plasma mass spectroscopy (ICP-MS) technique. All mothers signed a consent form approved by the Research Ethics Committee from Londrina State University. The median lead concentration in milk samples was 3.0 microg/L, varying from 1.0 to 8.0 microg/L. The median of lead in blood was of 2.7 microg/dl, varying from 1.0 to 5.5 microg/dl. In Spearman correlation analysis, significant but modest correlations could be observed between the concentration of lead in blood and in milk (r(s)=0.207, p=0.048), hemoglobin and ALAD activity (r(s)=-0.264, p=0.011), level of lead in blood and mothers age (r(s)=0.227, p=0.029). However, for hematocrit and hemoglobin, the correlation was higher (r(s)=0.837, p<0.001). No statistically significant associations were found between concentrations of lead in milk and blood and demographic variables studied, obtained through interviews and validated questionnaire. The mean of milk/blood lead ratio was equal to 0.11. In general, the values found in the present study are similar to those obtained in populations in other countries, and are within background levels.

Valores de referência para plumbemia em uma população urbana do Sul do Brasil

Objetivo. Descrever os valores de referencia para chumbo em sangue em uma populacao urbana do Municipio de Londrina, Estado do Parana, Brasil. Metodos. A populacao de referencia foi constituida por 520 voluntarios adultos avaliados de novembro de 1994 a dezembro de 1996. Os criterios de exclusao foram: exposicao ocupacional ao chumbo, exposicao atraves de habitos, fumar mais de 10 cigarros por dia e morar perto de industrias ou de locais que utilizam o chumbo em seus processos produtivos. Tambem foram excluidos individuos com valores de exames clinicos e laboratoriais fora da normalidade, doencas cronicas e disturbios cardiovasculares. Os teores de chumbo em sangue foram determinados por espectrofotometria de absorcao atomica com chama de ar-acetileno. O limite de deteccao obtido foi 1,23 mig/dL. Apos as analises de chumbo em sangue, foram determinados valor minimo, primeiro quartil, mediana, terceiro quartil e valor maximo; media geometrica; intervalo de confianca de 95%; intervalo experimental; e valor de referencia. Resultados. Os valores de referencia para plumbemia variaram de 1,20 a 13,72 mig/dL. A media geometrica foi igual a 5,5 mig/dL. Conclusoes. Em geral, os valores obtidos no presente estudo sao mais baixos do que aqueles obtidos em outros paises. Estudos adicionais deveriam enfocar a obtencao de valores de referencia em outras populacoes brasileiras que vivem em regioes mais industrializadas.

Valores de referência para plumbemia em população urbana

INTRODUCAO: Os valores de referencia utilizados no Brasil, para chumbo em sangue, advem de estudos realizados em outros paises onde as condicoes socioeconomicas, clinicas, nutricionais e ocupacionais diferem bastante das brasileiras. Para garantir uma correta biomonitorizacao da populacao ocupacionalmente exposta ao chumbo, um dos principais problemas identificados no municipio estudado, foram estabelecidos valores de referencia na populacao nao exposta ocupacionalmente da regiao sul do municipio. MATERIAL E METODO: Diferentes estrategias foram utilizadas para assegurar a qualidade de amostragem, que foi dimensionada em 206 sujeitos acima de 15 anos. Sujeitos que apresentaram valores clinicos e laboratoriais fora da faixa de normalidade foram excluidos, bem como os que apresentaram atividades especificas que pudessem interferir nos valores de plumbemia. RESULTADOS: Foram encontrados valores de referencia para chumbo em sangue de 2,4 a 16,6 mg.dL-1, obtidos atraves do intervalo ; ± 2s (onde ; e o valor medio e s e o desvio-padrao dos valores observados) e mediana = 7,9 µg.dL-1.INTRODUCTION: The lead reference values for blood used in Brazil come from studies conducted in other countries, where socioeconomic, clinical, nutritional and occupational conditions are significantly different. In order to guarantee an accurate biomonitoring of the population which is occupationally exposed to lead, a major health concern of the studied community, reference values for individuals who are not occupationally exposed and who live in the southern region of the city were established. MATERIAL AND METHOD: The sample was composed of 206 subjects of at least 15 years of age. Various strategies were employed to assure good-quality sampling. Subjects who presented values outside clinical or laboratory norms were excluded, as well as those whose specific activities might interfere with the results. RESULTS: Lead reference values for blood were found to be from 2.40 to 16.6 µg.dL-1, obtained by the interval ± 2s (where is the mean and s is the standard deviation form observed values) and the median was 7.9 µg.dL-1.INTRODUCTION The lead reference values for blood used in Brazil come from studies conducted in other countries, where socioeconomic, clinical, nutritional and occupational conditions are significantly different. In order to guarantee an accurate biomonitoring of the population which is occupationally exposed to lead, a major health concern of the studied community, reference values for individuals who are not occupationally exposed and who live in the southern region of the city were established. MATERIAL AND METHOD The sample was composed of 206 subjects of at least 15 years of age. Various strategies were employed to assure good-quality sampling. Subjects who presented values outside clinical or laboratory norms were excluded, as well as those whose specific activities might interfere with the results. RESULTS Lead reference values for blood were found to be from 2.40 to 16.6 micrograms.dL-1, obtained by the interval x +/- 2s (where x is the mean and s is the standard deviation form observed values) and the median was 7.9 micrograms.dL-1.

Nimesulide-induced fatal acute liver failure in an elderly woman with metastatic biliary adenocarcinoma. A case report

CONTEXT Nimesulide is a selective inhibitor of the enzyme cyclooxygenase 2. Although considered to be a safe drug, cases of acute hepatitis and fulminant liver failure have been reported in Europe, the United States and South America, especially among elderly female patients. Until now, there had not been any reports in the literature relating to Brazilian subjects. CASE REPORT An 81-year old female who had been using nimesulide therapy for six days presented hematemesis and epistaxis two days before hospitalization. Clinical examination showed an extensive coagulation disorder, diffuse hematomas, hypotension and tachypnea. Laboratory tests revealed abnormalities in coagulation tests; leukocytosis; reduced platelet, hemoglobin and red blood cell counts; and elevated direct bilirubin, serum aspartate transaminase (AST), gamma-glutamyl transpeptidase (GGT), alkaline phosphatase and renal function biomarkers. Hepatitis B and C tests were not reactive. Carcinoembryonic antigen (CEA), CA-19-9 and CA-125 levels were increased by, respectively, 1,000, 10,000 and 13 fold, whereas the alpha-fetoprotein level was normal, thus indicating a malignant tumor in the bile duct that did not originate from the liver. Thirty-six hours after hospitalization, the patients condition worsened, leading to death. The necropsy findings included acute hepatitis with hepatocellular collapse, as well as metastasis of a carcinoma, probably from the bile duct. CONCLUSION Despite the carcinoma presented by the patient, nimesulide use may have contributed towards the fatal acute liver failure. Until this issue has been clarified, caution is required in prescribing nimesulide for liver disease patients.

Perfil das exposições a medicamentos por mulheres em idade reprodutiva atendidas por um Centro de Informações Toxicológicas

The scope of this article is to analyze the epidemiological data relating to exposure to medication among women of reproductive age attended at a Toxicology Information Center. A study was conducted among women of reproductive age exposed to medication between 2007 and 2011. The variables relating to the patients, the occurrence and the medication involved were studied in a total of 777 notified cases. Data was collected from Aggravated Injury Notification System forms and processed on Epi Info for Windows software. The majority of the occurrences (90.5%) was intentional, 33.7% of theses incidents involved the intake of 2 or 3 types of drugs by the patients and the percentile of hospitalization was 35.6%. Drugs acting on the central nervous system were responsible for 59.9% of the incidents, and antidepressants (21.3%) and anti-epileptics (21.2%) were most commonly involved. The main factors associated with hospitalization were: delayed medical rescue after exposure, patients with higher education, ingestion of 2 or 3 types of drugs and exposure to anti-epileptics and antidepressants. Data from this study showed that exposure to medication is a serious health problem for women of reproductive age and it contributes to the increase in the number of hospitalizations.The scope of this article is to analyze the epidemiological data relating to exposure to medication among women of reproductive age attended at a Toxicology Information Center. A study was conducted among women of reproductive age exposed to medication between 2007 and 2011. The variables relating to the patients, the occurrence and the medication involved were studied in a total of 777 notified cases. Data was collected from Aggravated Injury Notification System forms and processed on Epi Info for Windows software. The majority of the occurrences (90.5%) was intentional, 33.7% of theses incidents involved the intake of 2 or 3 types of drugs by the patients and the percentile of hospitalization was 35.6%. Drugs acting on the central nervous system were responsible for 59.9% of the incidents, and antidepressants (21.3%) and anti-epileptics (21.2%) were most commonly involved. The main factors associated with hospitalization were: delayed medical rescue after exposure, patients with higher education, ingestion of 2 or 3 types of drugs and exposure to anti-epileptics and antidepressants. Data from this study showed that exposure to medication is a serious health problem for women of reproductive age and it contributes to the increase in the number of hospitalizations.

Antidepressants Self-Poisoning in Suicide and Suicide Attempt: Acute Toxicity and Treatment

It is estimated that a quarter of the patients that have been diagnosed with major depression attempt suicide during their lifetime, and 15% of these patients ultimately die from suicide. Antidepressants have been shown to be a highly effective treatment for depression; paradoxically, to achieve compliance, physicians must give patients access to a toxic drug, and a possible suicide method (Gunnell & Frankel, 1994; White, Litovitz & Clancy, 2008; Wong et al., 2010).