Enrique Paris

Prevalence and epidemiology of loxosceles laeta bite: Analysis of consultations to a poison control center

BACKGROUND Loxoscelism is caused by the bite of spider Loxosceles laeta. It can cause a cutaneous or systemic syndrome. AIM To determine the epidemiológica! and clinical features of patients bitten by the Chilean recluse spider (Loxosceles laeta). MATERIAL AND METHODS All communications received at a telephonic orientation center for intoxications during 2005 were analyzed, selecting those who involved patients with symptoms that suggested loxoscelism (i.e., pain, burning sensation, blue area, hematuria, fever or myalgia). These were derived to the emergency room for confirmation of the diagnosis. Forty-eight hours after the initial communication, patients were contacted by phone to find out about the definitive diagnosis. The variables analyzed were: gender, age, geographical location, time since exposure, part of the body involved, clinical signs and definitive diagnosis. RESULTS Of 2,831 telephonic consultations with suspected loxoscelism, the diagnosis was confirmed in 287. All of these patients had cutaneous loxoscelism and only 7.3% of them developed visceral loxoscelism. Fifty six percent of patients with loxoscelism presented two or more clinical signs. The most common were a blue area, pain and a burning sensation, in 69%, 58% and 38% of patients, respectively. Fifty-one percent of patients developed signs within the first 12 hours. All patients with visceral syndrome presented with hemoglobinuria. No cases of loxoscelism were registered in areas located southern than the Xth region of Chile. There were no fatalities attributed to loxoscelism. CONCLUSIONS Most cases of loxoscelism of this series were cutaneous. The population must be educated about the clinical signs of spider bite to seek early and adequate medical treatment.

Environmental pediatrics: an emerging issue

OBJECTIVE To review the most relevant articles regarding environmental pediatrics, its potential effects on health, and especially its advances in prevention. SOURCES A literature search was conducted using MEDLINE/PubMed and SciELO databases. Articles from 1990 to 2010 were reviewed, in addition to book chapters related to environmental pediatrics. SUMMARY OF THE FINDINGS There is a significant variety of factors that make children highly vulnerable to environmental hazard exposure, which are mainly associated with childrens comparatively greater consumption of water, food, and air in relation to body weight. According to the World Health Organization, every year more than 3 million children under the age of 5 die because of environment-related conditions. Approximately 30 to 40% of pediatric diseases are related to environmental factors. Children are constantly exposed to various environmental health hazards, among which the following stand out: contaminated water, lack of adequate sanitation facilities, air pollution, disease vectors, chemical hazards, injuries, and accidents. CONCLUSIONS Nowadays, pediatricians are challenged to address environmental pediatrics health care needs. The pediatric health history needs to be more comprehensive by adding pointed questions to help identify potential environmental risks. Awareness and understanding of the noxious effects of various environmental conditions and knowledge of the related prevention measures will result in timely and adequate interventions that will improve our childrens health and development.

Analysis of a learning assessment system for pediatric internship based upon objective structured clinical examination, clinical practice observation and written examination.

OBJECTIVE To describe and analyze three tools used in the assessment system applied to the pediatric internship over a 7-year period at the School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile. METHODS Retrospective observational research design for the assessment modalities implemented in the pediatric internship from 2001 through 2007. The tools were as follows: objective structured clinical examination (OSCE), written examination and daily clinical practice observation guidelines (DCPOG). The assessment methods were applied to the sixth-year pediatric internship with a total of 697 students. Statistical analysis included a descriptive assessment, with correlation and simple linear and multiple regressions (ANOVA), Bonferroni test and Cronbachs alpha coefficient. Significance level was set at p < 0.05. RESULTS OSCE success scores were reached in 75.7+/-8%, with a better mean among females (p < 0.001). OSCE scores improved after the third year of implementation. Cronbachs alpha coefficient was 0.11-0.78. Written examination had a mean score of 79.8+/-10% and there were no sex differences. Mean DCPOG score was 97.1+/-3% and the results were better among females (p < 0.005). Correlation between the three assessment methods showed a moderate positive relationship except in the year of 2007, where the correlation was higher (p < 0.001). CONCLUSIONS Analysis of the learning assessment system was performed using OSCE, written examination and DCPOG, which are complementary to each other, and yielded good results.

Pediatria ambiental: um tema emergente

OBJECTIVE: To review the most relevant articles regarding environmental pediatrics, its potential effects on health, and especially its advances in prevention. SOURCES: A literature search was conducted using MEDLINE/PubMed and SciELO databases. Articles from 1990 to 2010 were reviewed, in addition to book chapters related to environmental pediatrics. SUMMARY OF THE FINDINGS: There is a significant variety of factors that make children highly vulnerable to environmental hazard exposure, which are mainly associated with children’s comparatively greater consumption of water, food, and air in relation to body weight. According to the World Health Organization, every year more than 3 million children under the age of 5 die because of environment-related conditions. Approximately 30 to 40% of pediatric diseases are related to environmental factors. Children are constantly exposed to various environmental health hazards, among which the following stand out: contaminated water, lack of adequate sanitation facilities, air pollution, disease vectors, chemical hazards, injuries, and accidents. CONCLUSIONS: Nowadays, pediatricians are challenged to address environmental pediatrics health care needs. The pediatric health history needs to be more comprehensive by adding pointed questions to help identify potential environmental risks. Awareness and understanding of the noxious effects of various environmental conditions and knowledge of the related prevention measures will result in timely and adequate interventions that will improve our children’s health and development.

Acute respiratory distress syndrome resulting from inhalation of powdered copper

Background. Copper is an essential element. Poisoning with elemental copper is infrequent and manifestations rarely include the ones that our case presented. Case report. A previously healthy 2-year-old female patient unintentionally inhaled copper dust, developed respiratory failure a few hours later, and required mechanical ventilation. On hospital day three, the patient developed acute respiratory distress syndrome and was treated with high-frequency oscillatory ventilation for six days. She also developed hemolytic anemia, liver failure, oliguric renal failure, and evidence of acute tubular injury. During her stay in the intensive care unit she received inotropic support, packed red cells transfusion, and diuretics. A sample of bronchoalveolar lavage showed macrophages that stained positive for copper. Serum and urine copper concentrations were within the normal range after several days. Extubation was successfully achieved after two weeks and the patient was discharged on day 30 without sequelae. This is the first report of acute respiratory distress syndrome secondary to copper aspiration in a pediatric patient. Conclusion. To our knowledge, this is the first case reported of acute respiratory distress syndrome secondary to elemental copper aspiration. It is important to the clinician to be aware of acute respiratory distress syndrome as a differential diagnosis to copper aspiration by treating the patient aggressively in an adequate clinical setting.

Caracterización de las exposiciones a plaguicidas entre los años 2006 y 2013 reportadas al Centro de Información Toxicológica de la Pontificia Universidad Católica de Chile

BACKGROUND Pesticides are widely used to increase crop yields and vector control. However, both acute and chronic exposure have health consequences. There is paucity of information about the global occurrence of pesticide poisonings. AIM To characterize the reports of pesticide exposures received by a University Poison Information Center. MATERIAL AND METHODS All pesticide exposures reported in Chile between 2006 and 2013 were analyzed. A data-collection sheet provided by the International Programme on Chemical Safety of the World Health Organization, was used to collect information. RESULTS In the study period, 13,181 reports were analyzed. The main age groups exposed were preschoolers and adults. Sixty one percent of exposures occurred accidentally and 24.8% were suicide attempts. Exposures to acetylcholinesterase inhibitors was reported in 29.3% of cases, to superwarfarin rodenticides in 28.5% and to pyrethroids in 24.0%. An increased risk of suicide attempts with pesticides was observed among women, when compared with men (odds ratio: 1.5; 95% confidence intervals: 1.4-1.6; p < 0.001). The risk was higher among teenage girls. CONCLUSIONS The amount of cases under acetyl cholinesterase inhibitor exposure, the most toxic pesticides currently in use should be highlighted. Workers should be educated and all cases should be reported to take actions aiming at reducing these events.

Caracterización de la ingestión por sobredosis de paracetamol: Reporte de un centro de información toxicológica chileno

BACKGROUND Paracetamol (acetaminophen) is an analgesic and antipyretic drug widely used across the world. Its ingestion is one of the most common causes of drug overdose. In the United States is the first cause of acute hepatitis in adults. AIM To describe the epidemiological profile of paracetamol overdose in Chile. MATERIAL AND METHODS Cross sectional retrospective study that included all the phone call inquiries received at the Poison Control Center of the Pontificia Universidad Catolica de Chile (CITUC) during 2009. RESULTS Nine hundred fifty nine inquiries involving acute paracetamol exposures were received. Women represented a 63.1% of the cases. Half of the cases were suicide attempts, of which 74.8% were women. Accidental exposures occurred mainly in children. In 29.3% of the patients, the exposure was considered to involve a hepatotoxic dose. Women had 2.7 times the risk of men to ingest a toxic dose of paracetamol with suicidal purpose (Odds ratio (OR) = 2.7; 95% confidence interval (Cl): 2.1-3.6; p < 0.001). Adolescents had 3.4 times the risk of the general consultants (OR: 3.4; 95% Cl: 2.4-4.7; p < 0.001). CONCLUSIONS Paracetamol overdose is common in Chile. Authorities should carry out preventive measures. Antidotes and the capacity to measure plasma levels of paracetamol should be available in healthcare centers.Background: Paracetamol (acetaminophen) is an analgesic and antipyretic drug widely used across the world. Its ingestion is one of the most common causes of drug overdose. In the United States is the first cause of acute hepatitis in adults. Aim: To describe the epidemiological profile of paracetamol overdose in Chile. Material and Methods: Cross sectional retrospective study that included all the phone call inquiries received at the Poison Control Center of the Pontificia Universidad Catolica de Chile (CITUC) during 2009. Results: Nine hundred fifty nine inquiries involving acute paracetamol exposures were received. Women represented a 63.1% of the cases. Half of the cases were suicide attempts, of which 74.8% were women. Accidental exposures occurred mainly in children. In 29.3% of the patients, the exposure was considered to involve a hepatotoxic dose. Women had 2.7 times the risk of men to ingest a toxic dose of paracetamol with suicidal purpose (Odds ratio (OR) = 2.7; 95% confidence interval (Cl): 2.1-3.6; p Language: es

Impacto de los tóxicos en el neurodesarrollo

de la organogenesis e histogenesis delcerebro puede interferir en que el nino sufrauna alteracion de la funcion cerebral de porvida o que aparezca en su etapa adulta. Laexposicion a toxicos ambientales provoca alte-racion de los procesos del neurodesarrollo ydesordenes, con consecuencias y cambios pro-fundos y permanentes, e incapacidades perdu-rables de por vida con gran costo familiar,social y economico.Es importante recalcar que las exposicionestoxicas merecen una atencion especial porque

Exposición a agentes de riesgo biológico en trabajadores chilenos: Reporte del Centro de Información Toxicológica de la Pontificia Universidad Católica de Chile (CITUC)

Objetivo. Caracterizar las exposiciones a agentes de riesgo biologico ocupacional en trabajadores chilenos registradas por el Centro de informacion toxicologica de la Pontificia Universidad Catolica de Chile (CITUC) durante cuatro anos. Metodologia. Estudio descriptivo de las exposiciones a agente de riesgo biologico ocupacional registradas durante el periodo comprendido entre el 1o de enero de 2006 y el 31 de diciembre de 2009 . Resultados. En el periodo mencionado, se recibieron 77 llamados por exposiciones a agentes de riesgo biologico laboral. Se observo predominio del sexo femenino (57,1 %). El promedio de edad fue 34,8 (DS: 14,5). El principal agente correspondio a vacunas de uso veterinario (41,6%), seguido por arana de rincon (15,5%). Las principales vias de exposicion correspondieron a inyecciones y lesiones corto-punzantes (39,0%) y picaduras y mordeduras (37,7%). La mayor tasa de exposiciones se observo en las regiones de Los Rios y Los Lagos, principalmente por auto-inoculacion accidental de vacunas veterinarias utilizadas en la industria salmonera (22,7*100.000). Los llamados a CITUC fueron realizados principalmente por personal de salud (58,4%) en su mayoria desde un recinto hospitalario (50,6%). El 59,7% de las exposiciones se produjo durante las estaciones verano y primavera. El sexo femenino presento 4,5 veces mas riesgo de exposicion laboral a picaduras o mordeduras de animales, aranas e insectos en relacion al sexo masculino (OR: 4,5; IC 95% : 1,5-13,9; p El sexo masculino presento 4,2 veces mas riesgo de exposicion laboral a vacunas y medicamentos de uso veterinario en relacion al sexo femenino (OR: 4,2, IC 95% : 1,4-12,6, pBACKGROUND Exposure to Biological Agents during work is an emergent type of occupational risk. AIM To characterize occupational biological risk exposure among Chilean workers which have been registered by the Toxicology Information Center, between January 2006 and December 2009. MATERIAL AND METHODS All incoming calls reporting exposure to biological agents during the studied period were analyzed. The information obtained from the caller was registered using the Communication Record Instrument of the WHO International Programme on Chemical Safety (IPCS INTOX). RESULTS In the studied period, 77 calls were received. The mean age of exposed patients was 35 ± 15 years and 57% of them were females. The most common involved agents were vaccines for veterinary use (42%) followed by Loxosceles laeta bites in 16%. The main routes of exposure were injections, cuts and needle stick injuries in 39% and stings and bites in 38%. The highest exposure rates were observed in Southern Chile due to self-inoculation of veterinary vaccines used in the salmon industry (22.7/100.000 actual workers). Fifty-eight percent of calls were from health care workers, and 51% of them were from health care facilities. Sixty percent of exposures occurred during summer and spring. There was a fourfold higher risk of calls involving women exposed to bites or stings (odds ratio (OR) 4.5 (CI95 1.5-13.9, p < 0.01). Men had a fourfold higher risk of being exposed to vaccines or medications for veterinary use (OR 4.2, CI95 1.4-12.6 p < 0.01). CONCLUSIONS Most calls involving an exposure to a biological agent were caused by self-inoculation of veterinary medications.

Chapter 83 – Chile

Publisher Summary In Chile, the teaching of toxicology started shortly after 1900 in the Pharmacy School of the University of Chile when that school was part of the Medicine Faculty, under the direction of Dr. Carlos Ghighliotto. The subjects taught there were compiled under the title “Toxicology, Legal Pharmacy.” In 1950 Professor Hermann Schmidt Hebbel, pharmacist and professor of bromatology, published articles in the journal The Pharmacist. These were later compiled in the text Toxicology Manual: Its Projections Toward Industrial Hygiene and Forensic Chemistry, which was a required study text for several generations.