RESUMO Objetivo: Identificar e caracterizar a população de casos pediátricos encaminhados para o nosso centro de oxigenoterapia hiperbárica. Métodos: Estudo retrospetivo e observacional, que incluiu doentes pediátricos tratados com oxigenoterapia hiperbárica, de 2006 a 2021, no centro de referência de medicina hiperbárica do norte de Portugal. As variáveis de interesse foram extraídas dos processos clínicos eletrônicos. Resultados: O nosso estudo incluiu 134 casos. Os motivos de encaminhamento mais frequentes foram intoxicação por monóxido de carbono (n=59) e surdez súbita neurossensorial (n=41). Em 75 casos (56%) o tratamento foi iniciado em contexto de urgência. Os sintomas de apresentação à admissão variaram entre os diferentes casos, sendo os mais frequentes cefaleias e náuseas/vômitos. No que diz respeito à intoxicação por monóxido de carbono, as fontes mais comuns foram o aquecedor, lareira/braseiro e caldeira. Com relação aos efeitos adversos, foram identificados um caso de intoxicação por oxigênio e quatro casos de barotrauma do ouvido médio. Conclusões: A causa mais frequente de encaminhamento foi a intoxicação por monóxido de carbono. Todos os pacientes evoluíram favoravelmente e foram registrados poucos efeitos adversos, o que enfatiza a segurança desta terapia. Uma vez que a maioria dos pediatras pode não estar informada sobre os potenciais benefícios da oxigenoterapia hiperbárica, é de extrema importância promovê-los para que esta técnica seja cada vez mais implementada. Objetivo Métodos observacional 200 2021 Portugal eletrônicos Resultados 13 n=59 n59 n 59 (n=59 n=41. n41 n=41 . 41 (n=41) 7 56% 56 (56% urgência náuseasvômitos náuseas vômitos náuseas/vômitos aquecedor lareirabraseiro lareira braseiro caldeira adversos médio Conclusões terapia promovêlos promovê los implementada 20 202 1 n=5 n5 5 (n=5 n4 n=4 4 (n=41 (56 2 n= (n= (n=4 (5 (n (

ABSTRACT Objective: To identify and characterize the population of Pediatric patients referred to our hyperbaric oxygen therapy center. Methods: Retrospective and observational study, including pediatric patients treated with hyperbaric oxygen therapy, from 2006 to 2021, at the hyperbaric medicine reference center in the north of Portugal. Variables of interest were extracted from electronic medical records. Results: Our study included 134 patients. The most frequent reasons for referral were carbon monoxide poisoning (n=59) and sudden sensorineural hearing loss (n=41). In 75 cases (56%), treatment was initiated in an urgent context. Symptom presentation at Emergency Department varied among patients, the most frequent being headache and nausea/vomiting. Concerning carbon monoxide poisoning, the most common sources were water heater, fireplace/brazier, and boiler. Regarding adverse effects, it was identified one case of intoxication by oxygen and four cases of middle ear barotrauma. Conclusions: The most frequent cause for referral was carbon monoxide poisoning. All patients evolved favorably, with few side effects being reported, emphasizing the safety of this therapy. While most pediatricians may not be aware of the potential benefits arising with hyperbaric oxygen therapy, it is of upmost importance to promote them, so that this technique is increasingly implemented. Objective Methods 200 2021 Portugal records Results 13 n=59 n59 n 59 (n=59 n=41. n41 n=41 . 41 (n=41) 7 56%, 56 56% , (56%) context nauseavomiting nausea vomiting nausea/vomiting heater fireplacebrazier fireplace brazier fireplace/brazier boiler barotrauma Conclusions favorably reported them implemented 20 202 1 n=5 n5 5 (n=5 n4 n=4 4 (n=41 (56% 2 n= (n= (n=4 (56 (n (5 (

Resumo: A hipercalemia é uma das patologias que podem ser encontradas em ambientes de emergência, podendo colocar em risco a vida do paciente, gerando arritmias fatais. Porém, a identificação precoce através do uso do eletrocardiograma e a suspeita clínica tornam seu diagnóstico rápido e eficaz e por isso o início do tratamento é precoce. Apresentamos um caso clínico de intoxicação por citrato de potássio causando hipercalemia grave que foi diagnosticado e tratado em um dos serviços de emergência de uma clínica em Cali. É discutido como o primeiro caso deste tipo relatado na Colômbia.

Resumen : La hiperkalemia es una de las patologías que se pueden encontrar en los escenarios de urgencias, pueden poner en riesgo la vida del paciente generando arritmias fatales. No obstante, la identificación temprana mediante el electrocardiograma y la sospecha clínica hacen que su diagnóstico sea rápido y efectivo y por tal razón el inicio del tratamiento sea precoz. Presentamos un caso clínico de intoxicación por citrato de potasio causante de hiperkalemia severa que fue diagnosticado y tratado en uno de los servicios de urgencias de una clínica de Cali. Se presenta como el primer caso reportado en Colombia de este tipo.

Abstract: Hyperkalemia is one of the pathologies that can be found in emergency settings, and can put the patient's life at risk by generating fatal arrhythmias. However, early identification through the use of electrocardiogram and clinical suspicion make its diagnosis fast and effective and therefore the start of treatment is early. We present a clinical case of potassium citrate poisoning causing severe hyperkalemia that was diagnosed and treated in one of the emergency services of a clinic in Cali. It is discussed as the first reported case of this type in Colombia.

Abstract Background: Healthcare-associated infections are a prevalent issue in health systems that affect everyone. The incidence and prevalence of healthcare-associated infections depend on the context in which they occur. An example of this is ventilator-associated pneumonia in intensive care units. Objective: To analyze the determinants of ventilator-associated pneumonia in an intensive care unit of a central hospital in northern Portugal. Methodology: A retrospective, descriptive-correlational quantitative study was conducted with 705 patients admitted to the ICU of the hospital under investigation. Results: The results show that male gender, previous antibiotic use, endotracheal reintubation, level of consciousness, cuff pressure, ventilation time, injury, poisoning, and certain other consequences of external causes as admitting diagnosis are among the determinants of ventilator-associated pneumonia. Moreover, the incidence of ventilator-associated pneumonia was of 4.5%. Conclusion: The study recommends the judicious use of antibiotics, limiting the duration of invasive ventilation, implementing ventilator weaning protocols, and auditing compliance with the care bundle for ventilator-associated pneumonia. This study sheds light on the prevention of ventilator-associated pneumonia and its recommendations contribute to better care and more effective and safer nursing interventions.

Resumo Enquadramento: As infeções associadas aos cuidados de saúde (IACS) são uma problemática atual dos sistemas de saúde variando a sua incidência, prevalência do contexto de cuidados. A pneumonia associada à ventilação (PAV) é disso um exemplo ocorrendo em unidades de cuidados intensivos (UCI). Objetivo: Analisar determinantes da PAV, em doentes internados numa UCI de um hospital central do norte de Portugal. Metodologia: Estudo descritivo-correlacional e retrospetivo, com base nos registos de 705 doentes internados na UCI. Resultados: Constituíram-se determinantes da PAV o sexo masculino, tratamento prévio com antibiótico, reintubação endotraqueal, nível de consciência, pressão de cuff, tempo de ventilação, diagnóstico de entrada lesões, envenenamento e algumas outras consequências de causas externas. A incidência de PAV foi de 4,5%. Conclusão: O uso criterioso de antibióticos, o menor tempo possível de ventilação invasiva, a implementação de protocolos de desmame ventilatório e auditorias ao cumprimento da bundle da PAV podem contribuir para melhores cuidados e intervenções de enfermagem mais eficazes e seguras.

Resumen Marco contextual: Las infecciones asociadas a los cuidados sanitarios (IACS) son un problema actual en los sistemas sanitarios, y su incidencia y prevalencia varían en función del entorno asistencial. Un ejemplo de ello es la neumonía asociada a la ventilación mecánica (PAV), que se da en las unidades de cuidados intensivos (UCI). Objetivo: Analizar los determinantes de la PAV en pacientes ingresados en la UCI de un hospital central del norte de Portugal. Metodología: Estudio descriptivo-correlacional y retrospectivo, basado en los registros de 705 pacientes ingresados en la UCI. Resultados: Los factores determinantes de la PAV fueron el sexo masculino, el tratamiento antibiótico previo, la reintubación endotraqueal, el nivel de consciencia, la presión del manguito, el tiempo de ventilación, el diagnóstico de entrada de lesiones, la intoxicación y algunas otras consecuencias de causas externas. La incidencia de PAV fue del 4,5%. Conclusión: El uso prudente de antibióticos, el menor tiempo posible de ventilación invasiva, la aplicación de protocolos de destete del ventilador y las auditorías de cumplimiento del paquete de PAV pueden contribuir a mejorar los cuidados y a que las intervenciones de enfermería sean más eficaces y seguras.

ABSTRACT In order to describe the incidence rates per 100 000 population of foodborne disease (FBD) cases during the period 2015-2020 in Ecuador, we carried out a secondary analysis of epidemiological surveillance records and population projections from the National Institute of Statistics and Census. A total of 113,695 cases were reported with an incidence of more than 100 cases per 100 000 population (2015-2019). In 2020, the records are considerably lower than those reported in previous years. Most cases were reported as “other food poisoning”. The highest incidence rates of FBD were found in the Amazon region. In general, there is a marked annual variability in the incidence of FBD according to the geographic regions of Ecuador. In conclusion, FBD represent a public health problem in Ecuador. Comprehensive preventive strategies should be designed with special emphasis on the Amazon region.

RESUMEN Con el objetivo de describir las tasas de incidencia por cada 100 000 habitantes de los casos de enfermedades transmitidas por alimentos (ETA) durante el periodo 2015-2020 en Ecuador se realizó un análisis secundario de los registros de vigilancia epidemiológica y de las proyecciones poblacionales del Instituto Nacional de Estadística y Censos. Se reportaron 113 695 casos con una incidencia superior a los 100 casos por cada 100 000 habitantes (2015-2019). En el 2020 los registros son considerablemente inferiores a los reportes de años anteriores. La mayoría de los casos se reportaron como «otras intoxicaciones alimentarias». Las tasas de incidencia de ETA más altas se observaron en la región amazónica. En general existe una marcada variabilidad anual en la incidencia de las ETA según las regiones geográficas del Ecuador. En conclusión, las ETA representan un problema de salud pública en el Ecuador. Se deben diseñar estrategias preventivas integrales con especial énfasis en la región amazónica.

Resumen Los hongos con amatoxinas son los que generan la mayor cantidad de intoxicaciones mortales por mice tismo en el planeta. Estas toxinas son producidas no solo por las especies de Amanita, como la muy conocida Amanita phalloides, sino también por otros géneros, entre los que se encuentra Lepiota. En este trabajo se expone el tratamiento de un paciente de 51 años con un peso de 79 kg, derivado al hospital luego de 36 h de haber ingerido hongos, los cuales fueron identificados como Lepiota brunneoincarnata, en nuestro conocimiento una especie hallada por primera vez en la Argentina. El paciente presentaba malestar general, con náuseas y repetidos vómitos acompañados de dolor abdominal y diarrea. Gracias a una rápida anamnesis e identificación aproximada y temprana del hongo se le colocó sonda nasogástrica y se suministró carbón activado seriado. Además de N-acetilcisteína, fitomenadiona y penicilina G EV. El paciente fue dado de alta a los 11 días de su ingreso. Este caso realza la importancia de obtener una anamnesis correcta y suficiente sobre hongos, poder rea lizar un rápido análisis de ellos e iniciar un tratamiento oportuno de la intoxicación. Queda demostrado, una vez más, la importancia de tener Centros de Información y Asesoramiento Toxicológico (CIAT) con experiencia y conocimiento de micetismos.

Abstract Mushrooms containing amatoxins generate the high est number of fatal mycete poisonings on the planet. These toxins are produced not only by Amanita species, such as the well-known Amanita phalloides, but also by other genera, including Lepiota. In this work we report the treatment of a 51-year-old male patient weighing 79 kg who was referred to the hospital after 36 h of ingesting mushrooms. The mushrooms were identified as Lepiota brunneoincarnata, found for the first time in Argentina. The patient presented general malaise, nausea and repeated vomiting, abdominal pain, and diarrhea. Thanks to a quick anamnesis and early and accurate identifica tion of the fungus, he was administered a nasogastric tube and serial activated charcoal. Additionally, N-ace tylcysteine, phytomenadione and penicillin G EV were administered. The patient was discharged 11 days after admission. This case highlights the importance of obtain ing a correct and sufficient anamnesis on fungi, enabling rapid analysis of them, and initiation of timely treatment for intoxication. Once again, the importance of having Toxicological Information and Advice Centers (CIAT) with experience and knowledge of micetisms is demonstrated.

Resumen El paracetamol es una droga analgésica y antipiré tica comúnmente utilizada, que ha experimentado un aumento en su consumo en los últimos años en nuestro medio. También se ha observado un incremento en el número de sobredosis accidentales e intencionales que fueron atendidas por el sistema de salud. Su toxicidad es dosis dependiente y puede causar falla hepática fulminante, convirtiéndose en una de las principales razones de trasplante hepático en países angloparlan tes. Se presenta el caso de una mujer de 28 años con antecedentes de depresión mayor y cinco intentos de suicidio previos, quien ingirió deliberadamente una cantidad significativa de comprimidos de paracetamol. Desarrolló una falla hepática fulminante y acidosis metabólica, por lo que fue sometida a un trasplante hepático de emergencia debido a la gravedad de su condición evolucionando favorablemente. La decisión de realizar un trasplante hepático en casos graves como este y bajo una condición de vulnerabilidad psiquiátrica grave, es un desafío y debe considerarse cuidadosamente. Este caso en particular ilustra la im portancia de la atención multidisciplinaria incluyendo la evaluación psiquiátrica en pacientes con intoxicación por paracetamol.

Abstract Acetaminophen is a commonly used analgesic and antipyretic drug, which has experienced an increase in its consumption in recent years in our environment. There has also been an increase in the number of accidental and intentional overdoses that were treated by the health system. Its toxicity is dose-dependent and can cause ful minant liver failure, becoming one of the main reasons for liver transplantation in English-speaking countries. The case of a 28-year-old woman with a history of major depression and five previous suicide attempts, who de liberately ingested a significant amount of paracetamol tablets, is here presented. She developed fulminant liver failure and metabolic acidosis, for which she underwent an emergency liver transplant due to the severity of her condition, from which she evolved favorably. The decision to perform a liver transplant in serious cases like this and under a condition of severe psychiatric vulnerability is challenging and must be carefully considered. This particular case illustrates the importance of multidisci plinary care including psychiatric evaluation in patients with acetaminophen poisoning.

Drug poisoning is an important area of study in South Africa as a treatable cause of mortality. While research has been conducted on poisoning, there is a paucity of literature on the availability of antidotes in South Africa. The objectives of this study were to assess the availability of antidotes in selected teaching hospitals in the Southern Gauteng City-Region and to explore doctors' experiences of antidote supply. The availability of antidotes in the emergency departments (EDs) and pharmacies was assessed and recorded using a data sheet that was completed in person at each of the teaching hospitals. A questionnaire exploring experiences of antidote supply was distributed to 126 doctors working in the EDs. Our results indicate that N-acetylcysteine, atropine, diazepam, clonazepam, sodium bicarbonate, vitamin K, calcium gluconate, naloxone, ethanol, and pyridoxine were present in all EDs; activated charcoal was present in 80%; lorazepam, glycopyrrolate, and calcium chloride in 60%; freeze-dried plasma in 40%; glucagon and desferrioxamine in 20%; and fresh frozen plasma, hydroxocobalamin, sodium nitrite, sodium thiosulfate, sodium calcium edetate, and intralipid were not present in any of the EDs. Doctors reported organophosphate poisoning and paracetamol overdose as the most common drug poisonings (81.7% and 14.3% of 126 respondents, respectively). Most doctors experienced no supply issues for N-acetylcysteine, calcium gluconate, sodium bicarbonate, or pyridoxine (85.7%, 83.3%, 87.3%, and 75.4% of 126 respondents, respectively). The antidotes to the most common poisonings reported by doctors were present in all EDs. However, concerns were raised about consistency of supply, which will be an important avenue for further research. SIGNIFICANCE: • These findings highlight the lack of uniform availability of antidotes to common and critical drug poisonings in emergency departments. • The experiences of doctors in Gauteng concerning the most commonly encountered poisonings contrast with existing literature from South Africa, suggesting regional differences within the country.

Abstract Introduction: Staphylococcus aureus is a Gram-positive bacterium producing staphylococcal enterotoxins, responsible worldwide for outbreaks of staphylococcal poisoning. Objective: To determine the genotypification and prevalence of enterotoxigenic Staphylococcus aureus type B, C, D, and E in nasopharyngeal smears of food-handlers. Material and method: Nasopharyngeal samples were obtained of 100 food-handlers from food services of Chillán city, after signing informed consent, the samples were transported to 4 ° C, and then inoculated for 48 hours at 37 ° C in Baird Parker Agar plates. After the confirmatory tests of catalase and coagulase for Staphylococcus aureus, DNA extraction and subsequent molecular identification of enterotoxin type B, C, D, and E were performed by means of conventional PCR amplification. Results: The 38% of the sample was positive by Staphylococcus aureus. Of the total carriers of the bacteria, it was identified that 28.9% produced enterotoxin type B and 7.9% produced type E enterotoxin, of this 2.6% were producers of both enterotoxins. The presence of enterotoxins C and D was not detected by PCR. Conclusions: The 38% of 100 the food-handlers studied carry Staphylococcus aureus, and 36,8% of them produce enterotoxins B and E, representing 14% of the total group of study. Our observation suggests the necessity of strict protocols of food manipulation to prevent contamination of food with S. aureus.

Resumen Introducción: Staphylococcus aureus es una bacteria Gram positiva productora enterotoxinas estafilocócicas, responsables a nivel mundial de brotes por intoxicación estafilocócica. Objetivo: Determinar la genotipificación y prevalencia de Staphylococcus aureus enterotoxigénico tipo B, C, D y E en frotis nasofaríngeos de manipuladores de alimentos de Chile. Material y método: Este estudio se realizó en una muestra de 100 manipuladores de alimentos de servicios de alimentación de Chillán. Realizando en una primera etapa, previa firma de consentimiento informado, muestreo nasofaríngeo en los lugares de trabajo. Las muestras se trasladaron a 4°C, para luego ser inoculadas por 48 horas a 37 °C en placas Agar Baird Parker. Posterior a las pruebas confirmativas de catalasa y coagulasa para Staphylococcus aureus, se realizó extracción de ADN y posterior identificación molecular de enterotoxina tipo B, C, D y E, mediante la amplificación por PCR convencional. Resultados: El 38% de la muestra estaba colonizada por Staphylococcus aureus. Del total de portadores de la bacteria se identificó que el 28,9% producían la enterotoxina tipo B y el 7,9% producían la enterotoxina tipo E, de estos un 2,6% era productor de ambas enterotoxinas. No se detectó presencia de las enterotoxinas C y D. Conclusiones: El 38% de los 100 manipuladores de alimentos de servicios de alimentación estudiados es portador de Staphylococcus aureus, y 36,8% de estos producen enterotoxinas B y E, representando un 14% del grupo total de estudio.

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.

ABSTRACT 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.

RESUMEN 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.

Resumen Introducción: El lavado gástrico implica la eliminación de sustancias potencialmente tóxicas del estómago antes de que sean absorbidas sistémicamente. Apesar de su uso generalizado, el lavado gástrico aún carece de consenso entre la comunidad clínica y científica. Objetivo: Identificar y mapear la evidencia científica disponible sobre el lavado gástrico en personas que sufren intoxicación aguda. Métodos: La revisión siguió la metodología JBI para revisiones de alcance y se llevó a cabo según la lista de verificación PRISMA-ScR. Consideramos estudios que involucraban a individuos adultos, víctimas de intoxicación, sometidos a lavado gástrico en entornos intra o extrahospitalarios. Se incluyeron estudios en inglés, francés, español y portugués. La selección de estudios fue realizada por dos revisores independientes, con un tercer revisor en caso de desacuerdo. Resultados: Después del proceso de selección, se incluyeron 10 artículos. El lavado gástrico se realiza instilando 300 ml de solución salina/agua a través de un catéter nasogástrico con la posterior eliminación de todo el contenido gástrico. El lavado gástrico debe realizarse dentro de la primera hora después de la intoxicación; más allá de este límite temporal, no es beneficioso, excepto en casos de intoxicación por antidepresivos tricíclicos. Existes otros métodos de descontaminación, como el carbón activado (mayor eficacia) y el jarabe de ipecacuana (eficacia similar). Conclusión: Se ha demostrado que el lavado gástrico es un procedimiento que debe aplicarse en circunstancias muy concretas y que debe tener en cuenta aspectos como el momento de la contaminación, la persona y su estado clínico. También deben considerarse otros procedimientos, que pueden ser más eficaces y menos arriesgados para la persona intoxicada.

Resumo Introdução: A lavagem gástrica consiste na remoção de substâncias potencialmente tóxicas do estômago antes que sejam absorvidas sistemicamente. Apesar da sua larga utilização, a lavagem gástrica continua a não reunir consenso junto da comunidade clínica e científica. Objetivo: Identificar e mapear a evidência científica disponível acerca da lavagem gástrica à pessoa vítima de intoxicação aguda. Métodos: A revisão regeu-se pela JBI methodology for scoping reviews e foi elaborada segundo a checklist PRISMA-ScR. Consideramos estudos que incluíssem indivíduos em idade adulta, vítimas de intoxicação, submetidos a lavagem gástrica em contextos intra ou extra-hospitalares. Abrangemos estudos em inglês, francês, espanhol e português. A seleção dos estudos foi realizada por dois revisores independentes, utilizando um terceiro revisor em caso de discordância. Resultados: Após o processo de seleção, foram incluídos 10 artigos. A lavagem gástrica realiza-se instilando 300mL de solução salina/ água potável, através de um cateter nasogástrico com posterior remoção de todo o conteúdo gástrico. A lavagem gástrica deve ser executada durante a primeira hora após intoxicação, posteriormente a esse limite temporal, é despromovida de benefícios, exceto em intoxicações por antidepressivos tricíclicos. Existem outros métodos de descontaminação, como o carvão ativado (maior eficácia) e o xarope de ipeca (eficácia semelhante). Conclusão: A lavagem gástrica revelou ser um procedimento que deve ser implementado em circunstâncias muito específicas e deve ter em conta aspetos como o tempo da contaminação, pessoa e condição clínica. Deverão ser considerados, também, outros procedimentos, que podem apresentar maior eficácia e menores riscos para a pessoa intoxicada.

Abstract Introduction: Gastric lavage involves the removal of potentially toxic substances from the stomach before they are systemically absorbed. Despite its widespread use, gastric lavage still lacks consensus among the clinical and scientific community. Objective: To identify and map the available scientific evidence regarding gastric lavage in individuals suffering from acute poisoning. Methods: The review followed the JBI methodology for scoping reviews and was conducted according to the PRISMA-ScR checklist. We considered studies involving adult individuals, victims of poisoning, undergoing gastric lavage in intra or extra-hospital settings. Studies in English, French, Spanish, and Portuguese were included. Study selection was performed by two independent reviewers, with a third reviewer in case of disagreement. Results: After the selection process, 10 articles were included. Gastric lavage is performed by instilling 300mL of saline/water through a nasogastric catheter with subsequent removal of all gastric contents. Gastric lavage should be performed within the first hour after poisoning; beyond this time limit, it is not beneficial, except in cases of tricyclic antidepressant poisoning. Other decontamination methods, such as activated charcoal (greater efficacy) and ipecac syrup (similar efficacy), exist. Conclusion: Gastric lavage has been shown to be a procedure that should be applied in very specific circumstances and should take into account aspects such as the time of contamination, the person and their clinical condition. Other procedures should also be considered, which may be more effective and less risky for the poisoned person.

RESUMEN Introducción: Las enfermedades infecciosas intestinales (diarrea) son una causa importante de morbilidad y mortalidad a nivel mundial. En 2015, constituyeron la novena causa principal de muerte para todas las edades. Objetivo: describir las características epidemiológicas de la mortalidad por enfermedades infecciosas intestinales (diarreas) en Paraguay durante los años 2015 al 2019. Metodología: Estudio descriptivo, ecológico, transversal, retrospectivo, muestreo no probabilístico de casos consecutivos. Se consideraron los óbitos del CIE - 10, que incluyen al cólera (A01), fiebres tifoidea y paratifoidea (A01), shigelosis (A03), otras infecciones intestinales bacterianas (A04), otras intoxicaciones alimentarias bacterianas (A05), amebiasis (A06), otras enfermedades intestinales debidas a protozoarios (A07), infecciones intestinales debidas a virus (A08) y diarrea y gastroenteritis de presunto origen infeccioso (A09). Se utilizaron datos de acceso abierto de la página WEB de la Dirección General de Información Estratégica en Salud del MSP y BS de todos los Departamentos del país. Se calcularon tasas crudas y ajustadas (por 100.000 habitantes). Se utilizaron Excel y EPI INFO 7.0. Resultados: Se registraron 495 muertes, la mayor prevalencia fue en 2019 (tasa ajustada de 1,83) y menor en 2017 (1,36). Los meses con mayor mortalidad fueron enero y julio (9,9%). El 51,72% fueron mujeres (256), 30,91% mayores de 80 años y 28,28% (140) menores de 5 años, edad promedio 50,8, solteros 56,77% (281) y sin ningún tipo de educación 41,82% (207). El 80,61% (399) residía en área urbana. Las mayores tasas se registraron en Boquerón (33,3) y Amambay (15,2). El 95,56% (473) fueron diarreas y gastroenteritis de origen infeccioso. Discusión: Se registra alto porcentaje de mortalidad de diarreas de origen infeccioso. Los extremos de la vida constituyen la población más vulnerable.

ABSTRACT Introduction: Infectious intestinal diseases (diarrhea) are a major cause of morbidity and mortality worldwide. In 2015, it constituted the ninth leading cause of death for all ages. Objective: To describe the epidemiological characteristics of mortality due to infectious intestinal diseases (diarrhea) in Paraguay from 2015 to 2019. Methods: Descriptive, ecological, cross-sectional, retrospective, and non-probabilistic sampling of consecutive cases was performed. ICD-10 deaths included cholera (A01), typhoid and paratyphoid fever (A01), shigellosis (A03), other bacterial intestinal infections (A04), other bacterial food poisoning (A05), amebiasis (A06), other intestinal diseases due to protozoa (A07), intestinal infections due to viruses (A08), and diarrhea and gastroenteritis of presumed infectious origin (A09). Open access data were obtained from the WEB page of the General Directorate of Strategic Information in Health of the MSP and BS of all the Departments of the country. Crude and adjusted rates (per 100,000 inhabitants) were calculated. Excel and EPI INFO 7.0 were used. Results: 495 deaths were registered; the highest prevalence was in 2019 (adjusted rate of 1.83) and the lowest in 2017 (1.36). The months with the highest mortality rates were January and July (9.9%). 51.72% were women (256), 30.91% were over 80 years old and 28.28% (140) were under 5 years old, average age 50.8, single 56.77% (281) and without any type of education 41.82% (207). A total of 80.61% (399) of the respondents resided in urban areas. The highest rates were registered in Boquerón (33.3) and Amambay (15.2). Diarrhea and gastroenteritis of infectious origin accounted for 95.56% of the cases (473). Discussion: There was a high percentage of mortality from infectious diarrhea. Extremes of life were the most vulnerable populations.

Abstract In the county of Pedra Lavrada - PB, various mineral occurrences of pegmatite are observed with prominence at Alto Dois Irmãos - PB, where quartz, feldspar and mica are mined. The understanding of mineral constituents is fundamental to define their industrial employment and to implement improvements in the beneficiation process. The proposal of this research is the detailed characterization and proof of that part of the ore (quartz) considered waste, presenting low poisoning (Fe2O3) and high silica (SiO2) content, to enable its industrial use. Besides that, to minimize the environmental impact through the reuse of this waste, and to determine the correct utilization of the milling equipment. For the pegmatite characterization, done were density determination tests, mineralogical identification by X-ray diffraction (XRD), chemical analysis by fluorescents X-rays and morphological analysis by scanning electron microscopy (SEM/EDS). Then tests were done for the Work Index (WI) calculous and consequently the empirical determination of the dimensions (LxD) of the pebble mill. The sterile presented a medium density of 2.66g/cm³, majority chemical composition of silicon and oxygen and quartz as the main mineralogical stage, indicating that this material has high purity. The. The Work Index (WI) was 15.9 kwh/t showing that this material can be considered resistant to breaking in the grinding process. The necessary energy to the milling was defined in 11.52 kwh/st, that corresponds to 57.28 HP. This power allowed the mill selection with diammeter and length of 1.83m, that provides the production maximization and the energy saving. PB mined process (quartz waste Fe2O3 FeO Fe O (Fe2O3 SiO2 SiO (SiO2 content use equipment Xray X ray XRD, XRD , (XRD) Xrays rays SEM/EDS. SEMEDS SEM/EDS . SEM EDS (SEM/EDS) WI (WI LxD (LxD 266gcm³ gcm 2 66g cm³ g cm 2.66g/cm³ stage purity 159 15 9 15. kwht kwh t 1152 11 52 11.5 kwhst st kwh/st 5728 57 28 57.2 HP 183m m 1 83m 1.83m saving Fe2O (Fe2O (SiO (XRD (SEM/EDS 266gcm 2.66g/cm 115 5 11. 572 57.

Resumen Introducción: La mortalidad por intoxicaciones agudas de sustancias psicoactivas representa un problema de salud pública, especialmente en personas jóvenes. El objetivo del estudio fue crear un perfil de las víctimas mortales por intoxicación aguda en Costa Rica entre los años 2012 y 2021 asociado al consumo de sustancias psicoactivas y drogas de abuso. Materiales y métodos: Se recopilaron datos de Sección de Patología Forense del Departamento de Medicina Legal en Costa Rica, con los cuales se realizó una revisión de las víctimas mortales por intoxicaciones agudas a partir del 1 de enero de 2012 hasta el 31 de diciembre de 2021. La revisión incluyó las siguientes variables: variables epidemiológicas: sexo, edad, nacionalidad, ocupación, estado civil, provincia, consumo frecuente asociado, manera de muerte, tipo de sustancia y lugar de intoxicación. Resultados: De los 456 casos de muertes asociados a intoxicaciones agudas por etanol, metanol, benzodiacepinas, anfetaminas, heroína, cocaína y mixtas; reportados entre el 1 de enero de 2012 y el 31 de diciembre de 2021: el año que más casos reportó fue 2020; 82% de las víctimas fueron hombres y 18% mujeres; las principales edades de las personas reportadas abarcan entre 41 y 60 años. 80% de las personas eran costarricenses; San José fue la provincia con mayor número de casos de intoxicación letal, siendo el domicilio el sitio más frecuente. 14% de las víctimas eran desempleadas; 77% de las personas presentaban algún trastorno de la adicción o consumo frecuente de alguna de las sustancias estudiadas. La mayoría de muertes fueron de manera accidental. Conclusiones: El perfil predominante de las víctimas fue: masculino, entre 41 y 60 años, costarricense, de estado civil indeterminado o soltero, desempleado, que muere de manera accidental, en su domicilio, por intoxicación aguda con alcohol o mixta (alcohol y cocaína).

Abstract Introduction. Mortality from acute poisoning of psychoactive substances represents a public health problem, especially in young adults. The purpose of the study was to create a profile of fatalities due to acute poisoning in Costa Rica between 2012 and 2021 associated with the consumption of psychoactive substances and drugs of abuse. Materials and methods. Data were collected from the Forensic Pathology Section of the Legal Medicine Department in Costa Rica, then a review of fatalities due to acute poisoning was carried out from January 1, 2012 to December 31, 2021. The review included the following epidemiological variables: sex, age, nationality, occupation, marital status, province, consumption associated, manner of death, type of substance, and place of intoxication. Results. Out of the 456 reported cases of deaths associated with acute intoxication with ethanol, methanol, benzodiazepines, amphetamines, heroin, cocaine, and mixed substances between January 1, 2012, and December 31, 2021: the year with the highest number of cases reported was 2020; 82% of the victims were male, and 18% were female; the main age group of reported victims ranged from 41 to 60 years old. 80% of the victims were Costa Rican, and San Jose was the province with the highest number of lethal intoxication cases, with the home being the most frequent site. 14% of the victims were unemployed, and 77% of the individuals had some addiction disorder or frequent consumption of one of the studied substances. The majority of deaths were accidental. Conclusion. The main profile of the victims was male, between 41 and 60 years old, Costa Rican, of indeterminate or single marital status, unemployed, who died accidentally, at home, due to acute intoxication with alcohol or a mixture of substances (alcohol and cocaine).

ABSTRACT We present a case of a 69-year-old man who presented for routine check-up and was incidentally found to have kidney failure with an initially unrevealing history and bland urinary sediment. He was diagnosed with oxalate nephropathy in the setting of chronic turmeric supplementation and chronic antibiotic therapy with associated diarrhea. Our case provides several key insights into oxalate nephropathy. First, the diagnosis requires a high index of clinical suspicion. It is uncommonly suspected clinically unless there is an obvious clue in the history such as Roux-en-Y gastric bypass or ethylene glycol poisoning. Diagnosis can be confirmed by histopathologic findings and corroborated by serum levels of oxalate and 24-hour urinary excretion. Second, the diagnosis can often be missed by the pathologist because of the characteristics of the crystals unless the renal pathologist has made it a rule to examine routinely all H&E sections under polarized light. This must be done on H&E, as the other stains dissolve the crystals. Third, one oxalate crystal in a routine needle biopsy is considered pathologic and potentially contributing to the AKI or to the CKD in an important way. Fourth, secondary oxalosis can be largely mitigated or prevented in many cases, especially iatrogenic cases. This can come through the surgeon or the gastroenterologist providing proper instructions to patients on an oxalate-restricted diet or other specific dietary measures. Lastly, this case highlights the success that results from cooperation and communication between the pathologist and the treating physician. 69yearold yearold 69 year old checkup check up sediment diarrhea First suspicion RouxenY Roux en Y poisoning 24hour hour 24 excretion Second HE H E light Third way Fourth cases oxalaterestricted restricted measures Lastly physician 6 2

RESUMO Relatamos o caso de um homem de 69 anos que se apresentou para exame de rotina e descobriu-se incidentalmente que ele tinha insuficiência renal, com histórico inicialmente não revelador e sedimento urinário brando. Ele foi diagnosticado com nefropatia por oxalato no contexto de suplementação crônica de cúrcuma e antibioticoterapia crônica com diarreia associada. Nosso caso fornece diversas sugestões importantes sobre nefropatia por oxalato. Primeiro, o diagnóstico requer elevado índice de suspeita clínica. A suspeita clínica é incomum, a menos que haja evidência óbvia no histórico, como bypass gástrico em Y de Roux ou envenenamento por etilenoglicol. O diagnóstico pode ser confirmado por achados histopatológicos e corroborado por níveis séricos de oxalato e excreção urinária de 24 horas. Segundo, o diagnóstico pode passar despercebido pelo patologista devido às características dos cristais, a menos que o patologista renal estabeleça como regra examinar rotineiramente todas as seções coradas com H&E sob luz polarizada. Isso deve ser feito com H&E, pois, outras colorações dissolvem os cristais. Em terceiro lugar, um cristal de oxalato em biópsia por agulha de rotina é considerado patológico, contribuindo potencialmente para LRA ou para DRC de maneira significativa. Em quarto lugar, a oxalose secundária pode ser amplamente mitigada ou prevenida em muitos casos, especialmente casos iatrogênicos. Isso pode ser feito pelo cirurgião ou pelo gastroenterologista, fornecendo instruções adequadas aos pacientes sobre uma dieta restrita em oxalato ou outras medidas dietéticas específicas. Por fim, esse caso destaca o sucesso que resulta da cooperação e comunicação entre o patologista e o médico assistente. 6 descobriuse descobriu brando associada Primeiro incomum etilenoglicol 2 horas Segundo cristais HE H E polarizada pois lugar patológico significativa iatrogênicos gastroenterologista específicas fim assistente