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SAN COSME Y SAN DAMIAN. HERMANOS MÁRTIRES: MÉDICOFARMACÉUTICO (300 AD- DIOCLECIANO), FESTIVIDAD 26 DE SEPTIEMBRE


Dr. Profesor Siegbert Holz Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level


Mary Kellerman (12), 1982


POISONING KILLS MORE THAN CAR CRASHES- N.BAKALAR. NYT.DEC 26,2011

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HERBICIDA MORTAL

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HASHT-BEHESHT PALACE ISFAHAN 1669

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CDCI- RAZÓN DE SER I-B: HLMTDr. H.Campos: CGI: 2657 Ps Intoxicaciones por Medicamentos: 45%/ No Medicamentos: 55% Medicamentos: SNC (23%): Alcohol/ Bs/ DPH/ CMZ/ BDZ/ ADTs (75%) Anticolinérgicos (8%)/Analgésicos (2%)/Ds Ilícitas (10%)/Otros:2 % Agentes NO medicamentos: Plaguicidas: OP/OCl/Rat./Paraquat (25%) Envenenamiento animal: Mordeduras, Picaduras (15%) Productos de Uso Doméstico (10%)/ OTROS: 5% Casuística: 47.4% (niños< 10a)/ 33% (< 5a ). En NIÑOS: Meds SNC, Escorpionismo y Ps de Uso Doméstico son la tríada preponderante Mortalidad general (0.4%): 33% NIÑOS < 7a / 95% de los CASOS Corresponden a ACIDENTES EN EL HOGAR


ESCORPIONISMO EN EL EMBARAZO : Hospital E.M.T.


CDCI: RAZÓN DE SER II: OMS-UN OMS (WHO): SALUD PARA TODOS EN EL MILENIO 2000: “Cada persona debe tener acceso a la información relevante sobre cómo lidiar y prevenir las INTOXICACIONES. Los Centros de Información Toxicológica proporcionan tal Información y son parte esencial de un país para garantizar la seguridad sobre el manejo de agentes químicos de variada naturaleza” UN: CONFERENCIA SOBRE AMBIENTE Y DESARROLLO: Solicita a los Países la Promoción de Centros de Información Toxicológica con facilidades Analíticas (CDCI-Fase III) para asegurar un diagnóstico y tratamiento expedito y adecuado de las intoxicaciones, incluyendo REDES para responder ante las EMERGENCIAS QUÍMICAS ALMA ATA- 1978 JICA (JAPAN INTERNATIONAL COOPERATION AGENCY)


Educación Médica Internacional: FEPAFEM IIME WFME UNIVERSITY OF GRONINGEN PPulido et al. Changes, trends and challenges of medical education in Latin America Medical Teacher, Vol. 28, No. 1, 2005, 1–6

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Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level DRUG OFFENCES AND DIALOG UE AND TRAINING DRUG PROBLEMS HAVE BECOME SERIOUS ON A MASS GLOBAL SCALE DUE TO SCALATED PROBLEMS OF SYNTHESIZED DRUG AND SUBTLETY OF SMUGGLING BY INTERNATIONAL DRUG CRIME ORGANIZATIONS. MOSTLY OF SUPPLIED SOURCES OF DRUGS ARE LOCATED IN DEVELOPING COUNTRIES AND POVERTY IS ONE OF THE BACKGROUND FACTORS JICA OPERATIONS SINCE 1974: CONVICTION THAT “CAPACITY DEVELOPMENT” IS CENTRAL TO THE SOCIOECONOMIC DEVELOPMENT OF ANY COUNTRY AT THE CORE OF THIS PROCESS WAS THE “ADOPT AND ADAPT” CONCEPT MOST OF THE KNOW - HOW THAT HAS ENABLED JAPAN TO BECOME WHAT IT IS TODAY HAS EMANATED FROM THIS “ADOPTION AND ADAPTATION” PROCESS , WHICH OF COURSE HAS BEEN ACCOMPANIED BY COUNTLESS FAILURES AND ERRORS BEHIND THE SUCCESS STORIES


Consulta de Despistaje y Control de Intoxicaciones (CDCI) del Ambulatorio DocenteAsistencial (ADA) del Hospital Universitario de Caracas (HUC)


QUIENES SOMOS? Somos una Consulta de Despistaje y Control de Intoxicaciones (CDCI), Certificada, Bilingüe, cuya principal función es Servir a la Comunidad. Todas las llamadas telefónicas (fase II) son importantes, particularmente aquellas donde se involucra la sobrevivencia de una persona de cualquier edad, otorgando consejos oportunos que orienten además sobre la conveniencia o no de asistir de inmediato al puesto de emergencia más cercano, incluyendo CDCI.


OTRAS ACTIVIDADES Prevención de Accidentes Tóxicos Educación Toxicológica para la Comunidad Educación Toxicológica para los Profesionales de la Salud Otras Actividades por mandato del Sistema de CERTIFICACIÓN de CDCI


CERTIFICACIÓN? La CERTIFICACIÓN es un sistema internacional (USA y Europa) de aplicación para Venezuela, cuya meta primaria es asegurar que todos los residentes de la Región Capital tengan acceso inmediato a los servicios de una Consulta de Despistaje y Control de Intoxicaciones (CDCI) de la más alta calidad. Los criterios de certificación además de los señalados en D-3 son: PROGRAMA DE PROTOCOLOS CLÍNICOS DE TOXICOLOGÍA PROGRAMA DE BANCO DE ANTÍDOTOS PROGRAMA DE BIBLIOTECA TOXICOLÓGICA: Biblioteca Clásica actualizada permanentemente y Biblioteca On Line actualizada PROGRAMA DE CONSULTA AMBULATORIA DE DESPISTAJE TOXICOLÓGICO


CERTIFICACIÓN (continuación) PROGRAMA DE BASE DE DATOS PROGRAMA DE ASESORES EXTERNOS PROGRAMA DE AUDITORÍA DE ACTIVIDADES NOTAS: Estos PROGRAMAS estructurados sobre una medicina basada en la evidencia, sin precedentes dentro del Ministerio de Salud de Venezuela, son el producto del auspicio y patrocinio de la Dirección del Hospital Universitario de Caracas y del Ambulatorio Docente Asistencial-HUC, dentro del concepto de una lucha por el cambio necesario postulado por las instituciones nacionales El reconocimiento de CDCI tendrá el sello de la Dirección de HUC


EL INTOXICADO COMO UN SISTEMA FARMACOCINÉTICA (Absorción, Distribución, Metabolismo, Excreción) Feto X

Xm X

Depósito

XD

K1

Placenta

X

D+ X

K2

X

FARMACODINAMIA (Mecanismo de acción)

Xm X

Desintegración Disolución

X

X+P

K1

[ XP ]

X+R

XR

TERAPÉUTICO

X

Riñón

SECUNDARIO INDESEABLE TÓXICO (SOBREDOSIS)

Forma farmacéutica (Tabletas) Dosis

EFECTO

K2

X, Xm Orina

LETAL

Indicaciones Advertencias Precauciones Interacciones Información al paciente


LABORATORIO TOXICOLÓGICO


Banco de AntĂ­dotos en Papel


Toxicology. 290:Issues 2–3, 18 Dec. 2011, 150–156Ben Avi Weissman, Lily Raveh. Multifunctional drugs as novel antidotes for organophosphates’ poisoning (OPs) Casali Institute of Applied Chemistry, Institute of Chemistry, The Hebrew University of Jerusalem, Jerusalem 91904, Israel. Ben.Avi@mail.huji.ac.il

Drugs that demonstrate the ability to interact with several systems (e.g., caramiphen) were found to afford a superior protection against OPs as compared to specific antimuscarinic ligands (e.g., scopolamine). Compounds that potently block muscarinic receptors, interact with the NMDA ion channel and in addition are able to modulate σ1 sites and/or GABAergic transmission seem to represent the emerging backbone for novel antidotes against OP poisoning. Several multifunctional drugs are already used for complex diseases e.g., cancer and depression.


Marihuana HĂ­brida


At the Sweet Relief Collective, a Medical marijuana dispensary in Oildale, Calif., Lora Manlugot helped Caydee Shelton, center, with a selection.


BLACK MARKET PESTICIDES: TEMPO, TRES PASITOS, CHINESE CHALK

For years, one of the most popular black market products from China was a stick of chalk loaded with insecticides, including the chemical deltamethrin.

Known as Chinese Chalk or Miraculous Chalk, it was used to draw a line along a wall or around a piece of furniture, like a bed or a kitchen table. Insects would die when they touched the line.

The arrests of several vendors in the city, and a public education campaign warning of the chalk’s dangers, apparently chilled the market. Professional exterminators say customers no longer request the product as often as they used to.

“Tres pasitos” contains the powerfull ALDICARB (Dominican Republic)


Cannabis and the increased incidence and persistence of psychosis - BMJ 2011


Marihuana SintĂŠtica Comercial


Marihuana Natural y SintĂŠtica


Medical Marijuana Industry Is Unnerved by U.S. Crackdown: 24-11-2011

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MARIHUANA EN BRONX N.Y. 02-02-12


http://www.webmd.com/parenting/news/20111213/accidental-drug-overdoses-on-rise-among-kids

CDC – AAPCC Blog, February 04-2012

CDC Reports Increase In Accidental Childhood Overdoses In US. "Even with improvements to packaging, no medication package can be 100% childproof," Richard Dart, MD, PhD. president of the American Association of Poison Control Centers –


Intravenous Acetaminophen in the United States: Iatrogenic Dosing Errors Richard C. Dart, MD, PhDa,b and Barry H. Rumack, MD

PEDIATRICS 2012

An intravenous formulation of acetaminophen was introduced to the United States in 2011. Experience from Europe indicates that serious dosing errors are likely to occur. Most events have involved a 10-fold dosing error in small children caused by calculating the dosage in milligrams, but then administering the solution in milliliters. The solution is 10 mg/mL; therefore, a 10-fold overdose occurs. Evaluation of overdose with the intravenous formulation is similar to oral overdose. A serum acetaminophen concentration should be drawn 4 hours after the infusion was started or as soon thereafter as possible. If the serum acetaminophen concentration plots above the treatment line on the RumackMatthew nomogram, treatment with acetylcysteine should be initiated. Health care providers are encouraged to contact their regional poison center (1-800-222-1222) so that dosing errors will be reported, and the experience with this new product can be accumulated.


Rumack-Matthew ACETAMINOPHEN overdose nomogram

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GENERIC DRUGS PROVE RESISTANT TO DAMAGE SUITS PROMETHAZINE (PHENERGAN®): CASES OF GANGRENE; ACCUTANE: U. COLITIS –

“FDA: revision of labeling for promethazine, including addition of a BOX WARNING, including the risk of gangrene, requiring amputation following IV administration”.

“CLINICAL CASES: DS : E.R. IV of Promethazine (hand) DL: IV injection of Phenergan®

Gangrene/amputation

Gangrene/amputation (hand and

forearm)”

CB (18): since 12 began taken the generic version of the entiacne drug ACCUTANE and developed U. Colitis and she had to have her large intestine removed. Now: CB has been transformed from a talented softball athlete to someone who will struggle with a debilitating physical challenges for the rest of her life”.

¿ ?: Que sucede en un pais LA donde se usan con autorización del Ministerio de Salud y de la Presidencia de la República productos farmacéuticos genéricos y patentados sin control sanitario sobre eficacia


Contrabando de medicinas ilegales UNODC/OMS-I http://www.unodc.org/unodc/en/press/releases/2011/May/not-whatthe-doctor-ordered-the-growing-linkages-between-fraudulentmedicines-and-organized-crime.html Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level


Contrabando de medicinas ilegales UNODC/OMS-II La UNODC informa por medio de OMS (Mayo, 2011): 3-10 productos farmacéuticos de los mercados combinados de Asia, África y Latinoamérica están siendo falsificados.

50-60% de los antiinfecciosos analizados en partes de Asia y África contienen ingredientes fuera de límites aceptables.

Estos falsos productos matan indiscriminadamente, deprivan a los pobres de medicinas salvadoras y causan muertes incontables.

Estas medicinas fraudulentas ofrecen a grupos criminales organizados mercancías de alto retorno con relativamente bajo riesgo

DISTRIBUCIÓN: medicinas falsas en regiones con marcos legales y regulatorios sometidos a políticas internacionales que siguen acuerdos que violan leyes sanitarias que una vez fueron respetuosas de la salud pública nacional.


AMERICAN HEPARIN CHINESE MADE

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Doctor Is Accused of Selling Prescriptions


Catherine Chung et al. Characteristic purpura of the ears, vasculitis, and neutropenia–a potential public health epidemic associated with levamisole-adulterated cocaine. JAAD. 2010 http://www.eblue.org/article/S0190-9622(10)00992-8/abstract

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+


DIOXINA Y VIKTOR YUSHCHENKO, 2004


Alexander Litvinenko- Polonium-210, 2006


BATH SALTS http://aapcc.wordpress.com/ METHYLENEDIOXYPYROVALERONE (MDPV) (Cocaine, LSD, Methamphetamine)

Hipertensi贸n, taquicardia, paranoia, alucinaciones


Smith KM . Club Drugs: Am J Health-Syst Pharm 59(11):1067– 1076, 2002. http://www.drugabuse.gov/infofacts/clubdrugs.html Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level


CDCI- RESUMEN CDCI es primariamente un Centro de Atención Toxicológica para la COMUNIDAD con ATENCIÓN TELEFÓNICA gratuita (FASE II) Adicionalmente mediante una CERTIFICACIÓN que asegura la organización de un servicio de alta calidad CDCI ejecutará PROGRAMAS de Educación, de Prevención, de Vigilancia Toxicológica, de Tratamientos de Emergencia y Triaje, de Investigación, Publicaciones, de Control de Calidad del Servicio, Base de Datos y un Sistema de Auditoría semestral programada. Organizará un Banco de Antídotos, una Biblioteca Toxicológica de acceso público y un Laboratorio de Análisis Toxicológico (Fase III) CDCI es una unidad estructural y funcional del HUC-ADA- MPPS


CDCI - BIBLIOGRAFÍA – EJEMPLO MÍNIMO - R. Gosselin et al. Clinical Toxicology of Commercial Products. W. & Wilkins, 1976 - L.Anzola. Índice Agropecuario. Ingravenca, 2001 - Martindale The Extra Pharmacopoeia. The Pharmaceutical Press, 1989 - J. Arena. Human Poisoning from Native & Cultivated Plants. Duke, 1969 - Formulario Terapéutico Nacional (FTN). MSDS-OPS-OMS, 2004 - H. Campos y L.A. Hernández. Uso Racional de los Antiinflamatorios No Esteroideos. Disinlimed, 1991 - PDR for Herbal Medicines. Medical Economics, 2000 - Crop Protection Chemical Reference. Wiley, 1986 - Haddad & Winchester’s Clinical Management of Poisoning and Drug Overdose. Elsevier, 2007 -H. Campos , N. Yafar.. Protocolos Clínicos de Toxicología. Tomo I. Enc Dn


HORACIO (Roma) – 65-8 aC

Carminum I, 11 («Carpe diem») No pretendas saber, pues no está permitido, el fin que a mí y a ti, Leucónoe, nos tienen


Goethe´s G.b (1815?)

The leaf of this Eastern tree which has become entrusted to my garden offers a feast of great significance for the edification of the initiated

Is it one living thing that has become divided within itself? Are these two who have chosen each other so that we know them as one?

I think I have found the right answer to these questions


Gyngko biloba ≈ 220 años – terpenos y lactonas

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Goethe´s poem: Ginkgo biloba, 1815

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WAGNER´S TRISTAN UND ISOLDE Before the Liebestod

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W. Weitz. LOVE AND DEATH IN WAGNER´S TRISTAN UND ISOLDE – AN EPIC ANTICHOLINERGIC CRISIS. BMJ. 2003; 327:1469

Synopsis of the symptoms caused by the love potion described by Wagner and the symptoms of an anticholinergic syndrome caused by Solanaceae:

Wagner’s description of the symptoms—Act I, scene 5: They are seized with trembling They clutch convulsively at their hearts [fast rhythm, Tristan chord] and raise their hands to their heads Then their eyes seek out one another, are cast down in confusion . . .—Tristan—bewildered [fails to recognise King Marke]: “. . .Which King?”

[Tristan chord] Isolde—confused: “. . . Where am I? Am I alive? . . .” Isolde falls on his breast, unconscious

Act II, scene 3 (a few days later) [Intolerance of light] “Oh, now we were dedicated to night! Spiteful day with ready envy could part us with his tricks . . .” [Cluster of Tristan chords]

Act III, scene 3 (a few weeks later) (“Liebestod”) Isolde, aware of nothing round about her, fixes her gaze with mounting ecstasy upon Tristan’s body: “How softly and gently he smiles, how sweetly his eyes open—can you see it my friends, do you not see it? . . .Do I alone hear this melody, so wondrously and gently. . .”—

Isolde dies [Tristan chord]


MANUEL REPETTO 2009


ODISEA Capitulo II - Partida de Telémaco

UN PRETENDIENTE:

“Sin duda piensa Telémaco cómo darnos muerte : Traera veladores de la

arenosa Pilos o de Esparta , y tan vehemente es su deseo!, o quizás intente ir

a la fértil tierra de Efira para llevarse DROGAS mortíferas y echarlas luego en

la cratera (del vino) , a fin de acabar con todos nosotros”.


CRĂ TERA con vino imaginario y sabroso: SALUD!


CON OTOÑOS DE ORO LO INVENTARON…EL VINO FLUYE ROJO A TRAVÉS DE LAS EGENERACIONES


RALPH WALDO EMERSON 1803-1882, USA

“TOBACCO, COFFEE, ALCOHOL, HASHISH, PRUSSIC ACID STRICNINE, ARE WEAK DILUTIONS: THE SUREST POISON IS TIME”


http://www.cell.com/neuron/fulltext/S08966273(11)00075-4 Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level


http://drugfactsweek.drugabuse.gov/files/teenbroc hure_508.pdf - NIDA- 2011Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level


UDCI-LLAMADA TELEFÓNICA


UDCI-CONSULTA TOXICOLÓGICA


UDCI-MEDICAMENTOS


UDCI-DROGAS DE ABUSO


UDCI-DROGAS DE ABUSO


UDCI-DROGAS DE ABUSO


UDCI-ACCIDENTES


UDCI-PRODUCTOS DE USO DOMÉSTICO


UDCI-PLANTAS VENENOSAS


UDCI-ENVENENAMIENTO ANIMAL


Dermorphin is found on the skin of a frog called Phyllomedusa

sauvagei, commonly known as â&#x20AC;&#x153;waxy monkey tree frogâ&#x20AC;?, which is native to South America


UDCI-PLAGUICIDAS


UDCI-PLAGUICIDAS


UDCI-DESASTRES NATURALES


Buber y la Filosofía del Diálogo Click to edit Master text styles Second level ● Third level ● Fourth level ● Fifth level


http://drcampos-manualdetoxicologia.jimdo.com/

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