This survey is part of a more comprehensive study on the health consequences of pesticide exposure. In the county (municipality) of Paty do Alferes, Rio de Janeiro State, Brazil, 55 agricultural workers were interviewed on the use of pesticides, use of personal protective equipment, data on health status, and symptoms related to pesticide exposure, disposal of agrochemical containers, and technical assistance. The most widely used pesticides were insecticides such as abamectin, organophosphate compounds, and pyrethroids, and fungicides such as mancozeb, chlorothalonil, and copper products. As a rule, pesticides are handled carelessly, and 92% of workers involved in the mixing, loading, and spraying of insecticides and fungicides used no protective clothing or equipment whatsoever. Some 62% of workers reported at least one illness associated with mixing or spraying pesticides. The most frequently reported symptoms were headache, nausea, vomiting, dizziness, skin irritation, and blurred vision, and 21% of affected workers required medical care. In more than half (51%) of the cases, workers reported using organophosphate insecticides from toxicological class I when they felt sick.

OBJECTIVES: to evaluate risk factors involving environmental and occupational parental exposures associated with occurrence of orofacial clefts in a group of Brazilian children. METHODS: a secondary base case-control study was conducted with 274 cases of cleft lip with or without cleft palate (CL±P) and cleft palate only, with 548 controls (1:2). The authors analyzed residential proximity to industrial areas, exposure to commercial insecticides, agricultural pesticides, and vector control spraying, as well as various occupational exposures. The results were obtained by conditional regression analysis. RESULTS: proximity to industrial installations as a risk factor (OR = 3,32; 95%CI: 2,18-5,05) for all orofacial clefts, as well as the combined use of household insecticides and urban vector control pesticide spraying (OR = 5,73; 95%CI: 2,51-11,28). A group of maternal occupations heavily associated with orofacial clefts was domestic services (OR = 2,89; 95%CI: 1,76-4,86). CONCLUSIONS: solvents are frequently associated with CL ± P and that they are contained in numerous industrial products and household cleaning products, the results pertaining to occupational exposure become plausible. Other associations such as the routine use of domestic insecticides require further specific research for confirmation of the hypothesis.

O uso de medicamentos na gravidez é cada vez mais intenso, enquanto a prática médica volta-se para a incorporação do conceito de risco. Embora a tragédia da talidomida tenha marcado o início da reflexão sobre a ocorrência de efeitos adversos de medicamentos usados durante a gestação, as percepções dos prescritores, no âmbito da terapêutica medicamentosa na gravidez, ainda oscilam entre a certeza de que tudo é nocivo e a relativa crença de que tudo é seguro até que se prove o contrário. Faz-se necessária a produção de evidências que substanciem as condutas clínicas. O ensaio clínico randomizado é considerado a pedra angular do paradigma da medicina baseada em evidências. Sugerem-se os contextos nos quais a aplicação dos diversos tipos de pesquisa clínica seriam apropriados na gestação e ainda o emprego ampliado da farmacoepidemiologia para a construção de evidências nessa população, por meio de estudos analíticos, em especial a coorte. Entende-se que estes estudos, desde que executados com rigor metodológico, possam oferecer informação balizada, geradora de hipóteses, essenciais para a prática clínica.

Introduction: So far, there is no vaccine, nor are there effective drugs to treat COVID-19, an emerging viral respiratory infection deadlier than influenza. Objective: To take a snapshot picture of planned and ongoing clinical research addressing drugs potentially useful for treating SAR-CoV-2 infections. Method: A search was conducted (20 April 2020) in an international registry of clinical studies (https://ClinicalTrials.gov, US NIH). After excluding observational studies and other interventions that fell outside the scope of this study, 294 research protocols (out of 516 retrieved protocols) were selected for analysis. Results: Of 294 included trials, 249 were Randomized Controlled Trials (RCT), 118 of which were double-, triple-or quadruple-blinded studies. The interventions (drug therapies) were compared with "standard-of-care" (SOC) or with the placebo plus SOC, or yet with presumed "active" comparators. RCT focused on the primary treatment of the disease (inhibitors of viral replication) or on the therapy for resolution of hyperinflammation in pneumonia/Acute Respiratory Distress Syndrome (ARDS) and thromboembolism associated with SARS-CoV-2. The trials found in the database involve existing antiviral compounds and drugs with multiple modes of antiviral action. Antiparasitic drugs, which inhibited viral replication in cell-culture assays, are being tested as well. Regarding the adjunctive immunomodulatory, anti-inflammatory and antithrombotic therapies, a number of drugs with distinct pharmacological targets are under investigation in trials enrolling patients with severe COVID-19. Conclusions: Although many clinical studies of drugs for COVID-19 are planned or in progress, only a minority of them are sufficiently large, randomized and placebo-controlled trials with masking and concealment of allocation. Owing to methodological limitations, only a few clinical trials found in the registry are likely to yield robust evidence of effectiveness and safety of drugs repurposable for COVID-19.