Report
on Issues Related to the Aerial Eradication of Illicit Coca in Colombia
Released by the Bureau for International Narcotics and Law Enforcement
Affairs
September 2002
The Government of Colombia's Procedures for Handling
Claims of Colombian Citizens That Their Health Was Harmed or Their Licit
Agricultural Crops Were Damaged by Aerial Eradication
Summary:
Since the inception of the aerial illicit crop eradication program,
the Government of Colombia has had a process by which Colombian citizens
might seek compensation for claims of harm to legal crops or human health. The
process was recently updated to make it more efficient and well-publicized.
With Embassy support, the process of investigating harm to legal crops
has recently been improved to provide for faster investigation and resolution
of complaints. If sufficient evidence is presented to identify the site,
date, and details of the incident that allegedly caused harm, farmers who
have suffered damage to legal crops will be compensated for the market value
of the lost crops.
To ensure that local citizens are aware of their rights under the new
process, Embassy Bogotá, working with the National Directorate of Dangerous
Drugs (DNE), has placed a series of newspaper and radio announcements
informing citizens of their rights. These also air and/or are published in
major municipalities in each spray zone before and during each spraying
operation.
The Embassy, DNE, and Colombian National Police are engaged in this
new process. Complaints are being received, logged, investigated, verified,
and compensation is being allocated to cases with merit.
With respect to complaints of harm to individuals’ health, Embassy
Bogotá will continue to investigate serious complaints for which sufficient
identifying information is provided, as it has done in the past.
Background:
The Government of Colombia has long had a process under which
Colombian citizens could seek compensation for claims of harm to legal crops
or human health. Over the years in which the aerial eradication program has
operated, there have been fairly regular complaints by citizens who claimed
their legal crops were damaged by spraying, and scattered complaints of harm
to individuals’ health. Most are ruled out by an initial check of flight
records establishing that spraying did not take place near the site of the
claimed harm.
Process for complaints of legal crops sprayed in error:
On October 4, 2001, the GOC formally instituted a new process for
compensation for legal crops sprayed in error. The GOC directs the process
with funds provided by the United States Government.
Under this new system, complaints are routed through municipal
representatives ("Personeros") who record them on standardized
forms, then immediately refer them to the Colombian Farming and Livestock
Institute (ICA) and the Municipal Offices of Technical Agricultural
Assistance (UMATA) for preliminary field verification. Within two days of a
field visit, the Personero will submit the complaint and a record of
preliminary verification to the Antinarcotics Police (DIRAN) and the National
Directorate of Dangerous Drugs (DNE). Within five days of receipt of these
materials, the DIRAN certifies whether or not it had sprayed in the area
where the alleged damage took place. If not, the complaint is dismissed, and
the DNE sends a letter notifying the claimant of the outcome. If so, a field
visit is made within ten days to determine whether spraying in fact caused
the alleged damage and, if so, the amount of compensation to be paid. The
evidence must "clearly establish" that any harm was due to
spraying. Required proof includes certification from DIRAN that there was
spraying in the area; copies of flight logs; reports on the field visits; and
"other relevant evidence."
The Director of the DNE has informed Embassy Bogotá that for each
spray operation (i.e., each period of spraying in a given location) the DNE
will schedule and publicize a specific period for the receipt of complaints,
and that all complaints received in that period will be investigated and
adjudicated within sixty days from the first day scheduled for receipt of
complaints. To ensure that local citizens are aware of their rights under the
new process, Embassy Bogotá, working with the DNE has placed a series of
newspaper and radio announcements informing citizens of their rights. These
also air and/or are published in major municipalities in each spray zone
before and during each spraying operation.
DNE has certified to Embassy Bogotá that the new complaints process is
functioning. Embassy officials have accompanied representatives from the DNE
and the DIRAN on verification missions in Putumayo, Nariño, and Cesar and
have seen first-hand a commitment to having a process that works.
As of the end of August 2002, the DNE has received over 1,000
complaints through the streamlined complaint resolution procedure. Of these,
close to 800 have been closed on paper after further investigation that
showed that spraying did not take place in the complainant’s vicinity during
the date of the complaint. Some 220 complaints require field verification and
are in the pipeline for in situ verification. Fourteen sites have been
physically verified (11 in Putumayo, 2 in Nariño and one in Cesar) and in one
of these cases, the DNE has agreed to pay damages that are currently being
estimated. Although security and safety factors sometimes delay verification
missions, the Embassy, the DNE, and the DIRAN are committed to this process.
Process for complaints of harm to human health:
Embassy Bogotá and INL have taken great care to seek and evaluate
scientific evidence on the health effects of the spray mix and its component
ingredients, and are convinced that the mix poses no serious risk to human
health. Glyphosate - the only active ingredient in the spray herbicide we use
- is one of the most common weed killers in the world. It is widely used in
the United States in commercial agriculture. The glyphosate applied in the
coca and opium eradication program constitutes only about one eighth of all
the glyphosate applied throughout Colombia. Glyphosate has been registered by
the United States Environmental Protection Agency (USEPA) since the 1970's. USEPA
says it is of low toxicity, non-carcinogenic, and does not cause mutations or
birth defects. The World Health Organization and the International Programme
on Chemical Safety report similar findings.
The glyphosate formulation we use consists of glyphosate, water, and a
surfactant. This formulation is further mixed with water and a
Colombian-manufactured and approved surfactant called Cosmo-Flux 411F. The
surfactants help the herbicide penetrate the waxy surface of the leaves of
the coca or opium plants. Although Cosmo-Flux 411F is not registered in the
United States, the USEPA has certified that its ingredients are within
accepted tolerances for use on food crops. The application rate we use for
our spray mixture is within the limits prescribed by the manufacturers.
Because of their wide use, glyphosate-based formulations have been the
subject of numerous health studies over a period of more than 25 years. These
have consistently concluded that these formulations can, at most, cause
short-term and completely reversible irritation of eyes, nose, mouth, and
skin, but do not pose a serious health risk to human beings exposed as
bystanders, for example to spray drift. This body of literature was reviewed
in a recent comprehensive article published in a peer-reviewed journal. Williams,
Kroes, and Munro, Safety Evaluation and Risk Assessment of the Herbicide
Roundup and its Active Ingredient, Glyphosate, for Humans, Regulatory
Toxicology and Pharmacology 31, 117-165 (2000).
In addition, Embassy Bogotá has contracted Colombian medical experts
to investigate every allegation of serious health harm brought to its
attention. None has been substantiated. The reports of two of the four major
investigations undertaken to date in San Bernardo (Nariño department) and
Argelia (Putumayo) are attached. The two reports that investigate
health-related complaints allegedly caused by spraying in Aponte (Nariño) and
Orito, San Miguel and Valle de Guamuez
(Putumayo) have been widely distributed
previously and not included here due to their size (they are posted on the
Embassy’s website).
In contrast, to date, there is no equally credible scientific or field
evidence to support the proposition that the spray mix ingredients can cause
health harm other than the minor mucous membrane irritation described above. Such
harm is not, however, subject to the same claims procedure as for claims of
damage to legal crops. It can be very difficult to establish causation in
health-related cases. That is especially so in the context of rural Colombia
– where a claimant would be hard pressed to establish that an alleged health
harm was caused by spraying and not by poverty, unsanitary living conditions,
poor access to health care, lifestyle, or use of dangerous chemicals for coca
cultivation and processing.
Colombian law provides that citizens may claim that their health was
harmed by aerial eradication, and they may seek compensation if their claims
are meritorious. Citizens may do so either by the legal action known as
"tutela" or by a direct action against the appropriate Government
of Colombia entity. An action for "tutela" seeks to enforce a right
guaranteed under the Colombian Constitution. It is available for citizens who
have no other means under the law of avoiding an "irrevocable
injustice." A citizen may also bring a direct action against the
responsible government entity. The Government of Colombia does not enjoy
immunity from prosecution in such suits.
Embassy Bogotá shall continue to investigate all claims of
spray-related health epidemics or serious harm for which sufficient detail is
provided. In addition, the Embassy is participating in two other
health-related projects. First, it has instituted a Medical Civic Action
Program ("MEDCAP"), in cooperation with the Colombian Army, in
which Army medics will offer to all citizens living in spray zones vitamins,
immunizations, and medical treatment for the health problems most commonly
suffered by rural Colombians. The medics' training has been completed, and
MEDCAP’s will be scheduled in each spray zone when operational and security
needs permit. Since these actions will take place in the spray zones
concurrently with spraying, they will provide an effective means of
immediately assessing conditions that might be attributed to spraying. Secondly,
the Interamerican Drug Abuse Control Commission (CICAD) of the Organization
of American States will design and lead an independent, scientific study of
the health effects of the spray program on people, fauna/flora and the
environment; the Embassy is prepared to fully cooperate with this project.
To summarize, a large body of scientific evidence holds that exposure
to the spray mix may cause minor and short-term mucous membrane irritation
but not serious health effects. There is no equally credible evidence that
spray products cause other types of harm. Embassy Bogotá investigates all
claims of serious harm brought to its attention and none has yet been
substantiated. CICAD will complete a scientific study to monitor effects of
the spray program, within one year. And the Colombian Army has initiated a
new program in which its military medics will treat citizens in spray zones
for common rural ailments and assess spray-related conditions.
REPUBLIC OF COLOMBIA
THE NATIONAL DRUG COUNCIL RESOLUTION NO. 0017 OF
2001
[Seal] October 4, 2001
"For adoption of a procedure to address complaints of damage
presumably derived from aerial spraying with the herbicide glyphosate by the
Illicit Crop Eradication Program"
THE NATIONAL DRUG COUNCIL
In exercise of its legal faculties and pursuant to Article 91,
sub-sections a, b, c and particularly sub-section g, and Article 92 of Law 30
/1986
WHEREAS Law 30 of 1986 establishes an
illicit crop eradication procedure and designates the National Drug Council,
in particular, to arrange for the eradication of marijuana, coca and other
crops from which addictive substances may be extracted, using the means most
appropriate for this purpose and with the concurrence of the agencies
commissioned to safeguard public health and guarantee preservation and
stability of the nation’s ecosystem (Sub-section g, Article 91);
WHEREAS Resolution No. 0001 of February
11, 1994 was amended by the National Drug Council under Resolution No. 0005
of 2000 to reinforce control, follow-up and monitoring mechanisms aimed at
evaluating the impact of the Illicit Crop Eradication Program on the
environment, agriculture and health, and to establish specific criteria for
its implementation;
WHEREAS the National Narcotics Office
(DNE), pursuant to Resolution No. 0005 of 2000, is the agency responsible for
coordinating the Illicit Crop Eradication Program, and the Counter-narcotics
Office is responsible for planning the program from an operational
standpoint;
WHEREAS the Single Convention Governing
Narcotic Drugs, 1961, amended by the 1972 Protocol Amending the Single
Convention Governing Narcotic Drugs, 1961, ratified by Colombia under Law 13
of 1974, considered that effective measures against abuse of narcotic drugs
require coordinated and universal action, that such action calls for
international cooperation guided by the same principals and aimed at common
objectives, and desired to provide for continuous international cooperation
and control for the achievement of the aims and objectives set forth in said
Convention;
WHEREAS a Letter of Agreement on
Cooperation to Prevent and Control the Drug Problem was signed on September
7, 1999 by the government of Colombia, represented by the Director of the
National Narcotics Office, and the government of the United States,
represented by the Director of the Narcotics Affairs Section at the American
Embassy;
WHEREAS the parties to said agreement
promised to supply the resources and to undertake all action specified
therein, including, as outlined in Point II - Project Description, a build-up
in the technical and logistic capacity and equipment of the National
Narcotics Office to implement, coordinate, monitor and evaluate the National
Plan for the War on Drugs.
WHEREAS the Narcotics Supply Reduction strategy
outlined in the National Plan for the War on Drugs contains Objective No. 2,
which calls for Goal No. 1 - Technical and Controlled Illicit Crop
Eradication.
WHEREAS eradication of illicit crops
through aerial spraying with the herbicide glyphosate might produce
collateral effects with an impact on legal crops in the vicinity;
WHEREAS the Illicit Crop Eradication
Program has new systems and advanced satellite information technology for
illegal crop detection, including medium- resolution satellite images,
high-resolution color and panchromatic aerial photographs and satellite
location systems aboard the aircraft used for spraying, all of which
facilitate more and better protection for the rights of individuals in areas
where the Illicit Crop Eradication Program operates;
WHEREAS complaints from citizens in several
regions of the country have increased due to presumed damage to agriculture
from aerial spraying with the herbicide glyphosate, making it necessary to
issue regulations to ensure these complaints are addressed promptly and
effectively;
IT HAS AGREED AS FOLLOWS:
CHAPTER ONE
PROCEDURE
ARTICLE ONE. OBJECTIVE. The purpose of this resolution is to help
guarantee the protection of fundamental rights pursuant to the terms of the
Colombian constitution by adopting a simple procedure for due attention to
complaints from individuals presumably affected by aerial spraying with the
herbicide glyphosate as part of the Illicit Crop Eradication Program.
ARTICLE TWO. RESPONSIBLE AUTHORITIES. The National Narcotics Office
and the Antinarcotics Directorate of the National Police are the authorities
responsible for handling complaints from people presumably affected by the
herbicide glyphosate used in Illicit Crop Eradication Program, with due
consideration for speed, effectiveness, transparency, good faith and
promptness, in addition to all other principles provided for by law.
ARTICLE THREE. RECEIPT OF COMPLAINTS. Complaints related to illicit
crop eradication through aerial spraying with the herbicide glyphosate shall
be received by the municipal representatives, in their capacity as the
Attorney General’s representatives in towns throughout the country.
ARTICLE FOUR. FILING A COMPLAINT. Complaints may be filed verbally or
in writing and shall include the following required information:
PARAGRAPH: For added clarity and quicker verification of the facts
related to the complaint, a form shall be adopted with the foregoing items
and with an attached map of the municipality. It shall be filled out in the
presence of the municipal representative, who shall identify the presumably
affected property or properties on the map attached to the form.
ARTICLE FIVE. PRELIMINARY VERIFICATION OF THE FACTS CONNECTED WITH THE
COMPLAINT. Once the municipal representative receives the complaint, he shall
immediately ask the local ICA and/or UMATA official to visit the site
indicated in the complaint for preliminary verification of the facts in
question. A record of this field visit shall be drawn up and attached to the
complaint for delivery to the National Narcotics Office.
PARAGRAPH: A guide or format for verifying the information shall be
adopted to this end. It shall be filled out by the ICA and/or UMATA official
and by the municipal representative, and is to be accompanied by full
identification of the presumably affected property on the map provided for
this purpose.
ARTICLE SIX. DELIVERY OF THE COMPLAINT TO THE NATIONAL NARCOTICS
OFFICE. Within two (2) days subsequent to preliminary verification, the
municipal representative shall send the complaint and a record of preliminary
verification to the Counter-narcotics Office of the National Police, with a
copy of the complaint to the National Narcotics Office (DNE). This shall be
done simultaneously, and the municipal representative shall inform the
petitioner accordingly.
ARTICLE SEVEN. PRIOR REPORT. Within five (5) days after receipt of the
complaint, the Counter-narcotics Office of the National Police (DIRAN) shall
certify whether or not the zone in question was sprayed. This certification
shall be based on satellite location flight reports, copies of spraying
records and polygrams, and reports from illicit crop detection and monitoring
systems used by the Illicit Crop Eradication Program in the municipality or
area related to the complaint.
If it is concluded, on the basis of the foregoing certification, that
no aerial spraying was conducted in the area connected with the complaint,
DIRAN shall immediately inform the municipal representative and the DNE to
this effect.
ARTICLE EIGHT. FIELD VISIT AND REPLY. If DIRAN certification indicates
the area in question was sprayed by the Illicit Crop Eradication Program, the
complaint group created for this purpose shall conduct a field visit within
ten (10) days thereafter to:
If the conclusion, based on this verification, is that damage was done
and is the result of aerial spraying, the complaint group shall estimate its
amount and sign a damage recognition certificate.
However, should the complaint group conclude that no damage was
inflicted, it shall advise the municipal representative accordingly within
two (2) days after the visit, explaining the reasons for this decision.
PARAGRAPH: The field visit mentioned in this article shall be ruled
out in cases where public unrest prevents an inspection of this type. Such
unrest is to be certified by the National Police.
CHAPTER TWO
CROP REPLACEMENT
ARTICLE NINE. CROP REPLACEMENT. The complaint group shall reimburse
only those whose legal crops are affected as a direct consequence of aerial
spraying with the herbicide glyphosate by the Illicit Crop Eradication
Program, provided they have not taken prelegal or legal action.
ARTICLE TEN. DEADLINE FOR PRESENTING A COMPLAINT. Complaints filed
sixty (60) days after the date of aerial spraying with the herbicide
glyphosate by the Illicit Crop Eradication Program shall not be processed.
ARTICLE ELEVEN. CROP CLASSIFICATION AND REPLACEMENT CRITERIA. To
replace legal crops that have been damaged, these shall be classified as
permanent or temporary.
Permanent crops have a vegetation period of more than one year and are
harvested more once during that time.
Temporary crops, for genetic or technical reasons, yield only one
harvest during their vegetation period, which is one year or less.
Permanent crop replacement shall include:
Temporary crop replacement shall include only:
ARTICLE TWELVE. CALCULATING REPLACEMENT. The complaint group shall
estimate the replacement cost of the probable harvest according to the number
of plants affected, with maximum possible production calculated on this basis
and in accordance with the tables established for this purpose by the
Colombian Agricultural Institute.
ARTICLE THIRTEEN. REQUIRED EVIDENCE. To proceed with crop replacement,
the crop in question must be certified as being legal and the damage as being
a direct result of aerial spraying with the herbicide glyphosate used in the
Illicit Crop Eradication Program.
For the above, the following evidence of damage is required:
ARTICLE FOURTEEN PAYMENT. To acknowledge the replacement of affected
crops and to proceed with payment, the complaint group coordinator and the
beneficiary shall sign a damage recognition certificate.
If the beneficiary is not available at the time of this procedure, the
damage recognition certificate duly signed by the complaint group coordinator
shall be deposited at the office of the municipal representative for
subsequent signature by the beneficiary.
Once this procedure is complete, the certificate in question shall be
sent to the National Narcotics Office and, as of that moment, steps shall be
taken to effect payment in the most suitable way.
CHAPTER THREE
GENERAL PROVISIONS
ARTICLE FIFTEEN. FORMATION OF THE COMPLAINT GROUP: The National
Narcotics Office and the Counter-Narcotics Office of the National Police
shall form an interdisciplinary group to address the complaints referred to
in this resolution.
ARTICLE SIXTEEN. CASE FILE. A case file shall be established at the
National Narcotics Office and at the Counter-Narcotics Office of the National
Police with copies of all action to which this resolution refers. Said file
shall constitute a documentary report and evidence of how complaints have
been addressed.
ARTICLE SEVENTEEN. VALIDITY. The regulations contained in this
resolution apply as of the date of its publication. Failure to observe them
on the part of officials from the proper agencies or bureaus shall constitute
inappropriate conduct and be cause for pertinent disciplinary action.
Let it be published, made known and observed.
Issued in the city of Bogota on October 4, 2001.
[Signature] Rómulo
González Trujillo, Chairman
[Signature] Mercedes
Vasquez de Gomez, Executive Secretary
Publicity for new GOC Compensation Process
Radio Announcements:
Colombian citizens living in areas where aerial spraying of illicit
coca and opium poppy crops is taking place should know they have a right to
seek compensation from their government if their legal crops are mistakenly
sprayed. The Government of Colombia will reimburse citizens for losses in
such cases. If your legal crops have been damaged by aerial spraying, please
contact your Municipal Representative, who will ask you to provide basic
information about your claim and will turn it over to national government
authorities for a decision. Please make your claims as soon as possible, as
there are time limits for doing so.
This announcement is sponsored by the Dirección Nacional de Estupefacientes.
Newspaper Announcements:
IMPORTANT NOTICE: ATTENTION CITIZENS WHOSE LEGAL CROPS WERE SPRAYED
Colombian citizens living in areas where aerial spraying of illicit
coca and opium poppy crops is taking place should know they have a right to
seek compensation from their government if their legal crops are mistakenly
sprayed. The Government of Colombia will reimburse citizens for losses in
such cases. If your legal crops have been damaged by aerial spraying, please
contact your Municipal Representative, who will ask you to provide basic
information about your claim and will turn it over to national government
authorities for a decision. Please make your claims as soon as possible, as
there are time limits for doing so.
This announcement is sponsored by the Dirección Nacional de
Estupefacientes.
A REPORT ON TWO DEATHS IN THE VILLAGE OF LA ARGELIA, MUNICIPALITY OF
LA HORMIGA, VALLE DEL GUAMUÉZ, By: Jorge Hernán Botero Tobón, M.D., Chemical
Risk, Toxicology and Human Health Consultant, Bogotá, Colombia, January 2002
1. BACKGROUND
On November 27, 2001, the 24th Colombian Army Brigade Intelligence
Division received a report of two deaths at the Sacred Heart of Jesus
Hospital in La Hormiga, a state institution.1The first was an
11-month-old boy. When interviewed by the hospital staff and the
investigating officer, his mother said the child was in the patio of his home
when spray aircraft flew over. He reportedly developed acute diarrhea and
vomiting immediately thereafter, which led to severe dehydration and death
within 24 hours. She indicated the boy’s father and cousin experienced
diarrhea and vomiting as well.
1Report on two deaths in La Argelia (La
Hormiga, Valle del Guamuéz) allegedly caused by glyphosate. 24th Army Brigade
Intelligence Division, November 25, 2001.
According to the same report, another child in La Argelia experienced
diarrhea, which improved initially then worsened, accompanied by respiratory
failure. He died the next day at the same hospital.
The family of the 11-month old deceased child and the municipal
representative attributed his illness and death to aerial spaying of coca in
La Argelia township, La Hormiga Municipality, where he resided with his
family. The family of the 4-year-old did not, but the hospital apparently
reported both cases to the Army at the same time.
The author of this report was retained by the U.S. Embassy, Narcotics
Affairs Section, to investigate the deaths. He traveled to La Hormiga by
plane on Wednesday, December 5, departing at 09:00 hours and arriving at 10:30
hours. There, he met with the municipal representative, Mr. Leandro Antonio
Romo-Pantoja, and the Director of the Sacred Heart of Jesus Hospital, Dr.
José Victor Pérez (both of whom had been in contact with the families of the
deceased) and reviewed the children's medical records.
According to the municipal representative, both cases were preceded by
the death of fish and chickens in the villages of El Tigre, El Paraíso and
Maraveles, at about the time of aerial spraying on November 13, 2001.
2. THE HERBICIDE USED IN AERIAL SPRAYING
The commercial formulation of glyphosate used in the illicit crop
eradication program consists of glyphosate, water, and a surfactant. This
formulation is mixed with water and a Colombian-manufactured and approved
surfactant, Cosmo-Flux 411F. A surfactant, which is like a soap, helps the
herbicide penetrate the leaves of a plant.
The dose used in the aerial eradication program for coca spraying
contains 10.4 liters (2.75 gallons) of the commercial glyphosate formulation
per hectare. The dose of the active ingredient, glyphosate, is 3.74 kilograms
(acid equivalent) per hectare. This is equivalent to 374.4 mg of glyphosate
per square meter.2
There is a large body of scientific literature indicating that
glyphosate is of low toxicity for humans, animals and the environment.3
3. CASE REVIEW
3.1 CASE 1: Edwin Xavier Daza Fernández
3.1.1 Clinical History
During the interviews with the officials mentioned above, the
complaint filed with the municipal representative by the child’s relatives
was reviewed, as was his clinical history. It says, in summary, that a
nursing child 11 months old was admitted to the hospital in a state of shock,
and that his relatives had reported that his symptoms initiated 24 hours
earlier, characterized initially by diarrhea and vomiting on multiple
occasions and instability after exposure to spraying for fumigation. According
to the municipal representative, these symptoms were preceded by nasal and
ocular itching, inability to maintain posture and ocular deviation. However,
this information is not included in the hospital’s emergency care record,
according to which " the symptoms worsened and his condition at the time
of admission to the hospital did not respond to treatment." 4
2Parra, L.E., (Consultant to Narcotics Affairs
Section, US Embassy, "Overview of Risks of Exposure to Glyphosate,"
July 2000.
3Environmental Health Criteria No. 159, Glyphosate,
International Programme on Chemical Safety, World Health Organization,
Genève, 1994; Williams, G.M., Kroes, R., Munro, I.C., "Safety Evaluation
and Risk Assessment of the Herbicide Glyphosate," J Regulatory
Toxicology and Pharmacology, 31: 117-165, Academic Press, 2000; Giesy,
J.P., Dobson, S., Solomon, K., "Ecotoxicological Risk Assessment for
Glyphosate Herbicide," Rev. Environ Contam Toxicol, (Sic) 167:
32-120, Springer Verlag, 2000.
4Record of emergency care, Sacred Heart of Jesus Hospital, La
Hormiga, Putumayo.
The child was not transferred to La Hormiga until the following day,
when he was taken to the hospital at 18:00 hours. Transportation and movement
in the region are difficult because the Revolutionary Armed Forces of
Colombia (FARC) and the Colombian Self-defense Forces (AUC) are fighting for
control of the area. According to the hospital record, a physical examination
revealed the child was "in a state of shock" and exhibited obvious
signs of severe dehydration, such as a depressed fontanel [note: this is the
"soft spot" on the top of a baby's skull], sunken and dull eyes,
dry mucus, mucocutaneous pallor, intercostal retraction, crackles in the
bases of the lungs, lowered tone rhythmic cardiac noises and cardiac
frequency, a depressed abdomen with no intestinal noise, rigid extremities
and a profoundly depressed state of consciousness. (Here, the record refers
to "Glasgow 4/5," a reference to a neurological classification of
one's state of consciousness. However, this is probably not appropriate,
because this illness does not appear to have been a traumatic or neurological
disease.) Treatment was initiated with a saline solution administered
intravenously, ampicillin, and gentamicin. Admission was at 19:30 hours and
the patient died 45 minutes later.
An autopsy was performed and samples were taken of the liver, lungs
and brain. They were sent to the Institute of Forensic Medicine in Bogota for
analysis. As yet there have been no results.
According to the medical director of the hospital, the child’s
grandfather and four-year-old brother were treated as well: the grandfather
for exacerbation of chronic symptoms of severe epigastralgy (a painful
burning sensation in the upper abdomen) and the brother for diarrhea and
vomiting.
Although not noted in the child’s medical records, Dr. Pérez indicated
the local water supply is extremely poor. Because sewage from rural homes is
dumped directly into surface flows, most water sources are polluted with
solid waste.
3 .1.2 Discussion of the Findings
In this case, the mother apparently believes there may have been
direct exposure to the sprayed mixture ("an airplane flew over")
prior to appearance of the symptoms.
However, computerized spray flight records indicate that on November
14, the date of the alleged exposure, spraying took place in the townships of
El Tigre, La Chorrosa, El Diamante, Campoalegre, El Venado, San Francisco and
Guadualito.5 Guadualito is three miles south of Argelia; the other
townships are further away. Although there may be slight drift of the spray
mix at times, it is highly unlikely that the spray could not have drifted
that far.
Even if the child were directly exposed to spraying, however, there is
no indication that his illness was related to such an exposure. Even
full-body exposure would have been minimal in comparison to harmful doses. Considering
the dose used in aerial eradication, and assuming a conservative body weight
of nine kilograms (actual weight is not on record), a corporal surface of
0,44 m26 and total exposure to spraying, the dose on the cutaneous
surface would be:
5Flight data from aerial eradication records,
2001.
6Corporal surface of an 11-month-old child weighing nine
kilograms, according to the Boyd & West modified nomogram (a graphic
representation of several lines marked to scale and arranged so that by using
a straightedge to connect known values, an unknown value can be read at the
point of intersection), Nelson’s Textbook of Pediatrics, 12th Edition,
McGraw-Hill, 1993.
Moreover, a review of existing literature shows no fatalities from
cutaneous exposure. Mortality associated with glyphosate exposure has been
observed only with the ingestion of large quantities of the commercial
formula (80 to 250 mL, 184 mL on average).9
7"Lethal Dose 50," or
"LD50," is a universally-applied marker for evaluating toxicity. The
LD50 of a chemical is that single dose which will, on the average, result in
death of 50% of a given population of experimental animals. Normally, this is
a standardized test species. The oral LD50 of glyphosate is over 4,320
milligrams per kilogram of body weight, meaning that ingestion of more than
4,320 milligrams of glyphosate per kilogram of body weight would be necessary
to prove lethal to the test species, in this case, rats.
8The "ADI" is a standard risk assessment indicator
established by the World Health Organization International Programme on
Chemical Safety and the U.S. Environmental Protection Agency (EPA). It
indicates the maximum allowable amount of a toxic substance that can be
ingested daily over a lifetime without a probability of suffering an adverse
affect. Environmental Health Criteria No. 6, Risk Assessment of Chemical
Substances, International Programme on Chemical Safety, World Health
Organization, Genève, 1984.
9Talbot et al. (1991), Sawada & Nagai (1992), Tominack et
al. (1993) in Environmental Health Criteria No. 159 , Glyphosate, International
Programme on Chemical Safety, World Health Organization, 1994.
The child’s symptoms correspond to the unspecified signs of acute
diarrhea with severe dehydration. However, those the mother reported to the
municipal representative; namely, conjugated deviation of the eye and
corporal instability, also suggest the presence of a major hydroelectrolytic
imbalance, toxicity of a neurotoxic pesticide (a property of other
pesticides, not glyphosate) or the clinical manifestations preceding
incipient meningitis.
The grandfather and brother experienced similar discomforts, but no
source indicates they were exposed to spraying. This could denote an
infectious-contagious disease or one of toxic-food origin.
The toxic potential of glyphosate is minimal and the level of exposure
does not coincide with the symptoms observed in this case. However, exposure
to a more potent chemical neurotoxic agent, such as one of the
organophosphate or carbamate pesticides used to protect coca (which are
widely used without safety precautions both in legal and illegal agriculture
in the rural regions of Colombia), could conceivably have been the cause. 10
In conclusion, a toxic etiology of the disease responsible for death
cannot be identified. However, even if the child had been exposed to aerial
spraying with glyphosate, the dose would not have been significant. Exposure
by the cutaneous pathway is inefficient for absorption, which some authors
say is around 2 percent.11 The action of glyphosate is not known
to produce severe diarrhea,12 and the region’s epidemiological
patterns point to the high likelihood of an infectious cause. Finally, there
are no reported cases of glyphosate being responsible for human death, except
in cases involving intentional ingestion of significant quantities of the
undiluted commercial product. (See references on intentional exposure in
footnotes 2, 3 and 10).
The samples taken during the autopsy are being analyzed at the
Institute of Forensic Medicine in Bogota.
4.2 CASE 2: Diomedes Niasa Villa
4.2.1 Clinical History
On November 22 at 19:00 hours, the second child, a four-year-old boy
and neighbor of the first child, was treated at the hospital for fever and
diarrhea, which began the afternoon of November 21, 2001. The patient was
feverish upon admission (39ºC temperature and a cardiac frequency of 150
beats per minute). A blood test showed leukocytosis (an increase of white
blood cells) with neutrophilia (the condition that results when neutrophilic
cells predominate to an abnormal degree). At 06:00 hours, the patient
registered "confusional syndrome, labial cyanosis, coldness, periungual
cyanosis without diuresis" then "cardiorespiratory arrest. It was
managed with endotracheal intubation, cardiac massage, adrenaline, atropine
but without effect and was followed by death.
The final diagnosis was noted as "acute diarrhea,
hydroelectrolytic imbalance and possible paraquat intoxication".13
According to the medical director of the hospital, the autopsy showed a
massive amount of parasites migrating from the respiratory tract to the
digestive tract.
10"Retrospective Study of Reported Human
Health Effects From Glyphosate Exposure in Putumyo", Uribe, C. et al.,
June 2001.
11Williams, G.M., Kroes, R., Munro, I.C., Safety Evaluation and
Risk Assessment of the Herbicide Glyphosate, J Regulatory Toxicology and
Pharmacology, 31: 117-165, Academic Press, 2000.
12Reigart, J. R., Roberts, J.R., Recognition and Management of
Pesticide Poisonings, 5th Edition, See information on human exposure in
notes 2 and 3.
13Emergency Care Record No. 49729, Sacred Heart of Jesus Hospital,
La Hormiga, Putumayo.
4 .2.2 Discussion of the Findings
There was no spraying at La Hormiga on November 21, which was the
first day of the acute illness observed in the second case. On November 22,
the other date of possible exposure in this case, spraying took place in
Brisas del Placer, Arauca, La Paloma, El Palmar, and Brisas del Guamuéz. However,
only two of these locations (Palmar and Brisas del Guamuéz) are in the
municipality of La Hormiga. The closest, Palmar, is located 20 miles west of
La Argelia. As in the first case discussed above, this is too far for
exposure to spray drift to have been a reasonable possibility.
As to the medical findings, the second child was also a case of severe
diarrhea. He was ultimately found to have a definite history of massive
intestinal parasite infestation and symptoms of infection (fever +
leukocytosis). However, the child's parents did not claim that he had been
exposed to spraying, nor was there any other evidence of exposure to aerial
spraying. In fact, it is not clear why this case was brought to the attention
of the Army, since it appears neither the parents nor the municipal
representative made a complaint. Most likely, the hospital mentioned this
case to the Army because it occurred close in time to the death of the first
case discussed above (which was attributed to spraying) and in a region where
aerial spraying was thought to have occurred.
As to the child’s illness and cause of death, a review of the
patient’s treatment at the hospital shows the quantity and infusion rate and
the sodium content of the liquids administered intravenously were
insufficient to replace losses incurred earlier through diarrhea and vomiting,
or to restore diuresis within a period of at least three hours and to
initiate the administration of potassium, which probably was reduced
substantially by diarrhea, at least during the previous 24 hours. In the end,
death was the result of a severe hydroelectrolytic deficit, hypokalemia and
subsequent multisystemic failure, which could not be reversed through
resuscitation.
In this case, infestation with Ascaris lumbricoides, a very
common intestinal parasite, is, in addition to Stongyloides stercolaris infestation,
one of the most common causes of diarrhea.14 This alone could
explain the origin of the disease responsible for death. Additionally, the
notes of the treating physicians suggest that exposure to paraquat, a highly
toxic agricultural chemical commonly used in coca cultivation in Colombia,
was a possibility, although no tests for that substance were apparently
conducted.
14Plata Rueda et al., El
Pediatra Eficiente, Chapter 8 "Diarreas," Salvat, 1986; Nelson’s
Textbook of Pediatrics, 12th Edition, McGraw-Hill, 1993.
The presence of fever accompanied by leukocytosis is the clinical
event that suggests infection was responsible for the diarrhea that led to
dehydration, which was the ultimate cause of death. This was aggravated by an
insufficient supply of liquids and electrolytes during treatment. It is quite
possible that migration of parasites to the respiratory tract and symptoms of
asphyxia were contributing factors as well.
5. EPIDEMIOLOGICAL ANALYSIS
An epidemiological analysis of the cause of an outbreak of diarrhea or
gastrointestinal disease must consider the time, form and place, in addition
to the factors that could be responsible and the extent and intensity of
exposure to them.
These infectious factors (bacterial, parasital, viral), the most
common in the environment, and the toxins that produce the symptoms
characteristic of diarrhea and gastrointestinal disease, as in the case of
certain pesticides, must be considered when assessing the possible cause of
death.
With diarrhea, the most probable cause in patients with no previous
illness is infection. The risk situation in La Hormiga (described below)
points to infection as a highly probable cause. Toxic agents such as
organophosphate and carbamate pesticides are far more likely to cause
diarrhea with fatal dehydration than is glyphosate (See footnote 13).
As to the two cases in question, the most important environmental
event is water pollution resulting from solid waste disposal. This is a
predominant risk factor for the people of La Hormiga and is an effective
means of dissemination and exposure to infectious diarrhea.
According to health statistics, acute diarrhea (ADD) is the leading
cause of death in La Hormiga.
TABLE 1. Morbidity per Outpatient
La Hormiga, Department of Putumayo
1992 - 1996
Municipality |
Diagnosis |
1992 |
1993 |
1994 |
1995 |
1996 |
La Hormiga |
ADD |
113 |
72 |
98 |
102 |
51 |
|
ARI |
88 |
63 |
81 |
103 |
71 |
|
Dermatopathy |
49 |
49 |
42 |
65 |
51 |
|
Conjunctivitis |
5 |
5 |
2 |
4 |
8 |
|
Cephalea |
28 |
22 |
9 |
51 |
41 |
Source: Figures on the Department of Putumayo were supplied by the
National Health Institute and originate with the National Health Policy
Analysis and Planning Office. SIS103, Ministry of Health.
Notes:
Due to the social and political situation in Colombia and because
departmental health officials are slow about reporting data to the National
Health Institute (INS), these figures could be incomplete and should be
regarded with caution. Figures from recent years are not consolidated and, in
some cases, none have been reported. The system was changed in 1997 and
departmental officials only report when notification is mandatory, as is the
case with diseases transmitted by vectors, those preventable through vaccination
and sexually transmitted diseases.
All infectious skin diseases are grouped as dermatopathies, even
though WHO differentiates between specific diseases such as dermatophytosis,
eczemas, pruritus, allergic dermatitis, other types of dermatitis, etc. According
to the INS, this change in procedure is not fully understood, especially at
municipal level. As a result, there are problems with records on morbidity.
In addition, the risk of morbidity associated with water and
sanitation is 57.67 percent in La Hormiga. This is one of the highest rates
in the country and is near 60 points, which is the health unfeasibility limit
for a community or region.15
The intensive and uncontrolled use of pesticides to protect coca crops
and the potential for environmental transport of these substances after
application are also factors to consider. A wide variety of highly toxic
products are used in rural Colombia to protect coca against pests and blight.
In most instances, for obvious reasons, these substances are not applied
properly or in the correct dose, nor are they stored, handled or mixed
according to safety standards. Disposal of empty containers and similar waste
is usually inadequate. At some point, they could result in significant
exposure to humans. Those who are most vulnerable, such as children and the
elderly, would be affected first, as would certain types of wildlife. This could have been the case.16
15"Segunda Fase de Actualización
del Inventario Nacional de la Calidad del Agua," Colombian Ministry of Health,
1998.
16op. cit. in
Note 11.
The following table shows the products used most often, their toxicity
and their measured lethal dose.
TABLE 2.3. Main Insecticides and Fungicides Used on Illicit Crops (10)
Trade Name |
Active Ingredient |
Toxicity Category in Colombia |
Toxicity Category according to the EPA |
LD 50 |
|
INSECTICIDES |
|||||
Tamaron |
Metamidophos |
I |
I |
21-16 |
118 |
Sevin |
Carbaryl |
II |
I |
250-850 |
>2,000 |
Metavin |
Metomil |
I |
I |
30 |
>2,000 |
Furadan/Liquid/ |
Carbofuran |
I |
I |
5 |
885 |
Curacrón |
Prophenophos |
II |
II |
630 |
143.4 |
Thionil |
Endosulfan |
I |
I |
18-220 |
200-359 |
Parathión |
Methyl parathion |
I |
I |
4.5-24 |
6 |
Matador |
Lambda-cyhalothrine |
III |
II |
56-79 |
632 |
Thiodan |
Endosulfan |
I |
I |
18-220 |
200-359 |
Malathión |
Malation |
III |
III or IV |
480-10,700 |
>2,000 |
Nuvacron |
Monocrotophos |
I |
I |
17 |
354 |
Lorsban: Liquid/ |
Chlorpiriphos |
II |
II |
82-270 |
1,000-2,000 |
Convoy |
Cypermetrine and diazinon |
III |
III |
2.75-450 |
- |
Politrin |
Cypermetrine |
II |
II |
|
>2,000 |
FUNGICIDE |
|||||
Manzate |
Mancozeb |
III |
III |
4,500-11,200 |
5,000-15,000 |
Copper Oxychloride |
Copper oxychloride |
III |
- |
- |
- |
Bavistin |
Carbendazim |
III |
- |
- |
- |
Source: "Retrospective Study of Reported Human Health Effects
From Glyphosate Exposure in Putumyo", Uribe, C. et al., June
2001.
CONCLUSION
There is no evidence in the two cases discussed above of either
exposure to aerial spraying or of glyphosate as a causal agent in the deaths
of the two children in La Hormiga.
APPENDICES
CLINICAL HISTORY NO. 1
CLINICAL HISTORY NO. 2
LETTER: NATIONAL INSTITUTE OF LEGAL MEDICINE AND FORENSIC SCIENCES
REPORT: ASSESSMENT OF A PATIENT IN THE TOWN OF SAN BERNARDO
(NARIÑO, COLOMBIA), Bogota, September 21, 2001
TABLE OF CONTENTS
Timeline of Activities
Medical
History
Differential Diagnoses
Medical Opinion and Conclusions
Bibliography
Figure 1 and Photos [not available]
TIMELINE OF ACTIVITIES
I visited the town of San Bernadino on September 1 and 2 of this
year. I had originally started my trip on August 31, but due to the
strong winds in the city of Pasto, my flight was forced to return to
Bogota. On September 1, I left Bogota at 7:00 a.m. for Pasto, where I
arrived at 8:30 a.m. I took ground transportation from the airport to the bus
terminal and then took public transportation to the town of San Bernadino,
where I arrived at 1:00 p.m. I made my way to the Mayor’s Office and was
received by the municipal spokesperson and the Mayor, Mr. Paulino
Erazo-Imbachi.
The minor Yeison Aurelio Bolaños-Castillo, a two-year-old boy, was
waiting with his parents at the Mayor’s Office, and I proceeded with my
assessment, taking down his medical history as part of the assessment
process. I finished at 3:30 p.m. and once again traveled to the city of
Pasto, where I spent the night, returning to Bogota on September 2.
On September 3 and 5, Dr. Camilo Uribe-Granja evaluated the case and
conducted a review of the relevant literature. From September 6 to 9,
the case was presented to and analyzed with Dr. Carlos Martín Restrepo, Head
of the Genetics Unit of the Rosario University Medical School. On
September 10, the report with the final diagnosis was put together.
MEDICAL HISTORY
NAME: Yeison Aurelio Bolaños-Castillo.
AGE: Two (2) years old.
SEX: Male.
DOB: May 15, 1999.
DATE OF ASSESSMENT: September 1, 2001.
TIME: 1:45 pm
HISTORY OF THE ILLNESS:
This patient displayed birth defects involving the reduction of his
four (4) extremities, hydrocephalus and delayed neural development. He was
evaluated for the purpose of determining and diagnosing the possible cause of
his congenital abnormalities.
PERSONAL BACKGROUND:
The patient was the product of a first full-term gestation with no
prenatal medical check-ups, and he is one of two (2) siblings. Gestation took
place in the months from September 1998 to May 1999, dates which are
inconsistent with fetal exposure to Phosphonomethylglycine (a substance also
known as Glyphosate). There were no aerial eradication operations until
August 14, 1999, three (3) months after the child’s birth. This was a vaginal
delivery at home, and the somatometry at birth is unknown, nor was any
mention made of this in the documents presented by the Municipal Health
Center. The closest data that we have at present are: Weight: 4 Kg;
Length: 42 cm; and Cephalic Perimeter: 52 cm at five (5) months of age. The
child underwent a ventricular-peritoneal valve derivation at one (1) year of
age at the San Pedro Hospital in Pasto, due to hydrocephalus. Five (5) months
ago he suffered convulsions, apparently a secondary episode to hypothermia
due to acute respiratory infection. His vaccinations are up to date for his
age. Respiratory infections are repeatedly mentioned, and there is
documentation of delayed psychomotor development.
FAMILY BACKGROUND:
The patient’s parents are 22 years old and come from the Pindal
countryside, an area with a population of approximately 2,000 that belongs to
the greater San Bernardo municipal area, in the Department (i.e., Province)
of Nariño with an estimated population of 10,000 inhabitants.
The parents are healthy and are not related to each other
(non-consanguineous). Both have been employed in manufacturing hemp (natural
rope fiber), for the last seven (7) years. As a couple, they have started
three (3) gestations, G3P2V2, and they are
currently in the eighth month of gestation of their third child, and have
been without obstetrical check-ups. The children of this couple are the
patient and another son, who is referred to as healthy and who was not
brought to the appointment. There is no history of other anomalies similar to
those found in the patient, nor of any heredopathy on either side of the
patient’s family.
PHYSICAL EXAMINATION OF THE PATIENT:
VS: CF: 98 per minute, RF: 21 per minute, Weight: It was not possible
to weigh the patient. The last weight reported was at 15 months of age
in which he weighed 8 kg and his height was 52 cm. Cephalic perimeter: 54.5
cm.
The patient was microsomic with apparent macrocephaly, open and
normotensive fontanel. The neurological exam showed isochoric pupils with
normal reaction to light. He cannot hold up his head and has difficulty with
decubital changes (changing the horizontal position of his body, i.e.,
rolling over). Normal deglutition. The patient apparently conserves
sensitivity, and there is no evidence of fascia or hemangomia. Normal eyes,
normal mouth, normal buccal cavity. Normal external ear canopies and lobes.
Symmetrical neck. Normal hair and normal follicular implantation on neck.
Symmetrical thorax. Cardiopulmonary assessment showed sight raling (noisy
accessory breathing) at the base of the lungs. Heart beat with systolic
murmur in the fourth intercostal space to the left of the sternum. The
patient displayed a soft abdomen with no abnormally large organs
(organomegaly). Intestinal noise was present. The patient’s extremities show
severe defects and reduction, consistent with the absence of the middle and
distal segments, though remnants can be seen in the proximal region. The
lower extremities are totally absent, with cutaneous fossas in the areas
where the missing extremities would be inserted (see photos 1 and 2).
DIAGNOSIS:
1. Amelia / Hypomelia
Complex
2. Congenital Hydrocephalus
3. Delayed psychomotor development
Adriana Zamora-Suárez, M.D.
Toxicologist & Medical Physician
Med. License 01-1532/98
DIFFERENTIAL DIAGNOSES
Possible etiological diagnoses considered for this patient were
Roberts Syndrome, TAR Syndrome and Odontotrichomelic Syndrome.
Roberts Syndrome (RS) is also known as Pseudothalidomide or CS
Syndrome, because of its similar phenotype to the clinical manifestations of
fetal exposure to Thalidomide. It was described for the first time by Roberts
in 1919, and is not a very common syndrome, with probably fewer than one (1)
case in every 100,000 births. Nevertheless, in Colombia, over 60 cases have
been documented in the Cundinamarca-Boyaca high plateau region. It is a
hereditary recessive autosomal disorder, frequently associated with consanguinity
of the parents, and accompanied by a characteristic chromosomal defect that
is consistent with the premature separation of the heterochromatin during the
metaphase. The principal characteristics are tetraphocomelia (the severe
reduction of the extremities with no absence of the relevant proximal, medial
and distal structures, accompanied by medial-line facial malformations such
as cleft lip or cleft palate, variable mental retardation and other
alterations, such as scarce, thin and gray hair, facial hemangiomas,
cryptorchidism, microcephaly, hydrocephalus, microphtalmia, cataracts,
corneal opacity, various cardiac and renal abnormalities, thromocytopenia and
hypospadias. Those suffering from the syndrome normally show an average
lifespan of 10 years, and the parents are at 25% risk of having another child
with the disorder in each subsequent pregnancy (see Figure 1).
TAR Syndrome, or Radial Aplasia-Thrombocytopenia Syndrome, was
discovered in 1956, and is also an inherited autosomal recessive disorder. Those
suffering from the syndrome have thrombocytopenia with an absence or
hypoplasia of the megacaryocytes; it can also be accompanied by eosinophilia
in 53% of patients and granulocytosis in 62%. There is an absence or
hypoplasia of the radius, usually bilaterally. It can manifest itself as
occasional abnormalities, such as shortness, kidney problems, spina bifida,
syndactyly and shortened humerus. In terms of the prognosis, close to 40% of
all patients die due to hemorrhaging during childhood.
The Odontotrychomelic Syndrome (OTMS) is another inherited recessive
autosomal disorder. The most important clinical findings are extensive
deficiencies in the development of the extremities, tetra amelia,
hypotrichosis, abnormal dentition and deformity of the ear canopies and
lobes. This syndrome has been reported with greater frequency in Caucasian
Italian and Brazilian families. The prognosis for lifespan is better than in
the case of RS and STAR.
There was no aerial eradication in Nariño until August 14, 1999, three
(3) full months after the child’s birth. Consequently, any connection with
aerial eradication exercises can be discarded based simply on these dates.
Even if this were not the case, however, there is no report in the
body of medical literature of fetal teratogenic syndrome in connection with
phosphonomethylglycine. A review of the literature shows that reproductive
and development studies of rats and rabbits by researchers, such as Schroeder
in 1981 and Yusef in 1995, show no reproductive disturbances. Other studies
of teratogenicity carried out on pregnant rats with phosphonomethylglycine
doses of up to 3,500 mg/kg/day administered from days 6-9 of gestation
produced the following effects: increased softer fecal depositions, reduced
activity, delayed growth, and fewer implanted fetuses. With doses below 1,000
or even 2,000 mg/kg/day, no effects were observed. In rabbits, doses of 350
mg/kg/day administered from days 6-27 of gestation once again showed a higher
number of fecal depositions and reduced activity. With doses of 175
mg/kg/day, these effects were no longer present. In both animals, there have
been no reported general or appendicular skeletal defects, which once again
confirms that the experimental administration of glyphosate is not linked to
teratogenic effects.
MEDICAL OPINION AND CONCLUSIONS
In summary, the patient has a combination of symmetrical hypomelia in
his upper extremities and amelia in his lower ones, accompanied by
hydrocephalus and delayed psychomotor development, probably secondary to
hydrocephalus. Possibly, the cause of his malady is the primary absence of
development of the extremities for an unknown cause. Nevertheless, from a
clinical point of view, the three (3) Syndromes mentioned earlier, RS, STAR
and OTMS, are discarded since the anatomical or family-history findings are
not consistent.
Phosphonomethylglycine is also discarded as a cause, not only by the
fact that the spraying dates do not coincide with those of the pregnancy, but
also because the scientific literature shows no teratogenic potential for the
glyphosate molecule.
Furthermore, the three (3) hereditary entities that were considered
show discrepancies between the findings that characterize them and what was
observed in the patient.
The risk of recurrence of this entity in another sibling of Yeison’s
is probably very low (less than 1%). Despite this, Level III Ultrasound
follow-up is recommended for the unborn sibling of the patient.
Carlos Martín
Restrepo-Fernández, MD, MSc.
Head of the Genetics Unit, ICB
Medical School
Rosario University
Camilo Uribe-Granja, MD
Toxicologist and Medical Physician
Scientific Director
Uribe-Cualla Toxicology Clinic
Adriana Zamora-Suárez, MD
Toxicologist and Medical Physician
Uribe-Cualla Toxicology Clinic
BIBLIOGRAPHY
Buyse ML. Birth Defect Encyclopedia. First Edition. U.S.A:
Blackwell Scientific Publications; 1990.
Milunsky A. Genetic Disorders and The Fetus. Diagnosis, Prevention and
Treatment. Third Edition. U.S.A: The Johns University Press; 1992.
Jones KL. Smith´s Recognizable Patterns of Human Malformation. Fourth
Edition. U.S.A: W.B. Saunders Company; 1988.
Thompson MW, McInnes RR, Willard HF. Genetics In Medicine. Fifth
Edition. U.S.A: W.B. Saunders Company; 1991.
Emery AE. Mueller RF. Principios de Genética Médica (Principles of Medical Genetics).
Seventh Edition. Spain: Churchill Livingstone; 1992.
Benzacken B. Savary JB. Manouvriers S, et al. Prenatal Diagnosis
of Roberts Syndrome: Two New Cases. Prenatal Diagnosis 1996; 16: 125-130.
Temtamy SA. McKusick UA. The Genetics of Hand Malformations. Vol XIV,
Number 3. First Edition. New York: Alan R. Liss. INC; 1978.
Shepard TH. Catalog of Teratogenic Agents. Sixth Edition. U.S.A: The
Johns University Press; 1989.
International Programme on Chemical Safety (IPCS). Environmental
Health Criteria 159, Glyphosate. World Health
Organization. Finland, 1994.
Environmental Protection Agency of the United States (EPA). Diagnosis
and Treatment of Cases of Pesticide Poisoning. Fourth Edition, September
1995.
Bronstein A.C., and J. B. Sullivan. Herbicides, fungicides, biocides,
and pyrethrines. Hazardous Materials Toxicology, Clinical Principles
of Environmental Health. J. B. Sullivan, Jr., and G.R. Krieger
(editors). Baltimore, Maryland: Williams and Wilkins. Pp.
1063-77, 1992.
Canadian Centre for occupational Health and Safety. Glyphosate.
Hamilton, Ontario. Chemical safety information Sheet.
Herbicide. Toxicity irritation of respiratory tract, skin and eyes,
1990.
Flaherty D.K, Gross C. J., McGarity K. L., Winzenburger P. P., and
Wratten S. J. The effect of agricultural herbicides on the function
of human immunocompetente cells. Effect on natural killer cell and
cytotoxic T cel function. In Vitro Toxicology. A Journal
of Molecular and Cellular Toxicology 4, no. 2:145-60, 1991.
Williams G, Kroes R, Munro I. Evaluación de la Seguridad y el Riesgo para Humanos del Herbicida Roundup y su ingrediente Activo, Glifosato (Human Safety & Risk Assessment of the Herbicie Roundup and its Active Ingredient: Glyphosate). Canada. 1999.
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