1
|
Solís Albamonte P, Romero García CS, Mateo Rodríguez EM. [Influence of the SARS-CoV-2 pandemic on ICU admissions for severe acute poisoning]. Med Clin (Barc) 2023; 161:359-360. [PMID: 37574411 DOI: 10.1016/j.medcli.2023.06.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/24/2023] [Accepted: 06/27/2023] [Indexed: 08/15/2023]
Affiliation(s)
| | | | - Eva María Mateo Rodríguez
- Sección UCI, Servicio de Anestesiología, Reanimación y Tratamiento del Dolor del Consorci Hospital General de Valencia, Valencia, España
| |
Collapse
|
2
|
Noseda R, Franchi M, Pagnamenta A, Müller L, Dines AM, Giraudon I, Heyerdahl F, Eyer F, Hovda KE, Liechti ME, Miró Ò, Vallersnes OM, Yates C, Dargan PI, Wood DM, Ceschi A. Determinants of Admission to Critical Care Following Acute Recreational Drug Toxicity: A Euro-DEN Plus Study. J Clin Med 2023; 12:5970. [PMID: 37762912 PMCID: PMC10532086 DOI: 10.3390/jcm12185970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/07/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
This study aimed to characterize patients admitted to critical care following Emergency Department (ED) presentation with acute recreational drug toxicity and to identify determinants of admission to critical care. A retrospective multicenter matched case-control study was conducted by the European Drug Emergency Network Plus (Euro-DEN Plus) over the period 2014-2021. The cases were ED presentations with acute recreational drug toxicity admitted to critical care, the controls consisted of ED presentations with acute recreational drug toxicity medically discharged directly from the ED. The potential determinants of admission to critical care were assessed through multivariable conditional stepwise logistic regression analysis and multiple imputation was used to account for the missing data. From 2014 to 2021, 3448 Euro-DEN Plus presentations involved patients admitted to critical care (76.9% males; mean age 33.2 years; SD 10.9 years). Patient age ≥35 years (as compared to ≤18 years) was a determinant of admission to critical care following acute recreational drug toxicity (adjusted odds ratio, aOR, 1.51, 95% confidence interval, CI, 1.15-1.99), along with polydrug use (aOR 1.39, 95% CI 1.22-1.59), ethanol co-ingestion (aOR 1.44, 95% CI 1.26-1.64), and the use of gamma-hydroxybutyrate/gamma-butyrolactone (GHB/GBL, aOR 3.08, 95% CI 2.66-3.57). Conversely, lower odds of admission to critical care were associated with the use of cocaine (aOR 0.85, 95% CI 0.74-0.99), cannabis (aOR 0.44, 95% CI 0.37-0.52), heroin (aOR 0.80, 95% CI 0.69-0.93), and amphetamine (aOR 0.65, 95% CI 0.54-0.78), as was the arrival to the ED during the night (8 p.m.-8 a.m., aOR 0.88, 95% CI 0.79-0.98). These findings, which deserve confirmation and further investigation, could contribute to a more complete understanding of the decision-making process underlying the admission to critical care of patients with acute recreational drug toxicity.
Collapse
Affiliation(s)
- Roberta Noseda
- Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (R.N.); (L.M.)
| | - Matteo Franchi
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy;
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, 20126 Milan, Italy
| | - Alberto Pagnamenta
- Clinical Trial Unit, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland;
- Department of Intensive Care, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland
- Division of Pneumology, University of Geneva, 1211 Geneva, Switzerland
| | - Laura Müller
- Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (R.N.); (L.M.)
| | - Alison M. Dines
- Clinical Toxicology, Guy’s and St Thomas’ NHS Foundation Trust and King’s Health Partners, London SE1 7EH, UK; (A.M.D.); (P.I.D.); (D.M.W.)
| | - Isabelle Giraudon
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), 1249-289 Lisbon, Portugal;
| | - Fridtjof Heyerdahl
- Prehospital Division, Oslo University Hospital, 0424 Oslo, Norway;
- The Norwegian Air Ambulance Foundation, 0184 Oslo, Norway
| | - Florian Eyer
- Department of Clinical Toxicology, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany;
| | - Knut Erik Hovda
- The Norwegian CBRNE Centre of Medicine, Oslo University Hospital, 0450 Oslo, Norway;
| | - Matthias E. Liechti
- Clinical Pharmacology and Toxicology, University Hospital and University of Basel, 4056 Basel, Switzerland;
| | - Òscar Miró
- Emergency Department, Hospital Clínic, University of Barcelona, 08036 Catalonia, Spain;
| | - Odd Martin Vallersnes
- Department of General Practice, University of Oslo, 0318 Oslo, Norway;
- Oslo Accident and Emergency Outpatient Clinic, City of Oslo Health Agency, 0182 Oslo, Norway
| | - Christopher Yates
- Emergency Department and Clinical Toxicology Unit, Hospital Universitario Son Espases, 07120 Mallorca, Spain;
| | - Paul I. Dargan
- Clinical Toxicology, Guy’s and St Thomas’ NHS Foundation Trust and King’s Health Partners, London SE1 7EH, UK; (A.M.D.); (P.I.D.); (D.M.W.)
- Clinical Toxicology, Faculty of Life Sciences and Medicine, King’s College London, London WC2R 2LS, UK
| | - David M. Wood
- Clinical Toxicology, Guy’s and St Thomas’ NHS Foundation Trust and King’s Health Partners, London SE1 7EH, UK; (A.M.D.); (P.I.D.); (D.M.W.)
- Clinical Toxicology, Faculty of Life Sciences and Medicine, King’s College London, London WC2R 2LS, UK
| | - Alessandro Ceschi
- Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (R.N.); (L.M.)
- Clinical Trial Unit, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland;
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland
- Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, 8091 Zurich, Switzerland
| | | |
Collapse
|
3
|
Kovacic V, Kvartuc L, Mikacic M, Jerkovic I, Begovic TI, Maras M, Nazlic J. Clinical and demographic features with outcome predictors of adult patients with acute intoxication admitted to a medical intensive care unit in the Mediterranean part of Croatia. Toxicol Res (Camb) 2023; 12:626-634. [PMID: 37663800 PMCID: PMC10470373 DOI: 10.1093/toxres/tfad054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 05/30/2023] [Accepted: 06/20/2023] [Indexed: 09/05/2023] Open
Abstract
Background The objective of the study was to assess the demographics, clinical parameters, and outcome of acute intoxications among adult patients admitted to a medical intensive care unit in southern Croatia. Materials and Methods An observational retrospective study was conducted over a 1-year period. The subjects were patients admitted to the intensive care unit for acute poisoning. Results In all, 81 subjects (32.1% females) aged 43.16 ± 14.77 years were admitted to the intensive care unit because of poisoning (14.97% of the total annual intensive care unit admissions). Psychiatric disorders were previously established in 76.5% participants, and 69.1% of all acute intoxications were classified as suicidal. Non-suicidal subjects differed from suicidal subjects in age (37.36 ± 9.71 vs. 45.75 ± 15.93 years; P = 0.009), in pCO2 (6.38 ± 1.78 vs. 5.50 ± 1.26 kPa; P = 0.020), in length-of-stay in intensive care unit (median 1.00, interquartile range 1.00 vs. median 2.00, interquartile range 2.00 days; P = 0.022), and in length-of-stay in hospital (median 2.00, interquartile range 2.00 vs. median 10.50, interquartile range 15.25 days; P < 0.001). Three (3.7%) patients died. Pharmaceutical psychoactive drug intoxications were the most common poisoning cases; of these, diazepam was the most frequent (16.8%), followed by ethanol (9.0%) and alprazolam (7.8%). Benzodiazepines/hypnotics were the most common group (28.7%), followed by antipsychotics (13.2%). Intoxications with more than 1 poison accounted for the largest number of cases (67.9%). The number of toxins was significantly correlated with length-of-stay in the hospital (rho = -0.265; P = 0.008), systolic blood pressure (rho = -0.318; P = 0.002), and diastolic blood pressure (rho = -0.262; P = 0.009). The electrocardiogram was considered abnormal in 50.62% of the cases. Conclusion Acute intoxicants were most commonly caused by psychiatric pharmaceutical drugs. Multidrug exposure was a typical pattern of acute intoxication.
Collapse
Affiliation(s)
- Vedran Kovacic
- Internal Medicine Department, Division of Emergency and Intensive Medicine with Clinical Pharmacology and Toxicology, University Hospital of Split, 21000 Split, Croatia
| | - Lukas Kvartuc
- University of Split School of Medicine, 21000 Split, Croatia
| | - Marijana Mikacic
- Internal Medicine Department, Division of Emergency and Intensive Medicine with Clinical Pharmacology and Toxicology, University Hospital of Split, 21000 Split, Croatia
| | - Ivan Jerkovic
- Internal Medicine Department, Division of Emergency and Intensive Medicine with Clinical Pharmacology and Toxicology, University Hospital of Split, 21000 Split, Croatia
| | - Tanja Ilic Begovic
- Internal Medicine Department, Division of Emergency and Intensive Medicine with Clinical Pharmacology and Toxicology, University Hospital of Split, 21000 Split, Croatia
| | - Marina Maras
- Internal Medicine Department, Division of Emergency and Intensive Medicine with Clinical Pharmacology and Toxicology, University Hospital of Split, 21000 Split, Croatia
| | - Jurica Nazlic
- Internal Medicine Department, Division of Emergency and Intensive Medicine with Clinical Pharmacology and Toxicology, University Hospital of Split, 21000 Split, Croatia
| |
Collapse
|
4
|
Behnoush AH, Bazmi E, Forouzesh M, Koehler SA, Monabati SJ, Behnoush B. Impact of COVID-19 on poisoning-related mortality in Iran: An interrupted time series study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 117:104051. [PMID: 37182353 PMCID: PMC10160529 DOI: 10.1016/j.drugpo.2023.104051] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 03/09/2023] [Accepted: 05/02/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND The COVID-19 pandemic had many negative effects worldwide. These effects involved mental health status issues such as suicide, depression, and the pattern of death associated with drug/poisonings. One of the major concerns of the healthcare community during the pandemic was mortality from poisonings. This study aimed to investigate the trends of mortality from different types of poisonings before and after COVID-19. METHODS The patients who died from six different categories of drugs or poisons were identified by forensic analysis of body fluids/tissues in Tehran, Iran. The pandemic was separated into the pre-COVID-19 period (April 2018 to January 2020), and the COVID pandemic (February 2020-April 2022). Demographic characteristics were collected from each victim, and comparisons of death trends before and after the pandemic were conducted using the interrupted time series analysis. The absolute number of deaths and proportion of deaths from each type of drug/poisoning were used for the analyses. RESULTS A total of 6,316 deaths from drugs/poisoning were identified between April 2018-Mar 2022). During this period, 2,485 deaths occurred pre-COVID, and 3,831 were during the COVID-19 era. There were no statistical differences in terms of demographic characteristics before and after the pandemic, except for job status. There was a sharp increase in proportion of methanol death among all poisonings after the start of the pandemic (16.5%, p-value = 0.025), while there was a decreasing trend during the pandemic (-0.915 deaths monthly, p-value = 0.027). The trends for opioids, stimulants, and drug-related deaths changed from decreasing to increasing. No change was seen in the trends for ethanol and volatile substance deaths. This pattern was mirrored in the proportion of each type of poisoning relative to the total number. CONCLUSION Changes in poisoning-related mortality patterns showed dramatic changes after the start of the pandemic, especially deaths from methanol. Other poisonings such as opioids, stimulants, and drugs should also be addressed as there was an increasing trend during the COVID-19 period, compared to the pre-COVID data.
Collapse
Affiliation(s)
| | - Elham Bazmi
- Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran.
| | - Mehdi Forouzesh
- Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
| | | | | | - Behnam Behnoush
- Department of Forensic Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
5
|
Wang Y, Zha H. Neuroimaging for differential diagnosis of transient neurological attacks. Brain Behav 2022; 12:e2780. [PMID: 36350080 PMCID: PMC9759151 DOI: 10.1002/brb3.2780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/04/2022] [Accepted: 09/14/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Rapid yet comprehensive neuroimaging protocols are required for patients with suspected acute stroke. However, stroke mimics can account for approximately one in five clinically diagnosed acute ischemic strokes and the rate of thrombolyzed mimics can be as high as 17%. Therefore, to accurately determine the diagnosis and differentiate mimics from true transient ischemic attacks, acute ischemic stroke is a challenge to every clinician. DISCUSSION Medical history and neurological examination, noncontract head computed tomography, and routine magnetic resonance imaging play important roles in the assessment and management of patients with transient neurological attacks in the emergency department. This review attempts to summarize how neuroimaging can be utilized to help differentiate the most common mimics from transient ischemic attack and acute ischemic stroke. CONCLUSION Although imaging can help direct critical triage decisions for intravenous thrombolysis or endovascular therapy, more detailed medical history and neurological examination are crucial for making a prompt and accurate diagnosis for transient neurological attack patients.
Collapse
Affiliation(s)
- Ying Wang
- Department of Neurology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Hao Zha
- Department of Reproductive and Genetics, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| |
Collapse
|
6
|
Hashim A, Mohammed NA, Othman A, Gab-Allah MAK, Al-Kahodary AHM, Gaber ER, Hassan AM, Aranda M, Hussien R, Mokhtar A, Islam MS, Lee KY, Asghar MS, Tahir MJ, Yousaf Z. Pattern of novel psychoactive substance use among patients presented to the poison control centre of Ain Shams University Hospitals, Egypt: A cross-sectional study. Heliyon 2022; 8:e10084. [PMID: 36039128 PMCID: PMC9418213 DOI: 10.1016/j.heliyon.2022.e10084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/10/2022] [Accepted: 07/21/2022] [Indexed: 11/11/2022] Open
Abstract
Background Novel psychoactive substances (NPSs) are relatively new substances in the illicit drug market, not previously listed in the United Nations Office on Drugs and Crime (UNDOC). Strox and Voodoo are considered some of the most popular blends of NPS in the Egyptian drug market. Objectives The current study was conducted to assess NPS's use pattern: Voodoo and Strox among acutely intoxicated patients presented to the poison control center of Ain Shams University Hospitals (PCC- ASUH). Methods A single center based cross-sectional study was carried out in the PCC-ASUH among acutely intoxicated patients presenting to the emergency department (ED) over four months (from January–April 2019. using a previously adopted and validated Fahmy and El-Sherbini socioeconomic scale (SES). Data were presented as mean, median and range as appropriate. Both smoking and crowding indexes were calculated and presented as previously reported. Results Fifty-one patients were presented to the ED of PCC-ASUH during the study period. A total of 96.1% (n = 49) were males. The mean age was 25 ± 7.5 years. The most common NPS used was Strox: 54.9% (n = 28), followed by Voodoo: 27.4% (n = 14). Neurological and gastrointestinal (GI) symptoms were the most frequent presentations. The most common motive behind NPS use was the desire to give a trial of new psychoactive substances. The mean SES score was 35.1 ± 13.17. Most patients have the preparatory as the highest education 36.0% (n = 18). Conclusions NPS use is common among young males in preparatory education from different social classes, starting it most commonly as a means to experiencing a new high. Neurological and GI manifestations are the most common presenting symptoms of NPS intoxication.
Collapse
Affiliation(s)
- Ahmed Hashim
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Nouran A Mohammed
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - AlFadl Othman
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohab A K Gab-Allah
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed H M Al-Kahodary
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Eslam R Gaber
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed M Hassan
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mahmoud Aranda
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Rania Hussien
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Amany Mokhtar
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Md Saiful Islam
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh.,Centre for Advanced Research, Excellence in Public Health, Savar, Dhaka-1342, Bangladesh
| | - Ka Yiu Lee
- Swedish Winter Sports Research Centre, Department of Health Sciences, Mid Sweden University, Östersund, Sweden
| | | | | | | |
Collapse
|
7
|
Banaye Yazdipour A, Moshiri M, Dadpour B, Sarbaz M, Heydarian Miri H, Hajebi Khaniki S, Kimiafar K. The trend of top five types of poisonings in hospitalized patients based on ICD‐10 in the northeast of Iran during 2012–2018: A cross‐sectional study. Health Sci Rep 2022; 5:e587. [PMID: 35509401 PMCID: PMC9059223 DOI: 10.1002/hsr2.587] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 02/19/2022] [Accepted: 02/21/2022] [Indexed: 11/21/2022] Open
Abstract
Background and Aims Poisoning remains a major health issue in developing countries with high morbidity and mortality rates; also it is one of the most common causes of admission to hospitals. This study aimed to investigate the trend of the top five types of poisonings in hospitalized patients according to the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD‐10) in Imam Reza hospital, Mashhad, Iran. Methods This was a cross‐sectional study performed from March 20, 2012, until September 22, 2018. We collected data from all patients hospitalized for poisoning admitted to the poisoning center at Imam Reza hospital in northeast Iran. ICD‐10 was adopted to categorize all types of poisonings (T36‐T65). The results obtained were analyzed by SPSS 16. Results Thirty‐four thousand eight hundred and ten cases were included. The mean age of the patients was 29.64 ± 14.69 years, of them, 50.7% were males. Benzodiazepine poisoning (T42.4) has the highest frequency among other subcategories and it was more common among females (60.5%). Opium poisoning (T40.0) has the highest mortality rate (5.4%) among other subcategories that is more common in males (72.0%). The mortality associated with narcotics was the highest frequency (2.7%). Suicide (83.6%) was the most common cause of poisoning. Most poisonings occurred in summer (27.4%). Conclusion These findings could help health care managers and policymakers develop prevention and educational programs to reduce these poisonings and limit people's easy access to drugs and substances.
Collapse
Affiliation(s)
- Alireza Banaye Yazdipour
- Department of Health Information Management, School of Allied Medical Sciences Tehran University of Medical Sciences Tehran Iran
- Students' Scientific Research Center (SSRC) Tehran University of Medical Sciences Tehran Iran
- Department of Medical Records and Health Information Technology, School of Paramedical Sciences Mashhad University of Medical Sciences Mashhad Iran
| | - Mohammad Moshiri
- Medical Toxicology Research Center, School of Medicine Mashhad University of Medical Sciences Mashhad Iran
- Department of Pharmacodynamy and Toxicology, School of Pharmacy Mashhad University of Medical Sciences Mashhad Iran
| | - Bita Dadpour
- Medical Toxicology Research Center, School of Medicine Mashhad University of Medical Sciences Mashhad Iran
| | - Masoumeh Sarbaz
- Department of Medical Records and Health Information Technology, School of Paramedical Sciences Mashhad University of Medical Sciences Mashhad Iran
| | - Hamid Heydarian Miri
- Department of Epidemiology, School of Health Mashhad University of Medical Sciences Mashhad Iran
| | - Saeedeh Hajebi Khaniki
- Student Research Committee, Department of Biostatistics, Faculty of Health Mashhad University of Medical Sciences Mashhad Iran
| | - Khalil Kimiafar
- Department of Medical Records and Health Information Technology, School of Paramedical Sciences Mashhad University of Medical Sciences Mashhad Iran
| |
Collapse
|
8
|
Şen B, Öztürk İ. A Retrospective Evaluation of Suicidal and Accidental Drug Intoxication in Intensive Care Unit. CYPRUS JOURNAL OF MEDICAL SCIENCES 2022. [DOI: 10.4274/cjms.2020.1827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
9
|
Frequency of Poisoning Leading to Hospitalization in the Intensive Care Units in Northeastern Iran, 2008-2018. JOURNAL OF RESEARCH DEVELOPMENT IN NURSING AND MIDWIFERY 2021. [DOI: 10.52547/jgbfnm.18.1.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023] Open
|
10
|
Wahba MA, Alshehri BM, Hefny MM, Al Dagrer RA, Al-Malki SDS. Incidence and profile of acute intoxication among adult population in Najran, Saudi Arabia: A retrospective study. Sci Prog 2021; 104:368504211011339. [PMID: 33940992 PMCID: PMC10358563 DOI: 10.1177/00368504211011339] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Acute poisoning is considered one of the most important medical emergencies, resulting in severe morbidity and mortality, and is an economic burden on governments. This study aimed to determine the extent of acute adult intoxication among the population located in the Najran area, Saudi Arabia, over the last 3 years (from January 2017 to December 2019). The study is a hospital-based retrospective observational study. The data of all acutely intoxicated adult patients were collected from patients' files of King Khalid Hospital, the main hospital in the Najran area. In this study, the total number of intoxicated patients was 852. Patients were divided into three groups according to their age: 15-25 years, 26-35 years and >35 years. Accidental intoxication was predominant (64.6%), especially with therapeutic drugs (60.2%), predominantly acetaminophen and amphetamine, which intoxicated 24.5% and 23.4% of the patients, respectively. Moreover, this study showed that 10.6% of patients were intoxicated with overdoses of alcohol, mostly among patients aged over 35 years. Furthermore, the present study revealed that 23.9% of patients were intoxicated with household chemicals, especially Clorox bleach or Flash. Patients presented with a wide range of symptoms; some were even asymptomatic. Overall, patients' outcomes were good; mortalities were few (1.2%), and most fatalities were found in patients aged over 35 years (60%). The present study showed that pharmaceutical drugs constituted the most common causative agents in acute intoxication. Household chemicals, especially Clorox bleach, Flash and pesticides, are highly implicated in the acute toxicity problem. Drug abuse, especially amphetamine and alcohol, still represents a great threat facing people from the Najran region. It is crucial to deliver effective public health education programmes to increase community awareness about the predisposing risk factors of acute toxicity, whether as overdoses or suicide attempts.
Collapse
Affiliation(s)
- Mohamed A Wahba
- Department of Forensic Medicine and Toxicology, Faculty of Medicine, Najran University, Saudi Arabia
- Gastroenterology Surgery Center, Faculty of Medicine, Mansoura University, Egypt
| | - Bandar M Alshehri
- Department of Clinical Laboratory, Faculty of Applied Medical Sciences, Najran University, Najran, Saudi Arabia
| | - Mona M Hefny
- Department of Biochemistry, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | | |
Collapse
|
11
|
Simbeye J, Navab E, Bahramnezhad F. Pain Management Interventions for Drug-addicted Patients Admitted in Intensive Care Units: An Integrative Review. Open Nurs J 2020. [DOI: 10.2174/1874434602014010240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Pain management interventions among critically ill drug-addicted patients admitted to ICUs are still the major challenge faced by healthcare practitioners.
Objective:
Therefore, this study aimed to identify and appraise the pain management approaches of patients with drug addiction (substance use disorder) admitted in ICUs.
Methods:
An integrative review of the literature was performed; narrative data synthesis was used for data extraction. The search was performed using scientific databases, including Google Scholar, PubMed, Scopus, Web of Science, Ovid Medline and EMBASE from January 2000 to September 2019. All studies that assessed pain management interventions for drug-addicted patients (substance use disorder) admitted in ICUs were included in the review.
Results:
Initially, four studies were included in this review. All these studies were Randomized Controlled Trials. The settings were intensive care units in the United States and Iran. The evidence identified from all studies included administration of intravenous paracetamol and midazolam, implementation of Buprenorphine-Naloxone therapy, adjuvant therapy and proper utilization of nursing sedation and pain management interventions for addicted patients admitted in ICUs.
Conclusion:
Management of pain in drug-addicted patients admitted in ICUs is relevant to healthcare practitioners, especially critical care nurses, as these patients’ subpopulation is at risk of underestimation of pain levels and not getting appropriate treatment.
Collapse
|
12
|
|
13
|
Oladunjoye AO, Oladunjoye OO, Olubiyi O, Yee MR, Espiridion ED. Predictors and Outcomes of Invasive Mechanical Ventilation in Opioid Overdose Hospitalization in the United States. Cureus 2020; 12:e9788. [PMID: 32953304 PMCID: PMC7491682 DOI: 10.7759/cureus.9788] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 08/16/2020] [Indexed: 11/05/2022] Open
Abstract
Introduction Opioid overdose is increasingly becoming common and so is the need for invasive mechanical ventilation (IMV) for opioid overdose admissions in hospitalized patients. Respiratory failure requiring invasive mechanical ventilation is the most common reason for the admission of opioid-associated overdose patients. The aim of our study was to assess the demographic and clinical characteristics associated with the increased need for IMV in hospitalized opioid overdose patients. Methods We analyzed all adult admissions (18 years and above) using the National Inpatient Sample (NIS) database for five years from January 1, 2010-December 31, 2014 to identify opioid overdose patients requiring invasive mechanical ventilation. We compared the demographic and clinical characteristics of opioid overdose patients requiring and not requiring mechanical ventilator support and performed univariate and multivariate analyses to determine the odds ratio (OR) of association. Results A total of 2,528,751 opioid overdose patients were identified among which 6.4% required IMV during hospitalization. The prevalence of opioid overdose and the need for IMV increased by 31% and 38%, respectively, over the study period. Multivariate logistic regression (OR (95% CI), p<0.001) determined the following to be associated with increased odds of mechanical ventilator use: (OR 1.12 (1.06-1.19)) among patients aged 25-39 years vs (1.36 (1.28-1.44)) for the age group 40-64 years when compared to 18-24 years; hospital locations in the south US region (OR 1.62 (1.49-1.75)) when compared to the northeast US region; the presence of aspiration pneumonia (OR 14.30 (13.63-15.0)), rhabdomyolysis (3.22 (3.04-3.42)), septic shock (9.15 (8.41-9.97)), and anoxic brain injury (15.5 (13.70-17.50)). Other factors associated with decreased odds of IMV include hepatitis C virus infection (OR 0.75 (0.72-0.79)) and black race (OR 0.68 (0.63-0.74)]. Opioid overdose patients requiring IMV had a higher length of stay by 8.9 ± 0.1 days, higher hospitalization cost by US$ 28,117.81 ± 373.53, and higher in-hospital mortality rate (13.4% vs 0.3%). Conclusion The prevalence of opioid overdose and the need for IMV increased over the five-year study period, reflecting an increase in the relatively high in-hospital mortality of opioid overdose patients on IMV. Patient's age, geographic location, race, and several comorbidities affect the need for invasive mechanical ventilation in hospitalized opioid overdose patients. These findings emphasize the need for a better understanding of these risk factors in creating a strategic approach for hospital care of opioid overdose patients.
Collapse
Affiliation(s)
- Adeolu O Oladunjoye
- Medical Critical Care, Boston Children's Hospital, Harvard Medical School, Boston, USA
- Psychiatry, Reading Health Tower Health, West Reading, USA
| | | | | | - Maria Ruiza Yee
- Psychiatry, Philadelphia Collge of Osteopathic Medicine, Philadelphia, USA
- Psychiatry, Reading Hospital Tower Health, West Reading, USA
- Psychiatry, Drexel University College of Medicine, Philadelphia, USA
| | - Eduardo D Espiridion
- Psychiatry, Drexel University College of Medicine, Philadelphia, USA
- Psychiatry, West Virginia School of Osteopathic Medicine, Lewisburg, USA
- Psychiatry, West Virginia University School of Medicine, Martinsburg, USA
- Psychiatry, Philadelphia College of Osteopathic Medicine, Philadelphia, USA
- Psychiatry, Reading Hospital Tower Health, West Reading, USA
| |
Collapse
|
14
|
Wedin A, Sandström S, Sandström L, Forsberg A. Critical care nurses' experiences of nursing intoxicated patients after abuse of drugs. Nurs Crit Care 2020; 27:66-72. [PMID: 32749035 DOI: 10.1111/nicc.12533] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 04/23/2020] [Accepted: 06/07/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patients intoxicated after abusing illicit drugs constitute a significant proportion of patients cared for in intensive care units. Intensive critical care nurses who nurse accidentally intoxicated patients face complex and demanding situations, and there is a lack of studies regarding this topic. AIMS AND OBJECTIVES To illuminate Swedish intensive critical care nurses' experiences of nursing accidentally intoxicated patients after abuse of illicit drugs. DESIGN A qualitative design with an inductive approach was used. METHODS Semi-structured interviews were conducted with eight intensive critical care nurses at an intensive care unit in Sweden. Data were analysed using qualitative content analysis. FINDINGS The themes found illuminate intensive critical care nurses' experiences of nursing accidentally intoxicated patients after their abuse of illicit drugs: feeling empathy and a wish to provide dignified care; dreading nursing the patient and feeling a lack of empathy; feeling frustration and questioning the care; lacking knowledge about a complex and challenging situation. CONCLUSIONS It is essential to respond to intoxicated patients with empathy and dignity. Intensive critical care nurses should learn how to identify factors that lead to provocation and agitation in order to reduce the occurrence of dangerous situations in intensive care units. RELEVANCE TO CLINICAL PRACTICE To create a caring environment where the interaction becomes more positive and harmonious, an intensive care nurse needs a deep understanding of what a drug abuse disorder means. Moreover, the ability to see the person behind the abuse and to provide non-judgemental support is required. WHAT IS KNOWN ABOUT THIS TOPIC Patients intoxicated after abuse of illicit drugs constitute a significant proportion of patients cared for in ICUs worldwide. Intensive critical nurses who nurse accidentally intoxicated patients face complex and demanding situations, and few studies have addressed this topic. WHAT THIS PAPER CONTRIBUTES It is essential to respond to intoxicated patients who are admitted to the ICU with empathy and dignity, as well as to learn how to identify factors that lead to provocation and agitation in order to reduce the occurrence of dangerous situations. Education is warranted and must be enhanced, including knowledge about drug abuse and training in communication and empathy Nursing should include an understanding of what the disease of drug abuse means and the development of the ability to see the person behind the abuse and to provide non-judgemental support.
Collapse
Affiliation(s)
- Adam Wedin
- Intensive Care Unit 57, Sunderby Hospital, Luleå, Sweden
| | | | - Linda Sandström
- Division of Nursing, Department of Health Science, Luleå University of Technology, Luleå, Sweden
| | - Angelica Forsberg
- Intensive Care Unit 57, Sunderby Hospital, Luleå, Sweden.,Division of Nursing, Department of Health Science, Luleå University of Technology, Luleå, Sweden
| |
Collapse
|
15
|
Mudan A, Love JS, Greenwood JC, Stickley C, Zhou VL, Shofer FS, Jang DH. The management of the poisoned patient using a novel emergency department-based resuscitation and critical care unit (ResCCU). Am J Emerg Med 2020; 38:2070-2073. [PMID: 33142177 DOI: 10.1016/j.ajem.2020.06.068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 06/17/2020] [Accepted: 06/22/2020] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVES The Resuscitation & Critical Care Unit (ResCCU) is a novel ED-based ICU designed to provide early critical care services. This study sought to identify characteristics of poisoned patients treated in the ResCCU. METHODS We conducted a retrospective, single-center case study of poisoned patients over the age of 18 years old over a 16-month period. Patient demographics, drug concentrations, and severity of illness scores were extracted from electronic medical records. Patients were divided into two groups, those who required short term ICU level care (< 24 h) and prolonged ICU care (> 24 h). RESULTS A total of 58 ED visits with a tox-related illness were analyzed. There were 24 women (41%) and 34 men (59%). There were 42 patients (72%) who required short term ICU level care and 16 patients (28%) who required prolonged ICU care. In the short-term ICU group, 13 patients (31%) were discharged home directly from the ResCCU, 29 patients (69%) were sent to the inpatient floor, and 1 of the admitted floor patients expired. There were no patients admitted to the floor that required a step-up to the inpatient ICU. 56 patients (97%) were alive at post-admit day 7 and 28, and only 8 (14%) were re-admitted within 30 days. CONCLUSIONS Patients who were treated in the ED-based ICU for toxicology-related illnesses were frequently able to be either discharged home or admitted to a regular floor after their initial stabilization and treatment, and none that were sent to the floor required an ICU step-up.
Collapse
Affiliation(s)
- Anita Mudan
- Department of Emergency Medicine, University of California San Francisco, United States
| | - Jennifer S Love
- Department of Emergency Medicine, Oregon Health & Science University, United States
| | - John C Greenwood
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States; Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Carolyn Stickley
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Victoria L Zhou
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Frances S Shofer
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - David H Jang
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States.
| |
Collapse
|
16
|
Gao L, Xiang W, Deng Z, Shi K, Wang H, Shi H. Cocaine detection using aptamer and molybdenum disulfide-gold nanoparticle-based sensors. Nanomedicine (Lond) 2020; 15:325-335. [PMID: 31976806 DOI: 10.2217/nnm-2019-0046] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Aim: The current work highlighted a novel colorimetric sensor based on aptamer and molybdenum disulfide (MoS2)-gold nanoparticles (AuNPs) that was developed for cocaine detection with high sensitivity. Materials & methods: Due to the presence of the plasmon resonance band on the surface of AuNPs, AuNPs aggregated and the color was changed from red to blue after adding a certain concentration of NaCl. We used MoS2 to optimize the sensing system of AuNPs. The folded conformation of the aptamer in combination with cocaine enhanced the salt tolerance of the MoS2-AuNPs, effectively preventing their aggregation. Results & conclusion: The detection limit of cocaine was 7.49 nM with good selectivity. The method based on MoS2-AuNPs colorimetry sensor is simple, quick, label-free and low cost.
Collapse
Affiliation(s)
- Li Gao
- Precision Medical Center Laboratory, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, 325015, PR China
| | - Wenwen Xiang
- Precision Medical Center Laboratory, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, 325015, PR China
| | - Zebin Deng
- Precision Medical Center Laboratory, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, 325015, PR China
| | - Keqing Shi
- Precision Medical Center Laboratory, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, 325015, PR China
| | - Huixing Wang
- Precision Medical Center Laboratory, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, 325015, PR China
| | - Haixia Shi
- Precision Medical Center Laboratory, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, 325015, PR China
| |
Collapse
|
17
|
Cervellione KL, Shah A, Patel MC, Curiel Duran L, Ullah T, Thurm C. Alcohol and Drug Abuse Resource Utilization in the ICU. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2019; 13:1178221819869327. [PMID: 31548794 PMCID: PMC6743197 DOI: 10.1177/1178221819869327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 07/18/2019] [Indexed: 11/16/2022]
Abstract
Alcohol and drug abuse continue to be major causes of morbidity and mortality and
have significant social and economic ramifications. Studies have shown that for
every $1 spent on substance use disorder treatment, $4 are saved on healthcare
costs. Characterizing the healthcare resource utilization of these patients may
shed light on the burden of disease and opportunities for intervention. A
retrospective chart review of all patients admitted to the ICU between July 1,
2017 and December 31, 2017 was completed. Variables regarding demographic and
clinical characteristics as well as healthcare resource utilization were
collected. Of 737 admissions to the ICU, 158 (21%) were due to acute or chronic
complications of alcohol or drug abuse. Even though alcohol and drug users were
significantly younger (average age 50 years) than the general ICU cohort
(average age 66 years), resource utilization was similar between these patients.
The median length of stay in the ICU was similar. The number of patients
transferred to in-patient rehab was low (8%), and all of those were due to
comorbid psychiatric illness. The total hospital charges for the alcohol and
drug abuse cohort was over 7 million dollars for the 6 months observed. A
significant number of patients had at least one ER visit (49%) during the
previous year, and most of these had numerous visits. ICU resource utilization
by patients with acute and chronic sequelae of drug or alcohol abuse disorders
continues to be high. These patients utilize resources at rates similar to an
older group with other disease processes. Patients are unlikely to receive
intervention for their disorder unless they have a comorbid psychiatric illness.
Patients admitted to the ICU with alcohol or drug-related illness were
frequently seen in the ER or were admitted to the hospital in the year prior to
ICU admission, providing opportunities for intervention.
Collapse
Affiliation(s)
| | - Aashir Shah
- Jamaica Hospital Medical Center, Jamaica, NY, USA
| | | | | | - Tofura Ullah
- Jamaica Hospital Medical Center, Jamaica, NY, USA
| | - Craig Thurm
- Jamaica Hospital Medical Center, Jamaica, NY, USA
| |
Collapse
|
18
|
Shokrzadeh M, Hoseinpoor R, Jafari D, Delaram A, Pouyan Sadr A, Deylami M, Shayeste Y. A Ten-Year Study of Drug Poisoning Cases Admitted to the Intensive Care Unit of 5 Azar Hospital in Gorgan, Iran. JOURNAL OF CLINICAL AND BASIC RESEARCH 2019. [DOI: 10.29252/jcbr.3.2.8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
|
19
|
Mehrpour O, Akbari A, Jahani F, Amirabadizadeh A, Allahyari E, Mansouri B, Ng PC. Epidemiological and clinical profiles of acute poisoning in patients admitted to the intensive care unit in eastern Iran (2010 to 2017). BMC Emerg Med 2018; 18:30. [PMID: 30231863 PMCID: PMC6146606 DOI: 10.1186/s12873-018-0181-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 09/12/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Acute poisoning is a common chief complaint leading to emergency department visits and hospital admissions in developing countries such as Iran. Data describing the epidemiology of different poisonings, characteristics of the clinical presentations, and the predictors of outcome are lacking. Such data can help develop more efficient preventative and management strategies to decrease morbidity and mortality related to these poisonings. This manuscript describes the epidemiology of acute poisoning among patients admitted to the intensive care unit (ICU) in Birjand, Iran. METHODS This retrospective, cross-sectional study was conducted to characterize acute poisonings managed in the ICU during a 7-year period from March 2010 to March 2017 in a single center in Birjand, Iran. Patient characteristics, suspected exposure, the route of exposure, and outcome data were collected from hospital medical records. RESULTS During the study period, 267 (64% male and 36% female) patients met inclusion criteria. Pharmaceutical medication (36.6%), opioids (26.2%) followed by pesticides (13.9%) were the most common exposures 38.2% of these cases were identified as suicide attempts. There were different frequencies in terms of xenobiotic exposure in relation to gender (p = 0.04) and the survival (p = 0.001). There was a significant difference between various xenobiotics identified as the cause of poisoning (p = 0.001). Mortality rate in our study was 19.5%. The incidence of outcomes was significantly higher in patients poisoned with opioids, pesticides, benzodiazepines, and tricyclic antidepressants (p < 0.05). The median length of hospital stay was higher in pesticide-poisoned patients (p = 0.04). CONCLUSION Opioids and pesticides were the most common exposures. The mortality rate of the poisoned patients in the ICU was proportionately high. The mortality rate due to opioid poisoning is a major concern and the most significant cause death due to poisoning in the region. Further monitoring and characterization of acute poisoning in Birjand, Iran is needed. These data can help develop educational and preventative programs to reduce these exposures and improve management of exposures in the prehospital and hospital settings.
Collapse
Affiliation(s)
- Omid Mehrpour
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Moallem Avenue, Birjand, 9717853577 Iran
- Rocky Mountain Poison and Drug Center, Denver, CO USA
| | - Ayob Akbari
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Moallem Avenue, Birjand, 9717853577 Iran
| | - Firoozeh Jahani
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Moallem Avenue, Birjand, 9717853577 Iran
| | - Alireza Amirabadizadeh
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Moallem Avenue, Birjand, 9717853577 Iran
| | - Elaheh Allahyari
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Borhan Mansouri
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Moallem Avenue, Birjand, 9717853577 Iran
| | - Patrick C. Ng
- Rocky Mountain Poison and Drug Center, Denver, CO USA
| |
Collapse
|
20
|
Rehman S, Vallamkonda O, Raut NB. Acute recreational drug toxicity: An update. INDIAN JOURNAL OF MEDICAL SPECIALITIES 2018. [DOI: 10.1016/j.injms.2018.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|