Epidemiologic profile and triggering factors of voluntary poisoning in teenagers

Titanate nanotubes as an efficient oral detoxifying agent against drug overdose: application in rat acetaminophen poisoning

Voluntary drug intoxication is mainly due to drug overdose or the interaction of several drugs. Coma and its associated complications such as hypoventilation, aspiration pneumopathy, and heart rhythm disorders are the main hallmarks of drug intoxication. Conventional detoxification treatments, including gastric lavage or vomiting, administration of ipecac or activated charcoal (CH), and the use of antidotes, have proven to be inefficient and are generally associated with severe adverse effects. To overcome these limitations, titanate nanotubes (TiNTs) are proposed as an efficient emerging detoxifying agent because of their tubular shape and high adsorption capacity. In the present study, the detoxifying ability of TiNTs was evaluated on paracetamol (PR)-intoxicated rats. Results indicate that the loading ability of PR into TiNTs (70%) was significantly higher than that recorded for CH (38.6%). In simulated intestinal medium, TiNTs showed a controlled drug release of less than 10% after 72 h of incubation. In PR-intoxicated rats, TiNTs treatment resulted in a 64% decrease of PR after 4 h of poisoning versus 40% for CH. Concomitantly, TiNTs efficiently reduced PR absorption by 90% after 24 h of poisoning, attenuated the elevated levels of biochemical markers (i.e., alanine aminotransferase, aspartate aminotransferase, creatinine, and TNF-α) and mitigated oxidative stress by increasing the activity of superoxide dismutase and reducing the oxidized glutathione/total glutathione ratio, suggesting a histoprotective effect of TiNTs against paracetamol-induced toxicity in rats. In addition to their safety and high stability in the entire gastro-intestinal tract, biodistribution analysis revealed that TiNTs exhibited low intestinal absorption owing to their large cluster size of compact aggregate nanomaterials across the intestinal villi hindering the absorption of paracetamol. Collectively, these data provide a new and promising solution for in vivo detoxification. TiNTs are expected to have great potential for the treatment of voluntary and accidental intoxication in emergency care.

Prevalence of Depression and Predictors of Discharge to a Psychiatric Hospital in Young People with Hospital-Treated Deliberate Self-Poisoning at an Australian Sentinel Unit

OBJECTIVE

Hospital treated deliberate self-poisoning is common in young people. Internationally, estimates of rates of depression in this population are very wide (14.6% to 88%). The aims of this study were to determine the prevalence of depression and the independent predictors of referral for psychiatric hospitalisation in young people (aged 16 to 25 years) following an index episode of hospital treated deliberate self-poisoning.

METHOD

A retrospective cohort study design (n = 1410), with data drawn from a population-based clinical case register. Unadjusted and adjusted estimates of predictors of referral for psychiatric admission (after-care) used logistic regression models.

RESULTS

Prevalence of any depression diagnosis was 35.5% (n = 500); and 25.4% (n = 358) were referred for a psychiatric admission. The adjusted estimates for predictors of psychiatric inpatient referral were: high suicidal level (OR 118.21: CI 95% 63.23-220.99), low/moderate suicidal level (14.27: 9.38-21.72), any depression (2.88: 1.97-4.22), any psychosis (4.06; 1.15-14.36), older age (1.12: 1.04-1.21), and number of support people (0.88: 0.78-0.98).

CONCLUSION

Depression was diagnosed in more than a third and was an independent predictor of psychiatric inpatient referral, so service providers need to account for this level of need in the provision of assessment and after-care services. Evidence-based guidelines for psychiatric inpatient after-care for deliberate self-poisoning and/or depression in young people are limited. Our explanatory model included suicidal level, depression, psychosis, older age, and available support persons, suggesting that the treating clinicians were making these discharge decisions for admission in keeping with those limited guidelines, although the balance of benefits and harms of psychiatric hospitalisation are not established. Future research examining patient experiences, effectiveness of psychiatric hospitalisation, and alternatives to hospitalisation is warranted.

Characteristics of suicidal poisoned patients admitted to tertiary care center during COVID-19 pandemic

Background

Suicidal poisoning is a major concern during the COVID-19 pandemic that has several physical and mental hazards. This study aimed to evaluate the characteristics of suicidal poisoned patients admitted to a tertiary poison control center during the pandemic lockdown and assess COVID-related knowledge and attitude among those patients to identify the high-risk group for suicide. This cross-sectional study was conducted on acutely poisoned patients admitted to Tanta University Poison Control Center from June to December 2020. Upon admission, socio-demographic data, causative poisoning agents, COVID-related knowledge and attitude, Hamilton Anxiety Rating Scale (HAM-A), and Hamilton Depression Rating Scale (HAM-D) were collected from all participants.

Results

A total of 254 poisoned patients were categorized into suicidal (85.04%) and accidental (14.96%) poisoning groups. The former was caused mainly by phosphides and was significantly associated with a history of using psychotropic medications and high HAM-A and HAM-D results. Logistic regression analysis showed that a history of psychiatric illness, low attitude scores, and high HAM-D scores were significant risk factors for suicidal poisoning.

Conclusions

Considerable number of suicidal poisoned patients had moderate-to-severe depressive symptoms, highlighting the importance of providing specialized psychiatric services in poisoning centers, particularly among vulnerable populations, to prevent the overwhelming repeated suicidal attempts.

Clinical Assessment of Acute Organophosphorus Pesticide Poisoning in Pediatric Patients Admitted to the Toxicology Emergency Department

Pesticide poisoning in pediatric patients is still an important reason for presenting to the emergency department in Romania. In this context, the present study aims to raise awareness of the toxicological impact of pesticides on human health in pediatrics. For this purpose, the demographic characteristics, clinical assessment, and outcome of pediatric patients with acute pesticide poisoning admitted to the toxicology department of "Saint Mary" Emergency Children's Hospital from Iasi, were analyzed. This retrospective study focused on the clinical and laboratory data of patients aged under 18 years diagnosed with acute pesticide poisoning between 2010-2020. The statistical analysis was performed using the Statistica 10 package. A total of 49 patients presented with manifestations of acute pesticide poisoning, and the most common pesticide involved was diazinon. The most frequent exposure route was accidentally ingesting pesticide products (95%). The primary clinical manifestations were toxic encephalopathy, coma, depressive disorder, gastric disorders, and respiratory failure. Changes in the glycemic status, liver, and kidney damage were also present. Treatment included decontamination, administration of antidote, supportive care, and recommendations to be closely monitored to avoid a new incident. These results highlight the toxic potential of pesticides on human health and their biological consequences, which require an increase in consciousness of the precautions imposed on their use, especially when children are nearby.

Clinical and Epidemiological Characteristics of Acute Poisoning in Children in Southwestern China: A Review of 1755 Cases from 2014 to 2020

Purpose

Acute poisoning is a major cause of disability and death in children, but there is a lack of large-scale and multicenter epidemiological data on acute poisoning in children.

Patients and Methods

The current study was a retrospective analysis of clinical data from 1755 children aged 0 to 14 years who were hospitalized between 01 January 2014 and 31 December 2020 in southwestern China.

Results

Acute poisoning was common in childhood, particularly in early childhood (607; 34.6%) and preschool (655; 37.3%), and most cases occurred in rural areas (1191; 67.9%). It was more common in boys (934; 53.2%) than in girls (821; 46.8%). In urban areas, poisoning was mainly caused by drugs (266; 47.2%), chemical agents (59; 10.5%), and alcohol (54; 9.6%). In rural areas, it was mainly caused by pesticides (620; 52.1%) and medications (213; 17.9%), the route of poisoning was usually the digestive tract (1671; 95.2%), in most cases the poisoning was accidental (1618; 92.3%), and pesticides (659; 37.5%) and medications (479; 27.3%) predominated. After timely treatment, the majority of patients had no substantial organ damage, sequelae, or disabilities, and mortality was low (17; 1.0%).

Conclusion

Acute poisoning is a frequent accident in childhood, mainly in infants and preschool children, mostly in rural areas, and poisoning mostly occurs via the digestive tract. Family and community education should be conducted to prevent poisoning.

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An epidemiological study of poisoning cases in Babol (northern Iran) from 2015 to 2018

BACKGROUND

Poisoning is a major public health problem that constitutes a significant share of the global burden of disease. Previous studies conducted in this area indicated the importance of such epidemiological studies. The most critical impact of these studies is their effect on changing current regulations and, therefore, decreasing poisoning cases. We aimed to evaluate all poisoning cases with regard to the patients' demographics and the involved intoxicants.

METHODS

The present study was conducted to investigate all poisoning cases who were admitted during a three-year period. Causes of poisoning, hospitalization, management procedures and outcome of the cases were surveyed. A total of 1448 patients referred to Shahid Beheshti Hospital (Babol, Iran) from 2015 to 2018.

RESULTS

More than half of the patients were females (51.7%), and the majority of poisoning cases were seen in patients aged between 15 to 25 years (34.2%). It was found that suicide made a large part of poisoning cases (65.6%), and females tend to attempt suicide more than males (64.3% vs. 35.7%, respectively). Also, regular drugs followed by club drugs were the most abundant toxic agents (52.1% and 23.3%, respectively). Aluminum phosphide (AlP) was the most lethal intoxicant in our study, accounting for 68.2% of all deaths.

CONCLUSION

According to the results, it is concluded that the existing regulations for drug control and suicide prevention have not been efficient enough and further actions yet to be made to reduce the consequences of drug- and non-drug-related toxicities.