A retrospective evaluation of analgesic exposures from Izmir, Turkey

Minimum Data Set for a Poisoning Registry: A Systematic Review

Poisoning, as a well-known medical condition, puts everyone at risk. As a data management tool, a registry plays an important role in monitoring the poisoned patients. Having a poisoning minimum data set is a major requirement for creating a poisoning registry. Therefore, the present systematic review was conducted in 2019 to identify the minimum data set for a poisoning registry. Searches were performed in four scientific databases, i.e., PubMed, Scopus, Web of Science, and Embase. The keywords used in the searches included minimum data set, "poison", and "registry". Two researchers independently evaluated the titles, abstracts, and texts of the papers. The data were collected from the related papers. Ultimately, the minimum data set was identified for the poisoning registry. Data elements extracted from the sources were classified into two general categories: administrative data and clinical data. Ninety-eight data elements in the administrative data category were subdivided into three sections: general data, admission data, and discharge data. One-hundred and thirty-one data elements in the clinical data category were subdivided into five sections: clinical observation data, clinical assessment data, past medical history data, diagnosis data, and treatment plan data. The minimum data set is a prerequisite for creating and using a poisoning registry and data system. It is suggested to evaluate and use the poisoning minimum data set in accordance with the national laws, needs, and standards based on the opinion of the local experts.

Demographic and Clinical Characteristics of Theophylline Exposures between 1993 and 2011

BACKGROUND

Acute and chronic exposure to theophylline can cause serious signs and symptoms of poisoning. Additionally, with a narrow therapeutic range, toxicity could be observed even with therapeutic doses of theophylline. Epidemiological data on theophylline exposures in our country are extremely limited. The results of our study may improve the clinical management of theophylline poisoning in our country and elsewhere.

AIMS

To present aetiological and demographic features, clinical findings and treatment attempts with regard to theophylline exposures reported to Dokuz Eylül University Drug and Poison Information Center (DPIC), between 1993 and 2011.

STUDY DESIGN

Descriptive study.

METHODS

The data regarding demographics, date, time, type of exposure, route of and reason for exposure, signs and symptoms upon admission, clinical management and outcome were retrospectively evaluated.

RESULTS

The DPIC recorded 88,562 poisoning calls between 1993 and 2011; 354 (0.4%) of them were due to theophylline exposure. The mean age of all cases was 24.1±15.4 (range between 1 month and 90 years). Females dominated all age groups (72.6%, 257 females). Intentional exposure was significantly higher in women than in men (88.2% vs. 68.2% for all age groups; p<0.001 for children; p<0.001 for adults; p<0.001 for all age groups). While 60.5% of the cases had no symptoms, severe signs of toxicity were present in 1.9% of theophylline exposure cases during the telephone inquiry. Signs and symptoms were found to be significantly more prevalent in adults than in children (p<0.01). The serum theophylline level was regarded as toxic in 74% (65 toxic levels) of theophylline measured cases. Clinical signs and symptoms were found to be significantly prevalent in cases with toxic theophylline levels (p<0.001). The rate of gastrointestinal decontamination procedures was higher than that of recommended gastrointestinal decontamination procedures by DPIC (83% and 66%, respectively). There were two fatalities (4.6%) associated with chronic theophylline toxicity and theophylline overdose in an acute setting for suicide (a 90 year-old and 25 year-old, respectively).

CONCLUSION

Although most of the theophylline exposure cases had no symptoms, some reported serious signs and symptoms of poisoning such as hypokalaemia, tachycardia and hyperglycaemia. DPICs have an important role in the management of theophylline exposure without unnecessary gastrointestinal decontamination procedures.

Evaluation of paracetamol distribution and stability in case of acute intoxication in rats

Effects of different storing conditions on paracetamol concentration in biological samples of acute intoxicated rats were investigated. The stability and distribution of paracetamol was observed in postmortem serum, liver, kidney and brain tissues. The serum samples were stored for 30 days and daily changes were evaluated for paracetamol. A significant difference ( p = 0.05) was noticed on the 30th experimental day. Paracetamol serum levels changed as much as 66.30% and 33.78% for 4°C and −20°C, respectively. The stability of paracetamol in liver stored at −20°C was also evaluated for 30 days. The paracetamol concentration levels taken from liver samples dramatically decreased from 30.36% on the 1st day to 94.97% on the 30th day. The paracetamol distribution in organs was as 2.68 , 1.11 and 0.68 mg/g in liver, kidney and brain samples, respectively. Meaningful difference in paracetamol in serum and liver samples was in observed in 30th day values ( p = 0.05).

Cardiovascular medication exposures and poisonings in Izmir, Turkey: A 14-year experience

Cardiovascular medications (CVMs) are frequently prescribed for cardiovascular diseases. The unconscious use of cardiovascular drugs may lead to severe clinical manifestations, even to death, especially when in overdose. The objective of this study is to clarify the profile of CVM exposures admitted to Department of Emergency Medicine in Dokuz Eylul University Hospital (EMDEU) between 1993 and 2006. Case demographics, type of the medication, route and reason for exposure, clinical effects and outcome were recorded. Related to the CVM exposures, 105 poisoning cases were admitted. Mean age of children and adults were 12.8 ± 1.0 and 30.1 ± 1.8, respectively. Females were dominating (77.1%). Poisoning by accident occurred mainly among children in the 0—6 age group (64.3%) and suicide attempt was predominant in the 19—29 age group (47.8%). The most common ingested CVMs admitted to EMDEU were calcium channel blockers (19.7%), beta-blockers (17.3%), angiotensin converting enzyme inhibitors and diuretics (11.8%). Most of the patients were asymptomatic (59.1%). Frequently observed symptom was altered consciousness (18.6%). Antihypertensive drugs are responsible for the most of the CVM exposures. Prospectively designed multi-centered studies are needed to reflect the epidemiological properties of cardiovascular drug exposures throughout our country and would be very valuable for the determination of preventive measures.

Pattern of attempted suicide in Babylon in the last 6 years of sanctions against Iraq

Suicide among Muslims and in Muslim countries is rare (Hocaoglu et al, 2007). Although much of the research has comprised simple descriptive studies, and despite the possible underreporting of suicidal behaviour in countries where such behaviour is illegal, suicide rates do appear to be lower among Muslims than among the followers of other religions, even in countries which have populations belonging to several religious groups (Lester, 2006). However, rates of attempted suicide do not appear to be lower in Muslims than in non-Muslims (Pritchard & Amanullah, 2007), possibly because although there are strong religious sanctions against suicide, there are no clear principles regarding attempted suicide.