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Tanaka C, Tagami T, Nagano M, Nakayama F, Kaneko J, Kuno M. Risk factors for the need for advanced care among prescription and over-the-counter drug overdose patients. Acute Med Surg 2024; 11:e942. [PMID: 38500638 PMCID: PMC10946162 DOI: 10.1002/ams2.942] [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: 11/20/2023] [Revised: 02/24/2024] [Accepted: 03/06/2024] [Indexed: 03/20/2024] Open
Abstract
Aim Prescription drug and over-the-counter (OTC) drug overdose is a major problem in emergency departments in Japan, and some need advanced care which is more than observation. We aimed to identify the prehospital risk factors for the need of advanced care among overdose patients. Methods This was a single-center retrospective cohort study. We included overdoses patients of prescription drugs or OTC drugs, who admitted to our hospital between 2016 and 2021. We grouped them into advanced care and non-advanced care. The main outcome was the need for advanced care. We performed a multiple logistic regression analysis, calculated the PAV score (Paracetamol use, Alcohol use, abnormal Vital signs on scene) and performed a receiver operating characteristic (ROC) analysis. Results There were 229 subjects. The logistic regression analysis revealed that alcohol, paracetamol, and the abnormal vital signs on scene were associated with advanced care (alcohol-odds ratio [OR]: 2.95; 95% confidence interval [CI]: 1.29-6.75; paracetamol-OR: 5.47; 95% CI: 2.18-13.71; abnormal vital signs-OR: 4.61, 95% CI: 2.07-10.27). The rate of advanced care in the high PAV score (2 and 3) group was statistically higher than that in the low PAV score (0-1) group (p = 0.04). Area under the ROC curve of the PAV score was 0.72 (95% CI, 0.65-0.80). Conclusion Alcohol, paracetamol use and abnormal vital signs on scene might be risk factors for advanced care among prescription drugs or OTC drugs overdose patients, and the PAV score may predict the need for advanced care.
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Affiliation(s)
- Chie Tanaka
- Department of Emergency and Critical Care MedicineNippon Medical School Tama Nagayama HospitalTama‐shiJapan
| | - Takashi Tagami
- Department of Emergency and Critical Care MedicineNippon Medical School Musashikosugi HospitalKawasakiJapan
- Department of Clinical Epidemiology and Health Economics, School of Public HealthThe University of TokyoBunkyoJapan
| | | | - Fumihiko Nakayama
- Department of Emergency and Critical Care MedicineNippon Medical School Tama Nagayama HospitalTama‐shiJapan
| | - Junya Kaneko
- Department of Emergency and Critical Care MedicineNippon Medical School Tama Nagayama HospitalTama‐shiJapan
| | - Masamune Kuno
- Department of Emergency and Critical Care MedicineNippon Medical School Tama Nagayama HospitalTama‐shiJapan
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Zhou Y, Sham TT, Boisdon C, Smith BL, Blair JC, Hawcutt DB, Maher S. Emergency diagnosis made easy: matrix removal and analyte enrichment from raw saliva using paper-arrow mass spectrometry. Analyst 2023; 148:5366-5379. [PMID: 37702052 DOI: 10.1039/d3an00850a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
Paracetamol overdose is a leading cause of acute liver failure that can prove fatal. Establishing paracetamol concentration accurately and quickly is critical. Current detection methods are invasive, time-consuming and/or expensive. Non-invasive, rapid and cost-effective techniques are urgently required. To address this challenge, a novel approach, called Paper-Arrow Mass Spectrometry (PA-MS) has been developed. This technique combines sample collection, extraction, enrichment, separation and ionisation onto a single paper strip, and the entire analysis process, from sample to result, can be carried out in less than 10 min requiring only 2 μL of raw human saliva. PA-MS achieved a LOQ of 185 ng mL-1, mean recovery of 107 ± 7%, mean accuracy of 11 ± 8% and precision ≤5% using four concentrations, and had excellent linearity (r2 = 0.9988) in the range of 0.2-200 μg mL-1 covering the treatment concentration range, surpassing the best-in-class methods currently available for paracetamol analysis. Furthermore, from a panel of human saliva samples, inter-individual variability was found to be <10% using this approach. This technique represents a promising tool for rapid and accurate emergency diagnosis.
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Affiliation(s)
- Yufeng Zhou
- Department of Electrical Engineering and Electronics, University of Liverpool, Brownlow Hill, Liverpool, UK.
| | - Tung-Ting Sham
- Department of Electrical Engineering and Electronics, University of Liverpool, Brownlow Hill, Liverpool, UK.
| | - Cedric Boisdon
- Department of Electrical Engineering and Electronics, University of Liverpool, Brownlow Hill, Liverpool, UK.
| | - Barry L Smith
- Department of Electrical Engineering and Electronics, University of Liverpool, Brownlow Hill, Liverpool, UK.
| | - Joanne C Blair
- Department of Endocrinology, Alder Hey Children's Hospital, Liverpool, UK
| | - Daniel B Hawcutt
- NIHR Clinical Research Facility, Alder Hey Children's Hospital, Liverpool, UK
- Department of Women's and Children's Health, University of Liverpool, UK
| | - Simon Maher
- Department of Electrical Engineering and Electronics, University of Liverpool, Brownlow Hill, Liverpool, UK.
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Dart RC, Mullins ME, Matoushek T, Ruha AM, Burns MM, Simone K, Beuhler MC, Heard KJ, Mazer-Amirshahi M, Stork CM, Varney SM, Funk AR, Cantrell LF, Cole JB, Banner W, Stolbach AI, Hendrickson RG, Lucyk SN, Sivilotti MLA, Su MK, Nelson LS, Rumack BH. Management of Acetaminophen Poisoning in the US and Canada: A Consensus Statement. JAMA Netw Open 2023; 6:e2327739. [PMID: 37552484 DOI: 10.1001/jamanetworkopen.2023.27739] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/09/2023] Open
Abstract
Importance The US and Canada currently have no formal published nationwide guidelines for specialists in poison information or emergency departments for the management of acetaminophen poisoning, resulting in significant variability in management. Objective To develop consensus guidelines for the management of acetaminophen poisoning in the US and Canada. Evidence Review Four clinical toxicology societies (America's Poison Centers, American Academy of Clinical Toxicology, American College of Medical Toxicology, and Canadian Association of Poison Control Centers) selected participants (n = 21). Led by a nonvoting chairperson using a modified Delphi method, the panel created a decision framework and determined the appropriate clinical management of a patient with acetaminophen poisoning. Unique to this effort was the collection of guidelines from most poison centers in addition to systematic collection and review of the medical literature. Comments from review by external organizations were incorporated before the guideline was finalized. The project began in March 2021 and ended in March 2023. Findings The search retrieved 84 guidelines and 278 publications. The panel developed guidelines for emergency department management of single or repeated ingestion of acetaminophen. In addition, the panel addressed extended-release formulation, high-risk ingestion, coingestion of anticholinergics or opioids, age younger than 6 years, pregnancy, weight greater than 100 kg, and intravenous acetaminophen use. Differences from current US practice include defining acute ingestion as an ingestion presentation from 4 to 24 hours after overdose was initiated. A revised form of the Rumack-Matthew nomogram was developed. The term massive ingestion was replaced with the term high-risk ingestion and denoted by a specific nomogram line. Other recommendations include specific criteria for emergency department triage, laboratory evaluation and monitoring parameters, defining the role of gastrointestinal decontamination, detailed management of acetylcysteine treatment, associated adverse effects, and stopping criteria for acetylcysteine treatment, as well as criteria for consultation with a clinical toxicologist. Finally, specific treatment considerations, including acetylcysteine dosing, fomepizole administration, and considerations for extracorporeal elimination and transplant evaluation, were addressed. Conclusions and Relevance This qualitative study provides a consensus statement on consistent evidence-based recommendations for medical, pharmacy, and nursing education and practice to optimize care of patients with acetaminophen poisoning.
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Affiliation(s)
- Richard C Dart
- Rocky Mountain Poison and Drug Safety, Denver Health and Hospital Authority, University of Colorado School of Medicine, Denver
| | - Michael E Mullins
- Department of Emergency Medicine, Washington University School of Medicine, St Louis, Missouri
| | | | - Anne-Michelle Ruha
- Banner University Medical Center Phoenix, Phoenix Children's Hospital, University of Arizona College of Medicine, Phoenix
| | - Michele M Burns
- Massachusetts/Rhode Island Poison Center, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Karen Simone
- Northern New England Poison Center, Tufts University School of Medicine, Boston, Massachusetts
| | - Michael C Beuhler
- Northern Carolina Poison Control, Atrium Health, Charlotte
- Department of Emergency Medicine, Wake Forest School of Medicine, Salem, North Carolina
| | - Kennon J Heard
- Rocky Mountain Poison and Drug Safety, Denver Health and Hospital Authority, University of Colorado School of Medicine, Denver
| | - Maryann Mazer-Amirshahi
- MedStar Washington Hospital Center, National Capital Poison Center, Georgetown University School of Medicine, Washington, DC
| | - Christine M Stork
- Upstate New York Poison Center, Upstate Medical University, Syracuse
| | - Shawn M Varney
- South Texas Poison Center, University of Texas Health, San Antonio
| | | | - Lee F Cantrell
- Department of Clinical Pharmacy, University of California San Francisco School of Pharmacy, San Francisco
- California Poison Control System, San Diego Division, University of California San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, San Diego
| | - Jon B Cole
- Minnesota Poison Control System, Hennepin Healthcare, University of Minnesota Medical School, Minneapolis
| | | | | | | | - Scott N Lucyk
- Poison and Drug Information Service, University of Calgary Department of Emergency Medicine, Calgary, Alberta, Canada
| | | | - Mark K Su
- New York City Poison Control Center, New York University Grossman School of Medicine, New York
| | - Lewis S Nelson
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark
| | - Barry H Rumack
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora
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Biagioli M, Marchianò S, di Giorgio C, Roselli R, Bordoni M, Bellini R, Fiorillo B, Sepe V, Catalanotti B, Cassiano C, Monti MC, Distrutti E, Zampella A, Fiorucci S. Combinatorial targeting of G-protein-coupled bile acid receptor 1 and cysteinyl leukotriene receptor 1 reveals a mechanistic role for bile acids and leukotrienes in drug-induced liver injury. Hepatology 2022. [PMID: 36107019 DOI: 10.1002/hep.32787] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/22/2022] [Accepted: 09/09/2022] [Indexed: 12/08/2022]
Abstract
BACKGROUND AND AIM Drug-induced liver injury (DILI) is a common disorder that involves both direct liver cell toxicity and immune activation. The bile acid receptor, G-protein-coupled bile acid receptor 1 (GPBAR1; Takeda G-protein-coupled receptor 5 [TGR5]), and cysteinyl leukotriene receptor (CYSLTR) 1 are G-protein-coupled receptors activated by bile acids and leukotrienes, exerting opposite effects on cell-to-cell adhesion, inflammation, and immune cell activation. To investigate whether GPBAR1 and CYSLTR1 mutually interact in the development of DILI, we developed an orally active small molecule, CHIN117, that functions as a GPBAR1 agonist and CYSLTR1 antagonist. APPROACH AND RESULTS RNA-sequencing analysis of liver explants showed that acetaminophen (APAP) intoxication positively modulates the leukotriene pathway, CYSLTR1, 5-lipoxygenase, and 5-lipoxygenase activating protein, whereas GPBAR1 gene expression was unchanged. In mice, acute liver injury induced by orally dosing APAP (500 mg/kg) was severely exacerbated by Gpbar1 gene ablation and attenuated by anti-Cysltr1 small interfering RNA pretreatment. Therapeutic dosing of wild-type mice with CHIN117 reversed the liver damage caused by APAP and modulated up to 1300 genes, including 38 chemokines and receptors, that were not shared by dosing mice with a selective GPBAR1 agonist or CYSLTR1 antagonist. Coexpression of the two receptors was detected in liver sinusoidal endothelial cells (LSECs), monocytes, and Kupffer cells, whereas combinatorial modulation of CYSLTR1 and GPBAR1 potently reversed LSEC/monocyte interactions. CHIN117 reversed liver damage and liver fibrosis in mice administered CCl4 . CONCLUSIONS By genetic and pharmacological approaches, we demonstrated that GPBAR1 and CYSLTR1 mutually interact in the development of DILI. A combinatorial approach designed to activate GPBAR1 while inhibiting CYSLTR1 reverses liver injury in models of DILI.
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Affiliation(s)
- Michele Biagioli
- Dipartimento di Medicina e Chirurgia, Università di Perugia, Perugia, Italy
| | - Silvia Marchianò
- Dipartimento di Medicina e Chirurgia, Università di Perugia, Perugia, Italy
| | | | - Rosalinda Roselli
- Department of Pharmacy, Università di Napoli "Federico II", Naples, Italy
| | - Martina Bordoni
- Dipartimento di Medicina e Chirurgia, Università di Perugia, Perugia, Italy
| | - Rachele Bellini
- Dipartimento di Medicina e Chirurgia, Università di Perugia, Perugia, Italy
| | - Bianca Fiorillo
- Department of Pharmacy, Università di Napoli "Federico II", Naples, Italy
| | - Valentina Sepe
- Department of Pharmacy, Università di Napoli "Federico II", Naples, Italy
| | - Bruno Catalanotti
- Department of Pharmacy, Università di Napoli "Federico II", Naples, Italy
| | - Chiara Cassiano
- Department of Pharmacy, Università di Napoli "Federico II", Naples, Italy
| | | | - Eleonora Distrutti
- SC di Gastroenterologia ed Epatologia, Azienda Ospedaliera di Perugia, Perugia, Italy
| | - Angela Zampella
- Department of Pharmacy, Università di Napoli "Federico II", Naples, Italy
| | - Stefano Fiorucci
- Dipartimento di Medicina e Chirurgia, Università di Perugia, Perugia, Italy
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