1
|
Neumann NR, du Plessis A, van Hoving DJ, Hoyte CO, Lermer A, Wittels S, Marks C. Antivenom supply and demand: An analysis of antivenom availability and utilization in South Africa. Afr J Emerg Med 2023; 13:245-249. [PMID: 37745277 PMCID: PMC10517267 DOI: 10.1016/j.afjem.2023.08.002] [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: 12/09/2022] [Revised: 06/01/2023] [Accepted: 08/17/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction Snakebites are a neglected tropical disease. In many areas, envenoming incidence and antivenom administration rates are unknown. This study compared antivenom (AV) availability to rates of envenoming and recommendations to treat (RTT) in South Africa. Methods This retrospective study identified, extracted, and reviewed all cases of envenoming (snake bites and spits) reported to the Poisons Information Helpline of the Western Cape of South Africa (PIHWC) from June 1, 2015 to May 31, 2020 by public hospitals in the Western Cape. A standardized interview was administered to the pharmacies of the 40 hospitals in winter and summer to determine how many vials of monovalent and polyvalent AV they had on hand at the time of the call and their expiration dates. Descriptive analysis was used to compare rates of envenoming and recommendations to treat to antivenom stock in winter and summer and by hospital type and location. Results Public hospitals reported 300 envenomings, 122 from snakes. The PIHWC recommended antivenom administration in 26% of cases (N = 32). All hospital pharmacies queried answered our questions. Our study demonstrates urban district hospitals have higher ratios of AV vials compared to mean annual rates of envenoming and RTT than rural district hospitals at both the winter and summer timepoints. Conclusion This study evaluates antivenom supply and demand in a province of South Africa. The findings suggest South African urban hospitals have a relative excess of antivenom, and thus more capacity to meet demand, than their rural counterparts. It supports consideration of a redistribution of antivenom supply chains to match seasonal and local rates of envenoming. It indicates a need for higher quality, prospective data characterizing envenoming incidence and treatment.
Collapse
Affiliation(s)
- Natalie R Neumann
- Department of Emergency Medicine, Yale University School of Medicine, New Haven CT, USA
- Rocky Mountain Poison and Drug Safety, Denver CO, USA
| | - Arina du Plessis
- Division of Pharmacology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa
| | - Daniël J van Hoving
- Division of Emergency Medicine, Stellenbosch University, Cape Town, Western Cape, South Africa
| | - Christopher O Hoyte
- Rocky Mountain Poison and Drug Safety, Denver CO, USA
- Department of Emergency Medicine, University of Colorado Anschutz Medical Campus, Aurora CO, USA
| | - Anné Lermer
- Division of Pharmacology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa
| | | | - Carine Marks
- Division of Pharmacology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa
| |
Collapse
|
2
|
Sevigny EL, Greathouse J, Medhin DN. Health, safety, and socioeconomic impacts of cannabis liberalization laws: An evidence and gap map. CAMPBELL SYSTEMATIC REVIEWS 2023; 19:e1362. [PMID: 37915420 PMCID: PMC10616541 DOI: 10.1002/cl2.1362] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
Background Globally, cannabis laws and regulations are rapidly changing. Countries are increasingly permitting access to cannabis under various decriminalization, medicalization, and legalization laws. With strong economic, public health, and social justice incentives driving these domestic cannabis policy reforms, liberalization trends are bound to continue. However, despite a large and growing body of interdisciplinary research addressing the policy-relevant health, safety, and socioeconomic consequences of cannabis liberalization, there is a lack of robust primary and systematic research that comprehensively investigates the consequences of these reforms. Objectives This evidence and gap map (EGM) summarizes the empirical evidence on cannabis liberalization policies. Primary objectives were to develop a conceptual framework linking cannabis liberalization policies to relevant outcomes, descriptively summarize the empirical evidence, and identify areas of evidence concentration and gaps. Search Methods We comprehensively searched for eligible English-language empirical studies published across 23 academic databases and 11 gray literature sources through August 2020. Additions to the pool of potentially eligible studies from supplemental sources were made through November 2020. Selection Criteria The conceptual framework for this EGM draws upon a legal epidemiological perspective highlighting the causal effects of law and policy on population-level outcomes. Eligible interventions include policies that create or expand access to a legal or decriminalized supply of cannabis: comprehensive medical cannabis laws (MCLs), limited medical cannabidiol laws (CBDLs), recreational cannabis laws (RCLs), industrial hemp laws (IHLs), and decriminalization of cultivations laws (DCLs). Eligible outcomes include intermediate responses (i.e., attitudes/behaviors and markets/environments) and longer-term consequences (health, safety, and socioeconomic outcomes) of these laws. Data Collection and Analysis Both dual screening and dual data extraction were performed with third person deconfliction. Primary studies were appraised using the Maryland Scientific Methods Scale and systematic reviews were assessed using AMSTAR 2. Main Results The EGM includes 447 studies, comprising 438 primary studies and nine systematic reviews. Most research derives from the United States, with little research from other countries. By far, most cannabis liberalization research focuses on the effects of MCLs and RCLs. Studies targeting other laws-including CBDLs, IHLs, and DCLs-are relatively rare. Of the 113 distinct outcomes we documented, cannabis use was the single most frequently investigated. More than half these outcomes were addressed by three or fewer studies, highlighting substantial evidence gaps in the literature. The systematic evidence base is relatively small, comprising just seven completed reviews on cannabis use (3), opioid-related harms (3), and alcohol-related outcomes (1). Moreover, we have limited confidence in the reviews, as five were appraised as minimal quality and two as low quality. Authors’ Conclusions More primary and systematic research is needed to better understand the effects of cannabis liberalization laws on longer-term-and arguably more salient-health, safety, and socioeconomic outcomes. Since most research concerns MCLs and RCLs, there is a critical need for research on the societal impacts of industrial hemp production, medical CBD products, and decriminalized cannabis cultivation. Future research should also prioritize understanding the heterogeneous effects of these laws given differences in specific provisions and implementation across jurisdictions.
Collapse
Affiliation(s)
- Eric L. Sevigny
- Department of Criminal Justice and CriminologyGeorgia State UniversityAtlantaGeorgiaUSA
| | - Jared Greathouse
- Department of Criminal Justice and CriminologyGeorgia State UniversityAtlantaGeorgiaUSA
| | - Danye N. Medhin
- Department of Criminal Justice and CriminologyGeorgia State UniversityAtlantaGeorgiaUSA
| |
Collapse
|
3
|
Weleff J, Kovacevich A, Burson J, Nero N, Anand A. Clinical Presentations and Treatment of Phenibut Toxicity and Withdrawal: A Systematic Literature Review. J Addict Med 2023; 17:407-417. [PMID: 37579098 DOI: 10.1097/adm.0000000000001141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES This systematic review aimed to identify published articles that evaluated all phenibut toxicity and withdrawal cases to understand better their clinical presentations and treatments. METHODS A comprehensive literature search was conducted using Medline (Ovid), Embase (Ovid), and Cochrane Library databases to capture all published cases on the presentations and management of phenibut toxicity or withdrawal. RESULTS Sixty-two cases from 36 studies on presentation and management of phenibut toxicity or phenibut withdrawal were identified. Of all subjects, 80.7% were male. The average age was 30.9 years (SD, 13.2 years; range, 0-71 years). A total of 86.8% reported obtaining phenibut online, and 63.2% reported concomitant substance use with other addictive agents; benzodiazepines and alcohol were the most combined drugs. The average length of hospital stay was 5.0 days (n = 25; SD, 5.4 days; range, 1-25 days) for phenibut toxicity and 7.7 days (n = 20; SD, 7.8 days; range, 0-30 days) for phenibut withdrawals. The most common symptoms reported during phenibut toxicity were altered mental status, somnolence, psychosis, and movement disorders. Of the phenibut toxicity cases, 48.7% required intubation. Benzodiazepines and antipsychotics were most used to treat phenibut toxicity. For phenibut withdrawal cases, 95.7% reported daily use. The most common symptoms reported during phenibut withdrawals were anxiety, irritability or agitation, insomnia, and psychosis. Sixteen (69.6%) of phenibut withdrawal cases required multiple medications for treatment. Benzodiazepines, baclofen, atypical antipsychotics, gabapentanoids, and barbiturates were commonly used to treat phenibut withdrawals. CONCLUSIONS The seriousness of presentations, combined with the assortments of medications used for both syndromes, reflects the potential dangers of phenibut use and the need for systematized treatment protocols.
Collapse
Affiliation(s)
- Jeremy Weleff
- From the Department of Psychiatry, Yale University School of Medicine, New Haven, CT (JW); Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute, Cleveland Clinic, Cleveland, OH (JW, AK, AA); Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN (JB); Education Institute, Floyd D. Loop Alumni Library, Cleveland Clinic, Cleveland, OH (NN); Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH (AA)
| | | | | | | | | |
Collapse
|
4
|
Lermer A, Marks CJ, Kellermann TA. Snakebite in South Africa: A retrospective review May 2015-June 2020. Toxicon 2023; 224:107031. [PMID: 36669533 DOI: 10.1016/j.toxicon.2023.107031] [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: 10/27/2022] [Revised: 01/15/2023] [Accepted: 01/16/2023] [Indexed: 01/19/2023]
Abstract
Snakebite envenoming in Sub-Saharan Africa present a significant public health problem. An investigation into how often species responsible for envenomation were correctly identified, as well as which venomous species caused the most frequent and problematic envenomation symptomatology were conducted to establish severity of this problem from a South African context. Descriptive statistics were used to quantitatively describe the variables in snakebite related Telelog call records reported to the Poison Information Helpline of the Western Cape (PIHWC) over a five-year period. A total of 1411 snakebite related calls were received. In 44% of all snakebite calls the bite was inflicted by an unidentified snake specie. The most snakebites occurred during the summer months from December-March. The most bites occurred in males (20-39 years). The incidence of snakebite in South Africa was 2.39 per 100 000 population, with the highest incidence of snakebite in North-West province of South Africa. In sub-Saharan Africa there is a major underestimation of the incidence of snakebite due to under reporting and absence of physical attendance to health care facilities. The PIHWC provides an invaluable service in assisting and in-forming medical personnel and the public on the management of snakebites. Data collected by centers provides a source of information on the prevalence of snakebites and medically important species that research should be aimed towards.
Collapse
Affiliation(s)
- A Lermer
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa.
| | - C J Marks
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa
| | - T A Kellermann
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa
| |
Collapse
|
5
|
Al-Shami K, Almurabi S, Shatnawi J, Qasagsah K, Shatnawi G, Nashwan AJ. Ophthalmic Manifestations of Chlorine Gas Exposure: What Do We Know So Far? Cureus 2023; 15:e35590. [PMID: 37007383 PMCID: PMC10062433 DOI: 10.7759/cureus.35590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
Chlorine gas is a hazardous substance that can cause severe health effects when inhaled or exposed to the skin. It is an odorless, colorless gas in many industrial and manufacturing settings and conflict areas. While exposure to chlorine gas is generally limited to the workplace and public areas, there are instances in which people may be exposed to high levels of chlorine gas for a short period of time due to spills, mishaps on the road or railroads, or other tragedies. In addition to the general health effects of chlorine gas, this essay will focus on the effects of chlorine gas on the eyes. The eyes are particularly sensitive to chlorine gas, and exposure can cause various symptoms, ranging from mild irritation to severe damage. Symptoms of chlorine gas exposure to the eyes include redness, burning, tearing, and blurred vision. In more serious cases, exposure to chlorine gas can cause permanent damage to the eyes, including corneal ulcers, scarring, and blindness. It is important to be aware of the signs and symptoms of chlorine gas exposure and the potential long-term effects to take the necessary steps to protect oneself. In addition to the potential health effects, it is important to understand the properties of chlorine gas. Chlorine gas is heavier than air and tends to settle in low-lying areas. It is highly reactive and can react with other substances to form hazardous compounds. As such, it is important to be aware of the potential for chlorine gas to react with other environmental substances and accumulate in certain areas. Finally, it is important to understand the background of chlorine gas use in various conflict areas. Chlorine gas has been used as a chemical weapon for centuries, and its use in modern warfare has been documented in various conflicts. As such, it is important to be aware of the potential for chlorine gas to be used in war zones and to take the necessary precautions to protect oneself. In conclusion, chlorine gas is a hazardous substance that can cause severe health effects when inhaled or exposed to the skin. The eyes are particularly sensitive to chlorine gas, and exposure can cause various symptoms, ranging from mild irritation to severe damage. It is important to be aware of the signs and symptoms of chlorine gas exposure and the potential long-term effects to take the necessary steps to protect oneself. Additionally, it is important to understand chlorine gas's properties and its background use in various conflict areas.
Collapse
|
6
|
Tan JL, Stam J, van den Berg AP, van Rheenen PF, Dekkers BGJ, Touw DJ. Amanitin intoxication: effects of therapies on clinical outcomes - a review of 40 years of reported cases. Clin Toxicol (Phila) 2022; 60:1251-1265. [PMID: 36129244 DOI: 10.1080/15563650.2022.2098139] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND AIMS Amanita phalloides poisoning causes severe liver damage which may be potentially fatal. Several treatments are available, but their effectiveness has not been systematically evaluated. We performed a systematic review to investigate the effect of the most commonly used therapies: N-acetylcysteine (NAC), benzylpenicillin (PEN), and silibinin (SIL) on patient outcomes. In addition, other factors contributing to patient outcomes are identified. METHODS We searched MEDLINE and Embase for case series and case reports that described patient outcomes after poisoning with amanitin-containing Amanita mushrooms. We extracted clinical characteristics, treatment details, and outcomes. We used the liver item from the Poisoning Severity Score (PSS) to categorize intoxication severity. RESULTS We included 131 publications describing a total of 877 unique cases. The overall survival rate of all patients was 84%. Patients receiving only supportive care had a survival rate of 59%. The use of SIL or PEN was associated with a 90% (OR 6.40 [3.14-13.04]) and 89% (OR 5.24 [2.87-9.56]) survival rate, respectively. NAC/SIL combination therapy was associated with 85% survival rate (OR 3.85 [2.04, 7.25]). NAC/PEN/SIL treatment group had a survival rate of 76% (OR 2.11 [1.25, 3.57]). Due to the limited number of cases, the use of NAC alone could not be evaluated. Additional analyses in 'proven cases' (amanitin detected), 'probable cases' (mushroom identified by mycologist), and 'possible cases' (neither amanitin detected nor mushroom identified) showed comparable results, but the results did not reach statistical significance. Transplantation-free survivors had significantly lower peak values of aspartate aminotransferase (AST), alanine aminotransferase (ALT), total serum bilirubin (TSB), and international normalized ratio (INR) compared to liver transplantation survivors and patients with fatal outcomes. Higher peak PSS was associated with increased mortality. CONCLUSION Based on data available, no statistical differences could be observed for the effects of NAC, PEN or SIL in proven poisonings with amanitin-containing mushrooms. However, monotherapy with SIL or PEN and combination therapy with NAC/SIL appear to be associated with higher survival rates compared to supportive care alone. AST, ALT, TSB, and INR values are possible predictors of potentially fatal outcomes.
Collapse
Affiliation(s)
- Jia Lin Tan
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Janine Stam
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Analytical Biochemistry, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Aad P van den Berg
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Patrick F van Rheenen
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Bart G J Dekkers
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Daan J Touw
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Pharmaceutical Analysis, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| |
Collapse
|
7
|
du Plessis CE, Mohamed F, Stephen CR, Reuter H, Voigt G, van Hoving DJ, Marks CJ. A retrospective review of calls to the Poisons Information Helpline of the Western Cape during the first 6 months of the COVID-19 pandemic in South Africa. S Afr J Infect Dis 2022; 37:391. [PMID: 35399559 PMCID: PMC8990510 DOI: 10.4102/sajid.v37i1.391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 02/02/2022] [Indexed: 12/05/2022] Open
Abstract
Background Since the start of the coronavirus disease 2019 (COVID-19) pandemic, poison centres worldwide have reported an increase in exposures to chemicals used for infection prevention. Increased availability and use could lead to an increase in exposures. Potential effects on a South African Poison Information Helpline were unknown, therefore a study was performed to describe changes in call volume and profile of poison exposures. Methods A retrospective analysis was conducted on an observational database of telephone enquiries. All human-related poisoning exposure call data collected from 01 March to 31 August during 2018, 2019 and 2020 were extracted and analysed. Summary statistics were used to describe all variables. Results The total number of calls were 5137, 5508, and 5181 in 2018, 2019, 2020, respectively. The monthly call number during 2020 was mostly less than in 2019. More calls were received from the public calls (39.4% vs 33.1%) and for accidental exposures (65.6% vs 62.3%) increased during 2020 compared to 2019. Exposures to pharmaceuticals decreased by 14.8% from 2019 to 2020, while exposures to eucalyptus oil more than doubled from 21 in 2019 to 43 during 2020. Exposures to antiseptics and disinfectants increased by 60.4%, mainly due to hand sanitisers exposure which showed a 26-fold increase from 2019 (n = 6) to 2020 (n = 156). Conclusion A change in the profile of poison exposures was observed during the COVID-19 pandemic. Lockdown regulations and greater availability of antiseptics and disinfectants probably led to the increase in exposures. Although symptoms were mostly mild, the public should be educated on safe storage and proper use of all chemicals.
Collapse
Affiliation(s)
- Catharina E du Plessis
- Division of Clinical Pharmacology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Farah Mohamed
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Cindy R Stephen
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Helmuth Reuter
- Department of Medicine, Faculty of Medicine and Health Science, Stellenbosch University, Cape Town, South Africa
| | - Gonwayne Voigt
- Division of Clinical Pharmacology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Daniel J van Hoving
- Division of Emergency Medicine, Faculty of Medicine and Health Science, Stellenbosch University, Cape Town, South Africa
| | - Carine J Marks
- Division of Clinical Pharmacology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| |
Collapse
|
8
|
Mistry P, Smith RH, Fox A. Patient Safety Incidents Related to the Use of Parenteral Nutrition in All Patient Groups: A Systematic Scoping Review. Drug Saf 2021; 45:1-18. [PMID: 34932206 DOI: 10.1007/s40264-021-01134-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION There is limited comprehensive literature focussing on the range of patient safety incidents related to parenteral nutrition (PN). OBJECTIVE The aim of this review was to examine patient safety incidents related to the use of PN in all patient age groups. METHODS Literature published in the English language between January 2000 and April 2020 were searched across the MEDLINE, CINHAL and Embase databases. Articles were included if they contained PN-related patient safety incidents related to an avoidable event. No restrictions were applied to patient populations. The screening process was undertaken independently by two authors. RESULTS In total, 108 records were included in the review: 52 case studies, 54 observation studies (e.g. prevalence studies, surveys) and two experimental studies. All age groups were represented, with 62% of studies in paediatrics (of which two-thirds were neonates) and 23% in adults. They included all medication processes: prescribing, dispensing, compounding, administration and monitoring. Incidents were related to microbial contamination, venous access and specific components (e.g. lipid emulsion, amino acids, glucose, micronutrients and electrolytes) or the whole product. Incident outcomes ranging from near miss to death were reported. Intervention studies looked at the impact on patient safety incidents of computerised tools, healthcare processes, e.g. pharmacist screening, and standardisation. One study demonstrated more severe outcomes with paediatric than with adult PN. CONCLUSIONS This review demonstrates the vast range of PN-related patient safety incidents in all patient age groups and all medication process stages. The need for a national study looking at patient safety incidents related to PN in England is highlighted.
Collapse
Affiliation(s)
- Priya Mistry
- Pharmacy Department, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK.
| | - Rebecca Heather Smith
- Gastroenterology Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Andy Fox
- Pharmacy Department, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK
| |
Collapse
|
9
|
Khoshnamvand N, Azizi N, Hassanvand MS, Shamsipour M, Naddafi K, Oskoei V. Blood lead level monitoring related to environmental exposure in the general Iranian population: a systematic review and meta-analysis. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:10.1007/s11356-021-14148-2. [PMID: 33948843 DOI: 10.1007/s11356-021-14148-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/22/2021] [Indexed: 06/12/2023]
Abstract
Exposure to lead can cause adverse health problems incorporating hypophosphatemia, heart and liver disease, cancers, neurological and cardiovascular diseases, central nervous disorders, and sensory disorders. This study investigated the blood lead level in the general Iranian population with environmental exposure to lead. In the presented systematic review and meta-analysis, the authors searched Iranian dataset, including Magiran, SID, Iranmedex, and Nopa, and the main dataset, comprising PubMed, Scopus, Embase, and Web of Science, all available articles until 12 January 2019, and extracting 55 studies (with 63 data for analysis) to a meta-analysis. A comprehensive meta-analysis software, pooled standard deviation, mean, sample size, and the utterly random effects model was analyzed in this study. The results showed that the overall mean BLL (95% CI) in total inquiries was 6.41 μg/dL (5.96 to 6.87). Besides, the results for gender and age subgroups were as follows: mean BLL, 6.47 μg/dL, 95% CI, 5.79, to 7.15, mean BLL, 6.44 μg/dL, 95% CI, 5.96, to 6.91, respectively. Conclusively the mean BLL in the Iranian population was higher than the recommended level by the US Centers for Disease Control and Prevention (CDC). Results indicated that the mean BLL in men and adults was more elevated than in women and children, respectively. Therefore, BLL monitoring and screening of the general Iranian population are is necessary to determine a reference value.
Collapse
Affiliation(s)
- Nahid Khoshnamvand
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Nahid Azizi
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Sadegh Hassanvand
- Center for Air Pollution Research, Institute for Environmental Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Mansour Shamsipour
- Department of Research Methodology and Data Analysis, Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
| | - Kazem Naddafi
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
- Center for Air Pollution Research, Institute for Environmental Research, Tehran University of Medical Sciences, Tehran, Iran.
| | - Vahide Oskoei
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
10
|
Osinski K, Ross H, Clarke L, Dear J, Veiraiah A. A case of ingestion of two vape cartridges. Clin Toxicol (Phila) 2020; 59:674-675. [PMID: 33156713 DOI: 10.1080/15563650.2020.1834575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- K Osinski
- NPIS Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK.,Acute Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - H Ross
- Acute Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - L Clarke
- Acute Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - J Dear
- NPIS Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK.,Acute Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - A Veiraiah
- NPIS Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK.,Acute Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| |
Collapse
|
11
|
Potts AJ, Cano C, Thomas SHL, Hill SL. Synthetic cannabinoid receptor agonists: classification and nomenclature. Clin Toxicol (Phila) 2019; 58:82-98. [DOI: 10.1080/15563650.2019.1661425] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- A. J. Potts
- NIHR Health Protection Research Unit for Chemical Threats and Hazards, Medical Toxicology Centre, Newcastle University, Newcastle upon Tyne, UK
| | - C. Cano
- School of Chemistry, Newcastle University, Newcastle upon Tyne, UK
| | - S. H. L. Thomas
- NIHR Health Protection Research Unit for Chemical Threats and Hazards, Medical Toxicology Centre, Newcastle University, Newcastle upon Tyne, UK
| | - S. L. Hill
- NIHR Health Protection Research Unit for Chemical Threats and Hazards, Medical Toxicology Centre, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
12
|
Evans-Brown M, Sedefov R. Responding to New Psychoactive Substances in the European Union: Early Warning, Risk Assessment, and Control Measures. Handb Exp Pharmacol 2018; 252:3-49. [PMID: 30194542 DOI: 10.1007/164_2018_160] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
New psychoactive substances (NPS) are drugs that are not controlled by the United Nations international drug control conventions of 1961 and 1971 but that may pose similar threats to public health. Many of them are traded as "legal" replacements to controlled drugs such as cannabis, heroin, benzodiazepines, cocaine, amphetamines, and 3,4-methylenedioxymethamphetamine (MDMA). Driven by globalization, there has been a large increase in the availability and, subsequently, harms caused by these substances over the last decade in Europe. The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) is monitoring more than 670 NPS that have appeared on Europe's drug market in the last 20 years, of which almost 90% have appeared in the last decade. While some recent policy responses have been successful in reducing availability and sales of these substances in some settings - such as "legal highs" and "research chemicals" sold openly in the high street and online - and there are signs that growth in the market is slowing, new challenges have emerged. This includes monitoring a growing number of highly potent substances - including 179 synthetic cannabinoid receptor agonists and 28 fentanils - that can pose a high risk of life-threatening poisoning to users and can cause explosive outbreaks. This chapter briefly traces the origins of NPS, provides an overview of the situation in Europe, and discusses the work of the EMCDDA as part of a legal framework of early warning, risk assessment, and control measures that allows the European Union to rapidly detect, assess, and respond to public health and social threats caused by these substances.
Collapse
Affiliation(s)
| | - Roumen Sedefov
- European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal
| |
Collapse
|
13
|
Caustic Ingestion in the Elderly: Influence of Age on Clinical Outcome. Molecules 2017; 22:molecules22101726. [PMID: 29036912 PMCID: PMC6151719 DOI: 10.3390/molecules22101726] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 10/10/2017] [Accepted: 10/11/2017] [Indexed: 01/20/2023] Open
Abstract
Caustic poisonings are still associated with many fatalities. Studies focusing on the elderly are rare. The purpose of the present study was to compare the clinical outcomes of caustic ingestion injury in elderly and non-elderly adults with regard to gender, intent of exposure, substance ingested, severity of mucosal injury, complications, and mortality. Caustic substance exposures reported to the National Toxicological Information Centre in Slovakia during 1998–2015 were reviewed retrospectively. The patients were divided into two groups: the non-elderly (<60 years) and elderly adults (≥60 years). The mortality rate in the elderly was significantly higher (elderly 23.0% vs. non-elderly 11.3%; p = 0.041). The risk of fatal outcome in the elderly was increased by acid ingestion (OR = 7.822; p = 0.002), particularly hydrochloric acid (OR = 5.714, p = 0.006). The incidence of respiratory complications was almost two times higher in the elderly was 31.1% vs. 17.4% for the non-elderly (p = 0.037). Respiratory complications significantly correlated with an increased mortality rate (p = 0.001) in the elderly whereas there was no association between GI complications and mortality in the elderly (p = 0.480). Elderly patients with respiratory complications had the poorest clinical outcomes. The highest risk of complications and fatalities was observed in patients after hydrochloric acid ingestion.
Collapse
|
14
|
Wong A, Sivilotti MLA, Gunja N, McNulty R, Graudins A. Accuracy of the paracetamol-aminotransferase product to predict hepatotoxicity in paracetamol overdose treated with a 2-bag acetylcysteine regimen. Clin Toxicol (Phila) 2017; 56:182-188. [PMID: 28756679 DOI: 10.1080/15563650.2017.1355058] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Paracetamol concentration is a highly accurate risk predictor for hepatotoxicity following overdose with known time of ingestion. However, the paracetamol-aminotransferase multiplication product can be used as a risk predictor independent of timing or ingestion type. Validated in patients treated with the traditional, "three-bag" intravenous acetylcysteine regimen, we evaluated the accuracy of the multiplication product in paracetamol overdose treated with a two-bag acetylcysteine regimen. METHODS We examined consecutive patients treated with the two-bag regimen from five emergency departments over a two-year period. We assessed the predictive accuracy of initial multiplication product for the primary outcome of hepatotoxicity (peak alanine aminotransferase ≥1000IU/L), as well as for acute liver injury (ALI), defined peak alanine aminotransferase ≥2× baseline and above 50IU/L). RESULTS Of 447 paracetamol overdoses treated with the two-bag acetylcysteine regimen, 32 (7%) developed hepatotoxicity and 73 (16%) ALI. The pre-specified cut-off points of 1500 mg/L × IU/L (sensitivity 100% [95% CI 82%, 100%], specificity 62% [56%, 67%]) and 10,000 mg/L × IU/L (sensitivity 70% [47%, 87%], specificity of 97% [95%, 99%]) were highly accurate for predicting hepatotoxicity. There were few cases of hepatotoxicity irrespective of the product when acetylcysteine was administered within eight hours of overdose, when the product was largely determined by a high paracetamol concentration but normal aminotransferase. CONCLUSIONS The multiplication product accurately predicts hepatotoxicity when using a two-bag acetylcysteine regimen, especially in patients treated more than eight hours post-overdose. Further studies are needed to assess the product as a method to adjust for exposure severity when testing efficacy of modified acetylcysteine regimens.
Collapse
Affiliation(s)
- Anselm Wong
- a Department of Medicine , School of Clinical Sciences, Monash University , Victoria , Australia.,b Austin Toxicology Service and Victorian Poisons Information Centre, Austin Health , Victoria , Australia
| | - Marco L A Sivilotti
- c Departments of Emergency Medicine and Biomedical & Molecular Sciences , Queen's University , Kingston , Canada
| | - Naren Gunja
- d Westmead and Blacktown Hospitals , Western Sydney Toxicology Service , Sydney , Australia
| | - Richard McNulty
- d Westmead and Blacktown Hospitals , Western Sydney Toxicology Service , Sydney , Australia
| | - Andis Graudins
- a Department of Medicine , School of Clinical Sciences, Monash University , Victoria , Australia.,e Monash Toxicology Service, Monash Health , Dandenong , Australia
| |
Collapse
|
15
|
Lam RPK, Tang MHY, Leung SC, Chong YK, Tsui MSH, Mak TWL. Supraventricular tachycardia and acute confusion following ingestion of e-cigarette fluid containing AB-FUBINACA and ADB-FUBINACA: a case report with quantitative analysis of serum drug concentrations. Clin Toxicol (Phila) 2017; 55:662-667. [PMID: 28393558 DOI: 10.1080/15563650.2017.1307385] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND AB-FUBINACA and ADB-FUBINACA are structurally similar synthetic cannabinoids with potent CB1 receptor agonistic effects. Very little is known about their pharmacology and toxicology. OBJECTIVE To report a case of supraventricular tachycardia and acute confusion after ingestion of e-cigarette fluid containing AB-FUBINACA and ADB-FUBINACA, with quantitative analysis of the serum drug concentrations. CASE REPORT A healthy 24-year-old man ingested two drops of e-cigarette fluid which were later found to contain AB-FUBINACA and ADB-FUBINACA. Within 30 min of ingestion, he became somnolent, confused, and agitated, with palpitation and vomiting. On arrival to the emergency department, a short run of supraventricular tachycardia was noted, which resolved spontaneously. Bedside urine immunoassay failed to detect recreational drugs. Laboratory blood tests showed mild hypokalemia. Exposure to AB-FUBINACA and ADB-FUBINACA was confirmed analytically, with serum concentrations of 5.6 ng/mL and 15.6 ng/mL, respectively, in the blood sample collected on presentation. The patient recovered uneventfully with supportive treatment and was discharged 22 h after admission. DISCUSSION AB-FUBINACA and ADB-FUBINACA are orally bioavailable with rapid onset of toxicity after ingestion. In this case, supraventricular tachycardia was likely the result of exposure to AB-FUBINACA and ADB-FUBINACA. The serum concentrations of AB-FUBINACA and ADB-FUBINACA were higher than those previously reported in fatal cases. CONCLUSION In the context of acute poisoning, the presence of unexplained tachyarrhythmias, confusion, and a negative recreational drug screen should prompt clinicians to consider synthetic cannabinoid toxicity as a differential diagnosis.
Collapse
Affiliation(s)
- Rex Pui Kin Lam
- a Emergency Medicine Unit, Li Ka Shing Faculty of Medicine , The University of Hong Kong , Hong Kong Special Administrative Region , China
| | - Magdalene Huen Yin Tang
- b Hospital Authority Toxicology Reference Laboratory , Princess Margaret Hospital, Lai Chi Kok , Hong Kong Special Administrative Region , China
| | - Siu Chung Leung
- c Accident and Emergency Department , Queen Mary Hospital , Hong Kong Special Administrative Region , China
| | - Yeow Kuan Chong
- b Hospital Authority Toxicology Reference Laboratory , Princess Margaret Hospital, Lai Chi Kok , Hong Kong Special Administrative Region , China
| | - Matthew Sik Hon Tsui
- c Accident and Emergency Department , Queen Mary Hospital , Hong Kong Special Administrative Region , China
| | - Tony Wing Lai Mak
- b Hospital Authority Toxicology Reference Laboratory , Princess Margaret Hospital, Lai Chi Kok , Hong Kong Special Administrative Region , China
| |
Collapse
|
16
|
Caustic effects of chemicals: risk factors for complications and mortality in acute poisoning. MONATSHEFTE FUR CHEMIE 2017. [DOI: 10.1007/s00706-016-1900-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
17
|
Abouchedid R, Hudson S, Thurtle N, Yamamoto T, Ho JH, Bailey G, Wood M, Sadones N, Stove CP, Dines A, Archer JRH, Wood DM, Dargan PI. Analytical confirmation of synthetic cannabinoids in a cohort of 179 presentations with acute recreational drug toxicity to an Emergency Department in London, UK in the first half of 2015. Clin Toxicol (Phila) 2017; 55:338-345. [PMID: 28421836 DOI: 10.1080/15563650.2017.1287373] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
CONTEXT Synthetic cannabinoid receptor agonists are the largest group of new psychoactive substances reported in the last decade; in this study we investigated how commonly these drugs are found in patients presenting to the Emergency Department with acute recreational drug toxicity. METHODS We conducted an observational cohort study enrolling consecutive adult patients presenting to an Emergency Department (ED) in London (UK) January-July 2015 (6 months) with acute recreational drug toxicity. Residual serum obtained from a serum sample taken as part of routine clinical care was analyzed using high-resolution accurate mass-spectrometry with liquid-chromatography (HRAM-LCMSMS). Minimum clinical data were obtained from ED medical records. RESULTS 18 (10%) of the 179 patient samples were positive for synthetic cannabinoid receptor agonists. The most common was 5F AKB-48 (13 samples, concentration 50-7600 pg/ml), followed by 5F PB-22 (7, 30-400 pg/mL), MDMB-CHMICA (7, 80-8000 pg/mL), AB-CHMINACA (3, 50-1800 pg/mL), Cumyl 5F-PINACA (1, 800 pg/mL) and BB-22 (1, 60 pg/mL). Only 9/18 (50%) in whom synthetic cannabinoid receptor agonists were detected self-reported synthetic cannabinoid receptor agonist use. The most common clinical features were seizures and agitation, both recorded in four (22%) individuals. Fourteen patients (78%) were discharged from the ED, one of the four admitted to hospital was admitted to critical care. CONCLUSIONS Synthetic cannabinoid receptor agonists were found in 10% of this cohort with acute recreational drug toxicity but self-reported in only half of these. This suggests that presentations to the ED with acute synthetic cannabinoid receptor agonist toxicity may be more common than reported.
Collapse
Affiliation(s)
- Rachelle Abouchedid
- a Clinical Toxicology , Guy's and St Thomas' NHS Foundation Trust , London , UK
| | - Simon Hudson
- b Laboratory and Managed Services , LGC Ltd , Fordham , Cambridgeshire, UK
| | - Natalie Thurtle
- a Clinical Toxicology , Guy's and St Thomas' NHS Foundation Trust , London , UK
| | - Takahiro Yamamoto
- a Clinical Toxicology , Guy's and St Thomas' NHS Foundation Trust , London , UK
| | - James H Ho
- a Clinical Toxicology , Guy's and St Thomas' NHS Foundation Trust , London , UK
| | - George Bailey
- a Clinical Toxicology , Guy's and St Thomas' NHS Foundation Trust , London , UK
| | - Michelle Wood
- c Department of Health Sciences , Waters Corporation , Wilmslow , Cheshire, UK
| | - Nele Sadones
- d Laboratory of Toxicology , Ghent University , Ghent , Belgium
| | | | - Alison Dines
- a Clinical Toxicology , Guy's and St Thomas' NHS Foundation Trust , London , UK
| | - John R H Archer
- a Clinical Toxicology , Guy's and St Thomas' NHS Foundation Trust , London , UK.,e Faculty of Life Sciences and Medicine , King's College London , London , UK
| | - David M Wood
- a Clinical Toxicology , Guy's and St Thomas' NHS Foundation Trust , London , UK.,e Faculty of Life Sciences and Medicine , King's College London , London , UK
| | - Paul I Dargan
- a Clinical Toxicology , Guy's and St Thomas' NHS Foundation Trust , London , UK.,e Faculty of Life Sciences and Medicine , King's College London , London , UK
| |
Collapse
|
18
|
Bäckberg M, Tworek L, Beck O, Helander A. Analytically Confirmed Intoxications Involving MDMB-CHMICA from the STRIDA Project. J Med Toxicol 2016; 13:52-60. [PMID: 27638057 PMCID: PMC5330960 DOI: 10.1007/s13181-016-0584-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 08/03/2016] [Accepted: 08/17/2016] [Indexed: 11/02/2022] Open
Abstract
INTRODUCTION About a decade ago, synthetic cannabinoids (SC) started to appear as recreational drugs on the new psychoactive substance (NPS) market. This report from the STRIDA project describes analytically confirmed intoxications involving MDMB-CHMICA (methyl-2-(1-(cyclohexylmethyl)-1H-indol-3-ylcarbonylamino)-3,3-dimethylbutanoate), a SC that was first detected in 2014. STUDY DESIGN This is an observational case series of patients from Sweden with suspected NPS exposure presenting in emergency departments and intensive care units. The results of retrospective serum and urine toxicological analysis were compared with clinical signs reported during consultation with the Poisons Information Centre and retrieved from medical records. METHODS Clinical and bioanalytical data in nine acute intoxications associated with MDMB-CHMICA during 2014-2015 are presented. The patients were aged 23-62 (median 34) years, and eight were men. MDMB-CHMICA (parent compound) was analytically confirmed in serum samples, using a liquid chromatography-high-resolution mass spectrometry multi-component method. RESULTS Of the nine MDMB-CHMICA-positive patients, eight had a Poisoning Severity Score (PSS) of 2 or 3, and five were monitored in the intensive care unit and all patients survived. Development of seizures and deep unconsciousness were common features. All cases except one also tested positive for other NPS and/or classical psychoactive compounds, hampering the possibility to establish a causal relationship between drug and toxic symptoms. MDMB-CHMICA was also identified in seven drug materials donated by the patients. CONCLUSIONS The association with severe adverse reactions in nine acute analytically confirmed intoxication cases involving MDMB-CHMICA is consistent with other reports of serious toxicity linked to this substance, suggesting that MDMB-CHMICA might be a particularly harmful SC.
Collapse
Affiliation(s)
- Matilda Bäckberg
- Swedish Poisons Information Centre, SE-171 76, Stockholm, Sweden.
| | - Luiza Tworek
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Olof Beck
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.,Karolinska University Laboratory, Clinical Pharmacology, Stockholm, Sweden
| | - Anders Helander
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.,Karolinska University Laboratory, Clinical Pharmacology, Stockholm, Sweden
| |
Collapse
|
19
|
Vincristine. REACTIONS WEEKLY 2016. [PMCID: PMC7149258 DOI: 10.1007/s40278-016-19002-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|