1
|
Sagah GA, Fayed MM. Body mass index as a predictor of the outcomes of acute clozapine toxicity: a cross-sectional study. Toxicol Res (Camb) 2023; 12:599-607. [PMID: 37663813 PMCID: PMC10470374 DOI: 10.1093/toxres/tfad051] [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: 12/16/2022] [Revised: 06/06/2023] [Accepted: 06/13/2023] [Indexed: 09/05/2023] Open
Abstract
Acute antipsychotic overdose is frequently reported nowadays. Clozapine is one of the atypical agents that are highly lipophilic, highly protein-bound, has a large volume of distribution, and accumulates in the brain and other tissues. Obesity is an essential factor controlling patients' treatment and clinical course. The current study aimed to study the prognostic value of body mass index (BMI) in patients with acute clozapine poisoning. All patients were evaluated on admission using the Poison Severity Score (PSS) and Glasgow Coma Score (GCS). The BMI was calculated. Mortality and the need for ICU admission were defined as primary outcomes, whereas secondary outcomes included cardiovascular complications and the need for mechanical ventilation. Thirty-eight patients presented with acute clozapine poisoning. The mean age of included patients was 25.2 ± 6. Patients were categorized regarding BMI into average weight (26.3%), overweight (31.6%), and obese (42.1%). Pearson's correlation indicated a significant positive correlation between BMI and respiratory rate (r = .364, p = .025). A significant negative correlation existed between BMI and GCS (r = .674, p ≤ .001). ROC curve reveals that BMI is an excellent predictor for the requirement of mechanical ventilation area under the curve (AUC > .9), a fair predictor of ICU admission AUC (.747). BMI had a sensitivity of 100% and specificity of 51.7 for the prediction of ICU admission. In conclusion, obesity increased the severity of toxicity and the incidence of poor clinical outcomes in patients with acute clozapine poisoning.
Collapse
Affiliation(s)
- Ghada A Sagah
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University, Tanta 31527, Egypt
| | - Manar M Fayed
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University, Tanta 31527, Egypt
| |
Collapse
|
2
|
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
|
3
|
Al-Hinaai H, Al-Busaidi I, Al Farsi B, Al Saidi Y. The Prevalence of Substance Misuse and its Effects among Omani College Students: A Cross-sectional Study. Oman Med J 2021; 36:e224. [PMID: 33585045 PMCID: PMC7868041 DOI: 10.5001/omj.2021.04] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/11/2020] [Indexed: 12/22/2022] Open
Abstract
Objectives Many studies have confirmed that the use of alcohol, tobacco, and cannabis is prevalent among university students. This study aimed to assess the prevalence of substance misuse among college students in Oman, identifying the most commonly used substances, and reviewing the effect of substance misuse on the students’ performance. Methods This cross-sectional study was conducted in a higher learning institution in an urban setting in Oman from April 2018 to December 2018. A descriptive, self-administered online questionnaire, the Alcohol, Smoking, and Substance Involvement Screening Test, version 3.0 (Arabic version), adapted from the World Health Organization was sent to 12 000 students at the college. The sample size was calculated using online software (Raosoft), with a margin of error of 5% and a confidence level of 95%. Results A total of 375 students responded (response rate = 3.1%). The overall lifetime prevalence for any substance misuse (including tobacco and alcohol) among the participants was 41.3%, with the overall prevalence without tobacco or alcohol at 29.9%. Tobacco was the most common substance used, with a prevalence of around 23.5%, followed by alcohol at 10.7%. Male students had a significantly higher rate of substance abuse, for any substance, compared to female students (p < 0.001). There was a significant correlation between tobacco use, alcohol misuse, and misuse of other substances. Most of the adverse effects attributed to substance misuse reported by the respondents in this study were social (27.7%) and health-related (25.8%) problems. The impact of substance abuse on their performance was also high (23.8%). Furthermore, 15.4% of the respondents had financial problems, and 4.7%% were struggling with legal issues. Notably, only 49.1% of the respondents perceived that substance misuse was a serious problem. Conclusions Although college students are expected to be more aware of the negative impacts of substance misuse, this study found a high prevalence of smoking, alcohol, and other substance misuses among the group of Omani college students. Further research in this field is essential, and the results of this study have shed light on a critical problem among Omani college students. It is hoped that the findings of this study will be used and built on in future research to recognize students at risk of substance misuse from early school life, leading to early intervention, and potentially preventing the possible negative consequences.
Collapse
Affiliation(s)
| | - Issa Al-Busaidi
- Department of Family Medicine, Royal Oman Police Hospital, Muscat, Oman
| | - Badriya Al Farsi
- Department of Family Medicine, Armed Forces Hospital, Muscat, Oman
| | - Yaqoub Al Saidi
- Department of Family Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| |
Collapse
|
4
|
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
|
5
|
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
|
6
|
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
|
7
|
Al Wahaibi N, Al Lawati A, Al Ruqeishy F, Al Khatri A, Al-Farsi Y, Juma TMA, Al Hinai F, Al-Sibani N, Mahadevan S, Al-Adawi S. The characteristics and patterns of utilization of healthcare services among Omanis with substance use disorders attending therapy for cessation. PLoS One 2019; 14:e0210532. [PMID: 30703131 PMCID: PMC6354979 DOI: 10.1371/journal.pone.0210532] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 12/27/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND It is indicated that Oman is witnessing an increase in issues pertinent to alcohol and psychoactive substance use. AIM The aim of this study was to identify the characteristics of Omanis with substance use disorder attending a specialized hospital in Oman and the pattern of their utilization of healthcare services. A related aim was to ascertain the age group most vulnerable to alcohol and substance use in Oman. METHOD A cross-sectional study was conducted in a tertiary care center specialized for treatment of those engaging in substance use in Oman. The participants in the study were selected from a convenience sample among patients seeking consultation at the center for alcohol and substance use. A six-part questionnaire was designed to obtain information regarding socio-demographic background, clinical history, healthcare utilization and perceived hurdles to access. Chi-square analyses were used to evaluate the significance of differences among categorical data. Logistic regression modelling was used to obtain measures of association after adjusting for confounding factors. RESULTS Among the patients (n = 293) seeking cessation therapy, 99% were male and less than 30 years of age. Peer influences on the initiation of substance use were significant. Most patients had a history of polysubstance use, including intravenous substance use. Cannabis and alcohol were the first substances consumed by most patients and Hepatitis C and psychiatric disorders were found to be the most common co-morbidities. The participants that reported use of cannabis and benzodiazepines were more likely to perceive "improvement" upon receiving treatment. CONCLUSION This study indicated that males below 30 years of age with a history of polysubstance use were likely to attend a hospital specialized in treating substance use disorder in Oman. This study identified information regarding socio-demographic background, risk factors and perceived hurdles to healthcare that could serve as groundwork for further studies conducted on newly emerging issues of substance use in Oman.
Collapse
Affiliation(s)
- Nabila Al Wahaibi
- Wadi Kabir Health Centre, Directorate General of Health Services, Muscat Governorate, Ministry of Health, Muscat, Oman
| | - Anwaar Al Lawati
- Ruwi Health Centre, Directorate General of Health Services, Muscat Governorate, Ministry of Health, Muscat, Oman
| | - Falaah Al Ruqeishy
- Muscat Health Centre, Directorate General of Health Services, Muscat Governorate, Ministry of Health, Muscat, Oman
| | | | - Yahya Al-Farsi
- Department of Family Medicine and Public Health, Sultan Qaboos University, College of Medicine and Health Sciences, Muscat, Oman
| | - Tahira M. A. Juma
- Directorate of Health Services, Muttrah, Muscat Governorate, Ministry of Health, Muscat, Oman
| | - Fatma Al Hinai
- Directorate of Health Services, Muttrah, Muscat Governorate, Ministry of Health, Muscat, Oman
| | - Nasser Al-Sibani
- Department of Behavioral Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Sangeetha Mahadevan
- Department of Behavioral Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Samir Al-Adawi
- Department of Behavioral Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| |
Collapse
|
8
|
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]
|
9
|
Takeuchi I, Omori K, Nagasawa H, Jitsuiki K, Iso T, Kondo A, Ishikawa K, Ohsaka H, Yanagawa Y. An Analysis of Intoxicated Patients Transported by a Doctor Helicopter. Air Med J 2017; 37:37-40. [PMID: 29332774 DOI: 10.1016/j.amj.2017.09.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 08/23/2017] [Accepted: 09/28/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We retrospectively investigated all of the intoxicated patients who were transported by a doctor helicopter (DH) in eastern Shizuoka between April 2004 and December 2015 to determine when air medical transport was used in cases of toxic exposure. METHODS Subjects were divided into 2 groups: an outpatient group of subjects who went home after receiving a medical evaluation and treatment and an admission group. RESULTS The outpatient and admission groups included 17 and 31 subjects, respectively. The ratio of dispatching the DH to the scene and the median Glasgow Coma Scale score in the outpatient group were greater, and the shock index in the outpatient group was significantly smaller than in the admission group. The duration from exposure of intoxicated agents to contact by staffs of the DH in the outpatient group was also smaller than in the admission group. CONCLUSION The level of consciousness and shock index may be important factors dictating whether or not to dispatch the DH in order to prevent secondary damage induced by unstable circulation.
Collapse
Affiliation(s)
- Ikuto Takeuchi
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizouka, Japan
| | - Kazuhiko Omori
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizouka, Japan
| | - Hiroki Nagasawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizouka, Japan
| | - Kei Jitsuiki
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizouka, Japan
| | - Takashi Iso
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizouka, Japan
| | - Akihiko Kondo
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizouka, Japan
| | - Kouhei Ishikawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizouka, Japan
| | - Hiromichi Ohsaka
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizouka, Japan
| | - Youichi Yanagawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizouka, Japan.
| |
Collapse
|
10
|
Orsini J, Din N, Elahi E, Gomez A, Rajayer S, Malik R, Jean E. Clinical and epidemiological characteristics of patients with acute drug intoxication admitted to ICU. J Community Hosp Intern Med Perspect 2017; 7:202-207. [PMID: 29046744 PMCID: PMC5637637 DOI: 10.1080/20009666.2017.1356189] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 07/13/2017] [Indexed: 02/06/2023] Open
Abstract
Background: Drug overdose continues to be the most common cause of acute poisoning worldwide. There has been a substantial increase in drug overdose incidence and prevalence over the past decade, probably as a result of the emergence of new synthetic designer drugs. The purpose of this study is to describe the clinical and epidemiological characteristics of patients with acute drug intoxication admitted to the Intensive Care Unit (ICU). Methods: A single center, prospective, observational study was conducted among all adult patients with clinical signs suggestive of acute drug intoxication admitted from the Emergency Department (ED) to ICU during a 6-month period (September to March). Results: Sixty-five patients were admitted. Their median age was 49 years (mean 48.2, range 20–72), and the majority were male (48, 74%). Median Sequential Organ Failure Assessment (SOFA) score on admission to ICU was 6 (mean 6, range 0–13). Fifty-five patients (85%) had a positive urine and/or serum toxicology screen. Most commonly detected substances were: opiates (18, 33%), cocaine (13, 24%), methadone (12, 22%), benzodiazepines (10, 18%), and marijuana (9, 16%). In 16 patients (29%), >1 substance was isolated. Twenty-three patients (35%) had negative urine toxicology screen. Ethyl alcohol was detected in the serum of 23 patients (35%). Five patients (8%) expired in ICU. Conclusion: Classic recreational drugs remain the most common substances involved in acute drug poisoning. More sensitive detection methods are warranted to identify new designer drugs of abuse such as synthetic cannabinoids.
Collapse
Affiliation(s)
- Jose Orsini
- Department of Medicine, New York University School of Medicine, Woodhull Medical and Mental Health Center, Brooklyn, New York, USA
| | - Nanda Din
- Department of Medicine, New York University School of Medicine, Woodhull Medical and Mental Health Center, Brooklyn, New York, USA
| | - Ershad Elahi
- Department of Emergency Medicine, New York University School of Medicine, Woodhull Medical and Mental Health Center, Brooklyn, New York, USA
| | - Anthony Gomez
- Department of Emergency Medicine, New York University School of Medicine, Woodhull Medical and Mental Health Center, Brooklyn, New York, USA
| | - Salil Rajayer
- Department of Medicine, New York University School of Medicine, Woodhull Medical and Mental Health Center, Brooklyn, New York, USA
| | - Ryan Malik
- Department of Medicine, New York University School of Medicine, Woodhull Medical and Mental Health Center, Brooklyn, New York, USA
| | - Elie Jean
- Department of Medicine, New York University School of Medicine, Woodhull Medical and Mental Health Center, Brooklyn, New York, USA
| |
Collapse
|
11
|
Abstract
Because coma has many causes, physicians must develop a structured, algorithmic approach to diagnose and treat reversible causes rapidly. The three main mechanisms of coma are structural brain lesions, diffuse neuronal dysfunction, and, rarely, psychiatric causes. The first priority is to stabilise the patient by treatment of life-threatening conditions, then to use the history, physical examination, and laboratory findings to identify structural causes and diagnose treatable disorders. Some patients have a clear diagnosis. In those who do not, the first decision is whether brain imaging is needed. Imaging should be done in post-traumatic coma or when structural brain lesions are probable or possible causes. Patients who do not undergo imaging should be reassessed regularly. If CT is non-diagnostic, a checklist should be used use to indicate whether advanced imaging is needed or evidence is present of a treatable poisoning or infection, seizures including non-convulsive status epilepticus, endocrinopathy, or thiamine deficiency.
Collapse
Affiliation(s)
- Jonathan A Edlow
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Rochester, MN, USA.
| | | | - Stephen J Traub
- Department of Emergency Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | | |
Collapse
|