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Romanova OL, Blagonravov ML, Djuvalyakov PG, Barinov EK, Ershov AV, Kislov MA. [Features of lung damage in baclofen poisoning]. Sud Med Ekspert 2024; 67:29-33. [PMID: 38353012 DOI: 10.17116/sudmed20246701129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
OBJECTIVE To reveal pathological lung changes in baclofen poisoning and to assess their dynamics. MATERIAL AND METHODS The experiment included 20 mature (at age 20 weeks) male rats of Wistar line weighing 290-350 gr. The animals were divided into 3 study groups (5 rats in each) depending on experiment's duration after 85 mg/kg baclofen administration: 3, 4.5 and 24 h in the 1st, 2nd and 3rd groups, respectively. Control group consisted of 5 animals without baclofen administration. RESULTS A number of pathological reactions, including circulatory disorder (venular and capillary congestion, hemorrhage in interalveolar septa, alveoli, sludge) and the appearance of emphysema loci (interalveolar septa at emphysema loci are thinned), alternating with atelectases and dystelectases. The area taken up by vessels after 4.5 h. baclofen administration was statistically significantly higher than in control group, and after 24 h. - statistically significantly higher than in 4.5 h. The area with white blood cells and WBC/IAP ratio after 4.5 h of baclofen administration were statistically significantly higher than in control group after 3 and 24 h of administration. The number of white blood cells, giving PAS positive reaction, increases during baclofen administration. The complex of pathological lung changes, revealed by ourselves, has a certain dynamics. CONCLUSION The data on morphological lung changes combined with results of chemical examination can be used to diagnose baclofen poisoning and to determine the time elapsed since this medicine administration.
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Affiliation(s)
- O L Romanova
- Russian University of People Friendship, Moscow, Russia
- Avtsyn Research Institute of Human Morphology «Petrovsky Russian Scientific Center of Surgery», Moscow, Russia
| | | | - P G Djuvalyakov
- Russian University of People Friendship, Moscow, Russia
- Avtsyn Research Institute of Human Morphology «Petrovsky Russian Scientific Center of Surgery», Moscow, Russia
| | - E Kh Barinov
- Russian University of People Friendship, Moscow, Russia
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - A V Ershov
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitation, Moscow, Russia
| | - M A Kislov
- Pirogov Russian National Research Medical University, Moscow, Russia
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Abstract
BACKGROUND The use of ketamine, a controlled dissociative anesthetic, has become more widespread in recent years with recreational/nonmedical use increasing and ketamine becoming more widely available in clinics to treat depression. AIMS We examined recent trends in adverse effects related to ketamine use. METHODS US National Poison Control data were examined, focusing on ketamine exposures among those aged ⩾13 between 2019 and 2021 (n = 758). We examined quarterly trends in exposure and delineated correlates of patients experiencing a major adverse effect or death. RESULTS The number of reported exposures increased 81.1% from 2019 Quarter 1 through 2021 Quarter 4, from 37 to 67 (p = 0.018). The majority of patients were male (57.1%), and the plurality of cases involved intentional misuse or "abuse" (39.5%), followed by suspected suicide attempt (19.7%) and unintentional exposure (18.9%). A fifth (19.6%) experienced a major adverse effect or death. A third (33.4%) co-used other drugs; the drugs most commonly co-used were benzodiazepines (14.6%), alcohol (10.3%), and opioids (8.7%). Co-use of gamma-hydroxybutyrate (GHB; adjusted prevalence ratio (aPR) = 3.43, 95% confidence interval (CI): 1.57-7.46) and opioids (aPR = 2.44, 95% CI: 1.46-4.08) was associated with increased risk for a major adverse effect or death, as was injection-only administration (aPR = 2.68, 95% CI: 1.21-5.92). CONCLUSIONS Although still rare, poisonings involving ketamine have increased in recent years. Polydrug use-particularly with opioids or GHB-appears to be a particular risk factor for more serious adverse effects. As prevalence of use increases, it is important to monitor adverse effects and co-occurring behaviors to inform timely prevention and harm reduction as needed.
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Affiliation(s)
- Joseph J. Palamar
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Nicole D. Fitzgerald
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, FL, USA
| | - David J. Grundy
- A Division of Denver Health, Rocky Mountain Poison & Drug Safety (RMPDS), Denver, CO, USA
| | - Joshua C. Black
- A Division of Denver Health, Rocky Mountain Poison & Drug Safety (RMPDS), Denver, CO, USA
| | - Jennifer S. Jewell
- A Division of Denver Health, Rocky Mountain Poison & Drug Safety (RMPDS), Denver, CO, USA
| | - Linda B. Cottler
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, FL, USA
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3
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Sørensen AMS, Petersen J, Christensen MB, Schelde AB, Andersen JT, Jimenez Solem E, Petersen TS. Short-term mortality following tramadol poisonings in Denmark. Basic Clin Pharmacol Toxicol 2022; 131:83-92. [PMID: 35538919 PMCID: PMC9324776 DOI: 10.1111/bcpt.13741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 05/04/2022] [Indexed: 11/29/2022]
Abstract
Tramadol is a commonly used opioid with a potential of addiction and abuse. Using Danish nationwide registers, we aimed to (1) characterise opioid poisonings; (2) assess the 30-day mortality following morphine, oxycodone, and mixed poisonings compared to tramadol poisonings; and (3) assess the development in tramadol poisonings during a 12-year period. Poisonings were identified from 2006 to 2017. A Cox proportional hazards regression model was used to estimate adjusted hazard ratios (aHRs) along with 95% confidence intervals (CIs) for 30-day mortality following morphine, oxycodone or mixed poisonings compared to tramadol poisonings. We identified 7718 opioid poisonings among 6365 patients. The patients with a tramadol poisoning were younger and had less comorbidities than the patients with a morphine, oxycodone or mixed poisoning. Within 30 days, a total of 205 patients died. The 30-day mortality risk was higher following morphine (aHR 3.2, 95% CI 2.0-5.1), oxycodone (aHR 2.1, 95% CI 1.2-3.6) and mixed poisonings (aHR 1.6, 95% CI 1.0-2.7) compared to tramadol poisonings. The annual number of tramadol poisonings increased from 233 in 2006 to 501 in 2013 and declined to 348 in 2017. In conclusion, despite a lower mortality risk compared to other opioid poisonings, physicians should consider the poisoning and abuse risks when prescribing tramadol.
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Affiliation(s)
| | - Janne Petersen
- Copenhagen Phase IV unit (Phase4CPH), Department of Clinical Pharmacology and Center of Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Bring Christensen
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Astrid Blicher Schelde
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Jon Traerup Andersen
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Espen Jimenez Solem
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,Copenhagen Phase IV unit (Phase4CPH), Department of Clinical Pharmacology and Center of Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Tonny Studsgaard Petersen
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Champagne AS, McFaull SR, Thompson W, Bang F. Surveillance from the high ground: sentinel surveillance of injuries and poisonings associated with cannabis. Health Promot Chronic Dis Prev Can 2021; 40:184-192. [PMID: 32529978 DOI: 10.24095/hpcdp.40.5/6.07] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION In October 2018, Canada legalized the nonmedical use of cannabis for adults. The aim of our study was to present a more recent temporal pattern of cannabis-related injuries and poisonings found in the electronic Canadian Hospitals Injury Reporting and Prevention Program (eCHIRPP) database and provide a descriptive summary of the injury characteristics of cannabis-related cases captured in a nine-year period. METHODS We conducted a search for cannabis-related cases in the eCHIRPP database reported between April 2011 and August 2019. The study population consisted of patients between the ages of 0 and 79 years presenting to the 19 selected emergency departments across Canada participating in the eCHIRPP program. We calculated descriptive estimates examining the intentionality, external cause, type and severity of cannabis-related cases to better understand the contextual factors of such cases. We also conducted time trend analyses using Joinpoint software establishing the directionality of cannabis-related cases over the years among both children and adults. RESULTS Between 1 April 2011, and 9 August, 2019, there were 2823 cannabis-related cases reported in eCHIRPP, representing 252.3 cases/100 000 eCHIRPP cases. Of the 2823 cannabis-related cases, a majority involved cannabis use in combination with one or more substances (63.1%; 1780 cases). There were 885 (31.3%) cases that involved only cannabis, and 158 cases (5.6%) that related to cannabis edibles. The leading external cause of injury among children and adults was poisoning. A large proportion of cannabis-related cases were unintentional in nature, and time trend analyses revealed that cannabis-related cases have recently been increasing among both children and adults. Overall, 15.1% of cases involved serious injuries requiring admission to hospital. CONCLUSION Cannabis-related cases in the eCHIRPP database are relatively rate, a finding that may point to the fact that mental and behavioural disorders resulting from cannabis exposure are not generally captured in this surveillance system and the limited number of sites found across Canada. With Canada's recent amendments to cannabis regulations, ongoing surveillance of the health impacts of cannabis will be imperative to help advance evidence to protect the health of Canadians.
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Affiliation(s)
| | | | | | - Felix Bang
- Public Health Agency of Canada, Ottawa, Ontario, Canada
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Abstract
CONTEXT Gummy formulations are widely available with estimated 65% marketed for children. Currently, there are few studies describing children ingesting gummy formulated medications. The aim of this study was to quantify and identify the type of ingestions due to gummy formulated medications, evaluate their clinical significance as defined by adverse outcomes: associated symptoms, emergency department (ED) visits, and hospitalizations. METHODS Retrospective study in children aged 0-19 exposed to gummy formulated medications from 2015 to 2017 as identified by calls made to the Regional Poison Control Center (RPCC). A list of potentially toxic gummy formulated medications was compiled and reviewed by medical and clinical toxicologists. We categorized medications into vitamins, minerals and supplements, melatonin, and other. Data collected included: medication name, number of units, age, sex, symptoms described, ED visit, hospitalization, and unintentional or intentional ingestion. DISCUSSION Of the 66,059 pediatric exposures received by RPCC, 1143 (1.7%) involved gummy formulated medications of which 1098 were analyzed. Median age was 3 years, 57.7% were males and 7% were symptomatic. Seventy-four percent exposures involved vitamins and 24% melatonin. In comparison to other gummy exposures, those who ingested melatonin had 8.4 times higher odds of being symptomatic (OR: 8.4, 95% CI: 5.1, 14) and 4.8 times higher odds of visiting ED (OR: 4.8, 95% CI: 2.5, 9). The predominant symptoms reported were drowsiness, gastrointestinal upset, and hyperactivity. Two patients were hospitalized who ingested multiple medications, one was unintentional, and one was intentional as a suicide attempt thus admitted for psychiatric stabilization. CONCLUSIONS Gummy formulated medications comprised <2% of the total pediatric calls to the RPCC. Although, the occurrence of symptoms is rare, these medications especially those containing melatonin should be safely stored.
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Affiliation(s)
- Erika Bishop Crawford
- Pediatric Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Children's of Alabama, Birmingham, AL, USA
| | - Teresa Coco
- Pediatric Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Children's of Alabama, Birmingham, AL, USA
| | | | - Nipam Shah
- Pediatric Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Children's of Alabama, Birmingham, AL, USA
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Al Alaywa K, Jouffroy R, Le Beller C, Rapalen JH, Lamhaut L, Le Louet AL, Baud F. Toxicological Analysis Unveiling the Low Rate of Self-Reporting of Addictive/Recreative Substances in Acute Severe Drug Overdose Cases. Turk J Anaesthesiol Reanim 2020; 48:148-155. [PMID: 32259147 PMCID: PMC7101186 DOI: 10.5152/tjar.2019.28003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 07/17/2019] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Toxicological analysis (TA) is advised when assessing the prognosis and the treatment of drug overdose patients. Apart from this use, the value of TA has remained unclear. This study aimed at defining the value of TA regarding the toxicological diagnosis in severe overdose cases that involved addictive or recreational drugs (ARDs) that were used either alone or in combination with medicinal drugs. METHODS The patients who were enrolled in the study had been admitted to our intensive care unit for the treatment of poisoning. TA was performed using advanced technologies such as mass spectrometry of blood/urine on admission. An occurrence indicated the supposed ingestion of a defined substance. Patients were included in a group depending on the combination of the occurrences of supposed ingested drugs (SID) and the results of the 1) TA: SID+, TA+; 2) SID+, not searched by TA; 3) SID-, TA+. RESULTS There were 224 occurrences of 90 substances in 70 patients. ARDs were present in 30 patients (43%). ARD accounted for 24 occurrences in the SID+, TA+ group, 10 occurrences in the SID+, not searched group and 196 occurrences in the SID-, TA+ group. In the SID+, TA+ group, 9 occurrences (69%) of ethanol were confirmed by TA. Ingestion of ethanol was invalidated in 4 occurrences (31%). In the patients who denied ethanol ingestion, TA confirmed the non-ingestion of ethanol using 30 blood measures (81%). Ethanol was involved in 57% of the patients, being the lone substance in only 1 case. CONCLUSION In drug overdose instances that result in organ failure(s) and involve ARDs, self-reporting is of limited value in assessing the patients' exposure to ARD. Multiple consumptions expose patients to unexpected drug interactions.
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Affiliation(s)
- Khadija Al Alaywa
- UMR - 8257, Cognitive Action Group; University Paris Descartes, Paris, France
| | - Romain Jouffroy
- Department of Anaesthesiology, Intensive Care Unit, SAMU de Paris, Necker Hospital Paris, APHP, Paris, France
| | - Christine Le Beller
- Regional Center of Pharmacovigilance of Paris-HEGP, European Hospital of Georges Pompidou, Paris, France
| | - Jean-herlé Rapalen
- Department of Anaesthesiology, Intensive Care Unit, SAMU de Paris, Necker Hospital Paris, APHP, Paris, France
| | | | - Agnes Lillo Le Louet
- Regional Center of Pharmacovigilance of Paris-HEGP, European Hospital of Georges Pompidou, Paris, France
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Abstract
Injuries continue to be a public health concern in Canada. National injury death data are essential for understanding the magnitude and pattern of injuries. This paper used the Vital Statistics - Death database to examine deaths associated with injuries in 2015. Injuries were ranked against causes of death, and more in-depth analysis of injury categories was conducted by sex and age. Unintentional injuries were the 6th leading causes of death overall, with different ranking by sex. Among unintentional injury deaths, leading causes included falls, poisonings, motor vehicle traffic collisions, and suffocation, which varied by age group.
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Affiliation(s)
- Xiaoquan Yao
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Robin Skinner
- Public Health Agency of Canada, Ottawa, Ontario, Canada
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8
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Sengoelge M, Leithaus M, Braubach M, Laflamme L. Are There Changes in Inequalities in Injuries? A Review of Evidence in the WHO European Region. Int J Environ Res Public Health 2019; 16:ijerph16040653. [PMID: 30813329 PMCID: PMC6406953 DOI: 10.3390/ijerph16040653] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 02/17/2019] [Accepted: 02/19/2019] [Indexed: 11/16/2022]
Abstract
Decreases in injury rates globally and in Europe in the past decades, although encouraging, may mask previously reported social inequalities between and within countries that persist or even increase. European research on this issue has not been systematically reviewed, which is the aim of this article. Between and within-country studies from the WHO European Region that investigate changes in social inequalities in injuries over time or in recent decades were sought in PubMed, Scopus, and Web of Science. Of the 27 studies retained, seven were cross-country and 20 were country-specific. Twelve reported changes in inequalities over time and the remaining 15 shed light on other aspects of inequalities. A substantial downward trend in injuries is reported for all causes and cause-specific ones—alongside persisting inequalities between countries and, in a majority of studies, within countries. Studies investigate diverse questions in different population groups. Depending on the social measure and injury outcome considered, many report inequalities in injuries albeit to a varying degree. Despite the downward trends in risk levels, relative social inequalities in injuries remain a persisting public health issue in the European Region.
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Affiliation(s)
- Mathilde Sengoelge
- Department of Public Health Sciences, Karolinska Institutet, Widerströmska Huset, Tomtebodavägen 18 A, 171 77 Stockholm, Sweden.
| | - Merel Leithaus
- Department of International Health, Maastricht University, Universiteitssingel 40, 6229 ET Maastricht, The Netherlands.
| | - Matthias Braubach
- WHO European Centre for Environment and Health, Platz der Vereinten Nationen 1, D-53113 Bonn, Germany.
| | - Lucie Laflamme
- Department of Public Health Sciences, Karolinska Institutet, Widerströmska Huset, Tomtebodavägen 18 A, 171 77 Stockholm, Sweden.
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9
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Beauchamp GA, Carey JL, Adams T, Wier A, Colón MF, Cook M, Cannon R, Katz KD, Greenberg MR. Sex Differences in Poisonings Among Older Adults: An Analysis of the Toxicology Investigators Consortium (ToxIC) Registry, 2010 to 2016. Clin Ther 2018; 40:1366-1374.e8. [PMID: 30072041 DOI: 10.1016/j.clinthera.2018.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 06/14/2018] [Accepted: 06/14/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE Adults aged >65 years are susceptible to intentional and unintentional poisoning, with contributing factors that include polypharmacy, comorbidity, susceptibility to medication error, and gaps in research. Although toxicologists are often tasked with managing and preventing poisoning among older adults, little is known about sex differences in these poisonings. The aim of this study was to review sex differences in poisonings among older adults managed at the bedside by medical toxicologists. METHODS All case subjects aged >65 years in the Toxicology Investigators Consortium (ToxIC) registry between January 2010 and December 2016 were reviewed. Data included reasons for exposure and consultation, exposure agents and routes, presenting clinical findings, and treatment provided. Cases missing age, sex, or primary reason for toxicology consultation data were excluded. We used χ2 tests to assess differences in distribution of study variables according to participant sex. FINDINGS Among 51,441 total registry cases, 542 (1.05%) were excluded because of missing data. Among the remaining 50,899 cases, 2930 (5.8%) were included for age >65 years; 52.3% of older adults were female. Race was missing or unknown for 49.2% of cases. Adverse drug reactions were more commonly encountered in female subjects than in their male counterparts (9.6% vs 6.4%; P = 0.001). No statistically significant sex differences were observed for total numbers of intentional, unintentional pharmaceutical, and nonpharmaceutical exposures. The most common medications involved were cardiovascular (16.8%) and analgesics/opioids (14.8%). Female subjects were more likely than male subjects to be evaluated by a toxicologist for cardiovascular medications (18.7% vs 14.7%; P = 0.004) and analgesics/opioids (17.6% vs 11.8%; P < 0.001). Male subjects were more likely than female subjects to be evaluated for ethanol toxicity (7.4% vs 1%; P < 0.001) and for envenomations (4.2% vs 1.8%; P < 0.001). The most common route of exposure was oral ingestion (81.3%). Signs/symptoms were noted in 54.8% of cases, with the most common abnormal vital sign being bradycardia (17.2%). Pharmacologic support was the most common intervention and was more common in male subjects than in female subjects (17.7% vs 12.3%; P < 0.001). Deaths were reported in 38 female subjects (2.45%) and 46 male subjects (3.34%); there was no statistically significant difference in death rate according to sex (P = 0.148). IMPLICATIONS Older female adults were more commonly evaluated by a medical toxicologist for an adverse drug reaction than older male adults. Female patients were more likely than male patients to be evaluated for poisoning related to analgesic/opioids and cardiovascular medications, and older male patients more frequently received pharmacologic support than older female patients. No significant sex differences were observed in numbers of toxicology consultations for intentional, unintentional pharmaceutical, and nonpharmaceutical exposures.
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Affiliation(s)
- Gillian A Beauchamp
- Lehigh Valley Health Network, Department of Emergency and Hospital Medicine/USF Morsani College of Medicine, Allentown, Pennsylvania; Lehigh Valley Health Network, Department of Emergency and Hospital Medicine, Section of Medical Toxicology, Allentown, Pennsylvania.
| | - Jennifer L Carey
- University of Massachusetts Medical School, Department of Emergency Medicine, Division of Medical Toxicology, Worcester, Massachusetts
| | - Tyler Adams
- Lehigh Valley Health Network, Department of Emergency and Hospital Medicine/USF Morsani College of Medicine, Allentown, Pennsylvania
| | - Amy Wier
- Lehigh Valley Health Network, Department of Emergency and Hospital Medicine/USF Morsani College of Medicine, Allentown, Pennsylvania
| | - Manuel F Colón
- Lehigh Valley Health Network, Department of Emergency and Hospital Medicine/USF Morsani College of Medicine, Allentown, Pennsylvania
| | - Matthew Cook
- Lehigh Valley Health Network, Department of Emergency and Hospital Medicine/USF Morsani College of Medicine, Allentown, Pennsylvania; Lehigh Valley Health Network, Department of Emergency and Hospital Medicine, Section of Medical Toxicology, Allentown, Pennsylvania
| | - Robert Cannon
- Lehigh Valley Health Network, Department of Emergency and Hospital Medicine/USF Morsani College of Medicine, Allentown, Pennsylvania; Lehigh Valley Health Network, Department of Emergency and Hospital Medicine, Section of Medical Toxicology, Allentown, Pennsylvania
| | - Kenneth D Katz
- Lehigh Valley Health Network, Department of Emergency and Hospital Medicine/USF Morsani College of Medicine, Allentown, Pennsylvania; Lehigh Valley Health Network, Department of Emergency and Hospital Medicine, Section of Medical Toxicology, Allentown, Pennsylvania
| | - Marna Rayl Greenberg
- Lehigh Valley Health Network, Department of Emergency and Hospital Medicine/USF Morsani College of Medicine, Allentown, Pennsylvania
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10
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Sungur S, Bilge U, Acar N, Unluoglu I. Retrospective evaluation of adult poisoning cases admitted to emergency department of a University Hospital in Turkey. Niger J Clin Pract 2018; 21:1023-1028. [PMID: 30074005 DOI: 10.4103/njcp.njcp_291_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE We aimed to evaluate demographic, etiological, clinical features, and prognosis of poisoning cases applied to a tertiary emergency department retrospectively. MATERIALS AND METHODS The recordings of poisoning cases aged 18 years old and over which applied to the department of emergency medicine between the dates of 2010-2015 were examined. Age, gender, admission date, amount of time passed since exposure to the poisonous substance, application method, cause of poisoning, laboratory findings at arrival, vital signs, type of poisonous substance, the way of taking, treatment method in urgent care, consultation need, and the outcome of cases were recorded. RESULTS Of the poisoning cases, 437 (52.1%) were female, and 402 (47.9%) were male. The mean age was calculated as 33.50. When the cause of poisonings are examined; 456 patients were found to be poisoned by a suicide attempt, 350 were accidentally poisoned, and 33 were poisoned by treatment complication. As the causing substance of poisoning, medicinal drugs were found in 465 cases (55.4%), carbon monoxide in 205 cases (24.4%), and narcotics in 119 cases (14.2%). Of medicinal drug poisonings, 221 (46.8%) were multiple drug intake. It was seen that 46.6% of the patients were kept under observation with only symptomatic treatment while nasogastric lavage and activated charcoal were applied in 40.2% of them. CONCLUSION It can be suggested that poisonings are encountered more commonly in young people, especially in women, with medicinal drugs and for suicidal purposes. Drugs detected at high rates in poisonings, such as painkillers and antidepressants, should be used more cautiously.
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Affiliation(s)
- S Sungur
- Department of Family Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - U Bilge
- Department of Family Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - N Acar
- Department of Emergency Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - I Unluoglu
- Department of Family Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
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11
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Tompa A, Balázs P. [Concise history of toxicology - from empiric knowledge to science]. Orv Hetil 2018; 159:83-90. [PMID: 29332417 DOI: 10.1556/650.2018.30950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Toxicology is a science of poisonings by xenobiotics and endogenous physiological changes. Its empiric roots may be traced back to the emerging of the human race because the most important pledge of our predecessors' survival was the differentiation between eatable and poisonous plants and animals. In the course of social evolution, there were three main fields of using poisons: 1) hunting and warfare, 2) to settle social tensions by avoiding military conflicts through hiding strategy of eliminating enemies by toxic substances, 3) medicines applied first as anti-poisons and later by introducing strong substances to defeat diseases, but paradoxically active euthanasia is also a part of the whole story. The industrial revolution of the 19th century changed the sporadic occupational diseases to mass conditions. Later the chemical industry and subsequently the mass production of synthetic materials turned out as a global environmental catastrophe. This latest change initiated the emerging of ecological toxicology which is a future history of the concerning ancient science. Orv Hetil. 2018; 159(3): 83-90.
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Affiliation(s)
- Anna Tompa
- Népegészségtani Intézet, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest, Nagyvárad tér 4., 1089
| | - Péter Balázs
- Népegészségtani Intézet, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest, Nagyvárad tér 4., 1089
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12
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Abstract
Lead is a heavy metal that remains a persistent environmental toxin. Although there have been a substantial number of reviews published on the health effects of lead, these reviews have predominantly focused on recent publications and rarely look at older, more historical articles. Old documents on lead can provide useful insight in establishing the historical context of lead usage and its modes of toxicity. The objective of this review is to explore historical understandings and uses of lead prior to the 20th century. One hundred eighty-eight English language articles that were published before the year 1900 were included in this review. Major themes in historical documentation of lead toxicology include lead's use in medical treatments, symptoms of lead poisoning, treatments for lead poisoning, occupational lead poisonings, and lead contamination in food and drinking water. The results of this review indicate that lead's usage was widespread throughout the 19th century, and its toxic properties were well-known. Common symptoms of lead poisoning and suggested treatments were identified during this time period. This review provides important insight into the knowledge and uses of lead before the 20th century and can serve as a resource for researchers looking at the history of lead.
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Affiliation(s)
| | - R Afshari
- 2 BC Centre for Disease Control, Vancouver, Canada.,3 Occupational and Environmental Health Division, School of Population and Public Health, University of British Columbia, Vancouver, Canada
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13
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Weaver LK, Deru K, Churchill S, Legler J, Snow G, Grey T. Carbon monoxide poisoning in Utah: 1996-2013. Undersea Hyperb Med 2016; 43:747-758. [PMID: 28777512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION The true incidence of carbon monoxide (CO) poisoning is not clearly known, but a description of possible trends could aid in prevention. METHODS Investigators searched Utah state databases for emergency department (ED) visits and admissions for CO poisoning and medical examiner records for CO-related fatalities. RESULTS From 1996-2013, 7,590 individuals were diagnosed with CO poisoning: 6,469 were treated/ released from EDs; 596 were admitted; 525 died. Of 7,065 non-fatal poisonings, 5,950 (84%) were accidental and 498 (7%) were suicide attempts. Few patients (9.7%) were treated with hyperbaric oxygen. For accidental poisonings, internal combustion engines accounted for 43%, smoke inhalation, 34%, and heating sources, 22%. Internal combustion engines were implicated in 97% of suicide attempts. Non-fatal poisonings declined following a 2008 legislative change requiring CO alarms in residences, but we do not know if legislation caused the decline. One hundred forty-one (27%) fatal poisonings were accidental, 361 (70%) suicides and two (0.4%) homicides. Victims with cardiovascular autopsy findings/past cardiovascular history had lower carboxyhemoglobin levels (mean 51.2%, n=53) compared to those without (70.8%, n=472). Mean postmortem carboxyhemoglobin was highest in ages 20-29 years (72.5%). CONCLUSIONS The incidence of CO poisoning in Utah is declining, but CO poisoning is still common. Alarm legislation may aid prevention efforts. An educational campaign addressing the many causes and circumstances of CO poisoning is required for prevention.
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Affiliation(s)
- Lindell K Weaver
- Hyperbaric Medicine, LDS Hospital, Salt Lake City, Utah U.S
- Hyperbaric Medicine Intermountain Medical Center, Murray, Utah U.S
- University of Utah School of Medicine, Salt Lake City, Utah U.S
| | - Kayla Deru
- Hyperbaric Medicine, LDS Hospital, Salt Lake City, Utah U.S
- Hyperbaric Medicine Intermountain Medical Center, Murray, Utah U.S
| | - Susan Churchill
- Hyperbaric Medicine, LDS Hospital, Salt Lake City, Utah U.S
- Hyperbaric Medicine Intermountain Medical Center, Murray, Utah U.S
| | - Joshua Legler
- Utah Department of Health, Salt Lake City, Utah U.S
- Joshua Legler LLC, Newberg, Oregon U.S
| | - Greg Snow
- Statistical Data Center, LDS Hospital, Salt Lake City, Utah U.S
| | - Todd Grey
- Utah Office of the Medical Examiner, Salt Lake City, Utah U.S
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Tadros A, Layman SM, Davis SM, Bozeman R, Davidov DM. Emergency department visits by pediatric patients for poisoning by prescription opioids. Am J Drug Alcohol Abuse 2016; 42:550-555. [PMID: 27398815 DOI: 10.1080/00952990.2016.1194851] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Prescription medication abuse is an increasingly recognized problem in the United States. As more opioids are being prescribed and abused by adults, there is an increased risk of both accidental and intentional exposure to children and adolescents. The impact of pediatric exposures to prescription pain pills has not been well studied. OBJECTIVES We sought to evaluate emergency department (ED) visits for poisoning by prescription opioids in pediatric patients. METHODS This retrospective study looked at clinical and demographic data from the Nationwide Emergency Department Sample (NEDS) from 2006 to 2012. RESULTS There were 21,928 pediatric ED visits for prescription opioid poisonings and more than half were unintentional. There was a bimodal age distribution of patients, with slightly more than half occurring in females. The majority of patients were discharged from the ED. More visits in the younger age group (0-5 years) were unintentional, while the majority of visits in the adolescent age group (15-17 years) were intentional. Mean charge per discharge was $1,840 and $14,235 for admissions and surmounted to over $81 million in total charges. CONCLUSION Poisonings by prescription opioids largely impact both young children and adolescents. These findings can be used to help target this population for future preventive efforts.
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Affiliation(s)
- Allison Tadros
- a Department of Emergency Medicine , West Virginia University , Morgantown , West Virginia , USA
| | - Shelley M Layman
- a Department of Emergency Medicine , West Virginia University , Morgantown , West Virginia , USA
| | - Stephen M Davis
- a Department of Emergency Medicine , West Virginia University , Morgantown , West Virginia , USA
| | - Rachel Bozeman
- a Department of Emergency Medicine , West Virginia University , Morgantown , West Virginia , USA
| | - Danielle M Davidov
- a Department of Emergency Medicine , West Virginia University , Morgantown , West Virginia , USA
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Lee JH, Hwang SY, Kim HR, Kim YW, Kang MJ, Cho KW, Lee DW, Kim YH. Effectiveness of the sequential organ failure assessment, acute physiology and chronic health evaluation II, and simplified acute physiology score II prognostic scoring systems in paraquat-poisoned patients in the intensive care unit. Hum Exp Toxicol 2016; 36:431-437. [PMID: 27387349 DOI: 10.1177/0960327116657602] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This study was conducted to assess the ability of the sequential organ failure assessment (SOFA) and acute physiology and chronic health evaluation (APACHE) II scoring systems, as well as the simplified acute physiology score (SAPS) II method to predict group mortality in intensive care unit (ICU) patients who were poisoned with paraquat. This will assist physicians with risk stratification. MATERIAL AND METHODS The medical records of 244 paraquat-poisoned patients admitted to the ICU from January 2010 to April 2015 were examined retrospectively. The SOFA, APACHE II, and SAPS II scores were calculated based on initial laboratory data in the emergency department and during the first 24 h of ICU admission. The probability of death was calculated for each patient based on the SOFA score, APACHE II score, and SAPS II. The ability of the SOFA score, APACHE II score, and SAPS II method to predict group mortality was assessed using a receiver operating characteristic (ROC) curve and calibration analyses. RESULTS A total of 219 patients (mean age, 63 years) were enrolled. Sensitivities, specificities, and accuracies were 58.5%, 86.1%, and 64.0% for the SOFA, respectively; 75.1%, 86.1%, and 77.6% for the APACHE II scoring systems, respectively; and 76.1%, 79.1%, and 76.7% for the SAPS II, respectively. The areas under the curve in the ROC curve analysis for the SOFA score, APACHE II scoring system, and SAPS II were 0.716, 0.850, and 0.835, respectively. CONCLUSION The SOFA, APACHE II, and SAPS II had different capabilities to discriminate and estimate early in-hospital mortality of paraquat-poisoned patients. Our results show that although the SOFA and SAPS II are easier and more quickly calculated than APACHE II, the APACHE II is superior for predicting mortality. We recommend use of the APACHE II for outcome predictions and risk stratification in paraquat-poisoned patients in the ICU.
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Affiliation(s)
- Jun Ho Lee
- 1 Department of Emergency Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Seong Youn Hwang
- 1 Department of Emergency Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Hye Ran Kim
- 1 Department of Emergency Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Yang Won Kim
- 2 Department of Emergency Medicine, Busan Paik Hospital, Inje University, Busan, Republic of Korea
| | - Mun Ju Kang
- 1 Department of Emergency Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Kwang Won Cho
- 1 Department of Emergency Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Dong Woo Lee
- 1 Department of Emergency Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Yong Hwan Kim
- 1 Department of Emergency Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
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Piekarska-Wijatkowska A, Kobza-Sindlewska K, Rogaczewska A, Zajdel R, Krakowiak A. Intentional poisoning among elderly people-residents of a large urban agglomeration in Poland. Hum Exp Toxicol 2016; 35:1328-1336. [PMID: 26860687 DOI: 10.1177/0960327116630353] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Poisoning is considered a significant health problem among elderly people in Poland. This report refers to patients treated for poisonings at the Toxicology Unit, Lodz, Poland, during the period 2008-2012. The data to be analyzed were obtained from medical records of elderly people. A group of 1167 patients aged 60+ was selected. The number of intentional poisonings in the group of patients was 417, which accounted for 35.7% of all poisonings among the elderly people. Patients attempting intentional poisonings included 301 (72.2%) women and 116 (27.8%) men. The most common cause of intentional poisonings were drugs-96.6% (n = 403). Benzodiazepines (46.9%) dominated among the intentional poisoning by drugs. During the analyzed 5 years, 80.3% (n = 335) were suicidal poisonings and 19.7% (n = 82) were demonstrative poisonings. Cardiovascular disease, which was diagnosed among 53.5% of the patients, was the most common physical illness. In conclusion, drugs are the most frequent type of the toxic agent responsible for poisoning cases among the elderly people. In this situation, the role of family doctors is very important: they should prescribe medicines in amounts not greater than absolutely necessary and maybe more often recommend psychiatric care for the elderly patients.
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Affiliation(s)
- Anna Piekarska-Wijatkowska
- Department of Toxicology, Poison Information Centre, Nofer Institute of Occupational Medicine, Lodz, Poland
| | - Katarzyna Kobza-Sindlewska
- Department of Toxicology, Poison Information Centre, Nofer Institute of Occupational Medicine, Lodz, Poland
| | - Anna Rogaczewska
- Department of Toxicology, Poison Information Centre, Nofer Institute of Occupational Medicine, Lodz, Poland
| | - Radosław Zajdel
- Department of Medical Informatics and Statistics, Faculty of Health Sciences, Medical University of Lodz, Poland
| | - Anna Krakowiak
- Department of Toxicology, Toxicology Unit, Nofer Institute of Occupational Medicine, Lodz, Poland
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Abstract
Injuries continue to be the leading cause of death for the first four decades of life. These injuries result from a confluence of behavioral, physical, structural, environmental, and social factors. Taken together, these illustrate the importance of taking a broad and multileveled approach to injury prevention. Using examples from fall, fire, scald, and poisoning-related injuries, this article illustrates the utility of an approach that incorporates a social-environmental perspective in identifying and selecting interventions to improve the health and safety of individuals. Injury prevention efforts to prevent home injuries benefit from multilevel modifications of behavior, public policy, laws and enforcement, the environment, consumer products and engineering standards, as demonstrated with Frieden's Health Impact Pyramid. A greater understanding, however, is needed to explain the associations between tiers. While interventions that include modifications of the social environment are being field-tested, much more work needs to be done in measuring social-environmental change and in evaluating these programs to disentangle what works best.
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Affiliation(s)
- Karin A Mack
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Grant Baldwin
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - David Sleet
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Unlu M, Ozturk C, Demirkol S, Balta S, Malek A, Celik T, Iyisoy A. Thrombolytic therapy in a patient with inferolateral myocardial infarction after carbon monoxide poisoning. Hum Exp Toxicol 2015; 35:101-5. [PMID: 25733729 DOI: 10.1177/0960327115577542] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION ST segment elevation myocardial infarction (STEMI) due to coronary artery occlusion caused by intracoronary thrombosis in the setting of acute carbon monoxide (CO) poisoning is a very rare presentation. We present a case of intracoronary large and mobile thrombus formation after CO poisoning. CASE PRESENTATION A previously healthy 50-year-old woman was referred for CO poisoning. She had chest pain after exposure to CO. Her initial mental status was preoccupied with chest pain. Her initial CO fraction was 28.1%, and initial laboratory data showed creatine kinase-myocardial isoenzyme of 134 U/L (upper limit 25 U/L) and troponin I of >50 ng/mL (upper limit 0.06 ng/mL). Electrocardiography was carried out on admission, revealing an ST segment elevation in the inferolateral leads. After initial evaluation, coronary angiography was performed and an intracoronary large mobile thrombus was seen in the proximal left anterior descending (LAD) artery with no significant stenosis. We administered tenecteplase with heparin. After the thrombolytic therapy, ST elevation in the inferolateral leads resolved. Repeat angiography was performed after 24 h; the thrombus in LAD had resolved. The patient was discharged after 5 days, with persistent Q wave in the inferior leads and mild hypokinesia of the inferoposterior wall suggesting myocardial injury. CONCLUSION We describe intracoronary thrombus formation induced by CO poisoning. Because intracoronary thrombus can result in myocardial infarction, its consideration following CO poisoning is important. Patients with CO poisoning who have symptoms of STEMI should be carefully evaluated with serial electrocardiograms, cardiac biomarkers, and an echocardiogram. When there is evidence of acute myocardial injury, a primer in coronary angiography can determine which patients could benefit from intervention.
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Affiliation(s)
- M Unlu
- Department of Cardiology, School of Medicine, Gulhane Military Medical Academy, Etlik-Ankara, Turkey
| | - C Ozturk
- Department of Cardiology, School of Medicine, Gulhane Military Medical Academy, Etlik-Ankara, Turkey
| | - S Demirkol
- Department of Cardiology, School of Medicine, Gulhane Military Medical Academy, Etlik-Ankara, Turkey
| | - S Balta
- Department of Cardiology, School of Medicine, Gulhane Military Medical Academy, Etlik-Ankara, Turkey
| | - A Malek
- Department of Cardiology, School of Medicine, Gulhane Military Medical Academy, Etlik-Ankara, Turkey
| | - T Celik
- Department of Cardiology, School of Medicine, Gulhane Military Medical Academy, Etlik-Ankara, Turkey
| | - A Iyisoy
- Department of Cardiology, School of Medicine, Gulhane Military Medical Academy, Etlik-Ankara, Turkey
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Abstract
Background The aim of this study was to map out some epidemiological aspects of intentional and unintentional injuries among Iranian women of reproductive age using a national registry. Methods Injury data were taken from a national-based injury surveillance system over the period 2000–2002. The study population comprised 31.5% of the population of Iran. Results Of all the 307,064 domestic injuries reported during the years 2000–2002, about 152,600 cases (49.7%) involved women. About half of these women (76,474) were in the reproductive age group. The majority (42.7%) of injuries among women of reproductive age were burn wounds followed by lacerations in 32.6%. Eighty-five percent of suicide cases were poisonings, followed by 11% for suicides by burning. However, 45.2% of burn suicides were fatal, compared with a 0.89% fatality rate for poisonings. Of all female suicide victims, 1029 died, 174 victims became disabled, while the remainder improved or were undergoing therapy when reported. Conclusion Injuries, especially burns, are a major public health problem for women of reproductive age.
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Affiliation(s)
- Zahra Fardiazar
- Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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20
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Abstract
BACKGROUND The national incidence of and risk factors for hospitalized poisonings in renal transplant recipients has not been reported. METHODS Historical cohort study of 39,628 renal transplant recipients in the United States Renal Data System between 1 July 1994 and 30 June 1998. Associations with time to hospitalizations for a primary diagnosis of poisonings (ICD-9 codes 960.x-989.x) within three years after renal transplant were assessed by Cox Regression. RESULTS The incidence of hospitalized poisonings was 2.3 patients per 1000 person years. The most frequent causes of poisonings were immunosuppressive agents (25.3%), analgesics/antipyretics (14.1%), psychotropic agents (10.0%), and insulin/antidiabetic agents (7.1%). In Cox Regression analysis, low body mass index (BMI, <21.6 vs. >28.3 kg/m2, adjusted hazard ratio (AHR), 3.02, 95% CI, 1.45-6.28, and allograft rejection, AHR 1.83, 95% CI, 1.15-2.89, were the only factors independently associated with hospitalized poisonings. Hospitalized poisonings were independently associated with increased mortality (AHR, 1.54, 95% CI 1.22-1.92, p = 0.002). CONCLUSIONS Hospitalized poisonings were associated with increased mortality after renal transplantation. However, almost all reported poisonings in renal transplant recipients were due to the use of prescribed medications. Allograft rejection and low BMI were the only independent risk factors for poisonings identified in this population.
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Affiliation(s)
- Kevin C Abbott
- Nephrology Service, Walter Reed Army Medical Center, Washington, D.C., and Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Rebecca A Viola
- Pharmacy Service, Walter Reed Army Medical Center, Washington, D.C, USA
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