The use of CytoSorb in acute oral mercuric chloride poisoning at a potentially lethal dose

INTRODUCTION

The study aims to present a case of acute mercuric chloride poisoning treated successfully with continuous renal replacement therapy using the CytoSorb filter.

CASE DESCRIPTION

A 21-year-old female patient after a suicide attempt by intentional ingestion of mercuric chloride, was admitted to the hospital with features of multiple organ damage for specific treatment. The performed laboratory tests confirmed high levels of mercury in the blood (1051 μg/L) and urine (22,960 μg/L). Due to acute renal failure, continuous renal replacement therapy (CRRT) CVVHD Ci-Ca was initiated; the procedure was then converted to CVVHDF Ci-Ca with ultrafiltration to optimise therapy, and CytoSorb was added to the artificial kidney system on day 3. Specific antidote therapy (DMPS) was administered concurrently. The ongoing treatment resulted in a reduction in subjective complaints, a decrease in blood mercury levels to 580 μg/L, and an improvement in parenchymal organ function.

CONCLUSION

In the event of poisoning with inorganic mercury compounds (mercuric chloride), continuous renal replacement therapy using the CytoSorb filter as an extracorporeal blood purification method may be considered.

Acute mercuric chloride poisoning at a potentially lethal dose ended with survival: symptoms, concentration in cerebrospinal fluid, treatment

This study aims to present a case of acute mercuric chloride poisoning at a potentially lethal dose treated with the antidote - 2,3-dimercapto- 1-propanesulfonic acid (DMPS) and continuous renal replacement therapy (CRRT) combined with CytoSorb. A 21-year-old woman was admitted to a hospital with abdominal pain, vomiting, and suspected gastrointestinal bleeding after taking 5000 mg of mercuric chloride for suicidal purposes. Due to the patient deteriorating general condition and multiple organ damage, on the third day she was transported to the Clinic of Anaesthesiology and Intensive Care (CAaIC), Łódź, Poland. Laboratory tests confirmed features of acute kidney injury and high mercury levels in the blood (1051 μg/l) and urine (22 960 μg/l) - DMPS therapy and CRRT combined with CytoSorb were instituted. Due to nervous system complaints (headache, dizziness), a lumbosacral puncture was performed - the mercury concentration in the cerebrospinal fluid (CSF) was 5.45 μg/l. During a colonoscopy, significant diagnostic abnormalities revealed features of colonic mucosal necrosis. The treatment resulted in a decrease in subjective complaints, decreased mercury levels in biological material, and improved parenchymal organ function. On the 15th day of therapy, the patient was transferred to the primary care center for further treatment. The case confirms the possibility of improvement of patient condition following ingestion of a potentially lethal dose (5 g) as a result of the initiation of appropriate therapy even on the third day. The presence of mercury in CSF confirms that inorganic mercury compounds (mercuric chloride) can pass through the blood-brain barrier after oral ingestion. Int J Occup Med Environ Health. 2023;36(5):685-92.

Viper envenomation in Central and Southeastern Europe: a multicentre study

INTRODUCTION

Snakebite incidence varies across Europe. However, there is limited research from Central and Southeastern Europe. These regions are notable for the presence of the common European adder (Vipera berus) and the more venomous nose-horned viper (Vipera ammodytes). No standard European antivenom protocol exists. The aim was to assess the epidemiology and treatment of viper bites in this region, focusing on a comparison of bites from Vipera berus and Vipera ammodytes.

METHODS

We conducted a prospective multicenter study in Central and Southeastern Europe from 2018 to 2020. This study included poison centres and toxicology-associated hospital wards in Poland, the Czech Republic, Slovakia, Hungary, Slovenia, Croatia, Serbia, and Bulgaria. The following data were collected: age, gender, Vipera species, snakebite site, clinical picture, laboratory results, Audebert's clinical severity grading score, and antivenom therapy.

RESULTS

The annual incidence of viper bites in Central and Southeast Europe was estimated at 2.55 bites per million population. Within their respective geographical distribution areas, the incidence of Vipera ammodytes bites (1.61 bites per million population) was higher than Vipera berus bites (1.00 bites per million population). Patients bitten by Vipera ammodytes more frequently reported local pain and developed thrombocytopenia. Antivenom treatment was more commonly administered in Vipera ammodytes bites (72%) compared to Vipera berus bites (39%). The incidence of Vipera ammodytes bites treated with antivenom within its geographical distribution area was three times higher than Vipera berus bites treated with antivenom (1.16 bites per million population versus 0.39 bites per million population). No deaths were reported.

CONCLUSIONS

The estimated incidence of viper bites in Central and Southeastern Europe is at least 2.55 per million population. Vipera ammodytes bites are more common and severe, characterized by higher frequencies of pain and thrombocytopenia. Antivenom is needed more often for Vipera ammodytes bites. It is vital that enough European Medicines Agency-approved Vipera ammodytes antivenom is produced and offered affordably.

Lithium batteries safety, wider perspective

Energy production and storage has become a pressing issue in recent decades and its solutions bring new problems. This paper reviews the literature on the human and environmental risks associated with the production, use, and disposal of increasingly common lithium-ion batteries. Popular electronic databases were used for this purpose focused on the period since 2000. Assessment of the toxicological and environmental impact of batteries should then have a holistic scope to precede and guide the introduction of appropriate safety measures. In this short review the authors will try to touch upon this complex subject and point out some important issues related to an unprecedented development of lithium ion batteries-powered world. Given the multi-billion dollar business with the risks associated with the development of new technologies requires careful consideration of whether the balance of profits and losses is beneficial to humans and the planet. Int J Occup Med Environ Health. 2023;36(1):3-20.

YouTube as a source of information on carbon monoxide poisoning: a content-quality analysis

OBJECTIVES

The variety of clinical presentation on the topic of carbon monoxide (CO) intoxication ranges from slight headache to coma or death. YouTube allows patients to search not only for entertainment but also medical advice. Therefore, the aim of this study was to evaluate the content and quality of YouTube videos concerning CO poisoning as a source of knowledge for non-medical audience.

MATERIAL AND METHODS

On the December 8, 2020 a YouTube search was conducted for the following phrases: "carbon monoxide poisoning," "carbon monoxide symptoms," "CO poisoning," "carbon monoxide asphyxiation," "carbon monoxide intoxication" using the "incognito mode" and without attachment to Google Account. The search results were set as: "default" in the YouTube browser. The first 50 results were taken into consideration. Two raters, a specialist in emergency medicine and a specialist in clinical toxicology rated videos with Quality Criteria for Consumer Health Information (DISCERN), Global Quality Score (GQS) and Journal of the American Medical Association (JAMA). "VidIQ Vision for YouTube" plug-in was used.

RESULTS

Ninety-five videos were included. The interclass coefficient for DISCERN, GQS and JAMA scores were: 0.8, 0.74 and 0.62 reaching good and moderate reliability. The mean DISCERN/GQS/JAMA was 28.1 (SD 7.9), 2.5 (SD 0.8) and 1.1 (SD 0.7) respectively. Higher DISCERN/GQS/JAMA had videos providing information on: exposure time, treatment options, hyperbaric chamber indications as well as physician speaker (p < 0.05). Video Power Index was higher when the video contained animations and presented patients own history of CO exposure but not influenced the DISCERN/ GQS/JAMA scores. Videos providing misleading information had a higher like ratio.

CONCLUSIONS

The overall video quality was poor indicating inappropriate educational and informative value for patients who search information about carbon monoxide poisoning. Int J Occup Med Environ Health. 2022;35(3):285-95.

OBESITY AND ATRIAL FIBRILLATION - BARIATRIC SURGERY AS A METHOD OF AF RISK DECREASE

The prevalence of obesity is growing at alarming rate worldwide. Obesity has reached the proportion of a global epidemic in both developed and developing countries. Growing number of obese patients with atrial fibrillation requires a closer look at how excessive body fat leads to AF. Excessive adipose tissue is the source of many cardiovascular diseases, like hypertension, ischemic heart disease, and arrhythmias such as atrial fibrillation. The prevalence of atrial fibrillation in the general population is estimated at 1-2%. Obesity and overweight occur in 25% of patients with AF. Pathophysiology of obesity and the relationship between atrial fibrillation, diabetes, obstructive sleep apnea and metabolicsyndrome are presented in this article as well as the benefit of bariatric surgery in qualifying patients. Paroxysmal AF and its risk factors should be carefully assessed in all patients referred for bariatric surgery. Proper diagnosis allows physicians to introduce appropriate anticoagulant prophylaxis, and significantly lower complication rate. Antiarrhythmic, respiratory, and metabolic therapy should also be considered in preoperative and postoperative care.

Predictors of stress among emergency medical personnel during the COVID-19 pandemic

OBJECTIVES

The COVID-19 pandemic has forced emergency services to implement new standards of practice around the world. The dynamic and unpredictable nature of many clinical situations has placed emergency service personnel in direct danger of contracting the disease. This work uses a validated survey developed for the study to assess the predictors of stress that paramedics, nurses and doctors experience in the face of the COVID-19 pandemic.

MATERIAL AND METHODS

The study group included 955 medical staff, and the level of significance adopted for statistical analysis was p = 0.05. Non-parametric Mann-Whitney and Kruskal-Wallis tests were used to analyze the qualitative variables divided into groups. The selection of tests was carried out based on the distribution of variables, verified using the Shapiro-Wilk test. In order to determine the predictors that caused the feelings of stress, it was necessary to use the linear regression model.

RESULTS

During the COVID-19 pandemic, stress among emergency medical personnel has increased considerably due to new factors that did not previously exist. The predictors of stress in the professional environment include the fear of contracting COVID-19, a decrease in the level of safety while conducting emergency medical procedures, and the marginalization of treatment for patients not suffering from COVID-19. Additional socio-demographic factors that increase stress among emergency medical personnel are being female and working in the nursing profession. Appropriate training, the supply of personal protective equipment and opinions on the preparedness of the system to deal with the outbreak of the pandemic did not affect the level of stress among health service personnel.

CONCLUSIONS

The factors that can be considered to act as predictors of occupational stress include the fear of contracting COVID-19, a decrease in the level of safety and security while conducting emergency medical procedures, and the marginalization of patients not suffering from COVID-19. Int J Occup Med Environ Health. 2021;34(2):139-49.

Clinical pattern of poisoning among patients declared as taking novel recreational drugs

OBJECTIVES

Intoxication with novel psychoactive drugs poses a significant challenge for medicine due to diagnostic difficulties, complex clinical patterns resulting from the polyethiology of poisoning, and the risk of fatal complications.

MATERIAL AND METHODS

The authors of the present work have made a retrospective review of medical records of the patients hospitalized at the Toxicology Unit (TU), diagnosed with poisoning by novel recreational drugs.

RESULTS

In 2008-2013, 576 patients diagnosed with that type of poisoning were admitted to the TU. Of those, 192 (33.3%) patients were positive for ethanol in addition to the most popular toxins found in the material collected from the patients, such as tetrahydrocannabinol (50 [8.6%] patients) and amphetamine (35 [6.1%] patients). The most frequent clinical symptoms observed on admission were: anxiety (433 [75.1%] patients), agitation (275 [47.7%] patients), and complaints associated with the circulatory system (225 [39.1%] patients). In the subgroup of 104 (18.0%) psychiatrist-interviewed people, a relationship was found between the suicidal ideation reported during history-taking and the following factors: earlier psychiatric treatment (p = 0.000), financial problems (p = 0.015) and prolonged unemployment (p = 0.022).

CONCLUSIONS

The observed clinical pattern may be associated with sympathomimetic syndrome due to poisoning by novel psychoactive substances. Preliminary results of this research show that financial problems and a history of psychiatric treatment may enhance suicidal ideation in patients after acute poisoning by psychoactive substances. Int J Occup Med Environ Health. 2020;33(4):445-55.

Acute intentional poisonings within an urban agglomeration in Poland in 2004-2013

OBJECTIVES

The aim of the research was to analyze the nature of changes and tendencies observed in the frequency, circumstances and causes of acute intentional poisonings within the agglomeration of Łódź, Poland. The study related to adults.

MATERIAL AND METHODS

As the research material, medical records of patients hospitalized due to an acute poisoning in the Department of Toxicology in Łódź were used. Information on the hospitalized patients was gathered in the database created in accordance with the assumed criteria and an approved system of the collection of variables describing the issues of intentional acute poisonings.

RESULTS

In the analyzed period, within the group of 18 918 adult patients hospitalized due to an acute poisoning, male patients prevailed, accounting for 57.17% of the whole group. Intentional poisonings constituted 40.19% of all poisonings, with women dominating within that group of patients - accounting for approximately 58.63%. The largest group was formed by young people, 18-35 years old, accounting for 43.22%. The average age of the intentionally poisoned patients showed an upward tendency; this tendency concerned women to a larger extent. Medications played the most powerful role in acute intentional poisonings. Within the whole population, they were responsible for 97.27% of intoxications. The analysis of the dynamics of changes in the percentage of patients referred for further mental treatment revealed that the number of patients continuing hospital treatment in psychiatric wards tended to grow.

CONCLUSIONS

Observations indicating that women are more likely to attempt intentional poisoning, and that the number of patients with psychiatric disturbances tended to grow in the analyzed period, demonstrate an urgent need for preventive measures to be taken in the local communities. Int J Occup Med Environ Health. 2020;33(1):77-90.

Pesticide poisonings in 2004-2014 in Łódź, Poland - an analysis of selected clinical and sociodemographic parameters

BACKGROUND

Acute pesticide poisonings constitute an important toxicological problem in numerous countries. This report refers to patients treated for poisonings at the Toxicology Unit, Łódź, Poland, in the period 2004-2014.

MATERIAL AND METHODS

Data to be analyzed were obtained from medical records of hospitalized people. A group of 24 301 patients aged ≥ 15 were selected. In the group of 149 people poisoned with pesticides (0.61% of all poisoning cases), there were 40 women and 109 men. Logistic regression analysis was used to evaluate the impact of age on suicide attempts using pesticides.

RESULTS

Suicide attempts significantly more frequently concerned younger people. In this type of behavior, coumarin derivatives were significantly more often used than organophosphorus compounds or pesticides classified as "others." The patients with suicidal pesticide poisonings stayed in the ward significantly longer than those poisoned unintentionally.

CONCLUSIONS

In the analyzed population inhabiting an area with a high degree of urbanization, in terms of the place of residence and employment, pesticide poisonings were more common in men than in women. Suicide attempts using pesticides more frequently concerned younger people. Information found in this study may prove useful for education purposes, and also in informing clinicians. Med Pr. 2019;70(6):655-67.

Straight and crosier‑shaped catheter techniques for phrenic nerve stimulation during cryoballoon pulmonary vein isolation for the treatment of atrial fibrillation

BACKGROUND

Cryoablation is an effective and safe method of pulmonary vein isolation (PVI) for the treatment of atrial fibrillation (AF). However, monitoring of phrenic nerve function during cryoballoon PVI remains an important issue.

AIMS

We aimed to compare 2 techniques of phrenic nerve stimulation (PNS) with the use of either a straight or a crosier‑shaped decapolar deflectable catheter.

METHODS

The study included 218 patients (mean [SD] age, 61.8 [10.9] years; 87 women) referred for cryoballoon PVI for AF. Patients were randomly assigned to PNS with either a straight or a crosier‑shaped catheter.

RESULTS

The groups did not differ in demographic characteristics or PVI effectiveness. The current threshold during PNS was lower in the group in which the crosier‑shaped catheter was applied (mean [SD], 6.7 [4.9] mA vs 4.8 [3.7] mA; P <0.01). In this group, the procedure time was shorter (mean [SD], 72.6 [22.8] min vs 64.4 [14.8] min; P <0.01), fewer repositioning maneuvers were required (31.8% vs 19.4%; P <0.05), and atrial capture during PNS was observed more frequently (11.5% vs 29.6%; P <0.01).

CONCLUSIONS

Straight and crosier‑shaped catheter techniques are equally effective in monitoring for phrenic nerve palsy. The crosier‑shaped catheter maintains its position better, thus leading to fewer dislocations and requiring fewer correction maneuvers, which might correlate with shorter procedure time. Moreover, this technique provides lower pacing thresholds. Both techniques may be safely used in patients with AF, and if stable phrenic nerve capture cannot be achieved, switching to another technique seems reasonable.

The right of a doctor to inform an employer of contraindications to perform a certain type of work by an employee

BACKGROUND

The aim of this study is to analyze the legal regulations that pertain to the duty of doctor-patient privilege and the possibility of its repeal on the plane to provide information about the patient’s health status to his employer.

MATERIAL AND METHODS

The material constitutes the current Polish law regulations relating to the medical duty of doctor–patient privilege as well as provisions defining the scope of information on the patient’s health status that may be transferred to a patient’s employer.

RESULTS

The doctor has no right to provide the employer with information on contraindications to perform a specific job, if the information was obtained in the mode of providing health services that are not eligible for the catalogue of preliminary/preventive/control examinations. The basis for the doctor providing information to the employer cannot be an exception to the obligation of medical confidentiality, which is governed by art. 40 § 2 pts 1–6 of the Act of Medical Profession, under which cases of admission of professional secrecy were listed, which makes it impossible to use the cited article in cases other than strictly specified in its content.

CONCLUSIONS

Polish law specifies the circumstances in which it is possible to provide an employer with the medical information on the patient’s health. However, there are regulations that provide for the information on contraindications to perform a certain type of work or job to be transmitted if the information has been obtained in a manner other than as provided in the ordinance on medical examinations of employees. Med Pr 2018;69(6):613–620

Poisonings in Poland reported to the Polish National Health Fund in the years 2009-2011

BACKGROUND

Poisonings constitute a significant medical, social and economic problem worldwide. In Poland there is no nationwide registry of poisonings, which results in a lack of accurate epidemiological data. Few publications dealing with the problem are based on data obtained from toxicology units and therefore do not include information about cases treated at emergency departments and other non-toxicology units.

METHODS

We analyzed all admissions due to poisonings reported to the Polish National Health Fund by all hospital units in Poland in the 2009-2011 period. Diagnoses were encoded according to the ICD-10 classification.

RESULTS

A total of 254,425 admissions were reported, 85,398 in 2009, 85,230 in 2010 and 83,797 in 2011. The male to female ratios were 1.88, 1.75 and 1.80 respectively. The most frequent causes of admissions were poisonings with ethanol (n = 121,874; 47.9%), carbon monoxide (n = 17,179; 6.8%) and benzodiazepines (n = 10,340; 4.1%). Alcohols were the reason for 104,680 admissions in men (63.2%) and 22,612 admissions in women (25.5%; p < 0.01). Poisonings with pharmaceuticals and other drugs were reported in 34,616 men (20.9%) and 45,238 women (51%; p < 0.01). There were 1680 cases of fatal poisonings in the analyzed period. The hospital mortality due to poisonings increased from 1.1% in 2009 to 1.5% in 2011 (p < 0.01). The mortality in general Intensive Care Units increased from 14.4% in 2009 to 22.3% in 2011 (p < 0.01). The etiology of fatal poisonings was highly dependent on the type of hospital unit.

CONCLUSIONS

The overall number of admissions due to poisonings decreased slightly during the study period, but they remained a significant cause of morbidity and mortality. Alcohols were the main cause of admissions in the analyzed period. Alcohol intoxications were more frequent in men while poisonings with pharmaceuticals were more frequent in women. Carbon monoxide exposures were a significant cause of morbidity and mortality in the studied period in Poland. A national poison information and toxicovigilance system should be created in Poland, ideally allowing for near real-time monitoring of cases of poisonings.

Legal grounds for 'extending the scope or type of procedure'

INTRODUCTION

The development of patient rights and increasing number of lawsuits based on medical malpractice make medical doctors constantly improve knowledge regarding the acceptability of changing the scope of operation. This is particularly important when patients have expressed their refusal to changing the scope and type of procedure (ESTP) or no informed consent (IC) has been obtained from the patient prior to the procedure.

MATERIAL AND METHODS

The method of study comprised content analysis of existing legislation. The current jurisprudence and doctrine were confronted with existing regulations. An algorithm of correct formal procedures was elaborated.

RESULTS

The doctor has right to realize ESTP when the patient has not given the consent to it or the refusal expressed by him was not fully conscious. Healthcare providers are absolutely prohibited from realizing ESTP when patient objected to any changes being thoroughly informed by the physician prior to the operation. When patient refuses possible ESTP, the doctor has the right to withdraw from performing surgery but should inform the patient about other places, where a similar procedure can be provided.

[Accidental severe poisoning with methemoglobinogenic substance: A case report]

A 45-year-old male patient was admitted to the Regional Poison Center because of poisoning with dimethyloaniline contained in a toxic resin-curing dimethyl aniline-based formulation ingested inadvertently. Intoxication happened at workplace. The patient was then transferred to the Toxicology Clinic, where he stayed for 3 weeks. During the hospitalization, the primary method of treatment involved administration of methylene blue, which is the antidote of choice in such cases. During the intensive care and treatment of the patient massive intravascular hemolysis was seen. In that case treatment with blood products was required. He also showed signs of liver dysfunction due to cholestatic liver damage and jaundice. The reported case shows that severe organ damage may result from poisoning with even a small amount of the toxicant. Med Pr 2017;68(6):795-801.

Poisoning deaths in Poland: Types and frequencies reported in Łódź, Kraków, Sosnowiec, Gdańsk, Wrocław and Poznań during 2009-2013

OBJECTIVES

The aim of this study has been to assess the characteristics of acute poisoning deaths in Poland over a period of time 2009-2013.

MATERIAL AND METHODS

The analysis was based on the data obtained from the patient records stored in toxicology departments in 6 cities - Łódź, Kraków, Sosnowiec, Gdańsk, Wrocław and Poznań. Toxicological analyses were routinely performed in blood and/or urine. Major toxic substances were classified to one of the following categories: pharmaceuticals, alcohol group poisonings (ethanol and other alcohols), gases, solvents, drugs of abuse, pesticides, metals, mushrooms, others. Cases were analyzed according to the following criteria: year, age and gender of analyzed patients, toxic substance category and type of poisoning. The recorded fatal poisonings were classified according to the International Classification of Diseases.

RESULTS

The record of 261 deaths were retrospectively reviewed. There were 187 males (71.64%) and 74 females (28.36%) and the male to female ratio was 2.52. Alcohol group poisonings were more frequently responsible for deaths in men compared to all poisonings, 91.1% vs. 71.6%, respectively (p < 0.05), and pharmaceutical agents were more frequently responsible for deaths in women, 47.4% vs. 28.4%, (p < 0.05). Methanol was the most common agent in the alcohol group poisonings, accounting for 43.75% (N = 49), followed by ethylene glycol, 39.29% (N = 44), and ethanol, 16.96% (N = 19).

CONCLUSIONS

Epidemiological profile data from investigation of poisoning deaths in Poland may be very useful for the development of preventive programs. Int J Occup Med Environ Health 2017;30(6):897-908.

High-mobility group box 1 protein levels in serum of subjects after exposure to fire smoke--short communication

INTRODUCTION

Fire smoke inhalation a recognized etiologic factor of airway injuries. The objective of this study was evaluation of serum high-mobility group box 1 (HMGB1) protein concentration in subjects exposed to fire smoke (SEFS).

MATERIAL AND METHODS

The study group consisted of 40 consecutive patients admitted to the Toxicology Unit, Lodz, Poland after exposure to fire smoke. Serum HMGB1 concentrations were measured upon admission to hospital and rechecked on the 2nd and on the day of discharge. Patients also underwent routine toxicological diagnostic procedures applied in case of those exposures, such as carboxyhaemoglobin (COHb) levels and urinary thiocyanate concentrations. The same diagnostic tests were performed in 10 healthy volunteers not exposed to smoke of the control group.

RESULTS

The average serum SEFS concentration of HMGB1 protein was not significantly higher on admission in comparison with the respective values recorded on the 2nd day and on the day of discharge. The mean serum level of HMGB1 protein of exposed group was higher than that one in the control group, however the difference was not statistically significant. The highest concentration of HMGB1 protein was noted in serum of 28 subjects exposed to fire smoke reporting at least one symptom and the difference was statistically significant in a comparison with the control group.

CONCLUSION

As indicated, an acute exposure to smoke may lead to transient increase of HMGB1 in serum in exposed subjects. Further studies are necessary in order to confirm the importance of this protein in pathogenesis of acute airway injury due to exposure to fire smoke.

Intentional poisoning among elderly people-residents of a large urban agglomeration in Poland

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.

[Acute alcohol poisonings among patients in Toxicology Unit, Nofer Institute of Occupational Medicine in the period of time 2007-2012]

The purpose of the research was to present the analysis of acute alcohol poisonings (ethanol, methanol, ethylene glycol, isopropanol) in Toxicology Unit (TU), Nofer Institute of Occupational Medicine (NIOM), Lódź, Poland.

MATERIALS AND METHODS

To further analysis were chosen all cases, whose were coded according to the International Statistical Classification of Diseases and Related Health Problems 10th Revision.

RESULTS

There were 10,936 acute poisonings in the analyzed period of time 2007-2012 years, 3,088 of them referred to alcohol poisonings (28%). The largest group of patients included cases with ethanol intoxication (2,883 subjects), the second and third one-cases with methanol and ethylene glycol poisonings (99 and 98 respectively), 8 cases were poisoned with isopropanol. The largest group of patients includes cases at age less than 30 years. Patients at age above 60 years formed the lowest group among the total number of poisonings. Most of the admitted cases were men (2,417 patients) and cases hospitalized due to ethanol abuseladdiction (93%). Ethylene glycol poisonings constituted the leading cause of deaths (10 subjects).

CONCLUSIONS

The study shows, that intoxications with alcohols are a big problem in NIOM and the number of alcohol poisonings markedly increased in the years 2007-2012.

[Pulmonary tuberculosis of occupational origin in a funeral director: a case report]

In Poland the incidence rate of tuberculosis is higher than the average for countries of the European Union, Norway or Iceland. On the other hand, occupational tuberculosis is still rarely recognized in our country. In this paper we present the first in Poland--to our best knowledge--case of pulmonary manifestation of this disease acquired at work in a funeral director. The recognition of the occupational etiology of the discussed illness gave rise to an array of diagnostic problems and became feasible after a thorough analysis of the patient's history and literature data, which allowed finding the relationship between infection and performed job. We speculated that the transfer of the dead body and handling of cadavers may expel residual air from the lungs of the deceased. Although tuberculosis occurs frequently in the general population, the recognition of work-related cases of this disease is still rare, especially among funeral directors.

Should a doctor stop rendering medical services? Principles of conduct towards patients attempting to commit suicide. Part 1 -- the Polish perspective

INTRODUCTION

According to the general idea a doctor can start the medical management process in an adult and not legally incapacitated patient after the patient has given consent to initiate such a process. The patient's refusal makes rendering medical services impossible, irrespective of their scope and kind. It should be emphasized that such a refusal is respected if it is expressed fully, clearly and consciously. Cases in which such a refusal is expressed by an intoxicated suicidal patient, remaining under the influence of narcotics, drugs or medicaments which characterize with a similar activity should be particularly analysed. Although such a person is able to verbally declare his objection, his ability to process the information given by the doctor before initiating medical procedures is limited, or even non-existant. The refusal therefore cannot be regarded as reliable, which results in rendering medical services to the patient.

MATERIALS AND METHODS

An analysis was made of Acts of Law and the opinions of the judiciar by comparing and excluding contradictory and incoherent elements.

RESULTS

Despite the lack of clear regulations of a patient rejecting procedures aimed at saving the patient's life, or the prevention of serious health impairment or sustaining injury, it should be assumed that the objection expressed by the patient who does not demonstrate the ability to process the information provided by the doctor is not reliable, and the doctor is therefore still obliged to render medical services. External factors, such as consumption of alcohol, narcotics and drugs, which characterize with a similar activity impair perception and make the taking of a conscious decision impossible. Not providing medical help and introducing direct compulsion would mean neglecting provision of due diligence in the process of treatment and, as a consequence, placing the patient's health at risk, and suffering from negative implications for the patient's life and/or health in the future.

CONCLUSIONS

Current provisions should directly regulate the negligence of respecting a refusal expressed 'unconsciously' by a patient who remains under the influence of alcohol, narcotics, drugs or medicaments which characterize with a similar activity. Moreover, apart from legal provisions, the law providers should consider introducing a direct compulsion in patients who are unable to make a conscious decision in the treatment process.

[Acute ethylene glycol poisoning among patients of Nofer Institute of Occupational Medicine in Łódź, Toxicology Unit, hospitalized in the years 2000-2009]

Acute poisonings with ethylene glycol pose real challenge in the clinical toxicology. The main objective of this study is an analysis of clinical features and identification of prognostic factors in poisoning with ethylene glycol of patients hospitalized in the Toxicology Unit in the years 2000-2009. The medical records of the patients were identified and separated. In the years 2000-2009, 102 patients were hospitalized due to ethylene glycol poisoning, what accounted for 0.38% of total admissions to the unit (26.801 hospitalized people). The mean age of patients amounted 48.05 +/- 12.55 years, the history positive for chronic alcohol abuse was present in 63 (61.76%) cases. Mean values of ethylene glycol concentration were as: in serum 173.14 mg/dl, in urine 6576.46 mg/l. Patients condition on admission varied, with 63 (61.76%) cases described as the severe state. The most frequently noted pathologies were consciousness disturbances and tachycardia. 14 patients died within the analysed group and 63 (61.76%) developed single or multiorgan complications in the course of disease. The most commonly encountered complication were: acute renal failure, anaemia, pneumonia and central nervous system damage. Such parameters as: BE and HCO3 measured on admission should be considered as the prognostic factors, determining the course of the disease and the outcomes of treatment. Poor prognosis may be associated with such clinical features on admission, as: respiratory and circulatory disturbances and cerebral sequelae. The importance of acute poisoning of ethylene glycol is determined both by high frequency of immediate life threatening conditions and by the risk of complications leading to permanent organs damage.

[Acute novel drugs poisoning among patients of Nofer Institute of Occupational Medicine in Lodz, Toxicology Unit, hospitalized in the years 2008-2012--epidemiology, clinical state]

Intoxication with novel recreational drugs poses significant challenge for medical staff due to diagnostic difficulties, complex clinical pattern, resulting from polyethiology of poisoning and potential risk of life threatening complications.

OBJECTIVES

Description of clinical pattern novel drug intoxication.

METHODS

retrospective review of medical records patients hospitalized in the Toxicology Unit (TU) with diagnosis of intoxication with novel recreational drugs.

RESULTS

During the period from 2008-2010--431 patients were admitted to TU with mentioned above diagnosis. 159 (36.9%) patients were positive for ethanol with its average concentration in blood 150 mg%. Presence of other substances like amphetamine, cannabinoids, atropine, ephedrine, carbamazepine, benzodiazepines and dextrometorphan was confirmed. The most frequent clinical symptoms observed on admission were: anxiety, agitation, complaints associated with circulatory system and vertigo Average pulse rate and both: diastolic and systolic pressure were within normal limits, however authors noted slight tendency toward tachycardia. One patients died due to multiorgan failure. Average period of hospitalization amounted 2.24 days. Co-poisoning with ethanol was associated with higher frequency of circulatory system disturbances.

RESULTS

Clinical pattern of poisoning with novel drugs could partially correspond with mild sympathomime. tic syndrome.

[Epidemiology of acute poisonings during 2002-2011 in Toxicology Unit; Department of Occupational Medicine and Toxicology, Nofer Institute of Occupational Medicine, Lodz, Poland]

INTRODUCTION

Intoxication poses significant challenge for medical staff due to diagnostic difficulties, complex clinical pattern, resulting from polyethiology of poisoning and potential risk of life threatening complications.

OBJECTIVES

the epidemiology of acute poisonings, observed in Toxicology Unit (TU) in Lodz during the period 2002-201--is the main objective of the study. Authors present their frequency and associated mortality and discuss the structure of poisonings with regard to type and causative agents.

MATERIALS

The data used for analysis were drawn from National Poison Information Center in Lodz. They were divided into two groups. The first one comprised informations about patients treated in TU, whereas the second one included cases treated in other hospitals and only consulted by TU staff.

RESULTS

Analysis of obtained data showed that medications overdose was the most frequent cause of hospitalization during 2002-2011. Patients between 15 and 30 years constituted the largest group in comparison with total number of poisonings. Medications, alcohols and gases constituted also the leading cause of deaths due to poisoning during the analysed period. Suicidal poisonings composed the largest group in 2002 and 2003 y respectively, whereas poisonings caused by abuse or abuse in the course of dependence were the most frequent in subsequent years.

[The problem of re-confirming the driving licence in the practice of the clinical department]

BACKGROUND

The standpoint published by the National Consultant in the Field of Occupational Medicine obliges physicians to send, to institutions responsible for traffic safety, the information on individuals who, for medical reasons, should not be permitted to drive motor vehicles. This situation is a source of a conflict: on the one hand the medical profession is a profession of public trust; on the other the doctor, when performing his/her official duties, is obliged to safeguard the wellbeing of the general population and, therefore, is expected to take suitable measures (including administrative) if he/she is in the possession of an information that something or someone may offer a threat to traffic safety.

MATERIAL AND METHODS

On the basis of the existing legal regulations as well as author's own experiences, it has been attempted to standardize clinical and certifying procedures to be used in cases when an individual (a driver candidate or a current driver) is reasonably suspected to be encumbered with a characteristic that precludes him/her from being granted permission to drive motor vehicles.

RESULTS

The authors of this publication developed and then implemented a standard clinical test procedure to be applied in circumstances as those described above. A statistical analysis of the implemented algorithm based on clinical cases hospitalized in 2008-2010 at the Nofer Institute of Occupational Medicine, Department of Occupational Diseases and Toxicology, Toxicology Unit (DODTTU) has been also performed.

CONCLUSIONS

This paper reports the first attempt to implement, in a hospital ward, the algorithm intended to ensure comprehensive and honest procedure to be applied when institution responsible for issue and/ or re-confirming of driving licenses must be notified by a hospital ward worker to the concerned institution that the examined patient should not, for medical reasons, be permitted to

[Intoxication or false-positive acetaminophen result of toxicological determinations? Two case reports]

The aim of this study was to show the diagnostic procedure used in the two cases with false-positive serum acetaminophen results in suspected acetaminophen poisoning. The determination of serum acetaminophen were carried out using a UV/VIS spectrophotometer (Specord 40 Analytik Jena), coupled with an analytic computer station WinASPECT. The employed method of determination was based on the acetaminophen reaction with sodium nitrite, which yields yellow colour of solution in the presence of sodium hydrate. The intensity of the yellow colour depends on the concentration of acetaminophen in serum. The relationship between absorbance and concentration was linear at concentrations in the range 50-600 microg/mL, with relative standard deviation of +/- 2.1% and detection limit of 30 microg/mL. To confirm or reject the doubtful results of colorimetric assays, the serums of patients were measured with high performance liquid chromatography with mass spectrometry detection and gas chromatography with mass spectrometry detection. The analysis of presented cases leads to a conclusion that acetaminophen results should be confirmed either by scanning urine for p-aminophenol presence (which is a routine procedure in our laboratory) or by using a different method of measuring acetaminophen serum levels.

Clara Cell protein and myeloperoxidase levels in serum of subjects after exposure to fire smoke

INTRODUCTION

Fire smoke inhalation is a well-recognized aetiological factor of airway injuries. The objective of this study was evaluation of Clara cell protein (CC16) and myeloperoxidase (MPO) concentrations in serum of patients after exposure to uncontrolled fire smoke.

METHODS

The study group consisted of 40 consecutive patients admitted to the Toxicology Unit after exposure to fire smoke. CC16 and MPO concentrations in their serum samples was measured on the day of admission to hospital and rechecked at the 2nd day and on the day of discharge. Patients also underwent routine toxicological diagnostic procedures applied in case of exposures, such as carboxyhaemoglobin (COHb) levels and blood lactate and urinary thiocyanate concentrations. The same diagnostic tests were performed in the control group consisting of 10 healthy subjects not exposed to fire smoke.

RESULTS

The average concentration of CC16 in the serum of subjects exposed to toxic factors was significantly higher at the day of admission in comparison with the respective values recorded on the 2nd day and on the day of discharge. The mean level of CC16 in the serum of the exposed group was also significantly higher than that in the control group. Tests for MPO concentrations in the serum did not reveal any significant changes in patients exposed to fire smoke.

CONCLUSIONS

As indicated, acute exposure to smoke induces injury at the alveolar level, which results in a transient increase of CC16 in serum of exposed subjects.

[Metformin poisoning--clinical features, diagnostics and treatment--case presentations]

Metformin has been used for many years as oral anti-hyperglycaemic agent in the treatment of type 2 diabetes mellitus either in Poland or in the world. Metformin is the most commonly prescribed agent, but acute poisonings of this agent are rare. A review of our experience indicates, that poisoning with this agent may lead to life-threatening or fatal metformin toxicity. The authors of this publication postulate, that each patient with metformin exposure should be hospitalized. Physician must be vigilant to recognize anti-hyperglycaemic agent poisonings like biguanides when hypoglycaemia and acidosis are present in laboratory results. We present patients with metformin toxicity, some of them with fatal course.

[Kidney transplants from donors burdened metabolic acidosis in the course of poisoning with methanol and carbon monoxide]

The question of obtaining organs from donors who died of methanol poisoning has been discussed in the medical literature for many years. The results of such transplants published so far are very optimistic. However, the possibility of permanent and significant injury to transplanted organs caused by poisons or its metabolites raises serious concerns regarding the procedure. The long-term effects of intensive treatment of poisoning need to be considered as well. Metabolic acidosis and high blood osmolality are agents with recognized damaging potential impairing organ function at cellular level. The study traced the fate of kidney transplants from 13 donors who died of methanol poisoning and one isoned with carbon monoxide. The donors group consisted of 12 men and 2 women, of mean age 49 years (SD +/- 7.93). The kidneys were transplanted 20 men and 8 women. The mean age of recipients was 50.29 years (SD +/- 12.9). At the time of admission to the Department of Toxicology all donors presented with profound metabolic acidosis and high plasma osmolality (mean 434.71 mOsm/kg H2O (SD +/- 73.29). Metabolic acidosis was treated high doses of sodium bicarbonate (mean infusion volume of was 409 ml) before the HD procedure. Blood methanol levels were between 125 and 470 mg% (mean 317.23 SD +/- 136.83). The carboxyhaemoglobin concentration of in the donor poisoned with carbon monoxide was 47.2%. Transplantation was performed after confirmation of the brain death, the period of cold ischemia (CIT) ranged from 6 to 22 hours (mean 16.06 hours; SD +/- 3.99). Kidneys have taken function immediately after transplantation in 21 recipients. In seven cases, patients required two or three HD procedures. A total of 16 dialysis were performed post-transplants. In the group of patients, the mean glomerular filtration rate (GFR) at 3 months after transplantation was 46.71 ml/min/1.73m2 (SD +/- 10.89). During the 18 months follow-up a constant upward trend to the mean GFR 50.55 was noticed. In the group of donors, the mean blood urea concentration (BUN) 3 months after transplantation was 61.43 mg/dL, including 7 patients with BUN within the range of 80-100 mg/dL. At 18 months post transplant, the average concentration was 42.36 mg/dL, with no cases exceeding 55 mg/dL. Similarly, serum creatinine level normalized with the mean value of 3.01 mg/dL at 3 months and 1.68 mg/dL at 18 months post the procedure. There was no case exceeding 2 mg/dL. One recipient died of a heart attack after a period of more than 18 months after transplantation. However, the transplant was efficiently active at all times (GFR 56-60 ml).

Clara Cell Protein and Myeloperoxidase Levels in Serum of Subjects after Exposure to Fire Smoke

Introduction: Fire smoke inhalation is a well-recognized aetiological factor of airway injuries. The objective of this study was evaluation of Clara cell protein (CC16) and myeloperoxidase (MPO) concentrations in serum of patients after exposure to uncontrolled fire smoke. Methods: The study group consisted of 40 consecutive patients admitted to the Toxicology Unit after exposure to fire smoke. CC16 and MPO concentrations in their serum samples was measured on the day of admission to hospital and rechecked at the 2nd day and on the day of discharge. Patients also underwent routine toxicological diagnostic procedures applied in case of exposures, such as carboxyhaemoglobin (COHb) levels and blood lactate and urinary thiocyanate concentrations. The same diagnostic tests were performed in the control group consisting of 10 healthy subjects not exposed to fire smoke. Results: The average concentration of CC16 in the serum of subjects exposed to toxic factors was significantly higher at the day of admission in comparison with the respective values recorded on the 2nd day and on the day of discharge. The mean level of CC16 in the serum of the exposed group was also significantly higher than that in the control group. Tests for MPO concentrations in the serum did not reveal any significant changes in patients exposed to fire smoke. Conclusions: As indicated, acute exposure to smoke induces injury at the alveolar level, which results in a transient increase of CC16 in serum of exposed subjects.

[Suicidal intoxication with digoxin--still actual problem in clinical toxicology--case report]

We present case a male patient who attempted suicide by ingestion of 90 tablets of digoxin in total dose of 22.5 mg. A measured peak level of digoxin was 6,75 ng/ml. Temporary invasive cardiac pacing with single chamber ventricular pacer was performed for treatment of the life-threatening rhythm and conduction disturbances that revealed within few hours after admission. According to the authors, presented method of therapy should always be taken into consideration in case development of cardiovascular disturbances in acute poisoning with digoxin.

[Acute methanol poisoning among patients of Toxicology Unit, Nofer Institute of Occupational Medicine in Łódź, during the period 2000-2009]

The main objective of this study was an analysis of the cohort of patients hospitalized due to intoxication with this agent during the period 2000-2009 and investigate factors, which determined the course of poisoning. During the search process, 288 (1.07%) patients were identified within total number of 26801 patients hospitalized. Within analysed cohort male patients formed majority with 227 males, whereas only 61 females were found within this group. The mean methanol blood concentration was 50.09 mg/dl and ethanol - 292.90 mg/dl. Patients condition on admission varied, the most frequently noted pathologies were consciousseness disturbances and tachycardia, namely the former was recorded in 171 cases (59.4%) whereas the latter in 89 patients (30.90%). 11 patients died within the analysed group and 72 developed single or multiorgan complications in the course of poisoning. The most commonly encountered complication was pneumonia. Features of central nervous system (CNS) damage were found in 20 cases (6.94%). Average concentrations of methanol in the group of the 11 deceased patients were: 158.73 mg/ dl, 20.91 mg/dl for ethanol. The average values of arterial blood gases parameters in this group were pH= 6.98; BE=(-) 22.482; HCO3=9.67 mmol/l. Within the non survivors group such complications as CNS damage, seizures, pneumonia, liver injury and pancreatitis were noted more frequently, with statistical significance. The concentrations of methanol and ethanol in the blood on admission and such ABG parameters as pH, BE, HCO3, pCO2 i pO2 also measured on admission should be considered as the prognostic factors, determining the course of the disease and the outcomes of treatment. Poor prognosis may be associated with such clinical features on admission, as: respiratory and circulatory disturbances and cerebral sequelae.

[Acute poisonings with carbon monoxide among the patients hospitalized in the Toxicology Unit during the period of 2006-2010]

Acute poisonings with carbon monoxide pose real challenge in the clinical toxicology. Its importance is determined both by high frequency of immediate life threatening conditions and by the risk of complications leading to permanent organs damage. The main objective of this study is an identification of prognostic factors on the base of analysis the cohort of patients hospitalized due to intoxication with these agents in the Toxicology Unit during the period 2006-2010. During the search process 571 patients hospitalized due to carbon monoxide poisoning during the period 2006-2010 were identified within total number of 21 400 subjects hospitalized during studied period. Therefore intoxications with carbon monoxide accounted for 2.66% of total admissions to the unit. The main sources of exposure were faulty gas heaters. Patients condition on admission varied, with most cases described as the moderate and severe state. At the moment of admission to hospital, the most frequently noted pathologies were: vertigo, headeache and complains from the respiratory tract. The most commonly encountered complication were labyrinths' injuries, neurological abnormalities and pneumonia. Mean concentration of COHb measured on admission in this group was in the blood 21.50 +/- 10.96%. Poor prognosis may be associated with such clinical features on admission, as: respiratory and circulatory disturbances, cerebral sequelae and reported sequelae from labyrinths. Such parameters as: COHb level, lactate and troponine concentrations and BE values measured on admission should be considered as the prognostic factors, determining the course of the disease and the outcomes of treatment.

[Toxic liver injuries--a current view on pathogenesis. Part II]

Liver plays an important role in biological detoxication of xenobiotics. During this process, one can observe the inactivation and successful elimination of metabolites and toxic substances. The metabolic reactions responsible for detoxications include phases I and II. The phase I reactions increase polarity of xenobiotics through inserting new functional groups to xenobiotic molecules, while during phase II conjugation to endogenous hydrophilic molecules results in potent increase in polarity and water solubility. Phase III involves the transport process mediated by transmembranous transporter proteins, which remove a large number of xenobiotics from blood into liver. Oxidative stress and oxidation of lipids may lead to liver injury. Functional impairment of mitochondrial metabolism is associated with intensive production of reactive oxygen species. The underlying mechanisms during mitochondrial dysfunction may lead to cellular necrosis and apoptosis.

[Toxic liver injuries--a current view on pathogenesis. Part I]

Toxic liver injury poses an important heath problem in occupational medicine. Toxic response of this organ may arise from acute or chronic exposure to different substances. The final toxicological response to different toxicants may be defined as the regeneration of cells, loss of their function or necrosis. The morphology of toxic drug- or chemical-induced liver injury usuall differentiates into one of the following phenotypes: cholestatic injury, hepato- cellular injury, often associated with elevated l enzymes, mitochondrial injuries and delayed immunological injury. In this article, the authors present current knowledge of the pathogenesis of morphological changes in hepatocytes as the result of exposure to xenobiotics.

[The analysis of legal basis of telediagnosis and teleconsultation in clinical practice. are we allowed to consult our patients via phone? Part I]

BACKGROUND

Telemedicine means the delivery of medical service without personal contact between the patient and physician. Although Polish legal regulations do not prohibit so called "distant medical treatment", they do not specify clear and ambiguous terms of such a service. The practitioner faces numerous doubts concerning the telediagnosis and teleconsultation. The authors discuss the problems of acceptability of telediagnosis and teleconsultation in Poland.

MATERIAL AND METHODS

The material comprised a whole set of legal acts of the Polish and European origin that could have any impact on the legal basis of telemedicine in Poland. The method applied was of interpretative nature, and the texts of above-mentioned acts were thoroughly analyzed, providing the first comprehensive study on this subject.

RESULTS

The results applied to practitioners of numerous medical specializations, but it should be stated that the examples studied and analyzed focused on teleconsultations in occupational medicine. The analysis revealed that current legal regulations do not specify the exact form the medical consultations should acquire. Nevertheless, it should be admitted that "distant consultation"; via the Internet, phone or other means of IT is not prohibited. The authors emphasize, however, that the distant consultations should be treated as an exception to the rule, which says that the patient should be personally consulted by the physician.

CONCLUSIONS

The achievements of information technology greatly contributes to the quality of diagnostic and therapeutic processes. The existence of many unclear and ambiguous rules and opinions makes it necessary to establish legal regulations specifying the principles of distant exchange of medical data.

[Health hazards associated with occupational exposure to birds]

The occupational group particularly exposed to contact with birds are zoo keepers, animal shop workers, individual bird's keepers and food industry workers. Work associated with contact with birds may contribute to the development of different symptoms and diseases, including allergic and contagious ones. This paper reviews the most common allergens occurring in the environment of bird's keepers, namely: feathers, egg proteins, allergens of plant origin, acarinae, allergens from latex and disinfectants. The most common health effects associated with occupational exposure to birds are also presented. Taking account of not fully understood pathogenesis of allergy to these allergens, complexity of occupational exposure and a possible coincidence of non-specific irritant effects of factors present in work environment, the diagnostic and certification procedures for occupational allergic diseases require highly specialized investigations. Objective and subjective medical examinations, taken medical history and physical examination also play a significant role in diagnostics of contagious diseases, whereas different laboratory tests are used in searching for their etiologic factors. The prevention of diseases associated with occupational exposure to birds comprises educational work, technical actions (hygiene prophylaxis) and medical prophylaxis.

[Poisoning with weever fish venom: a case report]

Poland's access to the EU causes that there is the risk of poisoning from sources outside Poland. This is confirmed by the case reported below. The Weeverfish Trachinus draco lives in the coastal waters of West Africa and Europe (including those of the Mediterranean Sea) and belongs to the most poisonous fish species. The venom of Trachinus draco contains proteins that cause cellular membrane depolarisation, and haemolysis. A 35-yr. man was admitted to the Toxicological Department of the Nofer Institute of Occupational Medicine for symptoms, such as: a strong pain, swelling and reddening of the left leg, that had appeared after contact with an unidentified fish when he had been enjoying a bath in the Mediterranean Sea. In the additional examinations, slight abnormalities were detected only in the results of blood agglutination test. The patient was discharged from the hospital 7 days later in good condition.

Challenge testing in the diagnosis of occupational allergic conjunctivitis

BACKGROUND

Providing evidence for the allergic aetiology of ocular symptoms developing as a result of occupational exposure is important for compensation procedures in many countries.

AIM

To perform cellular analysis of tear fluid before and after a specific challenge test with high-molecular weight allergens in symptomatic subjects.

METHODS

The subjects were 23 bakers with a history of conjunctivitis or rhinoconjunctivitis associated with occupational exposure to wheat flour and positive skin prick test with this allergen. A specific inhalation challenge test with wheat flour and a placebo test were performed. The symptom score (SS) and cellular changes in tear fluid and nasal washings were assessed.

RESULTS

Specific provocation test induced significant eosinophil influx in tear fluid in only six patients. No changes in the proportion of other cells could be observed. Cytological changes in tear fluid did not correlate with either ocular SS (Pearson r = 0.18, P = 0.40) or changes in the nasal lavage fluid or SS (Pearson r = 0.13, P = 0.56). However, an analysis of SS results obtained at 30 min and at 24 h after the challenge revealed that cellular changes in tear fluid correlated significantly both with the early and late changes in SS (Pearson r = 0.52, P < 0.05 and Pearson r = 0.81, P < 0.001, respectively).

CONCLUSIONS

Analysis of cellular changes in tear fluid during specific inhalation challenge test seems to be a valuable diagnostic tool in occupational ocular allergy. However, the discrepancy between the findings of cellular analysis and SS revealed by the present study requires further research.

Prevalence and host determinants of occupational bronchial asthma in animal shelter workers

OBJECTIVE

We examined the risk factors for the development of airway allergy in animal shelter workers.

METHODS

The study population comprised 88 animal shelter workers occupationally exposed to cats and dogs. They responded to a questionnaire concerning the history of exposure to animal allergens and job characteristics and were subjected to skin prick test (SPT) to common and occupational allergens (cat and dog), and determination of total serum IgE level and specific IgE. In addition, SPT with rat and mouse allergens were performed. Bronchial hyperreactivity and peak expiratory flow rate were measured at work and off work only in workers with work-related symptoms suggestive of occupational asthma (OA).

RESULTS

The prevalence of OA was 9.1%. Sensitization to dog allergens was higher than to cats. The multivariate logistic regression analysis revealed a significant role of positive family history of atopy and having a dog as pet in the past for the development of occupational airway allergy (OR 5.9; 95% CI 1.76, 20.00; P = 0.003; OR 6.47; 95% CI 1.90, 22.02; P = 0.002, respectively). In the multivariate logistic regression analysis, the risk for developing OA was most clearly associated with growing up in the country (OR 7.59; 95% CI 1.25, 45.9; P = 0.025).

CONCLUSIONS

Allergic disease is a serious occupational health concern for subjects who have occupational contact with cats and dogs.

Risk factors associated with airway allergic diseases from exposure to laboratory animal allergens among veterinarians

OBJECTIVES

Investigate the risk factors for the development of occupational airway allergy (OAA) from exposure to laboratory animal allergens (LAA) among Polish veterinarians.

METHODS

Two hundred veterinarians responded to the questionnaire and were subjected to skin prick test (SPT) to common allergens and LAA (rat, mouse, hamster, guinea pig, rabbit). Evaluation of total serum IgE level and specific IgE against occupational allergens was performed. In addition, bronchial hyperreactivity (BHR) and peak expiratory flow rate (PEFR) were measured before and after specific challenge testing (SCT) only in the subjects with work-related symptoms suggestive of occupational asthma (OA).

RESULTS

The prevalence of asthmatic and ocular symptoms was statistically more prevalent in the group of veterinarians sensitised to LAA versus non-sensitised subjects. The most frequent occupational allergens of skin and serum reactivity were LAA (44.5 and 31.5%, respectively). In 41 (20.5%) and in 22 (11%) subjects out of 200 veterinarians, serum specific IgE to natural rubber latex (NRL) allergens and disinfectants was also found. Serum sensitisation to cat allergens and daily contact with laboratory animals (LA) increased the risk for developing isolated occupational rhinitis. Furthermore, working time of more than 10 years and daily contact with LA were also significant risk factors for the development of OAA. Measuring PEFR and BHR before and after SCT is a useful method to confirm the presence of OA.

CONCLUSIONS

Allergy to LAA is an important health problem among veterinary medicine practitioners in Poland.

Glutaraldehyde-induced occupational asthma: BALF components and BALF and serum Clara cell protein (CC16) changes due to specific inhalatory provocation test

OBJECTIVES

The purpose of this study was to evaluate bronchoalveolar lavage fluid (BALF) components and Clara cell protein (CC16) concentration in serum and BALF in patients with glutaraldehyde (GA)-induced asthma, before and after a specific inhalatory provocation test (SIPT) with GA, in comparison to atopic asthmatics and healthy individuals.

METHODS

Spirometry and bronchoalveolar lavage were performed before and after SIPT. The serum and BALF concentrations of CC16 and cytogram content in BALF were evaluated.

RESULTS

In GA-sensitized asthmatics, the level of CC16 in BALF and serum was significantly lower at 24 h after SIPT in comparison with the values recorded prior to the experiment. There was a significant increase in the proportion of eosinophils, basophils and lymphocytes in BALF of GA-sensitized asthmatics obtained after SIPT.

CONCLUSIONS

The determination of CC16 either in serum or in BALF is a non-invasive test to detect Clara cell damage.

[Occupational allergy caused by ornamental plants]

The problem of allergy to decorative plants is still poorly known. Reports on occupational allergy to flowers are scarce and usually concern gardeners, greenhouse workers and florists. The handling, smelling and caring of flowers may cause rhinoconjunctivitis, asthma, urticaria and also contact dermatitis. Plants of the Compositae family that includes many different species have been frequently described. Chrysanthemum flowers, the strongest sensitizer among ornamental Compositae plants, especially contribute to the development of contact dermatitis. Allergy to Liliaceae, mostly to tulips, hyacinths, lilies and crocuses has quite often been reported as well as sensitization to rose pollen in rose planters. Occupational sensitization to flowers of other families, among which spathe flowers, primulas, weeping fig or Stephanotis floribunda should be mentioned, is less frequent. Exposure to ornamental flowers is common in the general population. Persons occupationally involved in cultivation of flowers and who demonstrate allergic symptoms are often forced to change their jobs. Candidates to these occupations with diagnosed atopy should be informed about the risk of developing allergy to flowers, which could make them unable to perform the job.

[Sick building syndrome due to exposure to pentachlorophenol in the office: a case report]

"Sick building syndrome" (SBS) is a group of symptoms experienced by people working in various buildings. This or another term "building-related illness" (BRI) is used to define illnesses related to modern buildings, mainly offices, in which people spend many working hours. SBS applies to a group of diseases with a fairly homogenous clinical picture and etiology (specific - infectious, allergic and non-specific--for example irritant symptoms). A case of a 51-year-old non-smoking female office worker is reported. After having her working premise renovated, she started to suffer from irritation of mucous membrane of the throat, sore throat and dysphonia. She claimed that these symptoms were associated with exposure to pentachlorophenol (PCP) emitted by the elements of ceiling impregnated with PCP-containing varnish. The concentration of PCP was below the hygiene standards adopted for the work environment. There were no grounds for recognizing occupational intoxication, but the case met the criteria for the sick building syndrome.

Outbreak of Lead Poisoning in High Voltage Tower Conservators

OBJECTIVES

A changing character of lead exposure has been observed over many years. However, construction workers involved in the renovation of painted steel structures are still severely exposed to lead and its compounds. In 2004, we observed an outbreak of lead poisoning in high voltage tower conservators working abroad.

MATERIALS AND METHODS

As many as 27 male workers with suspected lead poisoning were hospitalized in the Department of Occupational Disease, Nofer Institute of Occupational Medicine, Lódź, Poland. They were involved in removing an old lead-containing paint from high voltage towers.

RESULTS

On admission to the department, 70% of treated workers showed laboratory signs of anemia in their blood count. After treatment the signs persisted in 25% of patients. Also alkaline dotting in erythrocytes was present in 13 subjects. Sub-acute lead poisoning manifested by abdominal cramps with coexisting anemia and increased lead absorption symptoms was most frequently diagnosed.

CONCLUSIONS

The high lead exposure of the examined high voltage tower cleaners was due to specific working conditions. In such cases overprotection of the environment may lead to severe health effects in humans.