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Niżnik Ł, Toporowska-Kaźmierak J, Jabłońska K, Głąb N, Stach S, Florek J, Sowińska M, Adamczyk A, Jurowski K. Toxicovigilance 2.0 - modern approaches for the hazard identification and risk assessment of toxicants in human beings: A review. Toxicology 2024; 503:153755. [PMID: 38367941 DOI: 10.1016/j.tox.2024.153755] [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] [Received: 01/22/2024] [Revised: 02/01/2024] [Accepted: 02/12/2024] [Indexed: 02/19/2024]
Abstract
The attempt to define toxicovigilance can be based on defining its fundamental principles: prevention of infections with toxic substances, collecting information on poisonings, both in terms of their sources and side effects, and confirming poisonings, with the aim of improving treatment. Substances referred to include both those originating from animal bites, ingested inadvertently, and those resulting from environmental poisoning in industrial regions of countries, etc. In this review, we provide information about the crucial function of poison control centres in toxicovigilance, the importance of incorporating big data analytics and artificial intelligence to streamline toxicovigilance processes, and examples of toxicovigilance in different countries. In conclusion, we will present the direction that modern toxicovigilance should take, incorporating available artificial intelligence methods to maximise efficiency.
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Affiliation(s)
- Łukasz Niżnik
- Department of Regulatory and Forensic Toxicology, Institute of Medical Expertise, Łódź, ul. Aleksandrowska 67/93, Łódź 91-205, Poland; Toxicological Science Club 'Paracelsus', Institute of Medical Studies, Medical College, Rzeszów University, Al. mjr. W. Kopisto 2a, Rzeszów 35-959, Poland
| | - Joanna Toporowska-Kaźmierak
- Toxicological Science Club 'Paracelsus', Institute of Medical Studies, Medical College, Rzeszów University, Al. mjr. W. Kopisto 2a, Rzeszów 35-959, Poland
| | - Karolina Jabłońska
- Toxicological Science Club 'Paracelsus', Institute of Medical Studies, Medical College, Rzeszów University, Al. mjr. W. Kopisto 2a, Rzeszów 35-959, Poland
| | - Natalia Głąb
- Toxicological Science Club 'Paracelsus', Institute of Medical Studies, Medical College, Rzeszów University, Al. mjr. W. Kopisto 2a, Rzeszów 35-959, Poland
| | - Sabina Stach
- Toxicological Science Club 'Paracelsus', Institute of Medical Studies, Medical College, Rzeszów University, Al. mjr. W. Kopisto 2a, Rzeszów 35-959, Poland
| | - Julia Florek
- Toxicological Science Club 'Paracelsus', Institute of Medical Studies, Medical College, Rzeszów University, Al. mjr. W. Kopisto 2a, Rzeszów 35-959, Poland
| | - Marta Sowińska
- Toxicological Science Club 'Paracelsus', Institute of Medical Studies, Medical College, Rzeszów University, Al. mjr. W. Kopisto 2a, Rzeszów 35-959, Poland
| | - Aleksandra Adamczyk
- Toxicological Science Club 'Paracelsus', Institute of Medical Studies, Medical College, Rzeszów University, Al. mjr. W. Kopisto 2a, Rzeszów 35-959, Poland
| | - Kamil Jurowski
- Department of Regulatory and Forensic Toxicology, Institute of Medical Expertise, Łódź, ul. Aleksandrowska 67/93, Łódź 91-205, Poland; Laboratory of Innovative Toxicological Research and Analyses, Institute of Medical Studies, Medical College, Rzeszów University, Al. mjr. W. Kopisto 2a, Rzeszów 35-959, Poland.
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Berta GN, Di Scipio F, Bosetti FM, Mognetti B, Romano F, Carere ME, Del Giudice AC, Castagno E, Bondone C, Urbino AF. Childhood acute poisoning in the Italian North-West area: a six-year retrospective study. Ital J Pediatr 2020; 46:83. [PMID: 32527281 PMCID: PMC7291716 DOI: 10.1186/s13052-020-00845-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 06/01/2020] [Indexed: 03/30/2024] Open
Abstract
BACKGROUND Data about acute poisoning in Italian pediatric patients are obsolete or absent. This study would partially fill this exiting gap and compare the scene with others around the world. METHODS A retrospective evaluation was performed on a 2012-2017 data registry of the Children's Emergency Department at the Regina Margherita Hospital of Turin, where 1030 children under age 14 were accepted with a diagnosis of acute intoxication. RESULTS The median age of the patients was 2.2 years (IQR 2.3) and 55% were male. Events occurred mostly in children aged 1-4 years (n = 751, 72.9%). Six hundred and eight patients (59%) were exposed to Nonpharmaceutical agents, the household cleaning products being the more frequent (n = 298, 49%). Exposure to Pharmaceuticals were 422 (41%); the most common Pharmaceuticals were analgesics (n = 88, 20.8%), psychotropics (n = 77, 18.2%) and cardiovascular (n = 53, 12.6%) drugs. The 85% of the intoxications occurred accidentally, the 10.6% as therapeutic error, the 2.3% as suicide attempts and the 1.5% for recreational purposes. No patient died. CONCLUSIONS Despite acute poisoning being a relevant problem in pediatric emergency, our results would seem to paint a less worrying picture if compared to other countries, mainly when considering the children hospitalized in the pediatric intensive care unit and the number of deaths. Nevertheless, our study might represent a tool for public health authorities to program incisive interventions.
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Affiliation(s)
- Giovanni N Berta
- Department of Clinical and Biological Sciences, Pharmacology Unit, University of Turin, Turin, Italy
| | - Federica Di Scipio
- Department of Clinical and Biological Sciences, Pharmacology Unit, University of Turin, Turin, Italy
| | | | - Barbara Mognetti
- Department of Clinical and Biological Sciences, Pharmacology Unit, University of Turin, Turin, Italy.
- Department of Life Science and Systems Biology, University of Turin, Turin, Italy.
| | - Federica Romano
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
| | - Maria E Carere
- Department of Clinical and Biological Sciences, Pharmacology Unit, University of Turin, Turin, Italy
| | | | - Emanuele Castagno
- Department of Pediatric Emergency, Regina Margherita Children's Hospital, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Claudia Bondone
- Department of Pediatric Emergency, Regina Margherita Children's Hospital, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Antonio F Urbino
- Department of Pediatric Emergency, Regina Margherita Children's Hospital, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
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Muñoz Romo R, M Borobia Pérez A, A Muñoz M, Carballo Cardona C, Cobo Mora J, Carcas Sansuán AJ. Efficient diagnosis and treatment of acute paracetamol poisoning: cost-effectiveness analysis of approaches based on a hospital toxicovigilance program. Emergencias 2018; 30:169-176. [PMID: 29687671] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To evaluate 5 diagnostic-therapeutic strategies for suspected acute paracetamol poisoning in terms of cost-effectiveness in a tertiary university hospital with an active, validated poisoning surveillance program (SAT-HULP). MATERIAL AND METHODS Cost-effectiveness analysis of the 5 diagnostic-therapeutic alternatives considered when attending patients with suspected paracetamol poisoning. The alternatives were chosen by means of a decision tree. We studied patients detected by the SAT-HULP program between April 1, 2011, and January 31, 2015. The diagnostic-therapeutic alternatives were as follows: 1) systematic treatment of all patients with N-acetylcysteine (NAC), 2) NAC treatment according to the reported dose; 3) NAC treatment according to a Rümack-Matthew nomogram; 4) NAC treatment according to urine test results confirmed by a blood test, and 5) treatment according to elimination half-life calculation. Probability data were obtained from the SAT-HULP program and validation studies corresponding to the diagnostic tests. Deterministic and probabilistic sensitivity analyses were performed. RESULTS The approaches that were most cost-effective were those guided by reported doses and nomograms. The incremental cost-effectiveness of treatment according to reported dose was €5985.37. The sensitivity analysis showed that the model was highly dependent on variations in the main variables; the probabilistic sensitivity analysis indicated an incremental cost-effectiveness of €25 111.06 (SD, €1 534 420.16; range, €42 136.03-€92 358.75) between the first approach (treat all cases) and last (calculate elimination half-life); half-life calculation was the more efficient. CONCLUSION Treating according to nomogram was the most efficient diagnostic-therapeutic approach to treating paracetamol poisoning in our hospital. However, when the prevalence of paracetamol poisoning is higher and uncertainty is greater, it would be more efficient to treat based on calculating the half-life.
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Abstract
Phytovigilance consists in supervision of side effects and drug interactions consequential to use of herbal medicinal products, herbal food supplements, herbal cosmetics and/or medicinal plants. It includes thus pharmacovigilance applied to phytotherapy, nutrivigilance and cosmetovigilance but also addictovigilance in case of plants, which lead to drug addiction, and toxicovigilance in case of toxic plants. Becoming necessary owing to (acute or chronic) toxicity risks or to drug interactions risks (of pharmacocinetical or pharmacodynamical kind)--as far as it concerns interactions between several associated plants or between a plant and a chemical or biotechnological allopathic medicine--phytovigilance represents moreover a legal obligation. Pharmacovigilance--in case of herbal medicinal products--is indeed becoming mandatory according to title IX of the European directive 2001/83/EC, whereas nutrivigilance is imposed by the European Food Safety Agency (EFSA).
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Affiliation(s)
- H Lehmann
- EA 4487, centre de recherches en droit et perspectives du droit, faculté des sciences pharmaceutiques et biologiques, université Lille 2, 3, rue du Professeur-Laguesse, BP 53, 59006 Lille, France.
| | - J-Y Pabst
- EA 7307, centre d'études internationales et européennes (CEIE), faculté de pharmacie, université de Strasbourg, 74, route du Rhin, 67400 Illkirch, France
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