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Annals of Emergency Medicine Aug 2023Carbon monoxide (CO) poisoning causes central nervous system toxicity resulting in delayed neurologic sequelae. This study aims to evaluate the risk of epilepsy in...
STUDY OBJECTIVE
Carbon monoxide (CO) poisoning causes central nervous system toxicity resulting in delayed neurologic sequelae. This study aims to evaluate the risk of epilepsy in patients with a history of CO intoxication.
METHODS
We conducted a retrospective population-based cohort study using the Taiwan National Health Insurance Research Database and enrolled patients with and without CO poisoning matched for age, sex, and index year in a 1:5 ratio, between 2000 and 2010. Multivariable survival models were used to assess the risk of epilepsy. The primary outcome was newly developed epilepsy after the index date. All patients were followed until a new diagnosis of epilepsy, death, or December 31, 2013. Stratification analyses by age and sex were also conducted.
RESULTS
This study included 8,264 patients with CO poisoning and 41,320 without. Patients with a history of CO poisoning were strongly associated with subsequent epilepsy (adjusted hazard ratio [HR] 8.40; 95% confidence interval [CI], 6.48 to 10.88). In the age-stratified analysis, intoxicated patients aged 20 to 39 years had the highest HR (adjusted HR 11.06; 95% CI, 7.17 to 17.08). In the sex-stratified analysis, adjusted HRs for male and female patients were 8.00 (95% CI, 5.86 to 10.92) and 9.53 (95% CI, 5.95 to 15.26), respectively.
CONCLUSION
Patients with CO poisoning were associated with an increased risk of developing epilepsy compared with those without CO poisoning. This association was more prominent in the young population.
Topics: Humans; Male; Female; Retrospective Studies; Cohort Studies; Carbon Monoxide Poisoning; Epilepsy; Proportional Hazards Models; Risk Factors
PubMed: 36797130
DOI: 10.1016/j.annemergmed.2022.11.021 -
Journal of Clinical Laboratory Analysis Nov 2023Organophosphorus compound (OPC) poisoning undoubtedly being a major concern in cultivation sites of the developing world, including Bangladesh. Two potential biomarkers,...
INTRODUCTION
Organophosphorus compound (OPC) poisoning undoubtedly being a major concern in cultivation sites of the developing world, including Bangladesh. Two potential biomarkers, for example, serum creatine phosphokinase (CPK) and lactate dehydrogenase (LDH), are widely used in OPC poisoning severity indicators in patients. In this study, we sought to correlate the severity score of acute OPC poisoning with CPK or LDH level and subsequently explore their prognostic value.
METHODS
This study was performed on a total of 70 patients with OPC poisoning admitted to the inpatient care unit at a territory-based hospital in Bangladesh. Sociodemographics and poison types were recorded, and severity was assessed according to Peradeniya Organophosphorus Poisoning (POP) scale. Serum CPK and LDH levels were measured and recorded.
RESULTS
A total of seventy OPC patients were included with male to female ratio of 1.33:1, respectively, with a mean age of 28.7 ± 12.8 years. Chlorpyrifos and methylparathion were the most commonly utilized OP compounds, accounting for 42.9% and 28.6%, respectively. Among the OPC patients, the majority were married homemakers from rural areas. According to POP score, 55.7% and 37.1% of patients were categorized as mild and moderate, whereas very few were found to be severe. The mean serum CPK and LDH of OPC-patients at admission time were 235.6 ± 79.8 IU/L and 348.3 ± 154.1 IU/L, respectively. Serum CPK, atropine dose and hospital stay strongly correlated with clinical severity.
CONCLUSION
We conclude that the serum CPK level strongly correlates with the degree of OPC poisoning and can be used as a predictor of the clinical intervention approaches.
Topics: Humans; Male; Female; Adolescent; Young Adult; Adult; Organophosphate Poisoning; Creatinine; Prognosis; Atropine; Creatine Kinase; L-Lactate Dehydrogenase
PubMed: 37908063
DOI: 10.1002/jcla.24980 -
Chembiochem : a European Journal of... Aug 2023Ministry of Education and Key Laboratory of Neurons and glial cells of the central nervous system (CNS) are modified by glycosylation and rely on glycosylation to... (Review)
Review
Ministry of Education and Key Laboratory of Neurons and glial cells of the central nervous system (CNS) are modified by glycosylation and rely on glycosylation to achieve normal neural function. Neurodegenerative disease is a common disease of the elderly, affecting their healthy life span and quality of life, and no effective treatment is currently available. Recent research implies that various glycosylation traits are altered during neurodegenerative diseases, suggesting a potential implication of glycosylation in disease pathology. Herein, we summarized the current knowledge about glycosylation associated with Alzheimer's disease (AD), Parkinson's disease (PD), Huntington's disease (HD), and Amyotrophic lateral sclerosis (ALS) pathogenesis, focusing on their promising functional avenues. Moreover, we collected research aimed at highlighting the need for such studies to provide a wealth of disease-related glycosylation information that will help us better understand the pathophysiological mechanisms and hopefully specific glycosylation information to provide further diagnostic and therapeutic directions for neurodegenerative diseases.
Topics: Humans; Aged; Huntington Disease; Neurodegenerative Diseases; Alzheimer Disease; Amyotrophic Lateral Sclerosis; Parkinson Disease; Glycosylation; Poisons; Quality of Life
PubMed: 37440197
DOI: 10.1002/cbic.202300017 -
Injury Aug 2023Unintentional poisoning is among the leading cause of death in children less than 20 years age. The incidence of unintentional poisoning in Low-income countries LMICs is...
BACKGROUND
Unintentional poisoning is among the leading cause of death in children less than 20 years age. The incidence of unintentional poisoning in Low-income countries LMICs is four times higher compared to high-income countries (HICs). In Pakistan a 10% (25/211) incidence of unintentional poisonings among 0-15-year-old children has been reported. Most of the poisoning occur because of household chemical and medicines. This study aimed to assess the knowledge, attitude, and practices (KAP) of parents in Karachi regarding poisonous household chemicals and medicines.
METHODS
This KAP study was conducted at Aga Khan University Hospital, Karachi from May to August 2019. A maximum sample of 384 was calculated using a 50% knowledge about household chemicals. Data were collected about parental knowledge, attitude and practices about poisons and chemicals at home and presented as frequency and percentages. Chi-square test of independence (or Fisher's exact test) was used. Data were analyzed using SPSS version 20.
RESULTS
A total of 364 parents of 0-16-year-old children completed the survey out of which 229 were mothers and 127 were fathers (eight had missing data). We had 70% of parents that kept chemicals and medicines locked in cabinets and 80% chose to never leave medicines unattended, there are still 20-30% parents that need improvement in the parental knowledge and practices for storing chemicals and medicines. A general lack of knowledge regarding poisoning first aid and emergency response centers was noted.
CONCLUSIONS
Two-pronged approach for future interventions could be useful; (1) Improving the knowledge and practice among the remaining 20-30% through repeated awareness' sessions for the community. (2) Information regarding PCCS needs to be made readily available to the parents which is a measure useful in cases a child poisoning occurs.
Topics: Child; Humans; Infant, Newborn; Infant; Child, Preschool; Adolescent; Poisons; Pakistan; Health Knowledge, Attitudes, Practice; Parents; Hospitals, University; Poisoning
PubMed: 37573064
DOI: 10.1016/j.injury.2022.11.024 -
Zhonghua Lao Dong Wei Sheng Zhi Ye Bing... Jul 2023To investigate the clinical characteristics of patients with acute phosphine poisoning, and to follow up and evaluate the prognosis of patients. In May 2022, 12...
To investigate the clinical characteristics of patients with acute phosphine poisoning, and to follow up and evaluate the prognosis of patients. In May 2022, 12 patients with phosphine poisoning by respiratory inhalation in Beijing Chao-Yang Hospital of Capital Medical University were analyzed. The patients were treated with symptomatic support therapy. Three months later, patients were re-evaluated the symptoms of poisoning, pulmonary function and magnetic resonance imaging (MRI) of the brain to understand the prognosis of the phosphine poisoning. The main symptoms of 12 patients were respiratory and central nervous system symptoms with hypoxia. The symptoms of poisoning improved after treatment. Follow-up found that the patients had different degrees of residual symptoms. Pulmonary function showed increased airway resistance. Airway challenge test was positive in some patients. MRI of the head of some patients showed small ischemic focus in bilateral frontal lobes. Acute phosphine poisoning may cause persistent damage to the respiratory system and central system, and residual symptoms after 3 months.
Topics: Humans; Follow-Up Studies; Lung; Phosphines; Poisoning; Central Nervous System Diseases; Respiratory Tract Diseases
PubMed: 37524683
DOI: 10.3760/cma.j.cn121094-20220809-00395 -
Clinical Toxicology (Philadelphia, Pa.) Dec 2023: Aluminum phosphide is a pesticide that is used in developing countries. Aluminum phosphide poisoning has a high mortality rate and there is no known antidote. This... (Randomized Controlled Trial)
Randomized Controlled Trial
: Aluminum phosphide is a pesticide that is used in developing countries. Aluminum phosphide poisoning has a high mortality rate and there is no known antidote. This study aimed to evaluate the safety and efficacy of insulin-euglycemia therapy in the management of patients with acute aluminum phosphide poisoning.: This trial was prospectively registered in the Pan African Clinical Trials Registry (PACTR202008534546951). A total of 108 patients were randomly allocated to two groups. The intervention group received insulin-euglycemia therapy in addition to standard treatment (norepinephrine and supportive care); the control group received standard treatment plus placebo. The main outcome measures were survival, blood pressure, and laboratory investigations.: The two groups had similar baseline parameters. Insulin-euglycemia therapy was associated with a significant reduction in mortality compared with that in the control group (64.8 percent and 96.3 percent, respectively; value <0.001). Patients randomized to insulin-euglycemia also required lower doses of vasopressors (median was 7 mg versus 26 mg in control group; value 0.006) and fewer patients needed intubation (61.1 percent versus 81.5 percent in the control group; value 0.019). Insulin-euglycemia therapy significantly improved blood pressure (systolic, diastolic, and mean arterial pressure) (median at 6h post-admission was 80 mmHg, 55 mmHg and 65 mmHg compared with 20 mmHg, 10 mmHg and 13 mmHg in the control group respectively; value <0.001) and bicarbonate and lactate concentrations.: Insulin-euglycemia therapy appears to be a safe and effective treatment option for patients with aluminum phosphide poisoning. Vasopressor only therapy was associated with very poor outcomes in acute aluminum phosphide poisoning.
Topics: Humans; Insulin; Pesticides; Aluminum Compounds; Phosphines; Poisoning
PubMed: 38096041
DOI: 10.1080/15563650.2023.2279495 -
Toxins Jul 2023Humans have faced poisonous animals since the most ancient times. It is recognized that certain animals, like specific plants, produce toxic substances that can be... (Review)
Review
Humans have faced poisonous animals since the most ancient times. It is recognized that certain animals, like specific plants, produce toxic substances that can be lethal, but that can also have therapeutic or psychoactive effects. The use of the term "venom", which initially designated a poison, remedy, or magic drug, is now confined to animal poisons delivered by biting. Following Louis Pasteur's work on pathogenic microorganisms, it was hypothesized that venoms could be related to bacterial toxins and that the process of pathogenicity attenuation could be applied to venoms for the prevention and treatment of envenomation. Cesaire Phisalix and Gabriel Bertrand from the National Museum of Natural History as well as Albert Calmette from the Institut Pasteur in Paris were pioneers in the development of antivenomous serotherapy. Gaston Ramon refined the process of venom attenuation for the immunization of horses using a formalin treatment method that was successful for diphtheria and tetanus toxins. This paved the way for the production of antivenomous sera at the Institut Pasteur, as well as for research on venom constituents and the characterization of their biological activities. The specific activities of certain venom components, such as those involved in blood coagulation or the regulation of chloride ion channels, raises the possibility of developing novel therapeutic drugs that could serve as anticoagulants or as a treatment for cystic fibrosis, for example. Scientists of the Institut Pasteur of Paris have significantly contributed to the study of snake venoms, a topic that is reported in this review.
Topics: Animals; Horses; Immunization; Immunization, Passive; Poisons; Snake Venoms; Toxins, Biological
PubMed: 37505731
DOI: 10.3390/toxins15070462 -
Clinical Toxicology (Philadelphia, Pa.) Mar 2024When predicting future events, we often rely on analyzing past occurrences and projecting them forward. This methodology is crucial in various fields, including...
INTRODUCTION
When predicting future events, we often rely on analyzing past occurrences and projecting them forward. This methodology is crucial in various fields, including toxicology, in which predicting outcomes in poisoned patients plays a vital role in guiding treatment decisions and improving patient care.
IMPORTANCE OF PREDICTING OUTCOMES IN POISONED PATIENTS
In cases of poisoning, understanding a patient's medical history, current physiological status, and the toxicokinetics of the ingested substance is essential for predicting potential outcomes and determining appropriate interventions.
WHAT TO PREDICT?
Predicting whether an intoxicated patient needs (further) treatment or even admission to the hospital is one of the most difficult decisions a clinician needs to make. The prediction of the course of an intoxication often lacks crucial information, leaving physicians with a sense of uncertainty in treating and advising patients. A significant source of this uncertainty stems from patients' limited awareness of the specific chemical(s) causing their symptoms, making a targeted approach challenging. Adding to the complexity, both patients and physicians frequently lack knowledge of the exposure dose, onset time, and potential interactions, further complicating the prediction of symptom progression. Patients are commonly placed in observation wards until the pharmacodynamic effects have diminished, leading to extended observation periods and unnecessary healthcare utilization and costs. Therefore, a key objective of a predictive model is to determine the necessity for intensive care unit admission.
PREDICTING THE REQUIREMENT FOR ADMISSION TO AN INTENSIVE CARE UNIT
Factors such as age, Glasgow Coma Scale, and specific comorbidities like dysrhythmias and chronic respiratory insufficiency significantly influence the likelihood of intensive care unit admission. By examining a patient's trajectory based on past medical history and organ function deterioration, clinicians can better anticipate the need for critical care support.
ENHANCING PREDICTION MODELS FOR IMPROVED PATIENT CARE
To enhance prediction models, leveraging modern methodologies like machine learning on large datasets (big data) are crucial. These advanced techniques can uncover previously unknown patient groups with similar outcomes or treatment responses, leading to more personalized and effective interventions. Regular updates to clustering, discrimination, and calibration processes ensure that predictive models remain accurate and relevant as new data emerges.
CONCLUSIONS
The field of clinical toxicology stands to benefit greatly from the creation and integration of large datasets to advance toxicological prognostication. By embracing innovative approaches and incorporating diverse data sources, clinicians can enhance their ability to predict outcomes in poisoned patients and improve overall patient management strategies.
Topics: Humans; Hospitalization; Intensive Care Units; Poisoning; Prognosis
PubMed: 38683032
DOI: 10.1080/15563650.2024.2334820 -
Clinical Toxicology (Philadelphia, Pa.) Aug 2023
Topics: Humans; Poisons; Fat Emulsions, Intravenous; Lipids
PubMed: 37815249
DOI: 10.1080/15563650.2023.2254489 -
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue Dec 2023Phosgene is not only a dangerous asphyxiating chemical warfare agent, but also an important chemical raw material, which is widely used in chemical production. According...
Phosgene is not only a dangerous asphyxiating chemical warfare agent, but also an important chemical raw material, which is widely used in chemical production. According to statistics, there are more than 1 000 phosgene production enterprises in China, with an annual production volume of more than 3 million tons and hundreds of thousands of employees. Therefore, once the leakage accident occurs during production, storage and transportation, it often causes a large number of casualties. In the past 20 years, phosgene poisoning accidents in China have occurred from time to time, and due to the weak irritation, high density, and high concentration of phosgene at the scene of the accident, it often results in acute high-concentration inhalation of the exposed, triggering acute lung injury (ALI), and is very likely to progress to acute respiratory distress syndrome (ARDS), with a mortality rate up to 40%-50%. In view of the characteristics of sudden, mass, concealed, rapid and highly fatal phosgene, and the mechanism of its toxicity and pathogenicity is still not clear, there is no effective treatment and standardized guidance for the sudden group phosgene poisoning. In order to improve the efficiency of clinical treatment and reduce the mortality, this paper has summarized the pathophysiological mechanism of phosgene poisoning, clinical manifestations, on-site treatment, research progress, and innovative clinical therapies by combining the extensive basic research on phosgene over the years with the abundant experience in the on-site treatment of sudden mass phosgene poisoning. This consensus aims to provide guidance for the clinical rescue and treatment of patients with sudden mass phosgene poisoning, and to improve the level of treatment.
Topics: Humans; Phosgene; Chemical Warfare Agents; Acute Lung Injury; Respiratory Distress Syndrome; Treatment Outcome
PubMed: 38149382
DOI: 10.3760/cma.j.cn121430-20230717-00528