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Annals of Medicine and Surgery (2012) Jul 2022The use of household cleaning agents as a method of self-harm has been reported in the literature frequently. However, reports of Harpic ingestion a commonly used toilet...
INTRODUCTION
The use of household cleaning agents as a method of self-harm has been reported in the literature frequently. However, reports of Harpic ingestion a commonly used toilet cleaner is significantly lacking. Due to the ease of access of household cleaning agents, people tend to choose it as quick method of self-harm. The main focus after ingestion of acid is on the digestive tract injury. But due to the tendency to vomit after ingestion of such substance and inhalation of fumes generated there is a high possibility of injury to the respiratory tract as well.
CASE PRESENTATION
Here we present a case of 19-year-old female with injury to the aerodigestive tract presenting with stridor after ingestion of Harpic - a hydrochloriacid-based cleaning solution. In addition to the gastric mucosal injury a diagnosis of chemical pneumonitis was made and her airway was protected in time for her to have a good recovery.
DISCUSSION
Inducing vomiting in patients with hydrochloric acid is not advised because it can increase the risk of pulmonary complications as a result of aspiration [8]. Moreover, blind insertion of a nasogastric (Ryle's) tube is not done due to the risk of perforation and induction of regurgitation or vomiting. In few cases steroids have also been tried with no promising results [9]. Since there are no therapeutic standards for caustic injuries, treatment centers on correcting metabolic imbalances, coagulopathy, and emergency surgical intervention for severe injury and late sequelae. However, it is crucial to watch out for aspiration and respiratory tract injury and perform timely protection of the airway.
CONCLUSION
An awareness of the potential impacts of acid ingestion on the respiratory tract with a high level of suspicion towards airway injury and timely protection of airway is crucial for proper management of the patient.
PubMed: 35860066
DOI: 10.1016/j.amsu.2022.104041 -
Computers & Education Jan 2021While the hype around Massive Open Online Courses (MOOCs) has subsided in the past few years, such environments provide a rich opportunity to explore ongoing questions...
While the hype around Massive Open Online Courses (MOOCs) has subsided in the past few years, such environments provide a rich opportunity to explore ongoing questions at the intersection of teaching, learning, and technology. This paper explores how a set of facilitation teams described enacting their learner-centered pedagogical aspirations through MOOC platforms. Drawing on in-depth interviews, we present a set of six facilitator actions: "giving up control," "distributing facilitation," "being live," "amplifying," "modeling," and "being explicit." We discuss these actions as emerging from the negotiation between existing pedagogical aspirations and the realities of a new medium, highlighting how they involve facilitators both stepping (making space for and foregrounding learner expertise and perspectives) and stepping (intervening and directing as a facilitator). This research contributes to the ongoing work of articulating the substance and specificity of teaching in learner-centered pedagogy and the persistent challenges of enacting that pedagogy in massive, online spaces.
PubMed: 33071438
DOI: 10.1016/j.compedu.2020.104042 -
Taiwan Journal of Ophthalmology 2020Preoperatively, the surgeon instills two drops of 0.5% proparacaine and then marks the 0° and 180° points at the limbus using a Gentian violet marker and 26G needle...
Preoperatively, the surgeon instills two drops of 0.5% proparacaine and then marks the 0° and 180° points at the limbus using a Gentian violet marker and 26G needle edge. Intraoperatively, after phacoemulsification and irrigation and aspiration of the cortex are complete, the surgeon inspects the previously marked 0°-180° points on the limbus. In case the steeper astigmatic meridian needs to be marked, a Mendez Ring is used and the meridian is marked using a Gentian violet marker and 26G needle edge. The desired markings (2 mm in length only) on the anterior lens capsule can be made using 26G needle bent at the bevel or using micro-vitreoretinal scissors. The toric intraocular lens (IOL) is then rotated in the bag in the desired meridian (customized-toric IOL in 0°-180° meridian and noncustomized toric IOL in steeper marked meridian), viscoelastic substance is aspirated and corneal wounds are hydrated.
PubMed: 33437605
DOI: 10.4103/tjo.tjo_46_19 -
Sports Medicine - Open Aug 2020Several studies have highlighted the substantial role of the athlete's redox and inflammation status during the training process. However, many factors such as... (Review)
Review
BACKGROUND
Several studies have highlighted the substantial role of the athlete's redox and inflammation status during the training process. However, many factors such as differences in testing protocols, assays, sample sizes, and fitness levels of the population are affecting findings and the understanding regarding how exercise affects related biomarkers in adolescent athletes.
OBJECTIVES
To search redox homeostasis variables' and inflammatory mediators' responses in juvenile athletes following short- or long-term training periods and examine the effect size of those variations to training paradigms.
METHODS
A PRISMA-compliant systematic review and meta-analysis were conducted. The entire content of PubMed (MEDLINE), Scopus, and Science Direct were systematically searched until December 2019. Studies with outcomes including (1) a group of adolescent athletes from any individual or team sport, (2) the assessment of redox and/or inflammatory markers after a short- (training session or performance testing) or longer training period, and (3) variables measured in blood were retained. The literature search initially identified 346 potentially relevant records, of which 36 studies met the inclusion criteria for the qualitative synthesis. From those articles, 27 were included in the quantitative analysis (meta-analysis) as their results could be converted into common units.
RESULTS
Following a short training session or performance test, an extremely large increase in protein carbonyls (PC) (ES 4.164; 95% CI 1.716 to 6.613; Z = 3.333, p = 0.001), a large increase in thiobarbituric acid reactive substances (TBARS) (ES 1.317; 95% CI 0.522 to 2.112; Z = 3.247, p = 0.001), a large decrease in glutathione (GSH) (ES - 1.701; 95% CI - 2.698 to - 0.705; Z = - 3.347, p = 0.001), and a moderate increase of total antioxidant capacity (TAC) level (ES 1.057; 95% CI - 0.044 to 2.158; Z = 1.882, p = 0.060) were observed. Following more extended training periods, GSH showed moderate increases (ES 1.131; 95% CI 0.350 to 1.913; Z = 2.839, p = 0.005) while TBARS displayed a small decrease (ES 0.568; 95% CI - 0.062 to 1.197; Z = 1.768, p = 0.077). Regarding cytokines, a very large and large increase were observed in IL-6 (ES 2.291; 95% CI 1.082 to 3.501; Z = 3.713, p = 0.000) and IL-1 receptor antagonist (ra) (ES 1.599; 95% CI 0.347 to 2.851; Z = 2.503, p = 0.012), respectively, following short-duration training modalities in juvenile athletes.
CONCLUSIONS
The results showed significant alterations in oxidative stress and cytokine levels after acute exercise, ranging from moderate to extremely large. In contrast, the variations after chronic exercise ranged from trivial to moderate. However, the observed publication bias and high heterogeneity in specific meta-analysis advocate the need for further exploration and consistency when we deal with the assessed variables to ascertain the implications of structured training regimes on measured variables in order to develop guidelines for training, nutritional advice, and wellbeing in young athletes.
TRIAL REGISTRATION
PROSPERO CRD42020152105.
PubMed: 32748060
DOI: 10.1186/s40798-020-00262-x -
Computational and Mathematical Methods... 2022To discover the effect of propofol intravenous anesthesia along with press-needle therapy on analgesic effect during painless abortion.
OBJECTIVE
To discover the effect of propofol intravenous anesthesia along with press-needle therapy on analgesic effect during painless abortion.
METHODS
A total of 128 cases who experienced painless abortion in our hospital from January 2019 to August 2021 were recruited as the research subjects. They were categorized into control and observation groups through the haphazard number table approach, with 64 patients in each group. Propofol intravenous anesthesia was given to the control group, and the observation group was given combined anesthesia with press-needle on this basis. Ramsay score, hemodynamic indexes, operation-related indexes, and postoperative recovery were studied between the two groups before anesthesia (T0), at the time of uterine aspiration (T1), promptly following the operation (T2), and at the recovery time of directional force (T3). The stress state and the level of pain mediators in the two groups of sufferers were observed at each time period, and the visual analogue scale (VAS) was employed to assess the degree of postoperative uterine contraction pain.
RESULTS
Ramsay score at T1 and T2 time points in observation group was lesser than that in control group ( < 0.05). There existed no meaningful discrepancies in operation time and recovery time between both groups ( > 0.05). The total dosage of propofol in the observation group was lesser compared to that in the control group, and the recovery time of directional force was much shorter compared to that in the control group ( < 0.05). There existed no meaningful discrepancies in perioperative diastolic blood pressure (DBP), systolic blood pressure (SBP), and heart rate (HR) between both groups ( > 0.05). The levels of norepinephrine (NE), cortisol (Cor), glucose (GLU) and substance P (SP), prostaglandin E2 (PGE2), and 5-hydroxytryptophan (5-HT) in the observation group were lesser than those in the control group immediately after surgery and 24 hours following the operation ( < 0.05). There existed no meaningful discrepancies in vaginal bleeding time, endometrial thickness 3 weeks after operation, and time to start menstruating between both groups ( > 0.05). The score of VAS for the observation group was lesser than that of the control group at 10 min and 30 min after operation ( < 0.05). There existed no substantial discrepancy in the incidence of negative reactions between both groups ( > 0.05).
CONCLUSION
Propofol intravenous anesthesia combined with press-needle therapy can ameliorate the analgesic impacts during painless abortion, reduce postoperative uterine contraction pain, inhibit the release of postoperative pain mediators, and improve the stress state of the body.
Topics: Analgesics; Anesthesia; Anesthesia, Intravenous; Female; Humans; Pain; Propofol
PubMed: 35979057
DOI: 10.1155/2022/6543211 -
Irish Journal of Medical Science Jun 2023The aim of this study is to investigate the impact of the coronavirus pandemic on teenage psychiatry referrals following crisis presentation to the adult emergency...
Locked in and locked out: sequelae of a pandemic for distressed and vulnerable teenagers in Ireland : Post-COVID rise in psychiatry assessments of teenagers presenting to the emergency department out-of-hours at an adult Irish tertiary hospital.
OBJECTIVE
The aim of this study is to investigate the impact of the coronavirus pandemic on teenage psychiatry referrals following crisis presentation to the adult emergency department (ED) of an Irish tertiary hospital. In doing so, this study will specifically examine the effect of COVID-19 on self-injurious behaviour, suicidality and substance use among older adolescents (age 16/17 years).
METHODS
This is a retrospective descriptive analysis of acute adolescent psychiatry referrals assessed out-of-hours via the adult ED psychiatry service across three consecutive time points (during the months of March, April and May) from pre-pandemic, 2019 (T1); initial pandemic, 2020 (T2); and peak pandemic, 2021 (T3). Data were obtained via the hospital's ED-specific electronic database, review of original assessment notes and cross-referenced by manually extracting data logged in the on-call register.
RESULTS
Crisis psychiatry assessments of teenagers during on-call hours trebled during the period of this study (p < 0.001). Although ED/crisis referrals initially decreased overall at the start of the pandemic, the rate of teenage referrals remained constant, before increasing as restrictions tightened in lockdown. The negative impact of COVID-19 on teenagers' ability to cope was found to be statistically significant (p = 0.001). Changes in rates of self-harming and/or suicidal behaviours were not statistically significant between 2019, 2020 and 2021 (p = 0.082). Alcohol misuse occurred in up to one-third of cases across each timeframe and remained virtually constant throughout the pandemic. Drug misuse decreased from onset of COVID-19 (p = 0.01).
CONCLUSIONS
To our knowledge, this is the first study to specifically examine the impact of COVID-19 on suicidality, self-harming behaviours, substance misuse and on-call ED presentations of teenagers in Ireland. This study demonstrates that coronavirus-related stress is associated with negative mental health sequelae for vulnerable at-risk older adolescents, as evidenced by a rise in ED presentations and on-call referrals since the onset of the pandemic. Presentation of increased numbers of under-18's for psychiatry assessment at the adult ED/general hospital indicates a deepening chasm between available and aspirational emergency (adolescent-specific) psychiatric care in the community. Mobilising resilience factors and maximising coping skills for at-risk youth will inform tailored intervention and support strategies along with adequate resourcing of services for vulnerable adolescents in the community.
Topics: Humans; Adult; Adolescent; Tertiary Care Centers; Pandemics; Retrospective Studies; Ireland; COVID-19; Communicable Disease Control; Psychiatry; Emergency Service, Hospital; After-Hours Care
PubMed: 35739358
DOI: 10.1007/s11845-022-03080-0 -
International Journal of Public Health Nov 2020The current study tested the extent to which the neighborhood context influenced Roma youth adjustment (internalizing and externalizing problems, and academic... (Comparative Study)
Comparative Study
OBJECTIVES
The current study tested the extent to which the neighborhood context influenced Roma youth adjustment (internalizing and externalizing problems, and academic competence) and whether ethnicity moderated these links and explained unique variance.
METHODS
Cross-sectional data were collected from 369 Roma and non-Roma early and middle adolescents.
RESULTS
Roma youth reported significantly lower SES, school grades, and academic aspirations. Perceived fear or concerns about neighborhood safety predicted all three internalizing problems, for both Roma and non-Roma adolescents; neighborhood acquaintanceship density and nighttime social activities predicted externalizing behaviors, for both ethnic groups; and finally, both ethnicity and nighttime social activities predicted school grades, while only ethnicity predicted academic aspirations. No significant by ethnicity interaction effects were found.
CONCLUSIONS
Roma youth reported lower grades and academic aspirations, but no mean level differences were found in internalizing or externalizing problems by ethnicity. On the other hand, neighborhood variables were important for both groups of youth, and with the exception of measures of academic competence, ethnicity did not explain unique variance. Thus, developmental processes, the links between neighborhood variables and measures of adjustment, were highly similar in Roma and non-Roma youth.
Topics: Adolescent; Adolescent Behavior; Cross-Sectional Studies; Czech Republic; Educational Status; Ethnicity; Female; Humans; Male; Residence Characteristics; Roma; Social Behavior; White People
PubMed: 32656725
DOI: 10.1007/s00038-020-01425-z -
Drug and Alcohol Dependence Mar 2022Aims: To determine 1. The characteristics of all recorded cases of fatal drug poisoning involving novel synthetic opioids (NSOs) in Australia; 2. The toxicology of...
BACKGROUND
Aims: To determine 1. The characteristics of all recorded cases of fatal drug poisoning involving novel synthetic opioids (NSOs) in Australia; 2. The toxicology of cases; and 3. The major autopsy findings.
METHODS
Review of all fatal poisonings related to NSOs in Australia 2000-2021 identified in the National Coronial Information System.
RESULTS
Thirty-one cases were identified, 96.8% due to unintentional drug toxicity. The mean age was 31.9 years and 87.1% were male. Only six were aged over forty. A history of substance use problems was documented in 80.6% and 58.1% had a history of injecting drug use. In 32.3% the final route of administration of a NSO was by non-injecting routes of administration. Ten NSOs were identified. Fentanyl analogues were present in 67.2%, most commonly furanylfenatyl (19.4%). Other NSO types were present in 39.7%, most commonly U-47700 (35.5%). Substances other than NSOs were present in 90.3%, most commonly benzodiazepines (67.7%) and other opioids (51.6%). A CNS depressant in addition to NSOs was present in 90.3%, and a new psychoactive substance other than a NSO in 25.8%. Pulmonary oedema was diagnosed in 82.6%, aspiration of vomitus in 30.4%, and acute bronchopneumonia in 17.4%.
CONCLUSIONS
Ten NSOs were identified. Case characteristics suggest a younger cohort whose profile is more typical of use of other NPS than of the established opioids. A large proportion used NSOs by non-injecting routes of administration.
Topics: Adult; Aged; Analgesics, Opioid; Autopsy; Benzodiazepines; Fentanyl; Humans; Male; Substance-Related Disorders
PubMed: 35030539
DOI: 10.1016/j.drugalcdep.2022.109292 -
Healthcare (Basel, Switzerland) Dec 2023(1) Background: Cigarette smoking, risky alcohol consumption, and marijuana smoking are the most common behaviors related to legal and illicit drug use worldwide,...
Cigarette Smoking, Risky Alcohol Consumption, and Marijuana Smoking among University Students in Germany: Identification of Potential Sociodemographic and Study-Related Risk Groups and Predictors of Consumption.
(1) Background: Cigarette smoking, risky alcohol consumption, and marijuana smoking are the most common behaviors related to legal and illicit drug use worldwide, including among university students. To plan effective evidence-based programs to prevent the risky consumption of these substances among university students, the present study aimed to identify potential sociodemographic and study-related risk groups and predictors of consumption. (2) Methods: A cross-sectional online health survey with approximately 270 health-related items was conducted among students at the University of Mainz, Germany. Cigarette smoking, risky alcohol consumption (AUDIT-C score: female ≥ 4, male ≥ 5), and marijuana smoking were chosen as dependent variables. Of the 270 health-related items, 56 were chosen as independent variables and collated into five groups (sociodemographic, psychological, study-related psychosocial, general psychosocial and health behavior). The prevalence of cigarette smoking, risky alcohol consumption, and marijuana smoking was assessed using established and validated instruments. Pearson's chi-square test was used to analyze the differences in prevalence between the sociodemographic and study-related groups, and binary logistic regression was used for analyses with stepwise inclusion of the five variable groups. (3) Results: Of the 3991 university students who entered the analyses, 14.9% reported smoking cigarettes, 38.6% reported risky alcohol consumption, and 10.9% reported smoking marijuana. The prevalence of these differed between genders, fields of study, and aspired degree level, among other factors. Binary logistic regression analyses revealed nine significant predictors ( ≤ 0.05) of cigarette smoking (Nagelkerke R = 0.314), 18 significant predictors of risky alcohol consumption (Nagelkerke R = 0.270), and 16 significant predictors of marijuana smoking (Nagelkerke R = 0.239). (4) Conclusions: This study showed cigarette smoking, risky alcohol consumption, and marijuana smoking among university students in Germany to be associated with multiple factors, especially health behaviors. Furthermore, each of the substances was highly associated with each of the two other substances we examined. Other variable groups, such as psychological or psychosocial variables, seemed to play a rather minor role. Therefore, our recommendation for future prevention programs is that substance use among university students should be addressed as a whole, not just in terms of specific substances.
PubMed: 38132073
DOI: 10.3390/healthcare11243182 -
Addictive Behaviors Sep 2024The present systematic review aims to identify electronic interventions for addressing substance use and understand their effectiveness in primary care settings. A... (Review)
Review
The present systematic review aims to identify electronic interventions for addressing substance use and understand their effectiveness in primary care settings. A systematic search was carried out in the Web of Science, PubMed/MEDLINE, Scopus, and Cochrane Library. The search included the keywords "electronic intervention", "substance use", "primary care" and synonyms. To determine the quality and recommendation of the analyzed interventions, the efficacy results reported by the studies were considered, as well as the Mixed Methods Appraisal Tool (MMAT) assessment and the GRADE Evidence Assessment. Twenty-one electronic interventions in Primary Care were identified: internet, mobile or tablet applications, text messages, emails, automated telephone calls, or electronic self-reports. These interventions had diverse components, incorporating theories that have proven effective in face-to-face interventions as their theoretical frameworks. Some of them were complementary to in-person treatment, while others replaced it. Six interventions (28.5 %) displayed high quality: HealthCall, AB-CASI, Quit Genius, eCHECKUP-TOGO, CBI, and TES. Another nine interventions (42.8 %) were found to have moderate-high quality: Alcohol y Salud, IVR-BI, Program of Wallace et al., Let's Talk About Smoking, SMSalud, ESCAPE, AAC-ASPIRE, iQuit, and Programa VIH. One intervention (4.7 %) had moderate-low quality: Vive sin tabaco ¡Decídete! The remaining five interventions (23.8 %) were found to have very low quality: Connection to health, cSBI, Teen Well Check, the program of Helzer et al. (2008), and Down your drink. The programs with the highest recommendation for addressing alcohol-related issues are HealthCall and AB-CASI; for tobacco use, it is Quit Genius; for cannabis use, it is eCHECKUP-TOGO; for addressing both legal and illegal substances, it is CBI and TES. Finally, for specific illicit drug use, the only recommended program is CBI. This last intervention, CBI, is of the highest quality and, therefore, can be considered a model intervention for dissemination in the primary care setting.
Topics: Humans; Primary Health Care; Substance-Related Disorders; Text Messaging; Telemedicine; Internet; Mobile Applications; Electronic Mail
PubMed: 38821009
DOI: 10.1016/j.addbeh.2024.108073