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Critical Care (London, England) Feb 2023Ethylene glycol (EG) is metabolized into glycolate and oxalate and may cause metabolic acidemia, neurotoxicity, acute kidney injury (AKI), and death. Historically,...
Ethylene glycol (EG) is metabolized into glycolate and oxalate and may cause metabolic acidemia, neurotoxicity, acute kidney injury (AKI), and death. Historically, treatment of EG toxicity included supportive care, correction of acid-base disturbances and antidotes (ethanol or fomepizole), and extracorporeal treatments (ECTRs), such as hemodialysis. With the wider availability of fomepizole, the indications for ECTRs in EG poisoning are debated. We conducted systematic reviews of the literature following published EXTRIP methods to determine the utility of ECTRs in the management of EG toxicity. The quality of the evidence and the strength of recommendations, either strong ("we recommend") or weak/conditional ("we suggest"), were graded according to the GRADE approach. A total of 226 articles met inclusion criteria. EG was assessed as dialyzable by intermittent hemodialysis (level of evidence = B) as was glycolate (Level of evidence = C). Clinical data were available for analysis on 446 patients, in whom overall mortality was 18.7%. In the subgroup of patients with a glycolate concentration ≤ 12 mmol/L (or anion gap ≤ 28 mmol/L), mortality was 3.6%; in this subgroup, outcomes in patients receiving ECTR were not better than in those who did not receive ECTR. The EXTRIP workgroup made the following recommendations for the use of ECTR in addition to supportive care over supportive care alone in the management of EG poisoning (very low quality of evidence for all recommendations): i) Suggest ECTR if fomepizole is used and EG concentration > 50 mmol/L OR osmol gap > 50; or ii) Recommend ECTR if ethanol is used and EG concentration > 50 mmol/L OR osmol gap > 50; or iii) Recommend ECTR if glycolate concentration is > 12 mmol/L or anion gap > 27 mmol/L; or iv) Suggest ECTR if glycolate concentration 8-12 mmol/L or anion gap 23-27 mmol/L; or v) Recommend ECTR if there are severe clinical features (coma, seizures, or AKI). In most settings, the workgroup recommends using intermittent hemodialysis over other ECTRs. If intermittent hemodialysis is not available, CKRT is recommended over other types of ECTR. Cessation of ECTR is recommended once the anion gap is < 18 mmol/L or suggested if EG concentration is < 4 mmol/L. The dosage of antidotes (fomepizole or ethanol) needs to be adjusted during ECTR.
Topics: Humans; Antidotes; Fomepizole; Ethanol; Renal Dialysis; Glycolates; Ethylene Glycol; Poisoning
PubMed: 36765419
DOI: 10.1186/s13054-022-04227-2 -
Systematic Reviews Oct 2023Food-borne diseases are a global public health issue with 1 in 10 people falling ill after eating contaminated food every year. In response, the food industry has... (Meta-Analysis)
Meta-Analysis Review
Food-borne diseases are a global public health issue with 1 in 10 people falling ill after eating contaminated food every year. In response, the food industry has implemented several new pathogen control strategies, such as biotechnological tools using the direct application of bacteriophages for biological control. We have undertaken a systematic review and meta-analysis that evaluated the efficiency of patented phages as a biological control for food-borne pathogens and determined the physical-chemical characteristics of the antimicrobial effect. Included and excluded criteria was developed. Included criteria: Phage patent files with an application in biological control on food and scientific articles and book chapters that used phages patented for food biological control. Excluded criteria: Patent documents, scientific articles, and book chapters that included phage therapy in humans, animals, and biological control on plants but did not have an application on food were not considered in our study. The systematic analysis identified 77 documents, 46 scientific articles, and 31 documents of patents and 23 articles was included in the meta-analysis. Listeria monocytogenes and Salmonella sp. comprised most of the targets identified in the screening, so that we focused on these strains to do the meta-analysis. There are a total of 383 and 192 experiments for Listeria and Salmonella phages for quantitative data analysis.Indexing databases for the bibliographic search (Scopus, Web of Science (WoS) and PubMed (Medline) were addressed by an automated script written in Python 3 Python Core Team (2015) and deposited on GitHub ( https://github.com/glenjasper ).A random-effects meta-analysis revealed (i) significant antimicrobial effect of Listeria phages in apple, apple juice, pear, and pear juice, (ii) significant antimicrobial effect of Salmonella phages in eggs, apple, and ready-to-eat chicken, (iii) no heterogeneity was identified in either meta-analysis, (iv) publication bias was detected for Listeria phages but not for Salmonella phages. (v) ListShield and Felix01 phages showed the best result for Listeria and Salmonella biological control, respectively, (vi) concentration of phage and bacteria, time and food had significant effect in the biological control of Listeria, (vii) temperature and time had a significant effect on the antimicrobial activity of Salmonella phages. The systematic review and meta-analyses to determine the efficiency of bacteriophages previously patented against pathogenic bacteria on dairy products, meat, fruits and vegetables. Besides, the discovering of key factors for efficacy, so that future applications of phage biotechnology in foods can be optimally deployed.
Topics: Anti-Infective Agents; Bacteriophages; Foodborne Diseases; Listeria monocytogenes; Meat
PubMed: 37898821
DOI: 10.1186/s13643-023-02352-9 -
Clinical Toxicology (Philadelphia, Pa.) May 2015The Extracorporeal Treatments in Poisoning workgroup was created to provide evidence-based recommendations on the use of extracorporeal treatments (ECTRs) in poisoning.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The Extracorporeal Treatments in Poisoning workgroup was created to provide evidence-based recommendations on the use of extracorporeal treatments (ECTRs) in poisoning. Here, the workgroup presents its systematic review and recommendations for theophylline.
METHODS
After a systematic review of the literature, a subgroup reviewed articles, extracted data, summarized findings, and proposed structured voting statements following a pre-determined format. A two-round modified Delphi method was chosen to reach a consensus on voting statements and the RAND/UCLA Appropriateness Method was used to quantify disagreement. Anonymous votes were compiled, returned, and discussed. A second vote determined the final recommendations.
RESULTS
141 articles were included: 6 in vitro studies, 4 animal studies, 101 case reports/case series, 7 descriptive cohorts, 4 observational studies, and 19 pharmacokinetic studies, yielding a low-to-very-low quality of evidence for all recommendations. Data on 143 patients were reviewed, including 10 deaths. The workgroup concluded that theophylline is dialyzable (level of evidence = A) and made the following recommendations: ECTR is recommended in severe theophylline poisoning (1C). Specific recommendations for ECTR include a theophylline concentration [theophylline] > 100 mg/L (555 μmol/L) in acute exposure (1C), the presence of seizures (1D), life-threatening dysrhythmias (1D) or shock (1D), a rising [theophylline] despite optimal therapy (1D), and clinical deterioration despite optimal care (1D). In chronic poisoning, ECTR is suggested if [theophylline] > 60 mg/L (333 μmol/L) (2D) or if the [theophylline] > 50 mg/L (278 μmol/L) and the patient is either less than 6 months of age or older than 60 years of age (2D). ECTR is also suggested if gastrointestinal decontamination cannot be administered (2D). ECTR should be continued until clinical improvement is apparent or the [theophylline] is < 15 mg/L (83 μmol/L) (1D). Following the cessation of ECTR, patients should be closely monitored. Intermittent hemodialysis is the preferred method of ECTR (1C). If intermittent hemodialysis is unavailable, hemoperfusion (1C) or continuous renal replacement therapies may be considered (3D). Exchange transfusion is an adequate alternative to hemodialysis in neonates (2D). Multi-dose activated charcoal should be continued during ECTR (1D).
CONCLUSION
Theophylline poisoning is amenable to ECTRs. The workgroup recommended extracorporeal removal in the case of severe theophylline poisoning.
Topics: Bronchodilator Agents; Humans; Poisoning; Renal Dialysis; Theophylline; Treatment Outcome
PubMed: 25715736
DOI: 10.3109/15563650.2015.1014907 -
Toxicon : Official Journal of the... Oct 2021Enterolobium contortisiliquum (Vell.) Morong (Fabaceae) is a plant widely distributed in several regions of Brazil, occurring in the phytogeographic domains of Atlantic... (Review)
Review
Enterolobium contortisiliquum (Vell.) Morong (Fabaceae) is a plant widely distributed in several regions of Brazil, occurring in the phytogeographic domains of Atlantic Forest, Cerrado, and Caatinga. Cases of serious poisoning in cattle, goats, and sheep in the country caused by the ingestion of beans of this species have been reported by several studies. The present work aimed to carry out a systematic review of cases of poisoning by E. contortisiliquum in ruminants and list the main chemical compounds isolated from this plant. For this, searches were performed in the Google Academic, PubMed®, ScienceDirect®, and SciELO databases. A total of 26 articles published in the last 20 years (2001-2021) were included. Studies on cases of natural and experimental poisoning indicate that this species mainly causes photosensitization, abortions, digestive problems, and acute ruminal lactic acidosis in animals that ingest the pods of the plant. The main chemical compounds that occur in the species belong to the triterpene saponins, monoterpene, phenylpropene, and triterpene classes. It is likely that triterpene saponins isolated from E. contortisiliquum are associated with reported cases of photosensitization in cattle. New studies must be conducted to assess the mechanisms of action of chemical compounds isolated from this species in in vivo systems.
Topics: Animals; Brazil; Cattle; Fabaceae; Photosensitivity Disorders; Plant Poisoning; Ruminants; Sheep
PubMed: 34411592
DOI: 10.1016/j.toxicon.2021.08.008 -
Pharmacotherapy May 2021Isoniazid toxicity from self-poisoning or dosing errors remains common in regions of the world where tuberculosis is prevalent. Although the treatment of isoniazid...
Isoniazid toxicity from self-poisoning or dosing errors remains common in regions of the world where tuberculosis is prevalent. Although the treatment of isoniazid poisoning is centered on supportive care and pyridoxine administration, extracorporeal treatments (ECTRs), such as hemodialysis, have been advocated to enhance elimination of isoniazid. No systematic reviews or evidence-based recommendations currently exist on the benefit of ECTRs for isoniazid poisoning. The Extracorporeal Treatments in Poisoning (EXTRIP) workgroup systematically collected and rated the available evidence on the effect of and indications for ECTRs in cases of isoniazid poisoning. We conducted a systematic review of the literature, screened studies, extracted data on study characteristics, outcomes, and measurement characteristics, summarized findings, and formulated recommendations following published EXTRIP methods. Forty-three studies (two animal studies, 34 patient reports or patient series, and seven pharmacokinetic studies) met inclusion criteria. Toxicokinetic or pharmacokinetic analysis was available for 60 patients, most treated with hemodialysis (n = 38). The workgroup assessed isoniazid as "Moderately Dialyzable" by hemodialysis for patients with normal kidney function (quality of evidence = C) and "Dialyzable" by hemodialysis for patients with impaired kidney function (quality of evidence = A). Clinical data for ECTR in isoniazid poisoning were available for 40 patients. Mortality of the cohort was 12.5%. Historical controls who received modern standard care including appropriately dosed pyridoxine generally had excellent outcomes. No benefit could be extrapolated from ECTR, although there was evidence of added costs and harms related to the double lumen catheter insertion, the extracorporeal procedure itself, and the extracorporeal removal of pyridoxine. The EXTRIP workgroup suggests against performing ECTR in addition to standard care (weak recommendation, very low quality of evidence) in patients with isoniazid poisoning. If standard dose pyridoxine cannot be administered, we suggest performing ECTR only in patients with seizures refractory to GABA receptor agonists (weak recommendation, very low quality of evidence).
Topics: Animals; Humans; Isoniazid; Poisoning; Practice Guidelines as Topic; Pyridoxine; Renal Dialysis
PubMed: 33660266
DOI: 10.1002/phar.2519 -
Clinical Toxicology (Philadelphia, Pa.) Jun 2015The EXtracorporeal TReatments In Poisoning (EXTRIP) workgroup presents its systematic review and clinical recommendations on the use of extracorporeal treatment (ECTR)... (Review)
Review
BACKGROUND
The EXtracorporeal TReatments In Poisoning (EXTRIP) workgroup presents its systematic review and clinical recommendations on the use of extracorporeal treatment (ECTR) in valproic acid (VPA) poisoning.
METHODS
The lead authors reviewed all of the articles from a systematic literature search, extracted the data, summarized the key findings, and proposed structured voting statements following a predetermined format. A two-round modified Delphi method was chosen to reach a consensus on voting statements and the RAND/UCLA Appropriateness Method was used to quantify disagreement. Anonymous votes were compiled, returned, and discussed in person. A second vote was conducted to determine the final workgroup recommendations.
RESULTS
The latest literature search conducted in November 2014 retrieved a total of 79 articles for final qualitative analysis, including one observational study, one uncontrolled cohort study with aggregate analysis, 70 case reports and case series, and 7 pharmacokinetic studies, yielding a very low quality of evidence for all recommendations. Clinical data were reported for 82 overdose patients while pharmaco/toxicokinetic grading was performed in 55 patients. The workgroup concluded that VPA is moderately dialyzable (level of evidence = B) and made the following recommendations: ECTR is recommended in severe VPA poisoning (1D); recommendations for ECTR include a VPA concentration > 1300 mg/L (9000 μmol/L)(1D), the presence of cerebral edema (1D) or shock (1D); suggestions for ECTR include a VPA concentration > 900 mg/L (6250 μmol/L)(2D), coma or respiratory depression requiring mechanical ventilation (2D), acute hyperammonemia (2D), or pH ≤ 7.10 (2D). Cessation of ECTR is indicated when clinical improvement is apparent (1D) or the serum VPA concentration is between 50 and 100 mg/L (350-700 μmol/L)(2D). Intermittent hemodialysis is the preferred ECTR in VPA poisoning (1D). If hemodialysis is not available, then intermittent hemoperfusion (1D) or continuous renal replacement therapy (2D) is an acceptable alternative.
CONCLUSIONS
VPA is moderately dialyzable in the setting of overdose. ECTR is indicated for VPA poisoning if at least one of the above criteria is present. Intermittent hemodialysis is the preferred ECTR modality in VPA poisoning.
Topics: Anticonvulsants; Drug Overdose; Hemoperfusion; Humans; Poisoning; Renal Dialysis; Treatment Outcome; Valproic Acid
PubMed: 25950372
DOI: 10.3109/15563650.2015.1035441 -
Journal of Forensic and Legal Medicine Jan 2018Carbon monoxide (CO) poisoning is a common cause of emergency department (ED) visits worldwide with high levels of morbidity and mortality. No inclusive nationally... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Carbon monoxide (CO) poisoning is a common cause of emergency department (ED) visits worldwide with high levels of morbidity and mortality. No inclusive nationally statistics of CO poisoning in Iran is available. The present review aimed to describe and review the pattern of CO poisoning in Iran.
METHODS
The search of Medline, SCOPUS, Cochrane library, Google Scholar, Magiran, IranDoc and SID (Scientific Information Database) yielded only 10 studies discussing the epidemiology of CO poisoning in Iran. Outcomes of interest were determining the demographic characteristics, prevalence and mortality rates, annual trends, main sources and mechanisms, location of incidents of CO poisoning as well as providing the safety awareness and precautions.
RESULTS
Totally, 10 studies including 6372 victims of CO poisoning were reviewed. The estimated incidence rate of CO poisoning was 38.91 per 100,000, the proportionate mortality rate was 11.6 per 1000 death and the pooled case fatality rate of was 9.5% (95% CI 6.3%-14.30%). Of the total 5105 individuals with CO poisoning, 2048 (40.12%) were male and 3057 (59.88%) were female. In addition, of 5105 poisoned, 4620 (90.50%) were alive and 485 (9.50%) were dead. The number of fatal CO poisoning cases among men and women were 259 (5.07%) and 226 (4.43%) victims, respectively; while the number of non-fatal CO poisoning cases among men and women were 1790 (35.06%) and 2830 (55.44%) individuals, respectively. The mean age of victims was about 30 years. Most of the victims (36.37%) had the educational level of secondary school, marital status of single (52.74%), and occupational status of housekeeper (27.48%).
CONCLUSION
The incidence, proportionate mortality and case fatality rates of CO poisoning is high in Iran, particularly in young individuals. It seems that preventive strategies should be taught by health care providers more thoroughly and implemented by policy makers more strictly as a mandatory law.
Topics: Age Distribution; Carbon Monoxide Poisoning; Educational Status; Humans; Incidence; Iran; Marital Status; Occupations; Sex Distribution
PubMed: 29220732
DOI: 10.1016/j.jflm.2017.11.008 -
Critical Reviews in Food Science and... May 2018The aim of this study was to assess the mean of histamine concentration in food poisoning. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The aim of this study was to assess the mean of histamine concentration in food poisoning.
DESIGN
Systematic review and meta-analysis of reports published between 1959 and 2013.
STUDY SELECTION
Main criteria for inclusion of studies were: all report types that present outbreaks of "histamine poisoning' or "scombroid syndrome" from food, including histamine content and type of food. Health status of people involved must be nonpathological.
RESULTS
Fifty-five (55) reports were included, these studies reported 103 incidents. All pooled analyses were based on random effect model; histamine mean concentration in poisoning samples was 1107.21 mg/kg with confidence interval for the meta-mean of 422.62-2900.78 mg/kg; heterogeneity index (I2) was 100% (P < 0.0001); prediction interval was 24.12-50822.78 mg/kg. Fish involved in histamine poisoning was mainly tuna or Istiophoridae species. No clues of association between concomitant conditions (female sex, alcohol consumption, previous medication, and consumption of histamine releasing food) and histamine poisoning, were highlighted.
CONCLUSIONS
This is the first systematic review and meta-analysis that analyzes all the available data on histamine poisoning outbreaks evaluating the histamine concentration in food involved. Histamine mean concentration in poisoning samples was fairly high. Our study suffers from some limitations, which are intrinsic of the studies included, for instance the lack of a complete anamnesis of each poisoning episode. Protocol registration: Methods were specified in advance and have been published as a protocol in PROSPERO database (18/07/2012 -CRD42012002566).
Topics: Animals; Fishes; Food Contamination; Foodborne Diseases; Histamine; Humans; Marine Toxins
PubMed: 27791395
DOI: 10.1080/10408398.2016.1242476 -
Epidemiology and Infection Aug 2017Accurate knowledge of pathogen incubation period is essential to inform public health policies and implement interventions that contribute to the reduction of burden of... (Meta-Analysis)
Meta-Analysis Review
Accurate knowledge of pathogen incubation period is essential to inform public health policies and implement interventions that contribute to the reduction of burden of disease. The incubation period distribution of campylobacteriosis is currently unknown with several sources reporting different times. Variation in the distribution could be expected due to host, transmission vehicle, and organism characteristics, however, the extent of this variation and influencing factors are unclear. The authors have undertaken a systematic review of published literature of outbreak studies with well-defined point source exposures and human experimental studies to estimate the distribution of incubation period and also identify and explain the variation in the distribution between studies. We tested for heterogeneity using I 2 and Kolmogorov-Smirnov tests, regressed incubation period against possible explanatory factors, and used hierarchical clustering analysis to define subgroups of studies without evidence of heterogeneity. The mean incubation period of subgroups ranged from 2·5 to 4·3 days. We observed variation in the distribution of incubation period between studies that was not due to chance. A significant association between the mean incubation period and age distribution was observed with outbreaks involving only children reporting an incubation of 1·29 days longer when compared with outbreaks involving other age groups.
Topics: Campylobacter Infections; Disease Outbreaks; Foodborne Diseases; Humans; Infectious Disease Incubation Period
PubMed: 28669361
DOI: 10.1017/S0950268817001303 -
Seminars in Neurology Aug 2015Toxic neuropathies are a rare, but important cause of acquired polyneuropathy. In this review article, the authors discuss the general principles of toxic neuropathies... (Review)
Review
Toxic neuropathies are a rare, but important cause of acquired polyneuropathy. In this review article, the authors discuss the general principles of toxic neuropathies and provide a systematic review of neuropathies related to drugs, heavy metals, environmental and industrial agents, and alcoholic neuropathies.
Topics: Environmental Exposure; Humans; Neurotoxicity Syndromes; Occupational Exposure; Polyneuropathies
PubMed: 26502767
DOI: 10.1055/s-0035-1558977