-
American Journal of Public Health Oct 2012We conducted a systematic literature review to better understand aspects of disaster-related carbon monoxide (CO) poisoning surveillance and determine potentially... (Review)
Review
OBJECTIVES
We conducted a systematic literature review to better understand aspects of disaster-related carbon monoxide (CO) poisoning surveillance and determine potentially effective prevention strategies.
METHODS
This review included information from 28 journal articles on disaster-related CO poisoning cases occurring between 1991 and 2009 in the United States.
RESULTS
We identified 362 incidents and 1888 disaster-related CO poisoning cases, including 75 fatalities. Fatalities occurred primarily among persons who were aged 18 years or older (88%) and male (79%). Hispanics and Asians accounted for 20% and 14% of fatal cases and 21% and 7% of nonfatal cases, respectively. Generators were the primary exposure source for 83% of fatal and 54% of nonfatal cases; 67% of these fatal cases were caused by indoor generator placement. Charcoal grills were a major source of exposure during winter storms. Most fatalities (94%) occurred at home. Nearly 89% of fatal and 53% of nonfatal cases occurred within 3 days of disaster onset.
CONCLUSIONS
Public health prevention efforts could benefit from emphasizing predisaster risk communication and tailoring interventions for racial, ethnic, and linguistic minorities. These findings highlight the need for surveillance and CO-related information as components of disaster preparedness, response, and prevention.
Topics: Adolescent; Adult; Carbon Monoxide Poisoning; Female; Humans; Male; Middle Aged; United States; Young Adult
PubMed: 22897556
DOI: 10.2105/AJPH.2012.300674 -
BMJ Clinical Evidence Mar 2007Acute organophosphorus poisoning occurs after dermal, respiratory, or oral exposure to either low-volatility pesticides (e.g. chlorpyrifos, dimethoate) or... (Review)
Review
INTRODUCTION
Acute organophosphorus poisoning occurs after dermal, respiratory, or oral exposure to either low-volatility pesticides (e.g. chlorpyrifos, dimethoate) or high-volatility nerve gases (e.g. sarin, tabun). Most cases occur in resource-poor countries as a result of occupational or deliberate exposure to organophosphorus pesticides.
METHODS AND OBJECTIVES
We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for acute organophosphorus poisoning? We searched: Medline, Embase, The Cochrane Library and other important databases up to August 2006 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 22 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following interventions: activated charcoal, alpha2 adrenergic receptor agonists, atropine, benzodiazepines, butyrylcholinesterase replacement therapy, cathartics, extracorporeal clearance, gastric lavage, glycopyrronium bromide, ipecacuanha, magnesium sulphate, milk or other home remedies, N-methyl-D-aspartate receptor antagonists, organophosphorus hydrolases, oximes, sodium bicarbonate, washing the poisoned person and removing contaminated clothing.
Topics: Acute Disease; Administration, Oral; Charcoal; Gastric Lavage; Humans; Organophosphate Poisoning; Oximes; Pesticides; Receptors, N-Methyl-D-Aspartate; Sodium Bicarbonate
PubMed: 19454054
DOI: No ID Found -
Psychopharmacology May 2024Synthetic cathinones (SC), commonly referred to as "bath salts", are stimulants resembling the natural alkaloid cathinone found in the khat plant. These substances have... (Meta-Analysis)
Meta-Analysis Review
RATIONALE
Synthetic cathinones (SC), commonly referred to as "bath salts", are stimulants resembling the natural alkaloid cathinone found in the khat plant. These substances have the potential to induce serious health risks such as hallucinations, delusions, paranoia and agitation which can lead to substance-induced psychotic disorders. Despite growing concerns, there is a limited understanding of the association between SC consumption and the devolvement of such psychopathologies.
METHODS
We conducted a systematic review to investigate the frequency of substance-induced psychotic disorder (SIPD) and associated conditions in humans following synthetic cathinone consumption. We qualitatively and quantitatively analyzed SC exposure cases.
RESULTS
A total of 32 studies were included, with a diverse range of demographics, synthetic cathinone types, and consumption patterns. The proportion of individuals developing psychotic symptoms was reported at 0.380 (Random-effects model, 95% CI 0.289 - 0.475). Additionally, the significant heterogeneity in diagnostic approaches limited our ability to provide a precise estimate of prevalence.
CONCLUSIONS
Synthetic cathinone consumption is associated with the risk of developing psychotic symptoms as indicated by the prevalence of hallucinations and/or delusions. Due to the lack of information on classifying factors, particularly duration of symptoms, we are unable to conclude synthetic cathinone-induced psychosis. Further research is warranted to elucidate the underlying mechanism linking synthetic cathinone consumption and psychosis. This review underscores the urgency of addressing the growing health risks posed by synthetic cathinone use. Additionally, it highlights the necessity of proper quantification of psychotic symptoms through scales and reporting of classification criteria to accurately diagnose SIPD.
Topics: Humans; Synthetic Cathinone; Central Nervous System Stimulants; Substance-Related Disorders; Psychoses, Substance-Induced; Hallucinations
PubMed: 38446172
DOI: 10.1007/s00213-024-06569-x -
Clinical Toxicology (Philadelphia, Pa.) Jan 2023Risk stratification in paracetamol (acetaminophen) poisoning is crucial because hepatotoxicity is common and can be mitigated with treatment. However, current risk... (Meta-Analysis)
Meta-Analysis
Performance of the paracetamol-aminotransferase multiplication product in risk stratification after paracetamol (acetaminophen) poisoning: a systematic review and meta-analysis.
BACKGROUND
Risk stratification in paracetamol (acetaminophen) poisoning is crucial because hepatotoxicity is common and can be mitigated with treatment. However, current risk stratification tools have limitations.
AIMS
We evaluated the diagnostic performance of the paracetamol concentration × aminotransferase multiplication product, for predicting hepatotoxicity after paracetamol overdose.
METHODS
Medline, Cochrane Library and Embase were searched for eligible papers. We used random effects models to obtain pooled estimates of the likelihood ratios and diagnostic odds ratios, from which sensitivity and specificity were computed. We assessed two commonly used cut-off values of paracetamol × aminotransferase, 1500 mg/L × IU/L and 10,000 mg/L × IU/L. Using the confusion matrices of these two cut-offs, area under the summary receiver operator characteristic curve and optimal cut-off values in different clinical scenarios were established.
RESULTS
Six studies comprising 5036 participants were included. In 4051 patients, using the cut-off of 1500 mg/L × IU/L, a diagnostic odds ratio of 31.90 (95%CI: 9.52-106.90), sensitivity of 0.98 (95%CI: 0.94-1.00) and specificity of 0.66 (95%CI: 0.49-0.89) were obtained. In 3983 patients, using the cut-off of 10,000 mg/L × IU/L, a diagnostic odds ratio of 99.34 (95%CI: 12.26-804.87), sensitivity of 0.65 (95%CI: 0.51-0.82) and specificity of 0.97 (95%CI: 0.95-1.00) were obtained. For staggered ingestions, the 1500 mg/L × IU/L cut-off yielded a diagnostic odds ratio of 69.53 (95%CI: 4.03-1199.75), sensitivity of 1.00 (95%CI: 0.87-1.00) and specificity of 0.74 (95%CI: 0.43-1.00). Next, using the 10,000 mg/L × IU/L cut-off in this scenario yielded a diagnostic odds ratio of 254.58 (95%CI: 11.12-5827.60), sensitivity of 0.79 (95%CI: 0.59-1.00) and specificity of 0.98 (95%CI: 0.94-1.00). The overall summary receiver operator characteristic curve was 0.91 (95%CI: 0.75-0.97), and the optimal cut-off value was 3840 mg/L × IU/L. The summary receiver operator characteristic curve in patients with staggered ingestions was 0.96 (95%CI: 0.85-0.99). The summary receiver operator characteristic curve in patients with staggered ingestions and whose paracetamol concentration was below the detectable limit of 10 mg/L at presentation was 0.97 (95%CI: 0.94-0.99).
CONCLUSION
In this first meta-analysis, paracetamol × aminotransferase demonstrates its use in prognosticating hepatotoxicity in patients with paracetamol poisoning. It complements the Rumack-Matthew nomogram as it has shown promise in addressing two key limitations of the nomogram: it is usable after more than 24 h between overdose and acetylcysteine treatment, and it is applicable in staggered ingestions.
Topics: Humans; Acetaminophen; Analgesics, Non-Narcotic; Chemical and Drug Induced Liver Injury; Alanine Transaminase; Drug Overdose; Drug-Related Side Effects and Adverse Reactions; Risk Assessment; Retrospective Studies
PubMed: 36444937
DOI: 10.1080/15563650.2022.2152350 -
The Cochrane Database of Systematic... Sep 2015Lithium salts, particularly lithium carbonate, are frequently used to treat bipolar disorder and mania. Lithium poisoning, which can occur as a result of reduced renal... (Review)
Review
BACKGROUND
Lithium salts, particularly lithium carbonate, are frequently used to treat bipolar disorder and mania. Lithium poisoning, which can occur as a result of reduced renal elimination, prescribing error, drug-drug interactions, or deliberate overdosage, produces neurologic injury that can be permanent. Hemodialysis is often recommended to treat lithium poisoning. Although hemodialysis clearly enhances the elimination of lithium, it is unclear whether this translates into improved patient outcomes. Evidence from observational studies, generally of low methodological quality, shows similar outcomes in patients managed with or without the use of hemodialysis.
OBJECTIVES
To determine whether hemodialysis, applied in addition to standard therapy, reduces the likelihood, severity, or duration of neurological sequelae following lithium poisoning.
SEARCH METHODS
We ran the search on 15 May 2015. We searched the Cochrane Injuries Group's Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), MEDLINE (OvidSP), Embase Classic+Embase (OvidSP), CINAHL Plus, clinical trials registers and four other databases. We screened the reference lists of relevant studies, textbook chapters, and review articles, and performed a Google search to identify grey literature.
SELECTION CRITERIA
In the context of this review, hemodialysis was defined as any extracorporeal technique to filter and extract toxicants from the serum, including all forms of hemodialysis, hemofiltration, and continuous renal replacement techniques, but not peritoneal dialysis. We included any clinical trials in which patients were randomly allocated to receive, or not receive, hemodialysis in addition to standard care for lithium poisoning.
DATA COLLECTION AND ANALYSIS
Two authors reviewed the abstracts of all identified articles. If either author identified an article as potentially meeting the inclusion criteria, both authors reviewed the full text of the article.
MAIN RESULTS
No randomized controlled trials of hemodialysis therapy for lithium poisoning were identified.
AUTHORS' CONCLUSIONS
Although the use of hemodialysis to enhance the elimination of lithium in patients with lithium poisoning appears logical, there is no evidence from randomized controlled trials to support nor refute the use of hemodialysis in the management of patients with lithium poisoning.
Topics: Humans; Lithium Carbonate; Lithium Compounds; Poisoning; Renal Dialysis
PubMed: 26374731
DOI: 10.1002/14651858.CD007951.pub2 -
Journal of the Peripheral Nervous... Dec 2022Chemotherapy-induced peripheral neurotoxicity (CIPN) diagnosis is largely based on patient reported outcomes. Wearables, sensors, and smart devices may potentially... (Review)
Review
Wearables, sensors, and smart devices for the detection and monitoring of chemotherapy-induced peripheral neurotoxicity: Systematic review and directions for future research.
Chemotherapy-induced peripheral neurotoxicity (CIPN) diagnosis is largely based on patient reported outcomes. Wearables, sensors, and smart devices may potentially provide early detection and monitoring of CIPN. We systematically reviewed data on wearables, sensors, and smart devices to detect and/or monitor signs and symptoms of CIPN. Moreover, we provide directions and recommendations for future studies. A literature search using PubMed/MEDLINE, Web of Science, IEEE Xplore, and CINHAL databases was conducted from database inception until March 2021. The search was further updated in July 2022 to ensure currency of results. A total of 1885 records were title-abstract screened, 33 full texts were assessed, and 16 were included. The retrieved papers were heterogeneous in terms of study design, sample size, CIPN severity, chemotherapy agents, type of wearable/sensor/device applied, parameters of interest, and purpose. Data are promising and provide preliminary evidence on wearables, sensors, and smart devices for CIPN detection and monitoring. There are several issues and knowledge gaps that should be addressed. We propose a framework for future studies.
Topics: Humans; Wearable Electronic Devices; Antineoplastic Agents; Neurotoxicity Syndromes
PubMed: 36224713
DOI: 10.1111/jns.12518 -
PLoS Neglected Tropical Diseases Feb 2023Snakebite envenoming is a serious and life-threatening medical condition that predominantly affects people living in rural communities across Africa, Asia, and Latin... (Meta-Analysis)
Meta-Analysis Review
Assessing knowledge and awareness regarding snakebite and management of snakebite envenoming in healthcare workers and the general population: A systematic review and meta-analysis.
BACKGROUND
Snakebite envenoming is a serious and life-threatening medical condition that predominantly affects people living in rural communities across Africa, Asia, and Latin America. As our climate changes, there is a growing concern that negative human-snake interactions will increase. Our ability to prevent and manage snakebite requires effective antivenoms as well as knowledge regarding the prevention and management of snakebite among healthcare workers and affected communities across the globe. This systematic review aims to assess existing levels of knowledge regarding snakebite prevention and management in both healthcare workers and affected communities.
METHODS
This review was conducted on studies reporting quantitative measurements to evaluate knowledge and practice regarding snakebite prevention and management published in major databases between 1 January 2000 and 31 December 2021. Random effects modelling was used to obtain the pooled proportion. Heterogeneity (I2) was tested, and sensitivity analyses performed.
RESULTS
Out of 3,697 records, 16 studies from 12 countries assessing 7,640 participants were included. Four of the studies were ranked as good quality studies, 9 as fair, and 3 as poor. This study results demonstrated that 56% of the study population answered the knowledge question correctly (95% CI 48% to 63%, p < 0.001). High heterogeneity was observed (I2 = 97.29%), with marginal publication bias (Egger's regression test, p = 0.0814). Participants had relatively higher knowledge concerning use of antivenom as preferred treatment, followed by snakebite prevention, knowledge of signs and symptoms of snakebite, knowledge of first-aid, and knowledge of treatment. Participants had lower knowledge relating to types of snakes and the identification of snakes.
CONCLUSION
Adequate knowledge about snakebites and its management among the general population and healthcare workers was 56%. Healthcare workers and communities across Asia showed higher relative knowledge compared to those in Africa and the Middle East. These data suggest that further education is needed in both the general population and among healthcare workers to ensure that appropriate preventative and patient management techniques are being utilised in snakebite endemic regions. Greater local awareness of the risks and appropriate management of snakebite is required to reduce the burden of snakebite mortality and morbidity.
Topics: Animals; Humans; Snake Bites; Snakes; Antivenins; Health Personnel; Africa
PubMed: 36757933
DOI: 10.1371/journal.pntd.0011048 -
Journal of Receptor and Signal... Apr 2017Mustard gas (e.g. sulfur mustard (SM)) has been used as a chemical agent in several battles and is still a potential worldwide menace. Besides local absorption,... (Review)
Review
CONTEXT
Mustard gas (e.g. sulfur mustard (SM)) has been used as a chemical agent in several battles and is still a potential worldwide menace. Besides local absorption, particularly in the skin, eyes and lungs, systemic spread of the agent also has detrimental effects on gonads, bone marrow and nervous system. Moreover, chronic exposure of SM to respiratory system causes death. Inducing oxidative stress, and disturbing DNA and tissue repair systems, inflammation and cell death signaling pathways have been introduced as molecular mechanisms of the injury.
METHODS
In this systematic review, more than 1200 (2000-2014) articles focusing on gross or molecular pathological reports in the acute phase of the respiratory injury after SM exposure were reviewed, followed by two different layers of gross and molecular pathological data (clinic and laboratory) integrated together in a spatio-temporal order. Role of epithelial, neutrophil and macrophage cells and three signaling pathways of inflammation, oxidative stress and cell death are covered in details.
RESULTS AND CONCLUSION
Our results propose a critical role of interleukin-17 producing cells in acute and chronic inflammatory responses.
Topics: Cell Death; Chemical Warfare Agents; DNA Damage; DNA Repair; Inflammation; Interleukin-17; Mustard Gas; Oxidative Stress; Signal Transduction
PubMed: 27485024
DOI: 10.1080/10799893.2016.1212374 -
The Journal of Forensic... Aug 2022The forensic role of microbiology in bite mark analysis as evidence in a court of law has not yet been explored, as the analysis of bite marks is mostly...
The forensic role of microbiology in bite mark analysis as evidence in a court of law has not yet been explored, as the analysis of bite marks is mostly morphology-based. The aim of this systematic review is to investigate if the analysis of the oral microbiota may be helpful as a complementary forensic tool. Articles were searched on the PubMed database, using predefined data fields and keywords. The final selection included a total of 6 papers (out of 42). Our results indicated that the Streptococcus genus is a key player in the analysis of bite mark microbiology from a forensic perspective and its genomic analysis may facilitate the association of a bite mark to the perpetrator. However, much more research is still needed before this forensic strategy can be applied in real scenarios. There is a need to optimize and standardize the methods of microbiome analysis and to determine several factors that may influence the results, such as the frequency of bacterial genotypes in the human population and the temporal stability of the oral microbiome on human skin.
Topics: Bites and Stings; Bites, Human; Forensic Dentistry; Forensic Medicine; Humans; Streptococcus
PubMed: 36027898
DOI: No ID Found -
BMC Public Health Apr 2013The rate of non-fatal self-poisoning in Sri Lanka has increased in recent years, with associated morbidity and economic cost to the country. This review examines the... (Review)
Review
BACKGROUND
The rate of non-fatal self-poisoning in Sri Lanka has increased in recent years, with associated morbidity and economic cost to the country. This review examines the published literature for the characteristics and factors associated with non-fatal self-poisoning in Sri Lanka.
METHODS
Electronic searches were conducted in Psychinfo, Proquest, Medline and Cochrane databases from inception to October 2011.
RESULTS
26 publications (representing 23 studies) were eligible to be included in the review. A majority of studies reported non-fatal self-poisoning to be more common among males, with a peak age range of 10-30 years. Pesticide ingestion was the most commonly used method of non-fatal self-poisoning. However three studies conducted within the last ten years, in urban areas of the country, reported non-fatal self-poisoning by medicinal overdose to be more common, and also reported non-fatal self-poisoning to be more common among females. Interpersonal conflict was the most commonly reported short-term stressor associated with self-poisoning. Alcohol misuse was reported among males who self-poisoned, and data regarding other psychiatric morbidity was limited.
CONCLUSIONS
The findings indicate that pesticide ingestion is the commonest method of non-fatal self-poisoning in Sri Lanka, and it is more common among young males, similar to other Asian countries. However there appears to be an emerging pattern of increasing medicinal overdoses, paralleled by a gender shift towards increased female non-fatal self-poisoning in urban areas. Many non-fatal self-poisoning attempts appear to occur in the context of acute interpersonal stress, with short premeditation, and associated with alcohol misuse in males. Similar to other Asian countries, strategies to reduce non-fatal self-poisoning in Sri Lanka require integrated intervention programs with several key aspects, including culturally appropriate interventions to develop interpersonal skills in young people, community based programs to reduce alcohol misuse, and screening for and specific management of those at high risk of repetition following an attempt of self-poisoning.
Topics: Adolescent; Adult; Age Distribution; Child; Female; Humans; Male; Poisoning; Self-Injurious Behavior; Sex Distribution; Sri Lanka
PubMed: 23575389
DOI: 10.1186/1471-2458-13-331