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Ann Intern Med 2002 Jul 2;137(1):75
Publication Types:
PMID: 12093262, UI: 22088078
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Ann Intern Med 2002 Jul 2;137(1):74
PMID: 12093261, UI: 22088077
Gastroenterol Clin Biol 2002 Mar;26(3):300-1
PMID: 11981480, UI: 21977368
Gastroenterol Clin Biol 2002 Mar;26(3):295-7
PMID: 11981477, UI: 21977365
Hum Exp Toxicol 2002 Mar;21(3):123-7
Division of Clinical Pharmacology and Toxicology, The Hospital for Sick Children, Toronto, Ontario, Canada. eran.kozer@sickkids.on.ca
[Medline record in process]
BACKGROUND: Acetaminophen is frequently used in self-poisoning in Western countries. Although treatment with N-acetylcysteine (NAC) reduces liver injury, no consensus exists on the preferred management of acetaminophen toxicity. OBJECTIVES: To describe the approach taken by toxicologists in North America and Europe toward the management of acetaminophen toxicity. Methods: Medical directors of poison centers in the US, Canada, and Europe were surveyed by means of a questionnaire presenting two clinical scenarios of acetaminophen overdose: a healthy adolescent with no risk factors who had an acute ingestion of acetaminophen, and an adult with both acute ingestion and possible risk factors. For each case, several questions about the management of these patients were asked. RESULTS: Questionnaires were sent to medical directors of 76 poison centers in North America and 48 in Europe, with response rates of 62% and 44%, respectively. Forty percent of responders suggested using charcoal 4 hours after ingestion of a potential toxic dose of acetaminophen, and 90% recommended treatment with NAC when levels were above 150 microg/mL but below 200 microg/mL 4 hours after ingestion. Duration of treatment with oral NAC ranged from 24 to 96 hours; 38 responders suggested a duration of 72 hours. Of 49 centers recommending oral NAC, 18 (36.7%) said they might consider treatment for less than 72 hours. Eleven of 29 (37.9%) responders suggested treatment with intravenous NAC for more than 20 hours as their usual protocol or a protocol for specific circumstances. CONCLUSIONS: Our study showed large variability in the management of acetaminophen overdose. Variations in treatment protocols should be addressed in clinical trials to optimize the treatment for this common problem.
PMID: 12102537, UI: 22096850
Hum Exp Toxicol 2002 Apr;21(4):175-7
Department of Internal Medicine, University of Yuzuncu Yil, Medical Faculty, Van, Turkey. idrissahin41@hotmail.com
OBJECTIVE: The aim of this study was to evaluate the prevalence of pancreatitis in cases of organophosphate (OP) poisonings admitted to Yuzuncu Yil University Teaching Hospital over an 18-month period. MATERIALS AND METHODS: A total of 47 patients of acute poisoning with OP insecticides attended the Emergency Department of the Yuzuncu Yil Medical School Hospital, from May 1999 to December 2000, and were prospectively studied. Serum amylase and lipase levels were studied with colorimetric assay. Serum SGOT, SGPT, LDH, CPK, K levels, leukocyte count and total hospitalization days were also evaluated. RESULTS: Four of 47 patients had obviously elevated amylase and lipase levels (amylase >300 U/L, lipase >60 U/L). Only two of the patients with amylase levels between 100 and 300 U/L had also elevated levels of lipase. None of the patients with normal amylase levels had elevated levels of lipase. A total of 12.76% was diagnosed as acute pancreatitis. CONCLUSION: Acute pancreatitis as a complication of OP intoxication is not a rare condition. In order to improve the outcome of OP poisoning, early diagnosis of acute pancreatitis is important and serum levels of amylase and lipase should be routinely considered carefully. In acute pancreatitis, serum levels of SGOT, SGPT, LDH and leukocyte counts may also be found to be elevated. However, serum K levels are only slightly decreased.
PMID: 12099618, UI: 22093954
Hum Exp Toxicol 2002 Apr;21(4):171-4
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories. tykchan@cuhk.edu.hk
Ingestion of medicated oils containing methyl salicylate poses the threat of severe, rapid-onset salicylate poisoning. In this retrospective study of 24 adults who had ingested 'White Flower Oil' (n=18) or 'Red Flower Oil' (n=6), the main objective was to determine if the risk of severe salicylate poisoning was related to the product packaging. 'Red Flower Oil' had a large bottle opening so that its content could be emptied much more easily. It also had a larger bottle size and usually had a higher methyl salicylate concentration than 'White Flower Oil'. Patients tended to ingest a greater amount of 'Red Flower Oil' than 'White Flower Oil'. Five per cent of subjects who had taken 'White Flower Oil', but 67% of subjects who had taken 'Red Flower Oil', had admission plasma salicylate level >2.2 mmol/L (P=0.006). None of the subjects who had ingested 'White Flower Oil', but 50% of subjects who had taken 'Red Flower Oil', had moderate to severe symptoms (P=0.010). As a result, none of the subjects who had ingested 'White Flower Oil', but 33% of subjects who had taken 'Red Flower Oil', required urine alkalinization (P=0.054). One patient who had taken 'Red Flower Oil' died because of hospital-acquired pneumonia. All other patients made a complete recovery. To reduce the amount of methyl salicylate that can be readily swallowed during accidental or deliberate ingestion of medicated oils, improvements are needed in the existing packaging of these products.
PMID: 12099617, UI: 22093953
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J R Soc Med 2002 Jun;95(6):304-5
Department of Medicine and Geriatrics, Shatin Hospital, Hong Kong Special Administrative Region, China. dreddiewong@hotmail.com
PMID: 12042382, UI: 22038224
JAMA 2002 Jul 3;288(1):43; discussion 44
PMID: 12090858, UI: 22086491
Lancet 2002 Jun 22;359(9324):2164
Service of Neurology, University Hospital Marques de Valdecilla, 39008 Santander, Spain. polojm@unican.es
PMID: 12090983, UI: 22086518
N Engl J Med 2002 Jul 4;347(1):13-8
Chapel Hill Dermatology, Chapel Hill, NC 27514, USA. mark_fradin@med.unc.edu
BACKGROUND: The worldwide threat of arthropod-transmitted diseases, with their associated morbidity and mortality, underscores the need for effective insect repellents. Multiple chemical, botanical, and "alternative" repellent products are marketed to consumers. We sought to determine which products available in the United States provide reliable and prolonged complete protection from mosquito bites. METHODS: We conducted studies involving 15 volunteers to test the relative efficacy of seven botanical insect repellents; four products containing N,N-diethyl-m-toluamide, now called N,N-diethyl-3-methylbenzamide (DEET); a repellent containing IR3535 (ethyl butylacetylaminopropionate); three repellent-impregnated wristbands; and a moisturizer that is commonly claimed to have repellent effects. These products were tested in a controlled laboratory environment in which the species of the mosquitoes, their age, their degree of hunger, the humidity, the temperature, and the light-dark cycle were all kept constant. RESULTS: DEET-based products provided complete protection for the longest duration. Higher concentrations of DEET provided longer-lasting protection. A formulation containing 23.8 percent DEET had a mean complete-protection time of 301.5 minutes. A soybean-oil-based repellent protected against mosquito bites for an average of 94.6 minutes. The IR3535-based repellent protected for an average of 22.9 minutes. All other botanical repellents we tested provided protection for a mean duration of less than 20 minutes. Repellent-impregnated wristbands offered no protection. CONCLUSIONS: Currently available non-DEET repellents do not provide protection for durations similar to those of DEET-based repellents and cannot be relied on to provide prolonged protection in environments where mosquito-borne diseases are a substantial threat.
PMID: 12097535, UI: 22092560
N Engl J Med 2002 Jul 4;347(1):2-3
Harvard School of Public Health, Boston, MA 02115, USA.
PMID: 12097533, UI: 22092558
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