About Entrez
Text Version
Entrez PubMed
Overview
Help |
FAQ
Tutorial
New/Noteworthy
E-Utilities
PubMed Services
Journals Database
MeSH Database
Single Citation Matcher
Batch Citation Matcher
Clinical Queries
LinkOut
Cubby
Related Resources
Order Documents
NLM Catalog
NLM Gateway
TOXNET
Consumer Health
Clinical Alerts
ClinicalTrials.gov
PubMed Central
|
|
Items 1 - 25 of 25 |
One page. |
Comment on:
Tricyclic antidepressant treatment ambiguities.
Seger D.
Publication Types:
PMID: 15259163 [PubMed - indexed for MEDLINE]
-
Anaphylaxis after Rattlesnake bite.
Camilleri C, Offerman S.
Publication Types:
PMID: 15259161 [PubMed - indexed for MEDLINE]
Comment in:
The epidemiology of case fatality rates for suicide in the northeast.
Miller M, Azrael D, Hemenway D.
Harvard School of Public Health, Boston, MA 02115, USA. mmiller@hsph.harvard.edu
STUDY OBJECTIVE: We examine how method-specific case fatality rates for suicide differ by age and sex. METHODS: Seven northeastern states provided mortality and hospital discharge data (1996 to 2000). Suicide acts were divided into 8 categories according to the method used. For each method, the fraction of acts resulting in death (the method-specific case fatality rate) was calculated. Only suicide acts that resulted in hospitalization or death were included. RESULTS: Overall, 13% of all suicide acts proved lethal (23% for males compared with 5% for females; 7% for people aged 15 to 24 years compared with 34% for individuals aged > or =65 years). Poisoning with drugs accounted for 74% of acts but only 14% of fatalities; firearms and hanging accounted for only 10% of acts but 67% of fatalities. Firearms were the most lethal means (91% resulted in death), followed by drowning (84%) and hanging (82%). For every means, method-specific case fatality rates were higher for male victims and older individuals. Age and sex were associated with overall case fatality rates primarily because of their association with the distribution of methods chosen. CONCLUSION: Our findings are based on suicide acts that result in hospitalization or death and therefore underestimate the actual incidence of suicide acts and overestimate case fatality rates. Nevertheless, we find that age and sex influence overall case fatality rates primarily through their association with methods used, rather than because of variation in method-specific case fatality rates.
PMID: 15159703 [PubMed - indexed for MEDLINE]
-
Buprenorphine: a primer for emergency physicians.
Sporer KA.
Department of Emergency Services, San Francisco General Hospital, University of California-San Francisco, San Francisco, CA 94110, USA. ksporer@itsa.ucsf.edu
The recent approval of office-based treatment for opioid addiction and US Food and Drug Administration approval of buprenorphine will expand treatment options for opioid addiction. Buprenorphine is classified as a partial micro opioid agonist and a weak kappa antagonist. It has a high affinity for the micro receptor, with slow dissociation resulting in a long duration of action and an analgesic potency 25 to 40 times more potent than morphine. At higher doses, its agonist effects plateau and it begins to behave more like an antagonist, limiting the maximal analgesic effect and respiratory depression. This "ceiling effect" confers a high safety profile clinically, a low level of physical dependence, and only mild withdrawal symptoms on cessation after prolonged administration. Suboxone contains a mixture of buprenorphine and naloxone. The naloxone is poorly absorbed sublingually and is designed to discourage intravenous use. Subutex, buprenorphine only, will also be available primarily as an initial test dose. Clinicians will be using this drug for detoxification or for maintenance of opioid addiction. Patients with recent illicit opioid use may develop a mild precipitated withdrawal syndrome with the induction of buprenorphine. Acute buprenorphine intoxication may present with some diffuse mild mental status changes, mild to minimal respiratory depression, small but not pinpoint pupils, and relatively normal vital signs. Naloxone may improve respiratory depression but will have limited effect on other symptoms. Patients with significant symptoms related to buprenorphine should be admitted to the hospital for observation because symptoms will persist for 12 to 24 hours.
Publication Types:
PMID: 15111917 [PubMed - indexed for MEDLINE]
Delayed salicylate toxicity at 35 hours without early manifestations following a single salicylate ingestion.
Rivera W, Kleinschmidt KC, Velez LI, Shepherd G, Keyes DC.
Section of Toxicology, University of Texas Southwestern (UTSW) Emergency Medicine, Dallas, TX 75390-8579, USA. wilfredo.rivera@utsouthwestern.edu
OBJECTIVE: To report a case of delayed toxicity following a single ingestion of aspirin, where the initial concentrations were nearly undetectable and the patient was completely asymptomatic for the first 35 hours. CASE SUMMARY: A 14-year-old white female was evaluated after a single ingestion of 120 tablets of aspirin 81 mg/tablet hours before arrival to the emergency department. She denied nausea, abdominal pain, tinnitus, or shortness of breath. She received one dose of activated charcoal. The first salicylate concentration (4 h after ingestion) was 1 mg/dL. At 35 hours, the patient became symptomatic (dizziness, tinnitus, epigastric discomfort). Her salicylate concentration at that time was 46 mg/dL. A second dose of activated charcoal was administered, and intravenous bicarbonate with potassium was started as a continuous infusion for 30 hours. DISCUSSION: While delayed salicylate toxicity is well reported in the literature, no report was found regarding concentrations increasing to toxicity 35 hours after ingestion. The delayed aspirin absorption may be due to salicylate-induced pylorospasm or the formation of pharmacobezoars. CONCLUSIONS: In cases with known salicylate ingestion, it is important to follow salicylate concentrations every 4 hours until they are steadily decreasing according to a 4-hour half-life and the patient shows no symptoms of salicylate intoxication.
Publication Types:
PMID: 15173556 [PubMed - indexed for MEDLINE]
-
Mind your P's and Q's: transcription errors and elderly patients.
Sleeper RB.
Publication Types:
PMID: 15161946 [PubMed - indexed for MEDLINE]
Cutaneous findings in chronic lymphocytic leukaemia.
Agnew KL, Ruchlemer R, Catovsky D, Matutes E, Bunker CB.
Department of Dermatology The Royal Marsden Hospital, London SW3 6JJ, U.K. karenagnew@lineone.net
BACKGROUND: Chronic lymphocytic leukaemia (CLL) is a malignancy characterized by clonal expansion of B lymphocytes with distinct morphology and immunophenotype. The dermatological literature relating to CLL is sparse. A global descriptive survey of a large number of CLL patients has not previously been published. OBJECTIVES: To report the spectrum of dermatological conditions seen in a large series of CLL patients. METHODS: Skin complications in patients with established CLL were identified retrospectively from clinical and photographic records, principally a database of over 750 consecutive cases. These events were classified, enumerated and compared. RESULTS: Forty patients with 125 skin manifestations were identified and studied. Forty-one manifestations had documented clinical or histological atypia. In 21 of these 41 complications there had been no prior immunosuppressive therapy. We observed that cutaneous malignancies frequently presented atypically both clinically and histologically. There were 18 patients with 56 instances of basal cell carcinoma (BCC) or squamous cell carcinoma (SCC), and clinical atypia was more common with SCC than with BCC. Other cutaneous findings included varicella zoster (n = 6), leukaemia cutis (n = 3), acute graft-versus-host disease (n = 5), cutaneous drug eruptions (n = 9), multiple warts (n = 3), herpes simplex (n = 3), cutaneous T-cell lymphoma (n = 2), eosinophilic folliculitis (n = 2), malignant melanoma (n = 2) and Merkel cell tumour (n = 2). CONCLUSIONS: We have identified a range of dermatological conditions in CLL patients, with a tendency to atypical presentations. The atypia was independent of prior chemotherapy.
PMID: 15214899 [PubMed - indexed for MEDLINE]
Panniculitis induced by specific venom immunotherapy.
Eming SA, Theile-Ochel S, Casper C, Krieg T, Scharffetter-Kochanek K, Hunzelmann N.
Publication Types:
PMID: 15237271 [PubMed - indexed for MEDLINE]
-
Acute generalized exanthematic pustulosis: a case and an overview of side effects affecting the skin caused by celecoxib and other COX-2 inhibitors reported so far.
Goeschke B, Braathen LR.
Dermatological University Clinic, Inselspital Berne, Berne, Switzerland. bgoeschke@hotmail.com
A 55-year-old woman who was treated for periarthritis humeroscapularis with celecoxib (Celebrex) developed a generalized pustular exanthema on the head and upper trunk, accompanied by fever, leukocytosis and increased erythrocyte sedimentation rate. The histological findings were subcorneal pustules, necrotic keratinocytes, edema in the upper dermis and polymorphic perivascular infiltrates. Four days after stopping celecoxib, the pustules disappeared without any treatment. Four weeks after disappearance of the skin lesions, celecoxib demonstrated a positive lymphocyte stimulation test. In this article, we present to our knowledge the first case of acute generalized exanthematic pustulosis caused by celecoxib, and we give an overview of the side effects affecting the skin caused by celecoxib and other cyclooxygenase type 2 inhibitors reported so far. Copyright 2004 S. Karger AG, Basel
Publication Types:
- Case Reports
- Review
- Review of Reported Cases
PMID: 15237269 [PubMed - indexed for MEDLINE]
-
Successful desensitization to fixed drug eruption: the presence of CD25+CD4+ T cells in the epidermis of fixed drug eruption lesions may be involved in the induction of desensitization.
Teraki Y, Shiohara T.
Department of Dermatology, Kyorin University School of Medicine, Tokyo, Japan.
BACKGROUND: Fixed drug eruption (FDE) is a distinct type of drug-induced eruption, in which intraepidermal CD8+ T cells in the lesional skin are the final effector cells in the epidermal injury of FDE. Desensitization is a unique approach for the management of drug eruption, which has been reported to be effective in treating FDE. However, the mechanisms underlying desensitization to FDE are quite unknown. OBJECTIVE AND METHODS: We reported a case of successful desensitization to allopurinol-induced FDE. To clarify the mechanisms underlying desensitization to FDE, we examined the phenotype of T cells in the epidermis of FDE lesions before and after desensitization using flow cytometry. RESULTS: The overwhelming majority of intraepidermal T cells in the FDE lesion before desensitization consisted of CD8+ T cells, whereas a significant number of CD25+CD4+ T cells were present in the epidermis of FDE lesions after desensitization. CONCLUSION: The presence of CD25+CD4+ T cells in the epidermis of FDE lesions may be involved in the induction of desensitization to FDE. Copyright 2004 S. Karger AG, Basel
Publication Types:
PMID: 15237264 [PubMed - indexed for MEDLINE]
[Probable hepatoxicity from epigallocatecol gallate used for phytotherapy]
[Article in French]
Peyrin-Biroulet L, Petitpain N, Kalt P, Ancel D, Petit-Laurent F, Trechot P, Barraud H, Bronowicki JP.
Publication Types:
PMID: 15146159 [PubMed - indexed for MEDLINE]
Optic neuropathy and orbital inflammatory mass after wasp stings.
Sheth HG, Sullivan TJ.
Department of Ophthalmology, St Thomas' Hospital, Lambeth Palace Road, London SE1 7EH, UK. Hitengsheth@yahoo.co.uk
Publication Types:
PMID: 15340026 [PubMed - indexed for MEDLINE]
-
Acute poisoning with emamectin benzoate.
Yen TH, Lin JL.
Division of Clinical Toxicology, Department of Nephrology, Chang Gung Memorial Hospital, Chang Gung University School of Medicine, Taipei, Taiwan, Republic of China.
BACKGROUND: Emamectin benzoate is the 4'-deoxy-4'-epi-methyl-amino benzoate salt of avermectin B1 (abamectin), which is similar structurally to natural fermentation products of Streptomyces avermitilis. Emamectin benzoate is being developed as a newer broad-spectrum insecticide for vegetables and has a very low application rate. The mechanism of action involves stimulation of high-affinity GABA receptors and a consequent increase in membrane chloride ion permeability. Animal studies indicate a wide margin of safety because mammalian species are much less sensitive due to lower GABA receptor affinities and relative impermeability of the blood-brain barrier. Notably, the literature has not reported human exposure resulting in toxicity. CASE REPORT: This paper describes a case of acute poisoning with Proclaim insecticide (Syngenta, Taiwan), consisting of 2.15% w/w emamectin benzoate in 2, 6-bis (1, 1-dimethylethyl)-4-methyl-phenol and 1-hexanol. The clinical manifestation was transient gastrointestinal upset with endoscopy-proven gastric erosion and superficial gastritis, mild central nervous system depression, and aspiration pneumonia. No specific antidote exists for emamectin benzoate intoxication; this patient was treated successfully with gastric lavage, administration of activated charcoal, and empiric antibiotics. Drugs that enhance GABA activity such as barbiturates and benzodiazepines were avoided.
PMID: 15462160 [PubMed - in process]
-
Forearm compartment syndrome after intravenous mannitol extravasation in a carbosulfan poisoning patient.
Eroglu A, Uzunlar H.
Department of Anesthesiology and Reanimation, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey. erogluah@mynet.com
We report a case of forearm compartment syndrome caused by extravasation of mannitol in an intoxicated patient. The pathophysiology and management of a forearm compartment syndrome from extravasation of mannitol are discussed in this case.
PMID: 15462158 [PubMed - in process]
-
Regional variations in the use and awareness of the California Poison Control System.
Albertson TE, Tharratt RS, Alsop J, Marquardt K, Heard S.
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of California, Davis School of Medicine, 4150 V St., Suite 3400 PSSB Sacramento, CA 95817, USA. tealbertson@ucdavis.edu
PURPOSE: To investigate regional variations in public awareness and utilization of the services of Poison Control Centers (PCC) before and after an intervention. METHODS: This study examines call rates of different California regions based on the final five regional PCCs prior to the consolidation of these services under a single statewide California Poison Control System (CPCS) and interventions to increase utilization. Awareness surveys were performed before and after a media campaign that was directed primarily to the Los Angeles basin and to a lesser extent other high Hispanic concentration areas. Focus groups were also utilized to better define specific areas of poison knowledge and awareness of CPCS services. FINDINGS: Large differences in regional California call rates were seen, with the Los Angeles basin showing the lowest utilization of CPCS services compared with the rest of California. Significant seasonal variation in utilization was also found, with the highest average call rates observed in August and the lowest in February. Focus groups demonstrated that urban awareness of PCC was lower than suburban awareness, particularly in monolingual Hispanic households. An improvement was seen after the institution of a media education campaign that included use of Spanish language material and radio spots. Similar increases in call rates were also seen in Fresno county category, with a higher percentage of Hispanic population that was not as aggressively targeted by the awareness campaign. CONCLUSIONS: Significant regional variations in CPCS call rates were found and an increased awareness and utilization was seen in the Los Angeles basin after a directed media campaign compared with most areas of California. Further efforts to increase CPCS utilization in the Los Angeles region, primarily among urban monolingual Hispanics, are needed.
PMID: 15462155 [PubMed - in process]
-
The effects of fresh frozen plasma on cholinesterase levels and outcomes in patients with organophosphate poisoning.
Guven M, Sungur M, Eser B, Sari I, Altuntas F.
Department of Intensive Care, Faculty of Medicine, Erciyes University Medical School, 38039, Kayseri, Turkey. mguven@erciyes.edu.tr
OBJECTIVE: The aim of this study is to determine the effects of fresh frozen plasma, as a source of cholinesterase, on butyrylcholinesterase (BuChE; plasma or pseudo cholinesterase) levels and outcomes in patients with organophosphate poisoning. MATERIALS AND METHODS: This prospective study was performed at the Department of Intensive Care of Erciyes University Medical School. Over 2 yrs, patients admitted to the ICU for OP poisoning were entered into the study. OP poisoning was diagnosed on the basis of history and BuChE levels. All patients received atropine. Fresh frozen plasma was given to 12 patients. The study was approved by the Ethical Committee, and verbal informed consent was obtained. RESULTS: Thirty-three patients were included in the study. BuChE levels measured at admission and the pralidoxime and atropine doses administered were not different between groups (p>0.05). Although intermediate syndrome developed in 28.6% of patients receiving pralidoxime, there were no intermediate syndrome cases in patients receiving plasma prior to developing intermediate syndrome. The mortality rates were 14.3% in the pralidoxime group and 0% in the plasma+atropine+pralidoxime group. Two patients received plasma after developing the intermediate syndrome, and one patient who received only atropine died. BuChE levels of fresh frozen plasma were 4069.5 +/- 565.1 IU/L. Every two bags of plasma provided an increase in BuChE levels of approximately 461.7 +/- 142.1 IU/L. CONCLUSION: Fresh frozen plasma therapy increases BuChE levels in patients with organophosphate poisonings. The administration of plasma may also prevent the development of intermediate syndrome and related mortality. Plasma (fresh frozen or freshly prepared) therapy may be used as an alternative or adjunctive treatment method in patients with organophosphate pesticide poisoning, especially in cases not given pralidoxime. Further randomized controlled and animal studies are required to infer a definitive result.
PMID: 15462154 [PubMed - in process]
-
Compliance with poisons center referral advice and implications for toxicovigilance.
Watts M, Fountain JS, Reith D, Schep L.
National Poisons Centre, University of Otago, Dunedin, New Zealand. docmartin@clear.net.nz
BACKGROUND: When Poisons Information, or Poisons Control Centers (PCC) give directive advice in response to general public calls it is usually assumed that the advice will be followed, but it is difficult to measure the actual compliance of callers to a PCC. Epidemiological data regarding the incidence of poisoning incidents (Toxicovigilance) often utilizes reports of calls to a PCC. METHODS: Retrospective review of advice given to all callers to the New Zealand National Poisons Centre (NZNPC) from a defined area for the calendar year 2001. Callers to the NZNPC telephone hotlines who were advised to attend or not to attend the hospital Emergency Department (ED) were subsequently matched with actual ED visits. RESULTS: The compliance rate for those advised to attend the ED was 76.1%, whereas those advised not to attend had a compliance rate of 98.7%. The overall compliance rate was 94.1%. Of the patients presenting to the ED with a potential poisoning, only 10.2% were referred by the PCC. The callers referred by PCC and direct ED visitors appeared to differ in some respects. CONCLUSIONS: Compliance with PCC telephone advice is similar to the compliance rates in many other health interventions. Comparisons between populations calling a PCC and those self-presenting to an ED show that PCC data may not reflect the true burden of poisoning to health care systems.
PMID: 15462152 [PubMed - in process]
-
Retrospective review of Tizanidine (Zanaflex) overdose.
Spiller HA, Bosse GM, Adamson LA.
Kentucky Regional Poison Center, PO Box 35070, Louisville, KY 40232-5070, USA. Henry.Spiller@nortonhealthcare.org
BACKGROUND: Tizanidine is a centrally acting muscle relaxant with a novel mechanism of action and structurally related to clonidine. There are no large case series of tizanidine exposure. METHODS: Retrospective review of all ingestions involving tizanidine reported to a poison control center from January 2000 through February 2003. Exclusion criteria were polydrug ingestion, no follow-up or lost to follow-up. RESULTS: There were 121 cases of which 45 patients met entrance criteria. Mean age was 32 years (range 1 to 80). Thirty-seven patients were evaluated in a health care facility of which 27 were admitted for medical care. Clinical effects included lethargy (n = 38), bradycardia (n = 14), hypotension (n = 8), agitation (n = 7), confusion (n = 5), vomiting (n = 3), and coma (n = 2). Mean dose ingested by history was 72 mg (S.D. + 86). The lowest dose associated with hypotension was 28mg, which occurred in a 63-year-old female with a BP of 88/52 and a HR of 54. The lowest dose associated with coma was between 60 mg and 120 mg, which occurred in a 30-year-old female with a HR of 30 and BP of 81/48. There were 6 patients < 6 yrs. The lowest dose with bradycardia and drowsiness in a small child was 16 mg in a 2 YO (weight unknown). All other cases in children < 6 yrs involved ingestion of a single tablet (2 or 4 mg) with only mild drowsiness reported. Therapy in this series was primarily supportive and included pressors in 3 cases and intubation in 3 cases. Naloxone was administered to 7 patients. There was no response to naloxone in 5 patients, poor documentation of response in one, and arousal in one patient. All patients recovered without residual complications. CONCLUSION: Clinical manifestations of tizanidine overdose include alterations of mental status, bradycardia, and hypotension. In this series, outcome was good with supportive therapy.
PMID: 15462150 [PubMed - in process]
-
Space shuttle Columbia disaster: utilization of poison control centers in Texas and Louisiana.
Shepherd G, Keyes DC, Borys DJ, Ellis MD, Ryan ML, Watson WA.
Publication Types:
PMID: 15461247 [PubMed - in process]
-
Drug identification: a survey of poison control centers.
Jaramillo JE, Anderson HG Jr, Jaramillo JP, Nester ML, Shum S.
School of Pharmacy, Texas Tech University HSC, Amarillo, Texas 79106, USA. Jeanie.Jaramillo@ttuhsc.edu
OBJECTIVE: The objective of this study was to determine current practices and opinions of poison center staff and directors regarding drug identification (ID) calls. METHODS: Surveys were developed and mailed to 911 poison center staff members and 69 managing directors at 69 poison control centers in the United States in December 2001. RESULTS: Responses were received from 317 staff members and 33 directors from 49 centers. Nearly half of the staff respondents stated that they had not received drug ID training beyond how to look up the identity of an oral medication. About one-half of staff and director respondents stated that their centers had only informal (unwritten) drug ID policies, while one-fourth each responded they had formal written policies or had no policy at all. A majority of respondents indicated that their centers either allow or require specialists to provide ID for non-ingestion-related cases. Nearly all staff and director respondents routinely provide ID services to law enforcement officers and health care professionals regardless of whether ingestion was involved. Slightly more than one-half of staff respondents inquire about possible ingestion with almost every request, while one-third only inquire when the caller gives some indication that ingestion may have occurred. Case-based questions reveal that different practices are utilized depending on the type of medication for which ID is being requested. Factors such as risk of liability, patient confidentiality, guardianship, and the person's best interest appear to contribute to decisions regarding the provision of medication ID. CONCLUSION: Drug identification practices vary from center to center throughout the United States. Though the service is greatly utilized, few centers have written policies. In addition, training for the provision of this service appears to be inadequate in many centers. The development of drug identification guidelines to be utilized throughout poison centers would provide much needed consistency and guidance.
PMID: 15461245 [PubMed - in process]
-
Repeated episodes of endosulfan poisoning.
Dewan A, Bhatnagar VK, Mathur ML, Chakma T, Kashyap R, Sadhu HG, Sinha SN, Saiyed HN.
National Institute of Occupational Health, (Indian Council of Medical Research), Ahmedabad, India. dewanaruna@yahoo.com
INTRODUCTION: A number of families in a rural area of Jabalpur District (Madhya Pradesh), India, were affected by repeated episodes of convulsive illness over a period of three weeks. The aim of this investigation was to determine the cause of the illness. METHODS: The investigation included a house-to-house survey, interviews of affected families, discussions with treating physicians, and examination of hospital records. Endosulfan poisoning was suspected as many villagers were using empty pesticide containers for food storage. To confirm this, our team collected blood and food samples, which were transported to the laboratory and analyzed with GC-ECD. RESULTS: Thirty-six persons of all age groups had illness of varying severity over a period of three weeks. In the first week, due to superstitions and lack of treatment, three children died. In the second week, symptomatic treatment of affected persons in a district hospital led to recovery but recurrence of convulsive episodes occurred after the return home. In the third week, 10 people were again hospitalized in a teaching hospital. Investigations carried out in this hospital ruled out infective etiology but no facilities were available for chemical analysis. All persons responded to symptomatic treatment. The blood and food samples analyzed by our team showed presence of endosulfan, which was confirmed by GCMS. One of the food items (Laddu) prepared from wheat flour was found to contain 676 ppm of alpha-endosulfan. CONCLUSIONS: Contamination of wheat grains or flour with endosulfan and its consumption over a period of time was the most likely cause of repeated episodes of convulsions, but the exact reason for this contamination could not be determined. This report highlights the unsafe disposal of pesticide containers by illiterate farm workers, superstitions leading to delay in treatment, and susceptibility of children to endosulfan.
PMID: 15461244 [PubMed - in process]
-
Survival pattern in patients with acute organophosphate poisoning receiving intensive care.
Munidasa UA, Gawarammana IB, Kularatne SA, Kumarasiri PV, Goonasekera CD.
Teaching Hospital, Peradeniya, Sri Lanka.
BACKGROUND: Approximately 35% of patients acutely poisoned with organophosphates (OP) in developing countries like Sri Lanka require intensive care and mechanical ventilation. However, death rates remain high. OBJECTIVE: To study the outcomes and predictors of mortality in patients with acute OP poisoning requiring intensive therapy at a regional center in Sri Lanka over a period of 40 months. METHODS: Retrospective analysis of all intensive care records of patients with acute OP poisoning admitted to the Intensive Care Unit (ICU) between March 1998 and July 2001. RESULTS: During the study period, 126 subjects were admitted to the ICU with acute OP poisoning. Records of 10 patients were lost and those of 37 were incomplete and hence were excluded. All the remaining 71 patients (59 male) had required endotracheal intubation and mechanical ventilation for a period of four (median) days (range 1-27) in addition to gastric lavage and standard therapy with atropine and oximes and adequate hydration. Of these 71 patients, 36 (28 male) had died. Life table analysis demonstrated a steep decline in the cumulative survival to 67% during the first three days. Systolic blood pressure of < 100 mmHg and FiO2 of >40% to maintain a SpO2 of >92% within the first 24 h were recognized as poor prognostic indicators among mechanically ventilated patients. CONCLUSION: Mortality following OP poisoning remains high despite adequate respiratory support, intensive care, and specific therapy with atropine and oximes. One-third of the subjects needing mechanical ventilation and reaching intensive care units die within the first 72 h of poisoning. Systolic blood pressure of less than 100 mmHg and the necessity of a FiO2>40% to maintain adequate oxygenation are predictors of poor outcome in patients mechanically ventilated in the ICU.
PMID: 15461241 [PubMed - in process]
Overdose in young people using heroin: associations with mental health, prescription drug use and personal circumstances.
Burns JM, Martyres RF, Clode D, Boldero JM.
beyondblue: the national depression initiative, Hawthorn West, VIC, Australia.
OBJECTIVE: To identify patterns of mental health, prescription drug use and personal circumstances associated with heroin overdose in young people. DESIGN: Linkage of data on use of Pharmaceutical Benefits Scheme (PBS) prescription drugs with data from a self-report questionnaire. SETTING: Inner metropolitan Melbourne, Australia. SUBJECTS: 163 young people, 15-30 years, using heroin. MAIN OUTCOME MEASURES: Personal circumstances, mental health (as measured by various scales), and PBS-listed prescription drug use. RESULTS: Young people using heroin reported high rates of feelings of hopelessness, depression, antisocial behaviour, self-harm and diagnosed mental illness. A prior history of overdose was associated with previous mental illness, which in turn was associated with being female, having poor social support, being dissatisfied with relationships, and living alone or in temporary accommodation. While feelings of hopelessness and antisocial behaviour were strongly associated with overdose history, the number of PBS prescription drugs used had a very strong relationship with overdose, particularly benzodiazepines, other opioids, tricyclic antidepressants and tranquillisers. CONCLUSIONS: Further research to explore causal relationships between prescription drugs and heroin overdose is warranted. Improved data linkage to PBS records for general practitioners may facilitate safer prescribing practices.
PMID: 15462639 [PubMed - in process]
Carbon monoxide releases and poisonings attributed to underground utility cable fires--New York, January 2000-June 2004.
Centers for Disease Control and Prevention (CDC).
Carbon monoxide (CO) is a potentially deadly gas that is odorless, colorless, tasteless, and nonirritating. Each year, CO poisoning causes approximately 500 unintentional deaths in the United States. CO is generated during the incomplete combustion of carbon-based fuels such as oil, natural gas, kerosene, coal, charcoal, gasoline, and wood. Common sources of CO poisonings include furnaces, generators, and nonelectric space heaters. Another potential cause of CO poisonings is the unintentional burning of underground utility cables. The oxygen-poor environment below ground promotes incomplete combustion and the production of CO. The New York State Department of Health (NYSDOH) documented 234 events during January 2000-June 2004 in which CO releases resulted from underground utility cable fires (also known as CO burnout events). This report describes these events, summarizes data on reported CO burnouts, and discusses associated injuries. The findings underscore the need for preventive actions, such as installation of CO detectors in central locations in homes and businesses. In homes, CO detectors should be installed outside of each separate sleeping area.
PMID: 15470325 [PubMed - indexed for MEDLINE]
Clinical problem-solving. Footprints.
Kassutto S, Daily JP.
Division of Infectious Diseases, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA. skassutto@bidmc.harvard.edu.
Publication Types:
PMID: 15459306 [PubMed - indexed for MEDLINE]
|