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Items 1 - 13 of 13 |
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1: id: 15365950 Error occurred: Document retrieval error: document is empty
Comment on:
Droperidol and the black box warning.
van Zwieten K, Mullins ME, Jang T.
Publication Types:
- Case Reports
- Comment
- Letter
PMID: 15259182 [PubMed - indexed for MEDLINE]
3: id: 15374910 Error occurred: Document retrieval error: document does not exist
Victims of gas leak in Bhopal seek redress on compensation.
Kumar S.
Publication Types:
PMID: 15310593 [PubMed - indexed for MEDLINE]
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Fatal Datura poisoning: identification of atropine and scopolamine by high performance liquid chromatography/photodiode array/mass spectrometry.
Steenkamp PA, Harding NM, Van Heerden FR, Van Wyk BE.
Forensic Chemistry Laboratory, Department of Health, P.O. Box 1080, Johannesburg 2000, South Africa.
A forensic method comprising solid phase extraction and HPLC analysis was developed for the detection and confirmation of atropine and scopolamine, the main toxic alkaloids of Datura stramonium and Datura ferox. This method allowed the direct coupling of an electrospray (ZMD) mass selective detector to the HPLC system. Under these conditions, atropine and scopolamine were well separated from other components and detected on the PDA ( [Formula: see text] microg/ml) and ZMD ( [Formula: see text] pg/ml; [Formula: see text] pg/ml) detectors. Four geographically isolated populations of each of D. stramonium and D. ferox were analysed for seed alkaloids and it was found that the two species were diagnostically different in their atropine-scopolamine ratios. The optimised HPLC method was used to analyse three viscera samples of an adult Caucasian male whose death was ascribed to a fatal heart attack. Atropine and scopolamine were detected in the stomach and its contents, which contained Datura seeds. The chemical profile of the seeds found in the stomach contents was similar to those from four geographically different D. ferox plants.
PMID: 15374592 [PubMed - in process]
Paroxetine, other antidepressants, and youth suicide in New York City: 1993 through 1998.
Leon AC, Marzuk PM, Tardiff K, Teres JJ.
Department of Psychiatry, Weill Medical College of Cornell University, New York, NY10021, USA. acleon@med.cornell.edu
BACKGROUND: Regulatory agencies in the United Kingdom and the United States have recently issued warnings about a possible link between suicidal ideation and attempts and the use of paroxetine in a pediatric patient population. The objective of this study was to determine the proportion of youth suicides that tested positive for paroxetine or other antidepressants in medical examiner toxicologic testing in New York City from 1993 through 1998, the first 6 years that paroxetine was available in the United States. METHOD: Subjects in this medical examiner surveillance study were suicides less than 18 years of age. Serum toxicology was examined for paroxetine and other antidepressants. RESULTS: There were 66 suicides among persons under 18 years of age in the years 1993 through 1998. Toxicology was tested in 58 (87.9%) of the 66 suicides, and 54 (81.8%) had injury-death intervals of 3 days or less. None of the victims had paroxetine detected in their blood obtained at the time of autopsy. Imipramine was detected in 2 victims and fluoxetine in another 2. CONCLUSION: Despite regulatory concerns, none of the autopsies of youth suicides in New York City detected paroxetine in the victims, although other antidepressants were detected in 4 victims. However, in the vast majority of the youth suicides, there was no evidence of anti-depressant use immediately prior to death.
PMID: 15291679 [PubMed - indexed for MEDLINE]
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Relative toxicity of selective serotonin reuptake inhibitors (SSRIs) in overdose.
Isbister GK, Bowe SJ, Dawson A, Whyte IM.
Discipline of Clinical Pharmacology, University of Newcastle, Newcastle Mater Misericordiae Hospital, Waratah, New South Wales, Australia. gsbite@ferntree.com
BACKGROUND: Selective serotonin reuptake inhibitors (SSRIs) have increasingly replaced tricyclic antidepressants (TCAs) in the treatment of depression. They appear to be safer in overdose, but there is little information on their spectrum of toxicity in overdose, or relative toxicity of each agent. Objective: To determine the effect of SSRIs in overdose, as a group, and the relative toxicity of five different SSRIs. METHODS: A review of consecutive SSRI poisoning admissions to a single toxicology unit. Outcomes examined were length of stay [LOS], intensive care [ICU] admission rate, coma, seizures, electrocardiographic [ECG] abnormalities, and presence of serotonin syndrome [SS]. Logistic regression was used to model the outcome QTc >440 msec. RESULTS: There were 469 SSRI poisoning admissions analyzed after exclusions. The median LOS for all SSRI overdose admissions was 15.3 h (IQR: 10.5-21.3) and 30 of 469 (6.4%; 95% CI 4.3-9.0%) cases were admitted to ICU. The incidence of seizures was 1.9% and coma was 2.4%. Serotonin syndrome occurred in 14% of overdoses. Comparison of median QTc intervals of the five SSRIs was significantly different (p=0.0002); citalopram (450 IQR: 436-484) was individually different to fluoxetine (p=0.045), fluvoxamine (p=0.022), paroxetine (p=0.0002), and sertraline (p=0.001). The proportion of citalopram overdoses with a QTc >440 msec was 68%, differing significantly from sertraline (adjusted OR: 5.11 95% CI 2.32-11.27). Comparison of median QT intervals of the five SSRIs was statistically different (p=0.026); citalopram (400 IQR: 380-440) was individually different from sertraline (p=0.023). CONCLUSIONS: This study shows SSRIs are relatively safe in overdose despite serotonin syndrome being common. The exception was citalopram, which was significantly associated with QTc prolongation. We believe that cardiac monitoring should be considered in citalopram overdose, particularly with large ingestions and patients with associated cardiac disease.
PMID: 15362595 [PubMed - indexed for MEDLINE]
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Dipyrone overdose.
Bentur Y, Cohen O.
Faculty of Medicine, Israel Poison Information Center, Rambam Medical Center, Technion, Haifa, Israel. d_bentur@rambam.health.gov.il
BACKGROUND: Dipyrone is a pyrazolone derivative used as an analgesic and antipyretic. Agranulocytosis, dipyrone's most serious and potentially fatal adverse effect, has led to its withdrawal in several countries. However, agranulocytosis is subject to geographical variability, ratio with at risks ranging from 0.8-23.7. In many countries dipyrone is still widely used in adults and children and even as an over-the-counter (OTC) preparation. Information on the effects of dipyrone overdose is scanty. OBJECTIVE: To determine the demographic and clinical characteristics of dipyrone overdose. METHODS: Retrospective review of prospectively collected poison center data on acute exposure to dipyrone over a three-year period. The data were subjected to descriptive analysis. Mann-Whitney test and Chi-square analysis were performed where relevant. RESULTS: A total of 243 records met the inclusion and exclusion criteria. Median age was 17y (4m-83y), median amount 5 g (250 mg-45 g), and median time to consultation was 2 h (5 min-48 h). Toxic events (49) occurred in 39 (16%) patients; 57% of these were gastrointestinal and all were mild. Time to consultation was longer in the symptomatic patients (4 h vs. 1.5 h, respectively, p=0.001) and in children (8 h vs. 3.5 h in adults). Suicidal patients ingested significantly larger amounts (8 g vs. 3.7 g, respectively, p=0.001), as did patients with gastrointestinal symptomatology (7.5 g vs. 5 g in asymptomatics, p=0.001). No agranulocytosis was reported. DISCUSSION: Dipyrone overdose is associated with mild, mainly gastrointestinal toxicity; this was noted at a median dose of 7.5 g. Early gastrointestinal decontamination may have prevented toxicity. The suggested treatment includes gastrointestinal decontamination (if <1 h since ingestion) and supportive measures.
PMID: 15362592 [PubMed - indexed for MEDLINE]
Good for your heart but bad for your baby? Revised guidelines for fish consumption in pregnancy.
Bambrick HJ, Kjellstrom TE.
Publication Types:
PMID: 15257635 [PubMed - indexed for MEDLINE]
Images in clinical medicine. Marchiafava-Bignami disease.
Demaerel P, Van Paesschen W.
Katholieke Universiteit Leuven, Leuven B-3000, Belgium.
Publication Types:
PMID: 15356319 [PubMed - indexed for MEDLINE]
No sympathy for a boy with obtundation.
Osterhaudt KC.
Section of Medical Toxicology, Division of Emergency Medicine, The Poison Control Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA. osterhoudt@email.chop.edu
Publication Types:
PMID: 15179152 [PubMed - indexed for MEDLINE]
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Community childhood injury surveillance: an emergency department-based model.
Zuckerbraun NS, Powell EC, Sheehan KM, Uyeda A, Rehm KP, Barlow B.
Division of Pediatric Emergency Medicine, Children's Memorial Hospital and the Northwestern University's Feinberg School of Medicine, Chicago, IL 60614, USA.
OBJECTIVE: To describe the use of an emergency department (ED)-based injury surveillance model to determine the incidence and mechanisms of nonfatal injuries among children living in Cabrini Green, a poor urban community. METHODS: Using ED records and census data, population-based injury rates were determined for a retrospective cohort of children, 0 to 14 years old, (N = 3908) with nonfatal injuries resulting in ED treatment between January 1994 and December 1998. RESULTS: There were 1950 nonfatal injuries during the 5-year study period (annual injury incidence of 998/10,000). Age-specific rates (per 10,000 per year) were 899 among 0- to 4-year olds, 616 among 5- to 9-year olds, and 435 among 10- to 14-year olds. Sixty-three percent were male. The most common injury mechanisms were falls (339/10,000 per year), being struck by/against an object (201/10,000 per year), and being cut/pierced by an object (87/10,000 per year). Falls from a building window (2/10,000 per year) were infrequent. The incidence of housefire-related burns was 1.5/10,000 per year. Intentional injuries included alleged child abuse, 43/10,000 per year, and assaults, 30/10,000 per year. The assault rate among 10- to 14-year-old males was 100/10,000 per year. One hundred thirty-four children were admitted to the hospital (average annual rate of 69/10,000). The most frequent admission diagnoses were falls (22/10,000) among 0- to 9-year olds and assaults (13/10,000) among 10- to 14-year olds. CONCLUSION: An ED-based injury surveillance system can provide an efficient and useful way to determine injury incidence in a defined urban community. The data suggest that rates of violence-related injuries were high, while rates of window falls and housefires were low. These data have allowed targeted injury prevention efforts in Cabrini Green, and future surveillance will allow the evaluation of injury prevention activities.
PMID: 15179143 [PubMed - indexed for MEDLINE]
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Managing bite wounds. Currently recommended antibiotics for treatment and prophylaxis.
Taplitz RA.
Division of Infectious Diseases, Oregon Health & Science University School of Medicine, Portland 97239, USA. taplitzr@ohsu.edu
Animal and human bites are common in the United States. Although evidence-based practice guidelines have not been developed, bite wounds warrant an organized, standardized approach to care to help prevent complications. Such an approach involves first eliciting a history of the circumstances surrounding the bite and the patient's medical history. Next, basic bite wound care should be performed, including cleansing and irrigation of the wound. A good understanding of bite wound bacteriology and the situations in which antibiotics may be indicated is important. Finally, rabies and tetanus prophylaxis should be considered and appropriate follow-up care ensured.
Publication Types:
PMID: 15323154 [PubMed - indexed for MEDLINE]
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