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Balancing the risks and benefits of fish consumption.
Wilson JF.
jenwilson@acponline.org
PMID: 15611502 [PubMed - indexed for MEDLINE]
Moxifloxacin-associated drug hypersensitivity syndrome with toxic epidermal necrolysis and fulminant hepatic failure.
Nori S, Nebesio C, Brashear R, Travers JB.
Publication Types:
PMID: 15611441 [PubMed - indexed for MEDLINE]
 
Prospective cohort study of cannabis use, predisposition for psychosis, and psychotic symptoms in young people.
Henquet C, Krabbendam L, Spauwen J, Kaplan C, Lieb R, Wittchen HU, van Os J.
Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, PO BOX 616, 6200 MD Maastricht, Netherlands.
OBJECTIVE: To investigate the relation between cannabis use and psychotic symptoms in individuals with above average predisposition for psychosis who first used cannabis during adolescence. DESIGN: Analysis of prospective data from a population based sample. Assessment of substance use, predisposition for psychosis, and psychotic symptoms was based on standardised personal interviews at baseline and at follow up four years later. PARTICIPANTS: 2437 young people (aged 14 to 24 years) with and without predisposition for psychosis. MAIN OUTCOME MEASURE: Psychotic symptoms at follow up as a function of cannabis use and predisposition for psychosis at baseline. RESULTS: After adjustment for age, sex, socioeconomic status, urbanicity, childhood trauma, predisposition for psychosis at baseline, and use of other drugs, tobacco, and alcohol, cannabis use at baseline increased the cumulative incidence of psychotic symptoms at follow up four years later (adjusted odds ratio 1.67, 95% confidence interval 1.13 to 2.46). The effect of cannabis use was much stronger in those with any predisposition for psychosis at baseline (23.8% adjusted difference in risk, 95% confidence interval 7.9 to 39.7, P = 0.003) than in those without (5.6%, 0.4 to 10.8, P = 0.033). The risk difference in the "predisposition" group was significantly greater than the risk difference in the "no predisposition" group (test for interaction 18.2%, 1.6 to 34.8, P = 0.032). There was a dose-response relation with increasing frequency of cannabis use. Predisposition for psychosis at baseline did not significantly predict cannabis use four years later (adjusted odds ratio 1.42, 95% confidence interval 0.88 to 2.31). CONCLUSION: Cannabis use moderately increases the risk of psychotic symptoms in young people but has a much stronger effect in those with evidence of predisposition for psychosis.
PMID: 15574485 [PubMed - indexed for MEDLINE]
Fatal poisoning in childhood, England & Wales 1968-2000.
Flanagan RJ, Rooney C, Griffiths C.
Medical Toxicology Unit, Guy's & St Thomas' Hospital Trust, Avonley Road, London SE14 5ER, UK.
We analysed deaths certified as due to poisoning in England & Wales, 1968-2000, in children aged <10 years by age, sex, circumstances of death, intent, and agents involved. The number of deaths fell from 165 (20.6 per million children) in 1968 to 30 (4.6 per million) in 2000, a decrease of approximately 80%. The age-specific death rates were similar in boys and girls. The rate was initially much higher, and fell more, in those aged <5 years. Most deaths (n = 1923) occurred in fires, and had been attributed to inhaling combustion products. A small number (n = 104) occurred in fires resulting from motor vehicle and other transport accidents. From 1979 (use of ICD-9) the coding of some of these deaths changed from poisoning with carbon monoxide to poisoning with 'other gases, fumes or vapours'. These 'fire deaths' do not appear as poisonings in mortality statistics based on a single underlying cause of death, and cannot be tabulated as poisoning in many countries. Fire deaths and deaths coded to accidental, deliberate, or undetermined poisoning (n = 702) decreased substantially with time, and by 2000 numbered 14 and 10, respectively. Accidental deaths declined from 151 in 1968 to 23 in 2000, but homicides and open verdicts varied from 5 to 20 per year, with no clear trend. Deaths attributed to carbon monoxide and to 'other gases, fumes or vapours' (mostly fire-related) totalled 2431 (84% of all poisoning deaths). Overall, 10% of these deaths were either certified as homicides or open verdicts. However, homicide or open verdict was recorded in half of the 47 fatal opiate poisonings. Opioids have now superseded antidepressants as the commonest agents encountered in fatal poisoning with drugs in children.
PMID: 15639606 [PubMed - as supplied by publisher]
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Aldicarb poisoning: one case report.
Proenca P, Teixeira H, Mendonca MC, Castanheira F, Marques EP, Corte-Real F, Vieira DN.
Delegation of Coimbra, National Institute of Legal Medicine, Coimbra, Portugal.
The carbamate aldicarb (Temik((R))) is a highly toxic (LD50=0.9mg/kg oral in rats) insecticide often used in agriculture. The authors present a fatal intoxication case with aldicarb, in a 24-year-old male, under police custody in the island of S. Tome and Prince (STP), in Africa. He was found 3h after his arrest, lying on the floor of his cell, unconscious, frothing at the mouth, and entered into the hospital already dead. Aldicarb analysis was carried out by high-performance liquid chromatography, with a post-column derivatization system (with o-phthaldialdehyde and 2-mercaptoethanol, under alkaline conditions at 80 degrees C) with fluorescence detection at lambda(ex)=339nm and lambda(em)=445nm. The toxicological analysis revealed toxic concentrations of aldicarb in the post-mortem samples: blood (6.2mug/ml), stomach (48.9mug/g), liver (0.80mug/g), kidney (8.10mug/g), heart (6.70mug/g) and urine (17.50mug/ml). It was also detected to be the same substance in a grey granulate powder supplied by criminal authorities of that country, as a probable substance ingested by the victim. The toxicological analysis results, the autopsy findings and the information given, allowed us to conclude that death occurred due to an aldicarb acute intoxication. Although the case suggested a suicide, particularly based on the known information and on the high aldicarb concentration found in the stomach, it was not possible to indicate precisely its etiology (suicide or homicide).
PMID: 15639596 [PubMed - in process]
[Cytolytic hepatitis induced by darbepoetin alpha treatment]
[Article in French]
Dumortier J, Boucher A, Scoazec JY, Vial T.
Publication Types:
PMID: 15243335 [PubMed - indexed for MEDLINE]
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[Amoxicillin induced acute hepatitis]
[Article in French]
Romney R, Biour M, Belloula D, Elbaz D, Carriere J, Cadranel JF.
Publication Types:
PMID: 15243334 [PubMed - indexed for MEDLINE]
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Duodenal perforation after ibuprofen overdose.
Clarke SF, Arepalli N, Armstrong C, Dargan PI.
Emergency Department, South Manchester University Hospital, Wythenshawe, Manchester, UK. sfjclarke@doctors.org.uk
Publication Types:
PMID: 15641644 [PubMed - indexed for MEDLINE]
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Delayed dystonia following pimozide overdose in a child.
Gair RD, Friesen MS, Kent DA.
British Columbia Drug and Poison Information Centre, Vancouver, British Columbia, Canada. gair@dpic.ca
BACKGROUND: Pimozide overdose has rarely been reported in children. In adults, pimozide intoxication may cause seizures, extrapyramidal and anticholinergic effects, hypotension, QTc prolongation and torsades de pointes. We report dystonia, hypotension and drowsiness following pimozide ingestion in a child. CASE REPORT: An alert 18-month-old presented to hospital 40 minutes after ingesting up to 6 mg (0.5 mg/kg) of pimozide. Vital signs: BP 91/62 mmHg, HR 130/min, RR 26/min, temperature 97.2 degrees F (36.2 degrees C). She received gastric lavage and activated charcoal. One hour later, her QTc interval was 420 msec, HR 150. She remained asymptomatic until 12 hours post-ingestion, when she developed drooling, tongue thrusting and drowsiness. BP was 75/40, HR 150, QTc 440 msec. BP increased to 95/50 after a bolus of normal saline. Her dystonia subsided over the next 12 hours without treatment. Drowsiness and tachycardia persisted until 40 hours post-ingestion. QTc interval at this time was 370 msec. Patient recovered without sequelae. CONCLUSION: Pimozide overdose in children may be associated with delayed onset of symptoms, including dystonia.
Publication Types:
PMID: 15641643 [PubMed - indexed for MEDLINE]
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Pattern of acute poisonings in Mashhad, Iran 1993-2000.
Afshari R, Majdzadeh R, Balali-Mood M.
Scottish Poisons Information Bureau, The Royal Infirmary, University of Edinburgh, UK.
Drugs and chemicals are almost easily available in Iran. Natural toxins as poisonous plants and animals also exist in most parts of the country. Therefore, acute poisonings, either intentional or accidental and also drug abuse/addiction are common in Iran. In spite of these difficulties there is no center for poison control and surveillance in this country to gather information and analyse data. The files of a systematic randomised ten percent of all hospital-referred poisoned patients from 21 March 1993 to 20 March 2000 in Imam Reza (p) University Hospital of Mashhad (71589 cases) were screened retrospectively. Young adults (40.3%) and school children (22.9%) were the most vulnerable group. Mean age was 22.3 (S.D. 14.38) years with a minimum of less than one and a maximum of 98 years old. A female predominance was found (53.4%). Intentional poisoning was more common (54.4%) than accidental exposures (45.2%). Fourteen cases were classified as criminal poisoning. 79.7% of exposures were via ingestion, followed by dermal exposures (14.1%), and inhalation (6.2%). The majority (83.7%) of patients were from urban areas. Most patients (68.6%) were treated in the Emergency Toxicology Clinic and discharged, 19.2% were temporarily hospitalized and 11.3% were hospitalized for 24 hr. Main groups of poisons were pharmaceuticals (61.4%), chemicals (22.8%), and natural toxins (16.6%). The overall number of poisoned patients was higher in spring and summer (62.8%). In conclusion, acute poisonings, particularly self-poisonings, are common in Iran. Since medical documentation is not routinely provided in this country the results of this retrospective study can be used for surveillance. Establishment of fluent data gathering and analysis within the local health system are challenges for the future.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15641642 [PubMed - indexed for MEDLINE]
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Acute human self-poisoning with the N-phenylpyrazole insecticide fipronil--a GABAA-gated chloride channel blocker.
Mohamed F, Senarathna L, Percy A, Abeyewardene M, Eaglesham G, Cheng R, Azher S, Hittarage A, Dissanayake W, Sheriff MH, Davies W, Buckley NA, Eddleston M.
South Asian Clinical Toxicology Research Collaboration, Department of Clinical Medicine, University of Colombo, Colombo, Sri Lanka.
OBJECTIVE: Fipronil, a broad spectrum N-phenylpyrazole insecticide that inhibits GABAA-gated chloride channels, has been in use since the mid-1990s. A high affinity for insect compared to mammalian GABA receptors results in lower animal toxicity than other insecticides blocking this channel. To date, only two accidental cases of fipronil poisoning in humans have been published. CASE SERIES: We report seven patients with fipronil self-poisoning seen prospectively in Sri Lanka together with pharmacokinetics for four patients. Non-sustained generalized tonic-clonic seizures were seen in two patients (peak measured plasma fipronil concentrations 1600 and 3744 microg/L); both were managed with diazepam without complications. A patient with a peak measured plasma concentration of 1040 microg/L was asymptomatic throughout his stay. Plasma concentration was still high at discharge 3-4 days post-ingestion when the patients were well. Retrospective review of >1000 pesticide poisoning deaths since 1995 found only one death from fipronil-based products. In contrast to the good outcome of the above cases, this patient required intubation and ventilation and had continuous fits despite therapy with barbiturates and benzodiazepines. CONCLUSIONS: Our experience with prospectively observed patients suggests that fipronil poisoning is characterized by vomiting, agitation, and seizures, and normally has a favorable outcome. Management should concentrate on supportive care and early treatment of seizures. However, further experience is needed to determine whether increased susceptibility to fipronil or larger doses can produce status epilepticus.
Publication Types:
PMID: 15641641 [PubMed - indexed for MEDLINE]
Comment on:
Necrotic arachnidism: dispelling fact with fiction.
Durrheim D, Barnett FI.
Publication Types:
PMID: 15582055 [PubMed - indexed for MEDLINE]
Comment on:
A bitter tale.
Ritter MM.
Publication Types:
PMID: 15635787 [PubMed - indexed for MEDLINE]
Comment on:
A bitter tale.
Goyal SB, Spodick D.
Publication Types:
PMID: 15635124 [PubMed - indexed for MEDLINE]
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