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Items 1 - 12 of 12 |
One page. |
Carbon monoxide poisoning from a cooking stove in a tent.
Leigh-Smith S.
PMID: 15765349 [PubMed - in process]
Comment on:
Tardive dyskinesia and second-generation antipsychotics.
Ross DE.
Publication Types:
PMID: 15677620 [PubMed - indexed for MEDLINE]
Comment on:
Tardive dyskinesia and second-generation antipsychotics.
Saraf S, Chandra PS.
Publication Types:
PMID: 15677619 [PubMed - indexed for MEDLINE]
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Possible neuroleptic malignant syndrome with aripiprazole and fluoxetine.
Duggal HS, Kithas J.
Publication Types:
PMID: 15677611 [PubMed - indexed for MEDLINE]
Comment on:
Get the lead out.
Chan GM, Hoffman RS, Nelson LS.
Publication Types:
PMID: 15523754 [PubMed - indexed for MEDLINE]
Overdose of aripiprazole, a new type of antipsychotic.
Carstairs SD, Williams SR.
Department of Emergency Medicine, Naval Medical Center, San Diego, California.
Aripiprazole is the first member of a new class of antipsychotic medications. Unlike other antipsychotics, it acts as a partial agonist at dopamine D(2) and 5-HT(1A) receptors, thereby mitigating most of the adverse reactions such as extrapyramidal side effects and hyperprolactinemia. Additionally, most research to date has suggested a low incidence of QTc prolongation and orthostatic hypotension at therapeutic doses. Experience in the setting of intentional overdose, however, is limited. We present a case of a 27-year-old woman who intentionally ingested 330 mg of aripiprazole in a suicide attempt. Clinical effects were limited to mild sedation. Serum levels performed by the drug's manufacturer confirmed a total level (parent drug and active metabolite) of 716 ng/mL, nearly six times the upper limit of accepted therapeutic levels. This suggests that aripiprazole's therapeutic index is quite high and reinforces the drug's known safety profile.
PMID: 15769575 [PubMed - in process]
Do box jellyfish sleep at night?
Seymour JE, Carrette TJ, Sutherland PA.
School of Tropical Biology, James Cook University, Cairns, QLD. jamie.seymour@jcu.edu.au
PMID: 15588217 [PubMed - indexed for MEDLINE]
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Irukandji syndrome in northern Western Australia: an emerging health problem.
Macrokanis CJ, Hall NL, Mein JK.
Department of Medicine, Broome Health Service, Broome, WA. Conrad.Macrokanis@health.wa.gov.au
OBJECTIVES: (1) To assess the number and severity of episodes of Irukandji syndrome in Broome, Western Australia. (2) To correlate demographic, seasonal, geographic and climatic features of Irukandji stings. (3) To assess treatment of Irukandji syndrome at Broome Health Service. (4) To assess the public health impact. DESIGN AND SETTING: (1) A retrospective analysis of jellyfish data forms and charts of 111 patients, identified from Broome Health Service Emergency Department with a discharge diagnosis of marine sting between 1 January 2001 and 1 July 2003. (2) Correlation between climate and Irukandji envenomation data. MAIN OUTCOME MEASURES: Number of patients with Irukandji syndrome; their demographic and environmental features; the clinical syndrome; treatment requirements. RESULTS: 111 patients were prospectively identified with marine stings; 88 were identified with Irukandji syndrome. Non-Irukandji syndrome data were excluded for analysis. The "jellyfish season" extends from January to May, although stings occur all year round. Only 38% of patients had vinegar applied to the sting site before hospital presentation. Signs and symptoms were variable between individuals, with 20% having no signs of sting at all and welts found in 16%. Fifty per cent of patients were hypertensive at presentation. Distress was found in the majority of patients, with 90% requiring opioid analgesia (morphine equivalent: mean, 20 mg; median, 13 mg) and 17% requiring admission. There was one evacuation to Perth with cardiotoxic marine envenomation resulting in pulmonary oedema, which necessitated 4 days in intensive care. Stings were significantly more common when the ambient median temperature was greater than 28.3 degrees C, after midday, on an incoming high tide and on windy days. CONCLUSION: The rate of envenomation in northern WA is likely to be the highest currently documented in Australia. There is syndromic variability when compared with the north Queensland experience. This implies different causative jellyfish species that are not yet identified. Stings in Broome can be severe and life threatening; there are significant commercial and public health implications as a result. Management at Broome Hospital is contemporary and effective.
PMID: 15588216 [PubMed - indexed for MEDLINE]
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Snakebite in tropical Australia: a prospective study in the "Top End" of the Northern Territory.
Currie BJ.
Tropical and Emerging Infectious Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT. bart@menzies.edu.au
OBJECTIVE: To describe the epidemiology of snakebite in the "Top End" of the Northern Territory, and the envenoming syndromes of individual snake species. STUDY DESIGN: Prospective collection of clinical data and snake identity. SETTING: Royal Darwin Hospital (RDH), a 300-bed tertiary hospital servicing a population of 140,000 spread over 522 561 km2. PATIENTS: All patients with bites by confirmed snake species between September 1989 and March 2003, and all suspected snakebite cases between September 1989 and March 1998. OUTCOME MEASURES: Incidence rates of definite snakebite and envenoming. Clinical features of bites from defined snake species. RESULTS: There were 348 suspected snakebites over 8.6 years, with 114 aerial evacuations to RDH, 216 patients (62%) definitely bitten (23.2/100,000 per year) and 79 (23%) envenomed (7.6/100,000 per year). There were 156 bites from confirmed species over 13.6 years: 31 (20%) from western brown snakes (Pseudonaja nuchalis), with early collapse in 14 (45%), consumptive coagulopathy in 26 (84%) and 25 (81%) given antivenom; 21 from death adders (Acanthophis spp.), with neurotoxicity in 8 (38%) and 6 (29%) given antivenom; and 20 from mulga snakes (Pseudechis australis), with local swelling in 19 (95%), myotoxicity in 12 (60%) and 15 (75%) given antivenom. In 34 bites from less venomous species, there was no life-threatening envenoming. There were no deaths. CONCLUSIONS: Snakebite still causes morbidity in tropical Australia, but, with access to hospital and antivenom, deaths are rare. This study has enabled further definition of the envenoming syndromes of three highly venomous Australasian elapids.
PMID: 15588215 [PubMed - indexed for MEDLINE]
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Snakebite mortality at Port Moresby General Hospital, Papua New Guinea, 1992-2001.
McGain F, Limbo A, Williams DJ, Didei G, Winkel KD.
Australian Venom Research Unit, Department of Pharmacology, University of Melbourne, Melbourne, VIC.
OBJECTIVE: Fatal snakebites at Port Moresby General Hospital (PMGH), Papua New Guinea (PNG), were examined to identify interventions that may improve patient survival. DESIGN: Retrospective case series. SUBJECTS AND SETTING: Inpatients at PMGH who presented with snakebite, had evidence of envenomation, and died as inpatients between 1 January 1992 and 31 December 2001. OUTCOME MEASURES: Number and cause of fatalities; ventilation bed-days; antivenom timing, dose and price. RESULTS: 87 deaths occurred among 722 snakebite admissions to the intensive care unit (ICU). Of these 722 patients, 82.5% were ventilated, representing 45% of all ventilated ICU patients and 60% (3430/5717) of all ICU ventilator bed-days. The median duration of ventilation in fatal snakebite cases was significantly less than in non-fatal cases for children (3.0 v. 4.5 days) and adults (3.0 v. 5.0 days). The case-fatality rate for children (14.6%) was significantly greater than that for adults (8.2%). Sixty fatalities were examined in detail: 75% received blood products; 53% received antivenom (mostly a single ampoule of polyvalent), but only 5% received antivenom < or = 4 hours post-bite. Major causes of death included respiratory complications (50%), probable intracerebral haemorrhage (17%), and renal failure (10%). Antivenom unit costs increased significantly over the decade; in 2000 an ampoule of polyvalent antivenom was 40-fold more expensive in PNG than in Australia on a gross domestic product (A dollars) per capita basis. CONCLUSIONS: Management of severe snakebite is a major challenge for PMGH. Improved antivenom procurement and use policies (including increased use of appropriate monovalent antivenoms), combined with targeted snakebite education interventions (community- and hospital-based), are key interventions to reduce the ongoing toll from snakebite.
PMID: 15588214 [PubMed - indexed for MEDLINE]
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Antivenom, anecdotes and evidence.
Isbister GK.
Emergency Department, Newcastle Mater Misericordiae Hospital, NSW. gsbite@ferntree.com
Publication Types:
PMID: 15588213 [PubMed - indexed for MEDLINE]
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Antivenom dosing in 35 patients with severe brown snake (Pseudonaja) envenoming in Western Australia over 10 years.
Yeung JM, Little M, Murray LM, Jelinek GA, Daly FF.
Department of Emergency Medicine, Royal Perth Hospital, University of Western Australia, Perth, WA.
OBJECTIVE: To investigate the doses of antivenom administered to adult patients with severe brown snake envenoming. DESIGN AND SETTING: Review of charts from Western Australian adult teaching hospitals, December 1991 to December 2001. PATIENTS: 35 patients with severe brown snake envenoming, defined prospectively as afibrinogenaemia (< 0.3 g/L) after a bite by a brown snake (genus Pseudonaja). MAIN OUTCOME MEASURE: The dose of antivenom required to neutralise venom, defined prospectively as the dose of antivenom given before the return of detectable fibrinogen levels. RESULTS: Of 88 patients with brown snake envenoming admitted over the 10 years, at least 35 had severe envenoming. Afibrinogenaemia persisted for 10 hours (range, 1.4-68 hours) after the first dose of antivenom; in four patients afibrinogenaemia lasted more than 24 hours. The dose of antivenom given before venom neutralisation ranged from one to 23 ampoules. In two-thirds of cases, venom was neutralised with five ampoules, and 89% had venom neutralised with 10 ampoules. Two patients died, and another had serious bleeding complications. Another patient died during the study period from intracerebral haemorrhage, but did not have fibrinogen levels measured. CONCLUSIONS: Patients received initial doses of antivenom too small to neutralise circulating venom, and remained afibrinogenaemic for prolonged periods, with serious consequences. The authors now use 10 ampoules as an initial dose in severe brown snake envenoming.
PMID: 15588174 [PubMed - indexed for MEDLINE]
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