Clinical Toxicology最新文献

{"title":"Abnormalities in brain magnetic resonance imaging associated with vigabatrin therapy in an infant with infantile epileptic spasms syndrome.","authors":"Maria Inês de Sá, Filipa Proença","doi":"10.1080/15563650.2024.2418979","DOIUrl":"10.1080/15563650.2024.2418979","url":null,"abstract":"<p><strong>Introduction: </strong>Vigabatrin, an anticonvulsant drug used for refractory epilepsy and as first-line treatment for infantile epileptic spasms syndrome, can rarely cause brain abnormalities detectable on magnetic resonance imaging. These complications, potentially related to dose, young age, and concomitant high doses of adrenocorticotropic hormone and/or prednisolone, can lead to neurological symptoms. Upon withdrawal or dose reduction, symptoms and imaging changes tend to resolve.</p><p><strong>Case summary: </strong>A 7-month-old infant diagnosed with infantile epileptic spasms syndrome started treatment with vigabatrin and prednisolone. However, spasms recurred, prompting an increase in the dose of vigabatrin and the addition of adrenocorticotropic hormone, which reduced the frequency of spasms. The patient later developed encephalopathy and upper limb tremors.</p><p><strong>Images: </strong>Magnetic resonance imaging revealed symmetrical hyperintense lesions with concomitant restricted diffusion localized in the thalami, basal ganglia, brainstem, and cerebellar dentate nuclei.</p><p><strong>Conclusion: </strong>We report an infant with infantile epileptic spasms syndrome treated with vigabatrin who developed abnormalities on magnetic resonance imaging. There is currently no treatment other than drug withdrawal or reduction.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"137-138"},"PeriodicalIF":3.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142845929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction.","authors":"","doi":"10.1080/15563650.2024.2430917","DOIUrl":"10.1080/15563650.2024.2430917","url":null,"abstract":"","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"153"},"PeriodicalIF":3.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142686263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Human exposures due to animals and exotic pets reported to the poison information centre Erfurt from 2013 to 2022.","authors":"Jennifer Wessling, Dagmar Prasa, Michael Deters","doi":"10.1080/15563650.2024.2445231","DOIUrl":"https://doi.org/10.1080/15563650.2024.2445231","url":null,"abstract":"<p><strong>Introduction: </strong>In Germany, human exposures to animals are rare in comparison to those caused by drugs, chemicals, and plants. We aimed to characterize human exposures to animals and exotic pets, including the age group and sex of the involved person, symptom severity, management, the identity of the individual calling the Poisons Information Centre Erfurt, and the place of exposure.</p><p><strong>Methods: </strong>All human exposures involving animals and exotic pets referred to the Poisons Information Centre Erfurt from 2013 to 2022 were retrospectively analysed.</p><p><strong>Results: </strong>There were 1,799 human exposures to animals between 2013 and 2022, of which 62.8% were symptomatic. Children (<i>n</i> = 655) were involved in 36.4% of cases. The proportion of males (<i>n</i> = 892, 49.6%) exposed to animals was higher than that of females. Exposures to animals increased from 132 in 2013 to 221 in 2022. Between 2013 and 2022, there were 158 exposures to exotic pets, mainly aquatic species (<i>n</i> = 89), of which 63.9% were symptomatic. There were between seven to 22 human exposures to exotic pets per year (mean 15.8 per year). Severe symptoms occurred after exposures to <i>Vipera berus</i> (<i>n</i> = 4) and <i>Crotalus</i> spp. (<i>n</i> = 2). Severe anaphylaxis was observed after stings of <i>Vespa crabro</i> (<i>n</i> = 2), <i>Vespula/Dolichovespula</i> (<i>n</i> = 1), and <i>Insecta</i> spp. unknown (<i>n</i> = 1). A bite of <i>Cheiracanthium</i> spp. (<i>n</i> = 1) resulted in secondary infection. No fatality occurred.</p><p><strong>Discussion: </strong>The low proportion (0.7%) of human exposures to animals (<i>n</i> = 1,799) compared to all human exposures in our study (<i>n</i> = 259,679) can be explained by the lack of highly venomous animals in Germany.</p><p><strong>Conclusions: </strong>Exposures to animals reported to the Poisons Information Centre Erfurt slightly increased from 2013 to 2022, while exposures to exotic pets (mostly aquatic species) stayed at a low level.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":"63 2","pages":"118-126"},"PeriodicalIF":3.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Forensic pre-hospital deaths related to pentobarbital in the Paris area.","authors":"Léo Dubois, Marc Liautard, Lauriane Charuel, Marjorie Chèze, Bertrand Ludes, Isabelle Fortel, Caroline Rambaud, Charlotte Mayer, Jean-Claude Alvarez, Jérôme Langrand, Dominique Vodovar, Laurène Dufayet","doi":"10.1080/15563650.2024.2435395","DOIUrl":"10.1080/15563650.2024.2435395","url":null,"abstract":"","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"148-149"},"PeriodicalIF":3.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142799637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of squamous cell carcinoma at the bite sites several years following suspected cobra (<i>Naja naja</i>) envenomings.","authors":"Subramanian Senthilkumaran, José R Almeida, Jarred Williams, Harry F Williams, Ponniah Thirumalaikolundusubramanian, Sakthivel Vaiyapuri","doi":"10.1080/15563650.2024.2432407","DOIUrl":"10.1080/15563650.2024.2432407","url":null,"abstract":"<p><strong>Introduction: </strong>Snakebite envenoming is a multidimensional issue that causes severe functional and life-challenging consequences among rural communities in tropical countries. Current research and treatments are largely focused on the acute effects of envenomation and short-term health outcomes. The knowledge of snakebite-induced long-term consequences is highly limited.</p><p><strong>Case series: </strong>We report the development of squamous cell carcinoma at the bite site several years later in four patients who are suspected to have been bitten by cobras (<i>Naja naja</i>). Following bites, the victims presented typical symptoms of cobra envenomings including ptosis, altered sensorium, and breathing difficulties. However, difficult-to-heal wounds were a chronic health sequelae with frequent desquamation cycles which led to squamous cell carcinoma. Surgery as the primary therapeutic approach was used for all patients to address this issue.</p><p><strong>Discussion: </strong>These patients highlight the importance of squamous cell carcinoma in previously damaged tissue from snakebites as a possible long-term consequence. This emphasises the need for surveillance systems focused on a broad range of snakebite-induced consequences including long-term pathological, psychological, and socioeconomic conditions.</p><p><strong>Conclusion: </strong>This case series describes pathological complications following cobra bites that require further research to determine mechanistic and epidemiological insights in the most affected regions by snakebites, specifically in India.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"142-144"},"PeriodicalIF":3.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11854041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinico-epidemiology of tarantula (<i>Poecilotheria</i> spp.) bites in Sri Lanka.","authors":"R M M K Namal Rathnayaka, P E Anusha Nishanthi Ranathunga","doi":"10.1080/15563650.2024.2446555","DOIUrl":"https://doi.org/10.1080/15563650.2024.2446555","url":null,"abstract":"<p><strong>Introduction: </strong>Tarantulas of the <i>Poecilotheria</i> genus are medically important arthropods in Sri Lanka and are also found in India. This study aimed to describe the epidemiological and clinical features of tarantula bites in Sri Lanka.</p><p><strong>Methods: </strong>We conducted a prospective observational study of patients with tarantula bites over 3.5 years in the medical and paediatric wards at two hospitals in Sri Lanka starting in February 2021. Data were collected using an interviewer-administered questionnaire.</p><p><strong>Results: </strong>There were 17 patients with tarantula bites of whom 15 were adults and two were children. The median age of adults was 47 years (range 26-62 years). Most were males (12/17) and were bitten in the daytime (14/17), in small jungles (8/17), and on their feet (8/17). Most (11/17) were admitted to the medical facility within 1 h of the bite. Sixteen of 17 patients developed local envenoming features including local pain in 15, local swelling in 13, erythema at the site of the bite in five, and itching in four. Three of 17 had generalized muscle pain and four were found to have painful muscle cramps.</p><p><strong>Conclusion: </strong>Tarantula bites from the Poecilotheria genus frequently cause local envenoming effects but few patients develop muscle pain and painful muscle cramps.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":"63 2","pages":"112-114"},"PeriodicalIF":3.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Refractory methemoglobinemia after ingestion of <i>N,N</i>-dimethyl-<i>p</i>-toluidine.","authors":"Chih-Yang Mao, Yen-Syuan Liao, Te-I Weng, Hsien-Yi Chen","doi":"10.1080/15563650.2024.2439566","DOIUrl":"10.1080/15563650.2024.2439566","url":null,"abstract":"","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"150-151"},"PeriodicalIF":3.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142834344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regional readiness for sodium nitrite-induced methemoglobinemia: availability of methemoglobin testing and methylthioninium chloride (methylene blue) stocking in the Upper Midwestern United States.","authors":"Travis D Olives, Jack B Goldstein, Morgan L Forgette, Paul Young, Jon B Cole","doi":"10.1080/15563650.2024.2436059","DOIUrl":"10.1080/15563650.2024.2436059","url":null,"abstract":"<p><strong>Introduction: </strong>Sodium nitrite is a potent oxidizer, which may precipitate rapidly lethal methemoglobinemia. Prompt diagnosis and treatment may salvage otherwise fatal cases. It is unclear if emergency departments are prepared for increasing cases. We describe the availability and geographic distribution of real-time methemoglobin testing and methylthioninium chloride (methylene blue) availability in three contiguous United States.</p><p><strong>Methods: </strong>This is a cross-sectional survey of hospitals served by a regional poison center in the Upper Midwestern United States. Hospitals were identified by cross-referencing poison center, health department, and state trauma databases. We queried methemoglobin testing capabilities of each site as well as immediate methylthioninium chloride availability. Resulting data are described with descriptive statistics, and predictors of testing and treatment availability are evaluated in multivariable logistic regression.</p><p><strong>Results: </strong>We identified 320 hospitals with emergency care, analyzing 228 (71.3%) after exclusions. Real-time methemoglobin testing was available at 56 sites (30.6% of 183 respondents). Of hospitals describing methylthioninium chloride availability, 59.4% (130/219) reported having it on-site. A significant difference in real-time methemoglobin testing existed across largest and smallest population strata in adjusted analysis (OR: 64.6: 95% CI: 4.1-1,037). Similarly disparate availability of methylthioninium chloride was observed. Spatial distribution of methemoglobin testing and methylthioninium chloride availability demonstrated notable urban-rural disparities.</p><p><strong>Discussion: </strong>These data demonstrate a wide disparity in the availability of real-time methemoglobin testing and methylthioninium chloride availability, suggesting that the region is ill-prepared to care for severe methemoglobinemia. Our analysis points to a disconnect between our current poison center recommendations and the capacities of our consulting institutions.</p><p><strong>Conclusions: </strong>We demonstrate urban-rural disparities in diagnostic and therapeutic capacity for the management of acute methemoglobinemia in this region, as well as significant geographic variations in methylthioninium chloride stocking and poisoning preparedness. Poison centers must therefore maintain an awareness of antidote availability for this emerging toxicological emergency.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"92-101"},"PeriodicalIF":3.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterization of glucagon-like peptide-1 (GLP-1) agonist exposures reported to a single United States poison center.","authors":"Karen Muschler, Rachael Muschalek, Christopher Hoyte","doi":"10.1080/15563650.2024.2444642","DOIUrl":"10.1080/15563650.2024.2444642","url":null,"abstract":"<p><strong>Introduction: </strong>Glucagon-like peptide-1 agonists have gained attention in recent years due to their efficacy in managing type II diabetes mellitus and their emerging role in weight management. The purpose of this study was to characterize glucagon-like peptide-1 agonist exposures reported to a single United States regional poison center over nine years, including causes of exposure, associated clinical effects, and potential areas for improving patient education and safety.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed all poison center calls involving glucagon-like peptide-1 agonists submitted to a single United States regional poison center from 14 January 2014 to 1 May 2023. Data were abstracted from the electronic medical record of the poison center, including demographics, call volume, drug involved, type of exposure, frequency of hypoglycemia, and other side effects.</p><p><strong>Results: </strong>Two hundred and thirty-seven cases involving glucagon-like peptide-1 agonists were reported to the poison center. The annual number of cases increased sharply over this period. Most patients (<i>n</i> = 166, 70.0%) were females. Most calls (<i>n</i> = 164, 69.2%) were due to unintentional therapeutic errors. Semaglutide was the most frequently involved medication (<i>n</i> = 72, 36.0%). Hypoglycemia was identified in eight patients (3.4%). The lowest mean (±SD) blood glucose concentration in these hypoglycemic patients was 49.6 ± 23.7 mg/dL (2.76 ± 1.3 mmol/L).</p><p><strong>Discussion: </strong>Unintentional therapeutic errors were involved in 164 (69.2%) cases. Despite the generally mild clinical effects observed in this study, the occurrence of hypoglycemia in a subset of patients, often requiring hospitalization, is of concern. With reports of the acquisition of these medications through online platforms and poorly regulated compounding sources, this trend may pose public health risks.</p><p><strong>Conclusions: </strong>This study demonstrates the increasing incidence of glucagon-like peptide-1 agonist exposures reported to a United States regional poison center, predominantly due to unintentional overdoses, which highlights the need for ongoing patient education.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"133-136"},"PeriodicalIF":3.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142969900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting delayed neurological sequelae in patients with carbon monoxide poisoning using machine learning models.","authors":"Yunfeng Zhu, Tianshu Mei, Dawei Xu, Wei Lu, Dan Weng, Fei He","doi":"10.1080/15563650.2024.2437113","DOIUrl":"10.1080/15563650.2024.2437113","url":null,"abstract":"<p><strong>Introduction: </strong>Delayed neurological sequelae is a common complication following carbon monoxide poisoning, which significantly affects the quality of life of patients with the condition. We aimed to develop a machine learning-based prediction model to predict the frequency of delayed neurological sequelae in patients with carbon monoxide poisoning.</p><p><strong>Methods: </strong>A single-center retrospective analysis was conducted in an emergency department from January 01, 2018, to December 31, 2023. We analyzed data from patients with carbon monoxide poisoning, which were divided into training and test sets. We developed and evaluated sixteen machine learning models, using accuracy, sensitivity, specificity, and other relevant metrics. Threshold adjustments were performed to determine the most accurate model for predicting patients with carbon monoxide poisoning at risk of delayed neurological sequelae.</p><p><strong>Results: </strong>A total of 360 patients with carbon monoxide poisoning were investigated in the present study, of whom 103 (28.6%) were diagnosed with delayed neurological sequelae, and two (0.6%) died. After threshold adjustment, the synthetic minority oversampling technique-random forest model demonstrated superior performance with an area under the receiver operating characteristic curve of 0.89 and an accuracy of 0.83. The sensitivity and specificity of the model were 0.9 and 0.8, respectively.</p><p><strong>Discussion: </strong>The study developed a machine learning-based synthetic minority oversampling technique-random forest model to predict delayed neurological sequelae in patients with carbon monoxide poisoning, achieving an area under the receiver operating characteristic curve of 0.89. This technique was used to handle class imbalance, and shapley additive explanations analysis helped explain the model predictions, highlighting important factors such as the Glasgow Coma Scale, hyperbaric oxygen therapy, kidney function, immune response, liver function, and blood clotting.</p><p><strong>Conclusions: </strong>The machine learning-based synthetic minority oversampling technique-random forest model developed in this study effectively identifies patients with carbon monoxide poisoning at high risk for delayed neurological sequelae.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"102-111"},"PeriodicalIF":3.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142976823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}