Clinical Toxicology最新文献

{"title":"The arsenic eaters of Styria, the toxicophagi.","authors":"Anthony D Dayan, Ernst Hesse, Joshua Dayan","doi":"10.1080/15563650.2024.2371514","DOIUrl":"10.1080/15563650.2024.2371514","url":null,"abstract":"<p><strong>Introduction: </strong>From at least the fifteenth to late nineteenth centuries, peasants in the Austrian province of Styria ate up to several hundred milligrams of arsenic trioxide or sulfide daily or weekly for periods up to a number of years. Taking these doses of arsenic was believed to increase muscular power and enhance the beauty and sexual attractiveness of peasant girls. There do not appear to be contemporaneous records of the known consequences of chronic arsenic exposure. The historical records of arsenic eating there are reviewed and appear to be valid. The benefits are subjective judgements by arsenic eaters. The lack of objective reports of the anticipated external and internal clinical and pathological effects of arsenic poisoning depends on a smaller number of clinical accounts and autopsy reports and the general medical literature of those times, so it is weaker, but it is consistent.</p><p><strong>Can the claimed benefits of arsenic eating and the apparent absence of harmful toxic effects be true?: </strong>Why the arsenic eaters did not show the well-known consequences of prolonged exposure to high doses of arsenic is not known. Possible explanations include increases in detoxifying metabolism in the consumers due to induced genomic changes and selection in people and in the gut microbiome, as shown in other populations. Whether these effects would suffice to protect people against their high doses of arsenic has not been explored.</p><p><strong>Conclusion: </strong>Although the nature and mechanisms of arsenic toxicity have been extensively described, much still remains to be discovered.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"468-471"},"PeriodicalIF":3.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141533859","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":"Influence of the glutamate-glutamine cycle on valproic acid-associated hepatotoxicity in pediatric patients with epilepsy.","authors":"Linfeng Ma, Jingwei Zhu, Xiaoni Kong, Li Chen, Jiangdong Du, Liping Yang, Dan Wang, Zhe Wang","doi":"10.1080/15563650.2024.2366920","DOIUrl":"10.1080/15563650.2024.2366920","url":null,"abstract":"<p><strong>Introduction: </strong>Although valproic acid is generally well tolerated, hepatotoxicity is a common side effect in patients receiving long-term treatment. However, the mechanisms underlying valproic acid-associated hepatotoxicity remain elusive.</p><p><strong>Methods: </strong>To investigate the mechanisms and explore the potential risk factors for valproic acid-associated hepatotoxicity, 165 age-matched pediatric patients were recruited for laboratory tests and glutamate-glutamine cycle analysis.</p><p><strong>Results: </strong>The concentration of glutamate in patients with hepatotoxicity was significantly greater than that in control patients, while the concentration of glutamine in patients with hepatotoxicity was significantly lower than that in control patients (<i>P</i> <0.05). In addition, the frequencies of the heterozygous with one mutant allele and homozygous with two mutant alleles genotypes in <i>glutamate-ammonia ligase rs10911021</i> were significantly higher in the hepatotoxicity group than those in the control group (47.1 percent versus 32.5 percent, <i>P</i> = 0.010; 17.6 percent versus 5.2 percent, <i>P</i> = 0.001, respectively). Moreover, heterozygous carriers with one mutant allele and homozygous carriers with two mutant alleles genotypes of <i>glutamate-ammonia ligase rs10911021</i> exhibited significant differences in the concentrations of glutamine and glutamate concentrations (<i>P</i> ˂ 0.001 and <i>P</i> = 0.001, respectively) and liver function indicators (activities of aspartate aminotransferase, alanine aminotransferase, and gamma-glutamyl transferase, <i>P</i> <0.001, respectively). Furthermore, logistic regression analysis indicated that <i>glutamate-ammonia ligase rs10911021</i> (<i>P</i> = 0.002, odds ratio: 3.027, 95 percent confidence interval, 1.521 - 6.023) and glutamate (<i>P</i> = 0.001, odds ratio: 2.235, 95 percent confidence interval, 1.369 - 3.146) were associated with a greater risk for hepatotoxicity, while glutamine concentrations were negatively associated with hepatotoxicity (<i>P</i> = 0.001, odds ratio: 0.711, 95 percent confidence interval, 0.629 - 0.804).</p><p><strong>Discussion: </strong>Understanding pharmacogenomic risks for valproic acid induced hepatotoxicity might help direct patient specific care. Limitations of our study include the exclusive use of children from one location and concomitant medication use in many patients.</p><p><strong>Conclusion: </strong>Perturbation of the glutamate-glutamine cycle is associated with valproic acid-associated hepatotoxicity. Moreover, <i>glutamate-ammonia ligase rs10911021</i>, glutamate and glutamine concentrations are potential risk factors for valproic acid-associated hepatotoxicity.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"364-371"},"PeriodicalIF":3.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141445787","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":"Plant-origin rotenone poisoning - a rare cause of metabolic acidosis with hyperlactatemia diagnosed with DNA barcoding of gastric contents.","authors":"Kelvin Yat-Chung Yu, Ying-Hoo Lam, Sau-Wah Ng, Yee-Ting Cheung, Jeremiah Sik-Bit Tseung, Hok-Fung Tong, Chor-Kwan Ching, Yeow-Kuan Chong","doi":"10.1080/15563650.2024.2350597","DOIUrl":"10.1080/15563650.2024.2350597","url":null,"abstract":"","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"407-408"},"PeriodicalIF":3.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141305618","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":"Chlorpromazine overdose: a case series.","authors":"Ingrid Berling, Geoffrey K Isbister","doi":"10.1080/15563650.2024.2367672","DOIUrl":"10.1080/15563650.2024.2367672","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Chlorpromazine, one of the oldest antipsychotic medications, remains widely available and is still taken in overdose. We aimed to investigate the clinical effects of chlorpromazine overdose and determine if there is a relationship between the reported dose ingested and intensive care unit admission or endotracheal intubation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We performed a retrospective analysis of patients admitted to our toxicology tertiary referral hospital with chlorpromazine overdose (reported dose ingested greater than 300 mg) between 1987 and 2023. We extracted demographic information, details of ingestion, clinical effects and complications (Glasgow Coma Scale, hypotension [systolic blood pressure less than 90 mmHg], delirium, dysrhythmias), length of stay, intensive care unit admission, and endotracheal intubation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;There were 218 chlorpromazine overdose cases, with presentations decreasing in frequency over the 36 years. The median age at presentation was 32 years (interquartile range: 25-40 years) and 143 (61 per cent) were female. The median reported dose ingested was 1,250 mg (interquartile range; 700-2,500 mg). The majority of presentations (135; 62 per cent) involved reported co-ingestion of other medications, typically benzodiazepines, paracetamol or antipsychotics. There were 76 (35 per cent) chlorpromazine alone ingestions in which there was a slightly higher median reported dose ingested of 1,650 mg (interquartile range: 763-3,000 mg) compared to the reported co-ingestion group, median reported dose ingested of 1,200 mg (interquartile range: 700-2,100 mg). Of all presentations, 36 (27 per cent) had a Glasgow Coma Scale less than 9, 50 (23 per cent) were admitted to the intensive care unit, and 32 (15 per cent) were endotracheally intubated. There was a significant difference in the median reported dose ingested between patients intubated (2,000 mg; interquartile range: 1,388-3,375 mg) and those not intubated (1,200 mg; interquartile range: 644-2,050mg; &lt;i&gt;P&lt;/i&gt; &lt; 0.001), and between those admitted to the intensive care unit and not admitted to the intensive care unit (&lt;i&gt;P&lt;/i&gt; &lt; 0.0001). The median reported dose ingested in seven chlorpromazine alone presentations who were intubated was 2,500 mg (interquartile range: 2,000-8,000 mg, range: 1,800-20,000 mg). Eighteen (8 per cent) patients developed delirium, eight (4 per cent) had hypotension, three had seizures, and there was one death.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;Almost one quarter of cases were admitted to the intensive care unit and over half of these were intubated. Whist the decision to admit to an intensive care unit or intubate a patient is based on clinical need, there was a significant association between reported dose ingested and requirement for endotracheal intubation. Both the frequency of presentation and reported dose ingested declined after 2013. The major limitations of the study were a retr","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"372-377"},"PeriodicalIF":3.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141418108","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":"Clinical effects of cannabis compared to synthetic cannabinoid receptor agonists (SCRAs): a retrospective cohort study of presentations with acute toxicity to European hospitals between 2013 and 2020.","authors":"Mitchell L Waters, Paul I Dargan, Christopher Yates, Alison M Dines, Florian Eyer, Isabelle Giraudon, Fridtjof Heyerdahl, Knut Erik Hovda, Matthias E Liechti, Òscar Miró, Odd Martin Vallersnes, Kurt Anseeuw, Robertas Badaras, Marcin Bitel, Jeffrey Bonnici, Miran Brvar, Blazena Caganova, Feriyde Calýskan, Alessandro Ceschi, Karam Chamoun, Laurence Daveloose, Miguel Galicia, Birgit Gartner, Ketevan Gorozia, Damjan Grenc, Femke M J Gresnigt, Laura Hondebrink, Gesche Jürgens, Jutta Konstari, Soso Kutubidze, Gabija Laubner, Evangelia Liakoni, Viesturs Liguts, Cathelijne Lyphout, Roy McKenna, Bruno Mégarbane, Adrian Moughty, Gabriela Viorela Nitescu, Roberta Noseda, Niall O'Connor, Raido Paasma, Juan Ortega Perez, Marius Perminas, Per Sverre Persett, Kristiina Põld, Erik Puchon, Jordi Puiguriguer, Julia Radenkova-Saeva, Jan Rulisek, Caroline Samer, Yasmin Schmid, Irene Scholz, Roberts Stašinskis, Jonas Surkus, Irma Van den Hengel-Koot, Federico Vigorita, Severin Vogt, Wojciech Waldman, William Stephen Waring, Sergej Zacharov, Tobias Zellner, David M Wood","doi":"10.1080/15563650.2024.2346125","DOIUrl":"10.1080/15563650.2024.2346125","url":null,"abstract":"<p><strong>Introduction: </strong>Cannabis is the most common recreational drug worldwide and synthetic cannabinoid receptor agonists are currently the largest group of new psychoactive substances. The aim of this study was to compare the clinical features and outcomes of lone acute cannabis toxicity with lone acute synthetic cannabinoid receptor agonist toxicity in a large series of presentations to European emergency departments between 2013-2020.</p><p><strong>Methods: </strong>Self-reported drug exposure, clinical, and outcome data were extracted from the European Drug Emergencies Network Plus which is a surveillance network that records data on drug-related emergency department presentations to 36 centres in 24 European countries. Cannabis exposure was considered the control in all analyses. To compare the lone cannabis and lone synthetic cannabinoid receptor agonist groups, univariate analysis using chi squared testing was used for categorical variables and non-parametric Mann-Whitney U- testing for continuous variables. Statistical significance was defined as a <i>P</i> value of <0.05.</p><p><strong>Results: </strong>Between 2013-2020 there were 54,314 drug related presentations of which 2,657 were lone cannabis exposures and 503 lone synthetic cannabinoid receptor agonist exposures. Synthetic cannabinoid receptor agonist presentations had statistically significantly higher rates of drowsiness, coma, agitation, seizures and bradycardia at the time of presentation. Cannabis presentations were significantly more likely to have palpitations, chest pain, hypertension, tachycardia, anxiety, vomiting and headache.</p><p><strong>Discussion: </strong>Emergency department presentations involving lone synthetic cannabinoid receptor agonist exposures were more likely to have neuropsychiatric features and be admitted to a psychiatric ward, and lone cannabis exposures were more likely to have cardiovascular features. Previous studies have shown variability in the acute toxicity of synthetic cannabinoid receptor agonists compared with cannabis but there is little comparative data available on lone exposures. There is limited direct comparison in the current literature between lone synthetic cannabinoid receptor agonist and lone cannabis exposure, with only two previous poison centre series and two clinical series. Whilst this study is limited by self-report being used to identify the drug(s) involved in the presentations, previous studies have demonstrated that self-report is reliable in emergency department presentations with acute drug toxicity.</p><p><strong>Conclusion: </strong>This study directly compares presentations with acute drug toxicity related to the lone use of cannabis or synthetic cannabinoid receptor agonists. It supports previous findings of increased neuropsychiatric toxicity from synthetic cannabinoid receptor agonists compared to cannabis and provides further data on cardiovascular toxicity in lone cannabis use.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"378-384"},"PeriodicalIF":3.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141455720","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":"Radiological changes in lead poisoning.","authors":"Daniel Alvarenga Fernandes, Marília Assunção Jorge, Andréa de Melo Alexandre Fraga, Fabiano Reis","doi":"10.1080/15563650.2024.2342928","DOIUrl":"10.1080/15563650.2024.2342928","url":null,"abstract":"<p><strong>Introduction: </strong>Lead poisoning in childhood remains an important public health concern. We highlight the radiological findings in a patient with a high blood lead concentration.</p><p><strong>Case summary: </strong>A 7-year-old girl presented to hospital with abdominal pain, nausea, and asthenia. Laboratory tests showed severe hypochromic microcytic anemia, punctate basophilic stippling of erythrocytes, and a blood lead concentration of 880 µg/L (4.3 µmol/L).</p><p><strong>Images: </strong>Radiographs of the femur, tibia, and fibula demonstrated dense metaphyseal bands (\"lead lines\"). On cranial computed tomography, we observed multiple speck-like and curvilinear hyperdensities involving subcortical regions, putamen, and left cerebellar hemisphere.</p><p><strong>Conclusion: </strong>In patients with lead poisoning, imaging of the brain and bones may show characteristic features. These imaging findings may point to the diagnosis of lead toxicity when these radiographic findings are discovered during the evaluation of vague complaints such as abdominal pain or mental status changes or when a blood lead concentration is not readily available.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"404-406"},"PeriodicalIF":3.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141426494","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":"Association of the OPRM1 variant <i>rs1799971 (A118G)</i> and clinical manifestations in tramadol poisoned patients: a cross-sectional study.","authors":"Ali Ershad, Sahel Shafiee Dolat Abadi, Melika Ebrahimian, Seyed Kaveh Hadeiy, Naghmeh Zamani, Ali-Asghar Kolahi, Abolfazl Movafagh, Hossein Hassanian-Moghaddam","doi":"10.1080/15563650.2024.2366921","DOIUrl":"10.1080/15563650.2024.2366921","url":null,"abstract":"<p><strong>Introduction: </strong>The opioid receptor mu1 is a protein coding gene that can have different codes for a protein and may have variations (polymorphisms) affecting how opioids work. The aim of this study was to investigate the prevalence of the most common opioid receptor mu1 polymorphism (<i>A118G</i>) and any relationship between this polymorphism and features following tramadol overdose.</p><p><strong>Materials and methods: </strong>This was a cross-sectional study of patients admitted with tramadol poisoning to an Iranian hospital. These patients were not taking any other drugs or medications and had no history of seizures.</p><p><strong>Results: </strong>The results showed that among the 83 patients included in the study, 57 (69 per cent) had the AA genotype, 25 (30 per cent) had the AG genotype, and one (1 per cent) had the GG genotype for the opioid receptor mu1 <i>A118G</i> polymorphism. Nausea and/or vomiting occurred in nine (11 per cent) patients and dizziness in 38 (46 per cent) patients. Serious adverse events included seizures in 51 (60 per cent) patients and respiratory failure requiring mechanical ventilation in 21 (25 per cent) patients. However, there was no significant association between the opioid receptor mu1 <i>A118G</i> polymorphism and these adverse events.</p><p><strong>Discussion: </strong>In our study, the frequency of the A allele was greater than the G allele, and the AA genotype was more prevalent than AG. The GG genotype was the least common among the polymorphisms of opioid receptor mu1 <i>rs1799971</i>. There was no significant association between the opioid receptor mu1 <i>A118G</i> polymorphism and symptoms in tramadol-poisoned patients. Although these allele proportions are similar to the results reported in other Caucasian populations, they are dissimilar to the findings in Chinese and Singaporean populations. In these Asian studies, the predominant allele was the G allele. It has been suggested that a mutated G allele will decrease the production of opioid receptor mu1-related messenger ribonucleic acid and related proteins, leading to fewer mu-opioid receptors in the brain.</p><p><strong>Conclusions: </strong>This study found no significant association between the opioid receptor mu1 <i>A118G</i> polymorphism and adverse outcomes in tramadol-poisoned patients. However, more research is needed to draw more definitive conclusions due to the limited evidence and variability of opioid receptor mu1 polymorphisms in different populations.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"357-363"},"PeriodicalIF":3.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141466671","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":"Use of large language models to optimize poison center charting.","authors":"Nikolaus Matsler, Lesley Pepin, Shireen Banerji, Christopher Hoyte, Kennon Heard","doi":"10.1080/15563650.2024.2348107","DOIUrl":"10.1080/15563650.2024.2348107","url":null,"abstract":"<p><strong>Introduction: </strong>Efficient and complete medical charting is essential for patient care and research purposes. In this study, we sought to determine if Chat Generative Pre-Trained Transformer could generate cogent, suitable charts from recorded, real-world poison center calls and abstract and tabulate data.</p><p><strong>Methods: </strong>De-identified transcripts of real-world hospital-initiated poison center consults were summarized by Chat Generative Pre-Trained Transformer 4.0. Additionally, Chat Generative Pre-Trained Transformer organized tables for data points, including vital signs, test results, therapies, and recommendations. Seven trained reviewers, including certified specialists in poison information and board-certified medical toxicologists, graded summaries using a 1 to 5 scale to determine appropriateness for entry into the medical record. Intra-rater reliability was calculated. Tabulated data was quantitatively evaluated for accuracy. Finally, reviewers selected preferred documentation: original or Chat Generative Pre-Trained Transformer organized.</p><p><strong>Results: </strong>Eighty percent of summaries had a median score high enough to be deemed appropriate for entry into the medical record. In three duplicate cases, reviewers did change scores, leading to moderate intra-rater reliability (kappa = 0.6). Among all cases, 91 percent of data points were correctly abstracted into table format.</p><p><strong>Discussion: </strong>By utilizing a large language model with a unified prompt, charts can be generated directly from conversations in seconds without the need for additional training. Charts generated by Chat Generative Pre-Trained Transformer were preferred over extant charts, even when they were deemed unacceptable for entry into the medical record prior to the correction of errors. However, there were several limitations to our study, including poor intra-rater-reliability and a limited number of cases examined.</p><p><strong>Conclusions: </strong>In this study, we demonstrate that large language models can generate coherent summaries of real-world poison center calls that are often acceptable for entry to the medical record as is. When errors were present, these were often fixed with the addition or deletion of a word or phrase, presenting an enormous opportunity for efficiency gains. Our future work will focus on implementing this process in a prospective fashion.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"385-390"},"PeriodicalIF":3.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141305620","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":"Severe morel mushroom poisonings in France - a nationwide French poison centres study 2010-2020.","authors":"Dominique Vodovar, Laurine Le Visage, Weniko Caré, Jérôme Langrand, Hervé Laborde-Casterot","doi":"10.1080/15563650.2024.2367657","DOIUrl":"10.1080/15563650.2024.2367657","url":null,"abstract":"<p><strong>Introduction: </strong>In 2023, two fatalities attributed to the ingestion of uncooked morels (<i>Morchella</i> spp.) were reported in the United States; both patients developed severe gastrointestinal symptoms. Morel-induced gastrointestinal toxicity is well recognized, but no deaths had been reported until 2023, suggesting a potential shift in the severity of morel poisoning.</p><p><strong>Methods: </strong>Using the Poisoning Severity Score, we analyzed the severity of symptomatic cases of morel ingestion recorded in the French National Database of Poisonings from 2010 to 2020.</p><p><strong>Results: </strong>We found 446 cases of exposure in which morels were the sole mushroom species involved. Of these, 83.6 per cent and 53.3 per cent developed gastrointestinal and neurological symptoms, respectively. Eight patients developed shock attributed to severe gastrointestinal symptoms, resulting in two deaths.</p><p><strong>Discussion: </strong>Morel ingestion can lead to severe complications. As in the United States, the deaths reported in this study were attributed to imported cultivated morels. The shift, since 2006, towards a predominance of cultivated over wild morel sales may have played a role in the reporting of severe cases of morel poisoning.</p><p><strong>Conclusions: </strong>Reports of severe morel poisoning highlight the need for cautious consumption, particularly of raw or undercooked preparations. Emerging complications signal potential changes in toxicity. Surveillance and awareness are key to reducing the risks of consuming morels.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"391-395"},"PeriodicalIF":3.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141442213","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":"Significant increase in the number of occupational exposures reported to the Dutch Poisons Information Centre (2016-2022): the importance of poison centre data in health surveillance.","authors":"Anja Wijnands, Maël Thielman, Claudine Hunault, Arjen Koppen, Dylan de Lange, Saskia Rietjens","doi":"10.1080/15563650.2024.2370303","DOIUrl":"10.1080/15563650.2024.2370303","url":null,"abstract":"<p><strong>Introduction: </strong>Exposure to hazardous substances in the workplace can result in injuries and fatalities. This study aimed to investigate the characteristics and trend of occupational exposures reported to the Dutch Poisons Information Centre and to investigate whether the COVID-19 pandemic had an impact on the trend.</p><p><strong>Methods: </strong>A retrospective analysis of all acute occupational exposures reported to the Dutch Poisons Information Centre between 1 January 2016 and 31 December 2022 was performed. Data on patient and exposure characteristics, symptoms and treatment recommendations were analyzed.</p><p><strong>Results: </strong>Between 2016 and 2022, the Dutch Poisons Information Centre received 5,508 calls regarding acute occupational exposures. The annual number of calls on acute occupational exposures almost doubled over the years studied (from 475 in 2016 to 936 in 2022). During and after the COVID-19 pandemic (March 2020-December 2022), the number of calls stabilized, but the upward trend was not significantly affected. There were an estimated 0.20 calls per 1,000 human exposure calls per month (95 per cent confidence interval: -0.14; 0.53). Victims were often exposed through multiple routes, with inhalation being the most common route (44 per cent), followed by ocular (32 per cent) and dermal contact (30 per cent). Acids (1,138 exposures) and alkalis (912 exposures) were often involved. The Dutch Poisons Information Centre had information on 6,334 patients, although the total number of exposed patients was not known as some victims did not seek medical assistance, or were treated by healthcare professionals who did not consult our Centre. At the time of contact, 13 per cent (<i>n</i> = 795) of the patients reported no symptoms, 76 per cent (<i>n</i> = 4,805) reported mild to moderate symptoms and 3 per cent (<i>n</i> = 183) reported potentially severe symptoms. Information on symptoms was missing for 9 per cent (<i>n</i> = 551) of the patients. Hospital observation and treatment were recommended for 5 per cent (<i>n</i> = 325) of the patients.</p><p><strong>Discussion: </strong>This study highlights the necessity for poisoning prevention strategies to reduce the number of work-related incidents involving hazardous substances.</p><p><strong>Conclusion: </strong>The continuing increase in the number of workplace incidents involving hazardous substances is of concern. A comprehensive and multidisciplinary approach should be taken to gain a full understanding of occupational exposure to hazardous substances and to identify risk factors.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"396-403"},"PeriodicalIF":3.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141497328","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}