Neutrophil-to-lymphocyte Ratio as A Predictor of Aspiration Pneumonia in Drug Intoxication Patients

PURPOSE: To evaluate the association between neutrophil-to-lymphocyte ratio (NLR) and occurrence of aspiration pneumonia in drug intoxication (DI) patients in the emergency department (ED) and to evaluate the relationship between NLR and length of hospital admission/intensive care unit (ICU) admission. METHODS: A total of 466 patients diagnosed with DI in the ED from January 2016 to December 2017 were included in the analysis. The clinical and laboratory results, including NLR, were evaluated as variables. NLR was calculated as the absolute neutrophil count/absolute lymphocyte count. To evaluate the prognosis of DI, data on the development of aspiration pneumonia were obtained. Also, we evaluated the relationship between NLR and length of hospital admission and between NLR and length of ICU admission. Statistically, multivariate logistic regression analyses, receiver-operating characteristic (ROC) curve analysis, and Pearson's correlation (ρ) were performed. RESULTS: Among the 466 DI patients, 86 (18.5%) developed aspiration pneumonia. Multivariate logistic regression analysis revealed NLR as an independent factor in predicting aspiration pneumonia (odds ratio, 1.7; p=0.001). NLR showed excellent predictive performance for aspiration pneumonia (areas under the ROC curves, 0.815; cut-off value, 3.47; p 3.47).

Points requiring attention in primary-care settings in the treatment of patients with acute drug intoxication / 日本プライマリ・ケア連合学会誌

Objective: To develop an effective and safe therapeutic strategy, we studied the effect of the clinical characteristics of patients with acute drug intoxication on the duration of hospitalization. <br>Subjects and Methods: The subjects were 89 patients hospitalized for acute drug intoxication. They were divided into two subgroups; the short hospitalization group (duration of hospitalization < 7 days) and the long hospitalization group (duration of hospitalization ≥ 7 days). We compared age, sex, vital signs, drugs, and therapy between the two groups. <br>Results: There were no significant differences in sex or severity of consciousness disturbance between the short- and long-hospitalization groups. Age in the latter group was higher than that in the former, and age was significantly and positively correlated with the duration of hospitalization. Prolongation of hospitalization in patients with Japan Coma Scale (JCS) I or II is associated with psychiatric disease, and in patients with JCSIII, with physical disease. We used direct hemoperfusion (DHP) to treat patients with severe acute drug intoxication. The duration of hospitalization in patients treated by DHP tended to be shorter than those not so treated. <br>Conclusions: The present results suggest that aging is associated with prolongation of hospitalization and the onset of physical disease among patients with acute drug intoxication. When elderly patients with acute drug intoxication are treated in a primary-care setting, the question of whether or not physical diseases are present as complications should be considered. The appropriate use of DHP for the treatment of patients with severe acute drug intoxication requires further study.

Association of Prescribed Drug intoxication and Neuropsychiatric history

PURPOSE: The purpose of this study was to investigate the relationship between patients with a neuropsychiatric history and features of their suicide attempt, in order to analyze the risk associated with psychiatrist prescribed drugs. METHODS: We retrospectively investigated cases of intentional overdose drug ingestion in patients greater than 14 years of age who visited OO emergency medical center between January 1, 2008 and July 31, 2010. We evaluated patient medical records to ascertain their age, sex, neuropsychiatric history, and components of ingested intoxicant. Information regarding any suicide reattempt was obtained after discharge through follow up telephone survey. SPSS version 13.0 was used for statistical analysis. Fisher's exact test was performed with p<0.05 considered statistically significant. RESULTS: Ninety-six of 209 patients (46%) had a past history of psychological problems. Among those 96 patients with a history of psychological problems, 46(48%) used an overdose of the medicine prescribed by their psychologist in order to attempt suicide. However, for patients without a history of psychological problems, intoxication by neuropsychiatric drugs was insignificant. Neuropsychiatric patients required greater follow up care after discharge and exhibited significantly more suicide reattempts. CONCLUSION: This study revealed that patients sometimes use the medicine prescribed by their psychologist to attempt suicide. Therefore, an exhaustive plan to control the medicines prescribed to psychiatric patients should be established.

Clinical observation of modified gastric lavage in patients with drug intoxication / 中国实用护理杂志

Objective To discuss the best way of gastric lavage in patients with drug intoxication.Methods Patients with drug intoxication(128 cases)were divided into the observation group(68 cases)and the control group(60 cases).The observation group adopted modified method,left lateral decubitus without pillow,plastic mouth-gap to assist intubation,the tube Was prolonged 10 to 15 cm after successful intubation,then repeated gastric lavage with little lavage liquid was carried out under low pressure.The control group was treated with routine method.One-time success rate of intubation,the incidence of adverse reaction and complications were observed and compared between the two groups.Results One-time success rate of intubation was higher,and the incidence of adverse reaction and complications were lower in the observation group compared with those of the control group.Conclusions The modified gastric lavage method,that is,left lateral decubitus without pillow,plastic mouth-gap to assist intubafion,the tube was,prolonged 10 to 15 cm after successful intubation,then repeated gastric lavage with little lavage liquid,is better than the routine method in the following aspects,higher one-time success rate of intubation,rapid gastric lavage,patency of drainage,little stimulation and injury of gastric mucosa,light adverse reaction and complication and better lavage effect.

Histórico das tentativas de liberação da venda de medicamentos em estabelecimentos leigos no Brasil a partir da implantação do Plano Real / Description of attempts to obtain approval for selling medications at ordinary Brazilian establishments after the introduction of the Real Economic Stabilization Plan

Apesar de ilegal, a prática da venda de medicamentos em locais inadequados e não permitidos por lei, como armazéns e supermercados, sempre foi bastante comum no Brasil. A Medida Provisória (MP) 592/94, que implantou o Plano Real, liberou a venda de medicamentos anódinos nestes estabelecimentos; porém, este artigo foi suprimido quando a mesma foi convertida na Lei 9.069/95. A partir daí, iniciou-se uma série de tentativas de legalização deste comércio, que só se encerraram em 2004, com a proibição pelo STJ de tal comercialização. Mesmo assim, o comércio continua a ocorrer de forma ilegal. Este trabalho apresenta um histórico dos acontecimentos compreendidos entre 1994 e 2006, visando fornecer um material de atualização ao farmacêutico, acadêmicos e pesquisadores da área, devido à escassez de material bibliográfico sobre este tema específico.

Although not legal, the practice of selling medications through unlicensed outlets such as stores and supermarkets has long been common in Brazil. Introducing the Real Economic Stabilization Plan, Provisional Measure 592/94 allowed the sale of non-prescription medications (anodynes) in such establishments. However, this item was suppressed when this Provisional Measure was enacted as Law N° 9,069/95. Since then, other attempts have been made to establish this type of trade in medications, forbidden in 2004 through a decision handed down by the Superior Court of Justice. Nevertheless, this unlawful trade in medications still continues. Due to the scarcity of publications on this specific issue, this paper offers an updated overview for druggists, pharmacists, academics and researchers, describing the events that took place between 1994 and 2006.

Risk Factors for Developing Pneumonia in Acute Drug-intoxicated Patients

PURPOSE: Acute drug-intoxicated patients visiting the emergency room often develop pneumonia after emergency treatment. The purpose of this article is to investigate the risk factors associated with the development of pneumonia and to aid in the treatment of such patients. METHODS: 108 patients who visited the Chosun University Hospital emergency room from May 2002 through August 2004 for the treatment of acute drug intoxication were investigated retrospectively. RESULTS: In this study, 52(48.1%) of 108 patients developed pneumonia. The development of pneumonia was significantly higher in patients who were intoxicated with insecticide, were not alert, were hypotensive and apneic, vomiting, required artificial ventilation through intubation due to increased secretions patients. CONCLUSION: In acute drug-intoxicated patients, changes in consciousness, the amount of secretion and performed of endotracheal intubation are risk factors associated with an increased possibility of developing pneumonia. Careful inspection and observation are needed for acute drug-intoxicated patients with these risk factors.

A Clinical Analysis of Pneumonia in Acute Drug Intoxication / 결핵및호흡기질환

BACKGROUND: Acute drug intoxication has recently become an important issue in the social and clinical areas. There are various complications associated with acute drug intoxication such as pneumonia, but the process is was not fully understood. The aim of this study was to analyze our cases of pneumonia associated with acute drug intoxication and to determine the associated risk factors. METHOD: Forty four cases out of 237 patients, who were acute drug intoxicated from May 2000 to Feb. 2005, were diagnosed with pneumonia at the Konyang University hospital. These cases were analyzed by a retrospective review of their medical records. RESULTS: The incidence of pneumonia in acute drug intoxication was 18.6%. There was no gender difference in terms of the incidence, but the age group with the highest incidence was in the 5th decade (22.5%) followed by the 7th decade (17.9%). Most common drug of associated with pneumonia was organophosphate insecticides, and the others were herbicides. Suicidal attempts were the most common motive of intoxication. The incidence of pneumonia was increased in old age (beta=0.128, p<0.05). A drowsy or comatous mental status was an independent risk factors of pneumonia (beta=-0.209, p=0.006). A longer hospital duration was also a risk factor for pneumonia (beta=0.361, p<0.001). The intubated state, intensive care unit care and longer duration of admission correlated with the course of pneumonia in acute drug intoxicated patients (p<0.05). The culture study revealed MRSA to be most common pathogen. CONCLUSION: The incidence of pneumonia associated with acute drug intoxication was higher in the older aged patients, those with a decreased initial mental status and a longer hospital duration. The number of days in the intensive care unit and intubation were associated prognostic factors for pneumonia in acute drug intoxication patients.

A Case of 'ALUM' Intoxication Leading to ARDS / 결핵

A 77-year-old female was admitted 3 hours after intentionally ingesting 5 g of aluminum ammonium sulfate ('Alum') powder dissolved in water. Gastric lavage with normal saline, activated charcoal chelation, and supportive therapies were performed. She showed a high anion gap metabolic acidosis, which rapidly progressed to multiple organ failure including ARDS. The patient subsequently progressed to a refractory shock which eventually led to death.

A Case of 'ALUM' Intoxication Leading to ARDS / 결핵

A 77-year-old female was admitted 3 hours after intentionally ingesting 5 g of aluminum ammonium sulfate ('Alum') powder dissolved in water. Gastric lavage with normal saline, activated charcoal chelation, and supportive therapies were performed. She showed a high anion gap metabolic acidosis, which rapidly progressed to multiple organ failure including ARDS. The patient subsequently progressed to a refractory shock which eventually led to death.

Clinical observation of acute drug intoxications / 영남의대학술지

Clinical observations were made on 349 cases of acute drug intoxication who were visited to emergency room of Yeungnam University Hospital during recent 7 years from January 1984 to December 1990. The following results were obtained. 1) Total number of cases of acute drug intoxication was 349 which was 0.39% of the total patients of the emergency room during the same period. 2) The ratio of male to female was 1.1:1. The age incidence was highest in the third decade (26.7%). The monthly incidence was highest in May. Higher frequency was observed in summer season. 3) The most common drug of the intoxication was pesticides and herbicides (71.9%), the remainders were miscellaneous drugs (11.2%), sedatives (7.7%), rodenticides (6.3%) and unknown drug (3.2%) in orders. 4) The most common cause of drug intoxication was suicide (69.1%) and the others were accident, unknown cause, intention in orders. 5) Main clinical manifestations were the impairment of consciousness, nausea, vomiting and convulsion. Physical examination revealed increased pulses, increased blood pressure, miosis of the pupil and sweating. Above symptoms and signs were more prominent in pesticide intoxication. Leukocytosis, glycosuria and abnormal LFT were common findings in acute intoxications. 6) The complications were developed in 18.3% among 349 cases and the most common complication was respiratory failure, pneumonia, cardiovascular collapse and pulmonary edema in orders. 7) Overall mortality rate was 8.3% of total cases and mortality rate was highest in herbicide intoxication (22.2%).