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COVID-19 is one of the serious catastrophes that have a substantial influence on human health and the environment. Diverse preventive actions were implemented globally to limit its spread and transmission. Personnel protective equipment (PPE) was an important part of these control approaches. But unfortunately, these types of PPE mainly comprise plastics, which sparked challenges in the management of plastic waste. Disposable face masks (DFM) are one of the efficient strategies used across the world to ward off disease transmission. DFMs can contribute to micro and nano plastic pollution as the plastic present in the mask may degrade when exposed to certain environmental conditions. Microplastics (MPs) can enter the food chain and devastate human health. Recognizing the possible environmental risks associated with the inappropriate disposal of masks, it is crucial to avert it from becoming the next plastic crisis. To address this environmental threat, titanium dioxide (TiO2)-based photocatalytic degradation (PCD) of MPs is one of the promising approaches. TiO2-based photocatalysts exhibit excellent plastic degradation potential due to their outstanding photocatalytic ability, cost efficiency, chemical, and thermal stability. In this review, we have discussed the reports on COVID-19 waste generation, the limitation of current waste management techniques, and the environmental impact of MPs leachates from DFMs. Mainly, the prominence of TiO2 in the PCD and the applications of TiO2-based photocatalysts in MPs degradation are the prime highlights of this review. Additionally, various synthesis methods to enhance the photocatalytic performance of TiO2 and the mechanism of PCD are also discussed. Furthermore, current challenges and the future research perspective on the improvement of this approach have been proposed.
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Coronavirus (COVID-19) pandemic ushered in a new era that led to the adjustments of diverse ecosystems. The pandemic restructured the global socio-economic events which prompted several adaptation measures as a response mechanism to cushion the negative impact of the disease pandemic. Critical health safety actions were impera-tive to curtail the spread of the disease such as wearing personal protective equipment (PPEs), masks, goggles, and using sanitizers for disinfection purposes. The daily de-mands for the products by individuals and medical personnel heightened their pro-duction and consumption, leading to a corresponding increase of COVID-19 wastes in the environment following indiscriminate waste disposal and poor waste management. The persistent occurrence of COVID-19 wastes aggravated microplastics (MPs) con-tamination in the aquatic ecosystem following the breakdown of PPEs-based plastics via oxidation, fragmentation, and photo-degradation actions. These MPs are transport-ed in the aquatic environment via surface runoff and wind action, apart from discrete sources. MPs' presence in the aquatic systems is not without repercussions. Ingestion of MPs by aquatic organisms can cause several diseases (e.g., poor growth, oxidative distress, neurotoxicity, developmental toxicity, reproductive toxicity, immunotoxicity, and organ toxicity). Humans are at high risk of MPs uptake. Apart from aerial and soil contamination sources, consumption of aquatic food products is a critical pathway of MPs into the human body. MP toxicities in humans include liver disorder, respiratory failure, infertility, hormonal imbalance, diarrhea, developmental disorder, and mortal-ity. Measures to alleviate the effect of COVID-19 waste litters include effective waste management plans and the adoption of technologies to extract cum degrade MPs from the aquatic and terrestrial environment.
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A foreign body can be intentionally or accidentally ingested. Timing of endoscopy relies on foreign body shape and size, location in gastrointestinal tract, patient's clinical conditions, occurrence of symptoms or onset of complications. In this short case, we present a middle age woman, who accidentally swallowed a portion of a nasopharyngeal swab half-broken during a diagnostic test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Upper gastrointestinal endoscopy was promptly performed to prevent the swab from crossing the pylorus leading to serious complications and, therefore, risk of surgical intervention. The broken nasopharyngeal swab was detected in the gastric body, and immediately removed with a foreign body forceps. Our hospital performs many nasopharyngeal swabs and to our knowledge, this is only the second reported swab ingestion during SARS-CoV-2 test.Copyright © 2021 The Gastroenterological Society of Taiwan, The Digestive Endoscopy Society of Taiwan and Taiwan Association for the Study of the Liver.
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Contexte: Plus de 90 % des cas d'ingestions de corps etrangers en pediatrie se produisent a domicile. Notre hypothese etait que le temps supplementaire passe par les enfants a domicile durant la pandemie COVID-19 serait associe a une augmentation du nombre de cas d'ingestions de corps etrangers et leur severite. Nos objectifs etaient de comparer l'incidence d'ingestions pediatriques de corps etrangers et le taux de cas severes (hospitalisation, complications ou interventions par endoscopie) avant et pendant la pandemie. Methodes: Toutes les consultations pediatriques au CHU Sainte-Justine de Montreal pour ingestion de corps etrangers entre mars 2018 et fevrier 2020 (pre-pandemie) ainsi qu'entre mars 2020 et fevrier 2021 (pandemie) ont ete incluses (n=614). L'incidence d'ingestions de corps etrangers a ete calculee en rapportant le nombre de cas au nombre de visites aux urgences selon les periodes. Les differences entre les deux groupes ont ete analysees par un test T de Student ou Chi-carre. Resultats: L'age median des patients etait de 3,5 ans [(interquartile: 1,6-5,9);54 % garcons]. Le nombre mensuel moyen de cas (min-max) durant la pandemie [20,0 (12-28)] etait significativement plus eleve qu'avant la pandemie [15,5 (8-24)] (p=0,02). Le taux d'incidence a double, passant de 23,2 pour 10 000 visites aux urgences en pre-pandemie a 51,6 pour 10 000 visites pendant la pandemie (p=0,0002). Pres d'un quart de la cohorte a du etre hospitalise. Le taux d'hospitalisations (>1 jour) est reste stable entre les deux periodes: 6,95 % pre-pandemie et 7,08 % pendant la pandemie. Les taux d'endoscopies (21,3 %) et de complications (4,6 %) etaient similaires entre les deux periodes. Discussion/Conclusion: L'incidence d'ingestions de corps etrangers au CHU Sainte-Justine a augmente significativement durant la pandemie comparativement aux deux annees precedentes. Les taux eleves de cas severes, bien que stables durant la pandemie, temoignent de l'impact considerable des ingestions de corps etrangers en pediatrie. Declaration de liens d'interets: Les auteurs declarent ne pas avoir de liens d'interets.Copyright © 2022
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Six phthalates: dimethyl phthalate (DMP), diethyl phthalate (DEP), di(n-butyl) phthalate (DnBP), butyl benzyl phthalate (BBzP), di(2-ethylhexyl) phthalate (DEHP), and di(n-octyl) phthalate (DOP) in settled dust on different indoor surfaces were measured in 30 university dormitories. A Monte Carlo simulation was used to estimate college students' exposure via inhalation, non-dietary ingestion, and dermal absorption based on measured concentrations. The detection frequencies for targeted phthalates were more than 80% except for DEP (roughly 70%). DEHP was the most prevalent compound in the dust samples, followed by DnBP, DOP, and BBzP. Statistical analysis suggested that phthalate levels were higher in bedside dust than that collected from table surfaces, indicating a nonuniform distribution of dust-phase phthalates in the sleep environment. The simulation showed that the median DMP daily intake was 0.81 μg/kg/day, which was the greatest of the targeted phthalates. For the total exposures to all phthalates, the mean contribution of exposures during the daytime and sleeping time was 54% and 46%, respectively.
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Background. Myositis is a group of rare systemic disease and may be treated with immunosuppressives which increase the risk for poor outcome with the COVID19 pandemic. Patients with this condition may have higher rates of admission to the hospital. Methods. KP is a health insurance plan and provides care to about 800 thousand people (including Medicare and Medicaid population) in Maryland, District of Columbia and Northern Virginia. As part of quality improvements, we randomly looked at 40 patients from our larger cohort with myositis who are diagnosed and followed by a board-certified rheumatologist. We noted hospitalizations and Covid infection from March 1, 2020 to December 31, 2021. Results. Of the 40 patients, 29 (72%) were female and 11 were male. 19 (47%) were Blacks, 18 whites (including 6 Latino), and 3 Asians. Age ranged from 25 to 80 years with a mean age of 59.6 years. 25 (62%) patients had Dermatomyositis, 14 had polymyositis and 1 was IBM. The mean age at diagnosis was 55.9 years (range 23-80 years). 12 (30%) had myositis specific antibodies (4 Jo-1, 4 Mi-2, 1 PL 7, 1 PL 12, 1 PL7 plus PL12, 1 TIF Gamma). 22 (55%) were negative. Six did not have antibody testing. During this time, 11 (27.5%) were admitted to the hospital, 2 patients tested positive for COVID 19. One tested positive in the hospital and was asymptomatic. The other person was admitted for symptomatic COVID 19 infection. Other reasons for admission were cardiac, pulmonary (noncovid 19 related), infections, Gastrointestinal issues (including GI bleeding). One admission was for accidental bleach ingestion, and one for psychiatric admission. Of these 40 patients, 38 (95%) patients have received the COVID vaccinations, one patient refused, and for one person we do not have any record of vaccination. Conclusion. The admission rates to the hospital do appear to be higher for this group of patients with myositis, as is generally postulated. However, the reasons for admission were largely related to reasons other than COVID 19 infection and were related to general medical conditions.
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OBJECTIVES: Social disruption due to COVID-19 has detrimentally affected American adolescents' emotional well-being. Within our system, pediatric acetaminophen ingestions increased in 2020, compared with previous years. We sought to evaluate the rate of hospitalizations for acetaminophen self-harm ingestions and self-harm of adolescents during the COVID-19 pandemic. STUDY DESIGN: We identified patients (aged 0-23) from billing data with diagnosis of acetaminophen ingestion with self-harm intent (ICD-10 code T391X2A), from a multicenter urban, quaternary health care system. We performed retrospective chart review from 2016 to 2020 and performed statistics using a generalized estimating equation (GEE) logistic regression model. RESULTS: From 2016 to 2020, there were 25 790 discharges of adolescents with 65 acetaminophen self-harm ingestion and 148 self-harm discharges. Of the 65 acetaminophen patients, 75% identified as female and 54% identified as non-white; 71% with Medicaid insurance. The proportion of acetaminophen ingestion and self-harm admissions increased from 0.13% in 2016 to 0.46% by 2020 and 0.42% in 2016 to 0.73% by 2020, respectively. The odds of acetaminophen ingestion admission increased by 28% each additional year (odds ratio = 1.28; 95% confidence interval: 1.08, 1.53; P = .006). There was not enough evidence to conclude that the log-odds of a self-harm ingestion were linearly related to time (P = .06). CONCLUSIONS: Acetaminophen ingestion for self-harm has significantly increased, while overall self-harm has increased to a lesser, nonsignificant degree. Primarily females of color and those with Medicaid insurance are affected. It is important to note this growing, disturbing trend, and to continue to screen for depression in our adolescent community and ensure access to mental health resources.
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Background The prevalence of anxiety and depression has increased following the COVID pandemic. Young women are disproportionally at risk of suicidal behaviors. Ingestion of Taxus baccata (English Yew) may lead to cardiotoxicity and death. Intoxication is known to be resistant to standard treatments with no effective antidotes. Case A 20-year-old female with a history of major depressive disorder presented to our emergency department unresponsive in pulseless ventricular tachycardia (VT) (figure 1A). She underwent CPR and achieved ROSC, however, was persistently hypotensive despite multiple pressors and was subsequently placed on VA ECMO. Review of a home journal revealed a plan to ingest 50 grams of Yew with suicidal intent. Decision-making Taxoids have been reported to have similar properties to digoxin and therefore digoxin-specific FAB antibodies were administered. She was also started on amiodarone and lidocaine for management of VT. After 3 hours she converted into sinus rhythm and had no further episodes of VT. Her clinical course was complicated by severe LV dysfunction and dilation while on VA-ECMO necessitating placement of an LV impella. By day three, all mechanical support was weaned off and she had normalization of her EF. Patient was discharged to an inpatient psychiatry facility on day 7 of hospitalization. Conclusion Ingestion of English Yew with suicidal intent is rare but may cause cardiogenic shock and VT requiring aggressive hemodynamic support until the toxin is metabolized. [Formula presented]Copyright © 2023 American College of Cardiology Foundation
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Introduction: The need for healthcare workers (HCWs) to wear personal protective equipment (PPE) during the coronavirus disease 2019 (COVID-19) pandemic heightens their risk of thermal stress. Objective(s): To determine knowledge regarding heat stress and practice of PPE among HCWs during the COVID-19 pandemic. Material(s) and Method(s): A cross-sectional observational study was done among 115 HCWs using a self-designed questionnaire to identify their thoughts on heat stress caused by PPE wear during the COVID-19 pandemic. The ambient temperature, relative humidity (RH), and dew point in their respective locations were recorded using data loggers (EL-USB-2-LCD+, Lascar Electronics, Salisbury, UK). R version 3.6.2 was used to examine the frequency and descriptive statistics from the survey findings. Pearson's chi-square was used to determine associations. A p value of <0.05 was considered statistically significant. Result(s): The average wet bulb globe temperature (WBG) reported was 30.0oC (IQR 29.1-31.8oC) according to the heat exposure data. The majority of the 115 HCWs were involved in medical consulting (39%), followed by nursing (29%). The researchers discovered that 50% of the workers (n=57) were wearing 5-6 PPEs and had a fourteen-fold increased risk of developing an undesirable thermal health symptom (95 % CI: 0.77 to 280.24;p=0.0737). In addition, 36% of the participants (n=42) worked between 8 and 10 hours every shift with little or no rest. It was also important to note that 76% (n=88) of them worked in non-air-conditioned environments, and 33% (n=38) of them had excessive workloads, which could add to the employees' heat burden. More than half of them agreed that wearing PPE is extremely inconvenient, and they avoided taking breaks to maintain infection control. The impression of thermal stress was reported by 96% of the participants (n=111), and it was found to be substantially linked with the job they were engaged [OR 0.0654 (95% CI: 0.003- 1.246) P=0.001]. More than half of the participants strongly agreed that appropriate rest and hydration before work could help them lower their thermal stress. Conclusion(s): HCWs are cognizant of the effects of heat stress but might not adopt best practices due to various constraints. Ice slurry ingestion could be a practical and effective method for promoting thermal comfort. Adverse effects of heat stress on productivity and judgment of HCWs warrant further investigation.
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Children curiosity for exploring their surrounding environment make them prone to foreign body (FB) ingestion which may lead to injuries and surgical intervention. COVID pandemic and national lockdown has impacted children's normal environment in addition to the changes in the health care system provision. The aim was to determine if the pandemic had a direct impact on the number and management of FB ingestion cases. Method All patients who were referred to our institution with diagnosis of FB from March 2020 to December 2020 were included. They were compared with FB referral during the period March-Dec 2019 as a control. Data included patients' demographics time to presentation type of FB ingested and management approach. Results There was a total of 30 patients with diagnosis of gastrointestinal FB during the study period as compared to 12 patients during the control periods. Thus during the COVID pandemic there was 2.5 times rise in number of cases. The mean age at presentation was 6.4 years during the study period as compared to 4.6 years in the control group. Timing of presentation varied from 0 to 57 days during the COVID pandemic as compared to control group who presented within 24hr except one who presented after 48hr.The most common foreign bodies encountered during the pandemic were button batteries (12) magnets (7) coins (5), other sharp and metallic objects (6). Two third (67%) of patients in the study period required surgical intervention as compared to one third (33%) during the control period. Most common site of impaction was stomach (40%) followed by oesophagus (36.6%). Conclusion The total number of children diagnosed with FB ingestion had significantly increased during the COVID pandemic. Public campaigns should be focused on raising awareness about the danger and medical emergency as a result of FB ingestion.
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Over the last few years, we have seen 11 patients presenting with proton pump inhibitor (PPI) photosensitivity at our tertiary referral photodiagnostic service and in our local dermatology department. Many adverse effects, including the discovery in 2020 of an almost twofold increased risk of severe COVID-19, of this widely used group of drugs have been noted (Lee SW, Ha EK, Yeniova AO et al. Severe clinical outcomes of COVID-19 associated with proton pump inhibitors: a nationwide cohort study with propensity score matching. Gut 2020;DOI: 10.1136/gutjnl-2020-322248). Although PPIinduced phototoxicity has been described, phototest results have not been reported and all clinical presentations have not been described. We aimed to identify all patients with PPI photosensitivity who presented to our unit. We sought to better understand their clinical characteristics, blood test results and photodiagnostic results. We retrospectively reviewed all case notes and investigation results of patients who were diagnosed with PPI photosensitivity. Eleven patients were identified to have been seen between 2014 and 2019. Two patients were male and nine were female. Mean duration of disease was 3 6 years and mean duration of PPI ingestion was 5 years. Five patients presented with a drug-induced lupus pattern [subcutaneous lupus erythematosus (SCLE;n = 2), papulosquamous SCLE and discoid (n = 1), tumid (n = 1) and acute cutaneous (n = 1)], four with drug-induced phototoxicity (sunburn-like) and two with a drug-induced solar urticaria relating to a lupus mechanism. The majority of patients reported symptoms on sun-exposed sites. The most common indication for PPI prescription was gastroesophageal reflux disease with omeprazole being the most commonly prescribed PPI. All patients underwent phototesting. Three patients were not on an PPI while undergoing phototesting and did not demonstrate photosensitivity. Of the remaining patients who underwent phototesting the most common finding was delayed sensitivity to ultraviolet A and to visible light. Druginduced photosensitivity can be a challenging diagnostic entity owing to the varied clinical presentation and heterogeneous time to onset. We present this case series to further help clinicians in recognizing the clinical and diagnostic pattern of photosensitivity present with PPI use.
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In an attempt to improve access to food distribution systems during the Covid-19 pandemic, the United States Food and Drug Administration (FDA) issued temporary flexibility in food labeling requirements. This requirement affects the Top 8 allergens and could lead to accidental allergen ingestion. The purpose of this study was to utilize a qualitative method to collect and analyze comments to FDA that were available via Allergic Living's website from May 22, 2020, to June 18, 2020, following the release of the food labeling change. In total, 3,033 comments were analyzed using the thematic analysis six-phase framework approach. Various themes were extracted relating to the emotional responses of the new labeling including fear, safety concerns, and trust of certain food product brands among the food allergy community. This research has implications for a broad spectrum of the U.S. food industry including restaurants, grocery stores, specialty food associations, and consumers. Stakeholders and experts in the food allergy community should be consulted when a policy change is occurring, especially during a pandemic affecting access to safe food.
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INTRODUCTION: Hydrogen peroxide ingestions cause significant morbidity and mortality due to oxygen gas emboli and are treatable with hyperbaric oxygen therapy. Recommendations for observation are based on small case series. OBJECTIVES: The aim of this systematic review is to define the time of onset of embolic phenomena after hydrogen peroxide exposure and to describe the proportion of patients who received hyperbaric oxygen therapy. METHODS: Cases from a systematic literature search were combined with those from a prior study that used data derived from the American Association of Poison Control Centers National Poison Data System. Air-gas emboli were defined as embolic phenomena (stroke, myocardial infarction, obstructive shock) potentially reversed with hyperbaric oxygen therapy. Simple counts, mean, and interquartile range were used for description and comparisons. RESULTS: A total of 766 records were identified in the literature search. Three-hundred and eighty-three duplicate records were identified and removed. Of the 383 remaining records, 156 met inclusion criteria; 88 were excluded based on predetermined criteria yielding 68 records with 85 unique cases. Forty-one cases were extracted from the 2017 National Poison Data System study resulting in a total of 126 cases for analysis. Case descriptions: We analyzed these 126 cases and documented 213 discrete clinical events, excluding deaths. There were 108 high-concentration exposures, 10 low-concentration exposures, and 8 were unknown. Thirty-five cases were intentional ingestions but not for self-harm, and 84 were unintentional or accidental. Only 4 cases were for self-harm, and there were 23 pediatric cases. There were 99 air-gas emboli reported in 78 patients. Time to onset: The time to onset of air-gas embolic was documented in 70/78. Time to symptom onset ranged from immediate to 72 h after hydrogen peroxide exposure. Over 90% of embolic symptoms occurred within 10 h of ingestion. Hyperbaric oxygen therapy: A total of 54/126 cases received hyperbaric oxygen therapy. Of those 54 cases, 31 had primary portal venous gas while the remaining 23 had air-gas emboli. Of the 23 air-gas emboli cases treated with hyperbaric oxygen therapy, 13 made full recoveries while 10 had residual symptoms or died. Mean time from air-gas emboli symptom onset to hyperbaric oxygen therapy in the full recovery group was 9 h compared to 18.2 h in the partial recovery/death group. Portal venous gas: There were 63 total reported cases of portal venous gas. Forty-nine of these cases were primary portal venous gas, 13 were secondary findings in patients with air-gas emboli and one case was secondary to non-air-gas emboli symptoms. Twenty-seven of 49 patients with portal venous gas (55%) as the primary finding had gastrointestinal bleeding. Thirty of the 63 cases received hyperbaric oxygen therapy for portal venous gas without any documented air-gas emboli. Deaths: Seventeen deaths occurred in the combined cohort. Of these, 13 were associated with high-concentration exposures. All deaths with reported time to symptom onset had symptoms within 1 h of exposure. CONCLUSION: This review of hydrogen peroxide exposure cases suggests that clinically significant embolic phenomena occur within 10 h of exposure, although delayed air-gas emboli do happen and should considered when deciding duration of observation. It remains equivocal whether hyperbaric oxygen therapy is beneficial in cases of primary portal venous gas without systemic involvement.
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BACKGROUND AND AIM: While daily witnessed opioid agonist treatment (OAT) ingestion is common in British Columbia (BC), Canada, and elsewhere, sparse evidence supports this resource-intensive practice. Many settings across North America relaxed restrictions for take-home dosing during the COVID-19 pandemic and have reported consistent or improved patient outcomes. This study measured excess expenditures attributed to daily witnessed pharmacy dispensing compared with weekly or biweekly dispensation schedules. DESIGN, SETTING AND PARTICIPANTS: This study was a population-level retrospective analysis. We included all methadone, buprenorphine/naloxone and slow-release oral morphine dispensations in BC from 1 January 2014 to 30 December 2020. A total of 24 357 107 OAT dispensations among 51 195 unique individuals with 122 793 person-years of follow-up were included during the study period. MEASUREMENTS: Total expenditures for each person-week of OAT with an estimated expenditure under two scenarios are as follows: (1) a weekly dispensation scenario and (2) a biweekly dispensation scenario. FINDINGS: We estimated excess expenditures attributable to current dispensing practices of between $38 million (2014) and $47.4 million (2018) compared with a hypothetical weekly dispensing schedule, and $43.9 million (2014) to $54.9 million (2018) compared with biweekly dispensing. The majority of these expenditures (58-64%) were attributed to pharmacy dispensing fees ($23 million in 2014 to $30 million in 2018 compared with weekly dispensing; $26.6 million in 2014 to $34.7 million in 2018 compared with biweekly dispensing). CONCLUSION: Daily witnessed opioid agonist treatment ingestion results in more than $30 million in excess expenditures annually in the province of British Columbia, Canada compared with the costs of weekly or biweekly dispensation schedules.
Subject(s)
Buprenorphine , COVID-19 , Opioid-Related Disorders , Humans , Analgesics, Opioid/therapeutic use , Opioid-Related Disorders/drug therapy , British Columbia , Health Expenditures , Retrospective Studies , Pandemics , Methadone/therapeutic use , Opiate Substitution Treatment/methods , Eating , Buprenorphine/therapeutic useABSTRACT
Objectives: The goals of this study are to examine factors associated with completed screening for suicide risk in the emergency department, and to examine clinical patterns of risk for suicide in children with physical health and mental health chief complaints in universal screening in the emergency department. Method(s): Of the 18,903 emergency department encounters between December 2019 and April 2022, there were 16,722 (88%) encounters that included results for the Ask Suicide-Screening Questions (ASQ) Toolkit. The chief complaints for the encounters were coded based on categories identified through central nervous system (CNS) involvement or conditions known to be associated with mental health risk with questions reviewed. ASQ results were coded as at risk if any question was answered with "yes." Factors associated with completed screening were entered into a binary regression. chi2 analyses were used to examine the associations between categorical variables. Result(s): Of the 18,903 ED encounters, 88.5% included a completed ASQ. Overall, 1924 (10.2%) encounters had positive ASQ results. Among encounters for non-mental health chief complaints, 8.9% were positive. Only 37.3% of the positive ASQ results were associated with mental health-specific chief complaints. Compared to general physical chief complaints, COVID-19-related concerns had lower rates of positive ASQ and interpersonal trauma, reproductive health, altered mental status, accidental and unspecified ingestions, and specific mental health symptoms (p <.01). In a regression including demographic factors and clinical factors, young age, White race, gender (girls), and chief complaint of interpersonal trauma, ingestion, or mental health symptom contributed to variance in ASQ (Nagelkerke's R2 =.339). Conclusion(s): The majority of positive screens for symptoms of suicide are associated with physical health chief complaints, with specific chief complaints having elevated rates of suicidal symptoms. Universal screening identifies these patients, and targeted interventions may be valuable for youth with the highest-risk chief complaints. S, TREAT, RF Copyright © 2022
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Introduction: Alcohol-based hand sanitizers containing ethanol or is opropanol are being used in order to prevent person-to-person transmission during the COVID-19. Early signs and symptoms of this ingestion include nausea, vomiting, headache, abdominal pain, blurred vision, loss of coordination, and decreased level of consciousness. After hand sanitizer ingestion we have to suspect about methanol poisoning, monitoring the start of anion-gap metabolic acidosis, seizures, and blindness is essential. Treatment includes supportive care, acidosis correction, and the administration of an alcohol dehydrogenase inhibitor. In servere cases hemodialysis may be required. Objective(s): To present a case of an 29-year-old woman who was taken to the emergency department after voluntary ingestion of alcohol-based hand sanitizer in a suicide attempt. To describe the most common side effects of hand sanitizer ingestion and the literature review. Method(s): Clinical case presentation and literature review of similar cases. Result(s): A 29-year-old woman, with diagnosis of borderline personality disorder and previous suicide attempts was taken to the emergency department after 3 hours of voluntary ingestion of an unknown quantity of alcohol-based hand sanitizer. Initial laboratory findings showed laboratory a blood methanol concentration of 66 mg/dL, with an anion gap of 30 mEq/L, arterial blood pH of 7.2, serum bicarbonate concentration of 12 mEq/L. Patient complained of abdominal pain and nervoussness. Conclusion(s): Most common signs and symptoms of alcohol-based hand sanitizer ingestion include nausea, vomiting, headache, abdominal pain, blurred vision, loss of coordination, and decreased level of consciousness. Treatment includes supportive care, acidosis correction, the administration of an alcohol dehydrogenase inhibitor and sometimes may be required.
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Introduction. Poisoning has been reported as the fifth most common cause of injury-related deaths in children <5 years worldwide. Little is known about accidental poisoning among children in the regional setting. During the COVID-19 pandemic, lockdown measures may have increased home-based unintentional poisoning. Objectives. To determine the frequency, outcome and type of accidental poisoning in children admitted to a regional hospital and compare cases before and during the COVID-19 pandemic. Methods. A review of admissions to Queen Nandi Regional Hospital in Empangeni was performed to document cases of accidental poisoning >2 years. Equal periods during 2019 and 2020 (April to December) were compared. Children <13 years were included. Age, sex, date of admission, death, survival and type of poisoning were collected. Results. Accidental poisoning made up a small proportion of the total admissions (n=252/5 071;4.97%) with a low case fatality rate (0.40%). Boys made up the majority (n=132/252, 52.38%). Most were <5 years (n=220/252, 87.30%,). Medicines (n=114/252, 45.24%), hydrocarbons (n=61/252, 24.21%) and pesticides (n=26/252, 10.32%) were the main types of poisoning. Domestic cleaner, sanitiser or disinfectant-related admissions were significantly increased during the pandemic (p=0.020). Conclusion. Accidental poisoning commonly occurs in younger children. Medicines, hydrocarbons and pesticides make up the majority of cases. Domestic cleaner, hand sanitiser and disinfectant ingestion increased during the COVID pandemic. Future research involving primary care facilities and risk factors related to poisoning should be investigated.
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Aims Hand sanitizers are increasingly used in most households since the onset of the COVID-19 pandemic. However, improper use and accidental and deliberate ingestion of sanitizer solutions have been associated with numerous health risks to children. This study aimed to assess knowledge and practices regarding safe handling and disposal of alcohol-based hand sanitizers and surface disinfectants among a cohort of parents in urban Sri Lanka. Methods This observational cross-sectional study was performed including parents of children admitted to North Colombo Teaching Hospital for a period of six months from August 2021. Data were collected regarding parental knowledge regarding safe handling and disposal of hand sanitizers, and their health hazards by paediatric post-graduate trainees. Data were collected using a pre-tested interviewer administered questionnaire. All data were analysed using SPSS 17.0. Results Out of 153 children recruited to the study, the mean age was 5.3 years (range: 1 month - 14 years) and male children (92, 60.1%) outnumbered female children (61, 39.9%). The majority of mothers (126, 82.4%) and fathers (133, 86.9%) had received education at least up to secondary school. 124 parents (81%) had been using hand sanitizers at home regularly. Only 113(73.9%) parents believed that preschool children were the most vulnerable for accidental ingestion of sanitizers and 40 parents (26.1%) were unaware that sanitizer solutions can be accidentally inhaled by toddlers. Knowledge was poor regarding occurrence of potential symptoms and side effects such as sore throat (56, 36.6%), irritation of eyes (30, 19.6%), breathing difficulties (40, 26.1%), high heart rate (72, 47%), aspiration (43, 28.1%) and low blood sugar (108, 70.5%). Only 132 parents (86.2%) knew how to clean and disinfect their home premises safely and 29 parents (18.9%) didn't know how to store cleaning products safely. Sixty-four parents (41.8%) were unaware regarding how to get information on safe cleaning practices. Forty-two parents (27.4%) kept sanitizer bottles within easy access to children whilst 85 parents (55.5%) had been storing sanitizers in unlabeled bottles. Ninety-eight parents (64%) were not keen to read the signage alerts in sanitizer storage bottles. Only 25 parents (16.3%) safely disposed sanitizer bottles. Thirty-three parents (21.6%) put sanitizer bottles together with food items in carriage bags from super markets. Conclusion The findings of this study inform that knowledge in parents regarding safe use of sanitizers can further be improved specially, in areas of local and systemic effects of sanitizer poisoning and information resources of safe cleaning practices. As a number of parents use and dispose hand sanitizers unsafely, the effectiveness of awareness programs to improve safety practices among parents should be evaluated.
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Background: Vertatrum viride (false hellebore) is a perennial commonly found in eastern North America. The most common cause of exposure is misidentification when foraging for wild onion, or skunk cabbage. One regional poison center saw an increase in foraging-related poisonings during initial COVID-19 restrictions. The case report highlights severe delayed cardiac effects after ingestion of Veratrum viride in an otherwise healthy, young, female athlete. Case report: A 24-year-old female presented to an emergency room alongside family with complaints of nausea and vomiting that started 30 min after a meal consisting of foraged wild onion (Allium triccocum). Five others ate the same meal and noted similar symptoms. Vitals upon arrival (3 h post ingestion) are as described: HR 51, BP 88/52, Temp 36.7, RR 18 and O2 sat 100% on room air. The patient had no previous cardiac history and was athletic. Management included D5LR with K replacement, and dopamine infusion at 10mcg/kg/min. Dopamine was tapered slowly, down to 6 mcg/kg/min at 16.5 h. Vitals continued to be stable at 17.5 h post ingestion and dopamine was discontinued. The patient developed severe bradydysrhythmia 15 min later, consisting of complete heart block leading to prolonged sinus pause. She responded to 10 s of CPR with return of spontaneous circulation with a junctional escape rhythm which reverted back to sinus bradycardia. A repeat EKG was unremarkable. The dopamine infusion was reinstituted at 4 mcg/kg/min and continued until 26.5 h post ingestion. She was monitored an additional 9.5 h, and remained in sinus rhythm with mild complaints of dizziness that resolved before discharge. Discussion(s): Veratrum spp. toxicity is due to alkaloids found throughout the plant which cause sodium channel opening when bound to type 2 sodium channels. By increasing sodium ion influx during the resting potential and delaying inactivation to create a late sodium current, these alkaloids increase automaticity in conductive cells. This mechanism, paired with the Bezold-Jarisch reflex, is likely responsible for increased vagal tone leading to bradycardia, hypotension, sinus arrhythmia, and junctional escape rhythm. It is noteworthy that even 18 h post ingestion in a relatively stable patient with no significant cardiac history, cardiac arrest occurred just after treatment tapering. Clinicians should consider prolonged observation time in the setting of discontinuation of vasopressors. Conclusion(s): Both clinicians and amateur foragers should be aware of the risks associated with ingestion of Veratrum viride, especially during early spring when it more closely resembles wild onion. While uncommon, significant delayed cardiac effects are possible. Mistaking the plant for edible wild onions can be the difference between a delectable dinner, and a night in the ICU.
ABSTRACT
Background: Metformin is the most commonly used diabetes medication and at supratherapeutic levels can result in a severe type-A metabolic lactic acidosis known as metformin-associated lactic acidosis (MALA). Treatment of MALA includes aggressive fluid resuscitation, supporting blood pressure and correcting acidosis. Renal replacement therapy (RRT), usually hemodialysis (HD) is recommended in severe cases with refractory acidosis (with elevated lactate), altered mental status, or shock. To our knowledge, this is the second report of metformin half-life during treatment with continuous veno-venous hemodiafiltration (CVVHDF). Case report: A 53-year-old man died following a reported acute on chronic ingestion of 80 g of his metformin tablets resulting in severe, refractory shock and MALA. His peak serum metformin concentration was 53mcg/mL (therapeutic range 1-2mcg/mL), peak lactic acid concentration was 49.7 mmol/L, and arterial pH nadir was 7.06. Serial serum metformin concentrations were obtained while on RRT;both HD and CVVHDF. The switch from HD to CVVHDF was done due to staffing shortages during the COVID-19 pandemic. The patient died despite aggressive therapy with renal replacement therapy and multiple vasopressors on hospital day five. Serial metformin concentrations during CVVHDF suggested a half-life of 33-h. Discussion(s): Hemodialysis has been reported to clear metformin at a rate greater than 200mL/min and continuous venous-venous hemofiltration (CVVH) at greater than 50mL/min. In this case, metformin levels appear to follow first-order elimination kinetics during CVVHDF with an estimated half-life of 33 h. Comparatively, metformin has a half-life of 4.7-5.5 h during HD. To our knowledge, this is the second report of estimated metformin half-life while using the CVVHDF form of continuous renal replacement. The previous case report measured a half-life of 16.5 h on CVVHDF. This case report shows CVVHDF decreases half-life of metformin and provides first order elimination in the setting of overdose. Conclusion(s): The early initiation of HD appears warranted but prognostic indicators have not been well established. In the absence of HD availability, other forms of RRT (e.g., CCVHDF) can be used and may provide first-order elimination of metformin.