Second-generation antihistamines: a study of poisoning in children.

Background and objectives: The toxicity of second-generation antihistamines after an overdose by a child is still unknown. The objective of this study is to use data from Poisons Centres in France to describe the toxicity profile of second-generation antihistamines for children and to compare the severity of poisoning observed from these with a first-generation antihistamine.Method: This was a retrospective, multi-centre and observational study focusing on human cases of single-substance exposure to a second-generation antihistamine and to mequitazine, reported between 1 January 2001 and 31 December 2016 in Poisons Centres in France.Results: From a total of 9403 children included, 5980 were exposed to a second-generation antihistamine and 3423 were exposed to mequitazine. The severity of exposure to second-generation antihistamines in children is low: among the children followed until a known outcome, 9% of children were symptomatic and in 97% of cases, the symptoms shown were of a minor-level severity (primarily drowsiness or restlessness). Depending on the substance, children who ingested doses 16 to 69 times the maximum recommended therapeutic dose remained asymptomatic. No deaths or severe symptoms were observed. No cases of lengthening of the QT interval or arrhythmias were identified. Mequitazine led to more symptoms than other substances (14.8% symptomatic children vs. 7.5%, Odd ratio (OR): 2.3 (2.0-2.6), p < 0.0001), more symptoms of moderate intensity (1.4 vs. 0.2%, OR: 8.3 (4.1-18.5), p < 0.0001) and more hospitalisation (19.1 vs. 8.7%, OR: 2.5, 95% CI: (2.2-2.8), p < 0.0001).Conclusion: The severity of poisoning from second-generation antihistamines appears to be low among children and considerably lower than poisoning caused by mequitazine.

Clinical consequences related to a defective elimination of clobazam caused by homozygous mutated CYP2C19 allele.

Introduction: Voluntary drug intoxication with benzodiazepines is common and in most cases without consequences. We report an interesting case of voluntary drug intoxication with clobazam (CLB) in a patient with a homozygous mutated CYP2C19 genotype. Case report: A 63-year-old Caucasian man was admitted to an intensive care unit for voluntary drug intoxication with CLB (1200 mg) complicated by prolonged hospitalization (46 days). The levels of CLB and N-desmethylclobazam (NCLB) in plasma were initially 8.3 and 14.8 mg/L. The persistence of a high concentration of NCLB (14.3 mg/L on day 30) suggested a lack of elimination. A homozygous mutated allele of CYP2C19*2 without enzyme activity was discovered. To overcome this phenotype, NCLB metabolism was induced by administering 100 mg of phenobarbital for 10 days, allowing patient improvement. Discussion: NCLB is the major active metabolite of CLB with a longer half-life and much higher steady-state plasma concentrations compared to the parent drug. The half-life elimination of CLB is 18 h that of NCLB is between 40 and 50 h. However, there is considerable inter-individual variation in the metabolism of CLB and of the report NCLB/CLB under the dependence of genotype of CYP2C19. These polymorphisms are not generally well-known by physicians and may lead to severe poisoning.

Risks linked to accidental inoculation of humans with veterinary vaccines: a 7-year prospective study.

AIM: Accidental inoculation of humans with veterinary vaccines can lead to early and late complications. The aim of our study is to describe these complications and their risk factors. METHODS: Prospective observational study conducted from 2007 to 2014 at Angers University Hospital's Poison Control Centre. The endpoints examined were: early and late locoregional complications, surgical treatment, and absence from work. The statistical analysis was based on a multivariate analysis. DISCUSSION: The presence of mineral oil adjuvants, the injection of the vaccine under pressure and injection in joint and tendon of the hand significantly increased early locoregional complications and surgery but only the presence of mineral oil adjuvant increased significantly late locoregional complications at one month. Absence from work is significantly correlated to the site of injection and the presence of mineral oil adjuvant. CONCLUSION: It is important to know about the contents of the veterinary vaccine in order to anticipate early and late complications that may arise (particularly due to the presence of mineral oil adjuvants). Special attention must also be given do the site of injection. We think that any accidental injection of veterinary vaccine into humans, especially those containing mineral oils, must lead to an early medical consultation. This must also be indicated on the product.

Metodologia para determinação da zona de abscisão foliar em pomáceas / Methodology to determine abscission zone in apple trees

Estudos anatômicos e de ontogênese da abscisão foliar em pomáceas são escassos. A queda foliar promovida após formada a zona de abscisão é um processo natural nas pomáceas, e prolonga-se durante o outono, até que ocorram as primeiras geadas no Sul do Brasil. Ainda não se conhece até quando as folhas de macieiras permanecem funcionais. O objetivo deste trabalho foi desenvolver uma metodologia que permita estudar o início e o fim das zonas de abscisão foliar de macieiras. O trabalho foi realizado nas cultivares 'Galaxy' e 'Fuji' em pomares comerciais de macieira, de Vacaria, Rio Grande do Sul. O método proposto consistiu em coletar,ramos do ano, com 10cm a 20cm de comprimento, e utilizar um segmento contendo uma parte do caule, uma gema axilar e a base do pecíolo, descartando a parte das quatro folhas do ápice. Os segmentos foram fixados, seccionados e corados para a observação da zona de abscisão em microscopia óptica. Os resultados mostraram que a metodologia utilizada permitiu descrever a zona de abscisão em macieiras e que ela é formada por células alongadas com parede celular delgada, apresentando lignificação junto à parede celular. O processo manteve a gema intacta e ocorreu no sentido adaxial para o abaxial. A abscisão foliar natural, em plantas de Galaxy e Fuji em sintomas de doença e em condições ambientais favoráveis, pode ser acompanhada 7 e 14 dias antes e depois da colheita, e após, com intervalos de 14 e 21 dias até maio. A partir de maio, as coletas devem ser feitas semanalmente. Essas informações serão úteis na tomada de decisão para realizar práticas culturais e/ou de controle químico, para a manutenção das folhas sadias, resultando no maior acúmulo de reservas de carboidratos e/ou redução do número de aplicações de fungicidas.

Studies about anatomical and ontogeny of leaf abscission in pome fruit trees are scarce. The leaf fall occurs after the abscission zone is promoted, being a natural process in pome fruit, and it lasted from the fall until the first frost in southern Brazil. It is not known yet how long the leaves of apple trees remained functional. The aim of this study was to develop a methodology to study the beginning and the end zones of leaf abscission of Galaxy and Fuji apple trees. The study was conducted in commercial apple orchards in Vacaria, Rio Grande do Sul. The proposed method consisted of collecting branches to 10cm to 20cm in length, and use a segment containing a portion of the stem, an axillary bud and the base of the petiole, discarding the part of the four-leaf apex. The segments were fixed, sectioned and stained for observation of the abscission zone in optical microscopy. The methodology allowed the understanding of the abscission zone on apple trees. The abscission zone was formed by elongated cells with thin walls, presenting cell wall lignification. The process kept the bud intact and occurred from the adaxial to abaxial surface. The natural leaf abscission in Galaxy and Fuji plants without symptoms of disease and favorable environmental conditions , can be accompanied by 7 and 14 days before and after harvest, and after intervals of 14 and 21 days until May. From May, collections should be weekly. This information will be useful in making a decision to carry out cultural practices and / or chemical control, for the maintenance of healthy leaves, resulting in greater accumulation of carbohydrate reserves and / or reducing the number of fungicide applications.

[The critical role of the nurse in successful non-invasive ventilation in acute respiratory failure]. / L'infirmière moteur de la réussite de la ventilation non invasive dans l'insuffisance respiratoire aiguë.

Non-invasive ventilation is a common therapy for acute respiratory failure. Nurses play an important role in the setting up of this treatment, a time-consuming process, as well as its monitoring. It has been shown that the tolerance of non-invasive ventilation significantly influences the success of this treatment.

Risk factors for de Quervain's disease in a French working population.

OBJECTIVE: De Quervain's disease (DQD) is a significant cause of musculoskeletal pain among workers. The aim of this study was to assess the relative importance of personal and occupational risk factors for DQD in a working population. METHODS: A total of 3710 workers from a French region were randomly included in the cross-sectional study between 2002-2005. There were 45 subjects with DQD (of these, 5 subjects had a bilateral condition), diagnosed by 83 trained occupational physicians performing a standardized physical examination. Individual factors and work exposure were assessed by a standardized physical and a self-administered questionnaire. Statistical associations between DQD and individual and occupational factors were analyzed using logistic regression modeling in the whole sample and among women. RESULTS: The prevalence rates of uni- or bilateral DQD for the whole, male and female working populations were 1.2% [95% confidence interval (95% CI) 0.9-1.6], 0.6% (95% CI 0.3-0.9) and 2.1% (95% CI 1.4-2.8), respectively. Personal risk factors for DQD were mainly age (1.1 for 1-year increase in age) and female gender [odds ratio (OR) 4.9, 95% CI 2.4-10.1]. Work-related factors were workpace dependent on (i) technical organization (OR 2.0, 95% CI 1.0-4.0), (ii) repeated or sustained wrist bending in extreme posture (OR 2.6, 95% CI 1.3-5.3) and (iii) repeated movements associated with the twisting or driving of screws (OR 3.4, 95% CI 1.7-7.1). No association was found with psychosocial factors. CONCLUSIONS: Personal and work-related factors were associated with DQD in the working population; wrist bending and movements associated with the twisting or driving of screws were the most significant of the work-related factors.