Investigating the gene expression profiles of rehabilitated Florida manatees (Trichechus manatus latirostris) following red tide exposure.

To investigate a Florida manatee (Trichechus manatus latirostris) mortality event following a red tide bloom in Southwest Florida, an RNA sequencing experiment was conducted. Gene expression changes in white blood cells were assessed in manatees rescued from a red tide affected area (n = 4) and a control group (n = 7) using RNA sequencing. The genes with the largest fold changes were compared between the two groups to identify molecular pathways related to cellular and disease processes. In total, 591 genes (false discovery rate <0.05) were differentially expressed in the red tide group. Of these, 158 were upregulated and 433 were downregulated. This suggests major changes in white blood cell composition following an exposure to red tide. The most highly upregulated gene, Osteoclast associated 2C immunoglobulin-like receptor (OSCAR), was upregulated 12-fold. This gene is involved in initiating the immune response and maintaining a role in adaptive and innate immunity. The most highly downregulated gene, Piccolo presynaptic cytomatrix protein (PCLO), was downregulated by a factor of 977-fold. This gene is associated with cognitive functioning and neurotransmitter release. Downregulation of this gene in other studies was associated with neuronal loss and neuron synapse dysfunction. Among the cellular pathways that were most affected, immune response, including inflammation, wounds and injuries, cell proliferation, and apoptosis were the most predominant. The pathway with the most differentially expressed genes was the immune response pathway with 98 genes involved, many of them downregulated. Assessing the changes in gene expression associated with red tide exposure enhances our understanding of manatee immune response to the red tide toxins and will aid in the development of red tide biomarkers.

The short-term cost of falls, poisonings and scalds occurring at home in children under 5†years old in England: multicentre longitudinal study.

BACKGROUND: Childhood falls, poisonings and scalds, occurring predominantly in the home, are an important public health problem, yet there is limited evidence on the costs of these injuries to individuals and society. OBJECTIVES: To estimate National Health Service (NHS) and child and family costs of falls, poisonings and scalds. METHODS: We undertook a multicentre longitudinal study of falls, poisonings and scalds in children under 5 years old, set in acute NHS Trusts across four UK study centres. Data from parental self-reported questionnaires on health service resource use, family costs and expenditure were combined with unit cost data from published sources to calculate average cost for participants and injury mechanism. RESULTS: 344 parents completed resource use questionnaires until their child recovered from their injury or until 12 months, whichever came soonest. Most injuries were minor, with >95% recovering within 2 weeks, and 99% within 1 month of the injury. 61% emergency department (ED) attendees were not admitted, 35% admitted for ≤1 day and 4% admitted for ≥2 days. The typical healthcare cost of an admission for ≥2 days was estimated at £2000-3000, for an admission for ≤1 day was £700-1000 and for an ED attendance without admission was £100-180. Family costs were considerable and varied across injury mechanisms. Of all injuries, scalds accrued highest healthcare and family costs. CONCLUSIONS: Falls, poisonings and scalds incur considerable short-term healthcare and family costs. These data can inform injury prevention policy and commissioning of preventive services.

The measurement of disability weights for 18 prevalent acute poisoning conditions.

BACKGROUND: Disability weights (DWs) are used in disease burden studies, with the calculation of the weight of the disability as years lived with disability versus years of lost life accounting for mortalities. Currently, there is a single DW score available for poisoning, which is considered to be a single health state. This makes it difficult to evaluate the differing burdens of poisonings involving various substances/conditions in comparison with other health states in countries with different patterns of substance abuse. The aim of this study is therefore to estimate the DWs of 18 common poisonings based on the expert elicitation method. METHODS: A panel of 10 medical clinicians who were familiar with the clinical aspects of different poisonings estimated the DWs of 50 health states by interpolating them on a calibrated Visual Analogue Scale. The DWs of some poisonings, such as alcohol, cannabis and heroin, had been estimated in previous studies and so were used to determine the external consistency of our panel. As a matter of routine, the DWs could vary on a scale between 0 (best health state) and 1 (worst health state). RESULTS: Statistical analysis showed that both the internal (Cronbach's α = 0.912) and external consistency of the panel were acceptable. The DWs for the different poisonings were estimated along a range from 0.830 for severe aluminium phosphide to 0.022 for mild benzodiazepine. CONCLUSIONS: Different poisonings should be weighted differently since they vary widely. Unfortunately, they are currently all weighted the same.

Impacts of stress, self-efficacy, and optimism on suicide ideation among rehabilitation patients with acute pesticide poisoning.

BACKGROUND: The high incidence of pesticide ingestion as a means to commit suicide is a critical public health problem. An important predictor of suicidal behavior is suicide ideation, which is related to stress. However, studies on how to defend against stress-induced suicidal thoughts are limited. OBJECTIVE: This study explores the impact of stress on suicidal ideation by investigating the mediating effect of self-efficacy and dispositional optimism. METHODS: Direct and indirect (via self-efficacy and dispositional optimism) effects of stress on suicidal ideation were investigated among 296 patients with acute pesticide poisoning from four general hospitals. For this purpose, structural equation modeling (SEM) and bootstrap method were used. RESULTS: Results obtained using SEM and bootstrap method show that stress has a direct effect on suicide ideation. Furthermore, self-efficacy and dispositional optimism partially weakened the relationship between stress and suicidal ideation. CONCLUSION: The final model shows a significant relationship between stress and suicidal ideation through self-efficacy or dispositional optimism. The findings extended prior studies and provide enlightenment on how self-efficacy and optimism prevents stress-induced suicidal thoughts.

Manejo general del intoxicado / General management of intoxicated

Intoxications have become a relevant complaint in the emergency room since the second half of the last century. Toxidromes have been replaced by a more practical combined analysis of vital signs, directed physical examination and selected laboratory tests. Most of the mortality can be prevented by the correct and opportune implementation of general management strategies, including supportive care, prevention of absortion, enhancement of elimination and extracorporeal removal of toxins. Through the following pages we will review many of different diagnostic and therapeutic alternatives...

[Homeostasis changes during rehabilitation period after acute chemical poisoning].

The article deals with review of 78 patients of rehabilitation toxicological unit. The patients received resuscitation and detoxification. All patients were divided into three groups; 1st group--patients after poisoning with psychopharmaceuticals, 2nd group--patients after poisoning with cauterizing liquids and 3rd group--patients with encephalopathy after poisoning with neurotoxin (psychopharmaceuticals, narcotics and ethanol). Disorders of rheology, haemostasis and endotoxicosis accrued in all groups. These disorders were a signs of the erythrocytes and platelets aggregation developing and viscoelasticity disorder. Homeostasis changes during rehabilitation period need an accurate diagnostics for purposeful treatment of the defined disorders.

Saude do homem: internacoes hospitalares por intoxicacao registradas em um centro de assistencia toxicolo / Salud del hombre: internaciones hospitalarias por envenenamiento registradas en un centro de asistencia toxicologica / Men's health: hospital admissions for poisoning recorded in a toxicology treatment center

METODOS: Pesquisa descritiva, com abordagem quantitativa de registros da Listagem Mensal de Pacientes Internados do período de 2006 a 2010. RESULTADOS: Foram analisadas 2.448 internações masculinas, representado 60,9%. Os homens tinham idade média de 36,5 anos, 1.610 (65,8%) eram adultos, e a maioria (77,8%) foi internada com diagnóstico de intoxicação por drogas de abuso. Das 505 (20,5%) internações decorrentes de acidente individual, 252 (49,9%) envolviam crianças. A tentativa de suicídio foi responsável por 440 (18,0%) internações, sendo 110 (25,0%) em adolescentes. O tempo médio de internação foi de cinco dias, mas 81 (3,3%) homens ocuparam leitos em terapia intensiva e 106 (4,3%) morreram. CONCLUSÃO: Pela razão de internações por intoxicação entre os sexos, pode-se inferir maior gravidade nas intoxicações em homens em todas as faixas etárias. .

OBJETIVO: Caracterizar las internaciones hospitalarias de hombres con diagnóstico de intoxicación registradas en un centro de información y asistencia toxicológica del Paraná. MÉTODOS: Estudio descriptivo con enfoque cuantitativo de los listados mensuales de registros de pacientes hospitalizados en el período de 2006 a 2010. RESULTADOS: Fueron analizadas 2448 internaciones masculinas (60,9%). Los hombres tenían una edad media de 36,5 años, 1610 (65,8%) eran adultos y la mayoría (77,8%) fue ingresada con el diagnóstico de intoxicación por abuso de drogas. De los 505 (20,5%) ingresos procedentes de accidentes individuales, 252 (49,9%) envolvían niños. El intento de suicidio fue responsable por 440 (18,0%) hospitalizaciones, siendo 110 (25,0%) en adolescentes. CONCLUSIÓN: En razón de las hospitalizaciones por intoxicación entre los sexos, se puede inferir mayor gravedad en los casos de envenenamiento en hombres de todas las edades. .

OBJECTIVE: the study aims to characterize hospitalization among men with diagnoses of poisoning in a toxicology information and treatment center in the Brazilian state of Paraná. METHODS: Descriptive research, with a quantitative approach, on records in the Monthly Listing of Hospitalized Patients, in the period 2006 - 2010. RESULTS: 2448 hospitalizations of men were analyzed, representing 60.9%. The men had a mean age of 36.5 years; 1610 (65.8%) were adults, and the majority (77.8%) were hospitalized with the diagnosis of poisoning by abuse drugs. Of the 505 (20.5%) hospitalizations resulting from individual accidents, 252 (49.9%) involved children. Suicide attempts were responsible for 440 (18.0%) hospitalizations, of which 110 (25.0%) occurred among adolescents. The mean length of hospitalization was five days, although 81 (3.3%) men occupied beds in intensive care, and 106 (4.3%) died. CONCLUSION: Due to the ratio of hospitalizations from poisoning among the sexes, one can infer greater seriousness in poisoning in men at all age ranges. .

[Regional features of acute chemical trauma in Azerbaijan and Georgia].

Epidemiologic data on acute chemical poisonings in South Caucasus region are extremely limited. The purpose of this joint prospective study was evaluation and analyzes the rate and characteristics of acute chemical poisoning cases in Azerbaijan and Georgia. This investigation was performed on data of poisoned patients admitted to Republican Toxicology Center of Ministry of Health of Azerbaijan in Baku city and poisoned patients admitted to medical hospitals in Tbilisi (Georgia) from 1st January to 31st December, 2007. Total were 1182 hospitalizations in Republican Toxicology Center's (RTC) intensive care unit and 1646 poisoned patients admitted to medical hospitals in Tbilisi (Georgia). The mean lengths of hospitalization were 3.2 days in Azerbaijan and 1.2 days in Georgia. Acute intoxications were more frequent amount males (51% in Azerbaijan to 67% in Georgia) and in 20-40 age group. Among the pharmaceuticals poisonings by antiepileptic, sedative-hypnotic and antiparkinsonism drugs (T42) and poisonings by psychotropic drugs (T43) were the most frequent. The other cases of poisonings were inhalation of carbon monoxide (T58) - 173 hospitalization in Azerbaijan and 77 hospitalization in Georgia; toxic effect of alcohol (T51) - 50 admissions in Azerbaijan and 697 admissions in Georgia; poisoning by narcotics and psychodysleptics (T40) - 50 cases in Azerbaijan and 36 cases in Georgia; toxic effect of corrosive substances (T54) 176 patients in Azerbaijan to 56 patients in Georgia; toxic effect of pesticides (T60) - 39 patients in Azerbaijan to 11 patients in Georgia; toxic effect of contact with venomous animals (T63) - 70 patients in Azerbaijan to 23 patients in Georgia and toxic effect of other noxious substances eaten as food (T62) - 7 patients in Azerbaijan to 85 patients in Georgia The mortality rates were 3.1% in Azerbaijan and 0.74% in Georgia. Corrosive liquids (especially - concentrated acetic acid) poisonings were most often fatal (41% of total mortality) in Azerbaijan and alcohol poisonings were most often fatal (38% of total mortality) in Georgia. These data provide important preliminary information about toxicoepidemiological situation in South Caucasus countries and could help to develop program of chemical safety and prevention of acute chemical poisonings in this region.

Adverse drug reactions and deliberate self-poisoning as cause of admission to the intensive care unit: a 1-year prospective observational cohort study.

OBJECTIVE: The aim of the present study was (1) to determine the prevalence of intensive care unit (ICU) admissions due to an adverse drug reaction (ADR), and (2) to compare affected patients with patients admitted to the ICU for the treatment of deliberate self-poisoning using medical drugs. DESIGN: Prospective observational cohort study. SETTING: Fourteen bed medical ICU including an integrated intermediate care (IMC) section at a tertiary referral center. PATIENTS: A total of 1,554 patients admitted on 1 January 2003 to 31 December 2003. RESULTS: Ninety-nine patients were admitted to the ICU with a diagnosis of ADR (6.4% of all admissions), 269 admissions (17.3%) were caused by deliberate self-poisoning. Patients admitted for treatment of ADR had a significantly higher age, a longer treatment duration in the ICU, a higher SAPS II score, and a higher 6-month mortality than those with deliberate self-poisoning. Most patients (71.7%) suffering from ADR required advanced supportive care in the ICU while the majority of patients (90.7%) with deliberate self-poisoning could be sufficiently treated in the IMC area. All diagnostic and therapeutic procedures in the ICU except mechanical ventilation were significantly more often performed in patients with ADR. CONCLUSIONS: This study provides further evidence that ADR is a frequent cause of admission to medical ICUs resulting in a considerable use of ICU capacities. In the present setting patients with ADR required longer and more intense medical treatment in the ICU than those with deliberate self-poisoning.

[Problem in the rehabilitation of patients with acute chemical poisonings in the toxicological hospital].

Follow-ups of 693 patients treated at the rehabilitation toxicological department for poisonings with psychopharmacological agents (n=549), cauterants (n=72), and opium narcotics (n=72) were summarized. Moreover, factors, such as the development of complications and the prehospitalization psychosomatic status of patients, influenced the length stay in a unit. Treatment of such patients should be aimed at eliminating at once a few causes that negatively affect the course of recovery for which it is expedient to use the methods of physicochemical hemotherapy, mesodiencephalic modulation, intestinal lavage, and hyperbaric oxygenation.

Acute child poisonings in Oslo: a 2-year prospective study.

AIM: To study the current epidemiology, clinical course and outcome of poisonings among children in Oslo and compare findings to a similar study from 1980. METHODS: Observational study with prospective inclusion of all children (<15 years of age) with a main diagnosis of acute poisoning treated in hospital or outpatient clinic in Oslo for 2 years. RESULTS: One hundred seventy-five episodes of acute poisoning were included at the outpatient clinic only (n = 65), the paediatric department only (n = 82) or both (n = 28 referrals). Annual incidence was 97 per 100 000, significantly lower than in 1980 (230 per 100 000). Highest incidence was in 1-year-old males (576 per 100 000). In children <8 years of age, the most common toxic agents were pharmaceuticals (39%) and household products (32%); children > or = 8 years ingested mainly ethanol (46%) or pharmaceuticals (36%). Five percent of all children were comatose, and complications were seen in 13%. All children survived without sequelae. Half of the admissions needed treatment; most commonly used treatments were activated charcoal (33%), gastric lavage (9%) and emetics (9%). CONCLUSION: The incidence of child poisonings in Oslo has significantly reduced since 1980. Only half of the poisonings needed treatment, most of the poisonings were mild and the clinical outcome was good.

Intoxicación con litio / Litium intoxication

La intoxicación aguda por litio no es frecuente, entre el 75% al 90% de los pacientes con terapia de mantenimiento de litio pueden haber mantenido niveles tóxicos durante su tratamiento. La dosis por debajo de 2,5 mmol/L no suelen asociarse a la aparición de síntomas. Los sistemas más afectados son el neurológico, gastrointestinal y cardiovascular. Los síntomas aparecen desde las dos y las cuatro horas postingesta. En las horas posteriores a la ingestión de litio, los niveles de litio no reflejan la severidad del cuadro clínico, no obstante la monitorización hormonal es importante para dirigir la agresividad terapéutica y marcar el pronóstico del cuadro. La utilización de forzar diuresis con solución salina isotópica, son mencionadas por diversos autores. Entre otras opciones también descritas está la diálisis. En resumen, la intoxicación por litio puede ser un cuadro potencialmente frecuente y grave, por ello es necesario escribir unas normas de manejo terapéutico de esta entidad

Litium intoxication has a low prevalence, the 75% of patients with treatment with litium could have toxic levels of litium during the treatment. Asyntomatic patients have been observed with doses under 2.5 mmol/L. Systems with high prevalence of symptoms are the nervious system, gastrointestinal tube and cardiovascular. Symptoms could appear from two hours to four hours after ingestion. Early hours after Litium ingestion, levels of litium are not related with severity. However, monitoring seric levels is necessary to lead therapeutic approach and to give a prognosis. Induce urine with isotonic solution, is used during therapeutic approach. Other therapeutic option is dialysis. In summary, intoxication with litium could be a severe situation. It is necessary to describe therapeutic protocols in this entity

Emergency department utilization by crack-cocaine smokers in Dayton, Ohio.

The objective of this study was to determine the frequency, principal diagnoses, and correlates of emergency department (ED) visits made by persons with a history of crack-cocaine use (n = 333) over a 3-year period. Data were collected from participant self-reports and hospital records. During the study a total of 643 ED visits were made by 211 people, ranging from 53.5 to 76.7/100 persons/year. Injury and poisoning accounted for the largest single category of ED visits (29.5%). Men had lower odds of visiting the ED (OR=0.79, 95%CI=0.62-0.99), as did participants with higher levels of education (OR=0.83, 95%CI=0.73-0.94). Number of times in drug abuse treatment (OR=1.04, 95%CI=1.01-1.09), having a chronic disease (OR=1.46, 95%CI=1.06-1.99), and higher Addiction Severity Index composite medical scores (OR=1.62, 95%CI=1.15-2.29) increased the odds of an ED visit. Factors in addition to drug use are likely to affect ED utilization rates among crack-cocaine smokers.

Risk factors for suicide and other deaths following hospital treated self-poisoning in Australia.

OBJECTIVE: To analyze the risk factors for suicide, premature death and all-cause death in a representative population of hospital-treated deliberate self-poisoning patients. METHOD: A prospective cohort study using data-linkage between the Hunter Area Toxicology Service Database and the National Death Index of the Australian Institute of Health and Welfare, from January 1991 to December 2000. RESULTS: There were 4105 subjects, of whom 228 (5.6%) died, 122 (2.9%) by premature death and 58 (1.4%) by suicide. The probability of suicide after 10 years follow-up was 2%. The adjusted hazard ratios (95% CI) for suicide were: 'disorders usually diagnosed in infancy, childhood and adolescence', 5.28 (95% CI = 2.04-13.65): male gender, 4.25 (95% CI = 2.21-8.14); discharge to involuntary psychiatric hospital admission, 3.20 (95% CI = 1.78-5.76); and increasing age, 1.02 (95% CI = 1.01-1.04). Men and women showed different patterns of multivariate risks, although increased risk with increasing age and discharge to an involuntary psychiatric admission was true for both. The standardized all-cause mortality ratio (95% CI) was: for men, 6.42 (95% CI = 5.44-7.57), and for women 4.39 (95% CI = 3.56-5.41). The standardized suicide mortality ratio (95% CI) was: for men, 20.55 (95% CI = 15.24-27.73), and for women 22.95 (95% CI = 13.82-38.11). CONCLUSIONS: Men and women have different risk factors for subsequent suicide after self-poisoning. Hospital-treated self-poisoning patients have increased risk of subsequent suicide, premature and all-cause death. Psychiatric assessment, leading to discharge decisions, is worthwhile in identifying patients at long-term risk of suicide, premature and all-cause death.

[The pattern of poisonings with chemical compounds in Krakow inhabitants hospitalized at the Department of Clinical Toxicology of the Jagiellonian University Medical College in 1997-2001 in relation to age]. / Wiek a czestosc wystepowania i rodzaj zatruc wsród mieszkanców Krakowa, leczonych w Klinice Toksykologii CM UJ w latach 1997-2001.

The pattern of poisonings in patients hospitalised in the Department of Clinical Toxicology Jagiellonian University Medical College in 1997-2001 was presented in the study. The analysis includes 17,931 patients: 6,016 (33.5%) women and 11,915 (66.4%) men. The rate of patients between 20-39 years old was highest in all the analysed year, however downward trend was noticed. The upward tendency was noted in older group of poisoned patients. A suicidal poisonings were mostly common in 1998 and 1999 in the youngest and oldest groups: 37.1%, 37% in 1998, and 25.5%, 22.2% in 1999 respectively. The medication drugs were the most common cause of acute poisoning only in the group of adolescent patients. Ethyl alcohol was the common cause of poisoning in adult groups. The highest rate of ethanol intoxication was noted in patients between 40 to 59 years old. A 89 lethal intoxication were noted in analysed period. The average mortality rate was low (0.5). A medication drugs (30.4%) followed by ethanol (17.4%), carbon monoxide (13%) and solvents (13%) were involved in lethal poisonings in the oldest group of patients.

[Cardiovascular drugs poisoning in the elderly patients hospitalized in the Province Poisoning Center in Lublin in the years 1995-2001]. / Analiza zatruc lekami pierwotnie dzialajacymi na uklad sercowo-naczyniowy u pacjentów w wieku podeszlym hospitalizowanych w Wojewódzkim Osrodku Toksykologii w Lublinie w latach 1995-2001.

The aim of our research was retrospective analysis of poisoning with cardiovascular drugs (T46 according to ICD 10 classification) in patients over 59 years old, hospitalized in Province Poisoning Centre in Lublin, in the period from 1995 to 2001. There were hospitalized 288 patients at this time age, over 59 years old. Among this 16 persons were poisoned with cardiovascular drugs (one accidental and 15 suicidal intoxications), and 3 of them died. Different kinds of cardiovascular medications were used e.g. digoxin, nitrates, hypotensive drugs (as single and multiplied drug poisonings). At 3 of the patients depression was diagnosed.

[Benzodiazepine poisonings among elderly patients of Acute Poisoning Department of the Marciniak Memorial Hospital in Wroclaw in the years 2000-2001]. / Zatrucia benzodiazepinami u osób w wieku podeszlym w materiale Oddzialu Ostrych Zatruc Szpitala im. T. Marciniaka we Wroclawiu w latach 2000-2001.

Acute benzodiazepines poisonings in the group of 27 elderly patients is discussed. Majority of patients suffer from depression and cognitive impairment. Compared this special group of patients with younger the prognosis is worse what is expressed in greater number of deaths.

[Acute ethanol and drug poisoning in alcohol abusers]. / Ostre zatrucia etanolem i lekami u osób uzaleznionych od alkoholu.

In the period from 1997 to 1999 one hundred twenty one alcohol abusers were admitted to the clinic with acute ethanol and drug poisoning, including 95 men and 26 women from 18 to 69 (mean 36) years old. Fifty eight persons were poisoned by ethanol, in remaining 63 cases intoxications were mixed e.g. including benzodiazepines, tricyclic antidepressants, carbamazepine, amphetamine, phenothiazines, barbiturates, theophylline, salicylates. In the mixed poisonings group two men (3.2%) died at the age above 50 years old suffering from congestive heart failure, bronchopneumonia and ventricular fibrillation. In the ethanol intoxication group there was no fatal case.