Acute methanol poisoning in Tunisia: clinical features, biological and associated factors for mortality.

BACKGROUND: Acute Methanol Poisoning (MP) is rare but potentially serious. OBJECTIVES: To study the clinical and biological characteristics of acute MP and its associated factors of mortality. METHODS: We conducted a cross-sectional study including case series of MP which took place in Kairouan, Tunisia. Cases started consulting the emergency room on a festive day (1st day of Eid al- Fitr) corresponding to May 24, 2020. RESULTS: We included 65 male victims of MP. The median [interquartile] age was 28.0 [21.0 - 35.0] years with extremes ranging from 17 to 75 years. The median [interquartile] time between the ingestion of methanol and the medical consultation was 48.0 [24.0 - 50.0] hours. On admission, the majority of patients described neurological (98.4%) and gastrointestinal symptoms (51.4%). Four patients remained visually impaired and 8 patients (12.3%) had died. The univariate analysis reported an association between mortality and age, amount of methanol ingested, co-ingestion of cannabis, delay to consultation, neurological distress, seizures, lower systolic and diastolic blood pressure, metabolic acidosis, lower levels of potassium, higher levels of sodium, hematocrit, glycemia, creatinine, anion gap, and high Acute Physiology and Chronic Health Evaluation II score. CONCLUSION: Mortality rate following MP was high and was associated with several factors.

Nebulized budesonide combined with systemic corticosteroid vs systemic corticosteroid alone in acute severe asthma managed in the emergency department: a randomized controlled trial.

BACKGROUND: The additive benefit of inhaled corticosteroid when used with systemic corticosteroid in acute asthma is still unclear. The objective of this study was to assess the effect of high and repeated doses of inhaled budesonide when combined with the standard treatment of adult acute asthma. METHODS: It was a prospective double-blind randomized controlled study performed in the emergency department (ED) from May 1, 2010 to February 28, 2011 (ClinicalTrials.gov, NCT04016220). Fifty patients were included and were randomized to receive intravenous hydrocortisone hemisuccinate in association with nebulized budesonide (n = 23, budesonide group) or normal saline (n = 27, control group). Nebulization of budesonide or saline was done in combination with 5 mg of terbutaline every 20 min the first hour, then at 2 h (H2), and 3 h (H3). All patients received standard treatment. Efficacy and safety of inhaled budesonide were evaluated every 30 min for 180 min. RESULTS: A significant increase in peak expiratory flow (PEF) was observed in both treatment groups at evaluation times. The increase in PEF persisted significantly compared to the previous measurement in both groups. There was no significant difference in the PEF between the two groups at evaluation times. There was no significant difference between the two groups in the evolution in the respiratory rate and heart rate. There was also no statistically significant difference between the two groups in the rate of hospitalization, the discharge criteria before the end of the protocol. CONCLUSIONS: Considering its limited power, our study suggests that the association of nebulized budesonide with hydrocortisone hemisuccinate has no additional effect over the use of hydrocortisone alone in adults' acute asthma managed in the ED.