Dysfunction of Drosophila mitochondrial carrier homolog (Mtch) alters apoptosis and disturbs development.

Mitochondrial carrier homologs 1 (MTCH1) and 2 (MTCH2) are orphan members of the mitochondrial transporter family SLC25. Human MTCH1 is also known as presenilin 1-associated protein, PSAP. MTCH2 is a receptor for tBid and is related to lipid metabolism. Both proteins have been recently described as protein insertases of the outer mitochondrial membrane. We have depleted Mtch in Drosophila and show here that mutant flies are unable to complete development, showing an excess of apoptosis during pupation; this observation was confirmed by RNAi in Schneider cells. These findings are contrary to what has been described in humans. We discuss the implications in view of recent reports concerning the function of these proteins.

Self-injury and suicidal behavior in children and youth population: Learning from the pandemic.

INTRODUCTION: Suicidal behaviour and self-harm are increasing in children and adolescents. Non-suicidal self-harm are a dysfunctional method of emotional regulation, and it must be distinguished from suicidal behaviours. METHODS: Narrative review of the current situation on suicide and self-harm in Spain. Descriptive study of suicidal behaviours in paediatric emergencies. RESULTS: Mental health consultations were analysed (March-2019 to March-2020 and March-2020 to March-2021) in a multicentric study of the SEUP (Spanish Society of Pediatric Emergencies), finding a 122 % increase of the diagnosis of "non-accidental drug intoxication" and 56 % of "suicide/suicide attempt/suicidal ideation". In another prospective analysis, 281 attempts were recorded, with the patient profile being: female (90.1 %), 14.8 years old, 34.9 % without previous psychiatric diagnosis; 57.7% with previous suicidal behaviour. The presence of psychiatric disorders, especially depression, and previous attempts, are the best-known risk factors for suicidal behaviour, although other factors are involved (family, personal or social). Pediatricians should be trained to deal with questions about suicide and acquire the skills to conduct an interview with a supportive and empathetic attitude. In Spain, suicide prevention plans are heterogeneous among communities, and there is not a unified national suicide prevention plan. CONCLUSIONS: Primary, hospital and mental health care resources for paediatric population should be strengthened to prevent suicidal behaviours. Specific training for school staff, and child and adolescent psychiatry training for paediatricians and nurses are crucial in the prevention of suicide in children and adolescent population.

Differences in clinical signs and severity of intoxication due to street drugs in adolescents and young adults treated in emergency departments. / Características diferenciales en las manifestaciones clínicas y la gravedad de las intoxicaciones por drogas de abuso en adolescentes atendidos en servicios de urgencias en comparación con adultos jóvenes.

OBJECTIVES: To determine whether symptoms and levels of severity of intoxication from street drugs differ between adolescents and young adults who come to hospital emergency departments for treatment. MATERIAL AND METHODS: We studied a consecutive cohort of adolescents (aged 12-17 years) and young adults (aged 18-30 years) who were treated in 11 hospital emergency departments belonging to the Drug Abuse Network of Spanish Hospital Emergency Departments (REDURHE). Sociodemographic and clinical characteristics and level of severity were recorded for comparison between between adolescents and young adults, adjusted for sex, alcohol co-ingestion, and type of drug used. An intoxication was recorded as severe if at least 1 of the following indicators was present: cardiac arrest, tracheal intubation, intensive care unit admission, and in-hospital death. RESULTS: We included a total of 2181 patients: 249 adolescents (11.4%) and 1932 young adults (88.6%). Alcohol coingestion and use of multiple drugs were less common in adolescents, who had significantly more events related to cannabis (in 81.1% vs 49.0% of young adults) and benzodiazepines (13.3% vs 5.5%). The adolescents had significantly fewer intoxications from the use of cocaine (10.8% vs 45.1%), amphetamines (17.3% vs 32.3%), ketamine (0.4% vs 6.0%) and gamma-hydroxybutyrate (0.4% vs 4.0%). A higher proportion of adolescents than young adults presented with diminished consciousness (23.0% vs 16.9%), but fewer manifested anxiety (15.9% vs 26.3%), palpitations (11.0% vs 19.5%), or chest pain (2.8% vs 9.2%). The pattern of associations was similar in the subgroup of intoxications due to cannabis. The adjusted model confirmed that the adolescents were more likely to have diminished consciousness, with an odds ratio (OR) of 1.851 (95% CI, 1.204-2.844) and less likely to have anxiety (OR, 0.529 (95% CI, 0.347-0.807). Intoxication was severe in 46 patients overall (2.1%); in adolescents and young adults the proportions were 0.8% and 2.3%, respectively (P = 0.129). In adolescents, the OR was 0.568 (95% CI, 0.131-2.468) for severity; for component indicators, the ORs were 0.494 (95% CI, 0.063-3.892) for intubation and 0.780 (95% CI, 0.175-3.475) for intensive care unit admission. No deaths occurred. CONCLUSION: Adolescents requiring emergency care for street drug intoxication had co-ingested alcohol or taken multiple drugs less often than young adults. Cannabis was the drug most often used by adolescents, who presented more often with diminished consciousness but less often with anxiety. We detected no differences related to event severity.

OBJETIVO: Investigar si existen diferencias en las drogas, sintomatología y gravedad entre adolescentes y jóvenes atendidos por intoxicación por drogas en servicios de urgencias hospitalarios (SUH). METODO: Entre los pacientes consecutivos atendidos por consumo de drogas en los 11 SUH de la REDURHE (Red de estudio de Drogas en Urgencias Hospitalarios en España), se seleccionaron los adolescentes (edad = 12-17 años) y los jóvenes (edad = 18-30 años). Se compararon las características sociodemográficas, clínicas y la gravedad (evento adverso combinado ­EAC­: parada cardiorrespiratoria, intubación endotraqueal, ingreso en cuidados intensivos o muerte intrahospitalaria) en adolescentes y jóvenes, ajustadas por sexo, coingesta de etanol y drogas involucradas. RESULTADOS: Se incluyeron 2.181 pacientes (adolescentes = 249, 11,4%; jóvenes = 1.932, 88,6%). En adolescentes, la coingesta de etanol y múltiples drogas fue menos frecuente. Hubo significativamente más asistencias por cannabis (81,1% vs 49,0%) y benzodiacepinas (13,3% vs 5,5%) y menos por cocaína (10,8% vs 45,1%), anfetamínicos (17,3% vs 32,3%), ketamina (0,4% vs 6,0%) y gamma-hidroxibutirato (0,4% vs 4,0%). Los adolescentes presentaron más disminución de consciencia (23,0% vs 16,9%) y menos ansiedad (15,9% vs 26,3%), palpitaciones (11,0% vs 19,5%) y dolor torácico (2,8% vs 9,2%). Estas asociaciones se mantuvieron al analizar el subgrupo de intoxicados por cannabis. En el modelo ajustado, los adolescentes presentan más disminución de consciencia con (OR = 1,851, IC 95%: 1,204-2,844) y menos ansiedad (OR = 0,529, IC 95%: 0,347-0,807). Se observó EAC en 46 pacientes (2,0%; 0,8% vs 2,3%, p = 0,129). La OR ajustada en adolescentes para EAC fue 0,568 (IC 95%: 0,131-2,468), y para intubación 0,494 (IC 95%: 0,063-3,892) y para ingreso en intensivos 0,780 (IC 95%: 0,175-3,475). No hubo fallecimientos. CONCLUSIONES: Los adolescentes intoxicados por drogas atendidos en SUH presentan con menor frecuencia coingesta de etanol o múltiples drogas. La droga más frecuentemente implicada es el cannabis, y presentan más disminución de consciencia y menos ansiedad. No detectamos diferencias en la gravedad entre adolescentes y jóvenes.

Unintentional poisoning by cough and cold medications: Drugs with little usefulness and potential toxicity.

INTRODUCTION: The use of medications to relieve the symptoms of the "common cold" in children is very frequent. In addition to the lack of scientific evidence supporting its usefulness, there is evidence of potential toxicity, and serious and even fatal cases of intoxication have been described. The objective was to describe the clinical and epidemiological characteristics of the patients treated in a paediatric emergency department (PED) for suspected unintentional intoxication by a cold medicine. MATERIAL AND METHODS: Observational and analytical study of patients aged less than 18 years managed in a PED for suspected unintentional poisoning by a cold medicine between July 2012 and June 2020. We classified severity according to the Poisoning Severity Score (PSS): PSS-0 = no toxicity; PSS-1 = mild toxicity; PSS-2 = moderate; PSS-3 = severe; PSS-4 = lethal. If the intoxication occurred while the patient was in active treatment with the drug, we determined whether the patient's age was in the applicable range established in the therapeutic indications provided in the summary of product characteristics. RESULTS: The study included data for 63 cases. The drugs involved were decongestants and mucolytics (31; 49.2%), antitussives (26; 41.2%) and oral bronchodilators (6; 9.5%). The distribution by severity was 40 cases with PSS-0 (63.5%), 21 with PSS-1 (33.3%), 1 with PSS-2 (1.6%) and 1 with PSS-3 (1.6%). In 29 patients (46.0%) there was a history of therapeutic use; in 15 of these cases (51.7%) the age was lower than recommended in the summary of product characteristics. In 14 patients (22.2%) the intoxication was due to administration of the wrong dose by caregivers. CONCLUSION: Although scientific evidence does not support the use of cold medicines in children, unintentional intoxications by these drugs keep happening, in some cases causing moderate or severe symptoms.

Clinical manifestations and serious adverse effects after cannabis use: role of age according to sex and coingestion of alcohol. / Manifestaciones clínicas y eventos adversos graves tras consumo de cannabis: efecto de la edad y análisis diferenciado en función del sexo y la coingesta de etanol.

OBJECTIVES: To study whether there are age-related differences in the clinical effects of cannabis poisoning and whether any age differences found are also related to sex or coingestion of alcohol. MATERIAL AND METHODS: Descriptive observational study of patients treated in 11 emergency departments for symptoms related to cannabis use. We collected data on 11 clinical manifestations and used a restricted cubic spline model to analyze their relative frequency according to age. We also looked for any interactions between the findings and patient sex or alcohol coingestion. RESULTS: A total of 949 patients were studied. The mean age was 29 years, 74% were males, and 39% had also consumed alcohol. We identified 3 symptom patterns related to age. One set of symptoms (vomiting, headache, convulsions, and hypotension) remained stable across all ages. Manifestations that increased in the middle of the age range studied were agitation and aggressivity, psychosis, palpitations and hallucinations. Chest pain and hypertension increased in older-aged patients. The frequencies of palpitations, vomiting, and headache differed according to sex. These manifestations held constant in males but were markedly higher in young-adult females. Coingestion of alcohol was associated with agitation and aggressivity (in 34.0% vs 23.4%, P .001), fewer reports of palpitations (in 9.8% vs 15.6%, P = .01), less anxiety (in 20.7% vs 27.8%, P = .01), less psychosis (in 10.3% vs 16.6%, P = .007), and less chest pain (in 3.8% vs 9.5%, P = .001). The only significant interaction between age and alcohol coingestion occurred with respect to vomiting and psychosis. CONCLUSION: There are age-related differences in the acute clinical manifestations of cannabis poisoning requiring emergency hospital care. Sex and coingestion of alcohol modify the relationship between age and frequency of some manifestations.

OBJETIVO: Investigar si existen diferencias en las manifestaciones clínicas por consumo de cannabis según la edad, y si estas se modifican en función del sexo o el consumo de etanol. METODO: Estudio observacional descriptivo de pacientes atendidos en 11 servicios de urgencias con consumo de cannabis como motivo de consulta. Se recogieron 11 manifestaciones clínicas y se analizó su frecuencia relativa en función de la edad mediante curvas spline cúbicas restringidas. Se analizó si existía interacción en el comportamiento etario de cada uno de los síntomas en función del sexo y del consumo de etanol. RESULTADOS: Se analizaron 949 pacientes, edad media 29 años, 74% varones y 39% con coingesta de etanol. Se identificaron tres patrones de síntomas según la edad: estable (vómitos, cefalea, convulsiones, hipotensión), incrementada en edades medias (agresividad-agitación, ansiedad, psicosis, palpitaciones, alucinaciones) y con aumento progresivo con la edad (dolor torácico e hipertensión). En la relación síntoma-edad, la frecuencia de palpitaciones, vómitos y cefalea tuvo un comportamiento significativamente diferente según el sexo, más constante en hombres y con un incremento marcado en edades medias en mujeres. La coingesta de etanol se asoció con más agitación-agresividad (34,0%/23,4%, p 0,001) y menos palpitaciones (9,8%/15,6%, p = 0,01), ansiedad (20,7%/27,8%, p = 0,01), psicosis (10,3%/16,6%, p = 0,007) y dolor torácico (3,8%/9,5%, p = 0,001). En cuanto a la relación síntoma-edad, el etanol solo modificó significativamente la frecuencia de vómitos y de psicosis. CONCLUSIONES: La edad condiciona efectos clínicos diferenciales en algunas manifestaciones agudas de la intoxicación por cannabis que precisa asistencia hospitalaria, y el sexo y el consumo simultáneo de alcohol modifican esta relación entre edad y frecuencia de algunos síntomas.

Spanish Research Network on Drugs in Hospital Emergency Departments - the REDUrHE registry: general analysis and comparisons between weekend and weekday poisonings. / Red de Estudio de Drogas en Urgencias Hospitalarias en España (Registro REDUrHE): análisis general y comparación según asistencia en día laborable o festivo.

OBJECTIVES: To describe the sociodemographic characteristics, drug use patterns, and the severity of drug overdoses treated in hospital emergency departments according to the registry of the Spanish Research Network on Drugs in Hospital Emergency Departments (REDUrHE project), and to identify differences between patterns on weekdays and weekends/national holidays. MATERIAL AND METHODS: Eleven hospitals participated in the REDUrHE project, studying consecutive patients with symptoms of drug overdose over a 24-month period. The drugs implicated were extracted from clinical records or toxicology reports. An overdose was considered severe if management required intubation, cardiopulmonary resuscitation, or admission to the intensive care unit, or if in-hospital death occurred (composite event). Each of these variables was also analyzed by itself. RESULTS: A total of 4526 patients were studied (2218 [49%] on weekends/holidays; 2308 [51%] on workdays). The mean (SD) age was 33 (11) years, and 75.5% were men. The most commonly used drugs were cocaine (47.8%), paciencannabis (44.4%), amphetamine derivatives (25.5%), benzodiazepines (8.8%), and opioids (7.3%). Patients treated on weekends/holidays were younger (32.1 vs 33.1 years on weekdays, P = .006), and they were more often taken to the hospital in an ambulance (60.5% vs 57.3%, P = .035). Hospitals in large cities (Barcelona and Madrid) saw more patients on weekends/holidays (55.8%). Major tourist destinations (the Balearic and Canary Islands) saw fewer patients on weekends/holidays (44.7%, P .001). Alcohol was ingested along with a drug by 58.2%; this combination was more common on weekends/holidays (in 63.3% vs 52.9% on weekdays, P .001), and 39.4% used more than 1 drug. Use of more than 1 drug was less common on weekends (in 37.6% vs 41.2%, P = .013). Opioid emergencies were also less frequent on weekends (6.0% vs 8.6%, P = .001), when gamma-hydroxybutyrate (GHB) overdoses were more common (5.8% vs 3.6%, P .001). Severity indicators were present (the composite event) more often on weekends (in 3.6% vs 2.2%, P = .006). Likewise, weekends saw more intubations (in 2.3% vs 1.0%, P = .001) and intensive care unit admissions (2.4% vs 1.6%, P = .047). Twelve patients (0.3%) died; mortality was similar on weekends (0.2%) and weekdays (0.3%) (P = .826). After adjusting for age, sex, combined use of alcohol, and type of drug, the risk of the severe-event composite was greater on weekends (odds ratio, 1.569; 95% CI, 1.088-2.263). CONCLUSION: Weekend and holiday emergencies due to drug overdoses are more frequent in large city hospitals. Weekend emergencies share certain distinctive characteristics: patients are younger, alcohol more often is ingested with drugs but multiple-drug combinations are less common, and GHB is used more often while opioids are used less often. Severe poisonings occur more often on weekends and holidays.

OBJETIVO: Conocer las características sociodemográficas, el patrón de consumo y la gravedad de los pacientes atendidos en servicios de urgencias hospitalarios (SUH) españoles por intoxicación por drogas (Proyecto REDUrHE) e investigar si existen diferencias entre los días festivos y los días laborables. METODO: Once SUH integrantes del proyecto REDUrHE incluyeron durante 24 meses de forma consecutiva a los pacientes atendidos por sintomatología derivada del consumo de drogas ilegales. Estas se determinaron por la historia clínica o la determinación toxicológica. El indicador primario de gravedad fue el evento adverso combinado formado por intubación, parada cardiorrespiratoria, ingreso en cuidados intensivos o muerte intrahospitalaria y los indicadores secundarios cada uno de estos eventos adversos considerado individualmente. RESULTADOS: Se incluyeron 4.526 pacientes (festivo: 2.218, 49%; laborables: 2.308, 51%), con edad media de 33 años (DE 11) y 75,5% hombres. Las drogas más frecuentemente involucradas fueron cocaína (47,8%), cannabis (44,4%), derivados anfetamínicos (25,5%), benzodiacepinas (8,8%) y opiáceos (7,3%). Los pacientes atendidos en festivos eran más jóvenes (32,1 vs 33,1 años, p = 0,006) y más frecuentemente traídos al SUH en ambulancia (60,5% vs 57,3%, p = 0,035). Los SUH de grandes ciudades (Barcelona, Madrid) tuvieron la mayor afluencia en festivo (55,8%) y los de zonas de alto turismo lúdico (Baleares, Canarias) los de menor afluencia (44,7%; p 0,001). El 58,2% ingirió simultáneamente etanol (más en festivos, 63,3% vs 52,9%, p 0,001) y el 39,4% más de una droga (menos en festivos, 37,6% vs 41,2%, p = 0,013). En festivo, los opiáceos fueron menos frecuentes (6,0% vs 8,6%, p = 0,001) y el gamma- hidroxibutirato más (5,8% vs 3,6%, p 0,001). También en festivo, hubo más eventos combinados adversos (3,6% vs 2,2%; p = 0,006), más intubaciones (2,3% vs 1,0%, p = 0,001) y más ingresos en cuidados intensivos (2,4% vs 1,6%, p = 0,047). Fallecieron 12 pacientes (0,3%), sin diferencias entre grupos (0,2% vs 0,3%, p = 0,826). Al ajustar por edad, sexo, ingesta combinada de etanol y tipos de drogas implicadas, los pacientes atendidos en festivos tuvieron más riesgo de evento adverso combinado, con OR = 1,569 (IC 95% = 1,088-2,263). CONCLUSIONES: Las intoxicaciones por drogas atendidas en SUH en día festivo suceden con mayor frecuencia en grandes ciudades y presentan ciertas características distintivas (pacientes más jóvenes, más ingesta conjunta con etanol, menos combinación de drogas, más frecuente gamma-hidroxibutirato y menos frecuente piáceos). Durante los festivos, las intoxicaciones atendidas son de mayor gravedad.

Poisoning cases in Catalonia: characteristics according to age groups in the Intox.28 study. / Características de las intoxicaciones agudas atendidas en Cataluña y diferencias según grupos de edad: Estudio Intox-28.

OBJECTIVES: The Toxicology Working Group of the Catalan Society of Emergency Medicine (SoCMUETox) began the Intox-28 study in 2013. The aim was to identify differences in poisoning cases between 3 age groups. MATERIAL AND METHODS: Descriptive observational study of poisoning cases managed in 8 hospital emergency departments on the 28th day of each month from 2013 to 2019. We gathered information on patient particulars, type of poison, clinical data, and discharge destination. The patient sample was distributed into 3 groups for comparison: minors under the age of 17 years, adults aged 17 to 65 years, and adults over the age of 65 years. RESULTS: The hospitals registered 1088 cases: 132, 859, and 97 in each age group. In comparisons between the minors and the adults aged 65 years or younger, the minors had more females (58.3% vs 46.1%), fewer recreational poisonings (22% vs 46.1%) more poisonings inside the home (67.4% vs 51.1%), more medication poisonings (49.2% vs 31.1%), and less often received treatment (43.2% vs 73%) (P .001, all comparisons). The proportion of older adults receiving treatment (73.2%) was similar to that of the younger adults. CONCLUSION: The characteristics of poisonings vary according to age. Differences lie in gender, intentionality, and type of poison.

OBJETIVO: El Grupo de Trabajo de Toxicología de la Societat Catalana de Medicina d'Urgències i Emergències (SoCMUETox) inició en 2013 el estudio Intox-28. El objetivo de este trabajo es evaluar las diferencias existentes en las características de las intoxicaciones según la edad de los pacientes. METODO: Estudio descriptivo observacional de las intoxicaciones atendidas en 8 servicios de urgencias hospitalarios (SUH) el día 28 de cada mes durante el periodo 2013-19. Se recogieron datos demográficos, tipo de tóxico, datos clínicos y destino al alta. Los pacientes se dividieron en 3 grupos: menores de 17 años, adultos (entre 17 y 65 años) y mayores de 65 años. RESULTADOS: Se registraron 1.088 intoxicaciones: 132 (12,1%), 859 (78,9%) y 97 (8,9%) en cada grupo de edad respectivamente. En comparación a los pacientes adultos, en los menores de 17 años hubo más mujeres (58,3% vs 46,1%; p 0,001), menos intoxicaciones de tipo recreativo (22% vs 46,1%; p 0,001) y acontecieron más frecuentemente en el domicilio (67,4% vs 51,1%; p 0,001). El tipo de tóxico más implicado fueron los fármacos (49,2% vs 31,1%; p 0,001) y precisaron tratamiento con menor frecuencia (43,2% vs 73%; p 0,001). Los mayores de 65 años precisaron tratamiento en porcentaje similar a los pacientes de 17 a 65 años (73,2%). CONCLUSIONES: Existen diferencias entre los grupos de edad, entre las que destacan el sexo predominante, la intencionalidad de la intoxicación y el tipo de tóxico implicado.

[Actions that should not be taken with a paediatric patient who has been exposed to a potentially toxic substance]. / Acciones que no hay que hacer ante un paciente que ha contactado con un posible tóxico.

OBJECTIVE: To show the preparation process by the Poisoning Working Group of the Spanish Society of Paediatric Emergencies (GTI-SEUP), of the list of things «not to do¼ for a paediatric patient who has been exposed to a potentially toxic substance. METHOD: The preparation process of the list was carried out in three phases. First: «Brainstorming¼ that was open to all members of the GTI-SEUP. Second: Recommendations were selected by following modified-Delphi methodology. All participants were asked to rate the proposals (from 1 = strongly disagree to 9 = strongly agree). Those with an average score greater than 8 were accepted (provided that at least two-thirds of the participants had given them a score ≥ 7), and a second consultation was made for the recommendations with an average score between 6 and 8. Third: Writing and creating a consensus of the final document was done. RESULT: A total of 11 proposals were initially obtained. Thirty-two of the 57 GTI-SEUP participants completed the scoring questionnaire. In the first consultation, seven «not to do¼ recommendations were accepted, and four obtained a doubtful average score (between 6 and 8). After the second consultation, the list was made up of eight recommendations. Two refer to general management, four to gastrointestinal decontamination techniques, and two to the administration of antidotes. CONCLUSION: The list of actions that should not be taken with a child that has been exposed to a possible poison is a consensus tool, within the GTI-SEUP, to promote improvement in the quality of care offered to these patients. This improvement is based on avoiding unnecessary measures, which can sometimes be harmful to the child.

[Availability in Spain of "one pill killers" and other highly toxic drugs in infants]. / Disponibilidad en España de «one pill killers¼ y otros medicamentos altamente tóxicos en la infancia.

OBJECTIVE: To prepare a list of highly toxic drugs in infants (HTDs) marketed in Spain, comparing those that reach the lethal dose in a child of 10kg with the ingestion of 1 to 3 units. METHOD: HTDs are defined as those capable of causing severe or lethal poisoning in children less than 8-year-old. Severe poisoning is considered as that corresponding to Grade 3 in the Poisoning Severity Score classification and to the "major effects" category in publications in the American Association of Poison Control Centers. A literature review was carried out on the annual reports of the American Association of Poison Control Centers, as well as in PubMed, between January 2000 and February 2019 (Keywords "severe", "fatal", "life-threatening", "poisoning", "child", "paediatric", "toxicological emergency"). An observational, retrospective study was also conducted on infants less than 8-year-old that were seen in a Paediatric Emergency Department due to suspected drug poisoning between July 2012 and June 2018. The active ingredients responsible marketed in Spain were selected, and the lethal or highly toxic doses were determined. The number of units (pills) necessary to reach this dose in children of 10kg was calculated. RESULTS: A total of 7 HTD groups were identified: analgesics; psychotropics and other medication used in neurological disorders; catarrh decongestants - cough -antihistamine - asthma drugs; cardiovascular drugs; antibiotics, topical preparations, and other drugs. In 29 active ingredients, the ingestion of a single pill could cause death in 10kg infant, in another 13, the ingestion of 2 pills could cause death, as well as the ingestion of 3 pills in 10 cases. CONCLUSION: There are numerous HTDs marketed in Spain, some of which are available in potentially fatal presentations with few pills.

[Prehospital emergency care of patients exposed to poisoning: Assessment of epidemiological, clinical characteristics and quality of care]. / Atención prehospitalaria urgente de los pacientes pediátricos expuestos a tóxicos: características epidemiológico-clínicas y evaluación de la calidad asistencial.

OBJECTIVE: To describe the characteristics of paediatric patients with suspected poisoning treated by advanced life support (ALS) units, and to evaluate quality indicators (QI) for the prehospital emergency care of these patients. METHOD: A one-year observational study of patients under 18 years of age exposed to poisoning and treated by an ALS unit of the Medical Emergency System in Catalonia. Severe clinical criteria were defined, with 8 QI being evaluated for prehospital emergency care of poisoned paediatric patients. RESULTS: The study included a total of 254 patients, with a median age of 14 years-old (p25-75 = 7-16), with intentional poisoning in 50.8% of cases. The most frequently involved toxic agent was carbon monoxide (CO) (33.8%). Poisoning was found in 48.8% of those patients, being serious in 16.5%. Intentionally (OR 5.1; 95% CI: 1.9-13.8) and knowledge of the time of exposure (OD 3.1; 95% CI: 1.3-7.3) were independent risk factors associated with the appearance of severe clinical symptoms. Five QI did not reach the quality standard and included, availability of specific clinical guidelines, activated charcoal administration in selected patients, oxygen therapy administration at maximum possible concentration in carbon monoxide poisoning, electrocardiographic assessment in patients exposed to cardiotoxic substances, and recording of the minimum data set. CONCLUSIONS: Paediatric patients attended by ALS units showed specific characteristics, highlighting the involvement of CO and adolescents with voluntary poisoning. The QI assessment was useful to detect weak points in the quality of care of these patients and to develop strategies for improvement.

[Ingestion of caustic substances: An analysis of the safety and benefit of a less aggressive protocol]. / Ingesta de cáusticos: análisis de la seguridad y beneficio de un protocolo menos agresivo.

INTRODUCTION: The ingestion of a caustic agent is the most common cause of admission after being in contact with a domestic product. A group of patients could be considered low risk and not require aggressive procedures such a corticosteroid administration and endoscopy, especially in the paediatric population. OBJECTIVE: To evaluate the safety and benefit of a less aggressive protocol for patients defined as low risk. MATERIAL AND METHODS: An analytical-observational study conducted on patients who consulted for caustic ingestion between January 2011 and December 2015. Two periods were differentiated according to the current protocol. Period-1: usual protocol (which included admission and parenteral corticosteroid and antibiotic administration) and Period-2: less aggressive protocol for the low risk patients (oral intake test after 6hours and discharged if they remained asymptomatic). Low risk patients were considered as those who met the following criteria: unintentional intake, absence of symptoms and oral lesions. In the rest of the patients the usual protocol was performed. Re-admission with a diagnosis of digestive lesions was considered as a complication. RESULTS: Forty-eight patients were included in period 1, and 35 in period 2. In period 2, thirteen patients met low risk criteria. The adherence to the less aggressive protocol was 100%. None of the low risk patients required admission or endoscopy after discharge. In period 1 the adherence to the usual protocol was 60.4%. Six patients would have benefited from the application of the less aggressive protocol. CONCLUSIONS: Adopting a more conservative attitude in low risk patients is safe. These patients benefit from clinical observation, without performing more aggressive measures with their possible iatrogenic adverse effects.

Cannabis poisoning under the age of 3 years. / Intoxicación por cannabis en menores de 3 años.

EN: The increased use of cannabis among adults and the general perception that cannabis is harmless has been accompanied by a rise in the number of acute poisoning cases among children. We present a retrospective, descriptive study of patients aged 3 years or younger who were treated for cannabis poisoning in a pediatric emergency department between 2012 and 2017. Epidemiologic and clinical data as well as toxicologic findings are reported. We found 10 cases of cannabis poisoning in our records. Nine of the patients had diminished consciousness. Only 2 families initially reported exposure to cannabis when interviewed. Repeated exposure was demonstrated by analysis of hair from 2 patients. We conclude that cannabis poisoning should be included in the differential diagnosis of young children with acute neurologic symptoms of unknown origin. When cannabis is detected in urine samples collected in the pediatric emergency department, more specific diagnostic techniques should be used to assess the possibility of repeated exposure.

ES: El aumento en el consumo de cannabis y su trivialización por la población adulta se han traducido en un aumento de los casos de intoxicaciones agudas en niños. Se presenta un estudio observacional retrospectivo de los pacientes menores de 3 años intoxicados por cannabis entre 2012 y 2017 en un servicio de urgencias pediátricas (SUP). Se recogieron datos epidemiológicos, clínicos y toxicológicos. Se detectaron 10 intoxicaciones por cannabis. Nueve pacientes presentaron alteración en el nivel de conciencia. Solo en 2 casos la familia refirió la exposición al tóxico en la anamnesis inicial. La detección en cabello demostró exposición repetida en 2 pacientes. En conclusión, es necesario incluir la intoxicación por cannabis dentro del diagnóstico diferencial de los niños con clínica neurológica aguda no filiada. Ante la detección de cannabis en orina en el SUP, se debe solicitar la confirmación mediante técnicas específicas y valorar la posibilidad de exposiciones repetidas.

[Use of urine drug screening in the emergency department of a paediatric hospital]. / Utilidad de las técnicas de cribado de tóxicos en orina solicitadas desde el servicio de urgencias de un hospital pediátrico.

OBJECTIVE: To describe the situations in which urine drug screening is used in a Paediatric Emergency Department (ED). An analysis is also made on its potential usefulness on whether it changes the patient management, and if the results are confirmed by using specific techniques. METHODOLOGY: A retrospective study was conducted on patients under the age of 18 attended in the ED during 2014 and in whom urine drug screening was requested. Depending on the potential capacity of the screening result to change patient management, two groups were defined (potentially useful and not potentially useful). RESULTS: Urine drug screening was performed on a total of 161 patients. The screening was considered not to be potentially useful in 87 (54.0%). This was because the clinical history already explained the symptoms the patient had in 55 (34.1%) patients, in 29 (18.0%) because the patient was asymptomatic, and in 3 (1.9%) because the suspected drug was not detectable in the screening. The drug screening results changed the patient management in 5 (3.1%) cases. A toxic substance was detected in 44 (27.3%). Two out of the 44 that were positive (2.1%) were re-tested by specific techniques, and presence of the toxic substance was ruled out in both of them (false positives). CONCLUSIONS: Most of the drug screening tests are not justified, and it is very infrequent that they change patient management. It is very rare that the results are confirmed using more specific methods. Urine drug screening tests should be restricted to particular cases and if the result has legal implications, or if the patient denies using the drug, it should be followed by a specific toxicological study to provide a conclusive result.

Availability of antidotes in 70 hospitals in Catalonia, Spain. / Disponibilidad de antídotos en 70 hospitales de Cataluña.

BACKGROUND AND OBJECTIVE: Antidotes may have a relevant role in acute intoxication management and the time until its administration can influence patient survival. PATIENTS AND METHOD: Study conducted by a questionnaire sent in early 2015 to 70 hospitals in Catalonia providing emergency services. Qualitative availability on each antidote was considered adequate when present in at least 80% of hospitals. The quantitative availability was considered adequate when at least 80% of hospitals had the number of units of antidote recommended. RESULTS: Lower complexity hospitals (level A) showed a percentage of adequate qualitative and quantitative availability of 66.7 and 42.9% respectively. In higher complexity hospitals (level B) qualitative and quantitative availability was adequate in 64.5 and 38.7% of the antidotes respectively. Data showed no differences between the different health regions as well as a positive correlation (p<.05) between the number of emergencies attended and the percentage of adequate qualitative availability. CONCLUSIONS: The availability of antidotes in Catalonia hospitals is generally low and shows differences across health regions and depending on level of complexity.