Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 60
Filtrar
Mais filtros

Bases de dados
País/Região como assunto
Tipo de documento
Intervalo de ano de publicação
1.
Am J Emerg Med ; 58: 229-234, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35716536

RESUMO

BACKGROUND: Peri-intubation cardiac arrest is an uncommon, serious complication following endotracheal intubation in the emergency department. Although several risk factors have been previously identified, this study aimed to comprehensively identify risk factors associated with peri-intubation cardiac arrest. METHODS: This retrospective, nested case-control study conducted from January 1, 2016 to December 31, 2020 analyzed variables including demographic characteristics, triage, and pre-intubation vital signs, medications, and laboratory data. Univariate analysis and multivariable logistic regression models were used to compare clinical factors between the patients with peri-intubation cardiac arrest and patients without cardiac arrest. RESULTS: Of the 6983 patients intubated during the study period, 5130 patients met the inclusion criteria; 92 (1.8%) patients met the criteria for peri-intubation cardiac arrest and 276 were age- and sex-matched to the control group. Before intubation, systolic blood pressure and diastolic blood pressure were lower (104 vs. 136.5 mmHg, p < 0.01; 59.5 vs. 78 mmHg, p < 0.01 respectively) and the shock index was higher in the patients with peri-intubation cardiac arrest than the control group (0.97 vs. 0.83, p < 0.0001). Cardiogenic pulmonary edema as an indication for intubation (adjusted odds ratio [aOR]: 5.921, 95% confidence interval [CI]: 1.044-33.57, p = 0.04), systolic blood pressure < 90 mmHg before intubation (aOR: 5.217, 95% CI: 1.484-18.34, p = 0.01), and elevated lactate levels (aOR: 1.012, 95% CI: 1.002-1.022, p = 0.01) were independent risk factors of peri-intubation cardiac arrest. CONCLUSIONS: Patients with hypotension before intubation have a higher risk of peri-intubation cardiac arrest in the emergency department. Future studies are needed to evaluate the influence of resuscitation before intubation and establish airway management strategies to avoid serious complications.


Assuntos
Parada Cardíaca , Estudos de Casos e Controles , Serviço Hospitalar de Emergência , Parada Cardíaca/epidemiologia , Parada Cardíaca/etiologia , Parada Cardíaca/terapia , Humanos , Intubação Intratraqueal/efeitos adversos , Estudos Retrospectivos , Fatores de Risco
2.
J Formos Med Assoc ; 121(9): 1832-1840, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35365378

RESUMO

BACKGROUND: To compare gender differences in socio-demographics, clinical manifestations, and laboratory test results of individuals who visited emergency departments (EDs) involving drug use. METHODS: We retrospectively collected the data from 10 hospitals in Taiwan on drug-related ED visits from May 2017 to December 2020. We then examined the gender differences in their socio-demographics, clinical manifestations, urine toxicological results, and other laboratory tests results using chi-square or multivariable logistic regression. RESULTS: Among individuals with drug-related ED visits, there were 546 (73.7%) men and 195 (26.3%) women. The most commonly used drugs were meth/amphetamine, followed by synthetic cathinones, and ketamine and its analogs. Compared to men, women were younger (32.03 ± 10.86 vs. 36.51 ± 10.84 years, p < 0.001) and more likely to use new psychoactive substances (NPS) (p = 0.011). Men were more likely to have human immunodeficiency virus infection (p < 0.001), whereas women were more likely to report psychiatric comorbidities (p = 0.003). Women were less likely to have aggressive behaviors (odds ratio (OR): 0.59, 95% CI: 0.39-0.88). After adjusting for socio-demographics and drug types, women were still less likely to have aggressive behaviors than men (adjusted OR: 0.59, 95% CI: 0.38-0.93). The likelihood of rhabdomyolysis and intensive care unit admission was higher in men (p < 0.001). CONCLUSION: We found considerable gender differences in clinical characteristics among ED-visiting drug users, which could offer valuable information for the future development of more tailored gender-specific drug prevention and treatment strategies.


Assuntos
Drogas Ilícitas , Serviço Hospitalar de Emergência , Feminino , Hospitalização , Humanos , Masculino , Estudos Retrospectivos , Fatores Sexuais
3.
J Formos Med Assoc ; 115(8): 672-7, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26250942

RESUMO

BACKGROUND/PURPOSE: Four types of antivenom are used to treat snakebites by the six species of venomous snakes native to Taiwan. Research into antivenom use in Taiwan and its outcomes, as well as the utility of current Taiwan Poison Control Center guidelines for antivenom use, has been limited. We aimed to provide increased understanding by investigating the treatment and outcomes of patients treated for snakebite in Taiwan. METHODS: On the basis of data collected from the 2009 Taiwan National Health Insurance database, patients with snakebites were identified and categorized into two sets of groups according to types of antivenom administered. The relationships between antivenom types, dosage and the variables of antibiotic use, surgical intervention, acute respiratory failure acute, renal failure, antivenom-related allergic reaction, mortality, need for hospital admission, and length of hospitalization were analyzed by multivariate logistic regression and the Kruskal-Wallis test. RESULTS: The majority of patients were successfully treated by administration of 1 vial of antivenom and discharged without complications. However, patients treated for neurotoxic-type venom snakebite required administration of larger doses of antivenom and > 30% required surgical intervention, particularly those treated for Chinese cobra snakebite. Approximately 10% of patients were administered two types of antivenom. CONCLUSION: The results partially support Taiwan Poison Control Center guidelines for treating the hemorrhagic-type venom snakebite. However, deficit in the guidelines for treatment of neurotoxic-type venom snakebite is obvious and new guidelines for treatment of neurotoxic-type venom snakebite and diagnosis should be developed.


Assuntos
Antibacterianos/uso terapêutico , Antivenenos/administração & dosagem , Mordeduras de Serpentes/terapia , Adolescente , Adulto , Idoso , Animais , Antivenenos/classificação , Bases de Dados Factuais , Feminino , Humanos , Tempo de Internação , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Serpentes , Procedimentos Cirúrgicos Operatórios , Taiwan/epidemiologia , Adulto Jovem
4.
J Emerg Med ; 47(4): 401-7, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25060011

RESUMO

BACKGROUND: Acute paraquat poisoning has a high mortality rate. Several prognostic factors have been proposed to predict the mortality risk of paraquat-poisoned patients. However, these prognostic factors are complex and some require a laboratory. Corrected QT (QTc) has been used as a prognostic factor in several clinical conditions, such as acute organophosphate poisoning. In addition, the measurement can be obtained in a reasonable amount of time. STUDY OBJECTIVES: This study's objective was to investigate whether QTc can predict mortality in paraquat-poisoned patients. METHODS: This was a retrospective study. Potential prognostic factors such as QTc, vital signs at admission, and certain biochemistry variables were analyzed with Cox regression analyses for their ability to predict a patient's survival from paraquat poisoning. RESULTS: Sixty acute paraquat-poisoned patients were admitted to the emergency department during the study period. The QTc of the survival group ranged from 0.35 to 0.48 s, whereas the nonsurvivor group ranged from 0.32 to 0.63 s. The nonsurvivor group contained a higher percentage of patients with QTc prolongation (≥0.45 s) compared with the survivor group (p = 0.04). The hazard ratio of QTc prolongation for a patient's death was found to be 2.47 (95% confidence interval [CI] 1.68-5.67) in patients with a lower potassium level (<3.2 mEq/L) and 3.71 (95% CI 1.53-8.97) in patients with a higher potassium level (≥3.2 mEq/L). In addition, hyperdynamic circulation was observed upon admission of these poisoned patients. CONCLUSION: QTc prolongation is a useful prognostic factor for predicting death in acute paraquat-poisoned patients. Cardiovascular collapse may occur in some paraquat-poisoned patients. Physicians can use QTc as an indicator of a patient's severity of poisoning and mortality risk.


Assuntos
Herbicidas/intoxicação , Síndrome do QT Longo/fisiopatologia , Paraquat/intoxicação , Adulto , Idoso , Biomarcadores/sangue , Eletrocardiografia , Feminino , Humanos , Síndrome do QT Longo/induzido quimicamente , Masculino , Pessoa de Meia-Idade , Intoxicação/mortalidade , Intoxicação/fisiopatologia , Valor Preditivo dos Testes , Prognóstico , Análise de Regressão , Estudos Retrospectivos , Análise de Sobrevida , Sinais Vitais , Adulto Jovem
5.
Forensic Toxicol ; 2024 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-39031238

RESUMO

BACKGROUND/PURPOSE: Mephedrone, a ring-substituted synthetic cathinone derivative, gained popularity as a recreational drug in the late 2000s. Reports of fatalities related to mephedrone use have emerged with varying concentrations of blood mephedrone upon forensic investigations. This study aims to evaluate the existing literature on mephedrone concentrations in instances of clinical intoxication and fatal cases. METHODS: We comprehensively searched electronic databases, including Web of Science, PubMed, Embase, and the Cochrane Library, from inception to July 26, 2023. We selected case reports or case series of mephedrone intoxication presented with individual blood mephedrone concentration. Patient demographics, clinical characteristics, blood mephedrone concentrations, and outcomes were extracted for analysis. RESULTS: 77 cases from 14 case reports and 6 case series were identified for review. There were 34 deaths and 43 non-fatal intoxication cases. The median patient's age was 24 years (IQR: 10), and 91.4% were male. Forty-five of the 63 cases (71.4%) were reported with alcohol or other illicit drugs detected. The median blood mephedrone concentration was 0.37 mg/L (IQR: 1.09 mg/L). Death cases were older than non-fatal cases (median = 30 vs. 22 years, p = 0.029). The median blood mephedrone concentration was higher in death cases (1.30 mg/L vs. 0.12 mg/L, p < 0.0001). CONCLUSIONS: Blood mephedrone concentration in dead patients is approximately 11 times higher than in non-fatal cases. This finding could serve as a stepping stone to the diagnosis of concentrations in clinical poisoning cases and deaths, especially in the treatment of poisoning patients. In more extensive prospective studies, further research is necessary to establish a standardized, real-time available methodology and validate the predictive value of mephedrone concentrations in the prognostic value of mephedrone concentrations.

6.
Toxicon ; 247: 107843, 2024 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-38964621

RESUMO

BACKGROUND: Taiwan habu (Protobothrops mucrosquamatus), green bamboo viper (Viridovipera stejnegeri), and Taiwan cobra (Naja atra) are the most venomous snakebites in Taiwan. Patients commonly present with limb swelling but misdiagnosis rates are high, and currently available diagnostic tools are limited. This study explores the immune responses in snakebite patients to aid in differential diagnosis. METHODS: This prospective observational study investigated the changes in cytokines in snakebite patients and their potential for diagnosis. RESULTS: Elevated pro-inflammatory cytokines IL-6 and TNF-α were observed in all snakebite patients compared to the healthy control group. While no significant disparities were observed in humoral immune response cytokines, there were significant differences in IFN-γ levels, with significantly higher IL-10 levels in patients bitten by cobras. Patients with TNF-α levels exceeding 3.02 pg/mL were more likely to have been bitten by a cobra. CONCLUSION: This study sheds light on the immune responses triggered by various venomous snakebites, emphasizing the potential of cytokine patterns for snakebite-type differentiation. Larger studies are needed to validate these findings for clinical use, ultimately improving snakebite diagnosis and treatment.


Assuntos
Citocinas , Mordeduras de Serpentes , Humanos , Taiwan , Animais , Citocinas/sangue , Estudos Prospectivos , Adulto , Masculino , Pessoa de Meia-Idade , Feminino , Fator de Necrose Tumoral alfa , Viperidae , Interleucina-6/sangue , Idoso
7.
Int J Biol Macromol ; 262(Pt 2): 130080, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38354918

RESUMO

Animal testing has been the primary approach to assess the neutralization potency of antivenom for decades. However, the necessity to sacrifice large numbers of experimental animals during this process has recently raised substantial welfare concerns. Furthermore, the laborious and expensive nature of animal testing highlights the critical need to develop alternative in vitro assays. Here, we developed an antibody-detection enzyme-linked immunosorbent assay (ELISA) technique as an alternative approach to evaluate the neutralization potency of hyperimmunized equine plasma against B. multicinctus, a medically important venomous snake in Taiwan. Firstly, five major protein components of B. multicinctus venom, specifically, α-BTX, ß-BTX, γ-BTX, MTX, and NTL, were isolated. To rank their relative medical significance, a toxicity score system was utilized. Among the proteins tested, ß-BTX presenting the highest score was regarded as the major toxic component. Subsequently, antibody-detection ELISA was established based on the five major proteins and used to evaluate 55 hyperimmunized equine plasma samples with known neutralization potency. ELISA based on ß-BTX, the most lethal protein according to the toxicity score, exhibited the best sensitivity (75.6 %) and specificity (100 %) in discriminating between high-potency and low-potency plasma, supporting the hypothesis that highly toxic proteins offer better discriminatory power for potency evaluation. Additionally, a phospholipase A2 (PLA2) competition process was implemented to eliminate the antibodies targeting toxicologically irrelevant domains. This optimization greatly enhanced the performance of our assay, resulting in sensitivity of 97.6 % and specificity of 92.9 %. The newly developed antibody-detection ELISA presents a promising alternative to in vivo assays to determine the neutralization potency of antisera against B. multicinctus during the process of antivenom production.


Assuntos
Bungarotoxinas , Bungarus , Animais , Cavalos , Bungarus/metabolismo , Bungarus multicinctus , Antivenenos , Taiwan , Ensaio de Imunoadsorção Enzimática
8.
Toxins (Basel) ; 15(1)2023 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-36668897

RESUMO

Patients bitten by Protobothrops mucrosquamatus, Viridovipera stejnegeri, and Naja atra develop different degrees of wound infection. This study validated BITE and Cobra BITE scoring systems that we established previously. Bacteriological studies of patients with wound infection were conducted. The operating characteristic curves and area under the curve (AUC) and wound infection rates were compared between the derivation set (our previous study patient population) and the validation set (new patient cohorts enrolled between June 2017 and May 2021). No significant differences in the AUC for both the BITE (0.84 vs. 0.78, p = 0.27) and Cobra BITE (0.88 vs. 0.75, p = 0.21) scoring systems were observed between the derivation and validation sets. Morganella morganii and Enterococcus faecalis were the two most commonly detected bacteria in the microbiological study. More bacterial species were cultured from N. atra-infected wounds. Antibiotics such as amoxicillin with clavulanic acid, oxacillin, and ampicillin may not be suitable for treating patients with P. mucrosquamatus, V. stejnegeri, and N. atra bites in Taiwan. Carbapenem, third-generation cephalosporins, and fluoroquinolone may be superior alternatives.


Assuntos
Mordeduras de Serpentes , Infecção dos Ferimentos , Animais , Humanos , Mordeduras de Serpentes/terapia , Elapidae , Naja naja , Peçonhas , Taiwan/epidemiologia , Bactérias , Infecção dos Ferimentos/tratamento farmacológico , Venenos Elapídicos , Antivenenos
9.
J Forensic Leg Med ; 93: 102469, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36571928

RESUMO

BACKGROUND: New psychoactive substances (NPS) are synthetic alternatives to illicit drug abuse that are not under international control but may pose a public health threat. Moreover, the symptoms and signs of NPS users may be quite variable. This study aimed to figure out the clinical characteristics of NPS users presented to the emergency department (ED). METHODS: A total of 1385 cases were tested via urine toxicity screening from March 25, 2019, to January 28, 2020, in six medical centers, and ten hospitals, in Taiwan. A total of 123 non-NPS cases and 77 NPS-use cases were enrolled in this study. We compared the patient data-vital signs, presentation, co-morbidities, behaviors, symptoms, electrocardiograms, laboratory data, length of stays-and outcomes of NPS users and non-NPS drug users. RESULTS: NPS users were 5.7 years younger than the non-NPS drug users (37 vs. 42.7 years, p = 0.022). Presently, NPS users had a 2.6-fold (27.2%) higher rate of suicide and a 2.9-fold (11.7%) greater possibility of violence than non-NPS drug users. Moreover, in NPS users, eye-opening was affected at a scale of 3.1 versus 3.4 (p = 0.048) in non-NPS drug users in the evaluation of consciousness and they experienced a 4.3-fold greater feeling of palpitation (p = 0.024) and had 8.1-fold higher chance of presenting facial flush (p = 0.032) than non-NPS drug users. CONCLUSION: NPS users are relatively younger, are more likely to experience facial flush and palpitation and engage in more self-harm, violence, and suicide than non-NPS drug users. Physicians need to pay attention to people who have altered, bizarre mental statuses with the clinical characteristics described above.


Assuntos
Usuários de Drogas , Transtornos Relacionados ao Uso de Substâncias , Suicídio , Humanos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Psicotrópicos , Comorbidade
10.
Int J Biol Macromol ; 242(Pt 2): 124969, 2023 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-37210050

RESUMO

Snake envenoming is both a healthcare and socioeconomic problem for developing countries and underserved communities. In Taiwan, clinical management of Naja atra envenomation is a major challenge, since cobra venom-induced symptoms are usually confused with hemorrhagic snakebites and current antivenom treatments do not effectively prevent venom-induced necrosis for which early surgical debridement should be administered. Identification and validation of biomarkers of cobra envenomation is critical for progress in setting a realistic goal for snakebite management in Taiwan. Previously, cytotoxin (CTX) was determined as one of potential biomarker candidates; however, its ability to discriminate cobra envenoming remains to be verified, especially in clinical practice. In this study, we selected a monoclonal single-chain variable fragment (scFv) and a polyclonal antibody to develop a sandwich enzyme-linked immunosorbent assay (ELISA) for CTX detection, which successfully recognized CTX from N. atra venom over that from other snake species. Using this specific assay, the CTX concentration in envenoming mice was shown to remain consistent in about 150 ng/mL during the 2-hour post-injection period. The measured concentration was highly correlated with the size of local necrosis in mouse dorsal skin, which the correlation coefficient is about 0.988. Furthermore, our ELISA method displayed 100 % of specificity and sensitivity in discriminating cobra envenoming among snakebite victims through CTX detection and the level of CTX in victim plasma was ranged from 5.8 to 253.9 ng/mL. Additionally, patients developed tissue necrosis at plasma CTX concentrations higher than 150 ng/mL. Thus, CTX not only serves as a verified biomarker for discrimination of cobra envenoming but also a potential indicator of severity of local necrosis. In this context, detection of CTX may facilitate reliable identification of envenoming species and improve snakebite management in Taiwan.


Assuntos
Elapidae , Mordeduras de Serpentes , Animais , Camundongos , Antivenenos/farmacologia , Mordeduras de Serpentes/diagnóstico , Mordeduras de Serpentes/terapia , Citotoxinas , Venenos de Serpentes , Venenos Elapídicos , Ensaio de Imunoadsorção Enzimática/métodos , Necrose
11.
Artigo em Inglês | MEDLINE | ID: mdl-36721427

RESUMO

Background: Bivalent freeze-dried neurotoxic (FN) antivenom has been the primary treatment since the 1980s for Taiwan cobra (Naja atra) envenomation in Taiwan. However, envenomation-related wound necrosis is a significant problem after cobra snakebites. In the present study, we analyzed the changes in serum venom concentration before and after antivenom administration to discover their clinical implications and the surgical treatment options for wound necrosis. Methods: The patients were divided into limb swelling and wound necrosis groups. The clinical outcome was that swelling started to subside 12 hours after antivenom treatment in the first group. Serum venom concentrations before and after using antivenoms were measured to assess the antivenom's ability to neutralize the circulating cobra venom. The venom levels in wound wet dressing gauzes, blister fluids, and debrided tissues were also investigated to determine their clinical significance. We also observed the evolutional changes of wound necrosis and chose a better wound debridement timing. Results: We prospectively enrolled 15 Taiwan cobra snakebite patients. Males accounted for most of this study population (n = 11, 73%). The wound necrosis group received more antivenom doses than the limb swelling group (4; IQR:2-6 vs 1; IQR:1-2, p = 0.05), and less records of serum venom concentrations changed before/after antivenom use (p = 0.0079). The necrotic wound site may release venom into circulation and cause more severe envenomation symptoms. Antivenom can efficiently diminish limb swelling in cobra bite patients. However, antivenom cannot reduce wound necrosis. Patients with early debridement of wound necrosis had a better limb outcome, while late or without debridement may have long-term hospital stay and distal limb morbidity. Conclusions: Antivenom can efficiently eliminate the circulating cobra venom in limb swelling patients without wound necrosis. Early debridement of the bite site wound and wet dressing management are suggestions for preventing extended tissue necrosis and hospital stay.

12.
Am J Emerg Med ; 30(9): 1782-7, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-22633717

RESUMO

BACKGROUND: The risks of intravenous (IV) lidocaine before rapid sequence induction (RSI) have become a great concern. No study has investigated the hemodynamic effects of IV lidocaine during endotracheal intubation in patients with severe traumatic brain injury. OBJECTIVE: We investigated whether the use of IV lidocaine before RSI was associated with postintubation hemodynamic changes in patients with severe traumatic brain injury. METHODS: In this retrospective cohort study, adults who presented with isolated traumatic brain injury and definite intracranial hemorrhage were included. Patients who presented with other major injuries received prehospital intubation, had initial mean arterial pressure (MAP) less than 70 mm Hg, and/or had incomplete medical records were excluded. RESULTS: A total of 101 patients (82.2% men; mean age, 48.6 ± 19.6 years) were enrolled. Forty-six patients received IV lidocaine in addition to RSI before intubation (group 1), and 55 received RSI without IV lidocaine before intubation (group 2). There were no significant intergroup differences in baseline characteristics, the number of RSI doses, or the RSI dose used, with the exception of sex, diagnosis of subarachnoid hemorrhage, and diagnosis of subdural hemorrhage. Our results demonstrated no significant intergroup differences in MAP changes or the proportion of patients with hypotension (MAP <70 mm Hg) after intubation. Intravenous lidocaine remained unrelated to significant hypotension after adjusting for variables by logistic regression analysis. CONCLUSION: Intravenous lidocaine in addition to RSI before endotracheal intubation was not associated with significant hemodynamic changes in patients with severe traumatic brain injury.


Assuntos
Lesões Encefálicas/tratamento farmacológico , Hemodinâmica/efeitos dos fármacos , Lidocaína/uso terapêutico , Anestesia Geral/métodos , Pressão Sanguínea/efeitos dos fármacos , Lesões Encefálicas/fisiopatologia , Lesões Encefálicas/terapia , Serviço Hospitalar de Emergência , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Intubação Intratraqueal/métodos , Lidocaína/administração & dosagem , Lidocaína/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
13.
BMC Health Serv Res ; 12: 262-9, 2012 Aug 18.
Artigo em Inglês | MEDLINE | ID: mdl-22900613

RESUMO

BACKGROUND: To document the relationship between triage vital signs and in-hospital mortality among emergency department (ED) patients with acute poisoning. METHODS: Poisoning patients who admitted to our emergency department during the study period were enrolled. Patient's demographic data were collected and odds ratios (OR) of triage vital signs to in-hospital mortality were assessed. Receiver operating characteristic curve was used to determine the proper cut-off value of vital signs that predict in-hospital mortality. Logistic regression analysis was performed to test the association of in-hospital mortality and vital signs after adjusting for different variables. RESULTS: 997 acute poisoning patients were enrolled, with 70 fatal cases (6.7%). A J-shaped relationship was found between triage vital signs and in-hospital mortality. ED triage vital signs exceed cut-off values independently predict in-hospital mortality after adjusting for variables were as follow: body temperature <36 or >37°C, p < 0.01, OR = 2.8; systolic blood pressure <100 or >150 mmHg, p < 0.01, OR: 2.5; heart rate <35 or >120 bpm, p < 0.01, OR: 3.1; respiratory rate <16 or >20 per minute, p = 0.38, OR: 1.4. CONCLUSIONS: Triage vital signs could predict in-hospital mortality among ED patients with acute poisoning. A J-curve relationship was found between triage vital signs and in-hospital mortality. ED physicians should take note of the extreme initial vital signs in these patients.


Assuntos
Departamentos Hospitalares , Mortalidade Hospitalar , Estudos de Casos e Controles , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Triagem
14.
Toxics ; 10(3)2022 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-35324737

RESUMO

Today, the concomitant abuse of nitrous oxide (N2O) and illicit drugs is evident and problematic. However, there are few reports regarding the clinical manifestations of N2O users when they present to the emergency department (ED). The purpose of this study was to describe the clinical presentations, the associated illicit substances used in combination, and the outcomes in N2O users visiting the ED. This was a retrospective observational cohort study. All N2O adult users admitted to the ED at Linkou Chang Gung Memorial Hospital between 2012 and 2020 were included. Demographic variables, clinical symptoms, and examination results were collected from medical records. Univariate comparisons were conducted between pure N2O users and combined illicit drug users. A total of 40 patients were included, 24 of which were pure N2O users. Limb weakness and numbness accounted for the majority of chief complaints. Neurologic symptoms were the most common clinical manifestations (90%). A more severe ED triage level, faster heart rate, greater agitation, and cardiovascular symptoms were significantly noted in combined illicit drug users. In ED, limb numbness/weakness should arouse physicians' awareness of patients using N2O. Combined use of N2O and illicit drugs can cause great harm to health.

15.
J Acute Med ; 12(1): 13-22, 2022 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-35619724

RESUMO

Background: Snakebites constitute a common medical emergency in tropical and subtropical regions. Pediatric snake envenomation is a special category that has not been well studied. This study investigated the management and prognostic factors of snake envenomation in children using a Taiwanese national database. Methods: This observational study used the National Health Insurance database of all pediatric snake envenomation patients treated from 2005 to 2009. Patients' demographic data, antivenom types and doses, medical and surgical interventions, and prognostic variables were collected. Comparisons were made according to the envenomation types, age groups, and whether the patients were hospitalized using univariate and multivariate methods. Results: A total of 106 patients' data were collected. Of the patients, 73 (68.9%) were male, 62 (58.5%) were under the age of 12, 69 (65.1%) received intravenous (IV) antibiotic treatment, 38 (35.9%) were hospitalized, 5 (4.72%) required surgical intervention, and none died. Compared with non-hospitalized patients, the patients who required hospitalization were more likely to have suffered hemorrhagic envenomation ( p = 0.035), receive IV antibiotic treatment ( p = 0.0078), and require surgical intervention ( p = 0.005). In the multivariate analysis, hemorrhagic envenomation was an independent predictor for hospitalization (odds ratio: 3.47, 95% confidence interval: 1.18-10.21) after adjusting for other covariates. No significant differences were observed between age groups in total antivenom usage ( p = 0.2880), IV antibiotic usage ( p = 0.3190), hospitalization ( p = 0.3988), and surgical intervention ( p = 0.1874). Conclusions: In this Taiwanese population-based national database study, antivenom treatment of pediatric snakebite patients resulted in zero mortality and a low surgical intervention rate. Patients with hemorrhagic envenomation were associated with a higher probability of hospitalization.

16.
Clin Toxicol (Phila) ; 60(6): 708-715, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35315299

RESUMO

INTRODUCTION: The use of new psychoactive substances (NPSs) has markedly increased worldwide; thus, it is important to monitor NPS-related effects. The Taiwan Emergency Department Drug Abuse Surveillance (TEDAS) project aims to assess the patterns of recreational drug use in patients presenting to emergency departments (EDs) across the country. Here, we report the preliminary results of this project. METHODS: This observational study included the collection and analysis of urine samples and assessment of the clinical presentation of patients from 79 EDs across Taiwan. Clinical features were recorded through a questionnaire filled by attending doctors or nurses who collected urine samples for clinical diagnosis. Urine samples were analyzed for 110 drugs and metabolites using electrospray ionization liquid chromatography-tandem mass spectrometry (LC-MS/MS). RESULTS: Between February and November 2019, a total of 2649 patients were enrolled for urine drug analysis. A total of 675 cases older than 12 years (males, n = 480) had NPS or other illicit drugs detected in their urine samples. Overall, 1271 counts of drugs, among which 717 (56.4%) were NPS. At least one NPS was detected in 340 patients (50.4%), and 292 cases were positive for multiple drugs. The most frequently detected drug was methamphetamine/amphetamine, followed by synthetic cathinones, ketamine and its two analogs, and opioids. The most common drug combination was cathinones plus ketamine and/or its analogs (n = 56). Younger patients (OR = 3.3, p≤.0001) and women (OR = 1.5, p = .01) were more likely to have NPS detected in their urine samples. NPS-positive cases frequently experienced chest pain (OR = 2.6, p = .03), tachycardia (OR = 2.6, p = .0002), and suicide attempt/non-suicidal self-harm (OR = 1.8, p = .004), whereas depressed consciousness (OR = 0.5, p = .001) was less frequent among NPS-positive cases than among other illicit drug-positive cases. CONCLUSIONS: The TEDAS project provides a nationwide epidemiological profile of recreational drug use in Taiwan. More than half of the recreational drugs were NPSs, which were comprehensively detected using LC-MS/MS.


Assuntos
Drogas Ilícitas , Ketamina , Transtornos Relacionados ao Uso de Substâncias , Cromatografia Líquida , Serviço Hospitalar de Emergência , Feminino , Humanos , Drogas Ilícitas/urina , Masculino , Psicotrópicos/urina , Detecção do Abuso de Substâncias/métodos , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Taiwan/epidemiologia , Espectrometria de Massas em Tandem
17.
Clin Toxicol (Phila) ; 60(4): 446-450, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34543159

RESUMO

CONTEXT: Mortality prediction in paraquat poisoning is a major issue since most prediction rules are inapplicable if the exact ingestion time cannot be determined and/or the serum paraquat concentration is not readily available, as in most countries. Therefore, we aimed to develop and validate a new prediction rule not requiring these two parameters. METHODS: We designed a 10-year observational cohort study including all consecutive paraquat-poisoned patients managed in two Taiwanese hospitals. We built one cohort to define and one cohort to validate this prediction rule. Parameters independently related to mortality determined using a multivariate analysis were used to formulate the Acute Paraquat Poisoning Mortality (APPM) score. RESULTS: Overall, 321 paraquat-poisoned patients were included, 156 in the derivation and 165 in the validation cohort. Mortality rates in the derivation and validation cohorts were 73% and 81%, respectively (p = 0.20). The three parameters chosen of 28-day mortality at presentation were urine paraquat level >10 ppm (using a colorimetric sodium dithionite-based test; odds ratio (OR), 12.70; 95% confidence interval (CI), 2.64-61.24), white blood cells >13.0 G/L (OR, 5.50; CI, 1.41-21.48) and blood glucose >140 mg/dL [7.8 mmol/L] (OR, 7.45; CI, 1.70-32.86). In the derivation cohort, the area under the ROC curve (AUC-ROC) of the APPM score did not significantly differ from AUC-ROCs of serum paraquat (0.95, p = 0.25) and the Severity Index of Paraquat Poisoning (0.95, p = 0.33). AUC-ROCs of the APPM score in the derivation and validation cohorts were 0.91 and 0.94, respectively. CONCLUSION: We built and validated a reliable score to predict 28-day mortality in paraquat-poisoned patients at presentation, independently from the ingestion time and serum paraquat measurement.


Assuntos
Intoxicação , Venenos , Área Sob a Curva , Humanos , Paraquat , Intoxicação/diagnóstico , Prognóstico , Estudos Retrospectivos
18.
Toxins (Basel) ; 14(11)2022 11 15.
Artigo em Inglês | MEDLINE | ID: mdl-36422968

RESUMO

Snakebites from Protobothrops mucrosquamatus (Taiwan habus) and Viridovipera stejnegeri (green bamboo vipers) account for the most venomous snakebites in Taiwan. The bivalent freeze-dried hemorrhagic (FH) antivenom is employed to treat these two snakebite patients without a strict clinical trial. We evaluated the clinical usefulness of Taiwan bivalent freeze-dried hemorrhagic (FH) antivenom in Taiwan habu- and green bamboo viper-envenomed patients. We checked ELISA- based serum venom antigen levels before and after FH antivenom to evaluate FH's ability to neutralize patients' serum snake venom and its usefulness in reducing limb swelling after snakebites. Patients who had higher serum venom antigen levels had more severe limb swelling. Of the 33 enrolled patients, most of their snake venom antigen levels were undetected after the appliance of antivenom. Most enrolled patients (25/33) had their limb swelling subside within 12 h after antivenom treatment. The failure to reduce limb swelling was probably due to an inadequate antivenom dose applied in more severely envenomated patients. Our data indicate the feasibility of the FH antivenom in effectively eliminating venom and resolving the affected limb swelling caused by Taiwan habu and green bamboo viper bites.


Assuntos
Antivenenos , Mordeduras de Serpentes , Trimeresurus , Animais , Antivenenos/uso terapêutico , Edema/tratamento farmacológico , Hemorragia/tratamento farmacológico , Mordeduras de Serpentes/tratamento farmacológico , Venenos de Serpentes , Humanos
19.
Clin Toxicol (Phila) ; 60(8): 926-932, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35438590

RESUMO

BACKGROUND: Synthetic cathinones (SC) are popular new psychoactive substances that produce sympathomimetic toxicity. Meth/amphetamine and SC have similar chemical structures and pharmacological effects. We aimed to compare the clinical characteristics between meth/amphetamine and SC users presenting to the emergency department (ED). METHODS: This retrospective observational cohort study included patients who presented to six EDs from May 2017 to April 2021 with symptoms that related to recreational drug use and whose urine toxicology tests were positive only for meth/amphetamine or SC through liquid chromatography-tandem mass spectrometry. RESULTS: There were 379 patients who tested positive only for meth/amphetamine (MA group), and 87 patients tested positive only for SC (SC groups). Patients in the MA group were older than those in the SC group (median (IQR); MA: 37.0 (30-43.7), SC: 25.0 (21.0-32.7), p < 0.001). There were no significant between-group differences in the sex distribution and initial chief complaints. Compared with the MA group, the SC group had more cases of tachycardia (≥ 135/min; MA: 29 (8.2%), SC:16 (19.0%), p = 0.0031) and hyperthermia (≥ 38 °C; MA: 31 (8.2%), SC:18 (20.7%), p = 0.001). Besides, the SC group had significantly higher levels of creatinine kinase (CK, IU/L; MA: 263 (115-601), SC: 497 (206-9216), p = 0.008) as well as a higher risk of rhabdomyolysis (CK > 1000; MA:32 (8.4%), SC: 16 (18.4%), p = 0.006) and severe rhabdomyolysis (CK > 10,000; MA:10 (2.6%), SC:10 (11.5%), p = 001). Multivariable logistic regression analyses indicated SC group in comparison with the MA group (adjusted odds ratio: 2.732, 95% confidence interval: 1. 250-5.972, p = 0.012) was an association with the risk of rhabdomyolysis. CONCLUSION: Our findings demonstrate that tachycardia, hyperthermia, and rhabdomyolysis were more common among cathinone users than among meth/amphetamine users presented to EDs.


Assuntos
Metanfetamina , Rabdomiólise , Alcaloides , Anfetamina , Creatinina , Serviço Hospitalar de Emergência , Humanos , Estudos Retrospectivos , Rabdomiólise/induzido quimicamente , Rabdomiólise/epidemiologia , Simpatomiméticos
20.
Toxics ; 10(7)2022 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-35878292

RESUMO

Predictors of mortality in illicit drug users involving Novel Psychoactive Substances (NPS) and multiple substances have not been elucidated. We aimed to define predictors of mortality in the NPS endemic era's illicit drug users to strengthen patient care in emergency treatment. This was a retrospective study. LC-MS/MS-confirmed positive illicit drug users who visited the emergency departments (ED) of six medical systems were enrolled. Demographic information, physical examinations, and laboratory data were abstracted for mortality analysis. There were 16 fatalities in 355 enrolled patients. The most frequently used illicit drugs were amphetamines, followed by opioids, cathinones, and ketamine. The most frequently detected cathinones among the 16 synthetic cathinones were eutylone, followed by mephedrone. The combined use of cathinones and ketamine was most commonly observed in our results. Univariate analysis revealed that the mortality patients were older, with deep coma, faster heart rate and respiratory rate, lower blood pressures and O2 room air saturation, more seizures, abnormal breath sounds, and had urine incontinence compared to the survivor patients. The mortality patients also had acute kidney injury, higher potassium, blood sugar, liver function test, and lactate level. The results of multiple logistic regression demonstrated that SBP < 90 mmHg, dyspnea, blood sugar > 140 mg/dl, and HCO3 < 20.6 mmHg were independent predictors of in-hospital mortality. Regardless of the pattern of the use of illicit drugs, the predictors allow for risk stratification and determining the optimal treatment.

SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA