2022 Annual Report of the National Poison Data System® (NPDS) from America's Poison Centers®: 40th Annual Report.

INTRODUCTION: This is the 40th Annual Report of America's Poison Centers National Poison Data System (NPDS). As of 1 January, 2022, all 55 of the nation's poison centers (PCs) uploaded case data automatically to NPDS. The upload interval was 4.72 [4.40, 9.27] (median [25%, 75%]) minutes, effectuating a near real-time national exposure and information database and surveillance system. METHODS: We analyzed the case data tabulating specific indices from NPDS. The methodology was similar to that of previous years. Where changes were introduced, the differences are identified. Cases with medical outcomes of death were evaluated by a team of medical and clinical toxicologist reviewers using an ordinal scale of 1-6 to assess the Relative Contribution to Fatality (RCF) of the exposure. RESULTS: In 2022, 2,483,183 closed encounters were logged by NPDS: 2,064,875 human exposures, 50,381 animal exposures, 363,099 information requests, 4,790 human confirmed nonexposures, and 38 animal confirmed nonexposures. Total encounters showed a 12.9% decrease from 2021, and human exposure cases decreased by 0.771%, while health care facility (HCF) human exposure cases increased by 0.214%. All information requests decreased by 48.4%, medication identification (Drug ID) requests decreased by 21.2%, and medical information requests showed a 76.92% decrease, although these remain twice the median number before the COVID-19 pandemic. Drug Information requests showed a 52.4% decrease, due to declining COVID-19 vaccine calls to PCs but still comprised 5.55% of all information contacts. Human exposures with less serious outcomes have decreased 1.70% per year since 2008, while those with more serious outcomes (moderate, major or death) have increased 4.41% per year since 2000.Consistent with the previous year, the top 4 substance classes most frequently involved in all human exposures were analgesics (11.5%), household cleaning substances (7.23%), antidepressants (5.61%), and cosmetics/personal care products (5.23%). Antihistamines (4.81%) replaced sedatives/hypnotics/antipsychotics as the 5th substance class. As a class, analgesic exposures increased most rapidly, by 1,514 cases/year (3.26%/year) over the past 10 years for cases with more serious outcomes.The top 5 most common exposures in children age 5 years or less were household cleaning substances (10.3%), analgesics (9.54%), cosmetics/personal care products (9.49%), dietary supplements/herbals/homeopathic (6.65%), and foreign bodies/toys/miscellaneous (6.61%). NPDS documented 3,255 human exposures resulting in death; 2,622 (80.6%) of these were judged as related (RCF of 1-Undoubtedly responsible, 2-Probably responsible, or 3-Contributory). CONCLUSIONS: These data support the continued value of PC expertise and the need for specialized medical toxicology information to manage the increasing number of more serious exposures. Unintentional and intentional exposures continue to be a significant cause of morbidity and mortality in the US. The near real-time status of NPDS represents a national public health resource to collect and monitor US exposure cases and information requests. The continuing mission of NPDS is to provide a nationwide infrastructure for surveillance for all types of exposures (e.g., foreign body, infectious, venomous, chemical agent, or commercial product), and the identification and tracking of significant public health events. NPDS is a model system for the near real-time surveillance of national and global public health.

2021 Annual Report of the National Poison Data System© (NPDS) from America's Poison Centers: 39th Annual Report.

ABSTRACTINTRODUCTION: This is the 39th Annual Report of America's Poison Centers' National Poison Data System (NPDS). As of 1 January, 2021, all 55 of the nation's poison centers (PCs) uploaded case data automatically to NPDS. The upload interval was 4.87 [4.38, 8.62] (median [25%, 75%]) minutes, effectuating a near real-time national exposure and information database and surveillance system. METHODS: We analyzed the case data tabulating specific indices from NPDS. The methodology was similar to that of previous years. Where changes were introduced, the differences are identified. Cases with medical outcomes of death were evaluated by a team of medical and clinical toxicologist reviewers using an ordinal scale of 1-6 to assess the Relative Contribution to Fatality (RCF) of the exposure. RESULTS: In 2021, 2,851,166 closed encounters were logged by NPDS: 2,080,917 human exposures, 62,189 animal exposures, 703,086 information requests, 4,920 human confirmed nonexposures, and 54 animal confirmed nonexposures. Total encounters showed a 14.0% decrease from 2020, and human exposure cases decreased by 2.22%, while health care facility (HCF) human exposure cases increased by 7.20%. All information requests decreased by 37.0%, medication identification (Drug ID) requests decreased by 20.8%, and medical information requests showed a 61.1% decrease, although these remain about 13-fold higher than before the COVID-19 pandemic. Drug Information requests showed a 146% increase, reflecting COVID-19 vaccine calls to PCs. Human exposures with less serious outcomes have decreased 1.80% per year since 2008, while those with more serious outcomes (moderate, major or death) have increased 4.56% per year since 2000.Consistent with the previous year, the top 5 substance classes most frequently involved in all human exposures were analgesics (11.2%), household cleaning substances (7.49%), cosmetics/personal care products (5.88%), antidepressants (5.61%), and sedatives/hypnotics/antipsychotics (4.73%). As a class, antidepressant exposures increased most rapidly, by 1,663 cases/year (5.30%/year) over the past 10 years for cases with more serious outcomes.The top 5 most common exposures in children age 5 years or less were cosmetics/personal care products (10.8%), household cleaning substances (10.7%), analgesics (8.16%), dietary supplements/herbals/homeopathic (7.00%), and foreign bodies/toys/miscellaneous (6.51%). Drug identification requests comprised 3.64% of all information contacts. NPDS documented 4,497 human exposures resulting in death; 3,809 (84.7%) of these were judged as related (RCF of 1-Undoubtedly responsible, 2-Probably responsible, or 3-Contributory). CONCLUSIONS: These data support the continued value of PC expertise and the need for specialized medical toxicology information to manage more serious exposures. Unintentional and intentional exposures continue to be a significant cause of morbidity and mortality in the US. The near real-time status of NPDS represents a national public health resource to collect and monitor US exposure cases and information contacts. The continuing mission of NPDS is to provide a nationwide infrastructure for surveillance for all types of exposures (e.g., foreign body, infectious, venomous, chemical agent, or commercial product), and the identification and tracking of significant public health events. NPDS is a model system for the near real-time surveillance of national and global public health.

The real Theriac - panacea, poisonous drug or quackery?

ETHNOPHARMACOLOGICAL RELEVANCE: Theriac is considered the most popular cure-all multi-ingredient medicine and has been used for more than two millennia. It has also been used as one of the most important anti-epidemic drugs up to the 19th c., treated as an emergency medicine in case of e.g. bubonic plague. AIM OF THE STUDY: Until now, no reliable information regarding the pharmacological effect of the treacle was available, including its possible toxic or narcotic properties. In order to change the state of knowledge in this matter we have selected the Theriac recipe that had been actually used for producing the treacle in 1630, which was confirmed by the official municipal documents of the time. METHODS: The recipe was written in Latin, with the use of pre-Linnean nomenclature and then apothecary common names, which required translation into the modern scientific language in order to get reliable pharmacological conclusions. The information from historical sources has been compiled with the pharmacological data concerning the most potent compounds, which for the first time made it possible to calculate the amounts of active compounds in the doses taken by then patients. RESULTS: Only two species included in Theriac can be harmful in humans: poppy and sea squill, but in both cases the calculated quantity of morphine and cardiac glycosides, respectively, were below toxic level. There are no indications, both from the historical and pharmacological point of view, for Theriac being toxic or narcotic in patients, when used as prescribed. CONCLUSIONS: As for now, the most probable is that the treacle owed its postulated efficacy in the main indications to the placebo effect. Still, the results should be further confirmed by reconstructing the actual Theriac and subjecting it to modern tests and analyses.

Determination of arsenic in homeopathic drugs by bromide volatilization-inductively coupled plasma-atomic emission spectrometry.

Arsenic in homeopathic drugs was determined by coupling a volatile generation with inductively coupled plasma-atomic emission spectrometry. The method is based on the chemical vaporization of arsenic(III) with bromide ions in sulfuric acid media using a batch procedure and subsequent introduction of the gaseous analyte into the plasma torch. The main and interactive effects of the experimental variables affecting this method were evaluated by a 2-level full factorial design. In optimized conditions by Simplex, the method shows an absolute detection limit (3 s) of 0.28 microg for the injection of 230 microL sample. The precision (% relative standard deviation) of the determination was 4.2% at a level of 50 microg/mL As(III) (n = 5). The interference effect of various ions on the arsenic signal was evaluated.

Animal experiments, vital forces and courtrooms: Mateu Orfila, François Magendie and the study of poisons in nineteenth-century France.

The paper follows the lives of Mateu Orfila and François Magendie in early nineteenth-century Paris, focusing on their common interest in poisons. The first part deals with the striking similarities of their early careers: their medical training, their popular private lectures, and their first publications. The next section explores their experimental work on poisons by analyzing their views on physical and vital forces in living organisms and their ideas about the significance of animal experiments in medicine. The last part describes their contrasting research on the absorption of poisons and the divergences in their approaches, methods, aims, standards of proof, and intended audiences. The analysis highlights the connections between nineteenth-century courtrooms and experimental laboratories, and shows how forensic practice not only prompted animal experimentation but also provided a substantial body of information and new research methods for dealing with major theoretical issues like the absorption of poisons.

Arsenic: a beneficial therapeutic poison - a historical overview.

Arsenicals have been used since ancient Greek and Roman civilizations and in the Far East as part of traditional Chinese medicine. In Western countries, they became a therapeutic mainstay for various ailments and malignancies in the 19th and early 20th centuries. Fowler's potassium bicarbonate-based solution of arsenic trioxide (As2O3)solution was the main treatment of chronic myeloid leukaemia until the 1930s. After a decline in the use of arsenic during the mid-20th century, arsenic trioxide was reintroduced as an anticancer agent after reports emerged from China of the success of an arsenic trioxide-containing herbal mixture for the treatment of acute promyelocytic leukaemia. Arsenic trioxide was first purified and used in controlled studies in China in the 1970s.Subsequently, randomised clinical trials performed in the United States led to FDA approval of arsenic trioxide in the treatment of patients with relapsed or refractory acute promyelocytic leukaemia.

Estudo comparativo da patogenesia de quatro medicamentos homeopáticos de origem ofídica: relação da composição das toxinas e espécie de serpente / Comparative study of the pathogenetic symptoms of four homeopathic medicines derived from snakes: relationship between venom composition and snake species

Um dos fundamentos tradicionais da homeopatia é a experimentação no indivíduo sadio. Isto é, antes de ser utilizados na clínica através da lei dos semelhantes, as substâncias ou drogas são testadas em sujeitos sadios a fim de se identificar com precisão os sinais e sintomas que provocam. Os medicamentos homeopáticos produzidos a partir de toxinas ofídicas apresentam relevante utilização terapêutica, sobretudo Lachesis muta. O objetivo do presente estudo foi comparar a sintomatologia de quatro medicamentos homeopáticos de origem ofídica, Elaps corallinus, Bothrops lanceolatus, Crotalus horridus e Lach, obtida através de experimentação patogenética, visando relacionar as ações comuns e discutir as diferenças bioquímicas que justificam as especificidades de cada um. A relação entre as descrições patogenéticas dos medicamentos Lach, Elaps, Crot-h e Both-l apresentam muitas características comuns com os acidentes ofídicos provocados por Lachesis muta, Micrurus corallinus, Crotalus horridus e Bothrops jararaca, respectivamente, fato que justifica a utilização de informações toxicológicas como contribuição para a matéria médica homeopática. Conclui-se que os medicamentos estudados apresentam características patogenéticas comuns com eventos hemorrágicos, inflamatórios e neurotóxicos, porém, separadamente, guardam detalhes individuais e clinicamente específicos, sendo impossível a descrição de uma patogenesia única para os medicamentos elaborados a partir das diferentes espécies de serpentes. A composição de cada toxina justifica a maioria das ações patogenéticas dos respectivos medicamentos, bem como suas semelhanças com os relatos dos acidentes ofídicos.

One of the traditional foundations of homeopathy is the proving of medicines in healthy individuals. This to say, before used in clinical practice by means of the law of similarity, substances or drugs are tested in healthy volunteers to establish the signs and symptoms they cause with full precision. Homeopathic medicines prepared from snake venoms are used quite often in clinical practice, Lachesis muta in particular. The aim of the present study was to compare the set of pathogenetic symptoms of four homeopathic medicines derived from snakes, i.e., Elaps corallinus, Bothrops lanceolatus, Crotalus horridus, and Lach to correlate common actions, and discuss the biochemical differences that account for each one’s specificities. The pathogenetic descriptions of Lach, Elaps, Crot-h and Both-l exhibit many traits in common with the effects of the venoms of Lachesis muta, Micrurus corallinus, Crotalus horridus and Bothrops jararaca, respectively, which justifies the inclusion of toxicological data in the homeopathic materia medica. We conclude that the investigated homeopathic medicines exhibit pathogenetic traits corresponding to hemorrhagic, inflammatory, and neurotoxic events, however, they also exhibit individual and clinically specific actions that hinder the elaboration of a single pathogenetic picture. The composition of each snake venom accounts for the pathogenetic action of the corresponding homeopathic medicines, as well as their similarity with snake bites.

Estudo comparativo da patogenesia de quatro medicamentos homeopáticos de origem ofídica: relação da composição das toxinas e espécie de serpente / Comparative study of the pathogenetic symptoms of four homeopathic medicines derived from snakes: relationship between venom composition and snake species

Um dos fundamentos tradicionais da homeopatia é a experimentação no indivíduo sadio. Isto é, antes de ser utilizados na clínica através da lei dos semelhantes, as substâncias ou drogas são testadas em sujeitos sadios a fim de se identificar com precisão os sinais e sintomas que provocam. Os medicamentos homeopáticos produzidos a partir de toxinas ofídicas apresentam relevante utilização terapêutica, sobretudo Lachesis muta. O objetivo do presente estudo foi comparar a sintomatologia de quatro medicamentos homeopáticos de origem ofídica, Elaps corallinus, Bothrops lanceolatus, Crotalus horridus e Lach, obtida através de experimentação patogenética, visando relacionar as ações comuns e discutir as diferenças bioquímicas que justificam as especificidades de cada um. A relação entre as descrições patogenéticas dos medicamentos Lach, Elaps, Crot-h e Both-l apresentam muitas características comuns com os acidentes ofídicos provocados por Lachesis muta, Micrurus corallinus, Crotalus horridus e Bothrops jararaca, respectivamente, fato que justifica a utilização de informações toxicológicas como contribuição para a matéria médica homeopática. Conclui-se que os medicamentos estudados apresentam características patogenéticas comuns com eventos hemorrágicos, inflamatórios e neurotóxicos, porém, separadamente, guardam detalhes individuais e clinicamente específicos, sendo impossível a descrição de uma patogenesia única para os medicamentos elaborados a partir das diferentes espécies de serpentes. A composição de cada toxina justifica a maioria das ações patogenéticas dos respectivos medicamentos, bem como suas semelhanças com os relatos dos acidentes ofídicos.

One of the traditional foundations of homeopathy is the proving of medicines in healthy individuals. This to say, before used in clinical practice by means of the law of similarity, substances or drugs are tested in healthy volunteers to establish the signs and symptoms they cause with full precision. Homeopathic medicines prepared from snake venoms are used quite often in clinical practice, Lachesis muta in particular. The aim of the present study was to compare the set of pathogenetic symptoms of four homeopathic medicines derived from snakes, i.e., Elaps corallinus, Bothrops lanceolatus, Crotalus horridus, and Lach to correlate common actions, and discuss the biochemical differences that account for each one’s specificities. The pathogenetic descriptions of Lach, Elaps, Crot-h and Both-l exhibit many traits in common with the effects of the venoms of Lachesis muta, Micrurus corallinus, Crotalus horridus and Bothrops jararaca, respectively, which justifies the inclusion of toxicological data in the homeopathic materia medica. We conclude that the investigated homeopathic medicines exhibit pathogenetic traits corresponding to hemorrhagic, inflammatory, and neurotoxic events, however, they also exhibit individual and clinically specific actions that hinder the elaboration of a single pathogenetic picture. The composition of each snake venom accounts for the pathogenetic action of the corresponding homeopathic medicines, as well as their similarity with snake bites.

Bothrops jararacussu venom-induced neuromuscular blockade inhibited by Casearia gossypiosperma Briquet hydroalcoholic extract

The hydroalcoholic extract of Casearia gossypiosperma Briquet (Flacourtiaceae) was standardized for the first time through quality control procedures including pharmacognostic methods, fingerprint chromatograms, defined amounts of marker substances and physicochemical characteristics. The pharmacological activity of C. gossypiosperma (Cg) hydroalcoholic extract was assayed by a traditional in vitro test, which involved irreversible neuromuscular blockade induced by Bothrops jararacussu (Bjssu) venom (60 ìg/mL) in mouse phrenic nerve-diaphragm preparations. Bjssu venom blocked muscle activity for 26 (± 2.0) minutes (n = 6). Cg extract (0.1 mg/mL) induced changes on the baseline muscle activity without impairing the muscle function and inhibited 87.6% (± 1.8) (n = 6) of the Bjssu venom-induced blockade. Both flavonoids (0.624 g%) and polyphenols (4.63 g%) from the extract were spectrophotometrically quantified. Therefore, the present study confirms the antibothropic activity of Cg extract, supporting the ethnomedical use of Casearia sp. in the treatment of snakebite victims.

[The First School of Vienna and Samuel Hahnemann's pharmaceutical techniques]. / Der Einflub der Ersten Wiener Schule auf das Arzneiverständnis bei Samuel Hahnemann.

The First or Elder Vienna School of Medicine was initiated by Gerard van Swieten, the famous pupil of Herman Boerhaave. The aim of this school was to put medicine on new scientific foundations-promoting unprejudiced clinical observation, botanical and chemical research, and the introduction of simple but powerful remedies. One of the products of this school was Anton Störck (1731-1803), appointed Director of Austrian public health and medical education by Empress Maria Theresia. Following the tradition of the Vienna School, Störck was the first scientist to systematically test the effects of so-called poisonous plants (e.g., hemlock, henbane, meadow saffron). Discovering new therapeutic properties in previously dreaded plants, Störck used himself as a subject in experiments to determine tolerable dose levels. As a result of his investigations, Störck was able to successfully treat his patients using the drugs he discovered. Samuel Hahnemann's later writings, including his "Organon", show that he was considerably influenced by Störck's ideas. In fact, Hahnemann's clinical teacher at Vienna was a follower of Störck, Joseph Quarin. Hahnemann's elaborate system of validating homeopath material can be seen as a development and refinement of the techniques he learned in Vienna.

Compte rendu du 7e. aymoisium du GIRI - seconde partie / Render account of the 7. symposium of GIRI - second part

Nous presentons dans ce numero des Cahiers consagre a la recherche en homeopathie une selection des principaux travaux publies au 7. Symposium du GIRI, qui s'est tenu a Montpellier, les 20 et 21 novembre 1993. Au cours des... (AU)

Venenos animales / Animals poisons

Esta colaboración trata de explicar lo relativo de los conceptos manejados en relación a los venenos animales y su acción terapéutica homeopática a través de la dinamización hahnemanniana. Las diferencias entre su acción tóxica y patogenética; su justificación a través de los parágrafos 19, 20 y 110 del Organón de Hahnemann. El planteo que otros conceptos son posibles en ciencia y la sugerencia de tender a una epistemología homeopática