Pharmacovigilance and toxicovigilance system in Pomeranian province in 2015.

In Pomeranian Centre of Toxicology (PCT) pharmacovigilance (PhV) system is organized simultaneously with toxicovigilance system (ToxV). The purpose of the study was to explore the effectiveness and usefulness of the adverse reactions monitoring system in which PhV and ToxV are organized according to a common scheme. We evaluated the effectiveness of our PhV and ToxV system and investigated the frequency and the nature of adverse reactions after drugs and other chemical substances administration. All ADRs were designated as "A-type reactions" or "B-type reactions" according to their nature. The study has shown also some limitations of the standard form for ADRs monitoring (known as "yellow card") in case of reporting of adverse drug reactions after drug intoxication.

[Neurotoxic activity of uranium].

Uranium is a heavy metal, which occurs in nature and has wide application in the industry. Its toxic effect on the organism, especially on kidneys, has been widely described in medical literatures. Since it has been proved that this element can cross brain-blood barrier, researchers began to look more intensively at its neurotoxic effect.

[Methemoglobinemia as a result of acute accidental "poppres" poisoning ­ a case report].

Recently we observe an increase in the number of intoxications due to xenobiotics that may induce acute methemoglobinemia. Our study showed a case of acute methemoglobinemia (MetHb 55..2%) in 25 ­ year old man. Clinical symptoms were caused by ingestion of "poppers" which was used by patient as "aphrodisiac". Summary: Conclusions: 1. Oral intake of alkyl nitrites, including isobutyl nitrite, is burdened with the risk of life-threatening methemoglobinemia . 2. In the case of poisonings running with normal pO2, reduced level of oxygen saturation, clinical signs of cyanosis does not react to oxygen therapy, and "chocolate" tinge of blood methemoglobinemia should be suspected. 3. In every case of MetHb the use of antidote, which is methylene blue, should be considered. 4. The severity of cyanosis correlates with the level of methemoglobin.

[Chemical analysis of wastewater as a new way of monitoring drugs and medicines consumption at workplace]. / Analiza chemiczna scieków jako nowy sposób monitorowania stosowania narkotyków i leków w miejscu pracy.

The available information on the quality and frequency of illegal psychoactive substances used or medicines misused by workers, are often out of date at the time of its publication. This is due to the dynamic introduction of new synthetic drugs on the black market, changes in trends in the recreational use of medicines and the lack of readily available and reliable tests for fast identification. Strategy for detection of narcotic and non-medical psychoactive drugs use at workplace should embrace all possible sources of information. Classical sources of information on the use of psychoactive substances at the workplace include: statistical data (general information on trends and magnitude of drug and medicine addiction collected by the Polish National Police, the National Bureau for Drug Prevention and emergency medical services), surveys, psychomotor tests and qualitative and quantitative analyses of biological material. Of the new and promising methods, used throughout the world in recent years, chemical-toxicological analysis of surface water and wastewater deserve special mention. An increasing interest in the study of urban waste water can significantly complement the source of knowledge about drug and medicine addiction using obtainable conventional methods. In recent years, a municipal wastewater analysis has become a new and very promising way of collecting updated information on the use of psychoactive substances and medicines. It seems that this kind of study may play an important role in the ongoing monitoring of drug and/or medicines use by selected groups of population (e.g., students, military, firemen, policemen, etc.).

[Toxicological consultation data management system based on experience of Pomeranian Center of Toxicology]. / System zarzadzania informacja toksykologiczna na podstawie doswiadczen Pomorskiego Centrum Toksykologii.

BACKGROUND: In this paper the structure of poisonings is described, based on the material collected from tele-toxicology consults by the Pomeranian Center of Toxicology in Gdansk and harvested from its Electronic Poison Information Management System. In addition, we analyzed conclusions drawn from a 27-month operation of the system. MATERIAL AND METHODS: Data were harvested from the Electronic Poison Information Management System developed in 2012 and used by the Pomeranian Center of Toxicology since then. The research was based on 2550 tele-toxicology consults between January 1 and December 31, 2014. Subsequently the data were electronically cleaned and presented using R programming language. RESULTS: The Pomeranian voivodeship was the prevalent localisation of calls (N = 1879; 73.7%). Most of the calls came from emergency rooms (N = 1495; 58.63%). In the case of 1396 (54.7%) patients the time-lag between intoxication and the consult was less than 6 h. There were no differences in the age distribution between genders. Mean age was 26.3 years. Young people predominated among intoxicated individuals. The majority of intoxications were incidental (N = 888; 34.8%) or suicidal (N = 814; 31.9%) and the most of them took place in the patient's home. CONCLUSIONS: Information about Poison Control Center consultations access should be better spread among medical service providers. The extent of poison information collected by Polish Poison Control Centers should be limited and unified. This should contribute to the increased percentage of properly documented consultations. Additional duties stemming from the need of digital archiving of consults provided, require the involvement of additional staff, leading to the increased operation costs incurred by Poison Control Centers.

[Physician attitudes toward the reporting of adverse drug reactions on the Pomeranian region]. / Postawy pomorskich lekarzy wobec obowiazku raportowania niepozadanych dzialan produktów leczniczych.

INTRODUCTION: The purpose of the study was to explore the attitudes and knowledge about Pharmacovigilance (PhV) and determine the frequency of ADRs reporting by physicians. MATERIALS AND METHODS: This was a questionnaire based survey filled in by 62 physicians. RESULTS: The study has shown the lack of awareness of doctors about important role of adverse drug reporting in drug safety. Moreover, the majority of physicians who are aware how important is the PhV admitted, that they have never reported such reactions in the past. According to physicians, the main factors that discouraged them from reporting such reactions were unclear "yellow card", and a lack of confidence, whether the reaction was indeed caused by a drug. CONCLUSIONS: In order to improve the safety of the drugs there is a need to show important role of adverse reactions reporting for public safety and make clear and easy procedures to report ADRs.

[Dichloroacetate--a healing toxin or a toxic drug?]. / Dichlorooctan--leczaca toksyna czy toksyczny lek?

Dichloroacetate (DCA) is a compound which activity is observed by experimental and clinical toxicologists. DCA is a by-product of chlorination of water, it is toxic to many organs, such as liver, kidneys or nervous system. In a view of its metabolism it is also demonstrated that this substance may be treated as a drug in various medical conditions, such as different types of tumors for example.

[Drug interaction in 63-year-old male sportsman--a case report]. / Interakcje Ieków u 63-letniego sportowca--opis przypadku.

UNLABELLED: We present a case of 63-year-old male with hypertension and hyperlipidaemia, who was an athlete in the "masters category". Because of interaction between amlodipine and simvastatin, in combination with physical activity, the patient reported: muscle pain, weakness of the muscles, dizziness, and confusion. After amlodipine and simvastatin discontinuation, all symptoms resolved rapidly. CONCLUSIONS: (1) Concomitant use of several drugs by elderly individual patients, the risk of drug--physical activity interactions may occur.

[European Union funds and clinical toxicology]. / Fundusze Unijne i toksykologia kliniczna.

Since 2014 we are heading the third programming period of help from European Union (EU). The new budget will run until 2020. From common resources of EU, 106 billion euro will reach Poland, of which about 82.3 billion to cohesion policy, levelling differences of regional development. Clinical toxicology centres will be able to apply for funding under the allocation for the health service. Polish health service very actively benefited from EU funds in previous programming periods, between 2004-2006, and 2007-2013. Thanks to grants from the EU, a large number of health centres were built or renovated. Unfortunately the needs of hospitals, which were underinvested for many years, exceeded available funds according to UE programmes. Except investment projects, also projects training of health professionals were executed. In the current programming period European Union will still support projects aimed at health service. Clinical toxicology centres should have a try of using this period to fulfil their plans.

[Intoxication of female patient with generalised cancer in hospital--a case report]. / Zatrucie pacjentki z uogólniona choroba nowotworowa w szpitalu--opis przypadku.

Medical errors are crucial factors influencing hospital mortality. We present a case of 79-year-old female, who was admitted to the hospital due to complications associated with advanced cancer disease. After several days of hospitalization, the woman died as a result of cancer as well as severe drugs intoxication. The investigation showed extremely high concentrations of chlorprothixen and tramadol in the. blood of the patient. This paper describes a number of medical errors made by hospital staff, of which the most significant was an inappropriate drugs policy.

[Analysis of intoxication with novel psychoactive substance (NPS) in Pomeranian region, from January to July 2015]. / Analiza zatruc nowymi substancjami psychoaktywnymi (NPS) w województwie pomorskim, w okresie od stycznia do lipca 2015 r.

INTRODUCTION: During initial months of the year 2015 we observed the increase number of patients intoxicated with NPS in Poland. In our work we analysed the scale of this phenomenon in Pomeranian region. MATERIALS AND METHODS: Study was carried out on period from 1 January 2015 to 31 July 2015. Analysis was based on records derived from Electronic Poison Information Database developed and used on a daily basis on Pomeranian Centre of Toxicology (PCT), data obtained from Centre for Monitoring of Adverse Effects of Medicaments and Chemical Substances based in PCT and on information gathered from patients treated in Pomeranian Centre of Toxicology for NPS intoxication. RESULTS: Our study has shown slow, continuous rise in the number of intoxications with NPS in analysed period. The most frequent cause of intoxication were synthetic compounds. 99 cases needed treatment in Clinical Toxicology Unit due to their severe state. The youngest exposed person was 13 y.o., while the oldest was 53 y.o. Mean age was 22.5 y.o. with median 20 years. Majority of intoxications were among males (80.54%). 61.53% of all patients came from Tricity agglomeration. Ethanol was the prevalent coingestant. The most commonly used substance was generic NPS (70.59% of cases), followed by unknowns psychoactive substance (16.29% of cases), herbal mixture (16.29% of cases) and dextrometorphan (5.88% of cases). The study did not find one drug name that would be prevalent over others, with the most frequent commercial name being "Mocarz", found in 4 cases. Most dangerous substances found in NPS were PMA, PMMA, 25C-NBOMe and 251-NBOMe. There were no deaths of patients treated in PCT because of acute intoxication with NPS.

[Neurological disturbances in patient who ingested high doses of simvastatin]. / Zaburzenia neurologiczne u pacjenta przyjmujacego wysokie dawki simwastatyny.

We presented a case of 54-year old man, with dyslipidemia who, during his work, was exposed to prolonged electromagnetic radiation. Because of his concerns about the development of atherosclerosis, higher doses of simvastatin than recommended by the doctor, were used by him. After five weeks of such therapy the central nervous system symptoms such as: memory loss, cognitive disorders, sleeplessness, nervousness were presented. It is probable that the mentioned above symptoms were caused by high doses of drug took by the patient, and increased in blood-brain barrier permeability caused by electromagnetic radiation which lasted for about eight years.

[Age and gender trends of inpatient recreational acute dextromethorphan intoxication hospitalized in Pomeranian Center of Toxicology between 2009-2011]. / Struktura wieku i plci pacjentów hospitalizowanych w Pomorskim Centrum Toksykologii, w latach 2009 - 2011, z powodu rekreacyjnych zatruc dekstrometorfanem.

Dextromethorphan (DXM) is a derivative of codeine with an antitussive properties. Acute poisonings with this drug are related to serious, often life-threatening clinical symptoms. In the last decade the number of DXM poisonings increased and the problem was particularly noticeable among adolescents. The aim of this study was to analyze selected demographic and clinical parameters of patients who were hospitalized due to DXM poisoning in Pomeranian Centre of Toxicology between 2009-2011. The study included 170 individuals which was 2.7% of all admissions in this period. In 2009 and 2010, the proportion of patients poisoned with DXM did not exceed 1.5%, while in the years 2011- 2013 it tripled and reached up to 3.5%. The age of patients ranged from 12 to 42 (mean 18) years. Women were more frequently hospitalized. The dose of ingested DXM ranged from 150 to 2700 (mean 588.7) mg. The analysis revealed that the dose of ingested DXM was increasing with the age of patients.

[Quality of life among people addicted to psychoactive substances participating in the opiate substitution treatment]. / Jakosc zycia osób uzaleznionych od substancji psychoaktywnych uczestniczacych w programie opioidowego leczenia substytucyjnego.

INTRODUCTION: Opiate addiction remains a major threat to public health worldwide. It also had a number of negative consequences for the psychosocial and economic functioning of abusers. One of the most common addiction treatment method is maintenance methadone therapy. An important part of evaluating the effectiveness of the participation of a person addicted to methadone treatment is to assess the quality of life determined by participation in substitution therapy. AIM OF THE STUDY: Quality of life of persons addicted to psychoactive substances determined by socio-demographic situation. MATERIAL AND METHODS: The study involved 234 outpatient addicts included in the methadone maintenance treatment programs in Szczecin, Warsaw and Lublin. It was based on a diagnostic survey performed using an original questionnaire and the SF-36 v2. RESULTS: In a research of subjective qual- ity of life, respondents obtained results at the level sufficient, higher values were obtained in the domains of physical than mental health. Respondents from Szczecin and Warszawa scored higher, statistically significant, the assessment than patients from Lublin. CONCLUSIONS: 1. Variation of respondents quality of life was conditioned by the place of performance of therapy. 2. Respondents had the greatest disparity in the subjective evaluation of physical and mental health. 3. Age was an important factor affecting the marks obtained by the respondents in the SF-36 v2.

[Intoxication by powdered seeds of horse chestnut (Aesculus hippocastanum) used nasally as snuff - a case report]. / Zatrucie sproszkowanymi nasionami kasztanowca zwyczajnego (Aesculus hippocastanum) stosowanymi donosowo w formie tabaki-opis przypadku.

There are only few reports in the medical literature about side effects and toxicity of horse chestnut (Aesculus hippocastanum). We report a 15-year-old woman who was admitted to the hospital because of symptoms including: vomiting, dyspnea, burning in the nose and throat, and syncope, after intranasal snuff of powdered horse chestnut seeds. Laboratory tests showed no abnormalities. After 2 days of hospitalization the female was discharged home with subjective and objective improvement. Preparation and use of snuff is related to the tradition of the kashubian region. The powder formed from horse chestnuts, which is white in color, effects after about 5-10 minutes, and causes severe irritation of the nasal mucous membranes, which results in sneezing. Responsible for side effects is mainly aescin. The most frequently observed aescin intoxication symptoms were gastrointestinal irritation and allergic reactions. Intoxication by powdered seeds of horse chestnut used nasally as snuff may lead, as it was in our case, to sudden and self-limiting clinical symptoms. Supportive therapy and a short hospital observation seems to be sufficient in such cases.

[Selected data of acute poisonings with ethylene glycol and methanol in Poland in the year 2010]. / Wybrane zagadnienia dotyczace ostrych zatruc glikolem etylenowym i metanolem w Polsce w roku 2010.

UNLABELLED: There are no reliable studies in Poland evaluating the scale of acute intoxications with different type of xenobiotics. The aim of the study was to evaluate selected problems referring to the patients intoxicated with ethylene glycol and methanol, who were given the medical treatment in all Toxicological (TUs) and Intensive Care Units (ICUs), having contract with Polish National Fund of Health, in the year 2010. All cases of acute intoxications treated in polish hospitals in 2010 and reported to the Polish National Fund of Health were included to the analysis. To further analysis were chosen only those patients, whose main diagnosis or co-morbidities were coded as T 51.1 or T 52.3, according to the International Statistical Classification of Diseases and Related Health Problems 10th Revision and, according to the state of health, patients were treated in TUs and ICUs. All the cases, in which intoxication was not the main health problem were excluded. RESULTS: There were 85 230 acute poisonings in Poland in 2010, 503 of them referred to ethylene glycol and methanol poisonings. 220 patients were treated in TUs and ICUs. The most common methods of therapy in those units were extracorporeal toxin removal (53.22% in TUs and 52.08% in ICUs) and conservative treatment (46.78% in TUs and 47.92% in ICUs). The mortality rate in ethylene glycol and methanol poisonings in TUs and ICUs were 20.97% and 48.96% respectively. In the conservatively treated group the mortality rates in TUs and ICUs were 15.52% and 54.35% respectively, while in extracorporeal toxin removal group the mortality rates in TUs and ICUs were 25.76% and 44.00% respectively. The authors also observed one region (Maków Mazowiecki), in which the amount of ethylene glycol and methanol poisonings was much higher than in the rest part of the country. CONCLUSIONS: 1. All the cases of acute intoxications of glycol and methanol should be consulted with Polish Poison Control Centers. 2. It is necessary to establish diagnostic and treatment protocols for intoxicated patients in Poland. 3. There is a strong need for popularization of the modern methods of glycol and methanol poisonings therapy and increasing the availability of modern antidotes. 4. It is necessary to continue monitoring and evaluation of different ways of treatment glycol and methanol intoxications. 5. The cases of abnormally high rate of glycol and methanol intoxications in some hospitals should be investigated.

[How pupils of a secondary school cope with difficult situations?]. / Jak gimnazjalisci radza sobie w sytuacjach trudnych?

UNLABELLED: In the year 2013 a study of the assessment of dispositional and situational coping in difficult situations, among pupils of a secondary school, was done. 176 respondents of a secondary school, form the first and third class, were involved into a study. The analysis was based on the anonymous scale "How do you cope?". CONCLUSIONS: Girls more often than boys cope with stress by focusing on emotions. With increasing the age from 13 to 16 years-old the strategy of active coping and seeking social support were dominant. Among students aged 17 there were significantly reduced rank of concentration on emotions. Pupils who achieved a higher grade point more often used an active coping with the stress. For the assessment of situational coping the result indicates that the severity of the strategy of concentration on emotions is higher among girls than boys.

[Recent life events preceding suicide attempt by drug overdose]. / Aktualne wydarzenia zyciowe poprzedzajace próbe samobójcza z uzyciem leków.

Recent stressful life events (ASLE) are considered to be one of the factors precipitating suicidal behavior. They precede a suicide attempt in most cases and according to research occur more often during the month or week before the suicide attempt. Interpersonal events are most common. The article presents an analysis of ASLE timing and incidence of events from specific categories during the month preceding suicide attempt by drug overdose. 124 patients admitted to the hospital because of suicidal intoxication were included in the study. Data regarding ASLE were collected with the use of a structured interview. Majority of patients attempting suicide by drug overdose experience a stressful event during the month prior to the suicide attempt. Nearly 4 out of 10 study subjects experience a stressful event on the day of the attempt or on the preceding day. Most common events that occur during the month prior to the attempt and immediately before the attempt are interpersonal events and most of them are related to relationships with spouses or partners.

[The analysis of early stressful life events and parental relationships among patients after suicide attempts]. / Analiza wczesnych stresujacych wydarzen zyciowych i relacji rodzicielskich u pacjentów po próbach samobójczych.

A lot of data in literature shows the importance of early stressful life events for the later existence and possible difficulties including suicide behaviours in adult life. The aim of the study was to identify the intensity of traumatic events in childhood and adolescence and distinguish the most significant categories of those events. Remarkable is the fact that the patients who experienced in the childhood situations of emotional abuse focused on the negative attitude of the environment (79%) and physical violence (78%) represented the largest proportion of subjects. Specific difficulties during childhood and adolescence among patients after suicide attempts were proven. Patients after suicide attempts in a large extent early experienced situations connected with emotional distance, negative feedback from the environment, manifestations of rejection and humiliation and misunderstanding. Males more than females declared experiencing situations classified as physical violence, low economic status of the family, interpersonal loss and general trauma. Comparatively often both groups pointed at perilous parents' acts. Females more often pointed at events concerning sexual domain. Very strong emotions assisted stressful life events, particularly significant among females and characterized by anxiety and helplessness. Patients after suicide attempts most often described their fathers as over controlling, demanding and intrusive with the deficiency of care and protectiveness. This pattern was equally distinct in the group of females and males.

[Pregnant women and strategies of coping with stress and attachment styles]. / Kobiety w ciazy, a strategie radzenia sobie ze stresem i style przywiazaniowe.

UNLABELLED: In the year 2013 a study of the assessment strategies of coping with stress and attachment styles among pregnant women which were married or in relationship were done. There were 57 females participated in the study, including 30 pregnant women. Mini-COPE Coping Inventory) was used for the diagnosis of strategies to cope with stress, and QAS (Questionnaire of Attachment Styles) was used to assessment attachment styles. CONCLUSIONS: Pregnant women which are married or in relationship more often use adaptability of coping strategies under stress. Pregnant women which are married or in relationship reveal more often secure attachment. Female, which show safe attachment use in stressful situation strategies such as active coping, planning, sense of humor, seeking the emotional and instrumental support.