Viper envenomation in Central and Southeastern Europe: a multicentre study.

INTRODUCTION: Snakebite incidence varies across Europe. However, there is limited research from Central and Southeastern Europe. These regions are notable for the presence of the common European adder (Vipera berus) and the more venomous nose-horned viper (Vipera ammodytes). No standard European antivenom protocol exists. The aim was to assess the epidemiology and treatment of viper bites in this region, focusing on a comparison of bites from Vipera berus and Vipera ammodytes. METHODS: We conducted a prospective multicenter study in Central and Southeastern Europe from 2018 to 2020. This study included poison centres and toxicology-associated hospital wards in Poland, the Czech Republic, Slovakia, Hungary, Slovenia, Croatia, Serbia, and Bulgaria. The following data were collected: age, gender, Vipera species, snakebite site, clinical picture, laboratory results, Audebert's clinical severity grading score, and antivenom therapy. RESULTS: The annual incidence of viper bites in Central and Southeast Europe was estimated at 2.55 bites per million population. Within their respective geographical distribution areas, the incidence of Vipera ammodytes bites (1.61 bites per million population) was higher than Vipera berus bites (1.00 bites per million population). Patients bitten by Vipera ammodytes more frequently reported local pain and developed thrombocytopenia. Antivenom treatment was more commonly administered in Vipera ammodytes bites (72%) compared to Vipera berus bites (39%). The incidence of Vipera ammodytes bites treated with antivenom within its geographical distribution area was three times higher than Vipera berus bites treated with antivenom (1.16 bites per million population versus 0.39 bites per million population). No deaths were reported. CONCLUSIONS: The estimated incidence of viper bites in Central and Southeastern Europe is at least 2.55 per million population. Vipera ammodytes bites are more common and severe, characterized by higher frequencies of pain and thrombocytopenia. Antivenom is needed more often for Vipera ammodytes bites. It is vital that enough European Medicines Agency-approved Vipera ammodytes antivenom is produced and offered affordably.

Clinical pattern of poisoning among patients declared as taking novel recreational drugs.

OBJECTIVES: Intoxication with novel psychoactive drugs poses a significant challenge for medicine due to diagnostic difficulties, complex clinical patterns resulting from the polyethiology of poisoning, and the risk of fatal complications. MATERIAL AND METHODS: The authors of the present work have made a retrospective review of medical records of the patients hospitalized at the Toxicology Unit (TU), diagnosed with poisoning by novel recreational drugs. RESULTS: In 2008-2013, 576 patients diagnosed with that type of poisoning were admitted to the TU. Of those, 192 (33.3%) patients were positive for ethanol in addition to the most popular toxins found in the material collected from the patients, such as tetrahydrocannabinol (50 [8.6%] patients) and amphetamine (35 [6.1%] patients). The most frequent clinical symptoms observed on admission were: anxiety (433 [75.1%] patients), agitation (275 [47.7%] patients), and complaints associated with the circulatory system (225 [39.1%] patients). In the subgroup of 104 (18.0%) psychiatrist-interviewed people, a relationship was found between the suicidal ideation reported during history-taking and the following factors: earlier psychiatric treatment (p = 0.000), financial problems (p = 0.015) and prolonged unemployment (p = 0.022). CONCLUSIONS: The observed clinical pattern may be associated with sympathomimetic syndrome due to poisoning by novel psychoactive substances. Preliminary results of this research show that financial problems and a history of psychiatric treatment may enhance suicidal ideation in patients after acute poisoning by psychoactive substances. Int J Occup Med Environ Health. 2020;33(4):445-55.

Acute intentional poisonings within an urban agglomeration in Poland in 2004-2013.

OBJECTIVES: The aim of the research was to analyze the nature of changes and tendencies observed in the frequency, circumstances and causes of acute intentional poisonings within the agglomeration of Lódz, Poland. The study related to adults. MATERIAL AND METHODS: As the research material, medical records of patients hospitalized due to an acute poisoning in the Department of Toxicology in Lódz were used. Information on the hospitalized patients was gathered in the database created in accordance with the assumed criteria and an approved system of the collection of variables describing the issues of intentional acute poisonings. RESULTS: In the analyzed period, within the group of 18 918 adult patients hospitalized due to an acute poisoning, male patients prevailed, accounting for 57.17% of the whole group. Intentional poisonings constituted 40.19% of all poisonings, with women dominating within that group of patients - accounting for approximately 58.63%. The largest group was formed by young people, 18-35 years old, accounting for 43.22%. The average age of the intentionally poisoned patients showed an upward tendency; this tendency concerned women to a larger extent. Medications played the most powerful role in acute intentional poisonings. Within the whole population, they were responsible for 97.27% of intoxications. The analysis of the dynamics of changes in the percentage of patients referred for further mental treatment revealed that the number of patients continuing hospital treatment in psychiatric wards tended to grow. CONCLUSIONS: Observations indicating that women are more likely to attempt intentional poisoning, and that the number of patients with psychiatric disturbances tended to grow in the analyzed period, demonstrate an urgent need for preventive measures to be taken in the local communities. Int J Occup Med Environ Health. 2020;33(1):77-90.

Pesticide poisonings in 2004-2014 in Lódz, Poland - an analysis of selected clinical and sociodemographic parameters.

BACKGROUND: Acute pesticide poisonings constitute an important toxicological problem in numerous countries. This report refers to patients treated for poisonings at the Toxicology Unit, Lódz, Poland, in the period 2004-2014. MATERIAL AND METHODS: Data to be analyzed were obtained from medical records of hospitalized people. A group of 24 301 patients aged ≥ 15 were selected. In the group of 149 people poisoned with pesticides (0.61% of all poisoning cases), there were 40 women and 109 men. Logistic regression analysis was used to evaluate the impact of age on suicide attempts using pesticides. RESULTS: Suicide attempts significantly more frequently concerned younger people. In this type of behavior, coumarin derivatives were significantly more often used than organophosphorus compounds or pesticides classified as "others." The patients with suicidal pesticide poisonings stayed in the ward significantly longer than those poisoned unintentionally. CONCLUSIONS: In the analyzed population inhabiting an area with a high degree of urbanization, in terms of the place of residence and employment, pesticide poisonings were more common in men than in women. Suicide attempts using pesticides more frequently concerned younger people. Information found in this study may prove useful for education purposes, and also in informing clinicians. Med Pr. 2019;70(6):655-67.

Poisoning deaths in Poland: Types and frequencies reported in Lódz, Kraków, Sosnowiec, Gdansk, Wroclaw and Poznan during 2009-2013.

OBJECTIVES: The aim of this study has been to assess the characteristics of acute poisoning deaths in Poland over a period of time 2009-2013. MATERIAL AND METHODS: The analysis was based on the data obtained from the patient records stored in toxicology departments in 6 cities - Lódz, Kraków, Sosnowiec, Gdansk, Wroclaw and Poznan. Toxicological analyses were routinely performed in blood and/or urine. Major toxic substances were classified to one of the following categories: pharmaceuticals, alcohol group poisonings (ethanol and other alcohols), gases, solvents, drugs of abuse, pesticides, metals, mushrooms, others. Cases were analyzed according to the following criteria: year, age and gender of analyzed patients, toxic substance category and type of poisoning. The recorded fatal poisonings were classified according to the International Classification of Diseases. RESULTS: The record of 261 deaths were retrospectively reviewed. There were 187 males (71.64%) and 74 females (28.36%) and the male to female ratio was 2.52. Alcohol group poisonings were more frequently responsible for deaths in men compared to all poisonings, 91.1% vs. 71.6%, respectively (p < 0.05), and pharmaceutical agents were more frequently responsible for deaths in women, 47.4% vs. 28.4%, (p < 0.05). Methanol was the most common agent in the alcohol group poisonings, accounting for 43.75% (N = 49), followed by ethylene glycol, 39.29% (N = 44), and ethanol, 16.96% (N = 19). CONCLUSIONS: Epidemiological profile data from investigation of poisoning deaths in Poland may be very useful for the development of preventive programs. Int J Occup Med Environ Health 2017;30(6):897-908.

Intentional poisoning among elderly people-residents of a large urban agglomeration in Poland.

Poisoning is considered a significant health problem among elderly people in Poland. This report refers to patients treated for poisonings at the Toxicology Unit, Lodz, Poland, during the period 2008-2012. The data to be analyzed were obtained from medical records of elderly people. A group of 1167 patients aged 60+ was selected. The number of intentional poisonings in the group of patients was 417, which accounted for 35.7% of all poisonings among the elderly people. Patients attempting intentional poisonings included 301 (72.2%) women and 116 (27.8%) men. The most common cause of intentional poisonings were drugs-96.6% (n = 403). Benzodiazepines (46.9%) dominated among the intentional poisoning by drugs. During the analyzed 5 years, 80.3% (n = 335) were suicidal poisonings and 19.7% (n = 82) were demonstrative poisonings. Cardiovascular disease, which was diagnosed among 53.5% of the patients, was the most common physical illness. In conclusion, drugs are the most frequent type of the toxic agent responsible for poisoning cases among the elderly people. In this situation, the role of family doctors is very important: they should prescribe medicines in amounts not greater than absolutely necessary and maybe more often recommend psychiatric care for the elderly patients.

[Acute alcohol poisonings among patients in Toxicology Unit, Nofer Institute of Occupational Medicine in the period of time 2007-2012]. / Zatrucia alkoholami wsród pacjentów Oddzialu Toksykologii Instytutu Medycyny Pracy im. J. Nofera w Lodzi, hospitalizowanych w latach 2007-2012.

UNLABELLED: The purpose of the research was to present the analysis of acute alcohol poisonings (ethanol, methanol, ethylene glycol, isopropanol) in Toxicology Unit (TU), Nofer Institute of Occupational Medicine (NIOM), Lódz, Poland. MATERIALS AND METHODS: To further analysis were chosen all cases, whose were coded according to the International Statistical Classification of Diseases and Related Health Problems 10th Revision. RESULTS: There were 10,936 acute poisonings in the analyzed period of time 2007-2012 years, 3,088 of them referred to alcohol poisonings (28%). The largest group of patients included cases with ethanol intoxication (2,883 subjects), the second and third one-cases with methanol and ethylene glycol poisonings (99 and 98 respectively), 8 cases were poisoned with isopropanol. The largest group of patients includes cases at age less than 30 years. Patients at age above 60 years formed the lowest group among the total number of poisonings. Most of the admitted cases were men (2,417 patients) and cases hospitalized due to ethanol abuseladdiction (93%). Ethylene glycol poisonings constituted the leading cause of deaths (10 subjects). CONCLUSIONS: The study shows, that intoxications with alcohols are a big problem in NIOM and the number of alcohol poisonings markedly increased in the years 2007-2012.

[Epidemiology of acute poisonings during 2002-2011 in Toxicology Unit; Department of Occupational Medicine and Toxicology, Nofer Institute of Occupational Medicine, Lodz, Poland]. / Epidemiologia ostrych zatruc w latach 2002-2011 w Oddziale Toksykologii Instytutu Medycyny Pracy im. Prof. J. Nofera w Lodzi.

INTRODUCTION: Intoxication poses significant challenge for medical staff due to diagnostic difficulties, complex clinical pattern, resulting from polyethiology of poisoning and potential risk of life threatening complications. OBJECTIVES: the epidemiology of acute poisonings, observed in Toxicology Unit (TU) in Lodz during the period 2002-201--is the main objective of the study. Authors present their frequency and associated mortality and discuss the structure of poisonings with regard to type and causative agents. MATERIALS: The data used for analysis were drawn from National Poison Information Center in Lodz. They were divided into two groups. The first one comprised informations about patients treated in TU, whereas the second one included cases treated in other hospitals and only consulted by TU staff. RESULTS: Analysis of obtained data showed that medications overdose was the most frequent cause of hospitalization during 2002-2011. Patients between 15 and 30 years constituted the largest group in comparison with total number of poisonings. Medications, alcohols and gases constituted also the leading cause of deaths due to poisoning during the analysed period. Suicidal poisonings composed the largest group in 2002 and 2003 y respectively, whereas poisonings caused by abuse or abuse in the course of dependence were the most frequent in subsequent years.

Epidemiology of acute poisonings during 2003-2007 in Toxicology Unit, Department of Occupational Medicine and Toxicology, Nofer Institute of Occupational Medicine, Lódz, Poland.

OBJECTIVES: The epidemiology of acute poisonings, observed in Toxicology Unit in Lódz, is the main objective of the study. The authors present frequency of respective kinds of poisoning cases and associated mortality. They discuss also the structure of poisonings with regard to type and causative agents over a period between 2003 and 2007. MATERIALS AND METHODS: The data used for the analysis were obtained from National Poison Information Center in Lódz. They were divided into two groups. The first one comprised information about patients treated at the Toxicology Unit (TU), whereas the other one included cases treated in other hospitals and only consulted by TU staff. RESULTS: Analysis of the data shows that overdosage of medications was the most frequent cause of hospitalization during 2006-2007. It constituted also the leading cause of deaths due to poisoning during 2003-2005. However, it was superseded during the subsequent period of 2006-2007 by intoxication with alcohols which was associated with the highest number of deaths in the latter period. Situation changed dynamically also with regard to the intention of poisoning. Suicidal poisonings constituted the largest group in 2003, whereas poisonings caused by abuse, including dependence-related abuse, were the most frequent in subsequent years. Patients between 15 and 30 years old formed the largest group among the total number of poisonings. CONCLUSIONS: The results of our study on epidemiology of acute poisoning in Lódz between 2003-2007 show that poisoning is a frequent cause of admission to hospital and constitutes a major health problem in Lódz district because of large number of hospital admissions, associated mortality and the high proportion of patients at young age.