A 9-year retrospective study of poisoning-related deaths in Southwest China (Sichuan).

Poisoning is an increasing and significant burden that causes morbidity and mortality worldwide. In this retrospective study, poisoning-related cases that occurred in 19 cities and prefectures in Sichuan, Southwest China, between 2010 and 2018 were collected from the West China Forensic Medical Center of Sichuan and Public Security Bureaus. A total of 782 poisoning-related deaths were recorded, and their demographic characteristics, season of death, type of poison, and manner and cause of death were analysed. Of these cases, the victims were predominantly male (65.3%), and the 21∼50-year-old age group included the most victims (63.2%). The rural incidence was 71%. The most common poisoning agent was pesticide (40%), followed by toxic gases (32%), and there were cases of poisoning by poisonous animals and plants that are not common in other regions of China. The predominant manner of poisoning death was accident (50%), followed by suicide (38.3%) and homicide (5.0%). In this study, relevant information on poisoning-related cases was collected and compared with the poisoning data from other areas of China and foreign countries to provide guidance for the formulation of public health policies in Sichuan, Southwest China.

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.

Accidental phosphine gas poisoning with fatal myocardial dysfunction in two families.

Aluminum phosphide is commonly used as a rodenticide and insecticide and is one of the most fatal poisons. The active ingredient is Phosphine gas which inhibits cytochrome oxidase and cellular oxygen utilization. The clinical symptoms are due to multiorgan involvement including cardiac toxicity which is the most common cause of mortality. Severity of clinical manifestations depends upon the amount of the gas to which a person is exposed. There is no specific antidote available. High index of suspicion and early aggressive treatment is the key to success. We report 2 cases of aluminum phosphide toxicity in 2 families due to incidental exposure after fumigation.

Drugs and other chemicals involved in fatal poisoning in England and Wales during 2000 ­ 2011.

CONTEXT: Fatal poisoning data can reveal trends in the poisons encountered, which can help guide prescribing practices and product safety and other legislation, and more recently has helped to monitor the use of emerging drugs of abuse ( ' legal highs ' ). METHODS: We searched Mortality Statistics ­ Injury and poisoning, Series DH4 (2000 ­ 2005), Mortality Statistics ­ Deaths registered in England and Wales, Series DR (2006 ­ 2011), and the Office for National Statistics drug poisoning database for information on fatal poisoning during 2000 ­ 2011. We also searched the Pubmed database for ' fatal ' and ' poisoning ' and ' England ' and ' Wales ' : this search yielded seven papers that gave relevant information on deaths reported during 2000 ­ 2011 that were not superseded by later publications. DEATHS FROM POISONING: The annual number of deaths from poisoning fell from 2000 (3092) to 2010 (2749), before increasing to 3341 in 2011. This increase was due in part to a change in the ICD coding relating to alcohol poisoning, suggesting that such deaths had been under-recorded previously. Although fatalities from dextropropoxyphene declined (287 in 2004 and 18 in 2011) following the withdrawal of co-proxamol (paracetamol [acetaminophen] and dextropropoxyphene [propoxyphene] mixture) during 2005 ­ 2007, deaths involving codeine and most notably tramadol (836 deaths during 2000 ­ 2011) increased. Deaths from paracetamol poisoning either alone, or with alcohol reached 89 in 2011, the lowest annual figure since 1974. However, in reality there has been no marked downward trend since 1999 despite reductions in pack size, continued publicity as to the dangers of paracetamol overdose, and improved liver failure treatment, including transplantation. The annual number of deaths from antidepressants remained relatively stable (median: 397, range: 335 ­ 469). Although the number of deaths from dosulepin [dothiepin] decreased (186 in 2000 and 49 in 2011), the number of deaths involving selective serotonin reuptake inhibitors increased (50 in 2000 and 127 in 2011). Although annual numbers of deaths involving diamorphine/morphine (88% unintentional) declined, deaths involving methadone (89% unintentional) increased and the total annual number of deaths from these drugs showed little change (2000: 1061, 2011: 995). Deaths involving amfetamine/metamfetamine remained relatively constant at about 50 annually, and whilst cocaine-related deaths fell by 48% during 2008 ­ 2011, and deaths involving MDMA and related compounds fell by 69% over this same period, deaths involving ' legal highs ' , notably γ -hydroxybutrate/ γ -butyrolactone and ketamine, increased. CONCLUSIONS: Alterations in the availability of paracetamol and of prescription drugs such as dextropropoxyphene and dosulepin have not been accompanied by decreases in the number of deaths from poisoning. Despite intense media and other interest, the annual number of deaths (250 ­ 300) involving ' recreational ' drugs remains small in relation to the 1000 or so deaths a year from diamorphine and/or methadone.

A nationwide evidence-based study of factors associated with hospitalisations due to unintentional poisoning and poisoning mortality in Taiwan.

The aim of this study was to explore the epidemiologic characteristics of unintentional poisoning cases and the factors associated with inpatient mortality. Data were retrieved from the National Health Insurance database from 2005 to 2007. Patients with diagnosis classifications of ICD-9-CM E850-E869 (unintentional poisoning) were selected. SPSS 18.0 software was used for the analysis. In Taiwan between 2005 and 2007, a total of 11,523 patients were hospitalised due to unintentional poisoning, with a hospitalisation rate of 16.83 per 100,000, of which 60.1% and 39.9% were attributable to drug poisoning and solid, liquid and gas substance poisoning, respectively. The hospitalisation rate in men was higher than that of women. The age group of 45-64 had the highest hospitalisation rate of 52.85 per 100,000. The inpatient mortality rate increased with the presence of the following factors: age of 65 or older, surgery or procedure, a higher Charlson Comorbidity Index (CCI), short length of hospital stays, acute respiratory failure, alcohol poisoning, pesticide poisoning and a higher-level hospital visited. Methanol, herbicides and organophosphorus pesticide intoxications are associated with higher mortality rates. Therefore, when caring for patients poisoned by the above agents, healthcare professionals should look out for their clinical development to ensure quality of care and to reduce mortality.

Métodos suicidas e Internet / Suicide Methods and Internet

El suicidio es un problema de salud pública ya que su incidencia ha ido aumentando un 60% en los últimos 45 años. Sus aspectos epidemiológicos y preventivos están bien estudiados pero los métodos de comisión infrecuentes son menos conocidos. Internet y los medios han dado a conocer suicidios disimulados y colectivos que han logrado difusión entre distintos países. Los objetivos del estudio son evaluar la extensión de la información por las webs que aportan datos y medios para lograr la finalidad autolítica, así como valorar su repercusión en los distintos países. Se describen los métodos menos comunes como son el uso de gases, productos químicos, fármacos y otros más selectivos. En nuestro país se siguen utilizando los métodos clásicos de suicidio sin que se aprecie la influencia de la red en la comisión de los mismos. Se ha de considerar la influencia de Internet respecto a los métodos de suicidio sobre todo en los jóvenes usuarios, ya que los datos manejados muestran la difusión rápida por la red de nuevos métodos en esta población en particular(AU)

Suicide is a public health problem; incidence has increased by 60% in the last 45 years. Its epidemiologic and preventive aspects have been thoroughly studied, but the unusual methods of committing suicide are less known. The Internet and the media have made known both simulated and collective suicides that have achieved worldwide broadcast. The goals of the study are to evaluate the spread of information through webs providing material and means to achieve the self-harm purpose, as well as to assess its worldwide impact. The most uncommon methods, using gases, chemical products, drugs and other more selective ones are described. In our country, we observe that the classic methods are still being used, without detecting any influence of the web. The influence of the Internet in suicide methods must be considered especially among young users because the analyzed data show a fast spread of new methods, particularly in these groups(AU)

Suicide epidemics: the impact of newly emerging methods on overall suicide rates - a time trends study.

BACKGROUND: The impact of newly emerging, popular suicide methods on overall rates of suicide has not previously been investigated systematically. Understanding these effects may have important implications for public health surveillance. We examine the emergence of three novel methods of suicide by gassing in the 20th and 21st centuries and determine the impact of emerging methods on overall suicide rates. METHODS: We studied the epidemic rises in domestic coal gas (1919-1935, England and Wales), motor vehicle exhaust gas (1975-1992, England and Wales) and barbecue charcoal gas (1999-2006, Taiwan) suicide using Poisson and joinpoint regression models. Joinpoint regression uses contiguous linear segments and join points (points at which trends change) to describe trends in incidence. RESULTS: Epidemic increases in the use of new methods of suicide were generally associated with rises in overall suicide rates of between 23% and 71%. The recent epidemic of barbecue charcoal suicides in Taiwan was associated with the largest rise in overall rates (40-50% annual rise), whereas the smallest rise was seen for car exhaust gassing in England and Wales (7% annual rise). Joinpoint analyses were only feasible for car exhaust and charcoal burning suicides; these suggested an impact of the emergence of car exhaust suicides on overall suicide rates in both sexes in England and Wales. However there was no statistical evidence of a change in the already increasing overall suicide trends when charcoal burning suicides emerged in Taiwan, possibly due to the concurrent economic recession. CONCLUSIONS: Rapid rises in the use of new sources of gas for suicide were generally associated with increases in overall suicide rates. Suicide prevention strategies should include strengthening local and national surveillance for early detection of novel suicide methods and implementation of effective media guidelines and other appropriate interventions to limit the spread of new methods.

Suicide in England and Wales 1861-2007: a time-trends analysis.

BACKGROUND: Suicide is one of the leading causes of premature mortality worldwide. Few studies have assessed long-term trends or sex differences in its incidence over time. We have investigated the age-, sex- and method-specific trends in suicide in England and Wales from 1861 to 2007. METHODS: Overall age-standardized suicide rates using the European Standard Population and age-, sex- and method-specific rates were calculated for ages ≥15 years from 1861 to 2007. RESULTS: Rates in males were consistently higher than females throughout the 19th and 20th centuries, although the male-to-female sex ratio fluctuated from 4 : 1 in the 1880s to 1.5 : 1 in the 1960s. Suicide rates increased in all age groups in the 1930s, coinciding with the Great Depression. The highest male rates (30.3 per 100 000) were recorded in 1905 and 1934 and have since been declining. Female rates peaked in the 1960s (11.8 per 100 000), declining afterwards. In both sexes the lowest recorded rates were in the 21st century. There was a rapid rise in the use of domestic gas as a method of suicide in both sexes following its introduction at the end of the 19th century. There was no evidence that this rise was accompanied by a decline in the use of other methods. Self-poisoning also increased in popularity from the 1860s (5% of suicides) to the 1990s (22% of suicides). CONCLUSIONS: The epidemiology of suicide in England and Wales has changed markedly over the past 146 years. The rapid rise in gas suicide deaths in the 1920s highlights how quickly a new method of suicide can be established in a population when it is easily available. The increase in suicides during the Great Depression has implications in relation to the current economic crisis. Changes in the acceptability and lethality of various suicide methods may account for the large variations in sex ratios over time.

Acute respiratory distress syndrome secondary to inhalation of chlorine gas in sheep.

BACKGROUND: Toxic industrial chemicals (TICs) are potential terrorist weapons. Several TICs, such as chlorine, act primarily on the respiratory tract, but knowledge of the pathophysiology and treatment of these injuries is inadequate. This study aims to characterize the acute respiratory distress syndrome (ARDS) caused by chlorine gas (Cl2) inhalation in a large-animal model. METHODS: Anesthetized female sheep were ventilated with 300 L of a Cl2/air/oxygen mixture for 30 minutes. In phase 1 (n = 35), doses were 0 ppm (Group 1, n = 6); 120 ppm (Group 2, n = 6); 240 to 350 ppm (Group 3, n = 11); and 400 to 500 ppm (Group 4, n = 12). In phase 2 (n = 17), doses were 0 ppm (Group 5, n = 5); 60 ppm (Group 6, n = 5); and 90 ppm (Group 7, n = 7), and the multiple inert gas elimination technique (MIGET) was used to characterize the etiology of hypoxemia. Computed tomography (CT) scans were performed daily for all animals. RESULTS: In Phase 1, lung function was well maintained in Group 1; Cl2 caused immediate and sustained acute lung injury (PaO2-to-FiO2 ratio, PFR<3.0) in Group 2 and ARDS (PFR<2.0) in Groups 3 and 4. All animals in Groups 1 and 2 survived 96 hours. Kaplan-Meier analysis showed dose-related differences in survival (log-rank test, p < 0.0001). Logistic regression identified 280 ppm as the lethal dose 50%. CT and histopathology demonstrated lesions of both small airways and alveoli. In Phase 2, MIGET showed diversion of blood flow from normal to true-shunt lung compartments and, transiently, to poorly ventilated compartments. CONCLUSIONS: Cl2 causes severe, dose-related lung injury, with features seen in both smoke inhalation and in ARDS secondary to systemic disease. This model will be used to test new therapeutic modalities.

Suicide prevention through means restriction: assessing the risk of substitution. A critical review and synthesis.

The effectiveness of restricting access to certain means of committing suicide has been demonstrated, at least as regards toxic domestic gas, firearms, drugs and bridges. At the individual level, studies tend to indicate that many persons have a preference for a given means, which would limit the possibility of substitution or displacement towards another method. Similarly, the fact that suicidal crisis are very often short-lived (and, what is more, influenced by ambivalence or impulsiveness) suggests that an individual with restricted access to a given means would not put off his plans to later or turn to alternative methods. This has been more difficult to demonstrate scientifically in population studies. Nevertheless, it appears that, should such a shift occur towards other means, it would be put into effect only in part and over a longer term.

The Bhopal disaster and its aftermath: a review.

On December 3 1984, more than 40 tons of methyl isocyanate gas leaked from a pesticide plant in Bhopal, India, immediately killing at least 3,800 people and causing significant morbidity and premature death for many thousands more. The company involved in what became the worst industrial accident in history immediately tried to dissociate itself from legal responsibility. Eventually it reached a settlement with the Indian Government through mediation of that country's Supreme Court and accepted moral responsibility. It paid $470 million in compensation, a relatively small amount of based on significant underestimations of the long-term health consequences of exposure and the number of people exposed. The disaster indicated a need for enforceable international standards for environmental safety, preventative strategies to avoid similar accidents and industrial disaster preparedness. Since the disaster, India has experienced rapid industrialization. While some positive changes in government policy and behavior of a few industries have taken place, major threats to the environment from rapid and poorly regulated industrial growth remain. Widespread environmental degradation with significant adverse human health consequences continues to occur throughout India.

Method availability and the prevention of suicide--a re-analysis of secular trends in England and Wales 1950-1975.

BACKGROUND: In England and Wales in the 1960s there were marked declines in suicide rates. These reductions were partly attributable to the detoxification of the domestic gas supplies; however, their extent varied by age and gender, with the most striking effects seen in older men. The objective of this study was to investigate method-specific trends in suicide between 1950 and 1975 to elucidate possible explanations for the patterns seen in different demographic groups. METHODS: An analysis of age-standardised method-specific suicide rates for England and Wales between 1950 and 1975 was carried out using routinely available mortality and population statistics. RESULTS: As has previously been shown, there were marked reductions in suicides by gassing in men and women of all ages between 1960 and 1975. In women and younger men, the effects of these reductions on overall suicide rates were partially offset by rises in drug overdose deaths (method substitution), but there were no immediate increases in the use of other suicide methods. In contrast, in older men, reductions in suicide by gassing were accompanied by only a slight increase in overdose suicides as well as reductions in rates of suicide using all other methods. The modest rise in overdose fatalities in older men occurred despite the fact that they were more often prescribed barbiturates and tricyclic antidepressants than younger men. CONCLUSIONS: Accessibility to and the lethality of particular methods of suicide may have profound effects on overall suicide rates. Such effects appear to depend upon the popularity of the method and the extent to which alternative methods that are acceptable to the individual are available. Social and psychological interpretations of fluctuations in suicide rates should only be made after assessing the possible contribution to these of changes in method availability and lethality.

[Inhalation trauma]. / Inhalationstrauma.

Inhalation injury has an imminent impact on the morbidity and mortality of burn patients. Accuracy in diagnosis could be improved by fibre-optic bronchoscopy and arterial carbon monoxide oximetry. The heterogeneous components of inhaled smoke produce abnormalities of ventilation and lung perfusion. The objective of the management is to maintain sufficient oxygenation of the organism during the period of respiratory failure; there is no specific therapy. Adequate respirator therapy is the most important factor.

The impact of availability, attraction and lethality of suicide methods on suicide rates in Germany.

Substantial fluctuations have prevailed in both the rate and particular methods of suicide in the Federal Republic of Germany during the past 40 years. The current study examines the extent to which the availability, attraction and lethality of particular methods of suicide affect suicide rates. A close relationship existed in the period from 1949 and 1989 between the peaks of the suicide rate and the percentage of low threshold suicide methods according to De Catanzaro, whereby suicide in this context is understood to mean suicide by shooting or intake of solid, liquid or gaseous poisons. Our hypothetically expected lesser compensation between high and low threshold methods for women was confirmed. Between 1963 and 1976 the rate of suicide committed using domestic gas receded dramatically. Within the same period, however, the rate of suicide committed using other poisons rose accordingly.

The efficacy of different decontaminants in rats and pigs percutaneously poisoned with organophosphates.

The efficacies of clay or alcoholate as decontaminants and a polyethylene glycol + oxime N-octylpyridium-4-aldoxime bromide (OPAB) protective ointment were evaluated in rats and pigs percutaneously poisoned with O-ethyl S-2-diisopropylaminoethyl methylphosphonothioate (VX) and soman (GD) nerve gases. The use of protective ointment per se or combined with the decontaminants protected all rats poisoned with GD, regardless of the experimental procedure. No poisoning or fatalities were observed in pigs decontaminated 2 min later with clay or alcoholate, while the protective ointment delayed the onset of poisoning and even prevented death. The application of protective ointment, with or without the use of decontaminants, significantly postponed the onset of poisoning in animals contaminated with VX. There was no significant difference between procedures. Decontamination was very satisfactory and dependent on the duration of exposure, being somewhat more efficient if performed by 30 min after exposure.

The efficacy of different formulations of protective-decontaminating ointments based on polyethylene glycol in rats percutaneously poisoned with highly toxic organophosphates.

Protective-decontaminating ointments based on polyethylene glycols (PEG) of different molecular weights were tested alone or with oxime N-octylpyridinium-4-aldoxime bromide, against percutaneous poisoning by the nerve gases 0-ethyl S-2-diisopropyl methylphosphorothiolate and soman in rats after 60 min exposure. PEG-based ointments consisting of higher PEG combined with the oxime proved the most efficient for both poisons. The combination of lower and medium PEG was somewhat less efficient, while the formulation consisting of mostly lower PEG exerted protective effects only in soman poisoning.