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1.
Emerg Med Clin North Am ; 38(4): 841-856, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32981621
3.
Pediatrics ; 146(2)2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32732262

RESUMO

OBJECTIVES: Acute nystagmus (AN) is an uncommon neurologic sign in children presenting to pediatric emergency departments. We described the epidemiology, clinical features, and underlying causes of AN in a large cohort of children, aiming at identifying features associated with higher risk of severe underlying urgent conditions (UCs). METHODS: Clinical records of all patients aged 0 to 18 years presenting for AN to the pediatric emergency departments of 9 Italian hospitals in an 8-year period were retrospectively reviewed. Clinical and demographic features and the underlying causes were analyzed. A logistic regression model was applied to detect predictive variables associated with a higher risk of UCs. RESULTS: A total of 206 patients with AN were included (male-to-female ratio: 1.01; mean age: 8 years 11 months). The most frequently associated symptoms were headache (43.2%) and vertigo (42.2%). Ataxia (17.5%) and strabismus (13.1%) were the most common neurologic signs. Migraine (25.7%) and vestibular disorders (14.1%) were the most common causes of AN. Idiopathic infantile nystagmus was the most common cause in infants <1 year of age. UCs accounted for 18.9% of all cases, mostly represented by brain tumors (8.3%). Accordant with the logistic model, cranial nerve deficits, ataxia, or strabismus were strongly associated with an underlying UC. Presence of vertigo or attribution of a nonurgent triage code was associated with a reduced risk of UCs. CONCLUSIONS: AN should be considered an alarming finding in children given the risk of severe UCs. Cranial nerve palsy, ataxia, and strabismus should be considered red flags during the assessment of a child with AN.


Assuntos
Nistagmo Patológico/etiologia , Ataxia/complicações , Ataxia/diagnóstico , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/diagnóstico , Infecções do Sistema Nervoso Central/complicações , Infecções do Sistema Nervoso Central/diagnóstico , Criança , Pré-Escolar , Estudos de Coortes , Doenças dos Nervos Cranianos/complicações , Doenças dos Nervos Cranianos/diagnóstico , Doenças Desmielinizantes/complicações , Doenças Desmielinizantes/diagnóstico , Tontura/etiologia , Serviço Hospitalar de Emergência , Feminino , Cefaleia/etiologia , Humanos , Hipertensão Intracraniana/complicações , Hipertensão Intracraniana/diagnóstico , Itália , Masculino , Transtornos de Enxaqueca/complicações , Transtornos de Enxaqueca/diagnóstico , Náusea/etiologia , Envenenamento/complicações , Envenenamento/diagnóstico , Estudos Retrospectivos , Estrabismo/etiologia , Vertigem/etiologia , Doenças Vestibulares/complicações , Doenças Vestibulares/diagnóstico , Vômito/etiologia
5.
J Zoo Wildl Med ; 51(2): 407-415, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32549572

RESUMO

Over a period of 5 mo, seven out of eight American white pelicans (Pelecanus erythrorhynchos) housed on a spring-fed pond at a zoo died or were euthanized. Clinical signs included inability to stand, anorexia, and weight loss. Clinicopathologic findings included heterophilic leukocytosis and elevated creatine kinase and aspartate aminotransferase. Histopathologic findings on all pelicans demonstrated severe, chronic, diffuse rhabdomyofiber degeneration and necrosis, making vitamin E deficiency a differential diagnosis despite routine supplementation. Based on tissue and pond water assays for the cyanobacterial toxin, microcystin, toxicosis is suspected as the inciting cause of death in these cases. We hypothesize that vitamin E exhaustion and resultant rhabdomyodegeneration and cardiomyopathy were sequelae to this toxicosis.


Assuntos
Doenças das Aves/diagnóstico , Aves , Microcistinas/envenenamento , Necrose/veterinária , Envenenamento/mortalidade , Envenenamento/veterinária , Alabama/epidemiologia , Animais , Doenças das Aves/microbiologia , Doenças das Aves/mortalidade , Diagnóstico Diferencial , Feminino , Masculino , Necrose/diagnóstico , Necrose/microbiologia , Necrose/mortalidade , Envenenamento/complicações , Envenenamento/diagnóstico
6.
Forensic Sci Int ; 310: 110237, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32172178

RESUMO

BACKGROUND: Recently the number of new psychoactive substances have significantly increased, becoming popular among experienced users of designer drugs. A significant group includes benzodiazepine derivatives, which have not been introduced as medications but are abused by people experimenting with new and classical psychoactive substances. CASE PRESENTATION: The aim of this paper was to present the case of a clonazolam ingestion by a person who was not habituated to benzodiazepines. The intake caused only prolonged coma, decreased muscle tone, and deep tendon reflexes without any other concomitant toxicity and cardio-respiratory failure. CONCLUSIONS: Clonazolam concentrations in patient's blood, measured three times were 0.077 mg/L, 0.015 mg/L, 0.009 mg/L after 4, 8 and 12 h, respectively. Clonazolam's human toxicity has not been well established, so any case of poisoning should be closely monitored.


Assuntos
Benzodiazepinas/envenenamento , Drogas Desenhadas/envenenamento , Hipnóticos e Sedativos/envenenamento , Adulto , Benzodiazepinas/sangue , Análise Química do Sangue , Coma/etiologia , Feminino , Humanos , Hipnóticos e Sedativos/sangue , Envenenamento/complicações , Envenenamento/diagnóstico
7.
PLoS Negl Trop Dis ; 14(3): e0008060, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32163415

RESUMO

The northeast (NE) region of Brazil commonly goes through drought periods, which favor cyanobacterial blooms, capable of producing neurotoxins with implications for human and animal health. The most severe dry spell in the history of Brazil occurred between 2012 and 2016. Coincidently, the highest incidence of microcephaly associated with the Zika virus (ZIKV) outbreak took place in the NE region of Brazil during the same years. In this work, we tested the hypothesis that saxitoxin (STX), a neurotoxin produced in South America by the freshwater cyanobacteria Raphidiopsis raciborskii, could have contributed to the most severe Congenital Zika Syndrome (CZS) profile described worldwide. Quality surveillance showed higher cyanobacteria amounts and STX occurrence in human drinking water supplies of NE compared to other regions of Brazil. Experimentally, we described that STX doubled the quantity of ZIKV-induced neural cell death in progenitor areas of human brain organoids, while the chronic ingestion of water contaminated with STX before and during gestation caused brain abnormalities in offspring of ZIKV-infected immunocompetent C57BL/6J mice. Our data indicate that saxitoxin-producing cyanobacteria is overspread in water reservoirs of the NE and might have acted as a co-insult to ZIKV infection in Brazil. These results raise a public health concern regarding the consequences of arbovirus outbreaks happening in areas with droughts and/or frequent freshwater cyanobacterial blooms.


Assuntos
Morte Celular/efeitos dos fármacos , Microcefalia/patologia , Envenenamento/complicações , Envenenamento/patologia , Saxitoxina/toxicidade , Infecção por Zika virus/complicações , Infecção por Zika virus/patologia , Animais , Toxinas Bacterianas/análise , Toxinas Bacterianas/toxicidade , Encéfalo/patologia , Brasil/epidemiologia , Células Cultivadas , Modelos Animais de Doenças , Surtos de Doenças , Feminino , Humanos , Incidência , Toxinas Marinhas/análise , Toxinas Marinhas/toxicidade , Camundongos Endogâmicos C57BL , Microcistinas/análise , Microcistinas/toxicidade , Modelos Teóricos , Neurotoxinas/análise , Neurotoxinas/toxicidade , Saxitoxina/análise , Água/química
8.
J Vet Emerg Crit Care (San Antonio) ; 30(1): 60-65, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31714003

RESUMO

OBJECTIVE: To describe the prevalence of acute kidney injury (AKI), clinical course, decontamination procedures, and outcome in dogs following grape or raisin ingestion. DESIGN: Retrospective case series from 2005 to 2014. SETTING: Three university veterinary teaching hospitals. ANIMALS: One hundred thirty-nine client-owned dogs with known grape or raisin ingestion. MEASUREMENTS AND MAIN RESULTS: Among dogs with biochemical data, the prevalence of AKI was 6.7% (8/120). The prevalence of AKI in the early presentation (3/67) and late (5/53) presentation groups were 4.5% and 9%, respectively. The prevalence of AKI was not significantly different between groups (P = 0.27). Four dogs (3.3%) were azotemic at presentation and 4 dogs (3.3%) had increases in creatinine of ≥26.5 µmol/L (0.3 mg/dL) at recheck (3 from the early and 1 from the late group). Vomiting was the most common clinical sign (18/139). One hundred twenty-two dogs (88%) underwent gastrointestinal decontamination and significantly more dogs in the early group were decontaminated (P < 0.0001). Two dogs received continuous renal replacement therapy. One hundred thirty-eight dogs survived and 1 died. CONCLUSIONS: The prevalence of AKI and mortality was low in dogs with confirmed grape or raisin ingestion. Due to the retrospective nature of the study, conclusions about the utility of gastrointestinal decontamination and other therapies cannot be made.


Assuntos
Injúria Renal Aguda/veterinária , Doenças do Cão/epidemiologia , Vitis/envenenamento , Injúria Renal Aguda/complicações , Injúria Renal Aguda/epidemiologia , Animais , Doenças do Cão/sangue , Cães , Feminino , Masculino , Envenenamento/complicações , Envenenamento/veterinária , Prevalência , Estudos Retrospectivos , Estados Unidos/epidemiologia
9.
Cardiorenal Med ; 9(6): 337-340, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31597146

RESUMO

Cardiorenal syndrome describes an active inter-relationship between heart and renal malfunction. The notion of passive renal congestion because of heart dysfunction and the informative term "rein cardiaque" by the French pathologist Frédéric Justin Collet (1870-1966) that reiterates revolutionized physiological thinking based on autopsy findings will be briefly discussed here.


Assuntos
Síndrome Cardiorrenal/história , Síndrome Cardiorrenal/etiologia , Síndrome Cardiorrenal/patologia , Corpos Estranhos/complicações , Glomerulonefrite/complicações , História do Século XVIII , História do Século XIX , Humanos , Infecções/complicações , Rim/irrigação sanguínea , Doenças do Sistema Nervoso/complicações , Envenenamento/complicações
11.
Rev Med Interne ; 40(11): 742-749, 2019 Nov.
Artigo em Francês | MEDLINE | ID: mdl-31421899

RESUMO

A huge variety of medical diseases may potentially present with isolated psychotic symptoms, and disease-specific treatment or management is available for a significant part of them. The initial medical work-up of a first-episode psychosis (FEP) is of crucial importance. This literature review aimed to identify medical conditions potentially revealed by FEP, to list the warning signs of secondary psychosis, and to discuss a screening strategy. Underlying organic conditions may be drugs and medications, neurologic diseases, infections, inflammatory and/or autoimmune pathologies, and metabolic disorders whether of hereditary origin. Each patient presenting with a first-episode psychosis should be evaluated with a precise anamnesis, a careful clinical examination, and routine laboratory tests. Brain imaging and tests (depending on the context) should be performed in the presence of atypical clinical features or "red flags", leading to suspect an organic disease.


Assuntos
Transtornos Psicóticos/etiologia , Encéfalo/diagnóstico por imagem , Doenças do Sistema Nervoso Central/complicações , Doenças do Sistema Nervoso Central/diagnóstico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/complicações , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico , Humanos , Infecções/complicações , Infecções/diagnóstico , Anamnese , Doenças Neurodegenerativas/complicações , Doenças Neurodegenerativas/diagnóstico , Exame Neurológico , Testes Neuropsicológicos , Envenenamento/complicações , Envenenamento/diagnóstico
13.
Rev Bras Enferm ; 72(suppl 1): 32-40, 2019 Feb.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30942342

RESUMO

OBJECTIVE: to describe case of occupational exposure to chemical products. METHOD: descriptive retrospective study using record data of 382 workers assisted in the Outpatient Care for Occupational Toxicology of the Reference Center of Workers' Health of the Federal District, between 2009 and 2013. RESULTS: From the total, 66.7% were men, 55.2% had up to 9 years of activity and 81% did not use personal protective equipment (PPE). Nearly 60% were farmers and environmental surveillance agents, exposed to pesticides (63%), of which 40% were organophosphorus insecticides. The majority (68%) presented butyrylcholinesterase activity decreased, mostly farmers (85.9%); 57.3% of workers were considered poisoned - 61.6% by pesticides and 37.9% by industrial chemicals -, and away from work for at least 10 days. CONCLUSION: The profile was male workers, from 30 to 39 years, which not used PPE, indicating the need for prevention together with them to prevent poisonings.


Assuntos
Exposição Ocupacional/efeitos adversos , Envenenamento/etiologia , Adulto , Vazamento de Resíduos Químicos/estatística & dados numéricos , Fazendeiros/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Exposição Ocupacional/estatística & dados numéricos , Equipamento de Proteção Individual , Praguicidas/efeitos adversos , Envenenamento/complicações , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Inquéritos e Questionários
14.
Artigo em Chinês | MEDLINE | ID: mdl-30929357

RESUMO

Objective: To analyze the clinical characteristics, treatment and prognosis of rhabdomyolysis (RM) caused by acute poisoning.Summarize the clinical characteristics and treatment experience, pay attention to the complications and improve the quality of rescue. Methods: We collecte and summarize the clinical data, treatment and prognosis of 22 cases of RM caused by acute poisoning. Results: We found that 21 patients (95.5%) had muscle damage, 13(59.1%) with coma, 8(36.4%) with brown, tea or even soy sauce urine, 6(27.3%) had acute renal injury (AKI), and 4(18.2%) had multiple organ dysfunction syndrome (MODS). After the treatment, 21 cases (95.5%) got better, and one case were discharged. All the patients with AKI were survived, three of them were treated by hemodialysis, and the other recovered gradually after massive fluid replacement. Conclusion: Acute poisoning combined with RM is not uncommon in clinic. We should pay attention to examination of serum enzymes and other indicators, observe the clinical symptoms and make early diagnosis. The key to diagnosis and treatment is early fluid resuscitation, comprehensive treatment, blood purification and maintain the stability of water and electrolyte.


Assuntos
Envenenamento/complicações , Rabdomiólise/diagnóstico , Rabdomiólise/terapia , Injúria Renal Aguda , Humanos , Insuficiência de Múltiplos Órgãos , Prognóstico , Diálise Renal
15.
Vet J ; 244: 1-6, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30825884

RESUMO

Epileptic seizures are a common indication for neurological evaluation. This retrospective study reviewed 789 cats referred for epileptic seizure evaluation to the Department of Small Animal Medicine and Surgery of the University of Veterinary Medicine in Hannover, between 1998 and 2017. The aim of this study was to determine common causes for reactive seizures (RS) in cats. Reactive seizures were diagnosed in 62 (7.9%) of 789 feline patients. The most common cause of RS was presumptive or confirmed intoxication (n=34/62; 54.8%). Toxins included permethrin (n=5/62; 8.1%), fipronil (n=1/62; 1.6%), and pesticide (n=1/62; 1.6%). Other common causes were hepatic and renal encephalopathy (n=6/62; 9.7% each), hypertension (n=5/62; 8.1%), hyperthyroidism (n=3/62; 4.8%), hypoglycaemia (n=3/62; 4.8%), and hyperglycaemia (n=1/62; 1.6%). Most commonly, cats with RS presented with generalised tonic-clonic seizures (n=25/62; 40.3%). A single status epilepticus was observed in 9.7% (n=6/62) and 4.8% (n=3/62) presented only with cluster seizures. Focal seizures were the only presenting sign in 3.2% (n=2/62) of cases, however in 4.8% (n=3/62) they were accompanied by tonic-clonic seizures. The mean age of all cats presented for RS was 10.8 years. In the intoxication group, the mean age was 2.9 years. Intoxication (confirmed or presumptive) was the most common cause of RS identified. Clinicians should suspect intoxication when other causes of RS are excluded; when there are appropriate historical findings; when the cat is frequently unobserved by the owner; when symptomatic treatment leads to cessation of epileptic seizures; and when seizures do not recur after treatment has been discontinued.


Assuntos
Doenças do Gato/epidemiologia , Convulsões/veterinária , Animais , Doenças do Gato/etiologia , Gatos , Feminino , Alemanha/epidemiologia , Masculino , Exame Neurológico/veterinária , Praguicidas/toxicidade , Envenenamento/complicações , Envenenamento/veterinária , Recidiva , Estudos Retrospectivos , Convulsões/epidemiologia , Convulsões/etiologia
16.
PLoS One ; 14(2): e0199486, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30753193

RESUMO

INTRODUCTION: Repetition of deliberate self-harm is an important predictor of subsequent suicide. Repetition rates in Asian countries appear to be significantly lower than in western high-income countries. Methodological differences in studies, and the impact of access to means of self-harm with comparatively higher lethality have been suggested as reasons for these reported differences. This prospective study determines the rates and demographic patterns of deliberate self-poisoning (DSP), suicide and repeated deliberate self-harm resulting non-fatal and fatal outcomes in rural Sri Lanka. METHODS: Details of DSP admission in all hospitals (n = 46) and suicides reported to all police stations (n = 28) in a rural district were collected for the years 2011, 2012 and 2013. Demographic details of the cohort of patients admitted to all hospitals in 2011 due to deliberate self-poisoning (N = 4022), were screened to link with patient records and police reports of the successive two years with high sensitivity using a computer program. Then high specificity manual matching of all screened links was performed to identify repetition within 2 years of initial presentation. Life time repetition was assessed in a randomly selected subset of DSP patients (n = 433). RESULTS: There were 15,639 DSP admissions, aged more than 9 years, and 1078 suicides during the study period. The incidence of deliberate self-poisoning and suicide in the population within the study area were 248.3/100,000 and 20.7/100,000 respectively, in 2012. Repetition rates at four weeks, one-year and two-years were 1.9% (95% CI 1.5-2.3%), 5.7% (95% CI 5.0-6.4) and 7.9% (95% CI 7.1-8.8) respectively. The median interval between two attempts were 92 (IQR 10-238) and 191 (IQR 29-419.5) days for the one and two-year repetition groups. The majority of patients used the same poison in the repeat attempt. The age and duration of hospital stay of individuals with repetitive events were not significantly different from those who had no repetitive events. The rate of suicide at two years following DSP was 0.7% (95% CI 0.4-0.9%). The reported life time history of deliberate self-harm attempts was 9.5% (95% CI 6.7-12.2%). CONCLUSIONS: The comparatively low rates of repetition in rural Sri Lanka was not explained by higher rates of suicide, access to more lethal means or differences in study methodology.


Assuntos
Comportamento Autodestrutivo/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Estudos de Coortes , Feminino , Hospitalização , Humanos , Incidência , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Envenenamento/complicações , Envenenamento/epidemiologia , Envenenamento/psicologia , Estudos Prospectivos , Fatores de Risco , População Rural , Sri Lanka/epidemiologia , Suicídio/prevenção & controle , Suicídio/tendências , Tentativa de Suicídio
17.
Rev. bras. enferm ; 72(supl.1): 32-40, Jan.-Feb. 2019. tab, graf
Artigo em Inglês | LILACS, BDENF - Enfermagem | ID: biblio-990720

RESUMO

ABSTRACT Objective: to describe case of occupational exposure to chemical products. Method: descriptive retrospective study using record data of 382 workers assisted in the Outpatient Care for Occupational Toxicology of the Reference Center of Workers' Health of the Federal District, between 2009 and 2013. Results: From the total, 66.7% were men, 55.2% had up to 9 years of activity and 81% did not use personal protective equipment (PPE). Nearly 60% were farmers and environmental surveillance agents, exposed to pesticides (63%), of which 40% were organophosphorus insecticides. The majority (68%) presented butyrylcholinesterase activity decreased, mostly farmers (85.9%); 57.3% of workers were considered poisoned - 61.6% by pesticides and 37.9% by industrial chemicals -, and away from work for at least 10 days. Conclusion: The profile was male workers, from 30 to 39 years, which not used PPE, indicating the need for prevention together with them to prevent poisonings.


RESUMEN Objetivo: describir casos de exposición ocupacional a productos químicos. Método: estudio retrospectivo descriptivo utilizando datos del prontuario de 382 trabajadores atendidos en el Ambulatorio de Toxicología Ocupacional del Centro de Referencia en Salud del Trabajador del Distrito Federal entre 2009 y 2013. Resultados: El 66,7% eran hombres, el 55,2% tenía hasta 9 años de actividad y el 81% no usaba el equipo de protección individual (EPI). Casi el 60% eran agricultores y agentes de vigilancia ambiental, expuestos a agrotóxicos (63%), de los cuales 40% insecticidas organofosforados. La mayoría (68%) presentó actividad de butirilcolinesterasa disminuida, principalmente agricultores (85,9%); el 57,3% de los trabajadores fueron considerados intoxicados, 61,6% por agrotóxicos y 37,9% por productos químicos industriales, y alejados del trabajo por lo menos 10 días. Conclusión: El perfil de los trabajadores atendidos fue de hombres, predominantemente de 30 a 39 años, que no utilizaban el EPI, indicando la necesidad de acciones de prevención junto a esa población para evitar la ocurrencia de intoxicaciones.


RESUMO Objetivo: descrever casos de exposição ocupacional a produtos químicos. Método: estudo retrospectivo descritivo utilizando dados do prontuário de 382 trabalhadores atendidos no Ambulatório de Toxicologia Ocupacional do Centro de Referência em Saúde do Trabalhador do Distrito Federal, entre 2009 e 2013. Resultados: 66,7% eram homens, 55,2% tinham até 9 anos de atividade e 81% não usavam equipamento de proteção individual (EPI). Quase 60% eram agricultores e agentes de vigilância ambiental, expostos a agrotóxicos (63%), dos quais 40% inseticidas organofosforados. A maioria (68%) apresentou atividade de butirilcolinesterase diminuída, principalmente agricultores (85,9%); 57,3% dos trabalhadores foram considerados intoxicados, 61,6% por agrotóxicos e 37,9% por produtos químicos industriais, e afastados do trabalho por pelo menos 10 dias. Conclusão: O perfil dos trabalhadores atendidos foi de homens, predominantemente de 30 a 39 anos, que não utilizavam EPI, indicando a necessidade de ações de prevenção junto a essa população para evitar a ocorrência de intoxicações.


Assuntos
Humanos , Masculino , Feminino , Adulto , Envenenamento/etiologia , Exposição Ocupacional/efeitos adversos , Praguicidas/efeitos adversos , Envenenamento/complicações , Sistema de Registros/estatística & dados numéricos , Inquéritos e Questionários , Estudos Retrospectivos , Exposição Ocupacional/estatística & dados numéricos , Vazamento de Resíduos Químicos/estatística & dados numéricos , Equipamento de Proteção Individual , Fazendeiros/estatística & dados numéricos , Pessoa de Meia-Idade
18.
Clin Toxicol (Phila) ; 57(3): 181-188, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30318932

RESUMO

PURPOSE: To determine the demographic and social characteristics of acutely intoxicated patients in the emergency department (ED), intention of drug/chemical intake, main toxic agents, outcomes and time trends for all variables. METHODS: This prospective, observational study included acutely intoxicated patients treated in the ED of the University Hospital Centre Sisters of Charity, Zagreb, Croatia, during the years 2001, 2010 and 2015. The diagnosis was derived from patient's self-report, clinical observations and laboratory test results (quantitative test for serum ethanol levels and qualitative tests for drugs in urine). RESULTS: A total of 1593 patients were enrolled in the study (331 in 2001, 618 in 2010, 644 in 2015), with a predominance of men (55.9%, 65.2%, 70.7%, respectively). The median age was 28 [18-89], 39 [18-92] and 40 years [18-95], respectively. There was a decline in the number of suicide attempts during the study (46.2%, 22.2%, 17.1% of patients, respectively) with a predominance of women (64.1-68.2%), and an escalation in the number of unintentional overdoses by substances of abuse (50.2%, 72.3%, 81.7% of patients, respectively) with a predominance of men (74.1-79.1%). Ethanol was the main toxic agent (40.2%, 69.4%, 75.8% of patients, respectively), used primarily as a substance of unintentional overdose. Anxiolytics were the most frequently implicated pharmaceuticals among all patients (46.5%, 32.0%, 18.5% of patients, respectively) and the main substance used in suicide attempts. The number of patients hospitalized in the Intensive Care Unit (ICU) decreased during the study from 20.2% of all patients in 2001 to 7.9% in 2010 and 6.8% in 2015. They accounted for 7.2%, 5.8% and 5.6% of all ICU-treated patients, respectively. In-hospital mortality (ED and ICU) caused by acute intoxications was low (0.9%, 0.8%, 0.8%, respectively). CONCLUSIONS: The escalation of overdoses by ethanol was a major medical and public concern in Zagreb. Anxiolytics were the main substance used in suicide attempts, with a low death rate due to their good safety profile.


Assuntos
Envenenamento/complicações , Envenenamento/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Depressores do Sistema Nervoso Central/envenenamento , Comorbidade , Cuidados Críticos , Croácia/epidemiologia , Overdose de Drogas/epidemiologia , Etanol/envenenamento , Feminino , Seguimentos , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Envenenamento/terapia , Estudos Prospectivos , Fatores Socioeconômicos , Tentativa de Suicídio/estatística & dados numéricos , Resultado do Tratamento , Adulto Jovem
19.
BMC Pediatr ; 18(1): 274, 2018 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-30121087

RESUMO

BACKGROUND: The burden of poisoning among children is largely underexplored in rural Sri Lanka. This study describes the patterns of demographic characteristics, poison related factors, clinical management and outcome following acute poisoning among children (9 months- 12 years) in rural Sri Lanka. METHOD: This hospital based multi-center study included Anuradhapura Teaching hospital, Polonnaruwa District General hospital, and 34 regional hospitals within Regional Director of Health Services in North Central province of Sri Lanka. The study assessed clinical profiles, poison related factors, clinical management, complications, harmful first aid practices, reasons for delayed management, complications and outcomes following acute poisoning over 7 years. RESULTS: Among 1621 children with acute poisoning, the majority were in preschool age group. Household chemicals were accountable for 489 acute poisonings (30.2%). The most common poison was kerosene oil, followed by paracetamol. Most events occurred within their own domestic premises. Potentially harmful first aid measures were practiced by approximately one third of care givers. Reasons for delayed presentation at emergency center included lack of concern by family members regarding the urgency of the situation and lack of knowledge regarding possible complications. Complications were observed in 12.5% and the most common complication was chemical pneumonitis. CONCLUSIONS: Children with acute poisoing in rural Sri Lanka were predominantly preschoolers. They are poisonined mostly within their own housing premises. Kerosene oil, in addition to being the most common poison, had additional risks of aspiration pneumonia following potentially hazadrous first aid measures practised by the care givers. Complications though rare were potentially preventable by community education and awareness on timely attention to seek medical care, and avoidance of harmful first aid practices.


Assuntos
Agroquímicos/envenenamento , Produtos Domésticos/envenenamento , Envenenamento/epidemiologia , Doença Aguda , Distribuição por Idade , Cuidadores , Criança , Pré-Escolar , Feminino , Hospitalização , Humanos , Entrevistas como Assunto , Masculino , Envenenamento/complicações , Envenenamento/terapia , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , População Rural , Sri Lanka/epidemiologia , Resultado do Tratamento
20.
J Small Anim Pract ; 59(11): 659-669, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30102417

RESUMO

Hypoglycaemia is a common, life-threatening complication that occurs as a component of a wide variety of disease processes. Despite its frequent occurrence, information concerning the aetiology, characteristics and outcomes of hypoglycaemic crises in veterinary medicine is limited. This review summarises the current understanding of the pathophysiology of hypoglycaemia, the body's counter-regulatory response, underlying aetiologies, diagnosis and treatment. Disease mechanisms are discussed and published evidence in veterinary literature regarding prognostic indicators, prevalence, diagnosis and treatment is examined for hypoglycaemia-related disease processes including insulinoma, glucose-lowering toxins and medications.


Assuntos
Hipoglicemia/veterinária , Animais , Encéfalo/metabolismo , Sistema Cardiovascular/fisiopatologia , Glucose/metabolismo , Hipoglicemia/etiologia , Hipoglicemia/fisiopatologia , Hipoglicemia/terapia , Insulina/efeitos adversos , Neoplasias/complicações , Neoplasias/veterinária , Envenenamento/complicações , Envenenamento/veterinária
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