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.

[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.

[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.

[Electronic poison information management system]. / Elektroniczny system zarzadzania informacja toksykologiczna.

We describe deployment of electronic toxicological information database in poison control center of Pomeranian Center of Toxicology. System was based on Google Apps technology, by Google Inc., using electronic, web-based forms and data tables. During first 6 months from system deployment, we used it to archive 1471 poisoning cases, prepare monthly poisoning reports and facilitate statistical analysis of data. Electronic database usage made Poison Center work much easier.

Double, suicidal intoxication with hydroxycarbamide--a case report.

Hydroxycarbamide (HCB), also known as hydroxyurea, is an urea derivative used mainly as antineoplastic and antisickling agent. We described a 31 yrs. female, with essential thrombocythemia, who was admitted to our clinic because of double suicidal ingestion of hydroxycarbamide. First time it was 7.5 g of HCB with coingestion of 50 mg of diazepam, and several glasses of wine, second time it was 10 g of HCB, with coingestion of 100 mg paroxetine and few glasses of vodka. Both suicidal attempts were triggered by multiple reactive factors. At the time of admissions the patient was conscious, restless, with decreased mood. Transient decrease of total leukocyte count was noted on fourth day of first overdose. The second overdose led to no significant changes in blood count. There were no other abnormalities in biochemical results. According to the best of our knowledge this is the first report of acute suicidal intoxication with hydroxy-carbamide in an adult.

Can Social Media Profiles Be a Reliable Source of Information on Nutrition and Dietetics?

BACKGROUND: Social media are growing worldwide platforms for unlimited exchange of various content. Owing to their accessibility and short form, they can be utilized as usable, wide-range communication and information tools for companies, scientific communities, patient advocacy organizations, and special interest groups. This study aimed to investigate whether Instagram® profiles can be reliable sources of information and knowledge about nutrition and dietetics. MATERIALS AND METHODS: Random identification of nutrition-related posts was performed using a built-in website search engine. Posts were searched by five popular hashtags: #nutrition, #nutritionist, #instadiet, #diet, and #dietitian, 250 newest posts of each. Advertisement posts were discarded. Each eligible post was then categorized (dietetics, fitness, motivation, other) and assessed with regard to the quality of nutrition information provided (five levels from none to good quality), popularity (number of followers, likes, and comments), and engagement measures (like, comment, and engagement ratio). RESULTS: A total of 1189 posts were reviewed. The overall quality of the content regarding nutritional knowledge was extremely low (93.9% of all posts), also when divided into categories. Among all posts, 63.8% were categorized as "nutrition and dietetics", while "fitness", "motivation", and "other" categories comprised 8.2%, 4.8%, and 23.2% of the posts, respectively. Posts recognized as dietetics were the most liked (mean n = 116 likes per post) and of the highest quality. However, those motivational raised the greatest degree of engagement (32.7%). Posts with cooking recipes were the most commented. CONCLUSIONS: Random post search cannot provide viewers with valuable nutrition information. A dedicated search for high-quality professional profiles is preferred to obtain quality information.

Rhabdomyolysis related to acute recreational drug toxicity-A Euro-DEN study.

BACKGROUND: This study was conducted to retrospectively assess the relationships between: rhabdomyolysis (quantified by creatine kinase (CK) activity) and kidney injury (quantified by serum creatinine concentration), sex, age, body temperature on admission, presence of seizures, and agitation or aggression in patients presenting to the Emergency Department with acute recreational drug toxicity. We also investigated the association with the substances ingested. METHODS: All presentations to the 16 sentinel Euro-DEN centres in 10 European countries with acute recreational drug toxicity during the first year of the Euro-DEN study (October 2013 to September 2014) were considered. Cases that had abnormal CK activity recorded as part of routine clinical care were divided into 3 cohorts depending on peak CK activity. Cases with normal CK activity were included as a control group (4th cohort). RESULTS: Only 1,015 (18.4%) of the 5,529 Euro-DEN presentations had CK activity concentration recorded. Of this group 353 (34.8%) had also creatinine concentration measured. There were 375 (36.9%) with minor rhabdomyolysis, 69 (6.8%) with moderate rhabdomyolysis, and 24 (2.4%) with severe rhabdomyolysis; 547 (53.9%) were included in the control group. There was a positive correlation between CK activity and creatinine concentration (correlation coefficient r = 0.71, p<0.0001). There was no correlation between CK activity and body temperature at the time of presentation to the ED (correlation coefficient r = 0.07, p = 0.03). There was a positive correlation between CK activity and length of stay in the hospital (r = 0.31, p<0.001). There was no association between CK activity and the presence of seizures (p = 0.33) or agitation/aggression (p = 0.45), patients age (p = 0.4) or sex (p = 0.25). The 5 most common agents amongst patients presenting with rhabdomyolysis were: cocaine (n = 107; 22.9% presentations), amphetamine (76; 16.2%), cannabis (74; 15.8%), GHB/GBL (72; 15.4%) and heroin (67; 14.3%). The distribution of rhabdomyolysis in 5 most common drugs was (drug; patients with rhabdomyolysis, patients without rhabdomyolysis): cocaine (107, 122), cannabis (74, 117), GHB/GBL (72, 81), amphetamine (76, 66), heroin (67, 70). CONCLUSIONS: Abnormal values of CK activity occurred in almost half (46.1%) of presentations to the Emergency Department with acute recreational drug toxicity in whom CK activity was measured; however, severe rhabdomyolysis is seen in only a small minority (2.4%). Those with rhabdomyolysis are at significantly higher risk of kidney injury and have a longer length of hospital stay.

The characteristics and outcomes of toxin-induced massive rhabdomyolysis.

OBJECTIVES: This study investigates common patterns in patients with exceptionally high creatine kinase (CK) levels to identify factors that could have contributed to the development of severe rhabdomyolysis in the studied cohort. MATERIAL AND METHODS: The authors present a retrospective analysis of patients with massive rhabdomyolysis (measured CK activity >50 000 U/l) caused by xenobiotics. The patients were selected from a group of 7708 patients treated at the Regional Toxicological Center. RESULTS: The most frequent causative agents were recreational drugs, sedatives and anti-epileptics. Six patients developed multi-organ failure, including 1 who died. Substance abuse disorder was diagnosed in 90% of the patients. Each patient had at least 1 contributory factor present (hypothermia, hyperthermia, injury, an episode of agitation, seizures, prolonged immobilization), and the median was 3 factors. Acute kidney injury was observed in 90% of the patients, and 70% needed renal replacement therapy due to acute renal failure, which meant a longer hospital stay. Creatinine concentration differences between days 2 and 1 of the presentation (Cdiff) correlated with the length of hospital stay (r = 0.73, p = 0.02). All patients with negative Cdiff values did not need dialysis. No patients experienced liver failure. CONCLUSIONS: Massive rhabdomyolysis seems to be the effect of coincidence of several factors rather than the myotoxic effect alone. A creatinine concentration difference between days 2 and 1 of hospitalization was a good prognostic factor for the need for further dialysis. Int J Occup Med Environ Health. 2020;33(5):661-73.

Acute exposure to urea.

According to the best of our knowledge there are no reports in medical literature about massive and acute exposure to carbamide. We have described a man who has fallen into the wagon car full of granulated urea. A 34-year old male, without previous medical history, has fallen into train car full of carbamide. For about 10 minutes the patient was fully covered with granulate. After one year of follow-up the patient was still having symptoms of obturative respiratory insufficiency. Despite the fact that urea is thought as non toxic agent massive exposures to it, in some circumstances, may cause chronic respiratory problems.

Intoxication by gamma hydroxybutyrate and related analogues: Clinical characteristics and comparison between pure intoxication and that combined with other substances of abuse.

OBJECTIVE: To study the profile of European gamma-hydroxybutyrate (GHB) and gammabutyrolactone (GBL) intoxication and analyse the differences in the clinical manifestations produced by intoxication by GHB/GBL alone and in combination with other substances of abuse. METHOD: We prospectively collected data on all the patients attended in the Emergency Departments (ED) of the centres participating in the Euro-DEN network over 12 months (October 2013 to September 2014) with a primary presenting complaint of drug intoxication (excluding ethanol alone) and registered the epidemiological and clinical data and outcomes. RESULTS: We included 710 cases (83% males, mean age 31 years), representing 12.6% of the total cases attended for drug intoxication. Of these, 73.5% arrived at the ED by ambulance, predominantly during weekend, and 71.7% consumed GHB/GBL in combination with other substances of abuse, the most frequent additional agents being ethanol (50%), amphetamine derivatives (36%), cocaine (12%) and cannabis (8%). Among 15 clinical features pre-defined in the project database, the 3 most frequently identified were altered behaviour (39%), reduced consciousness (34%) and anxiety (14%). The severity ranged from mild cases requiring no treatment (308 cases, 43.4%) to severe cases requiring admission to intensive care (103 cases, 14.6%) and mechanical ventilation (49 cases, 6.9%). No deaths were reported. In comparison with only GHB/GBL consumption, patients consuming GHB/GBL with co-intoxicants presented more vomiting (15% vs. 3%, p<0.001) and cardiovascular symptoms (5.3% vs. 1.5%, p<0.05), a greater need for treatment (59.8% vs. 48.3%, p<0.01) and a longer ED stay (11.3% vs. 3.6% patients with ED stay >12h, p<0.01). CONCLUSIONS: The profile of the typical GHB/GBL-intoxicated European is a young male, requiring care for altered behaviour and reduced level of consciousness, mainly during the weekend. The clinical features are more severe when GHB is consumed in combination with other substances of abuse.