Wildflower (Hyoscyamus reticulatus) causes QT prolongation.

INTRODUCTION: In the environment, there are hundreds of poisonous and injurious plants with a wide variety of toxicity. Among all plants with anticholinergic effect, Hyoscyamus reticulatus is a species whose clinicopathological effects have been poorly described in literature. The paper is especially aimed at drawing attention to the possibly fatal syndrome of prolonged QT, as well as to clinical and laboratory changes in six members of a single family poisoned with this plant. CASES: Six female patients aged from 19 to 49 presented to our emergency room with a suspicion of being poisoned after having ingested a plant known as 'the mad axe plant' (Hyoscyamus reticulatus). At least one of anticholinergic symptoms including flushing, mydriasis, dry mouth and tachycardia was present in all of the patients. In addition, different levels of agitation were observed in four of the patients. A euphoric emotional state was present in two patients. The corrected QT distances were found to be prolonged in three of the patients. DISCUSSION AND CONCLUSION: Based on economical, social and cultural reasons, it is a very common habit in our country, especially in our region in spring and summer months, to consume some plants growing spontaneously in rural areas as food. Intoxication with Hyoscyamus reticulatus is a plant poisoning that is poorly described in literature. Its classical symptoms are predominantly anticholinergic. Although it is commonly self-limited and can be corrected with close observation and supportive treatments, it should be kept in mind that the prolongation of QT interval can accompany the symptoms of poisoning with this plant (Tab. 1, Fig. 3, Ref. 19).

The main differences in oral exposures in children and adults.

OBJECTIVES: This study aimed to determine the epidemiological differences between children and adult oral exposures in patients admitted to the busiest emergency department (ED) in the Eastern Anatolia region of Turkey. METHODS: The characteristics of 1950 patients were investigated retrospectively and in a cross-sectional manner in a two-year period. RESULTS: The ratio of poisoning exposures among all emergency admissions was 0.6%. Of these, 44.5% were children, and 54.4% were unintentional. The mortality rate was 0.1% and the rate of hospitalization was 14.9%. Among the children and adults, 50.3% and 29.5% were male, respectively. While the first two causes of exposures in both children and adults were licit drugs and foods, there were differences in other causes. Among causes, licit drugs and corrosive materials constituted the forefront in the 0-1 and 1-5-year age groups. In parasuicidal causes, the most common exposure was found to be licit drugs, followed by organophosphates. The most common cause of hospitalization was plants (60.5%). The hospitalization rate was found to be significantly high in males and unintentional exposures. The rate of admissions to the psychiatry polyclinic following exposure was 15%. CONCLUSION: This study hereby presents the original findings as to predict the problems in exposures. The distribution of etiological agents and suicidal intent rate may differ among pediatric and adult population (Tab. 4, Fig. 1, Ref. 50).

What are the predictors of scapula fractures in high-impact blunt trauma patients and why do we miss them in the emergency department?

AIM: To find out the predictors of scapula fractures in high-impact blunt trauma patients and the predictors of missing them in the emergency department (ED). METHODS: This is a retrospective descriptive review of patients treated at a single hospital over a 3.5-year period. The study included 1,039 high-impact blunt trauma patients of any age. The patients were divided into two groups: patients with scapula fractures (the patient group) and others (the control group). The patient group was re-assessed into two subgroups: patients with and without missed scapula fractures. Logistic regression analysis was used to assess the predictors of a scapular fracture in the ED. RESULTS: The incidence of scapula fractures was 4%. The Injury Severity Scores (ISS) of the scapula fracture group were significantly higher than those of the control group (P < 0.0001). Patients with scapula fractures were significantly older (P < 0.001). Patients with scapular body fractures stayed for significantly longer in the intensive care unit (ICU) (P = 0.039) and their mean Abbreviated Injury Scale (AIS)face score was higher (P = 0.04) compared to scapular fractures without body parts. Scapula fractures were missed in 35.7% of patients. All bilateral scapula fractures were missed. Computerized tomography showing shoulder region or scapula was obtained in 26.7% of missed injuries. CONCLUSION: After matching for ISS, the mortality of patients with scapula fracture was significantly higher than the control group. We observed that fractures in the glenoid and scapular neck occurred higher than in the body region. We found that the seniority of the ED doctor, consultation ratio for orthopedics in ED, and the existence of brain contusion were important parameters for missing scapula fractures in ED.