Preference for hotline versus mobile application/countdown-based mobile overdose response services: a qualitative study.

BACKGROUND: In response to the exacerbated rates of morbidity and mortality associated with the overlapping overdose and COVID-19 epidemics, novel strategies have been developed, implemented, operationalized and scaled to reduce the harms resulting from this crisis. Since the emergence of mobile overdose response services (MORS), two strategies have aimed to help reduce the mortality associated with acute overdose including staffed hotline-based services and unstaffed timer-based services. In this article, we aim to gather the perspectives of various key interest groups on these technologies to determine which might best support service users. METHODS: Forty-seven participants from various interested groups including people who use substances who have and have not used MORS, healthcare workers, family members, harm reduction employees and MORS operators participated in semi-structured interviews. Transcripts were coded and analyzed using a thematic analysis approach. RESULTS: Four major themes emerged regarding participant perspectives on the differences between services, namely differences in connection, perceived safety, privacy and accessibility, alongside features that are recommended for MORS in the future. CONCLUSIONS: Overall, participants noted that individuals who use substances vary in their desire for connection during a substance use session offered by hotline and timer-based service modalities. Participants perceived hotline-based approaches to be more reliable and thus potentially safer than their timer-based counterparts but noted that access to technology is a limitation of both approaches.

Recognising inaccuracies in Australian suicide and 'hidden suicide' data.

OBJECTIVE: To examine the effects of revision of Australian mortality statistics every year since 2007 on numbers and rates of suicide and 'hidden suicide'. METHOD: Nine months after the end of each year, the Australian Bureau of Statistics releases preliminary statistics concerning deaths registered in that year, together with revised and finalised data regarding previous years. Numbers and rates of suicide and of deaths coded to selected categories of accidental, undetermined and unknown cause deaths were tabled. RESULTS: Upward revision of suicide and accidental drug poisoning death numbers, three years after first release, show that true rates are substantially higher than initially released data suggested. Concomitant downward revision of rates of undetermined and unknown cause deaths supports evidence that at first release some suicides are coded to these categories. CONCLUSIONS: Australia's finalised suicide data are likely to be more accurate than equivalent data from nations that do not revise mortality data. More comprehensive investigation (including verbal or psychological autopsy) in doubtful cases in Australia and elsewhere would probably lead to reported suicide rates being higher.

Investigating uses of peer-operated Virtual Overdose Monitoring Services (VOMS) beyond overdose response: a qualitative study.

Background: Virtual overdose monitoring services (VOMS) are novel technologies that allow remote monitoring of individuals while they use substances (especially those who use alone) electronically.Objectives: The authors explored key partner perspectives regarding services offered by VOMS beyond overdose response with the aim of understanding the breadth and perception of the services amongst those that use these services and are impacted by them.Methods: Forty-seven participants from six key partner groups [peers who had used VOMS (25%), peers who had not used VOMS (17%), family members of peers (11%), health professionals (21%), harm reduction sector employees (15%), and VOMS operators (15%)] underwent 20-to-60-minute semi-structured telephone interviews. Of peer and family groups, thirteen participants identified as female, eleven as male and one as non-binary, gender data was not recorded for other key partner groups. Interview guides were developed and interviews were conducted until saturation was reached across all participants. Themes and subthemes were identified and member checked with partner groups.Results: Participants indicated that uses of VOMS beyond overdose monitoring included: (1) providing mental health support and community referral; (2) methamphetamine agitation de-escalation; (3) advice on self-care and harm reduction; and (4) a sense of community and peer support. Respondents were divided on how VOMS might affect emergency services (5).Conclusions: VOMS are currently being used for purposes beyond drug poisoning prevention, including community methamphetamine psychosis de-escalation, mental health support, and community peer support. VOMS are capable of delivering a broad suite of harm reduction services and referring clients to recovery-oriented services.

Associations with experience of non-fatal opioid overdose in British Columbia, Canada: a repeated cross sectional survey study.

INTRODUCTION: Lives lost in North America due to the unregulated drug poisoning emergency are preventable and those who survive an opioid overdose may suffer long-term disability. Rates of opioid overdose more than doubled following the onset of the COVID-19 pandemic in British Columbia, Canada. MATERIALS AND METHODS: Our analytical sample was comprised of 1447 participants from the 2018, 2019, and 2021 Harm Reduction Client Survey who responded yes or no to having experienced an opioid overdose in the past 6 months. Participants were recruited from harm reduction sites from across British Columbia. We used logistic regression to explore associations of experiencing an opioid overdose. RESULTS: Overall, 21.8% of participants reported experiencing an opioid overdose in the last six months (18.2% in 2019 and 26.6% in 2021). The following factors were positively associated with increased adjusted odds of experiencing a non-fatal opioid overdose: cis men relative to cis women (AOR 1.49, 95% CI 1.10-2.02), unstably housed compared to people with stable housing (AOR 1.87, 95% CI 1.40-2.50), and participants from 2021 compared to those from 2019 (AOR 3.06, 95% CI 1.57-5.97). The effects of both previous experience of a stimulant overdose and having witnessed an opioid overdose depended on the year of study, with both effects decreasing over subsequent years. CONCLUSIONS: Overdoses have increased over time; in 2021 more than one in four participants experienced an overdose. There is an urgent need for policy and program development to meaningfully address the unregulated drug poisoning emergency through acceptable life-saving interventions and services to prevent overdoses and support overdose survivors.

CLINICAL AND PATHOHISTOLOGICAL MANIFESTATIONS OF ACUTE KIDNEY INJURY AMONG PATIENTS WITH ACUTE DRUG POISONING (OVERDOSE).

OBJECTIVE: The aim: To investigate clinical and pathohistological manifestations of acute kidney injury among patients with drug poisoning (overdose). PATIENTS AND METHODS: Materials and methods: A cohort retrospective analysis of medical data of 86 patients treated in 2017-2021 with a diagnosis of "acute drug poisoning" com¬plicated by the development of acute kidney injury syndrome was conducted. A forensic medical examination of deceased patients (7 persons) was carried out. Histological samples were examined using an microscope OPTON Axioskop (Germany) in transmitted light, at magnifications of 100 and 400 times. Statistical analysis of the obtained data was carried out using the IBM SPSS Statistics 29.0.0.0 program, Pearson's correlation analysis was used, p≤0.05. RESULTS: Results: Acute renal failure in drug poisoning occurs under the influence of prerenal (hypoxia, r=0,66, р=0,0021; hypovolemia, r=0,61, р=0,0333) and renal factors (toxic effect of chemical components of the drug and rhabdomyolysis, r=0,743, р=0,0034). In the tissue samples, erythrocyte stasis in the capillaries, general fullness of blood vessels, signs of the sludge effect and small diapedesis hemorrhages were found; vasculitis and perivascular sclerosis are noted; foci of mononuclear infiltration of the stroma, focal edema, necrosis and interstitial fibrosis; desquamation, degenerative-dystrophic changes of the nephrothelium, tubular atrophy were found; hyaline casts in separate tubules; focal glomerular changes with segmental increase of the mesangial matrix and proliferation of endothelial cells, atrophy and hyalinosis of individual glomeruli were noted. CONCLUSION: Conclusions: The multifactorial effect of opioids is confirmed by microcirculation disorders, vascular, interstitial, tubular and glomerular changes in the kidneys.

[Rapid determination of acetaminophen in plasma by LC-MS/MS].

Objective: To establish a method for the rapid determination of acetaminophen (APAP) in human plasma by LC-MS/MS. Methods: The plasma samples were extracted by methanol and acetonitrile (1: 1) and purified directly. C(18) column was used for sample separation. The mobile phase were methanol (5 mmol/L ammonium acetate) and water (5 mmol/L ammonium acetate). Samples were analyzed by LC MS/MS with the electrospray ionization multi reaction monitoring (MRM) mode. Results: The calibration curves of APAP was linear in the concentration range of 0~10 mg/L, the correlation coefficient (r) was greater than 0.999 0. The relative standard deviation within and between batches was less than 10%. The recovery rate were 96.81%~101.7%. The detection limit of the method was 0.1 µg/L and the lower limit of quantification was 0.3 µg/L. Conclusion: This method has strong specificity, high sensitivity and reliable determination results. It is suitable for the rapid analysis of clinical plasma samples.

Suicidal and accidental drug poisoning mortality among older adults and working-age individuals in Spain between 2000 and 2018.

BACKGROUND: Although medication poisoning in older adults is considered an increasingly important, but preventable cause of death, it has received relatively little attention. We explored recent trends and correlates of suicidal and accidental fatal drug poisonings among older and working-age individuals using nationwide data from Spain. METHODS: We identified all 15,353 fatal drug poisonings involving decedents aged ≥15 years in Spain between 2000 and 2018 and divided them by age into older adults (≥65 years) and working-age (15-64 years) individuals. For each age group, we analyzed time trends in suicidal and accidental fatal drug poisoning rates (overall and by ICD-10 drug categories) using joinpoint regressions. To understand the specific drugs classified as "Non-psychotropic/non-specified", we used 2018 data including substance-specific ICD-10 supplementary codes. We explored relevant sociodemographic correlates of suicidal and accidental fatal poisoning rates using multivariable negative binomial regressions. RESULTS: Between 2000 and 2018, suicidal fatal poisonings increased faster among older (from 0.19 to 0.63 per 100,000 - average annual change: 7.7%) than working-age individuals (from 0.40 to 0.72 per 100,000 - average annual change: 3.8%). Accidental fatal poisonings increased among older adults (from 0.25 to 2.67 per 100,000 - average annual change: 16.2%) but decreased among working-age counterparts (from 2.38 to 1.42 per 100,000 - average annual change: - 1.9%). Anticoagulants and cardiac-stimulants glycosides accounted for 70% of the 223 accidental fatal poisonings due to non-psychotropic/non-specified drugs registered among older adults in 2018. Roles of gender and urban dwelling in suicidal and accidental poisonings were heterogeneous across age groups. CONCLUSION: Increases in suicidal drug poisonings were faster among older than working-age individuals. Accidental fatal poisonings increased only among older adults. Our findings that (i) sociodemographic correlates were heterogeneous across age groups and (ii) anticoagulant and cardiac-stimulant glycosides were particularly salient drivers of accidental poisonings among older adults have implications for prevention.

Sex-based differences in timely emergency department evaluations for patients with drug poisoning.

OBJECTIVES: Unintentional poisoning was the leading cause of injury-related death in the United States in 2017. Prescribed and illicit drugs are the most common cause of poisoning, and timely management in the emergency department (ED) is important. Our aim was to identify any disparities in wait times associated with sex for drug poisoning-related ED visits. STUDY DESIGN: We examined ED visits using data from the 2009-2017 National Hospital Ambulatory Medical Care Survey (NHAMCS). METHODS: Drug poisoning-related visits were identified using the International Classification of Diseases, Ninth or Tenth Revision, Clinical Modification codes. Delayed assessment was defined as wait times exceeding the recommended triage time. Weighted logistic regression was used. RESULTS: The average age was 36 years (standard error = 1.1), 54% female, 87% White and 29% had delayed assessment. Most common drugs were psychotropics (45%) and opioids (32%). Adjusting for race, payment source, urgency, multiple drug types and NSAIDs, females who had poisoning by substances other than opioids had 2.1 times higher likelihood of having a delayed assessment compared with males (odds ratio [95% confidence interval]: 2.1 [1.03-4.2]), although there was no difference between sexes among visits with opioid poisoning (P = 0.27). Neither race (P = 0.23) nor payment source (P = 0.22) were associated with delayed assessment, and the sex association was consistent across these groups. CONCLUSIONS: Females with non-opioid drug poisoning were more likely to have delayed assessment than men. None of the other demographic factors demonstrated a correlation. Identifying more populations vulnerable to delays in the ED can help guide the development of interventions and policies to expedite care and attenuate existing disparities.

[Prognostic criteria for the forensic diagnosis of acute drug poisoning at the stage of study of corpse]. / Prognosticheskie kriterii sudebno-meditsinskoi diagnostiki ostrykh otravlenii narkotikami na etape issledovaniya trupa.

We studied the morphological criteria that allow us to assess the need to send biological material to a forensic chemical study based on the results of a forensic medical study of a corpse in cases of suspected acute drug poisoning. According to a statistical analysis, it was determined that under the condition of death with a fast agonal period, the most characteristic prognostic signs of acute drug poisoning are young age, the presence of traces of injections and/or «wells¼, lung mass more than 1050 g, the sum of the size of the spleen exceeding 25. The use of a combination of the three indicated characteristic signs encountered in acute drug poisoning can increase the likelihood of detecting acute poisoning with psychoactive substances. Taking into account the tendency of recent years to increase the age of drug users, the possibility of using exclusively morphological characters has been objectively proven while maintaining the specificity of the diagnosis of acute drug poisoning.

Geospatial Analysis of Drug Poisoning Deaths Involving Heroin in the USA, 2000-2014.

We investigate the geographic patterns of drug poisoning deaths involving heroin by county for the USA from 2000 to 2014. The county-level patterns of mortality are examined with respect to age-adjusted rates of death for different classes of urbanization and racial and ethnic groups, while rates based on raw counts of drug poisoning deaths involving heroin are estimated for different age groups and by gender. To account for possible underestimations in these rates due to small areas or small numbers, spatial empirical Baye's estimation techniques have been used to smooth the rates of death and alleviate underestimation when analyzing spatial patterns for these different groups. The geographic pattern of poisoning deaths involving heroin has shifted from the west coast of the USA in the year 2000 to New England, the Mid-Atlantic region, and the Great Lakes and central Ohio Valley by 2014. The evolution over space and time of clusters of drug poisoning deaths involving heroin is confirmed through the SaTScan analysis. For this period, White males were found to be the most impacted population group overall; however, Blacks and Hispanics are highly impacted in counties where significant populations of these two groups reside. Our results show that while 35-54-year-olds were the most highly impacted age group by county from 2000 to 2010, by 2014, the trend had changed with an increasing number of counties experiencing higher death rates for individuals 25-34 years. The percentage of counties across the USA classified as large metro with deaths involving heroin is estimated to have decreased from approximately 73% in 2010 to just fewer than 56% in 2014, with a shift to small metro and non-metro counties. Understanding the geographic variations in impact on different population groups in the USA has become particularly necessary in light of the extreme increase in the use and misuse of street drugs including heroin and the subsequent rise in opioid-related deaths in the USA.

Epidemiology of overdose episodes from the period prior to hospitalization for drug poisoning until discharge in Japan: An exploratory descriptive study using a nationwide claims database.

BACKGROUND: Little is known about the nationwide epidemiology of the annual rate, causative substance, and clinical course of overdose-related admission. We aimed to describe the epidemiology of overdose episodes from the period prior to hospitalization for drug poisoning until discharge to home. METHODS: We assessed all cases of admission due to overdose (21,663 episodes) in Japan from October 2012 through September 2013 using the National Database of Health Insurance Claims and Specific Health Checkups of Japan. RESULTS: The annual rate of overdose admission was 17.0 per 100,000 population. Women exhibited two peaks in admission rates at 19-34 years (40.9 per 100,000) and ≥75 years (27.8 per 100,000). Men exhibited one peak in the admission rate at ≥75 years (23.7 per 100,000). Within 90 days prior to overdose, ≥60% and ≥9% of patients aged 19-49 years received a prescription for benzodiazepines and barbiturates, respectively. In addition, 59% of patients aged ≥75 years received a prescription for benzodiazepines prior to overdose, 47% had a history of congestive heart failure, and 24% had a diagnosis of poisoning by cardiovascular drugs. The proportion of patients with recent psychiatric treatments decreased with age (65.1% in those aged 35-49 years and 13.9% in those aged ≥75 years). CONCLUSIONS: The findings emphasize the need for overdose prevention programs that focus on psychiatric patients aged 19-49 years who are prescribed benzodiazepines or barbiturates and on non-psychiatric patients aged ≥75 years who are prescribed benzodiazepines or digitalis.

Fatal Overdoses of Opioids in Israel 2005-2014.

AIMS: To explore previously unreported rates and trends in opioid-related mortality in Israel, 2005-2014. METHODS: Data was obtained from the national database on causes of death. Drug poisoning deaths were divided into opioid-related deaths and deaths related to other drugs according to International Classification of Diseases (ICD)-10 code of underlying cause, and included drug poisoning of accidental, intentional or undetermined intent. Age-adjusted rates were calculated per 100,000 population. Rate ratios were calculated and a logistic model constructed to compare the risk of opioid-related deaths in both halves of the decade (2006-2009 and 2009-2013) and between various demographic groups. RESULTS: While age-adjusted rates of deaths related to other drugs remained relatively stable, rates of opioid-related deaths significantly decreased during this period across all groups. During the study period, the number of opioid-related deaths in Israel declined from 1.3 to 0.3 per 100,000. Opioid-related deaths were more common among men, young adults and immigrants from the Former Soviet Union. CONCLUSIONS: Rates of opioid-related deaths in Israel were low compared to those reported in the United States and United Kingdom. In addition, the decline in opioid-related deaths in Israel is contrary to trends observed in the United States and United Kingdom. Factors that may contribute to these differences are discussed.

Recent Overdose Experiences in a Community Sample of Military Veterans Who Use Opioids.

Rising rates of overdose mortality underscore the importance of understanding and preventing overdose. We developed a seven-item scale for the assessment of nonfatal opioid-related overdose experiences, adding items on others' perceptions of whether the participant had overdosed and whether an intervention was attempted to frequently used criteria. We administered the scale to 240 primarily male and minority veterans, recruited using venue-based and chain-referral sampling, who separated from the military post-9/11 and reported current opioid use. The items were internally consistent, and correlated well with overdose risk behaviors (r = .13-.45). The new scale detected overdose events in a significantly higher proportion of participants (36.5%) than that using either self-report criterion (18.2%) or difficulty breathing and losing consciousness criteria (23.8%). These experiences or perceptions should be investigated to inform and better tailor the development of more effective overdose prevention and response programs.

Drug poisoning and associated factors in western Saudi Arabia: A five-year retrospective chart review (2011-2016).

OBJECTIVE: Drug poisoning is a globally common cause of emergency-room admissions. This study explores drug-poisoning prevalence patterns, associated risk factors (gender, age and exposure circumstances), and outcomes in western Saudi Arabia. METHODS: Retrospective analysis of Clinical drug poisoning cases (2011-2016). The data were retrieved from the Saudi Ministry of Health's record and Patients' medical charts were analyzed. RESULTS: The Ministry of Health received 1,474 reports of drug poisoning during 2011-2016. More than half involved females (n=885, 60%) or young children (0-4 years old) (n=764, 51.8%) and occurred accidentally (n=786, 53.3%); almost all had an oral route of poisoning (n=1,466, 99.5%). The cases most frequently involved analgesic and non-steroidal anti-inflammatory drugs (n=373, 25.2%); antiepileptic, antipsychotic, psychoactive, and anxiolytic drugs (n=229, 16.3%); antihistamine, asthma, flu, and cough drugs (n=157, 12.0%); and antibiotic, anti-fungal; and antiprotozoal drugs (n=74, 5.0%). Antidotes were administered in only 2.2% of cases, and no deaths were reported. CONCLUSION: The drug poisoning cases involved females and young children (younger than 5 years old) and the most cases were accidental, and the most commonly used drugs were analgesics (Panadol), followed by antipsychotics, antihistamines, and antiepileptics (Tegretol).

Drug poisoning deaths in the United States, 1999-2012: a statistical adjustment analysis.

BACKGROUND: Drug poisoning mortality in the US has risen rapidly but the drugs involved are frequently unspecified on death certificates. METHODS: Reported and adjusted proportions of specific drug types involved in fatal drug poisonings were calculated using vital statistics mortality data from 1999 to 2012. The adjusted proportions were those predicted to occur if at least one specific type of drug had been identified on the death certificates of all poisoning fatalities. RESULTS: Adjusted involvement rates of opioid analgesic mentions in 2012 were 54.3 % (95 % confidence interval [CI]: 53.6 %-55 %), 40.8 % higher than the reported 38.6 % rate. Adjusted rates for all narcotics, other narcotics, sedatives, or psychotropics, and multiple drug use were 81.5 % (95 % CI: 80.9 %-82.2 %), 38.4 % (95 % CI: 37.8 %-39 %), 30 % (95 % CI: 29.4 %-30.7 %), 26 % (95 % CI: 25.4 %-26.6 %) and 42.8 % (95 % CI: 42.1 %-43.5 %) in 2012, compared to reported proportions of 60.7, 27.9, 18.7, 18 and 26.9 %. The adjustments typically had similar or slightly smaller effects on the estimates in 1999, and larger impacts on subcategories of drug types such benzodiazepines and antipsychotic medications. Based on the adjusted proportions, 22,534, 15,933, 12,457, 10,798, and 17,670 drug deaths in 2012 were estimated to involve opioid analgesics, other narcotics, sedatives, psychotropic medications, and drug combinations, compared to death certificate reports of 16,007, 11,567, 7,754, 7,467, and 11,176. CONCLUSIONS: Death certificates substantially understate the involvement of opioid analgesics, sedatives, psychotropics, and drug combinations in fatal drug poisonings. Adjustment procedures that account for cases where only unspecified drugs are reported on death certificates provide more accurate information.

Volatile substance misuse deaths in Washington State, 2003-2012.

BACKGROUND: Volatile substance misuse (VSM - also known as huffing or sniffing) causes some deaths, but because there are no specific cause-of-death codes for VSM, these deaths are rarely tabulated. OBJECTIVES: Count and describe VSM deaths occurring in Washington State during 2003-2012. METHODS: We used the textual cause-of-death information on death certificates to count VSM-associated deaths that occurred in Washington State during 2003-2012. We extracted records that contained words suggesting either a method of inhalation or a substance commonly used for VSM, and reviewed those records to identify deaths on which the inhalation of a volatile substance was mentioned. We conducted a descriptive analysis of those deaths. RESULTS: Fifty-six deaths involving VSM occurred in Washington State during 2003-2012. VSM deaths occurred primarily among adults age 20 and over (91%), males (88%), and whites (93%). Twelve different chemicals were associated with deaths, but 1 of them, difluoroethane, was named on 30 death certificates (54%), and its involvement increased during the study period. Gas duster products were named as the source of difluoroethane for 12 deaths; no source was named for the other 18 difluoroethane deaths. CONCLUSIONS: Most VSM deaths occurred among white male adults, and gas duster products containing difluoroethane were the primary source of inhalants. Approaches to deter VSM, such as the addition of bitterants to gas dusters, should be explored.

Exploring Prospective Predictors of Illicit Drug-Toxicity Deaths: Evidence From the General Social Survey.

BACKGROUND: This study was based on over 30,000 U.S. respondents who completed General Social Surveys between 1978 and 2002. AIMS: We approached these respondents prospectively, comparing and contrasting the responses of those who subsequently died from drug-poisonings (N = 135) with all respondents who were still living, N = 23,559. METHOD: We employed cross-tabulation and logistic regression analyses to test for statistically significant differences between drug-poisoning death casualties and all living respondents. RESULTS: Consistent with past research findings, younger males were over-represented among drug death casualties. Also consistent with past studies, drug casualties showed evidence of perceiving themselves as socially marginalized in comparison to living respondents: More reported themselves in poorer health, as having been sexual minority members during the last 5 years, as having spent their younger years in homes where parents' marriages disrupted, with fewer owning homes and feeling less satisfied about their financial situations. CONCLUSIONS: These exploratory findings obtained from a general population survey reinforce findings from clinical studies and help advance clinical assessments of potential at-risk individuals who might be identified sooner, lest they succumb to future fatal drug poisonings.

Accuracy of the Infectious Diseases Society of America and British Thoracic Society Criteria for Acute Pneumonia in Differentiating Chemical and Bacterial Complications of Aspiration in Comatose Ventilated Patients Following Drug Poisoning.

Drug poisoning frequently leads to admission to intensive care units, often resulting in aspiration, a potentially life-threatening condition if not properly managed. Aspiration can manifest as either bacterial aspiration pneumonia (BAP) or aspiration pneumonitis (AP), which are challenging to distinguish potentially leading to overprescription of antibiotics and the emergence of multidrug-resistant bacteria. This study aims to assess the accuracy of the Infectious Diseases Society of America (IDSA) and British Thoracic Society (BTS) criteria in differentiating BAP from AP in comatose ventilated patients following drug poisoning. This cross-sectional study included 95 patients admitted for drug poisoning at the Lille University Hospital intensive care department, between 2013 and 2017, requiring mechanical ventilation and receiving antibiotics for aspiration. Patients were categorized as having bacterial complications if tracheal sampling yielded positive culture results, and if they were otherwise considered to have chemical complications. The sensitivity, specificity, positive predictive value, and negative predictive value of IDSA and BTS criteria in identifying patients with bacterial complications were evaluated. Among the patients, 34 (36%) experienced BAP. The IDSA criteria demonstrated a sensitivity of 62% and specificity of 33%, while the BTS criteria showed a sensitivity of 50% and specificity of 38%. Both the IDSA and BTS criteria exhibited poor sensitivity and specificity in identifying microbiologically confirmed pneumonia in comatose ventilated patients following drug poisoning.

A case of lacosamide and mirtazapine self-poisoning.

Lacosamide is a relatively new antiepileptic drug that exerts its anticonvulsant effect by selectively inactivating sodium channels. Since its launch, it has been used widely for the treatment of intractable epilepsy, but there are scant data on the toxic or lethal blood concentrations. Here, we report a case of drug poisoning following simultaneous high-dose self-administration of lacosamide and mirtazapine. We developed and validated an approach that uses liquid chromatography coupled with electrospray ionization-tandem mass spectrometry to determine the concentrations of lacosamide and mirtazapine in cadaveric blood, urine and liver. Calibration curves showed good linearity (r2 > 0.995), and our method enabled repeatable and accurate quantification, with intra- and inter-assay coefficients of variation not exceeding 10.9 % and 12.8 %, respectively, for each target drug. We used the method to measure the drug concentrations in the blood of a dead victim and found a lacosamide concentration of 91.9 µg/mL and a mirtazapine concentration of 12.0 µg/mL. The blood mirtazapine concentration was in the lethal range, and that of lacosamide was about 10 times the therapeutic range. The synergistically central nervous system depressive and cardiotoxic effects of these drugs may have contributed to the cause of death. We concluded that the cause of death in this case was lacosamide and mirtazapine poisoning.

Prediction of naloxone dose in opioids toxicity based on machine learning techniques (artificial intelligence).

BACKGROUND: Treatment management for opioid poisoning is critical and, at the same time, requires specialized knowledge and skills. This study was designed to develop and evaluate machine learning algorithms for predicting the maintenance dose and duration of hospital stay in opioid poisoning, in order to facilitate appropriate clinical decision-making. METHOD AND RESULTS: This study used artificial intelligence technology to predict the maintenance dose and duration of administration by selecting clinical and paraclinical features that were selected by Pearson correlation (filter method) (Stage 1) and then the (wrapper method) Recursive Feature Elimination Cross-Validated (RFECV) (Stage2). The duration of administration was divided into two categories: A (which includes a duration of less than or equal to 24 h of infusion) and B (more than 24 h of naloxone infusion). XGBoost algorithm model with an accuracy rate of 91.04%, a prediction rate of 91.34%, and a sensitivity rate of 91.04% and area under the Curve (AUC) 0.97 was best model for classification patients. Also, the best maintenance dose of naloxone was obtained with XGBoost algorithm with R2 = 0.678. Based on the selected algorithm, the most important features for classifying patients for the duration of treatment were bicarbonate, respiration rate, physical sign, The partial pressure of carbon dioxide (PCO2), diastolic blood pressure, pulse rate, naloxone bolus dose, Blood Creatinine(Cr), Body temperature (T). The most important characteristics for determining the maintenance dose of naloxone were physical signs, bolus dose of 4.5 mg/kg, Glasgow Coma Scale (GCS), Creatine Phosphokinase (CPK) and intensive care unit (ICU) add. CONCLUSION: A predictive model can significantly enhance the decision-making and clinical care provided by emergency physicians in hospitals and medical settings. XGBoost was found to be the superior model.