Iatrogenic cyanoacrylate glue-induced eye injuries in the pediatric population: A national multicenter retrospective descriptive study.

Context: To date, there are no publicly available schemes designed and evaluated specifically for severity assessment of animal poisonings. This poses challenges for the evaluation and comparison of animal poisoning exposure data.Objective: Our objective for this pilot study was to evaluate agreement between raters using the Poisoning Severity Score (PSS) and National Poison Data System (NPDS) medical outcome scheme for severity assessment of canine exposures reported to a multistate poison center (PC) and to identify issues regarding their use for severity assessment of animal poisonings. Agreement between both schemes was also assessed.Methods: The first 196 canine exposures reported to a multistate PC between 1 January and 31 August 2016 were selected and initial inquiry data from exposures was scored by four independent raters. Interrater agreement and agreement between the severity systems was calculated using weighted kappa (Κ) (Light’s kappa). Reported clinical effects were also described.Results: Interrater agreement for both the PSS (Κ 0.31; 95% CI 0.19, 0.43) and NPDS schemes (Κ 0.34; 95% CI 0.22, 0.44) was low. Agreement between the schemes was slight (Κ 0.05; 95% CI −0.08, 0.16) for pooled results from all four raters. For the PSS, 71.7% (n = 281) of ratings were minor, 23.0% (n = 90) moderate, and 5.4% (n = 21) severe. For the NPDS, 69.6% (n = 273) of ratings were minor, 27.0% (n = 106) moderate, and 3.3% (n = 13) severe. The top three reported clinical effects included vomiting (n = 86, 29.9%) drowsiness/lethargy (n = 38, 13.2%), and diarrhea (n = 24, 8.3%).Discussion and conclusions: This study shows considerable variability between raters using either the PSS or NPDS schemes for canine exposures severity assessment. The subjective nature of the schemes, the influence of intra- and interrater variation, and predominance of minor cases on the study findings should be taken into account when interpreting this data. Further evaluation of these schemes is warranted and could help inform their future use for animal poisoning severity assessment.

Automatic dishwashing rinse aids are drying aids which contain non-ionic surfactants, usually ethoxylated alcohols, typically at concentrations of ≤30%. To assess the reported toxicity of rinse aids. Telephone enquiries to the UK National Poisons Information Service were analysed from January 2008 to June 2019. Ingestion: Ingestion was involved in 976 cases and produced gastrointestinal features, coughing and central nervous system depression, particularly in young children. In those in whom the amount ingested was known, the majority (56%) of children <18 years and of adults (57%) ingested <50 mL of rinse aid. Although moderate or severe exposures (Poisoning Severity Score (PSS) ≥ 2) were uncommon, they occurred significantly (p < 0.0008) more often in adults (9.0%) than in children (1.8%); however, three of the four adults with PSS ≥ 2 co-ingested other substances. Eye exposure: Ocular exposure was reported in 35 cases, of whom 29 developed features. Eye irritation (n = 10, 28.6%) and eye pain (n = 10, 28.6%) were reported most commonly, and three patients (8.6%) developed corneal abrasions (PSS 2). Dermal exposure: Thirty-four patients were exposed dermally, and six (17.6%) reported features, including rash, numbness, pruritus and burns (PSS 1). Overall, clinical features developed in 47% of patients exposed to rinse aids, but more severe features (PSS ≥ 2) were rare (<3%) following exposure by any route.

Background and aims: Poisoning represents a significant public health concern in the developing world. This study aimed to investigate the epidemiology, severity, and factors associated with poisoning incidents in the rural regions of western India. Methods: The required data were retrospectively collected from patients admitted to a private 20-bed rural hospital located in Pune, India, for acute poisoning between 2015 and 2019. The study examined patient characteristics, routes and types of exposure, and associated outcomes. Severity assessments were conducted using the Poison Severity Score (PSS) and the Glasgow Coma Scale (GCS) poisoning severity systems. Statistical analyses were performed using the Kruskal-Wallis and chi-square tests. Results: Overall, 386 cases of poisoning were analyzed in this study. The primary sources of poisoning were accidental incidents or envenomation (48.9%), followed by intentional poisoning (42.2%). Poisoning of unknown origin accounted for 8.8% of cases. In terms of the route of exposure, bites or stings (50.7%) were the most common, followed by ingestion (48.7%) and inhalation (0.5%). According to the GCS, mortality was observed in 33% of patients with severe poisoning compared to 15% of those with moderate-grade poisoning. Based on the PSS, 10.5% of patients classified with severe grades of poisoning experienced mortality. All patients with mild severity of poisoning survived and were subsequently discharged from the hospital. An intermediate correlation was observed between GCS and PSS (r=0.54, P≤0.001). The overall mortality rate was 3.6% (14 out of 386), while six patients were discharged against medical advice. Conclusion: The findings revealed that the outcomes of poisoning incidents are influenced by patient characteristics, the nature of toxic exposure, and access to an adequate quality of care. Both the GCS and the PSS are effective in predicting clinical severity in patients with poisoning. However, the PSS would benefit from modifications to account for cardiovascular and neurological variables.

Mood-stabilizer drugs are associated with a considerable incidence of morbidity and mortality. This study aimed to assess the pattern, severity, and outcomes of poisoning with acute mood stabilizer drugs among admitted patients to Tanta University Poison Control Center, Egypt between January 2021 and September 2023. This cross-sectional study was conducted in patients with acute mood stabilizer drug poisoning. Data from electronic medical records were observed. The poison severity score (PSS) assessed the severity of the patients. Primary outcomes were the pattern and severity assessment. Secondary outcomes included the incidence of mortality, the need for intensive care unit (ICU) admission, the need for intubation and mechanical ventilation, the incidence of complications, and the duration of hospital stay. A total of 67 patients with acute poisoning of mood stabilizers were included. Poisoning with carbamazepine accounted for 58.2% of all mood stabilizers, followed by valproic acid (29.8%), lithium (7.5%), and lamotrigine (4.5%). The highest proportion of patients were young, females, with intentional poisoning and were classified as mild to moderate poisoning based on PSS. There were significant statistical associations between PSS and the need for ICU admission, development of complications, and length of hospital stay among poisoned patients with carbamazepine or valproic acid. Carbamazepine poisoning and valproic acid poisoning were the most common mood stabilizers compared to lithium and lamotrigine poisoning. In acute carbamazepine and valproic acid poisoning, the PSS is a relevant score that could predict the need for ICU admission, the development of complications, and the duration of hospital stays.

Background: Toxicity by synthetic cannabinoids (SCs) is increasing steadily with limited data concerning their use. Serious adverse effects after acute exposure to SCs include myocardial ischemia, stroke, seizures, coma, and acute kidney injury. Aim: Characterization of the epidemiological pattern of acute toxicity by SCs in patients presented to Poison Control Center of Ain Shams University hospitals (PCC-ASUH), Cairo, Egypt; from January 2018 to June 2019, and severity assessment using poisoning severity score (PSS). Methods: A cross-sectional study included adult patients presented to emergency department of PCC-ASUH from January 2018 to June 2019, with history of acute exposure to SCs. Results: About 541 patients attended the PCC-ASUH with history of acute SCs toxicity and only 448 patients were enrolled to our study. Males outnumbered females (96.43 versus 3.57%, respectively). Strox predominated (72.54%) followed by voodoo (27.45%). Recorded PSS was minor in 42.63% of patients, moderate in 18.97% and severe in 5.36%. Two patients (0.45%) died. Metabolic abnormalities predominated (60%), followed by gastrointestinal manifestations (46.2%). Conclusion: Incidence of SCs toxicity has recently increased. Several variables could worsen PSS in acute SCs poisoning like age, sex, type of SCs, co-ingestion, medical comorbidities, and respiratory acidosis. Recommendations: Early combination of PSS and arterial blood gas analysis could help in identifying patients at risk for acute SCs toxicity.

Tibial eminence fractures can occur in adults and are equivalent to an acute ACL rupture. The purpose of this retrospective study was to compare the therapeutic outcomes of ARIF versus ORIF in tibial eminence fractures. Our hypothesis was that ARIF does not offer better results. A retrospective national multicentric study was conducted in five university hospitals between 2010 and 2015. A total of 65 consecutive patients were included. 33 patients were treated with ARIF and 32 with ORIF. Clinical functional outcomes were assessed using the Lysholm score and IKDC score. Radiographic findings were recorded, and a statistical analysis carried out. IKDC score at the mean last follow-up of 68.8 ± 11.8months was significantly higher in the ORIF group with a mean difference of 20.2 points ± 8.9 (p = 0.028). There were early osteoarthritis findings in 12 patients (18.4%). At last follow-up, 7 patients (10.7%) presented complications. In this retrospective multicentric study, better functional outcomes were observed in the ORIF group. This difference needs to be carefully interpreted as many confounding factors exist. In terms of complications, the results for both ORIF and ARIF are similar at midterm follow-up. ORIF should remain gold standard for tibial eminence fracture treatment. III.

Background:In Egypt, cannabis is on the top list of the substances abused according to statistics of Fund for Drug Control and Treatment of Addiction.Its widespread use translates to greater access for children.Cannabis intoxication in young children can cause encephalopathy and coma.Aim: to evaluate the prevalence of acute cannabis intoxication in pre-school children (less than 6yrs) in Egypt; analysis of different factors related to the problem, clinical picture, management, assessment of severity and outcome of the problem by poison severity score (PSS).Method: prospective observational cross sectional study carried on all pre-school children (less than 6yrs) of both sex who admitted to PCC-ASUH, during the period from first of March 2019 to the end of December 2019, with history of acute cannabis intoxication and confirmed by cannabis positive screen.Results: The prevalence of acute cannabis intoxicated pre-school children (less than 6yrs) was 89.9%.The mean age was (17.38 month ±8.75).Fifty four percentages were males.As regard PSS, the majority of patients (55.1%) were of group II, while (31.4%) were of group I & (13.5%) were of group III.Regarding clinical manifestations; tachycardia observed in (5.8%), hypertension in (13.5%), tachypnea (18%), drowsiness (31.4%), muscle rigidity (21.5%), extra-pyramidal manifestations presented in (21.5%), coma grade I in (67.7%), coma grade II in (0.9%), respiratory distress in (1.8%), vomiting in (17.9%), mydriasis in (13%), miosis in (18.8%), flushed skin (12.1%) and respiratory acidosis (26.5%) of patients .ICU admission occurred in (68,7%) of patients and the majority were admitted ≥24 hours (65.9%).Conclusions: The prevalence of acute cannabis toxicity in pre-school children (less than 6yrs) has dramatically increased.Severity of acute cannabis intoxication in pre-school children(less than 6yrs) can be evaluated simply by using PSS.Recommendation: Public education is very necessary to decrease the problem.Early arterial blood gas analysis with careful neurological examination could help in identifying patients at risk.

To make an accurate diagnosis of poisoning and determine the severity of poisoning quickly without losing time are critical for managing the patient's medical treatment and predicting the prognosis. This study aimed to investigate PSS and Glasgow Coma Scale Score (GCS) effectiveness in predicting outcomes in acute pediatric poisoning. We retrospectively reviewed the data of intoxicated patients aged under 18 years who were admitted to the pediatric emergency service of Ondokuz Mayıs University Faculty of Medicine Clinical Research and Practice Hospital between January 1, 2018, and December 31, 2018. Two hundred twenty-two patients were admitted to our pediatric emergency department (ED) after drug ingestions. Of the patients enrolled in the study, 148 (66.7 %) were female, and 74 (33.3%) were male. The mean age was 105.8±75.3 months, and the median age was 65 (12-213) months. 96 (43.3%) poisoning cases were in the age range of 12-18 years. According to Poisoning Severity Score, it was found that 84 cases (37.4%) were asymptomatic (PSS score=0), 86 cases (38.7%) were minor (PSS score=1), 48 cases (21.6%) were moderate (score=2) and four cases (1.8%) were severe (PSS score=3). Combined using the Poisoning Severity Score with the patient's biochemical and physiological values may help improve an accurate diagnosis of poisoning and determine the severity of poisoning more accurately.

Spinal muscular atrophy with respiratory distress type 1: A multicenter retrospective study

Assessment of severity and outcome of poisoning before and during the era of COVID-19 pandemic

Pancreatic head cancer accompanied by obstructive jaundice is a common clinical situation. The aim of this study was to assess the impact of preoperative biliary drainage (PBD) on clinical outcomes in patients with severe obstructive jaundice. Patients with a bilirubin level of ≥250 μmol/L at diagnosis who underwent PBD were included. The primary endpoints and secondary endpoints were the postoperative severe complications rates. Secondary endpoints were the degree of improvement in general condition, predictors of severe postoperative complications, and the impact of PBD on patients with bilirubin levels >300 μmol/L. In total, 289 patients were included, and 188 patients (65.1%) underwent PBD. The patients who met the American Society of Anesthesiologists (ASA) classification II-III stages decreased from 119 to 100 ( P = 0.047) after PBD. The overall severe complications were significantly more frequent in the direct surgery (DS) group than in the PBD group (34.7% vs. 22.9%, P = 0.031), especially the postoperative hemorrhage (6/43 [14.0%] vs. 9/35 [25.7%], P = 0.038) and intra-abdominal infection (6/43 [14.0%] vs. 10/35 [28.6%], P = 0.018). The ASA classifications II-III (odds ratio [OR]=2.89, 95% confidence interval [CI]: 1.38-4.31), P = 0.01) and DS (OR = 3.65, 95% CI: 1.45-7.08; P = 0.003) were independently associated with severe postoperative complications. The occurrence rate of severe postoperative complications in patients with a bilirubin level >300 μmol/L who underwent PBD was significantly lower than in patients who underwent DS (25.6% vs. 40.6%, P = 0.028), but the benefit of PBD was not observed in patients who had a bilirubin level between 250 and 300 μmol/L. PBD is useful in reducing severe postoperative complications, especially in patients with bilirubin levels >300 μmol/L.

Introduction Cocaine use has increased significantly over the past three decades. This study aimed to analyze cases of cocaine intoxication involving body packing and body stuffing, focusing on symptomatology, treatment, and clinical outcomes. Methods A retrospective analysis was performed of cases of cocaine poisoning recorded in the French national poison center database over a five-year period (2020–2024). Extracted data included demographics, amount and route of cocaine concealment, number of pellets, clinical presentation, management, outcomes, location of arrest, and packaging type. An ordinal logistic regression was conducted to identify factors associated with poisoning severity, using the Poisoning Severity Score as the dependent variable. Results Among 2,534 cases of cocaine intoxication, 146 involved body packers or body stuffers: 73 body packers and 73 body stuffers. The male-to-female ratio for body packers was 3.3:1, and for body stuffers, it was 72:1, with only one female. The median age of body packers was 25.5 years (range: 17–62 years) and for body stuffers, 28.2 years (range: 16–58 years). Body packers ingested between one and 190 pellets, while body stuffers ingested between one and ten pellets, each containing cocaine 1-15 g. Symptoms included gastrointestinal, cardiovascular, neurological, and respiratory effects. One death occurred among body packers, and two among body stuffers. Age was a significant predictor of severity, with older individuals at higher risk of severe outcomes. Discussion Cocaine intoxication in body packers and stuffers presents serious health risks. Body packers ingested larger quantities with more secure packaging, while body stuffers ingested smaller amounts but used less secure methods, often due to law enforcement urgency. Despite differences in ingestion patterns, both groups showed similar symptoms, with older body packers more likely to experience severe effects. Conclusion While severe complications were rare, cocaine intoxication in both body packers and stuffers can be fatal, highlighting ongoing public health risks related to cocaine trafficking and the need for timely medical intervention.

Intoxications pédiatriques par les triptans : revue des cas recensés au centre antipoison de Lille (2000–2010)

Objectives: Acute drug poisoning represents a significant public health issue among the pediatric population. The aim of this study was to evaluate the characteristics of drug poisoning in children and adolescents in the Vojvodina region from 2018 to 2023. Methods: In a retrospective observational study, 82 patients with confirmed drug poisoning were included, and data was collected regarding demographic characteristics, clinical manifestations, types of drugs involved, and the therapeutic interventions administered. The severity of poisonings was evaluated using the Poisoning Severity Score, and toxicological analysis was performed using gas chromatography-mass spectrometry. Results: The results indicated that poisonings were most prevalent in adolescent girls (72%), with 78% of cases resulting from intentional poisoning, while unintentional poisoning was more common in children. Benzodiazepines, antipsychotics, and analgesics were the primary drugs causing these poisoning incidents. The majority of patients (78%) experienced mild clinical symptoms, whereas 9% of pediatric patients suffered from severe poisoning, related to complications such as aspiration pneumonia and acute renal failure. Addressing pediatric drug poisoning in Vojvodina requires an increased focus on preventive strategies, including parental education and appropriate psychosocial support for the youth. Conclusions: Through collaborative efforts among healthcare providers, educators, and policymakers, prevention, treatment, and support mechanisms can be enhanced to combat this pressing public health challenge.

Objective: Coughing is a common symptom in the pediatric population. The wide variety of preparations available in pharmacies allows easy access to over-the-counter use. Dextromethorphan inhibits the cough reflex through an antagonistic mechanism at the NMDA-glutamate opioid receptor. Its effects are similar to those of drugs of abuse (phencyclidine and ketamine). In high doses, it produces tachycardia, hypertension, altered consciousness to coma, and neurological symptoms (agitation, hallucinations, seizures). According to the literature, patients between the ages of 12 and 20 years account for 50% of all dextromethorphan poisoning emergencies. The aim of our study is to determine the presence of arterial hypertension, its characteristics and the course of its development in dextromethorphan intoxication. Design and method: We present a series of 18 cases of acute dextromethorphan poisoning that were admitted to the Pediatric Antitoxic Center in Bucharest between January 2017 and November 2023. Results: The age range in the series of 18 patients is from 1 to 17 years. Voluntary intoxication was recorded in 13 cases (72.22%) Hypertension was noted in 15 cases (83.33%). Hypertension was present at the onset of symptoms. The poisoning severity score(PSS) showed that most of the cases were moderate (77.77%) Conclusions: Hypertension is a common symptom of dextromethorphan intoxication in patients between 0 and 18 years of age and may be accompanied by palpitations and precordialgia. It is mild to moderate in severity and does not require any specific treatment, as general management of the intoxication is sufficient. Severe cases or death are a rare event, while moderate cases are the most common.